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Results for “Implementation challenges”

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At least 433 records · Page 24Linked to original sources

PubMed1995

Community mental health care for former hospital in-patients. Predicting costs from needs and diagnoses.

BACKGROUND: In the UK the replacement of long-term in-patient care with community-based support has been part of central government health policy for many years. One of the challenges of implementing such a policy is the prediction of support and service needs in the community and the associated costs. METHOD: Using research data from north London analyses were undertaken to examine the associations between service use and costs in the community and the characteristics of hospital in-patients. RESULTS: Although clinical diagnosis was not a useful predictor of either service utilisation or costs, more than a third of the variation in community care costs could be explained by symptoms, behaviour and personal characteristics at least one year earlier.

Adult↗

PubMedDate not supplied

Building TQM into nursing management.

Total quality management (TQM) is a management philosophy that addresses problems currently faced by health care, specifically reducing costs while improving quality of services. As hospital administrators embrace this new management style, nurse executives and managers will be challenged to implement TQM. Building TQM into nursing management will improve quality and reduce costs while meeting the needs of health care customers.

Health Care Costs↗

PubMed1996

Psychoneuroimmunology and innovative behavioral interventions in patients with leukemia.

PURPOSE/OBJECTIVES: To review current research examining the effects of behavioral interventions on reducing symptom distress and improving quality of life in patients with cancer and to explore the application of behavioral interventions to patients with leukemia who are immunosuppressed by the disease or its treatment. DATA SOURCES: Published books, journal articles, and personal experiences. DATA SYNTHESIS: Interventions such as relaxation training, guided imagery, attentional/cognitive distraction, and therapeutic touch have been found to reduce pain, anxiety, and chemotherapy-related side effects, to elicit the relaxation response, and to improve several aspects of immune function in patients with cancer. CONCLUSIONS: A multicomponent, long-term program of behavioral interventions may provide the greatest and most lasting benefit, but it may be very challenging to implement. However, simple relaxation techniques are not difficult to learn, are not particularly time-consuming or costly to practice, and can be used anywhere. IMPLICATIONS FOR NURSING PRACTICE: Nurses in virtually any setting easily can incorporate behavioral modalities into their practices and help patients with leukemia to reduce their physiologic arousal and symptom distress. Nursing research examining the effects of behavioral interventions on immunocompetence and cancer pain in patients with leukemia is needed.

Arousal↗

PubMedDate not supplied

[Coding, nomenclatures, PMSI, medical records, cards with microprocessors: what coherence?].

Computerization of information on health care delivery is being implemented in France. Within hospitals, the PMSI program aimed at coding and storing medical information on patients and their treatment has started. More recently was launched a program for computerizing outpatient care (coding and storing information on medical acts, pathologies and prescriptions). Patient individual cards with microprocessor have been implemented. The challenge ahead is how to coordinate all these processes to make them compatible, and coherent and to avoid wasteful disorders.

Delivery of Health Care↗

PubMedDate not supplied

Nutrition strategies for adolescents with insulin-dependent diabetes mellitus.

Optimal metabolic control is a primary management objective for adolescents with insulin-dependent diabetes mellitus. Nutrition therapy plays an important role in meeting this challenging treatment goal. This article presents broad nutrition goals, makes macronutrient recommendations, and describes their effect on blood glucose levels. Various meal-planning techniques and other developmentally appropriate approaches to assist adolescents in meeting these nutrition objectives are described. Finally, challenges in implementing nutrition therapy in an adolescent population are discussed.

Adolescent↗

PubMed1997

Clinical chemistry in laboratory medicine in Europe--past, present and future challenges.

European experts in clinical laboratory sciences have different backgrounds, and development of expertise in this field started more than 100 years ago. Specific national activities have created the heterogeneity that now exists amongst the academic professional membership of more than 40 scientific societies in Europe. The recent political changes have in addition contributed to the rapidly changing profile of Clinical Chemistry and related fields. Based on a questionnaire answered by 31 national representatives, the past, present and future aspects of the European Clinical Laboratory are reviewed. Of the more than 30,000 members of national societies, the majority studied medicine (40.1%), chemistry (27.2%) and pharmacy (21.1%) with large national differences in relative percentages. Post-graduate education is provided by two thirds of the national societies. In most European countries the same experts cover not only clinical chemistry but also haematology, haemostaseology, immunology and transfusiology. National quality assurance programmes are said to be established in 25 countries, but mandatory in only 11 of them. Of the future challenges, the implementation of request strategies were named most often, with interpretative reports and preanalytical aspects estimated as similarly important. It was thought that information technology and new scientific developments would make the greatest impact in the coming years, with economic pressure being the major limiting factor. Despite these limitations an increase in the number of tests is anticipated by most representatives, supporting the assumption of an increasing role of the clinical laboratory in future clinical medicine.

Chemistry, Clinical↗

PubMedDate not supplied

What happens now? Oregon and physician-assisted suicide.

With assisted suicide now legally sanctioned, health care professionals in Oregon face the challenge of implementing Oregon's Death with Dignity Act. Physicians, hospice professionals, pharmacists, and other caregivers may find their relationships with patients, families, and fellow professionals changing in unanticipated ways as all learn what it means to make aid in dying openly and compassionately available to patients at the end of life.

Aged↗

PubMed2002

Implementation of colorectal cancer screening: the challenge.

Colorectal cancer is the second leading cause of cancer death among men and women in the United States, and its incidence is increasing in other developed countries throughout the world. Efficacious and cost-effectiveness screening measures exist for colorectal cancer, but successful implementation at a community level remains challenging. This article is a summary of recently published information on cost-effectiveness of colorectal screening, attempts to enhance acceptance and compliance by physicians and the public, and legislative efforts to ensure access to screening.

Journal Article↗

PubMed1998

Convincing cases: important component of user acceptance.

This paper is presenting the rational that lead to the organisation of the European workshop on Acceptance of Telematics Applications by Healthcare Professionals "Looking for the convincing cases," that took place in Thesaloniki 12-13 December, 1997. A brief overview is presented of the health telematics sector, the current situation of the usage of some applications, and major challenges towards wide implementation of health telematics applications. It focuses on user acceptance as one of the critical challenges towards wider implementation. It concludes that the support and promotion "Convincing cases" are important components contributing to user acceptance.

Attitude of Health Personnel↗

PubMedDate not supplied

Putting prevention into practice.

One of the three broad goals of Healthy People 2000 is that preventive services will be available to all Americans. Although there is professional agreement on the merits of prevention, there are challenges related to implementing preventive health care. Six of these challenges are confusion in terminology, issues related to nursing autonomy and initiative, differing conceptual frameworks, complexity of coordination within a delivery system that does not reward preventive services, prevalent cultural beliefs, and lack of uniform recommendations regarding prevention. The Put Prevention into Practice (PPIP) program is a national strategy to address those challenges. The American Nurses Association and the American Academy of Nurse Practitioners contributed to the development of the PPIP program. These organizations are actively disseminating the information through train-the-trainer methodology and other educational programs that will prepare nurses to improve the health of the population through the provision of preventive health services.

American Nurses' Association↗

PubMed2006

Malaria vector control and personal protection.

Malaria transmission rates and risks can be greatly reduced by vector control, mitigating high malaria incidence and prevalence rates. Methods and strategies for malaria vector control (MVC) have been well documented by WHO, although its implementation varies widely. Technical guidelines for MVC strategies and materials are readily available, but the status and role of MVC have not been reviewed and redefined in terms of programme management and resource allocation. There are huge changes since November 1993 when the last WHO Study Group reviewed vector control for malaria and other mosquito-borne diseases, following the 1992 adoption of the Global Malaria Control Strategy. Operationally, with reform of the health sector in many countries, the centrally managed and vertically structured malaria control programme (MCP) has been superseded by a community-based and decentralized one. This poses challenges for effective implementation of MVC strategies. Therefore it became evident that the role of vector control in malaria control needs to be reconsidered to develop a strategic framework for MVC implementation by national malaria control programmes and other partners. This report of a WHO Study Group on Malaria Vector Control and Personal Protection reviewed the current vector control strategies and their effectiveness in various operational and eco-epidemiological settings, and identified challenges for implementation in different health systems. An outline strategic framework for strengthening malaria vector control implementation was developed. The process of deciding about which mosquito control method is appropriate in a given situation should be guided by an analysis of the level of malaria endemicity and vector bionomics, the eco-epidemiological setting, the health management system and an estimate of the programme sustainability. This report also provides a basis for the development of a strategic framework for strengthening malaria vector control implementation.

Animals↗

PubMed2001

Implementation of guidelines in primary health care. A challenge for the municipal health centres in Finland.

OBJECTIVE: To assess the implementation of guidelines in Finnish primary health care units. DESIGN: A semi-quantitative analysis of a cross-sectional interview survey. SETTING: All municipal health centres in a selected region in Finland. SUBJECTS: Head physicians and head nurses of the 31 participating units. MAIN OUTCOME MEASURES: Number of guidelines adopted; methods used in the implementation; and the unit's estimated purposefulness in the implementation of guidelines. RESULTS: All health centres had adopted at least one guideline in the defined task areas, but only one-third of the units had implemented several guidelines. The implementation methods utilised were usually directive and passive rather than co-operative and problem-solving. Half of the units used training and methods involving active participation of the personnel, and in one-third a multiprofessional approach was applied. Clients' representatives were hardly ever involved in the adaptation of guidelines. A quarter of the health centres were assessed as purposeful in their policy to implement guidelines, the large units being more goal-oriented than the smaller ones. CONCLUSIONS: A minority of health centres are goal-oriented in the adoption of guidelines and use versatile methods to support the implementation; this presents an important managerial challenge for national health care development in Finland.

Cross-Sectional Studies↗

PubMed2006

[Prevention of type 2 diabetes in Germany. Ideas, evidence, implementation].

One of the challenges in clinical diabetology today is to develop and implement diabetes prevention management programs for clinical practice. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise, as well as pharmacological preventive strategies reduce the risk of progressing from impaired glucose tolerance to diabetes. With respect to the worldwide burden of diabetes, these studies offer a compelling evidence base for the important translation of the research findings into community-based prevention strategies and the development of a national diabetes prevention program. The work group "diabetes prevention" of the German Diabetes Association together with the National Action Forum Diabetes and the German Diabetes Foundation developed a concept for a national program. This comprises a three-step intervention: in a first step individuals at high risk of developing type 2 diabetes are identified. The second step provides an intensive group intervention to prevent diabetes, and in a third step continuous intervention should facilitate motivation maintenance and evaluation. This third step is the crucial step to maintain the effect in changing lifestyle. Recently, a compendium for diabetes prevention was developed as a practical guideline explaining how to implement prevention programs. This guideline also includes the structure of a national prevention program with a prevention manager having a central role in the concept and suggestions for evaluation and quality control.

Cross-Sectional Studies↗

PubMed1999

Strategies in disability management. Corporate disability management programs implemented at the work site.

Managers are challenged to demonstrate all programs as economically essential to the business, generating an appreciable return on investment. Further challenge exists to blend and integrate clinical and business objectives in program development. Disability management programs must be viewed as economically essential to the financial success of the business to assure management support for clinical interventions and return-to-work strategies essential for a successful program. This paper discusses a disability management program integrating clinical and business goals and objectives in return-to-work strategies to effect positive clinical, social-cultural, and business results. Clinical, educational, social, and economic challenges in the development, implementation, and continued management of a disability program at a large corporation with multiple global work sites are defined. Continued discussion addresses the effective clinical interventions and educational strategies utilized successfully within the workplace environment in response to each defined challenge. A multiple disciplinary team approach, clinical and business outcome measures, and quality assurance indicators are discussed as major program components. This article discusses a successful program approach focusing on business process and methodology. These parameters are used to link resources to strategy, developing a product for implementing and managing a program demonstrating economic value added through effective clinical medical case management.

Accidents, Occupational↗

PubMed2006

Opioid contracts in chronic nonmalignant pain management: objectives and uncertainties.

In this article, we review the principal objectives and ideal elements of opioid contracts, as articulated by proponents of the practice. We examine the limited empirical evidence for the effectiveness of opioid contracts in achieving their intended objectives and identify areas of uncertainty and of ethical concern regarding their implementation. We argue that the challenge in deciding about implementing opioid contracts in clinical practice relates to the multiplicity of potential objectives they might serve, to a lack of empirical evidence regarding their effectiveness, and to ethical concerns over their implementation. Specialty and primary care clinicians contemplating the use of opioid contracts in treating patients with chronic nonmalignant pain need to be sensitive to these considerations, and further debate and research is necessary to establish the proper objectives, elements, effectiveness, and ethical justifications of opioid contracts in clinical practice.

Analgesics, Opioid↗

PubMed2004

Design and implementation of software for assembly and browsing of 3D brain atlases.

Visualization software for three dimensional digital brain atlases present many challenges in design and implementation. These challenges include the design of an effective human interface, management of large data sets, display speed when slicing the data set for viewing/browsing, and the display of delineated volumes of interest (VOI). We present a software design, implementation and storage architecture that addresses these issues, allowing the user to navigate through a reconstructed volume quickly and smoothly, with an easy-to-use human interface. The software (macostat, for use with Macintosh OS) allows the user to rapidly display slices of the digital atlas at any arbitrary slicing angle, complete with delineated VOIs. The VOIs can be assigned colors of the user's choosing. The entire atlas, or selected portions, may be resliced with slices stored as individual image files, complete with delineations. These delineations may be transferred to corresponding sections of experimental materials using our analysis program (brain). The software may be obtained from the laboratory's web site: http://www.neuroterrain.org

Brain↗

PubMed2006

Challenges associated with privacy in health care industry: implementation of HIPAA and the security rules.

This paper discusses the challenges associated with privacy in health care in the electronic information age based on the Health Insurance Portability and Accountability Act (HIPAA) and the Security Rules. We examine the storing and transmission of sensitive patient data in the modem health care system and discuss current security practices that health care providers institute to comply with HIPAA Security Rule regulations. Based on our research results, we address current outstanding issues that act as impediments to the successful implementation of security measures and conclude the discussion and offer possible avenues of future research.

Computer Security↗

PubMed1997

Implementation of a patient charting system: challenges encountered and tactics adopted in a burn center.

The rapid movement of information technologies into health care organizations has raised managerial concern regarding the capability of today's institutions to satisfactorily manage their introduction. Indeed, several health care institutions have consumed huge amounts of money and frustrated countless people in wasted information systems implementation efforts. Unfortunately, there are no easy answers as to why so many health informatics projects are not more successful. In this light, the aim of this study is to provide a deeper understanding of how clinical information systems are being implemented by emphasizing research efforts on the dynamic nature of the process, that is, the "how" and "why" of what happened. Using a case study methodology, we examined the implementation of a patient charting system in the Burn Center of a large, not-for-profit, teaching hospital. Based on an in-depth examination of this implementation, several insights are offered to those who have responsibility for managing complex and risky clinical information system implementation projects.

Burn Units↗