SEARCH · PubMed Health

Results for “Implementation”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 433 records · Page 24Linked to original sources

PubMed2003

Collaborative practice: development, implementation, and evaluation of a weaning protocol for patients receiving mechanical ventilation.

BACKGROUND: Use of protocols to reduce weaning time for patients receiving mechanical ventilation helps reduce cost and length of stay. However, implementation of this type of protocol is not easy and requires a consistent collaborative effort. OBJECTIVE: To provide a systematic approach to the weaning process by developing, implementing, and evaluating a protocol for weaning patients from mechanical ventilation in a medical respiratory intensive care unit. METHODS: The weaning protocol used was a modification of a protocol developed by Ely et al. Modifications included a more aggressive approach in proceeding to the spontaneous breathing trial, inclusion of the Richmond Agitation-Sedation Scale, and documentation of the production of secretions. RESULTS: Implementation of the protocol significantly reduced the duration of mechanical ventilation as measured by 8-hour shifts and ventilator days. Although length of stay in the intensive care unit was not significantly reduced (P = .29), a continuing downward trend occurred, from a mean of 8.6 days before the protocol was implemented to 7.9 days during the last 6 months of data collection (P = .07). CONCLUSIONS: The need to provide efficient care requires the collaboration of all disciplines involved in providing patients' care. The weaning protocol introduced in this study demonstrates the benefits of using a collaborative team to identify best practices and implement them in a practice setting.

Clinical Protocols↗

PubMed2004

Typological and technological study of prehistoric implements in animal hard tissues.

Several series of prehistoric implements in animal hard tissues, either from ancient and recent excavations, were studied by the typological and technological points of views. Their morpho-typological description was in many cases associated to microscopic study of surface modifications, often allowing identification of traces related to manufacture. This technological information in some cases could be integrated by the observations of use-wear, thus providing functional indications. Implements came from sites of different antiquity and different geographic areas (from Liguria to Calabria). Implements considered by the research program included tools, pendants and other ornamental objects, as well as unfinished implements and manufacture left-overs often identified during revision of faunal remains. Middle Paleolithic bone fragments bearing traces of non-alimentary anthropic actions were limited to the so-called "retouchers". However, during Upper Paleolithic, implements in animal hard tissues were relatively frequent in most Italian sites, even if those industries were not so rich, elaborated and typologically differentiated as in other European areas.

Animals↗

PubMed2005

CIOs' views of HIPAA Security Rule implementation--an application of Q-methodology.

The purpose of this study is to uncover the attitudes held by chief information officers (CIOs) regarding the implementation of HIPAA's Security Rule. In March and April of 2004, five Chicago area CIOs were surveyed and asked to rank 26 opinion statements that presented possible implementation barriers to the Security Rule. Q-methodology, which is a powerful tool in subjective study, was employed to identify and categorize the viewpoints of CIOs toward the barriers. Two factors (opinion types) that represented two different views--socially motivated CIOs and resources-motivated CIOs--regarding the implementation barriers were extracted. The study sheds light on the attitudes and perceptions of CIOs as they begin rule implementation. Current CIOs can use this information as a way to begin to examine what the prevailing attitude may be at their institution and, therefore, how to begin building a successful implementation strategy.

Chicago↗

PubMed2005

Human factors considerations relevant to CPOE implementations.

Although many studies have discussed the benefits of computerized provider order entry (CPOE), the actual number of hospitals using this technology remains low because of the many challenges that accompany the implementation of CPOE in healthcare facilities. It is common for user resistance to challenge implementation efforts. As more hospitals undertake CPOE implementations, a solid understanding of how to foster acceptance of CPOE is necessary to reap the benefits of medical error reduction, improved quality of care, and decreased healthcare costs. The principles and practices of human factors can be used to bolster physician satisfaction and increase usability, thereby increasing the chances of success for CPOE implementation. This article reviews the recent literature regarding CPOE and human factors, discussing how the human factors principles of task analysis, interface design, and computer supported cooperative work can be utilized to promote user acceptance and enhance CPOE implementation efforts.

Attitude of Health Personnel↗

PubMed2005

Effectiveness of coping strategies used by hospitals in response to implementation of a case-based payment system by the National Health Insurance program.

BACKGROUND AND PURPOSE: The introduction of the case-based payment system by the Bureau of National Health Insurance resulted in greatly increased pressure on the health care industry in Taiwan. This study examined the relationship between the coping strategies adopted and the results attained by accredited teaching hospitals and non-teaching regional hospitals when responding to this regulatory change. METHODS: A cross-sectional survey was conducted using a structured questionnaire to assess the hospitals' characteristics, and coping strategies at the technical, managerial and institutional levels in response to the case-based payment system, and to compare these strategies with self-evaluation of the effectiveness of these strategies. The questionnaire was sent in early October 2000 to the superintendents of the 129 hospitals that were accredited at the medical center, regional hospital, and district teaching hospital levels in the year 2000. Factor analysis was applied to group the strategies into categories and stepwise regression analysis was used to explore the relationship between the reported coping strategies adopted and their effectiveness as evaluated by participants. RESULTS: Among the selected hospitals, 89 responded with complete data, a 69% response rate. The following 7 factors were extracted from 30 coping strategies: information and financial analysis; service shifting and unbundling; service integration and quality improvement; service specialization and strengthening; education and training; financial incentives; and claim submission skill. After adjusting for accreditation level or ownership status, 2 main findings were noted. First, hospitals that implemented financial incentives strategies such as holding physicians responsible for all or part of the shortfall between actual claim submissions and actual reimbursements, and reducing or withholding payment to physicians beyond the standard length of stay, tended to increase medical revenue (odds ratio, 1.21). Second, hospitals that implemented service integration and quality improvement strategies, such as implementing a discharge plan, implementing clinical pathways and periodic review of quality indicators, attained higher patient satisfaction rate (odds ratio, 1.40). CONCLUSIONS: This study suggests that hospitals confronting the implementation of a case based-payment system may benefit by adopting financial incentives strategies and by efforts to improve service integration and quality.

Cross-Sectional Studies↗

PubMed2005

Conceptual framework for the implementation of interventions in the construction industry.

OBJECTIVES: The objective of this study was to explore the necessary steps to define the implementation of interventions aimed at reducing physical work demands due to manual materials handling in the construction industry. METHODS: A theoretical structured framework of six steps is outlined as a method for developing the implementation of interventions. In this framework, both the proposal for implementing the intervention measures and the context analysis are conditional. RESULTS: Application of the framework in the development of the implementation of interventions to reduce the physical work demands for bricklayers and bricklayers' assistants has been presented. CONCLUSIONS: The framework was found appropriate for defining implementation strategies and (ergonomic) measures in the construction industry.

Facility Design and Construction↗

PubMed2006

[Early results of evidence-based perinatal care technologies implemented by Zestafoni maternity hospital].

The implementation of evidence-based effective perinatal care in Georgia is very limited. This study was planned as descriptive to define the results of implementation of effective perinatal care technologies, to compare them with existed obstetric practices and reliable research summaries. We identified procedures which should be avoided as routine and practices that should be encouraged. The rate of existed practices was defined retrospectively through analyses of hospital records and interview with health care providers participating in labor and delivery process. The results of implementation of effective perinatal care technologies were determined by exit interviews with postpartum women, verified using hospital notes. The four practices widely used in obstetric care where evidence suggests that they should be avoided as routine, decreased after implementation of effective perinatal care technologies: use of pubic shaving dropped from 97% to 6%, enema from 98% to 5%, episiotomy from 82% to 21%, and lithotomic position from 100% to 30%. Social support or companionship during labor and delivery has been encouraged and used routinely. Obstetric practice must follow best available evidence. There is a need to implement widely effective perinatal care technologies and develop evidence-based clinical practice guidelines which will ensure progressive changes in clinical practice.

Biomedical Technology↗

PubMed2006

Evaluation of reported medication errors before and after implementation of computerized practitioner order entry.

While a major objective of CPOE is to reduce medication errors, its introduction is a major system change that may result in unintended outcomes. Monitoring voluntarily-reported medication errors in a university setting was used to identify the impact of initial CPOE implementation on medical-surgical and intensive care units. A retrospective trend analysis was used to compare errors one year before and six months after implementation. Total error reports increased post-CPOE but the level of patient harm related to those errors decreased. Numerous modifications were made to the system and the implementation process. The study supports the notion that CPOE configuration and implementation influences the risk of medication errors. Implementation teams should incorporate monitoring medication errors into project plans and expect to make ongoing changes to continually support the design of a safer care delivery environment.

Diffusion of Innovation↗

PubMed2006

The clinical information system implementation evaluation scale.

Measurement instruments to assess user satisfaction with Clinical Information Systems (CIS) and with the implementation of CIS are needed as part of multi-faceted evaluation of CIS. Seven years of experience in developing measurement instruments to assess staff satisfaction with CIS preceded the development effort that created the Clinical Information System Evaluation Scale (CISIES). The scale was developed using precursors of the CISIES and it was guided by an expert panel. Following its construction the 37-item measurement instrument was piloted as part of the assessment of a Critical Care Clinical Information System implementation at a medical center in Florida, USA. Results indicated satisfaction with the implementation, although not strong, at the time of administration. The results of the CISIES administration were used by informaticians at the research site to plan and execute an intervention to improve satisfaction with the implementation. Re-administration of the CISIES at the site to evaluate the success of this intervention is planned. The CISIES was found to be a useful instrument, easy to administer, acceptable to respondents, easy to score and understandable by non-researcher at the study site. Early indications are that it will be useful in the formative and summative evaluation of CIS implementations.

Adult↗

PubMed2007

Implementation and evaluation of the MSc course in health informatics in Greece.

OBJECTIVES: Health informatics is a well established and important multi-disciplinary and inter-disciplinary field that not only involves informatics but also medicine, nursing, engineering, biology and other-related subjects. The program has been organized on the basis of an inter-university approach with the participation of five Greek universities. The paper aims at providing a current description of the academic program and a preliminary evaluation of the implementation phase. METHODS: The paper presents a case study of a curriculum implementation from the phase of curriculum development to the phase of implementation and evaluation. Due to the interdisciplinary character of the course appropriate procedures were undertaken to ensure that mixed backgrounds can assimilate the broad spectrum of the teaching material taught. In the first stages of the implementation international students mainly from Europe attended the course. In addition, local graduates provided an extra dimension to the multi-layered difficulties and challenges of such a course implementation. RESULTS: The students registered in the course were from different backgrounds and disciplines. They were mainly from health sciences and engineering schools. The interdisciplinary arrangement of the course facilitated the proper exchange of thoughts, skills, and knowledge among and between students and teachers. CONCLUSIONS: The postgraduate course in health informatics at the University of Athens has now been running for more than fifteen consecutive years and is one of the first and longest standing courses in Europe. Continuous evaluation and adaptation is required to fit within the changing and evolving amazing field of biomedical and health informatics.

Computational Biology↗

PubMed1991

Implementation issues in drug abuse prevention research.

This chapter reviews methodological issues in evaluating the quality of implementation of drug abuse prevention programs. Issues of definition (adherence, exposure, reinvention), measurement (self-report, other's report, behavioral observation), and parameters of influence (person, situation, environment) are addressed. Implementation results of recent drug prevention and health promotion studies are reviewed as they relate to these issues. A general model is then proposed that represents implementation as a multiply determined process involving the interaction of person, situation, and environmental influences. Using this model, several recommendations are offered for estimating the "true" drug abuse prevention program effect as the average of effect estimates generated from experimental program assignment and level of program implementation. Potential differences between researcher and programmer standards of quality or level of implementation are noted, using the common interpretation of the efficacy/effectiveness research trial continuum as an example.

Humans↗

PubMed1987

Implementation of nursing diagnoses through integration with quality assurance.

Implementation of nursing diagnosis is both a challenging and frustrating procedure. Guidelines and published experiences are limited. Efforts of one hospital to implement nursing diagnosis demonstrated the value of using quality assurance techniques to monitor the effectiveness of the implementation. Implementation of nursing diagnosis without consideration of intervention and outcome criteria results in trial and error practice. Monitoring the quality and appropriateness of care using standards and criteria for nursing diagnosis leads to new knowledge and insights. The nursing profession now faces the test of managing and disseminating the information that comes from the implementation of nursing diagnosis.

Accidental Falls↗

PubMed1985

Implementation and cost analysis of a syringe pump system for intermittent i.v. drug delivery.

Implementation of a syringe pump system for delivery of intermittent i.v. drug doses in a 452-bed teaching hospital is described; the system was evaluated for cost effectiveness one year after implementation. Drugs to be administered by syringe pump were diluted to concentrations recommended for i.v. push administration and then administered over 22-30 minutes. For batch preparation of more than 100 syringe doses, an automated dispensing pump was used. Before the syringe pump system was implemented hospitalwide, costs were predicted on the basis of data from the pharmacy's computerized i.v. administration records. In the first year after hospitalwide implementation of the system, 4687 patients received 113,898 doses of intermittent i.v. medications by syringe pump; this represented approximately 73% of all intermittent i.v. doses. The remaining doses were dispensed in minibags, and no substantial problems resulted from concurrent use of both systems. Based on current contract prices, use of the syringe pump system resulted in savings of more than +79,000 during the first year. Implementation of a syringe pump system for administration of most intermittent i.v. medications resulted in substantial cost savings.

Anti-Bacterial Agents↗

PubMed1984

Consultant evaluation of a hospital medication system: implementation and evaluation of the new system.

The effects of consultant-recommended modifications in a hospital medication system on medication-error rates and response times were evaluated. Fourteen recommendations for improving the medication system in a large teaching hospital were implemented to varying extents over a period of 1.5 years. The response times and medication-error rates of the newly implemented system were then measured using pharmacist-observers as was done in the old medication system. Medication-error rates were then compared on one medical-nursing unit and two surgical-nursing units both before and after implementation of the new system on the medical unit alone. Response times for routine medication orders decreased by 55% compared with the previous system; for "now" and "stat" orders, response times were reduced by 57% for orders filled from the central pharmacy and by 70% for orders filled from medication carts on the nursing units. No significant differences in medication-error rates were found when the old and new medication systems were compared. This finding was attributed primarily to the hospital's failure to implement recommendations related to computer printing and sorting of orders, use of dispensing envelopes for delivering medications in true unit dose form, and packaging of all medications in unit dose form. This study illustrates how the benefits of a unit dose system can be compromised in implementation and the need for close monitoring to ensure that performance standards are maintained.

Consultants↗

PubMed1995

Ribavirin therapy: implementation of hospital guidelines and effect on usage and cost of therapy.

OBJECTIVE: The American Academy of Pediatrics (AAP) recommends that ribavirin be reserved for infants who are severely ill and who are at high risk of morbidity and mortality, based on underlying clinical conditions. The purpose of this study was to evaluate current ribavirin use in our institution, implement hospital-specific guidelines for use, develop a prospective surveillance system to monitor ribavirin therapy, and evaluate the impact of these guidelines on subsequent use and cost of therapy. METHODS: Ribavirin use was compared with the recommendations of the AAP. Results were presented to the professional staff, and hospital guidelines were implemented. Ribavirin therapy was reevaluated in a 2-year period after hospital guidelines were implemented. RESULTS: In the initial evaluation period, only 67% of the ribavirin recipients met the AAP guidelines for use, and 19% received an inappropriate treatment regimen. The total cost and billed patient charges for ribavirin recipients who did not meet the guidelines for use in period 1 was $60,638 and $127,940, respectively. Over the next 2 years (period 2) after the implementation of hospital guidelines, the percentage of patients who received ribavirin decreased 35%, and approximately 96% of ribavirin recipients met the established criteria. Based on the decrease in the percentage of patients who received ribavirin in period 2 (41% versus 63%), the estimated cost avoidance and reduction in billed patient charges in period 2 was $55,540 and $117,334, respectively. This represents an estimated reduction in hospital costs and billed patient charges of $46,283 and $97,778 per 100 admissions for acute bronchiolitis. CONCLUSIONS: Before the implementation of hospital guidelines for use, a substantial percent of patients received ribavirin not consistent with the recommendations of the AAP. Following the adoption of a modified version of the AAP guidelines for our institution and the use of a multidisciplinary surveillance system for monitoring ribavirin therapy, we observed a substantial decrease in the overall ribavirin use. This has resulted in a significant savings in terms of cost avoidance and reduced billed patient charges.

Drug Costs↗

PubMed1995

Clinical guidelines: their implementation in general practice.

In recent years the development of clinical guidelines has received increasing attention from medical educators and those involved in standard setting, and has been initiated at both central and local levels. This review article outlines the current state of knowledge with regard to clinical guideline implementation in medical practice. It deals with the main aspects of the current guideline debate, such as, clinical freedom and doctor autonomy, the importance of ownership in guideline implementation, the effectiveness of guidelines in changing practice and, in particular, the strategies needed to implement clinical guidelines in general practice. Mechanisms of behavioural change that have been recognized as being important for implementation are also discussed. If implementation strategies are not treated as an integral part of the development process then clinical guidelines may fail to achieve their potential in changing clinical practice.

Family Practice↗

PubMed1995

The cost of implementation of the Clinical Laboratory Improvement Amendments of 1988--the example of pediatric office-based cholesterol screening.

OBJECTIVE: To measure the additional costs of office-based laboratory testing due to the implementation of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88), using cholesterol screening for children as an example. METHODS: Four- to ten-year-old children who received their well child care at one of seven participating pediatric practices were screened for hypercholesterolemia. The average number of analyses per day and days per month were derived from the volume of testing completed by the practices. Nurses and technicians time in the screening process were measured and personnel costs were calculated based on salary and fringe benefit rates. Costs of supplies, analyzing control samples, instrument calibration, and instrument depreciation were included. Costs estimates of screening were then completed. CLIA '88 implementation costs were derived from appropriate proficiency testing and laboratory inspection programs. RESULTS: In six practices completing a low volume of testing, 2807 children (5 to 6 children per week) were screened during the observation period, while 414 (about 25 children per week) were screened in one high-volume practice implementing universal screening over a 4-month period. For the six low-volume practices, the cost of screening was $10.60 per child. This decreased to $5.47 for the high-volume practice. Estimated costs of CLIA '88 implementation, including additional proficiency testing and laboratory inspection, added $3.20 per test for the low-volume practices, and $0.71 per test for the high-volume testing. CONCLUSIONS: Implementation of CLIA adds significantly to the cost of office-based chemistry laboratory screening. Despite these additional expenses, the cost of testing is still within a reasonable charge for laboratory testing, and is highly sensitive to the volume of tests completed.

Calibration↗

PubMed1994

An evaluation of the implementation and the effectiveness of two treatment and organizational strategies in the rehabilitation of long-term psychiatric outpatients.

Mental illness usually needs long-term treatment and rehabilitation. Since de-institutionalisation of psychiatric patients in the 1970s, most of this treatment and rehabilitation has needed to be done in the community through psychiatric clinics. It therefore is important to establish which rehabilitation strategies can be implemented in the South African services, and how effective they are. This study reports on two strategies which were implemented in the service to Black patients in psycho-education groups, and skills teaching. The implementation of the strategies was evaluated by looking at feasibility and effort, and their effectiveness was assessed by measuring functional status, symptom improvement and duration and frequency of hospitalisation. It was found that both strategies could be implemented although there were specific problems. These related to the physical facilities in the clinics, the lack of adequate training of nurses in these techniques, and the inadequacy of community resources. The psycho-educational groups were found to have no influence on either functional status or symptoms, but this might be related to difficulties in the research design. None of the patients were hospitalised from the time the study started so hospitalisation could not be used as a pre-and-post-test. Skills teaching was found to influence functional status positively. Although a positive influence on symptoms was also shown, this may have been due to rater un-reliability. The results of this study show that psychiatric community clinics should be reorganised to include psycho-social rehabilitation strategies. These strategies generally are effective and can be implemented if there is a rehabilitation philosophy in the service.

Adolescent↗