Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Health Plan Implementation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 919 records · Page 51Linked to original sources
PubMed2006

Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998.

OBJECTIVES: To determine effectiveness and costs of different guideline dissemination and implementation strategies. DATA SOURCES: MEDLINE (1966 to 1998), HEALTHSTAR (1975 to 1998), Cochrane Controlled Trial Register (4th edn 1998), EMBASE (1980 to 1998), SIGLE (1980 to 1988), and the specialized register of the Cochrane Effective Practice and Organisation of Care group. REVIEW METHODS INCLUSION CRITERIA: Randomized-controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series evaluating guideline dissemination and implementation strategies targeting medically qualified health care professionals that reported objective measures of provider behavior and/or patient outcome. Two reviewers independently abstracted data on the methodologic quality of the studies, characteristics of study setting, participants, targeted behaviors, and interventions. We derived single estimates of dichotomous process variables (e.g., proportion of patients receiving appropriate treatment) for each study comparison and reported the median and range of effect sizes observed by study group and other quality criteria. RESULTS: We included 309 comparisons derived from 235 studies. The overall quality of the studies was poor. Seventy-three percent of comparisons evaluated multifaceted interventions. Overall, the majority of comparisons (86.6%) observed improvements in care; for example, the median absolute improvement in performance across interventions ranged from 14.1% in 14 cluster-randomized comparisons of reminders, 8.1% in 4 cluster-randomized comparisons of dissemination of educational materials, 7.0% in 5 cluster-randomized comparisons of audit and feedback, and 6.0% in 13 cluster-randomized comparisons of multifaceted interventions involving educational outreach. We found no relationship between the number of components and the effects of multifaceted interventions. Only 29.4% of comparisons reported any economic data. CONCLUSIONS: Current guideline dissemination and implementation strategies can lead to improvements in care within the context of rigorous evaluative studies. However, there is an imperfect evidence base to support decisions about which guideline dissemination and implementation strategies are likely to be efficient under different circumstances. Decision makers need to use considerable judgment about how best to use the limited resources they have for quality improvement activities.

Evidence-Based Medicine↗
PubMed2003

Increasing clinical, satisfaction, and financial performance through nurse-driven process improvement.

Providers and regulatory agencies are increasing their demands for hospitals to document clinical quality and customer satisfaction at a decreased cost. Nurse leaders search for ways to meet these requirements while retaining their most valuable resource: healthcare workers (especially nurses). First-line leadership struggles with balancing quality, cost-effectiveness, and staff retention. The author discusses the planning, methodology, implementation, and outcomes of a staff driven process improvement initiative.

Cost Control↗
PubMed1984

Implementing regulatory reform: the saga of Michigan's debedding experiment.

This paper traces the implementation of Michigan's program for hospital bed reduction through four phases in the critical first 30 months following enactment: standard-setting, plan development, plan approval, and legislative oversight. Procedural complexity and goal conflict complicated implementation from the start: what began as a simple proposal to close unneeded beds soon became enmeshed in efforts to address long-standing issues of equity in access to care. A combination of administrative, political, and economic factors peculiar to Michigan, as well as the more generic problems incurred in applying a regulatory approach to containing medical care costs, contributed to the difficulties encountered in implementing bed reduction. Long-range prospects for the program depend upon whether the modest results it is likely to achieve are deemed to be worth the costs incurred in administering it.

Certificate of Need↗
PubMed1992

[Implementation rate of periodic health checkup at manufacturing factories in Kawasaki].

A questionnaire survey on periodic health checkup was conducted on 4,432 manufacturing factories in Kawasaki and the following results were obtained. 1) Implementation rate of periodic health checkup was 100% in factories with 100 workers or more. In smaller factories employing less than 100 workers, the implementation rate decreased with decrease in their total work force. The rate was 47.5% and 37.7% in factories with 9-4 and 3-1 workers, respectively. 2) The proportion of workers less than 30 years of age decreased and that of 60 or more years of age increased with decreasing size of the total work force. Distribution of both age groups was 12.6% and 12.9%, respectively in factories with less than 10 workers. The proportion of female workers increased from about 10% in factories with 300 workers or more to 26.8% in factories with less than 10 workers. 3) In large factories with 500 workers or more periodic health checkups were implemented mostly at their own or related medical facilities and in factories with 499-10 workers, almost 50% were implemented in independent health service facilities. In factories with less than 10 workers periodic health checkup were implemented mainly at health centers (33.1%) and at hospitals or clinics (26.9%). 4) The main reasons why small factories could not implement periodic health checkup were: (1) they could not afford the time for the implementation (50.0%) and (2) ignorance of the law of mandatory periodic health checkup for workers (23.6%).

Adult↗
PubMed2001

Maintaining prevention in practice: survival of PPIP in primary care settings. Put Prevention Into Practice.

INTRODUCTION: Put Prevention Into Practice (PPIP) consists of a kit of office-based tools intended to support the provision of preventive services by primary care providers. The purpose of this study was to examine the institutionalization of PPIP within five primary care clinics funded by the Texas Department of Health to implement PPIP, and to examine the organizational determinants of program institutionalization. METHODS: We utilized an adaptation of the Level of Institutionalizaton (LoIn) scales for qualitative data collection and for development of an institutionalization score for each site. The determinants of institutionalization were derived from the organizational behavior and health promotion literatures and used as categories for analysis. In addition, for purposes of triangulation, chart audit data for three documentation behaviors were also collected. RESULTS: PPIP has been maintained--at varying degrees of integration--in four of the five sites studied, for 6 years after adoption. Organizational factors that facilitated the institutionalization process were the site's institutional strength, the integration of PIPP within extant programs and services, visibility of the program within and outside the site, planning for the termination of grant funding, and presence of a program champion with mid- to upper-level managerial authority. Successful initiation of the program was not a predictor of institutionalization outcomes. CONCLUSIONS: We have highlighted the need to consider organizational determinants of institutionalization in relation to their specific sociopolitical contexts, and in relation to each other, not in isolation.

Health Plan Implementation↗
PubMed1996

Cornerstone: Illinois' approach to service integration.

Cornerstone is a management information system developed and implemented by the Illinois Department of Public Health as a mechanism to facilitate maternal and child health service integration. Its design features combined program registration, standardized risk assessment, automated care plan development, and consolidated referral and scheduling. Cornerstone is a flexible, PC- and local area network-based system, allowing portability across program applications and geographic areas. A wide-area network enables local agencies to share data about clients. Development of Cornerstone was a collaborative effort by potential Cornerstone users and statewide administrative staff. The standard for equipment is set at a one-to-one ratio of workstations to case managers.

Computer Systems↗
PubMed2005

On a policy of transferring public patients to private practice.

We consider an economy where public hospitals are capacity-constrained, and we analyse the willingness of health authorities to reach agreements with private hospitals to have some of their patients treated there. When physicians are dual suppliers, we show that a problem of cream-skimming arises and reduces the incentives of the health authority to undertake such a policy. We argue that the more dispersed are the severities of the patients, the greater the reduction in the incentives will be. We also show that, despite the patient selection problem, when the policy is implemented it is often the case that health authorities decide a more intensive transfer of patients to private practice.

Benchmarking↗
PubMed2002

Nursing Information System.

Nursing Information System (NIS) is a part of a health care information system that deals with nursing aspects, particularly the maintenance of the nursing record. The several objectives that a Nursing Information system should meet in order to succeed its aims, cover the users' needs and operate properly are described. The functions of such systems, which combine with the basic tasks of the nursing care process, are examined. As Nursing Information System is part of the health care and hospital information system, the different strategies and approaches for designing and developing Hospital Information Systems followed from the decade of 1970 until the recent decade of 1990, are presented. The three main approaches followed were the "centralized approach", the "departmental approach", and the "distributed approach". The advantages and drawbacks of each different approach are examined. For the implementation or upgrade of Nursing Information System a NIS committee comprised by different health care professionals, is necessary to be formed. The implementation and upgrade of a Nursing Information System follows some specific phases. These steps, include planning phase, analysis phase, design phase, development phase, implementation phase, and upgrade phase. A paragraph at the end of this chapter summarizes the future trends of Nursing Information Systems.

Health Plan Implementation↗
PubMed2003

Standardizing contact investigation protocols.

SETTING: The State of Alabama Department of Public Health Division of Tuberculosis Control. OBJECTIVE: To standardize contact investigation protocols and implement an intervention to increase TB field worker adherence to the protocols with the goal of promoting efficiency and effectiveness in contact investigations. DESIGN: A process evaluation of existing data collection and management systems and protocols was performed. Standardized protocols and an intervention to increase TB field worker adherence to the protocols were created and pilot tested. These were then implemented and formative evaluation data were collected. RESULTS: The process evaluation revealed considerable variance among field workers with regard to protocols and definitions of variables related to contact investigations. Protocols were standardized and an intervention targeted at TB field workers was developed. The intervention consisted of a training workshop and the development of a computer-based contact investigation module. This was successfully implemented throughout the state. CONCLUSIONS: To perform effective contact investigations and conduct studies to improve the effectiveness of these investigations, TB control programs must pay careful attention to precisely defining variables and concepts related to the contact investigation. Furthermore, protocols must be standardized and resources devoted to training of TB field workers to ensure adherence to protocols.

Alabama↗
PubMed1996

Quality assurance practices in the community dental services within the North and South Thames Regions.

The aim of this study was to describe the progress of implementing Quality Assurance (QA) programmes within the Community Dental Services (CDS) in the North and South Thames Regions. Nearly 70 per cent of CDS managers responded to the survey questionnaire. The results indicate that although definite progress has been achieved in most services, further progress is being limited by a lack of co-operation between different departments and the minimal support and guidance being given to those responsible for the management and development of the QA programmes.

Community Dentistry↗
PubMed2004

Inequality of water fluoridation in Southern Brazil--the inverse equity hypothesis revisited.

The purpose of this ecological study was to investigate the association between social and economic indicators at the municipal level and the presence of water fluoridation and time when water fluoridation was implemented in the 293 municipalities of Santa Catarina State in Southern Brazil. Several social and economic indicators were obtained from official Brazilian agencies as well as from UNICEF. Questionnaires were sent to local authorities and to the local government water supply Company to obtain information about the presence or not of a fluoridated water supply and the year when fluoridation was implemented. Differences in social and economic indicators between municipalities with and without fluoridated water and between those that have had this service for different lengths of time were compared by the Mann-Whitney U test. In addition, multiple logistic regression analyses was performed to identify associations between social and economic indicators at the municipal level and presence and time of implementation of water fluoridation. Results indicated that larger populations are associated with municipalities with fluoridated water. Larger populations, higher child development indexes and low illiteracy rates are associated with a longer time since the implementation of water fluoridation. The finding that less developed municipalities delayed the provision of water fluoridation corroborates the inverse equity hypothesis.

Brazil↗
PubMed1999

Regional variation in Russian medical insurance: lessons from Moscow and Nizhny Novgorod.

The implementation of Russia's 1993 legislation on obligatory medical insurance has been characterized by wide regional variation. Two areas in particular illustrate this phenomenon: for the last five years Moscow has enjoyed a sophisticated, well-developed insurance system, while the Nizhny Novgorod region has only recently taken the most rudimentary steps toward implementation of the law. Despite their radically differing approaches to the market-based insurance reforms, however, Moscow and Nizhny Novgorod continue to enjoy roughly the same quality of available health care services, at similar costs to consumers. They also suffer some of the same continued systemic defects inherited from the Soviet era. A comparison of the two regions demonstrates that, while reform of the Soviet health care system was desperately needed, the Russian version of obligatory medical insurance has not proved to be the panacea its architects intended. In fact, even its original pioneers are now moving forward with new schemes to correct some of its deficiencies.

Adult↗
PubMed2007

Monitoring a national cancer prevention program: successful changes in cervical cancer screening in the Netherlands.

The success of screening, an important cancer prevention tool, depends on the quality and efficiency of protocols and guidelines for screening and follow-up. However, even centrally organized screening programs such as the Dutch cervical screening program occasionally show problems in performance. To improve this program, the screening scheme, follow-up, administration and financing protocols and guidelines were thoroughly changed in 1996. This study evaluates the consequences for the performance of the national program. Five-year coverage rate, the proportion of screened women sent to follow-up, follow-up compliance and duration, and the yearly number of Pap smears before and after the changes in 1996 were compared. Five-year coverage increased substantially in the added target age groups (30-34, and 54-60 years); in the old target age group (35-53 years) it remained around 80%. The percentage of screened women sent to follow-up decreased from almost 19-3% per screening round, due to a more restrictive use of the Pap 2 classification, and an evidence-based cessation of follow-up of negative smears without endocervical cells. Follow-up compliance has improved, and the average time until a woman is either referred or rejoins the regular screening schedule, has become shorter. The total number of smears, a strong determinant of screening costs, has decreased by 20% primarily due to the changed follow-up recommendations. In conclusion, the 1996 changes in protocols and guidelines, and their implementation have increased coverage and efficiency, and decreased the screening-induced negative side effects.

Adult↗
PubMed2000

Implementing the integration of component services for reproductive health.

In the wake of the 1994 International Conference on Population and Development in Cairo, considerable activity has occurred both in national policymaking for reproductive health and in research on the implementation of the Cairo Program of Action. This report considers how effectively a key component of the Cairo agenda--integration of the management of sexually transmitted infections, including human immunodeficiency virus, with maternal and child health-family planning services--has been implemented. Quantitative and qualitative data are used to illuminate the difficulties faced by implementers of reproductive health programs in Ghana, Kenya, South Africa, and Zambia. In these countries, clear evidence is found of a critical need to reexamine the continuing focus on family planning services and the nature of the processes by which managers implement reproductive health policies. Implications of findings for policy and program direction are discussed.

Data Collection↗
PubMed2002

Development of a strategy for decreasing multi-drug resistant bacteria with implementation of a program emphasizing appropriate antibiotic utilization and strict infection control measures in western South Dakota.

In this follow-up of an article written in the South Dakota Journal of Medicine, February 2001, Antimicrobial Resistance: Steps to Reduce the Problem with Emphasis on Antibiotic Utilization--The Rapid City Experience, subsequent local analysis based on evolving literature, local measures undertaken, and results of these measures will be presented. With national numbers of Methicillin resistant Staphylococcus aureus (MRSA) and Vancomycin resistant enterococcus (VRE) rising, steps taken in the Rapid City Region have shown reduction in these two pathogens. The two key components of these programs have been appropriate antibiotic utilization and strict adherence to aggressive infection control measures.

Anti-Bacterial Agents↗