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PubMed2005

DOTS implementation in a middle-income country: development and evaluation of a novel approach.

BACKGROUND: DOTS is widely accepted as the most cost-effective strategy for tuberculosis (TB) control. However, there is little published information regarding methods for implementation in middle-income countries. METHODS: Over 3 years, the Canadian Lung Association assisted the Ecuadorian TB programme to implement DOTS for over half the nation's total population. A multilevel strategy developed by a team of Ecuadorian health professionals provided initial, in-service, replica and reinforcement training at the local level, and training at national level for specialist physicians, specialist societies and medical schools. Evaluation was based on international guidelines for case finding, treatment and laboratory quality control, and costs of all implementation activities. RESULTS: By January 2004, DOTS training had been provided to 1954 health professionals and 199 smear microscopy technicians, and DOTS was implemented in all 496 health facilities. Case detection activities at the local level increased substantially. Cure and treatment completion improved to 83% of new cases. Overall concordance of laboratory quality control readings was 98.7%. The total cost of DOTS implementation was US dollar 3 049 585. CONCLUSIONS: To achieve international targets for TB control, DOTS implementation in a middle-income country required intensive training at the local level and at multiple other levels.

Directly Observed Therapy↗

PubMed2005

[Implementation analysis of public functions of centers of disease prevention and control of China].

OBJECTIVE: To evaluate the implementation of public function and items of the centers of disease prevention and control(CDC). METHODS: 161 centers of disease prevention and control have been investigated by two-stage stratified sampling. The implementation analysis of public function and items of CDC is measured by multiplying average operational proportion and average operational degree. RESULTS: 1. For investigated centers, the average rate of function implementation is 42.9% ,with 56.0% at provincial level and 43.7% at city level, 41.3% for the county level; while 49.3% in east areas, 45.4% in middle areas and 35.3% in west areas. 2. Among all 7 functional items, the implemented rate of disease prevention and control is 54.3%, 65.8% for emergency treatment, 35.0% for epidemic situation report and information management of health relative factors, 31.3% for inspection and control of health risk factors, 39.1% for the laboratory examination and evaluation, 36.4% for health education and health promotion, and 56.7% for technological guidance and application study. CONCLUSION: The implemented degree of public function of CDC was generally lower, varied with regions and levels. Among 7 public functional items, the emergency treatment function had the highest implementation, with the lowest for the inspection and control of health relative factors.

China↗

PubMed2005

[Implementation analysis of public functions of 161 centers of disease prevention and control in 7 provinces].

OBJECTIVE: To evaluate the implementation of public function and items of the centers of disease prevention and control (CDC). METHODS: 161 centers of disease prevention and control have been investigated by two-stage stratified sampling. The implementation analysis of public function and items of CDC is measured by multiplying average operational proportion and average operational degree. RESULTS: (1) For investigated centers, the average rate of function implementation is 42.9%, with 56.0% at provincial level and 43.7% at city level, 41.3% for the county level, while 49.3% in east areas, 45.4% in middle areas and 35.3% in west areas. (2) Among all 7 functional items, the implemented rate of disease prevention and control is 54.3%, 65.8% for emergency treatment, 35.0% for epidemic situation report and information management of health relative factors, 31.3% for inspection and control of health risk factors, 39.1% for the laboratory examination and evaluation, 36.4% for health education and health promotion, and 56.7% for technological guidance and application study. CONCLUSION: The implemented degree of public function of CDC was generally lower, varied with regions and levels. Among 7 public functional items, the emergency treatment function had the highest implementation, with the lowest for the inspection and control of health relative factors.

China↗

PubMed2005

[Implementation of quality management in French hospitals: staff interplay and induced changes].

BACKGROUND: French hospitals have been encouraged to develop quality processes, in particular through the implementation of a mandatory accreditation. Our objectives were to study the models of quality management used in hospitals and to identify the induced changes in organisation and practices. METHODS: This multiple case study related to 9 acute care hospitals selected among the hospitals whose quality process were relatively old. The study was based on interviews related to 78 people including 26 administrative staff members, 33 physicians and 19 chief nurses. Implementation analysis and strategic analysis were applied. RESULTS: Accreditation played a major part in the institutionalisation of quality processes. Implementation appeared more complete in the small size and private statute hospitals compared to the large public statute hospitals. But the main factors accounting for implementation variability were the level of involvement of the executive directors and participation of doctors in the quality process' leadership. The most important changes were establishment of specific structures, appearance of new professions and elaboration of quality documentation. In the hospitals where the quality process was strongly implemented, there was a trend to the de-compartmentalization between the professions and between the structures and phenomena of employees'development and empowerment. CONCLUSION: Institutionalisation of quality management is recent and the level of implementation varies greatly among hospitals. Involving doctors remains a major challenge for the development of quality management so that the quality can lead changes in hospital.

Accreditation↗

PubMed2005

[A meeting center for people from Surinam with dementia and their informal caregivers. Development and implementation of culture specific combined support].

In this study we investigated the implementation of a support programme for Surinam people with dementia and their carers. The reason for setting up a new type of support was the finding that the regular care is unable to meet the needs of elderly people from ethnic minorities and their carers. We traced facilitating and impeding factors in the successful implementation of the support programme. We also evaluated the result of the implementation. Data were gathered among participants in the programme (n=24) by means of questionnaires. Semi-structured interviews were conducted with key figures (n=8) involved in setting up and implementing the meeting centre. The interview data were double coded and analyzed, using the computer programme NVivo. Demonstrably favourable factors for setting up the support program were: a thorough preliminary study and a type of support that is in line with the views of the organizations involved. Several factors proved to play a facilitating role during the phases of preparation and implementation, for example: motivated initiators and staff, effective cooperation between organizations and adequate financial resources. With regard to the result of the implementation, we concluded that this culture-specific type of support is feasible and successful; the targeted population is reached, people with dementia and their carers are satisfied with the support, and the attendance at the different elements of the support program has been very satisfactory.

Aged↗

PubMed2006

Same systems, different outcomes--comparing the implementation of computerized physician order entry in two Dutch hospitals.

OBJECTIVES: To compare the outcome of the implementation of computerized physician order entry (CPOE) systems in two Dutch hospitals. METHODS: Qualitative research methods, including interviews in both hospitals, observations of system in use, observations of staff meetings and document analysis were used to understand the implementation of CPOE. The transcribed texts and implementation documents were analyzed for relevant concepts. The transcripts and field notes were analyzed using a heuristic success and failure model with medical work as the primary focus. RESULTS: Occasions that determined the outcome of the implementation were classified according to factors that may influence the success or failure of implementing systems. CONCLUSIONS: The themes and patterns that emerged from the data helped validate the concept of medical work as the primary focus of our analysis model; in addition the concept of a support base necessary to accept changes in medical work that result from introducing CPOE may help to understand the different implementation outcomes.

Diffusion of Innovation↗

PubMed2006

[Accelerated increase in the number of involuntary admissions following the implementation of the Dutch Act on Compulsory Admission to Psychiatric Hospitals (BOPZ)].

OBJECTIVE: To determine whether the observed accelerated increase in the number of involuntary admissions in The Netherlands coincides with the implementation of the Dutch Act on Compulsory Admission to Psychiatric Hospitals (BOPZ) in 1994. DESIGN: Retrospective. METHOD: The extent to which the number of involuntary admissions changed after implementation of the BOPZ was examined by means of Poisson regression on the basis of national data from the Patient Registration of Intramural Mental Healthcare for the period 1979-1995 and data from the Healthcare Inspectorate for the period 1992-2004. For this purpose, the curve prior to implementation of the BOPZ was compared with that following its implementation. RESULTS: The number of involuntary admissions of psychiatric patients had more than doubled in 25 years, from 3101 in 1979 to 7450 in 2004. The increase in annual numbers accelerated significantly after implementation of the BOPZ in 1994. CONCLUSION: There was an accelerated increase in the number of involuntary admissions after the implementation of the BOPZ. Other possible contributing factors include an increased number of admissions, shorter hospital stays, and changes in social concepts.

Commitment of Persons with Psychiatric Disorders↗

PubMed1986

Implementing a stand-alone packaged pharmacy computer system in a 580-bed hospital.

The problems experienced by a hospital pharmacy department in implementing a stand-alone packaged computer system are discussed, and recommendations for avoiding and managing these problems are presented. In 1984, a stand-alone packaged computer system was implemented in a 580-bed, tertiary-care institution that provides services from a central pharmacy and five satellite pharmacies. The department developed a request for proposal and contracted with a vender for a system that would support unit dose drug distribution and i.v. admixture services. During the implementation process, the following problems were experienced: The hardware was insufficient for the department's workload, the software design was limited, and personnel were frustrated with learning to use the system. These problems were intensified by the heavy workload and the large number of users. In the 18 months since implementation, the department has purchased more hardware, improved the software applications, and resolved many of the problems associated with employee frustration. Pharmacy departments at other large institutions might avoid some of these problems by training personnel adequately before implementation and by researching and estimating hardware and software needs in advance. In this large hospital, the efficiency of a stand-alone packaged pharmacy computer system has improved 18 months after implementation.

Computers↗

PubMed1984

Research on disseminating and implementing health education programs in schools.

Numerous school health education programs have been developed. No matter how effective a given program may be, however, its impact will be determined by the extent to which it actually is disseminated and maintained in classrooms. The dissemination of a program involves purposeful efforts by agencies usually outside the school to implement the program in many different schools, efforts by agencies usually outside the school to implement the program in many different schools, while program implementation involves efforts by those within a given school to effectively use the program in its classrooms. This paper has been prepared to review concepts, strategies, and methods used to study dissemination and implementation; to specify the functions of dissemination and implementation research; and to describe general approaches and specific procedures to evaluate the effectiveness of dissemination and implementation activities. As we develop more and better school health education interventions, the need for research that will allow us to efficiently transport these interventions to classrooms throughout the nation becomes increasingly important.

Adolescent↗

PubMed1982

A computer primer: systems implementation.

It is important to recognize the process of implementing systems as a process of change. The hospital, through its steering committee, must manage this process, initiating change instead of responding to it. Only then will the implementation of information systems be an orderly process and the impact of these changes on the hospital's organization clearly controlled. The probability of success in implementing new systems would likely be increased if attention centers on gaining commitment to the project, gaining commitment to any changes necessitated by the new system, and assuring that the project is well defined and plans clearly specified. These issues, if monitored throughout the systems implementation, will lead to early identification of potential problems and probable failures. This highly increases the chance of success. A probably failure, once identified, can be given specific attention to assure that associated problems are successfully resolved. The cost of this special attention, monitoring and managing systems implementation, is almost always much less than the cost of the eventual implementation failure.

Computers↗

PubMed1993

Problems in interpreting cost effectiveness in clinical trials. Experimental versus implementation costs.

OBJECTIVE: To demonstrate the difficulty of estimating cost effectiveness of alternative implementation strategies using clinical trial data. DESIGN: Two examples drawn from a hearing-aid intervention trial and a physical-therapy trial for frail elderly are used to demonstrate how alternative implementation strategies may affect cost effectiveness. Sensitivity analysis is used to document a range of possible economic outcomes for each example and show how assumptions based on trials may bias implementation decisions. MAIN OUTCOME MEASURES: Costs and cost-effectiveness ratios are estimated for alternative implementation strategies and compared with trial results. MAIN RESULTS: Staffing and equipment substitutions, reconfigurations, and economies of scale can reduce the cost of trial interventions substantially. Such resource alterations as well as protocol and target group modifications may also have an impact on effectiveness. In both examples effectiveness can be reduced by as much as 50% and under certain conditions alternative implementation strategies will still be cost effective. CONCLUSIONS: Cost effectiveness of implementations can differ substantially from a trial when different resources or target populations are incorporated. Institutions must conduct preimplementation studies which consider alternative resource configurations before adopting an intervention based on trial results.

Aged↗

PubMed1995

Understanding the dynamics of information technology implementation: a study of clinical information systems.

Health care institutions are considering a variety of emerging information technologies (ITs) in the hope of increasing efficiency, reducing costs, re-engineering work processes, and improving quality of care. The recent, rapid advances made in the use of innovative ITs in the health care field can present a plethora of problems to the administrative staff. Perhaps the most pressing of these concerns is the ability of today's hospitals to effectively create and utilize computer-based information systems. IT implementation has long been of great interest for information systems researchers. This branch of information system study seeks to identify those factors that are integral to optimizing the usage of IT. For example, researchers have advised practitioners that managerial support, high quality system design, commitment to advancing with the field, and extensive project planning are all key elements of successful system. In sum, previous research has produced a set of managerial proscriptions which, taken as a whole, constitute the "ideal" way to implement an IT system. Yet despite these normative principles and proscriptions, many health care institutions continue to find their attempts to make use of IT fraught with difficulty. Therefore, the objective of this study is to broaden and edify our understanding of IT implementation. More specifically, we seek to dispel the myth of the "ideal" system setup by exploring some of the alternative systems in use. We wish to investigate how and why the components of these alternative systems interact to produce utilization success (or failure). The study investigates the establishment and subsequent use of three clinical information systems (CIS) in a large tertiary care teaching hospital. The first case study is that of the hospital-wide implementation of a computer system that allows physicians to sign their medical records electronically. The second case examines the use of an electronic patient chart used to support the work of a variety of clinicians. Finally, we study a nursing assessment system used by two groups of nurses (intensive care unit and resuscitation unit) at a state-of-the-art, newly established Trauma Center. Qualitative was gathered through semi-structured interviews with people involved in the implementation process as well as a sample of user representatives. More than 90 interviews were conducted over a period of six months. Observational data completed our qualitative assessment. Quantitative evidence was gathered through questionnaires administered to a small sample of key informants. Three techniques of qualitative data analysis are being used in combination, namely, coding, analytical memos and displays. Data analysis is still in its infancy at this point. Regarding its relevance to the role of the administrator, this study will allow general and health care management as well as IT professionals to gain insight into the dynamics of the implementation of innovative technologies. In other words, results from this study will provide clear and relevant answers to the questions of how and why the outcome of the information system project is influenced by the way in which the technology is introduced.

Attitude to Computers↗

PubMed1996

Implementation of computer-based patient records in primary care: the societal health economic effects.

OBJECTIVE: Exploration of the societal health economic effects occurring during the first year after implementation of Computerised Patient Records (CPRs) at Primary Health Care (PHC) centres. DESIGN: Comparative case studies of practice processes and their consequences one year after CPR implementation, using the constant comparison method. Application of transaction-cost analyses at a societal level on the results. SETTING: Two urban PHC centres under a managed care contract in Ostergötland county, Sweden. MAIN OUTCOME MEASURES: Central implementation issues. First-year societal direct normal costs, direct unexpected costs, and indirect costs. Societal benefits. RESULTS: The total societal effect of the CPR implementation was a cost of nearly 250,000 SEK (USD 37,000) per GP team. About 20% of the effect consisted of direct unexpected costs, accured from the reduction of practitioners' leisure time. The main issues in the implementation process were medical informatics knowledge and computer skills, adaptation of the human-computer interaction design to practice routines, and information access through the CPR. CONCLUSIONS: The societal costs exceed the benefits during the first year after CPR implementation at the observed PHC centres. Early investments in requirements engineering and staff training may increase the efficiency. Exploitation of the CPR for disease prevention and clinical quality improvement is necessary to defend the investment in societal terms. The exact calculation of societal costs requires further analysis of the affected groups' willingness to pay.

Computer Literacy↗

PubMed1998

TQM implementation strategies in hospitals: an empirical perspective.

This article reports an analysis of the effectiveness of Total Quality Management (TQM) programs. The objective of the study was gain a better understanding of how hospitals implement TQM and quality improvement initiatives. Results show that some hospital staffs have not realized that they are implementing TQM, even though they report to be using the strategies for quality improvement. On the other hand, some hospitals said that they were involved in quality programs, though not practically implementing TQM strategies. These results suggest two major conclusions about the implementation of TQM programs. First, data indicate that TQM programs may not be as effective as promised, due to a lack of understanding about TQM by the people within the organization. Second, implementation strategies that are statistically correlated are identified. These conclusions may be helpful for successful TQM implementation in from healthcare organizations as well as other service industries.

Cross-Sectional Studies↗

PubMed1994

Community-oriented primary care. Implementation of a national rural demonstration.

A major objective of community-oriented primary care (COPC) is to focus the clinical practice on the health care problems of the community that the practice serves. The COPC process defines the community of interest, identifies and prioritizes community health problems, and implements and evaluates interventions. Under sponsorship from the W. K. Kellogg Foundation, the COPC National Rural Demonstration Program was established to explore the feasibility of implementing COPC in 13 rural practices. An evaluation of the program found that local communities played critical roles in defining and implementing COPC interventions. These interventions were most often focused on health promotion/illness prevention activities. At most sites, clinical practices were limited in their ability to incorporate COPC activities by staff and physician turnover and the extensive patient demands on the time of rural primary care physicians. While the COPC process proceeded at different rates across the sites, after 2 1/2 years of grant funding, most sites continued to devote the majority of their resources to designing and implementing interventions. Thus, it appears that coordination by dedicated nonphysician staff and more than 2 years of effort are required to implement COPC concepts in rural practices in underserved areas.

Community Health Services↗

PubMed2025

Barriers and facilitators to implementing clinical genome-wide sequencing: A scoping review of the global landscape.

PURPOSE: The global demand for clinical genome-wide sequencing (GWS) continues to grow. This study describes the global landscape of genetic service delivery and the barriers and facilitators to implementing clinical GWS. METHODS: A scoping review was conducted using MEDLINE and Embase (January 2009-July 2025) to identify studies related to genetic service delivery, exome and genome sequencing, and implementation. RESULTS: Ninety-six articles representing 35 countries were analyzed using the updated Consolidated Framework for Implementation Research. The most frequently reported barriers were within the outer setting: insufficient Local Conditions (ie, genetics workforce shortage; 54/96, 56%), limited Financing (29/96, 30%), and lack of national Policies and Laws (regulations) for genomic testing (20/96, 21%). Negative Local Attitudes about genomics were reported as a barrier in 11 South American, Middle Eastern, Asian, and African countries. Identified outer setting facilitators included Partnerships and Connections between interested parties (eg, government, academic institutions; 14/96, 15%) and dedicated Funding for national genomics initiatives (6/96, 6%). CONCLUSION: This scoping review identified common barriers to implementing GWS across countries with varying capacities for delivering these services. Findings may help countries to anticipate barriers, leverage facilitators, and develop strategies for implementing genomic testing and services.

Humans↗

PubMed2006

International Primary Care Respiratory Group (IPCRG) Guidelines: dissemination and implementation--a proposed course of action.

There is growing evidence that good implementation of evidence-based guidelines can result in improvement in health outcomes. This paper on Dissemination and Implementation constitutes the final paper of the IPCRG Guidelines on the management of chronic respiratory diseases in primary care. It highlights the historical development of these guidelines following the formation of the International Primary Care Airways Group (IPAG) in 2001 together with its dissemination and implementation subgroup, and the subsequent transfer of this dissemination and implementation role to the IPCRG. It covers the main factors within the IPCRG workplan, including the issues of governance, launch, dissemination, implementation, and evaluation.

Delivery of Health Care↗

PubMed2026

Effectiveness and implementation of task-sharing cognitive-behavioral interventions for perinatal mental health: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of cognitive-behavioral interventions (CBIs) delivered by nonspecialist providers (NSPs) on perinatal depressive (PND) and anxiety symptoms, and to narratively synthesize their implementation processes and reported implementation outcomes, including acceptability, feasibility, fidelity, cost, and sustainability. METHODS: We systematically searched eight databases from inception to April 8, 2025. Eligible studies were randomised controlled trials (RCTs) assessing CBIs delivered by NSPs for PND and/or anxiety. Two reviewers independently screened, extracted, and assessed trials. Meta-analyses employed random-effects models, with subgroup, sensitivity, meta-regression, and publication bias analyses conducted in Stata 18.0. Implementation processes and outcomes were reported as frequencies or percentages across trials. RESULTS: A total of 47 trials (11, 357 participants) were included in the systematic review, of which 37 trials (8,709 participants) were included for meta-analyses. CBIs were conducted in 12 countries. Nurses and midwives delivered 45% of CBIs. CBIs were associated with reduced PND post-intervention compared with control conditions (standardized mean difference [SMD] -0.49, 95% CI -0.63 to -0.35; I² = 86.8%). Limited evidence from four trials suggested a small sustained effect at 12 months (SMD -0.14, 95% CI -0.27 to -0.02; I² = 26.4%). Reductions in anxiety symptoms were observed immediately post-intervention (SMD, -0.45, 95% CI -0.65 to -0.25; I²=81%), but evidence for longer-term effects was limited. Subgroup analyses confirmed consistent effects across diverse settings, populations, and intervention characteristics. Reporting of implementation processes (e.g., training, supervision, fidelity) was limited, with only 23.4% of trials assessing fidelity and 10.6% evaluating costs. CONCLUSIONS: NSP-delivered CBIs showed beneficial effects on PND and anxiety, with generally encouraging evidence for acceptability and feasibility. However, evidence for sustained effects beyond the immediate post-intervention period remains limited. Future studies should strengthen long-term follow-up and improve reporting of implementation processes and outcomes, particularly in rural and adolescent perinatal populations, to inform scalable and equitable task-sharing models.

Humans↗