Managed mental health care: a home grown product.
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Health Care Coalitions↗
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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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Planning and execution of a successful hepatitis B immunization program.
Today's college students occupy a "window" between older adults, whose need for hepatitis B vaccination is minimal, and younger people who receive the vaccine as part of their childhood immunization series. However, because of the high-risk activities that are often part of student behavior, college students are among the individuals who are at the highest risk for this disease; 75% of all reported hepatitis B cases occur in persons between the ages of 15 and 39 years. It is therefore imperative that college health professionals take seriously their responsibility to educate students about issues related to hepatitis B and make available programs that enable the students to receive immunizations. This article briefly describes a successful hepatitis B education and immunization program at an institution that has no mandatory prematriculation immunization requirements.
Adolescent↗
New challenges for VISION 2020.
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Delivery of Health Care, Integrated↗
Using clinical performance information to improve the quality of care in a specialist NHS trust.
This article offers a case study of how an National Health Service trust specializing in neurology and neurosurgery used clinical performance information to underpin its quality improvement strategy. This involved developing a clinical effectiveness framework and identifying trust-specific clinical indicators, an exercise which involved both staff and patients. Writing from personal experience as clinical effectiveness manager, the author argues that clinical indicators can be powerful tools for monitoring the quality and effectiveness of health care at a system-wide level. In the case of nursing care, the use of appropriate, nursing-sensitive indicators can provide a valuable complement to the qualitative information generated by the benchmarking approach used in 'Essence of Care'. The article contains details of the sort of problems encountered along the way--such as resistance from clinicians and general managers, and difficulties with the existing information technology infrastructure--and suggests how other trusts might approach them.
Benchmarking↗
The merger of rural primary care and home health services.
The merger of rural primary care and home health services offers the potential for increasing the administrative efficiency of health care, and thereby enhancing the quality of care and increasing access to services, particularly health promotion. However, the proposed benefits of any merger can only be realized if the merger process is successfully completed. An analysis of the factors that were important in a case study of successful and unsuccessful mergers of rural health centers and home health care agencies in northeastern Vermont is presented. Three components were found to be necessary to start the merger process: complementary needs, opportunity, and common philosophy. The involvement and support of key individuals was crucial to sustaining merger interest. Good communication throughout the process contributed substantially to the maintenance of both community and staff support. Others considering similar mergers should recognize that the process of consolidating organizations and satisfying regulations takes some time to complete.
Community Health Centers↗
Local public health system partnerships.
OBJECTIVES: Interorganizational collaboration aimed at community health improvement is an expectation of local public health systems. This study assessed the extent to which such collaboration occurred within one state (Wisconsin), described the characteristics of existing partnerships, and identified factors associated with partnership effectiveness. METHODS: In Stage 1, local health department (LHD) directors in Wisconsin were surveyed (93% response rate). In Stage 2, LHDs completed self-administered mailed surveys for each partnership identified in Stage 1 (85% response rate). Two-level hierarchical logit regression methods were used to model relationships between partnership and LHD variables and partnership outcomes. Data from 924 partnerships associated with 74 LHDs were included in the analysis. RESULTS: Partnerships most frequently addressed tobacco prevention and control, maternal and child health, emergency planning, community assessment and planning, and immunizations. Partnering was most frequent with other government agencies, hospitals, medical practices or clinics, community-based organizations, and schools. Partnership effectiveness was predicted by having a budget, having more partners contributing financially, having a broader array of organizations involved, and having been in existence for a longer period of time. A government mandate to start the partnership was inversely related to successful outcomes. Characteristics of LHDs did not predict partnership effectiveness. CONCLUSIONS: Financial support, having a broader array of partners, and allowing sufficient time for partnerships to succeed contribute to partnership effectiveness. Further study-using objective outcome measures-is needed to examine the effects of organizational and community characteristics on the effectiveness of local public health system partnerships.
Community Health Planning↗
Going beyond the rhetoric: the movement of critical health psychology towards social action.
Health is a fundamental human right. Unfortunately the pursuit of good health remains a struggle for marginalized individuals/groups because of the rise of new centres of power. Hepworth argues that critical health psychologists can contribute to the promotion of public health by moving towards 'greater practice and action orientation'. Until we learn to become more actively involved in translating our research into practice, our efforts will only end up being done in vain. To pursue our humanitarian aims, CHP needs to move beyond the confines of its academic circle and begin to share its vision with a greater audience-society itself.
Altruism↗
Using community ties to facilitate school-based prevention research.
One of the greatest obstacles to conducting school-based HIV/STD/pregnancy prevention research with adolescents is the reluctance of administrators or site-based decision-making councils to commit their teachers and students to participation in a project designed and managed by an outside group of researchers. A major concern is that researchers may not understand or agree with community sensitivities about such personal topics. By first establishing a collaborative relationship with health district educators currently working in Appalachian schools and residing in those communities, one finds a distinct advantage in terms of gaining admittance to area schools. The presence of local health educators at formative meetings also alloys many concerns of community members, as they view these local participants as monitors of outsider research efforts, thereby protecting the community culture from undue outside influence. During the course of the current study, health educators found they also learned more about their communities and about HIV prevention.
Adolescent↗
Ensuring a public health impact of programs to reduce HIV transmission from mothers to infants: the place of voluntary counseling and testing.
Since 1999, many African governments have launched programs to offer short-course antiretroviral drug regimens to reduce mother-to child transmission of HIV. HIV testing in prenatal care is the gateway to these antiretroviral regimens. Pilot projects in Africa show an uptake of antiretroviral drugs in 8% to 50% of pregnant women presumed to be HIV infected; often, a minority of eligible women in care received these regimens. Use of lay counselors and rapid onsite HIV testing may alleviate health service barriers. Community education to promote voluntary counseling and testing, which involves men, is the long-term solution. In the short term, possibilities to enhance delivery of an effective intervention include group pretest counseling, universal offer of testing with women having the right to "opt out," universal treatment (mass treatment for those whose HIV status is not determined by voluntary counseling and testing), universal testing with women having the right to "opt out" of learning their test results, and mass treatment for all without testing.
AIDS Serodiagnosis↗
The Louisiana Medicare Electro-Convulsive Therapy Quality Improvement Project.
The first collaborative statewide psychiatric quality improvement project, initiated by Louisiana Health Care Review, Inc, focused on the practice of inpatient electro-convulsive therapy (ECT) among Medicare patients. Data from the project indicated that the majority of Medicare patients receiving ECT were white females living at home, in good physical health, in their seventies, and with a diagnosis of major depression or major depression with psychotic features. The quality indicators for the project included: (documentation of) monitoring of cognitive side effects, monitoring of depressive target symptoms, ECT appropriateness, electrode placement, anesthesia evaluation, and dental examination. An additional indicator (administration of possibly detrimental medication during ECT) was developed based on the recommendation by the study group. At project conclusion, significant improvement occurred in all project indicators. ECT as practiced in the participating hospitals was effective and appropriate. Appropriateness was determined as depression refractory to two medication trails or an emergency due to severe suicidal ideation or physical deterioration secondary to malnutrition. Transient hypertension (13%) and cardiac dysrhythmia (3.5%) which resolved in the recovery period were the most frequent complications.
Aged↗
Leo Tolstoy, TB in Russia, and American perceptions.
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Antitubercular Agents↗
Challenges to implementing the national programme for information technology (NPfIT): a qualitative study.
OBJECTIVES: To describe the context for implementing the national programme for information technology (NPfIT) in England, actual and perceived barriers, and opportunities to facilitate implementation. DESIGN: Case studies and in depth interviews, with themes identified using a framework developed from grounded theory. SETTING: Four acute NHS trusts in England. PARTICIPANTS: Senior trust managers and clinicians, including chief executives, directors of information technology, medical directors, and directors of nursing. RESULTS: The trusts varied in their circumstances, which may affect their ability to implement the NPfIT. The process of implementation has been suboptimal, leading to reports of low morale by the NHS staff responsible for implementation. The overall timetable is unrealistic, and trusts are uncertain about their implementation schedules. Short term benefits alone are unlikely to persuade NHS staff to adopt the national programme enthusiastically, and some may experience a loss of electronic functionality in the short term. CONCLUSIONS: The sociocultural challenges to implementing the NPfIT are as daunting as the technical and logistical ones. Senior NHS staff feel these have been neglected. We recommend that national programme managers prioritise strategies to improve communication with, and to gain the cooperation of, front line staff.
Attitude of Health Personnel↗
Fifteen best practice recommendations for bar-code medication administration in the Veterans Health Administration.
BACKGROUND: Since 2000, the Veterans Health Administration (VHA) has pioneered the development and deployment of a bar-code medication administration (BCMA) system. Based on VHA experience, 15 "best practices" for BCMA implementation, integration, and maintenance are recommended. METHODS: Data were collected on potential barriers to the effectiveness of BCMA to improve patient safety by direct observation of medication administration, simulated BCMA use in a laboratory setting, a survey of nursing informatics specialists regarding policies and procedures, and 30 unstructured interviews with diverse stakeholders. RECOMMENDATIONS: Fifteen practices were proposed, categorized by implementation and continuous improvement, training, troubleshooting, contingency planning, equipment maintenance, medication administration, and maintenance of paper patient wristbands. For example, Recommendation 15 ("Periodic replacement of wristbands") advises weekly bar-coded wristband replacement in long term care settings to improve the scanning reliability. DISCUSSION: Lessons learned about best practices to address challenges may offer insight to others considering implementation of bar-code technology.
Electronic Data Processing↗
Designing and implementing an electronic health record system in primary care practice in sub-Saharan Africa: a case study from Cameroon.
OBJECTIVE: To review the key issues related to the design and implementation of an electronic health record (EHR) system in urban primary health care (PHC) practice in Cameroon. METHODOLOGY: The goal of the project was to assess EHR as a tool to improve providers' performance, quality and continuity of care, and the availability of data in PHC practice in Cameroon. A locally designed EHR system called MEDCAB was developed. The system was based on the International Classification for Primary Care (ICPC) and was designed taking into consideration the PHC practice environment in Cameroon. An original cohort of 14 users was involved in the experiment. RESULTS: Users generally showed good acceptance of the system. Monitoring the use of the system at the early stages of implementation was important to ensure immediate response to users' comments and requests. Some of the key issues identified during the development and implementation of the system were: user involvement, the choice of an appropriate terminology, pre-existing data collection culture and leadership issues. Some positive achievements brought about by the system included promotion of good medical practice and routine availability of consultation data. CONCLUSION: Strengthening the medical record in general, and the EHR in particular, could contribute to its position as a valuable source of information for healthcare delivery, public health and policy making in Cameroon. Challenges to adoption are huge and successful implementation for any specific setting will require a comprehensive modelling of the local medical practice, the choice of an appropriate terminology and a co-ordinated approach involving all stakeholders.
Africa South of the Sahara↗
Outcomes analysis of a pain management project for two rural hospitals.
There has been a strong emphasis on effective pain management in recent years, yet application of new knowledge and research in the area seems to be implemented inadequately. Traditional educational approaches for clinicians must be complemented by interventions in health care systems that more directly influence the routine behaviors of clinicians. In an effort to address this problem, a project was designed to increase institutional commitment to improving pain management in two rural hospitals. The purpose of this article is to present the change process used and the findings from the program.
Curriculum↗
[Comparison of anesthetic morbidity and mortality before and after the implementation of quality assurance in Tri-Service General Hospital].
The desire to improve anesthetic outcome is a cornerstone in modern anesthesia. There are many means to reach this goal, such as enforcement in personal training, elevation of monitoring standards, constant vigilance and stern quality assurance (QA). The department of Anesthesiology, Tri-Service General Hospital, has adopted the QA program and implemented it since March 1, 1990. Because there were no significant differences in terms of personnel training, monitoring standards and types of anesthesia and surgery before and after the application of QA program, we investigated the effects of QA on anesthetic major morbidity and coma/mortality. We analyzed the anesthetic results obtained in two separate periods respectively spanning from Jan. 1, 1989 to Dec. 31, 1989 and from Mar. 1, 1990 to Feb. 28, 1991. During the first two months of 1990, the department's personnel were trained to be familiar with the QA program. We compared the anesthetic major morbidity and coma/mortality of one year before the implementation of QA with those in a one-year period after its implementation. Before and after enforcement of QA, there were no significant differences (p greater than 0.05) regarding major morbidity and coma/mortality, but the rates of anesthetic complications were lower after the practice of QA program. Since the functions of QA was aimed at alerting the anesthetic personnel to keep constant vigilance over the act of anesthesia, QA in theory could reduce anesthetic accidents and mishaps related jointly to surgery and anesthesia. The reason why QA did not decrease anesthetic major morbidity and coma/mortality in this study may be due to limited number of anesthesia in relatively short period.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Success factors for implementation of the balanced scorecard in a NHS multi-agency setting.
Even though the balanced scorecard (BSC) has become a highly popular performance management tool, usage in local public sector National Health Service (NHS) organisations is still rare. This paper conditionally outlines some grounds in supporting such usage. In particular underlying conceptual concerns with the BSC system and its implementation pitfalls require full consideration. This paper then outlines some factors to be taken into account for "successful" BSC implementation in a NHS multi-agency setting. These findings emerged from a series of focus groups that took place with contributors drawn from all the key organisations within the Bradford Health Action Zone. Finally, this paper argues that if key criteria are met, successful implementation of the BSC may then proceed. However, "blind" BSC implementation without consideration of these factors may result in potential "failure".
Benchmarking↗
[Conception, implementation and evaluation of the new general medicine continuing education curriculum in Südbaden].
Since 1994, seminars for the new curriculum in general practice are conducted by the Academy of Continuing Medical Education (consists of the regional medical board and the association of public health insurance in Südbaden). Specialists of different medical disciplines supported by general practitioners in the role of moderators are preparing and teaching a wide range of topics. The general practitioners are supervising the different courses, thus, facilitating the learning process of the participants. Furthermore, the facilitators have to work out the specific needs and requirements of general practice and family medicine. The topics are presented in a form of lessons and clinical cases discussed in small groups (problem-oriented approach). The evaluation of two seminars was carried out in 1994 and 1995 including two thirds of the complete curriculum in general practice. From the positive results of the evaluation, modification and improvement of the didactic concept for future seminars in 1996 are derived.
Curriculum↗