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An analysis of predictors of sustainability efforts at the Inner-City Asthma Intervention sites: after the funding is gone.

BACKGROUND: The Inner-City Asthma Intervention was a national, multicenter implementation of an evidence-based intervention to reduce asthma morbidity in inner-city children that was funded by the Centers for Disease Control and Prevention. Funding was initially planned for 4 years beginning in April 2001, but because of budgetary changes funding ceased in September 2004, 6 months before the original plan. Some sites were able to sustain their asthma program when the funding ended and others were not. OBJECTIVE: To compare characteristics of sites that were able to sustain their asthma program after the original funding ended with those that were not. METHODS: Data were collected from the project manager at each site in an electronic survey and through telephone interview in November 2003 and August 2005. Using contingency tables, we examined the bivariate relationship between each proposed factor and our outcome measure, secured funding. RESULTS: Of the 18 sites that completed the survey, 50% reported continued funding. All sustainable sites received funding from multiple sources, including either the hospital or the community. One site received federal funding and one site received state funding. Of the sites that presented data to multiple funders, 6 of 9 were sustained (P = .05). CONCLUSIONS: Sustainable programs were more likely to be funded locally. Programs that used an evaluative process, including patient outcomes data, to demonstrate the importance of the program to their institution and community were more likely to obtain continued funding compared with those that did not.

Asthma↗

Implementing innovations in health care settings.

Innovations in health care settings are occurring at an unprecedented rate. New methods and ideas include computerized pumps, computer systems for documentation and communication, and alternative approaches to patient care. To be successfully adopted by nurses, innovations require well-planned administrative, educational and clinical support. A multi-agency research study has revealed factors that should be considered when planning innovations in health care settings.

Diffusion of Innovation↗

Impact of UK Colorectal Cancer Screening Pilot on hospital diagnostic services.

OBJECTIVE: To determine the impact of the UK Colorectal Cancer Screening Pilot on hospital services involved in the diagnosis of colorectal cancer (predominantly colonoscopy, double contrast barium enema and pathology). METHODS: Routine data from seven hospitals at two sites within Scotland and England participating in the Pilot were collected on activity levels and waiting times for key hospital services (GI medicine, surgery and radiology), plus questionnaire survey data from hospital consultants. RESULTS: Hospital colonoscopy activity increased by 31 per cent in Scotland and 21 per cent in England due to the investigation of faecal occult blood testing (FOBt) positive subjects. The demand for symptomatic (non-screening) colonoscopy also increased. Pilot-generated activity was less than predicted for barium enema services (maximum 3 per cent increase in service volume) but greater than expected for pathology, with approximately 200 specimens/month generated. Out-patient review of Pilot colonoscopy patients and associated administrative duties added substantially to overall GI service workload, but quantification was limited by the quality of routinely available data. There was a wide discrepancy in colonoscopy waiting times between screened and symptomatic patients, with predominantly longer waits for symptomatic patients: otherwise the quality of colonoscopy services appeared to improve. In any future national screening programme, follow-up of patients with adenomas will result in a further increase of 28 per cent in the number of colonoscopies generated (over and above colonoscopy for FOBt-positive subjects), adding substantially to overall workload. CONCLUSIONS: During the planning of any successful national colorectal cancer screening programme, careful consideration must be given to the wider aspects of workload associated with screening, as well as to the implementation of appropriate hospital data collection systems.

Aged↗

Using a public health nursing model to assess and plan for health needs at a summer day camp.

The epidemiologic prevention process model (EPPM; Clark, 1992) was designed to guide community health nursing practice and research. The model incorporates epidemiologic, nursing, and public health perspectives and directs assessment of health needs and the planning, implementation, and evaluation of health care services at primary, secondary, and tertiary levels of prevention. The EPPM was used to assess needs for nursing services at a summer day camp and to plan to meet those needs. Assessment indicated that underlying factors in each of four components of the model (human biology, environment, lifestyle, and the health system) contributed to needs for nursing services. Assessment data were used to derive community nursing diagnoses and to plan interventions to meet identified health care needs. In this application, the EPPM was found to be an effective way of organizing and interpreting findings and of translating those findings into improved health care services in a camp setting.

Adolescent↗

[Kangaroo Mother Care in public hospitals in the State of São Paulo, Brazil: an analysis of the implementation process].

This study analyzed the implementation of the Kangaroo Mother method in 28 different São Paulo State public hospitals. Teaching hospitals, Baby-Friendly Hospitals, hospitals with human milk banks, and those with more than 12 trained health professionals showed higher implementation scores. Because of staff resistance to family participation in neonatal care, the Kangaroo Mother method is basically applied in-hospital. Changes in the initial training, including manager awareness-raising and proper financial resource allocation, are necessary for implementation, follow-up, assessment, and feedback.

Brazil↗

Implementation of the WHO Multicentre Growth Reference Study in Norway.

The World Health Organization (WHO) Multicentre Growth Reference Study (MRGS) European site was Oslo, Norway. Oslo has a high breastfeeding rate. Ninety-nine percent of mothers initiate breastfeeding soon after delivery, and 80% continue for at least six months. There is no evidence that socioeconomic conditions constrain growth. As in other sites, the study had two components, longitudinal and cross-sectional. Recruitment for the longitudinal component was conducted in three hospitals that account for most births in Oslo. Approximately 850 subjects were screened in one year by using a systematic allocation scheme to recruit a sample of about 300. Recruitment for the cross-sectional component was based on a systematic interval sampling scheme prepared by the National Registry. More than 4,000 subjects were screened to achieve the required sample size. One of the major challenges of the study was to achieve an acceptable participation rate; great efforts were made to motivate pregnant women via the health care system and the media.

Breast Feeding↗

Implementation of evidence-based potentially better practices to decrease nosocomial infections.

OBJECTIVE: Six neonatal intensive care units (NICUs) that are members of the Vermont Oxford National Evidence-Based Quality Improvement Collaborative for Neonatology collaborated to reduce infection rates. There were 7 centers in the original focus group, but 1 center left the collaborative after 1 year. Nosocomial infection is a significant area for improvement in most NICUs. METHODS: Six NICUs participating in the Vermont Oxford Network made clinical changes to address 3 areas of consensus: handwashing, line management, and accuracy of diagnosis. The summary statements were widely communicated. Review of the literature, internal assessments, and benchmarking visits all contributed to ideas for change. RESULTS: The principle outcome was the incidence of coagulase-negative staphylococcus bacteremia. There was an observed reduction from 24.6% in 1997 to 16.4% in 2000. CONCLUSIONS: The collaborative process for clinical quality improvement can result in effective practice changes.

Bacteremia↗

The Interprofessional Rural Program of British Columbia (IRPbc).

The Interprofessional Rural Program of British Columbia IRPbc was established in 2003 as an important first step for the Province of British Columbia, Canada, in creating a collaborative interprofessional education initiative that engages numerous communities, health authorities and post-secondary institutions in working toward a common goal. Designed to foster interprofessional education and promote rural recruitment of health professionals, the program places teams of students from a number of health professional programs into rural and remote British Columbia communities. In addition to meeting their discipline specific learning objectives, the student teams are provided with the opportunity to experience the challenges of rural life and practice and advance their interprofessional competence. To date, 62 students have participated in the program from nursing, social work, medicine, physical therapy, occupational therapy, pharmaceutical sciences, speech language pathology, audiology, laboratory technology, and counseling psychology. While not without numerous struggles and challenges, IRPbc has been successful in meeting the program mandate. It has also had a number of positive outcomes not anticipated at the time the program was established.

British Columbia↗

A decade on: has the use of integrated care pathways made a difference in Lanarkshire?

This article aimed to: (1) review the work carried out in Lanarkshire between 1996 and 1999 on a Scottish Executive funded project and (2) to discuss the situation from 1999 to 2006. (1) This 3-year project led to the successful development and implementation of over 100 integrated care pathways in an urban teaching hospital (Glasgow) and a district general hospital (Lanarkshire) and was the first in-depth study of integrated care pathways to be undertaken in Scotland. The main report on the project was produced in 1999 (Clinical Audit and Quality using Integrated Pathways of Care) and reported increased adherence to British Thoracic Society and Scottish Intercollegiate Guidelines Network guidelines and multiple best practice statements, and improved standards of documentation. The general findings were that process indicators were improved by integrated care pathway use and there was some suggestion of improved length of stay with no apparent effect on outcome. Evidence was found that integrated care pathways have made a difference for both patients and staff. (2) This provides an update of integrated care pathway development in a changing environment within NHS Lanarkshire and examines some of the key factors for success.

Adult↗

Quality management in psychiatry.

Over the past 50 years, treatment possibilities in psychiatry have drastically improved, but the results we actually achieve under everyday treatment conditions fall far short of what could be accomplished. Quality management represents a suitable method of reducing this gap. Although it has been successfully practiced in other medical disciplines for a long time, its implementation in psychiatry has previously been restricted to pilot projects. Quality management programs in psychiatry have been slow to be accepted because, up to now, only a few mental health professionals have received training in quality management techniques. In order to compensate for this information deficit and to familiarize psychiatrists and other mental health care workers with this increasingly important topic, we will provide in this paper a brief survey of the most important principles and techniques of quality management. This information should encourage psychiatrists to apply this new method to their own areas of responsibility. The results of one of our own studies on schizophrenic outpatients, which are presented at the end of the paper, are intended to show that the outcome can be improved and costs reduced by implementing quality management programs in psychiatry.

Ambulatory Care↗

Rationale for use of Tdap booster vaccines for adolescent immunization: overview of efficacy, safety, and clinical use.

Pertussis is one of the only vaccine-preventable diseases with increasing incidence in the United States. The incidence of pertussis infection in adolescents is a growing concern; it can be a severe disease that may lead to significant morbidity and mortality when transmitted to susceptible populations (eg, infants). Experts have conceded that booster vaccination of adolescents may considerably decrease the incidence of pertussis infections in previously immunized, partially immunized, and nonimmunized populations. Studies in 2 tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccines licensed by the Food and Drug Administration (FDA) have shown efficacy against pertussis disease and have demonstrated a safety profile comparable to tetanus and diphtheria vaccine (Td) in adolescents. Immunization schedules now include use of Tdap vaccines for preadolescent and adolescent populations to counter the increase in pertussis outbreaks. Challenges for clinicians include prompt recognition of pertussis symptoms, proper diagnosis using appropriate tools, and timely reporting of pertussis infections to surveillance bodies. Additional studies are needed to monitor trends of pertussis incidence after implementing the new vaccination schedule for adolescents.

Adolescent↗

[Preliminary survey of a school health program implementation in Guinea].

The Sectorial Adjustment Education Program implemented in Guinea by the Ministry of Pre-University Education in 1995 includes health-related measures. An important part is the fight against parasitosis and in particular against intestinal helminth infection which has been shown to impair cognitive function in school children. In order to obtain data for this purpose, a survey was carried out in 7 subprefectures across the country. A total of 1,649 children were examined to determine the prevalence in each school of macroscopic hematuria-related schistosomiasis and of various intestinal helminthiasis in stools. In 1468 of these children blood tests were also made to measure hemoglobin levels and detect malarial hematozoons. Overall prevalence rates were 60.0% for soil-transmitted nematodes, 9.1% for urinary schistosomiasis, 57.6% for blood plasmodium, and 57.0% for anemia. Hemoglobin levels were lower in children presenting plasmodium, multiple parasitic infection, and high ankylostoma burdens. Prevalence rates varied widely between regions indicating differences in therapeutic measures. In two villages more than 200 children not attending school who had been informed by school children were treated. This word-of-mouth effect shows that school health programs are also useful to reach children outside the school health system.

Child↗