The American Red Cross of Greater Chicago's Asthma Program.
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Adult↗
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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.
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Community-oriented primary care: new relevance in a changing world.
Since its inception in rural, pre-apartheid South Africa, community-oriented primary care (COPC) has intrigued and informed public health and primary care leaders worldwide. COPC has influenced such programs as the US community health center movement, the general practice movement in the United Kingdom, and recent reforms in the public health system of South Africa. We provide a global overview of COPC, tracing its conceptual roots, reviewing its many manifestations, and exploring its future prospects as an organizational paradigm for the democratic organization of community health services. We examine the pitfalls and paradoxes of COPC and suggest its future utility. COPC has important values and methods to offer disparate but powerful movements in public health worldwide.
Community Health Centers↗
Public health lessons from a pilot programme to reduce mother-to-child transmission of HIV-1 in Khayelitsha.
OBJECTIVE: Short-course antiretroviral therapy (ART) has been shown to be effective in reducing mother-to-child transmission (MTCT) of HIV-1. This article details the public health lessons learnt from a district-based pilot programme where a short-course zidovudine (ZDV) regimen has been used in a typical South African peri-urban setting. METHODS: The pilot programme was initiated at two midwife obstetric units in January 1999. Lay counsellors conducted pre- and post-test counselling and nurses took blood for HIV enzyme-linked immunosorbent assay (ELISA) testing. Short-course ZDV was administered antenatally (from 36 weeks' gestation) and during labour. Mother-infant pairs were followed up at eight child health clinics where free formula feed was dispensed weekly. Infants received co-trimoxazole prophylaxis and were ELISA tested for HIV at 9 and 18 months. After 17 months protocol changes aimed at eliminating weaknesses included initiation of ZDV at 34 weeks, self-administration of the first dose of ZDV with the onset of labour, and rapid HIV testing for both mothers and infants. RESULTS: Voluntary counselling and testing was shown to be highly acceptable, with individual counselling more effective than group counselling. Based on less than optimal availability of records, ZDV utilisation was encouraging with up to 59% of subjects initiating treatment, 3 weeks' median duration of ZDV use, and up to 88% receiving at least one intrapartum ZDV dose. Self-administration of the intrapartum dose reached 41%. CONCLUSIONS: Short-course antenatal and intrapartum ART to prevent MTCT of HIV1 was shown to be feasible.
AIDS Serodiagnosis↗
Is Six Sigma the answer for nursing to reduce medical errors and enhance patient safety?
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Accident Prevention↗
The HSJ interview: Professor Louis Appleby. Interview by Paul Smith.
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Benchmarking↗
Blood culture in India: a proposal for a national programme for early detection of sepsis.
Septicaemia is a major contributor of mortality. Blood culture is the essential investigation for the management of sepsis. Due to lack of resources blood culture is an irregularly used investigation in India. A three-tier level of development is being proposed to develop the blood culture based national programme for early detection of sepsis. The plan envisages the establishment of manual blood culture based elementary system in the health centre and district hospital level (Level 1), direct Gram stain and direct antibiotic sensitivity testing from the "positive" blood culture broths at the medical college hospital level (Level 2) and development of automated methods, enhancement of quality control and safety measures, clinical liaison and re-orientation of microbiology training at the tertiary care centre level (Level 3).
Bacteremia↗
Successful outcomes with the h.e.a.l. program.
The successful treatment of acute and chronic wounds can be daunting. In an effort to improve client outcomes and manage spiraling nursing and dressing supply costs, the Community Care Access Centre of Wellington-Dufferin (Canada) implemented the Healing Excellence with Advanced Learning (h.e.a.l.) program in March 2003 as a standardized, evidence-based means of providing wound care to home care clients. While implementation challenges remain and education is ongoing, indepth wound management education and standardization of care have reduced the percentage of patients receiving nonevidence-based wound care and resultant frequent dressing changes. This has enabled the Centre to reallocate 1.5 million dollars from dressing change costs to new nursing initiatives beyond wound care. The initial goals of the program were met. Continuing documentation of its outcomes will help underscore the importance of evidence-based protocols and provider education to the wound healing process.
Bandages↗
Implementing standard precautions in home care.
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Communicable Disease Control↗
Implementing total quality management in an academic surgery setting: lessons learned.
Total Quality Management, a philosophy developed by W. Edwards Deming, has been used successfully in many countries and in many types of organizations to improve the quality of processes. The system is based upon the scientific method and provides the ability to solve long-standing, recalcitrant problems. The application of the TQM philosophy to health care, although recommended by many medical economists, is still in its infancy. At our medical center, three departments (Surgery, Anesthesiology, and Operating Room Services) joined forces to implement TQM. Critical activities early in implementation included establishing a Steering Committee, training key employees, providing systems for communicating TQM activities, and developing the leadership, facilitator, and other resources needed to support teams. Two of our first teams studied very different processes (one in the Operating Room, the other in outpatient Surgery clinics), providing many useful insights regarding keys to successful application of the TQM philosophy. We have learned strategies for increasing acceptance of and participation in TQM efforts on the part of staff members and, in particular, physicians, and for initiating the cultural change needed for TQM. Although the teams have met with resistance to behavioral changes and a lack of full support from some upper-level administrators in the Medical Center and the Hospital, most of them have been quite successful in improving the processes under study. We conclude that, with the proper leadership and facilitation, the TQM philosophy can be successfully implemented in the health care environment. Total Quality Management (TQM) as a system for improving the quality of processes has been successful in many countries throughout the world for organizations offering a wide variety of products and services. This article will describe specific TQM endeavors, both successful and unsuccessful, undertaken in an academic surgery department in the United States. This description will illustrate the lessons we have learned in our attempt to change a complex organization and will enable readers to determine whether an analogy exists between our organization's response to problem solving and theirs.
Academic Medical Centers↗
Does sharing process differences reduce patient length of stay in the emergency department?
STUDY OBJECTIVE: We assess the ability of the best demonstrated processes (BDP) methodology to decrease emergency department patient length of stay (LOS) in EDs in a large multihospital system. METHODS: Two hundred ninety-one EDs were ranked by LOS, and the fastest and slowest EDs were observed to identify the BDPs. The resulting "meaningful differences" were shared with all EDs throughout the hospital system. LOS studies were repeated after the BDP intervention. Five separate LOS measures were performed during a 19-month period, with 223 to 273 EDs participating in each measure. Three interval times were calculated: arrival to examination room, examination room to physician evaluation, and physician evaluation to discharge. RESULTS: Two hundred ninety-one EDs participated, and 386,837 patient visits were evaluated. Before intervention, the average LOS was 147 minutes for all EDs and 186 minutes in the slowest third. At 19 months after intervention, the average LOS was 139 minutes for all EDs and 157 minutes in the slowest third. Between the initial and final measurement period, there was an 8-minute (5.4%) improvement in LOS on a system-wide basis, and the slowest third of EDs improved LOS by 29 minutes (15.6%). Before intervention, arrival to examination room time was 27 minutes, examination room to physician evaluation was 20 minutes, and evaluation to discharge was 100 minutes. After intervention, these times decreased to 22 (P <.001), 18 (P <.001), and 99 (P =.33) minutes, respectively. The slowest one third of EDs went from 37 to 24 minutes for arrival to examination room time (P <.001), from 25 to 20 minutes for examination room to evaluation time (P <.001), and from 124 to 113 minutes for evaluation to discharge time (P <.001). CONCLUSION: Implementing observed BDP meaningful differences resulted in decreased patient LOS in EDs, particularly in the slowest one third of EDs in the hospital system.
Benchmarking↗
Implementing short-course zidovudine to reduce mother-infant HIV transmission in a large pilot program in Thailand.
OBJECTIVES: To describe a pilot mother-infant HIV prevention program started by the Ministry of Public Health of Thailand in July 1998 and to report on the first year of its implementation. DESIGN: Analysis of monthly summaries of data from project logbooks, simple data forms in antenatal clinics and delivery rooms, site visits and workshops, mail survey. SETTING: All 89 public hospitals in seven north-eastern provinces of Thailand. PARTICIPANTS: Childbearing women, program officials. INTERVENTIONS: Counseling and HIV testing for pregnant women, short-course antenatal zidovudine for HIV-infected pregnant women, and infant formula for their children. MAIN OUTCOME MEASURES: Proportion of women with HIV test, proportion of HIV-infected women receiving zidovudine. RESULTS: Of 75,308 women who gave birth between July 1998 and June 1999, 74,511 (98.9%) had antenatal care, 51,492 (69.1%) in the same district and 23,019 (30.9%) outside the district where they gave birth. HIV test results were available at delivery for 46,648 (61.9%) women, 410 (0.9%) of whom tested positive. Of these HIV-infected women, 259 (63.2%) participated in the zidovudine program and 6 (1.5%) received zidovudine from other sources. The proportion of women whose HIV test results were known and proportion of HIV-infected women who received zidovudine increased significantly during the year. CONCLUSIONS: A mother-infant HIV prevention program using short-course antenatal zidovudine was quickly implemented in a large region of Thailand with moderate HIV prevalence. This successful experience is leading to national implementation of a perinatal HIV prevention program in Thailand and may prompt other developing countries to start similar programs.
Adolescent↗
Survival among injured geriatric patients during construction of a statewide trauma system.
BACKGROUND: Patient outcomes are presumed to vary during early implementation of a trauma system because of fluctuations in processes of care. This study estimates risk-adjusted survival for injured geriatric patients during implementation of the Washington State trauma system. METHODS: A presystem (1988-1992) versus early construction phase (1993-1995) retrospective cohort analysis of hospitalized geriatric injured patients in Washington State was conducted. Hospital data were cross-linked to death certificates, providing patient follow-up. A Cox proportional hazards model assessed survival to 60 days from hospital admission. RESULTS: A total of 77,136 geriatric patients were assessed. No difference in survival was observed (before vs. after) for all geriatric injured patients. However, among severely injured patients (Injury Severity Score > 15), survival during the implementation phase increased by 5.1% compared with patients admitted during the presystem years (p = 0.03). CONCLUSION: This study demonstrates improved survival for seriously injured geriatric trauma patients during construction of the Washington State trauma system.
Aged↗
Pressure ulcer benchmarking within a primary care setting.
Patient-focused benchmarking was initially launched by the Department of Health. This article examines how the tissue viability service of Camden and Islington primary care trusts implemented the pressure of ulcer benchmarking process within the nursing teams of these trusts. This was achieved by: agreeing best practice through examination of local and national guidelines; developing a suitable audit tool for nursing teams to assess their clinical areas against this best practice; nursing teams producing core action plans to facilitate movement towards best practice; disseminating results; reauditing. The results of the audits carried out in October 2003 and February 2004 are presented. A plan for future work is described including: the involvement of other members of the multidisciplinary team and the Patient Advice Liaison Service; linking pressure ulcer benchmarking to the benchmarks of communication, privacy and dignity and record keeping.
Benchmarking↗
[Successful strategies and methods of nursing standards implementation].
UNLABELLED: Standards and guidelines are useful elements in quality development and helpful to influence practice of health professionals. However, there are some unanswered questions regarding the circumstances and preconditions of effective change in practice. In German research there is a lack of ambitious evaluation studies concerning implementing standards. Getting evidence about supporting and restricting factors of implementing guidelines into nursing practice is the aim of this article. METHOD: With the help of a search of relevant literature in appropriate data bases the research findings are systematically analysed. FINDINGS: Effective implementation and distribution strategies are programs that realise an active involvement of practitioners and that are practically orientated. Passive attempts to distribute information and specification reveal only little success. A multiple intervention program addressing the introduction process and organisational conditions promise the very best influence on the practice of care.
Evaluation Studies as Topic↗
[Hospital reform project, objectives, implementation, results and training].
Face to structural adjustments of the economy, the Tunisian public system of health, confronted with internal inefficiencies and to an inadequate financing, makes the object of a reform targeting teaching hospitals. Its objectives are to institute an autonomy of management and to exploit an integrated system of information that, associated to economic studies, will allow the Government to revise modes of financing of the health sector. This reform has modified the legal structure of university hospitals ending to a management of performances, based on the participation of the intervening, in an environment demarcated by the Government, by contracting multi-annual programs. By its impact, by reactions and surrounding opportunities, its viability and its sustainability are warranted especially if one minimizes potential risks linked to the exercise of the tutelage and to the adaptation to reforms of the other systems, notably the health insurance in order that a project of reform has been adopted and will be put in application soon. The strategy of implementation steady has allowed to reach convincing results to consolidate and to diagnose insufficiencies to fulfill, especially that an adapted extension of this reform is anticipated, to the level of regional hospitals, secondary care level.
Health Care Reform↗
Implementation of the prevention of mother-to-child transmission of HIV programme in Zimbabwe: achievements and challenges.
Recent scientific developments have led to feasible and effective interventions to reduce the risk of mother to child transmission of HIV. Even in resource poor countries, PMTCT programmes are being articulated as a priority in the national strategic frameworks. Thus PMTCT programmes are moving from being pilot projects to national programmes comprehensively integrated into other reproductive health programmes or HIV and AIDS prevention, care and support programmes. In Zimbabwe the prevention of mother-to-child transmission (PMTCT) of HIV infection has become an important national task. The 2001 national survey of HIV prevalence among women attending antenatal care revealed that 29.5% of the women were HIV positive. While an effective PMTCT programme using nevirapine can reduce the rate of this transmission by 50%, the Zimbabwe PMTCT National Expansion Programme has had its share of achievements and challenges since its launch in 2002.
Female↗
Developing policies and guidelines.
Practice guidelines are proliferating in the era of managed care. Hospital epidemiologists frequently are asked to author guidelines of infection control. The greatest challenge in the process is not writing the guidelines but implementing them. This article offers practical advice on which topic to select and on how to develop and implement guidelines.
Cost Control↗
Evolution of BCMA within the Department of Veterans Affairs.
The Department of Veterans Affairs Medical Center implemented Bar Code Medication Administration (BCMA) between 1999 and 2000 in 161 Medical Centers or Health Systems. BCMA has had a major impact on inpatient licensed nursing staff. Nurses have moved from manual to electronic medication documentation, increasing the complexity of medication administration. There has been acceptance of BCMA by the nurses who are able to see the positive benefits and patient safety aspects. A marked decrease in medication administration errors is a result of implementing BCMA.
Electronic Data Processing↗