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PubMed2000

Priority setting in public health and health services research.

Models for strategic priority setting in public health and health services research typically lack coherence or omit key considerations. We propose a new model, the Seven 'I's, with seven components: innovation, identification, inequalities, incorporation, importance, influences, and interventions. It tests the 'relevance' of research, while 'excellence' will be evaluated using existing criteria for peer review. It should be used to set research priorities primarily on the basis of expected health benefits, with adjustments for other non-health benefits as necessary. We discuss each component and compare our approach to other models. We argue that our model helps ensure resource allocation is transparent and accountable, and encourages the link to population health gains. It is flexible, and is applicable to both commissioned and investigator-driven research. It may be applied to assess existing proposals, or to generate research ideas.

Australia↗

PubMed2004

Using technical innovations in clinical practice: the Drinker's Check-Up software program.

Interest in assessing and treating a variety of psychological conditions with software programs is increasing rapidly. This article reviews a software program for problem drinkers entitled the Drinker's Check-Up (DCU) and illustrates its use with three patients. The DCU is based on the principles of brief motivational interventions and can be used as a stand-alone intervention by therapists without expertise in substance abuse or as a prelude to alcohol treatment services. It is the first software program to provide integrated assessment, feedback, and assistance with decision making for individuals experiencing problems with alcohol. Preliminary data from an ongoing clinical trial of the DCU as a stand-alone intervention indicate that it is an effective intervention for a wide range of problem drinkers.

Adult↗

PubMed2004

Making the business case for health and productivity management.

Health and productivity management (HPM) is an important innovation for businesses concerned with rising health care costs. Like any innovation, however, it will not be adopted rapidly unless it is tailored to the needs of employers. For the last 6 years the Institute for Health and Productivity Management has studied the needs of American employers and sponsored employer driven case studies of health care and productivity. From these studies and the work of academic experts we have fashioned a set of programs to effectively communicate the advantages of health and productivity measurement and management. To make the business case for health and productivity management, researchers need to (1) demonstrate the relative advantage of HPM, (2) keep the evidence simple, (3) show that HPM is compatible with employer practices, and (4) communicate the results within and across corporate departments.

Diffusion of Innovation↗

PubMed2005

Revisiting the factor structure of the Kirton Adaption-Innovation Inventory.

The original Kirton Adaption-Innovation Inventory, used to measure innovative (as opposed to adaptive) individual cognitive styles, has been reported to have three factors: Sufficiency of Originality, Efficiency, and Rule/Group Conformity. In exploring the construct validity of the Kirton Adaption-Innovation Inventory, findings from a 2003 study by Im, Hu, and Toh showed the existence of two subdimensions of the Sufficiency of Originality factor-Idea Generation and Preference for Change. In this study, using a sample of 356 household participants, with an average age of 56.0 yr. (SD = 14.0), average income of dollar 39,700 (SD = dollar 19,200), and average of 15.0 yr. of education (SD = 2), from the Arkansas Household Research Panel, we conducted factor analyses. The results specific to our selected sample indicate that a four-factor model recognizing the two subdimensions of Sufficiency of Originality has a better fit than the original three-factor model.

Adaptation, Psychological↗

PubMed1991

Time to adoption of an innovation by dentists in private practice: sealant utilization.

Dentists can be divided into five adoption categories based upon their time of adoption of pit and fissure sealants: innovators, early adopters, early majority, late majority, and laggards. The differences among dentists in the five adoption categories were examined for four classes of variables: practice characteristics, dentist characteristics, communication of information, and practice environment. Questionnaires were mailed in September 1984 to a random sample (N = 521) of Washington State dentists in general practices. A total of 376 completed questionnaires were returned, for a response rate of 72 percent. Adoption of sealants proceeded as follows: 5 percent of dentists through 1973, 24 percent through 1979, 50 percent through 1982, and 75 percent through 1984. Adoption category was related to percent of assistants who were certified, delegation to assistants and hygienists, magnitude of the fees charged by the practice, number of staff meetings per month, the dentist having been an officer in a dental organization, year the dentist adopted other new technologies, dentist's self-rating of willingness to try new things, percent of patients who are children, and percent of the dentist's colleagues who used sealants. These data lend some support to the two-stage or opinion-leader model of diffusion and suggest that new technologies can be promoted by first influencing dentists who consistently adopt early.

Adolescent↗

PubMed2003

Establishing a practice climate in academic settings.

This article describes an innovative educational approach that was introduced and developed in one occupational therapy program, favorably assessed by students, and promoted within the occupational therapy literature. A review of educational literature from other disciplines suggests that the approach characterized as creating a practice climate, may be useful to most allied health educators. We discuss (1) the meaning of the term practice climate, (2) the rationale for creating such a climate in larger classroom sessions, (3) nine process strategies that can establish this climate, and (4) an assessment of the approach by two groups of undergraduate students. Although introduced in a senior-level undergraduate course, the approach has merit for implementation in less advanced courses and in graduate education.

Diffusion of Innovation↗

PubMed2005

Continuous quality improvement as an innovation: which nursing facilities adopt it?

PURPOSE: We identify environmental and organizational predictors that best discriminate between formal continuous quality improvement (CQI) adopters and nonadopters in nursing homes (NHs) and create a diagnostic profile for facility administrators and policy makers to promote CQI. DESIGN AND METHODS: We performed a cross-sectional survey of licensed NH administrators in New Jersey in 1999, using The Nursing Care Quality Improvement Survey ( Zinn, Weech, & Brannon, 1998) and The New Jersey NH Profiles Chart. We also performed a discriminant analysis. Of 350 NHs, 46% returned completed questionnaires. RESULTS: Using variance innovation, resource dependence, and institutional perspectives for our framework, we found that new requirements, environmental competition, organizational time and structural facilitators, and manager training made statistically significant contributions to discriminating between formal CQI adopters and nonadopters. IMPLICATIONS: Regardless of size, NHs adopt formal CQI to meet external expectations of new regulations and accreditation criteria. CQI adoption is facilitated by information systems, flexible use of personnel, and team supports, as well as CQI training for managers. This profile of adopters can guide administrators and policy makers in promoting CQI for NHs, and it can help NHs already interested in CQI focus internal resources on key facilitators.

Diffusion of Innovation↗

PubMedDate not supplied

Through the looking glass: 21st century trauma registry innovations.

Trauma registries can be invaluable tools for improving quality of care and monitoring patient outcomes, but many function below their full potential. Reliance on low-tech, manual data management methods, such as the retyping of demographic information, can lead to inefficiency, increased personnel costs, and potential error. One low-cost solution is a digital interface between the medical records coding database and the trauma registry, allowing the registrar to pull demographic information and ICD-9 diagnostic and procedure codes directly from a reliable source without re-keying them. We created a batch interface for that purpose, reducing the burden of manual data entry and decreasing the time needed to complete patient records in the registry. The interface has eliminated our backlog and allowed the trauma registrar to focus on creating timely reports to track quality indicators.

Bias↗

PubMed1997

Future directions for clinical practice guidelines: needs, lead agencies and potential dissemination strategies identified by Australian general practitioners.

There has been an increasing interest in developing clinical practice guidelines for general practitioners as a means of improving health outcomes. We conducted a survey of a national random sample of Australian general practitioners in May 1995 to determine their needs, preferred formats and dissemination strategies and to identify potential lead agencies for guidelines development. Of 373 eligible general practitioners, 286 (77 per cent) returned completed questionnaires. At least 50 per cent of respondents considered guidelines in angina, psychotic illness, skin cancer and attention deficit disorder as 'extremely' or 'very' useful. However, three other topics identified as areas for future guidelines development in Better health outcomes for Australians were so rated by less than half of the general practitioners surveyed. The Australian Cancer Society and the Australian Medical Association outranked nine other organisations in terms of credibility in guidelines development. Innovative formats, including computerised medical records or text, were not highly rated, consistent with our finding that only 27 respondents (9 per cent) had Internet access. Strategies nominated as likely to increase the adoption of a guideline included a personal visit by a trained nurse, a lecture about its content or a Medicare rebate being available when a patient was managed in accordance with the guideline. Public health practitioners and nominated lead agencies are encouraged to respond to these findings and recognise potential strategies to enhance the effective dissemination of guidelines. Interventional studies are required to demonstrate and allow understanding of changes in clinical practice attributable to guidelines.

Adult↗

PubMed1995

Integrating the concepts of health promotion and community into occupational therapy practice.

Health reform activities in Canada have encouraged health care professionals to examine new and innovative ways to share their skills, not only with other professionals, but with the public. Historically, occupational therapists have been encouraged by leaders in the profession to expand their practice and to share their skills through active participation with their communities. Health promotion has been identified as a process through which this expansion can be pursued. In order for occupational therapists to contribute to their communities in a meaningful way, the concepts of health promotion and community require definition, development and reflection within their model of practice. Through a discussion of these concepts, this paper encourages occupational therapists to develop, expand and integrate new practice roles within the community by integrating health promotion into their practice.

Aged↗

PubMed2005

Your company's secret change agents.

Organizational change has traditionally come about through top-down initiatives such as hiring experts or importing best-of-breed practices. Such methods usually result in companywide rollouts of templates mandated from on high. These do little to get people excited. But within every organization, there are a few individuals who find unique ways to look at problems that seem impossible to solve. Although these change agents start out with the same tools and access to resources as their peers, they are able to see solutions where others do not. They find a way to bridge the divide between what is happening and what is possible. These positive deviants are the key, the authors believe, to a better way of creating organizational change. Your company can make the most of their methods by following six steps. In Step 1, Make the group the guru, the members of the community are engaged in the process of their own evolution. Step 2, Reframe through facts, entails restating the problem in a way that opens minds to new possibilities. Step 3, Make it safe to learn, involves creating an environment that supports innovative ideas. In Step 4, Make the problem concrete, the community combats abstraction by stating uncomfortable truths. In Step 5, Leverage social proof, the community looks to the larger society for examples of solutions that have worked in parallel situations. In Step 6, Confound the immune defense response, solutions are introduced organically from within the group in a way that promotes acceptance. Throughout the steps, the leader must suspend his or her traditional role in favor of more facilitatory practices. The positive-deviance approach has unearthed solutions to such complicated and diverse problems as malnutrition in Mali and human trafficking in East Java. This methodology can help solve even the most extreme dilemmas.

Administrative Personnel↗

PubMedDate not supplied

The physical, behavioral, and psychosocial consequences of Internet use in college students.

The purposes of this study were to identify the physical, behavioral, and psychosocial consequences of Internet use in undergraduate college students; and to evaluate whether time, social norms, and adopter category predict the consequences of Internet use. Rogers' model for studying consequences of innovation was adapted for this study. A descriptive, correlational design was used. Convenience sampling yielded 293 undergraduate students who answered the online survey. Consequences of Internet use were assessed with the researcher-developed instrument, the Internet Consequences Scale (ICONS). Mean scores on the behavioral and psychosocial subscales of the ICONS indicated positive consequences of Internet use, while the physical consequences subscale revealed negative consequences. Multiple regression analyses revealed a small, but significant, amount of variance in consequences of Internet use that could be explained by time, social norms, and adopter category, thus supporting the adapted model for the study of consequences of Internet use in college students.

Adult↗

PubMed2004

Research to practice: international dissemination of evidence-based behavioral medicine.

BACKGROUND: In recent years, there has been a dramatic rise in the global prevalence of chronic conditions. Cancer, diabetes, cardiovascular diseases chronic lung disorders, and their common behavioral risk factors are escalating rapidly in developing countries, many of which are still struggling with infectious diseases and poor health system infrastructures. PURPOSE: This article examines the role that behavioral medicine can play to improve global health. METHODS: The World Health Organization's Innovative Care for Chronic Conditions Framework provides a model for identifying areas for behavioral medicine influence, including patient-provider interactions, organization of health care, community mobilization, and national policy and financing. RESULTS: Behavioral medicine has a large role to play in international health. Examples from around the world are provided. CONCLUSIONS: Because behavior is the product of multilevel, multifactoral determinants, there are many areas of influence for behavioral medicine specialists who want to contribute to global health. By focusing attention internationally, with special attention toward the needs of developing countries, the field of behavioral medicine will be not only responding to its global responsibilities but also repositioning itself to be increasingly relevant for the 21st century.

Behavioral Medicine↗

PubMed2005

Consequences of health trends and medical innovation for the future elderly.

Recent innovations in biomedicine seem poised to revolutionize medical practice. At the same time, disease and disability are increasing among younger populations. This paper considers how these confluent trends will affect the elderly's health status and health care spending over the next thirty years. Because healthier people live longer, cumulative Medicare spending varies little with a beneficiary's disease and disability status upon entering Medicare. On the other hand, ten of the most promising medical technologies are forecast to increase spending greatly. It is unlikely that a "silver bullet" will emerge to both improve health and dramatically reduce medical spending.

Aged↗

PubMed1982

Clinical evaluation vs. economic evaluation: the case of a new drug.

To economically evaluate a new drug or other medical innovation one must assess both the changes in costs and in benefits. Safety and efficacy matter, but so do resources costs and social benefits. This paper evaluates the effects on expenditures of the recent introduction of cimetidine, a drug used in the prevention and treatment of duodenal ulcers. This evaluation is of interest in its own right and also as a "guide" for studying similar effects of other innovations. State Medicaid records are used to test the effects on hospitalization and aggregate medical care expenditures of this new medical innovation. After controlling to the extent possible for potential selection bias, we find that: 1) usage of cimetidine is associated with a lower level of medical care expenditures and fewer days of hospitalization per patient for those duodenal ulcer patients who had zero health care expenditures and zero days of hospitalization during the presample period; an annual cost saving of some $320.00 (20 per cent) per patient is indicated. Further analysis disclosed, however, that this saving was lower for patients with somewhat higher levels of health care expenditures and hospitalization in the presample period, and to some extent was reversed for the patients whose prior year's medical care expenditures and hospitalization were highest.

Cimetidine↗

PubMedDate not supplied

Innovation in international training in occupational and environmental health: challenging unspoken assumptions.

The Department of Community and Preventive Medicine of the Mount Sinai School of Medicine, in collaboration with Queens College of the City University of New York, is conducting a research training program in cooperation with partner institutions in Mexico, Brazil, and Chile to assist them to develop an enhanced capacity to identify, document, and ameliorate environmental and occupational health problems of major public significance. The Fogarty International Center of the National Institutes of Health sponsors the program, which focuses on tailoring training to the host countries' needs and conditions. The program's centerpiece is the Selikoff Fellowship, which had been awarded to 15 Fellows by 1998. Each Fellow spends three one-month training periods in New York, interspersed with distance learning, and, with the help of a mentor, completes a research project in the home country. Details of the program are provided.

Brazil↗

PubMed2006

The Midwest Nursing Centers Consortium Research Network: translating research into practice.

Community nursing centers (CNCs) serve the health needs of culturally diverse populations that are often marginalized and likely to experience disparities in health. CNCs utilize innovative models of primary health care that blend traditional medical management with nursing case management and community-based health promotion strategies. This article describes the mission and activities of the Midwest Nursing Centers Consortium Research Network (MNCCRN), a practice-based research network (PBRN) funded by the Agency for Healthcare Research and Quality, and is one of only two federally funded nonphysician primary care PBRNs and the only PBRN in the United States comprising exclusively CNCs. The MNCCRN utilizes Advanced Practice Nurses to deliver primary health care with a particular emphasis on reducing health disparities. The MNCCRN has successfully established a multisite, multistate collaboration for community-based participatory research that will ultimately inform practice, education, and health policy.

Community Health Centers↗

PubMed2006

Archaeological evidence for dental innovation: an eighteenth century porcelain dental prosthesis belonging to Archbishop Arthur Richard Dillon.

During archaeological investigation by Gifford of St Pancras Old Church burial ground, on the eastern edge of Somers Town, London, in advance of construction of the new London terminus for the Channel Tunnel Rail Link, a full porcelain denture was discovered. The high quality porcelain dentures, manufactured in the late eighteenth century French style, may have been brought with their owner, Archbishop Arthur Richard Dillon, on his journey into exile. There is evidence of prolonged use, not only for cosmetic or vocal functions but also in mastication. The dentures are unique archaeological artefacts and represent a pivotal time in dental history, with the adoption of new materials and methods of manufacture. They reflect a period of significant social and economic change for the upper echelons of French society. This paper outlines the development of porcelain dentures, discusses the prosthesis, their owner, and a possible provenance.

Dental Porcelain↗