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PubMed2006

NICHD research initiative in newborn screening.

Recent changes in genetics research have created new opportunities to improve the scope and quality of newborn screening services. Changes in newborn screening should be supported and directed by an organized program of research. The NICHD Research Initiative in Newborn Screening includes the development of systematic methods to identify additional conditions appropriate for newborn screening; development and testing innovative interventions and treatments to improve outcomes; education of the provider workforce; development and implementation of appropriate information and communication systems for parents and providers; and, sponsoring an ongoing program of research and research training. Future needs will include the development of a national translational research infrastructure, prevention research and research into behavioral and social sciences issues. The NICHD Research Initiative in Newborn Screening is expected to be an ongoing and vital initiative that adapts itself to new scientific findings, technological developments, changes in the public and personal health care system, and our evolving understanding of the needs of affected individuals, families and the community.

Diffusion of Innovation↗
PubMed2005

Vocational analysis of health care professions as a basis for innovative curricular planning. An analysis and prognosis of the development of the professional competencies of midwives--cornerstones of innovative curricula in tertiary education.

This article describes current and future tendencies in the development of curriculum planning for health care professions in Germany, using the example of midwifery education. In particular, it discusses 'output-based control' of curriculum planning giving consideration to issues related to German education, health policies and professional educational theories with a view to the general international development. The results of this analysis constitute the starting point for the conceptual planning of a dissertation at the medical faculty of the Berlin Charité with the goal of developing a competency model for the curriculum planning of midwifery education, thus creating a modern curriculum as a basis for a fundamental reform of German midwifery education.

Competency-Based Education↗
PubMed1997

Adoption of innovative caries-control services in dental practice: a survey of Washington State dentists.

To assess the adoptability of the medical model for caries control, the authors surveyed general dentists about their use of four caries-control services among adult patients: salivary functioning tests, fluoride varnishes, chlorhexidine rinses, and pit-and-fissure sealants. Responses indicated that leaders in the dental community and those with a wider network of professional colleagues were likely to adopt new services more quickly than other dentists. Earlier adopters also had more correct information about these services than later or nonadopters. Overall, the knowledge base of the services studied in this survey was not uniform, making adoption of the medical model for caries control premature.

Adult↗
PubMed2002

Assessing clinical pathways use in a community hospital: it depends on what "use" means.

BACKGROUND: Many benefits have been associated with the use of clinical pathways, yet developing them can be costly, and implementing them is not always successful. A 300-bed Midwestern community hospital began a clinical pathways program in 1995, and by fall 1998, 15 pathways were in various stages of implementation, with 3 under development. Many challenges had been encountered, but hospital leaders were eager to find ways to increase pathway use. METHODS: A qualitative case study design was used to investigate four clinical pathways, two perceived as being "used" and two that were perceived as "not used". Each pathway was analyzed as a separate case, followed by cross-case analysis. Qualitative data were collected in 65 semistructured interviews with administrators, physicians, physicians' office staff, nurses, and allied health professionals at the hospital. Data were also collected through observation and document analysis. RESULTS: The two used pathways had been introduced as part of a larger change in care, whereas the two pathways not used had been introduced as stand-alone innovations. Confusing and inadequately developed aspects of the hospital's clinical pathways program included its purposes, the definition of pathway use, pathway procedures, accountability, education, and incentives. A new case management department, ongoing administrative support, and a sophisticated medical information system were viewed as supports for continued growth in the program. CONCLUSIONS: Implementation of clinical pathways was delayed and complicated by the varied perceptions of the program among stakeholders. Lack of clarity and consistency in how information about the program was communicated made it difficult for clinicians to develop a shared understanding of clinical pathways.

Attitude of Health Personnel↗
PubMed2006

Computer-based nursing documentation in nursing homes: A feasibility study.

The burden of paper-based nursing documentation has led to increasing complaints and decreasing job satisfaction amongst aged-care workers in Australian nursing homes. The automation of nursing documentation has been identified as one of the possible strategies to address this issue. A major obstacle to the introduction of IT solutions, however, has been a prevailing doubt concerning the ability and/or the willingness of aged-care workers to accept such innovation. This research investigates the attitudes of aged-care workers towards adopting IT innovation. Questionnaire survey were conducted in 13 nursing homes around the Illawarra and Sydney regions in Australia. The survey found that an unexpected 89.3% of participants supported the strategy of introducing electronic nursing documentation systems into residential aged-care facilities. 94.3% of them would use such a system depending on circumstances. Despite a shortage of computers in the workplace, which is a major barrier, this research provides strong evidence that care workers in residential aged-care facilities are willing to accept electronic nursing documentation practice and the uptake of information technology in residential aged-care is feasible in Australia.

Adult↗
PubMed2006

Meeting the challenges--the role of medical informatics in an ageing society.

The objective of this paper is to identify trends and new technological developments that appear due to an ageing society and to relate them to current research in the field of medical informatics. A survey of the current literature reveals that recent technological advances have been made in the fields of "telecare and home-monitoring", "smart homes and robotics" and "health information systems and knowledge management". Innovative technologies such as wearable devices, bio- and environmental sensors and mobile, humanoid robots do already exist and ambient assistant living environments are being created for an ageing society. However, those technologies have to be adapted to older people's self-care processes and coping strategies, and to support new ways of healthcare delivery. Medical informatics can support this process by providing the necessary information infrastructure, contribute to standardisation, interoperability and security issues and provide modelling and simulation techniques for educational purposes. Research fields of increasing importance with regard to an ageing society are, moreover, the fields of knowledge management, ubiquitous computing and human-computer interaction.

Aging↗
PubMed2004

National environmental public health tracking program: bridging the information gap.

In January 2001 the Pew Environmental Health Commission called for the creation of a coordinated public health system to prevent disease in the United States by tracking and combating environmental health threats. In response, the Centers for Disease Control and Prevention initiated the Environmental Public Health Tracking (EPHT) Program to integrate three distinct components of hazard monitoring and exposure and health effects surveillance into a cohesive tracking network. Uniform and acceptable data standards, easily understood case definitions, and improved communication between health and environmental agencies are just a few of the challenges that must be addressed for this network to be effective. The nascent EPHT program is attempting to respond to these challenges by drawing on a wide range of expertise from federal agencies, state health and environmental agencies, nongovernmental organizations, and the program's academic Centers of Excellence. In this mini-monograph, we present innovative strategies and methods that are being applied to the broad scope of important and complex environmental public health problems by developing EPHT programs. The data resulting from this program can be used to identify areas and populations most likely to be affected by environmental contamination and to provide important information on the health and environmental status of communities. EPHT will develop valuable data on possible associations between the environment and the risk of noninfectious health effects. These data can be used to reduce the burden of adverse health effects on the American public.

Centers for Disease Control and Prevention, U.S.↗
PubMed2003

Learning technologies at the service of higher education: global trends and local Israeli opportunities.

This paper provides an overview of global trends in e-Learning and opportunities opened by harnessing learning technologies at the service of the Israeli higher education. The introduction of innovative learning technologies is examined in light of an organizational change. A series of substantial issues should be taken into account to successfully manage the change. Among these are: rethinking of academic learning and instruction, redefining the role of the teachers and the students, decoupling the learning materials and the learning process, new approaches to student assessment and program evaluation, and instituting a well thought out organizational plan including a support center. The above-mentioned issues guided the introduction of a recent call for project proposals for the integration of technologies into Israeli higher education. The main principles, criteria and results of this call are described.

Curriculum↗
PubMed2004

A survey of clinical practices and readiness to adopt evidence-based practices: Dissemination research in an addiction treatment system.

Addiction research is challenged to disseminate evidence-based practices into routine clinical settings. The successful adoption of innovation must consider issues of fit, such as the characteristics, readiness, and attitudes of clinicians in the community. We constructed a survey to assess clinical practices and readiness to adopt certain evidence-based practices in addiction treatment programs. The instrument was administered to directors (n = 21) and clinicians (n = 89) from 24 public addiction treatment programs in New Hampshire (USA). Clinicians are more motivated to adopt some evidence-based practices (twelve-step facilitation, cognitive behavioral therapy, motivational interviewing, relapse prevention therapy) than others (contingency management, behavioral couples therapy, pharmacotherapies). Translational strategies for treatment development and research dissemination are discussed.

Adult↗
PubMed2005

The Professor of Public Psychiatry Model in Ohio: the impact on training, program innovation, and the quality of mental health care.

The Ohio Department of Mental Health and five of Ohio's University-based Departments of Psychiatry have developed strong working partnerships that have improved the quality of psychiatric residency education and Ohio's mental health services. Strategies integral to Ohio's Public Psychiatry Model include identifying a strong champion, integrating expert consultation, and developing consensus expectations using a small amount of catalytic funding. Successful outcomes include the establishment of public psychiatry leadership roles in Ohio's community and academic settings; positive community-focused residency training experiences; revised curricula; and spin-off opportunities, such as "Coordinating Centers of Excellence" to accelerate adoption of evidence-based practices in community settings.

Community Mental Health Services↗
PubMed1997

Receptivity to protective garments among the elderly.

Hip fractures among elders resulting from falls are a growing concern as the proportion of elders increases and health care costs mount. A recent innovation is the development of an undergarment worn to protect against hip injuries. This study attempted to determine whether a community population of elders would be receptive to wearing such a garment and the characteristics of those who would and would not be receptive. It was assumed that receptivity can be predicted by variables that have been shown to relate to risks of falling. Predictor characteristics represent three domains: demographic/predisposition, health/mobility, and social support. A logistic regression procedure was employed to determine the probability and odds of receptivity among elders given a profile of specific characteristics. Results were interpreted with reference to past research on risks of falling.

Accidental Falls↗
PubMedDate not supplied

The effects of reengineering: fad or competitive factor?

Healthcare organizations have often participated in managerial innovations that have promised to revolutionize their operations (e.g., management by objectives, quality circles, total quality management, and reengineering). Historically, such managerial innovations began with a few devout adherents, snowballed into widespread acceptance, and then faded as their popularity waned. This cycle of managerial adoption generally has been complicated by a lack of a consistent, clear definition of the innovation and little or no evaluation of its organizational effects. This article examines a current managerial innovation, reengineering, that after widespread adoption has now begun to fall out of favor with many executives. A clear, practical definition of reengineering is first offered, followed by an evaluation of the effect of reengineering on competitive hospital costs. Finally, factors that influence the results of reengineering are explored. Overall, reengineering did not statistically improve a hospital's cost position; however, we suggest that providing clear and consistent feedback, codifying the reengineering process, and involving executives in core changes are key means for improving reengineering outcomes. Specific examples of how these factors may be used to facilitate reengineering are provided. Reengineering may still be beneficial if it is properly implemented.

Diffusion of Innovation↗
PubMed1996

The need to develop nursing practice through innovation and practice change.

This paper examines some of the strategies that can be used to produce change in nursing. These strategies range from the power-coercive through rational-empirical to the normative-re-educative. Strategies that promote a 'bottom-up' approach are advocated for clinical nursing and some of the principal factors towards success, such as team building, the presence of a clinical leader and planning are indicated. The paper will also expand on what needs to be changed in nursing, and what the purpose of such changes are. It is argued that externally focused efforts of change, such as the organization of care or new practices are only part of the picture. The journey of change also requires an inner exploration of who we are and what are we seeking to achieve in nursing.

Clinical Nursing Research↗
PubMed1999

[Attempts at innovations in the practice of teaching and practicing psychiatric nursing].

In the context of recent changes that are taking place in the field of mental health care in Brazil, the University has the responsibility to redimensioning human resources qualification of mental health workers. At the Mental Health Care and Educational Program of the University of São Paulo and São Paulo Health Office (São Paulo/Brazil), an experience still in course, the nursing students attending to psychiatric nurse training evaluated that theoretical-practical education dealing with health care issue in the field of Psychosocial Rehabilitation purpose, at the same time that directly interferes in the qualification of practices, simultaneously develops the students attitudes and knowledge that qualify them to perform coherent practices in accordance with rehabilitation models of care.

Attitude of Health Personnel↗
PubMed2000

The evolution of external quality evaluation: observations from the Joint Commission on Accreditation of Healthcare Organizations.

The Joint Commission on Accreditation of Healthcare Organizations, the oldest health care accrediting body in the world, currently accredits almost 20000 organizations in the USA. Although continuing to be professionally-sponsored, accreditation's rapid growth in recent years has been driven by the external users of accreditation--government, purchasers, and public--rather than by the original users, the professionals themselves. This experience in the USA suggests that over time successful external quality evaluation mechanisms throughout the world will involve representatives of the public, purchasers, and government in establishing standards and setting policies. Without this involvement, these stakeholders are unlikely to find the mechanisms credible in addressing their needs, and will seek alternatives--adding cost and duplication to the external quality evaluation system. Successful mechanisms are also likely to provide more detailed information about an organization's performance to the public, purchasers, and the government, while creating evaluation processes that provide for innovation and support improvement in efficiency, as well as quality, through incorporation of aspects of the Baldrige and European Foundation for Quality Management approaches to organizational excellence. Finally, successful evaluation mechanisms are likely to create a special focus on the safety of care, incorporating aspects of the International Organization for Standardization's ISO 9000 approach to quality management. While the specific nature, priority, and timing of these changes will differ from country to country, they are likely to influence the evolution of external quality evaluation throughout the world. External evaluation of health care organizations' quality holds great promise, but its long-term success depends on responding to all those who will want to depend on it.

Diffusion of Innovation↗
PubMed1996

The impact of market and organizational characteristics on nursing care facility service innovation: a resource dependency perspective.

OBJECTIVE: Using resource dependency theory as a conceptual framework, this study investigates both the organizational and environmental factors associated with an emerging health care service delivery innovation, the provision of specialty care in designated units in nursing care facilities. We consider two types of specialty units, Alzheimer's Disease and subacute care. DATA SOURCES: The Medicare/Medicaid Automated Certification Survey (MMACS) data file was merged with local market area data obtained from the 1992 Area Resource File and with state level regulatory data. STUDY DESIGN: The likelihood of providing Alzheimer's Disease or subacute care in dedicated units was estimated by separate logistic regressions. PRINCIPAL FINDINGS: Results indicate that facilities with fewer Medicare patients are more likely to operate a dedicated Alzheimer's care unit, while facilities located in markets with a large HMO population and greater hospital supply are more likely to operate a subacute care unit. While competition among nursing homes, for the most part, is an incentive to innovate, greater regulatory stringency appears to constrain the development of specialty care units of both types. Finally, organizational characteristics (e.g., size and proprietary status) appear to be important enabling factors influencing the propensity to provide specialty care in dedicated units. CONCLUSIONS: Nursing care facilities are moving toward providing specialty care units partly as a response to a growing demand by resource providers and to maintain a competitive edge in tighter markets. Loosening regulation directed at cost containment would further encourage the development of specialty care but should be preceded by some evaluation of population needs for specialty care and the effectiveness of specialty care units.

Alzheimer Disease↗
PubMedDate not supplied

The value of antihypertensive drugs: a perspective on medical innovation.

Using national survey data and risk equations from the Framingham Heart Study, we quantify the impact of antihypertensive therapy changes on blood pressures and the number and cost of heart attacks, strokes, and deaths. Antihypertensive therapy has had a major impact on health. Without it, 1999-2000 average blood pressures (at age 40+) would have been 10-13 percent higher, and 86,000 excess premature deaths from cardiovascular disease would have occurred in 2001. Treatment has generated a benefit-to-cost ratio of at least 6:1, but much more can be achieved. More effective use of antihypertensive medication would have an impact on mortality akin to eliminating all deaths from medical errors or accidents.

Adult↗
PubMed2006

Dissemination of physical activity evidence, programs, policies, and surveillance in the international public health arena.

The concepts of dissemination can be applied to the international challenges of promoting physical activity. With the 2004 release of the World Health Organization Global Strategy for Diet and Physical Activity, risk factor reduction and noncommunicable disease control are of global health interest. A six-step framework is proposed for understanding the attributes of successful international dissemination. These include the development of clear and evidence based resources or innovations, defining the target audience, selecting communication channels, engaging decision makers, and developing evaluation frameworks around dissemination. Four case studies to illustrate aspects of the framework are presented: (1) learning from dissemination of effective tobacco control initiatives, (2) the experience of developing global measures and surveillance systems for physical activity, (3) case study of disseminating the Agita program-an effective community wide intervention, and (4) disseminating the World Health Organization Global Strategy on Diet and Physical Activity. Substantial similarities across the experiences described in these case studies suggest underlying common themes for international dissemination, but developing a stronger evidence base for dissemination efforts remains a research priority.

Diffusion of Innovation↗