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At least 1,297 records · Page 72Linked to original sources
PubMed1994

Resident participation in the Better Beginnings, Better Futures prevention project: Part II--Factors that facilitate and hinder involvement.

Resident participation is the cornerstone of any community-based prevention program. However, many challenges exist which make it difficult to involve residents in a meaningful way in the development of such programs. How can programs be organized so as to provide for significant participation of community residents in the process of program development? This article outlines the procedures that were utilized in seven community-based prevention programs established under the Better Beginnings, Better Futures initiative of the Government of Ontario to enlist the participation of community residents in program decision making and implementation.

Affective Symptoms↗
PubMed2006

Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice.

The U.S. health care system is one of the world's most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them.

Diffusion of Innovation↗
PubMed2004

Universal Newborn Hearing Screening introduced to NICU infants in Canterbury Province, New Zealand.

AIMS: Universal Newborn Hearing Screening (UNHS) is being implemented worldwide as an effective method of early identification of hearing loss. The impact of delayed detection of sensorineural hearing loss is a major lifelong impairment. The aim of the study was to assess the feasibility of introducing universal newborn hearing screening over the 12-month period in the Neonatal Intensive Care Unit (NICU) at Christchurch Women's Hospital, and to assess the costs, and resources required. METHODS: Universal Newborn Hearing Screening was conducted over a 12 month period in the Neonatal Service of Christchurch Women's Hospital. Throughout the implementation period, data were collected to monitor and benchmark against World's best practice. RESULTS: During the 12 months of the study, 435 babies were screened for hearing loss in the Neonatal Service at Christchurch Women's Hospital. Of these babies, 19 (4.37%) were referred for diagnostic 'auditory brainstem response' ABR testing to confirm hearing loss. Two babies were confirmed with hearing loss, with only one baby exhibiting a known risk factor for deafness. This resulted in a positive predictive index of 10.53%. CONCLUSIONS: This study highlights that UNHS can be implemented efficiently and cost-effectively within the Neonatal Service of a New Zealand Hospital. The results were consistent with best practice, and show the benefits of UNHS against 'at risk' screening. The ultimate success of this study will be in the implementation of UNHS across New Zealand.

Costs and Cost Analysis↗
PubMed2000

The clinical guideline process within a managed care organization.

Clinical practice guidelines have been available to clinicians for almost two decades, but the consistency of their implementation in practice remains highly variable. This paper describes the various processes and mechanisms used by one managed care organization to develop clinical guidelines and promote their adoption. Some of these mechanisms include provision of individual physician report cards, financial incentives, and various documentation tools that serve as reminders of guideline recommendations and provide an easy format to document recommended services. There have been measurement challenges in evaluating the effectiveness of selected interventions designed to enhance guideline compliance. Most of these challenges relate to reliability and validity concerns regarding the three primary data sources used in the evaluation process: medical records, administrative claims data, and member survey data. Some of the interventions the health plan has implemented to address these measurement challenges include using hybrid methods of data collection and developing collaborative partnerships with outside organizations to enhance the accuracy and completeness of the available data. Outcomes of these efforts are described, as are physician response and recommendations for future enhancement of practice guidelines.

Documentation↗
PubMed1999

Focus on rehabilitation: teamwork that works.

The end-stage renal disease patient has progressed in the past 25 years from the patient who was chosen by a committee to continue life, to a patient who chooses to live well on dialysis. The Vanderbilt Dialysis Clinic (VDC) has developed a collaborative team approach to enable the patient to more effectively achieve this goal. The emphasis has been placed on the patient's "ability, not disability." The collaborative effort of the staff at the VDC has evolved based on the perspective of a team concept. Each discipline or member of the team has a specific goal but functions in a manner that is interdependent of the other team members. The physician, nurses, dietitians, social workers, technicians, and activities director all play an important role in the concept of rehabilitating the whole person. The key to a successful rehabilitation program is to begin with interested patients and staff to serve as a catalyst for others. The Rehabilitation Program at VDC has been based on the principles of continuous quality improvement (CQI) at the unit. The team used the CQI process to brainstorm ideas to implement the exercise program, to overcome barriers to success, and to recognize opportunities to motivate patients and staff. Physicians, nurses, technicians, and dietitians worked together to develop the screening protocols so that the staff would feel comfortable when assessing the patient for exercise. An exercise physiologist from Vanderbilt's Kim Dayani Human Performance Center participated in evaluating the exercise screening information and worked with individual patients and staff members as the program began. Equipment was acquired in the form of used stationary bicycles, smaller ergometer-style pedals, hand and ankle weights, and therabands. The exercise program was initiated with only 2 to 4 patients per week participating, after which time it was evaluated and modified. VDC discovered that heightened awareness does indeed impact the level of participation in the facility. The Rehabilitation Team implemented the exercise program in October 1996 with 60% patient participation, yet within 6 months, participation decreased to 25%. One year later in conjunction with a Rehabilitation Fair, interest again peaked to a participation level of 60% in the center and 66% with the home dialysis population. While the improvement in participation may have been due to more quantifiable measurement, it is perhaps more reflective of the emphasis placed on the importance of exercise. Motivators such as an Annual Rehabilitation Fair in which all areas of the Life Options Rehabilitation Advisory Council's "5 E's"--encouragement, education, exercise, employment, and evaluation--are emphasized and have been effective in generating renewed interest among staff and patients in improving overall rehabilitation of patients at the VDC. Continuous motivation of patients and staff through ongoing program implementation, evaluation, and modification based on the CQI process is necessary to maintain everyone's level of interest.

Administrative Personnel↗
PubMed1998

Community-based trauma systems in the United States: an examination of structural development.

OBJECTIVE: To examine the organizational, political, and community characteristics that facilitate or impede community progress in developing a coordinative network of health services for trauma delivery. STUDY SETTING/DESIGN: A comparative case study design was used to examine trauma network development in 6 U.S. cities with a population of 1,000,000 or more. Five key coordinative activities were selected for study. Each study site varied in the set of activities that had been implemented. DATA SOURCES: Information on the structure and composition of local trauma coordinating councils; interviews with a common set of informants in each site using a semi-structured interview protocol. STUDY METHODS: The literature on interorganizational community structures and local policy development was drawn upon to create a conceptual framework for assessing the development of a coordinative service network. Analytical techniques included network analysis to understand the linkages across organizations in overseeing trauma network operations, assessment of leadership structures to identify central actors and organizations, and pattern matching techniques of case study analysis to identify factors that affected trauma network development. PRINCIPAL FINDINGS: Leaders capitalized on local events and were instrumental in keeping network development on the top of the political agenda. Successful leaders spent substantial time and energy documenting problems, assessing the needs and understanding of stakeholders, educating stakeholders and politicians, and creating trust and shared understanding of values. CONCLUSIONS: Prior research has documented the importance of central actors and organizations in developing coordinative networks. The unique contribution of our research is its insights on how central actors and organizations are more likely to motivate collaboration in situations where they lack control over the allocation of payments across involved organizations. Our research suggests that under these circumstances central players should focus their time and energy educating stakeholders and developing a shared understanding rather than using their centrality to impose a particular coordinative structure. To date, U.S. trauma networks have served as models for other industrialized countries, and thus, lessons learned in the U.S. about implementing interorganizational networks of trauma care can assist other countries achieve more effective coordination and avoid mistakes that impede progress.

Community Health Planning↗
PubMed2006

Minimizing errors of omission: behavioural reenforcement of heparin to avert venous emboli: the BEHAVE study.

OBJECTIVE: To improve patient safety by increasing heparin thromboprophylaxis for medical-surgical intensive care unit patients using a multiple-method approach to evidence-based guideline development and implementation. DESIGN: Prospective longitudinal observational study. SETTING: Medical-surgical intensive care unit. PARTICIPANTS: Multidisciplinary clinicians caring for critically ill patients in a 15-bed medical-surgical closed intensive care unit. INTERVENTIONS: Phase 1 was a 3-month baseline period during which we documented anticoagulation and mechanical thromboprophylaxis. Phase 2 was a 1-yr period in which we implemented a thromboprophylaxis guideline using a) interactive multidisciplinary educational in-services; b) verbal reminders to the intensive care unit team; c) computerized daily nurse recording of thromboprophylaxis; d) weekly graphic feedback to individual intensivists on guideline adherence; and e) publicly displayed graphic feedback on group performance. Phase 3 was a 3-month follow-up period 10 months later, during which we documented thromboprophylaxis. Computerized daily nurse recording of thromboprophylaxis continued in this period. MEASUREMENTS AND MAIN RESULTS: Intensive care unit and hospital mortality rates were similar across phases, although patients in phase 2 had higher Acute Physiology and Chronic Health Evaluation II scores than patients in phases 1 and 3. The proportion (median % [interquartile range]) of intensive care unit patient-days of heparin thromboprophylaxis in phases 1, 2, and 3 was 60.0 (0, 100), 90.9 (50, 100), and 100.0 (60, 100), respectively (p=.01). The proportion (median % [interquartile range]) of days during which heparin thromboprophylaxis was omitted in error in phases 1, 2, and 3 was 20 (0, 53.8), 0 (0, 6.3), and 0 (0, 0), respectively (p<.001). CONCLUSIONS: After development and implementation of an evidence-based thromboprophylaxis guideline, we found significantly more patients receiving heparin thromboprophylaxis. Guideline adherence was maintained 1 yr later. Further research is needed on which are the most effective strategies to implement patient safety initiatives in the intensive care unit.

Aged↗
PubMedDate not supplied

Implementing clinical guidelines: how can informatics help?

Clinical guidelines are heralded as a positive contribution to improving quality of care and ensuring the effectiveness of care. From the perspective of the health services researcher, the authors propose a model of how informatics can support the implementation of clinical guidelines and their integration into systems for decision support and clinical audit. Each element of the model is discussed in turn.

Health Plan Implementation↗
PubMed1994

HIV counselling and care programmes at the district level in Ghana.

The district hospital is the focus for the presentation of HIV-related disease in rural sub-Saharan Africa. Patients require not only medical care, but often economic support and counselling for themselves and their families. Psychosocial support should be provided at the hospital and in the home, the latter often being the preferred option. A team approach to HIV disease care and counselling, with careful selection and support of staff, and appropriate training in counselling skills is essential. A primary health care approach at the district level, mobilizing community participation and intersectoral support is necessary. Community Health Outreach Departments, as integral parts of the district hospital, are recommended and could pilot low-cost HIV hospital and home-care programmes.

Community Health Services↗