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PubMed2004

Experience from Bangladesh: implementing emergency obstetric care as part of the reproductive health agenda.

This paper describes the activities of the Ministry of Health and Family Welfare of the Government of Bangladesh and UNFPA to introduce emergency obstetric care (EmOC) services into the reproductive health care agenda. Working through the existing system of Maternal and Child Welfare Centers (MCWC), the quality and availability of comprehensive Reproductive Health and Emergency Obstetric Care services was improved. Investments in training, infrastructure, management information systems, quality assurance mechanisms and linkages between health care facilities in Bangladesh, have produced positive results in terms of increased utilization of these services. The Ministry of Health first implemented services in one division of the country and later scaled up to include all of the MCWCs nationally. While there are still obstacles to preventing obstetric deaths in Bangladesh, this experience shows that improvements in the quality and expansion of the range of services in existing health systems is an important step toward increasing the use of reproductive health care services by the women who need them most.

Bangladesh↗
PubMed2005

[Implementing integrated health care--current state and progress].

The legal framework for Integrated Health Care since 2004 offers many opportunities for health professionals and insurers in the competition for "high quality care". Germany's largest statutory health insurance fund, BARMER, has already developed around 100 Integrated Health Care Projects for a wide range of conditions. One important issue is the relationship to disease management programs. Our program "integrated cardiological care" combines both DMP and integrated health care and thus already shows good results with respect to patient acceptance as well as savings trough the changing patterns in interventional cardiology.

Cardiology↗
PubMed2004

[Quality management in the ophthalmologist's practice].

Since 1 January 2004, new health system rules have become law in Germany. All ophthalmologists who practice in the German national health system are obliged to implement an internal quality management system. However, for economic reasons it is necessary for every physician as the owner of a medium-sized business to introduce a quality management system to survive in the healthcare market. The rules in the German health system are changing rapidly and physicians have to react to these new situations. The competition on the healthcare market has begun and will become much harder in the future. Quality management is the tool to successfully handle this challenge.

Cost-Benefit Analysis↗
PubMed1998

Factors that contribute to effective community health promotion coalitions: a study of 10 Project ASSIST coalitions in North Carolina. American Stop Smoking Intervention Study for Cancer Prevention.

The purpose of this study was to identify factors that contribute to the effectiveness of community health promotion coalitions. Member survey data from 10 coalitions formed as part of North Carolina Project ASSIST were analyzed at the coalition level to identify factors related to member participation, member satisfaction, quality of the action plan, resource mobilization, and implementation. The results suggest that coalitions with good communication and skilled members had higher levels of member participation. Coalitions with skilled staff, skilled leadership, good communication, and more of a task focus had higher levels of member satisfaction. Coalitions with more staff time devoted to them and more complex structures had greater resource mobilization, and coalitions with more staff time, good communication, greater cohesion, and more complex structures had higher levels of implementation. Neither member participation nor member satisfaction correlated with the other measures of coalition effectiveness.

Communication↗
PubMed2001

The impact of assessing the prevalence of pressure ulcers on the willingness of health care institutions to plan and implement activities to reduce the prevalence.

BACKGROUND: In 1998, 89 health care institutions (hospitals, nursing homes, residential homes, and community care institutions) participated in the first Dutch National Pressure Ulcer Prevalence Study. AIM: Based on the innovation-decision process for individuals (Rogers 1995), the effect of their participation was investigated at different levels in the institutions [prevalence assessment coordinator, director, ward management (enrolled) nurses, and the pressure ulcer committee]. METHOD: A mail questionnaire was developed and filled out by 54 coordinators of the participating health care institutions. RESULTS: Results showed that according to the coordinators most levels of the institutions were familiar with the results of the prevalence assessment, understood them, and were persuaded that their prevalence rate had to be changed. As a result, almost all of the coordinators of the institutions were planning activities to change pressure ulcer management, while half of the coordinators had already implemented some actions. The main activities planned or implemented were developing or updating the prevention and treatment protocol and educating the (enrolled) nurses. Some institutions were planning or had already implemented the appointment of a nurse specialist or a nurse paying special attention to pressure ulcers. Results showed that the different levels of the institutions took initiatives on different categories of activities. CONCLUSION: It is concluded that participating in the first national prevalence study was a positive experience for the institutions, because agenda-setting took place and most started to plan or implement activities to improve the prevention and treatment of pressure ulcers.

Cross-Sectional Studies↗
PubMed2005

[Modern concepts of medical care--what has been achieved by the implementation of disease management programs?].

Since 2003, structured treatment programs for chronically ill patients (disease management programs; DMPs) have been under development in Germany. Virtually nationwide, programs in which physicians and patients can register are being offered for diabetes mellitus types 1 and 2, breast cancer, coronary heart disease and asthma/COPD. The medical content of the programs is determined on the basis of evidence-based medicine. Even though the effectiveness of structured treatment programs is documented for diabetes, adequate studies confirming the overall transferability of results to the German health care system are as yet lacking. Physicians above all strongly criticise the coupling of DMPs with the risk adjustment scheme of the statutory health insurance funds, as well as the large amount of paperwork involved.

Cardiology↗
PubMed2004

Implementing empirically supported treatments in the schools: what are we asking?

The research reported in this special issue addresses important areas for the continued development of empirically supported school-based treatments. Although advances in the development and evaluation of treatment services have occurred, there is little public demand for the widespread dissemination of these treatments. In this commentary, the authors draw data from historical examples, related research, and personal experience to demonstrate the need to create a societal mandate for change. They present specific implications for future areas of research and the type of public education and marketing campaign that will be needed to create a demand for empirically supported school-based treatments.

Adolescent↗
PubMedDate not supplied

[Necessary steps for implementing the Australian DRG system].

The introduction of the DRG-System will be followed by severe changes in the German hospitals. From the view of today departments or hospitals are threatened by closing if they do not deal with the new rules. A common implementation of this system by all participants of the health system is necessary before the introduction at 1.1.2003. Only this will guarantee an adequate presentation of the different defaults in the future because the conditions of the implementation of the system are not qualified yet. The hospitals are forced to prepare the introduction of the DRG-System, however. Only the Arrangement of an extensive documentation of all diagnoses and all conservative and operation methods together with a cost--cutting administration will be consequently followed by a financial healthy situation. The most important points to be emphasized are the medical documentation, the controlling, the improvement of the processes and the computer assisted documentation. By an intensive information concerning all further resources the involvement of the employees of the hospital is a necessary part for the success of the introduction.

Cost Control↗
PubMed1998

[The quality assurance program of mandatory social security in the realm of medical rehabilitation. Concept, status of implementation and prospects].

The quality improvement programme aims at the comparison of clinics in charge of the statutory pension insurance. The programme has been implemented successively in 1994, supported by researchers and teams of experts on specific subjects. Instruments and procedures have been developed to all programme items including a clinic comparing and information system, thus permitting routine use in practice. Performing regular clinic-comparisons analysing structural quality (equipment, staff, clinical concept, management), procedural quality (recording of rehabilitation process), and outcome quality (success of the rehabilitation estimated by physician and patient) of rehabilitation facilities shall initiate quality competition and stimulate a constant improvement of quality. significant basis, therefore, is a clinic-comparing information and reporting system. The developed instruments and procedures are available for all institutes providing rehabilitation.

Germany↗
PubMed2001

Implementing evidence-based practices in routine mental health service settings.

The authors describe the rationale for implementing evidence-based practices in routine mental health service settings. Evidence-based practices are interventions for which there is scientific evidence consistently showing that they improve client outcomes. Despite extensive evidence and agreement on effective mental health practices for persons with severe mental illness, research shows that routine mental health programs do not provide evidence-based practices to the great majority of their clients with these illnesses. The authors define the differences between evidence-based practices and related concepts, such as guidelines and algorithms. They discuss common concerns about the use of evidence-based practices, such as whether ethical values have a role in shaping such practices and how to deal with clinical situations for which no scientific evidence exists.

Combined Modality Therapy↗
PubMed1998

Treatment of major depression before and after implementation of a behavioral health carve-out plan.

OBJECTIVE: The study examined utilization, payments, and quality indicators for treatment of major depressive disorder before and after the 1993 implementation of a behavioral health care carve-out plan for Massachusetts state employees who received medical coverage through indemnity plans or preferred provider organizations. METHODS: The sample of 2,259 enrollees with claims for treatment of major depressive disorder was drawn from the group of 39,541 persons continuously enrolled in preferred provider organizations or indemnity plans for fiscal years 1992 to 1995. A subsample of 243 users of inpatient services accounted for 352 admissions. Bivariate tests were used to compare utilization and quality indicators before and after implementation of the carve-out plan. Simple comparisons of current-year dollars were used. RESULTS: The proportion of enrollees with claims for treatment of major depressive disorder increased significantly under the carve-out plan. Inpatient utilization decreased substantially, mostly due to a significantly lower average length of stay (16 days before implementation of the carve-out plan and nine days after). Net inpatient payments fell 71 percent overall, 65 percent per admission, and 40 percent per day. The unadjusted proportion of discharged patients treated for major depressive disorder who were readmitted within 15 and 30 days did not change significantly. The unadjusted proportion of cases receiving follow-up within those time frames increased significantly. CONCLUSIONS: Implementation of a behavioral health carve-out plan may be accompanied by substantial reductions in inpatient utilization and payments for treatment of major depressive disorder. Descriptive findings suggest that such reductions may not have a detrimental impact on readmission and follow-up treatment rates within 30 days. However, this analysis did not control for patient characteristics, used short follow-up periods, and did not include some relevant outcome measures.

Behavior Therapy↗
PubMed2000

Making research relevant to the primary health care team.

There is, as yet, no strong culture of research in primary care and much of the existing research is conceived and undertaken by people outside primary care. The poor implementation of research findings may, in part, be owing to the fact that those delivering the service are not involved in asking or answering questions that are relevant to their practice. This paper reports how three practices constructed a research agenda based on the unanswered questions of their primary care teams. The research questions prioritised by the teams tended towards patient behaviour and service organisation rather than clinical issues. This contrasts with national research priorities. The process has contributed towards the development of a culture of enquiry among team members. Other primary care teams may benefit from a similar approach. National research priority setting in primary care should take more account of the unanswered questions of primary care teams.

Family Practice↗
PubMed2001

Zero-sum politics, the Herbert thesis, and the Ryan White CARE Act: lessons learned from the local side of AIDS.

This study examines the dynamics of grass-roots decision-making processes involved in the implementation of the Ryan White CARE Act. Providing social services to persons with HIV/AIDS, the CARE act requires participation of all relevant groups, including representatives of the HIV/AIDS and gay communities. Decision-making behavior is explored by applying a political (zero-sum) model and a bureaucratic (the Herbert Thesis) model. Using qualitative research techniques, the Kern County (California) Consortium is used as a case study. Findings shed light on the decision-making behavior of social service organizations characterized by intense advocacy and structured on the basis of volunteerism and non-hierarchical relationships. Findings affirm bureaucratic behavior predicted by the Herbert Thesis and also discern factors which seem to trigger more conflictual zero-sum behavior.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Implementing a job hazard analysis program.

Analyzing the workplace for hazards and controlling the hazards identified to reduce risk is a proactive approach to workplace safety and the primary prevention of occupational illnesses and injuries. A JHA is a simple, time tested, and effective tool to assist in this analysis. Job hazard analysis methods may enhance and complement many current business initiatives. When programs can be integrated to contribute to leadership mandates, there are opportunities for increased support and resources. Involving other departments and disciplines with complementary programs also reduces duplication of effort. Prioritizing jobs to be analyzed based on risk assessment results in a manageable approach for beginning a program. A team process involving employees, supervisors, and key safety participants is most effective. Successful programs encourage each team member to observe or videotape key jobs, list the job steps, and involve the team in developing hazard reduction solutions and safe job procedures. When effectually used, JHAs have been proven to improve communication and participation, while enhancing worker safety.

Health Plan Implementation↗
PubMed1998

[The "rehabilitation sciences" promotional emphasis--a promotional program and its implementation].

The German Federal Research Ministry and the German pension insurance have set up a special funding programme for medical rehabilitation research. Eight regional research networks with about 70 projects receive funds for a first three year period. Rehabilitation experts from several countries selected the promising networks and studies from more than 100 proposals. In these networks medical and social scientists from universities and other research units cooperate with rehabilitation centers and pension insurance institutes in order to combine forces for the development of German rehabilitation science. The programme aims at improving the research structures and at tackling the major challenges of medical rehabilitation research. The following subjects represent the main fields of the ongoing research: a) etiology, course and prognosis of chronic diseases and their consequences to rehabilitation, b) diagnostics in rehabilitation, c) evaluation and improvement of rehabilitation therapy, d) the patient's perspective in rehabilitation and e) rehabilitation system research. As yet funding is limited to the year 2001. Further support of the networks will depend on the results of a thorough evaluation of the progress of their research and their structural perspective.

Cost-Benefit Analysis↗