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Results for “Implementation challenges”

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.

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At least 613 records · Page 34Linked to original sources

PubMed2001

Health benefit vouchers: all talk and no action?

This article discusses the voucher--also called defined contribution--health care benefits model in terms of its features, the impetus for its development, obstacles to its implementation and the challenges it creates for employers. Although employers appear to have little current interest in health benefit vouchers, the author argues that a serious economic downturn could renew employers' interest in this promising concept.

Community Participation↗

PubMedDate not supplied

Efficacy, safety, and patient preference of inhaled nasal corticosteroids: a review of pertinent published data.

Most clinical studies of inhaled nasal corticosteroids have established comparable safety and efficacy; therefore, there remains little to distinguish the various products from each other in the treatment of allergic rhinitis. However, patient preference is recognized increasingly as an important factor in selecting appropriate treatment. This review discusses the different methodologies that have been used to measure patient preference for intranasal corticosteroids. Patient questionnaires and other instruments for assessment that are used to measure such preferences are discussed as well as several different study designs. Now, the challenge is to implement more studies that show the reliability and consistency of instruments used to assess patient preference.

Administration, Inhalation↗

PubMedDate not supplied

What do you think? Are you a genius?

How much of your day is absorbed with solving problems, implementing changes, overcoming challenges, and finding new ways to do more with less? The majority of each day? If this sounds like you, then read on. Below are instructions for you to become a genius by learning to use your brain better.

Administrative Personnel↗

PubMed1995

Aging in the United Kingdom: a review of demographic trends, recent policy developments and care provision.

"Although the U.K.'s population is not predicted to grow very much in the future, the population structure is changing and there is a shift towards a much older age distribution. The characteristics of demographic aging in the U.K. include a marked reduction in fertility rates, increasing rates of life expectation at birth..., increasing dependency ratios and variations in mortality and social class in old age. The U.K.'s demographic context has important implications for aged care policy and planning. This paper documents the demographic trends, reviews recent major policy changes and their impact on care provision, and discusses some of the emerging implementation issues that challenge the potential of such policies to meet the needs of an aging population."

Age Distribution↗

PubMed2003

An adaptable, transportable web-based data acquisition platform for clinical and survey-based research.

Given the need for multicenter clinical trials to support evidence-based treatments, the authors hypothesized that the process of gathering large amounts of data from disparate clinical sites could be facilitated through direct input of clinical and survey data through a Web interface. A series of data collection instruments was created and published as Web pages to support a clinical study performed at Des Moines University Osteopathic Medical Center. The most challenging tool to implement was the visual analog scale, which required special programming. Specific Web pages allowed research study participants to input their own data, while other Web pages were restricted to use by the investigator for inputting clinical and laboratory observations. Data from these sources were automatically combined in a single spreadsheet by the Web administrator in a manner that maintained the confidentiality of participants. Subsequently, the system was tested from a remote site (Chicago), and data were captured at Des Moines University Osteopathic Medical Center. This test involved a variety of data including the visual analog scale. Although this system provided a facile method for collecting and analyzing a large amount of data in almost real time, with a demonstrable savings of time and money, the authors believe the more important use for this data collection system is in large multicenter clinical trials. Hence, the authors commend its use for support of large outcomes studies for osteopathic researchers engaged in interinstitutional efficacy studies.

Data Collection↗

PubMed2003

Finding and interpreting cancer screening guidelines: an oncology nursing challenge.

It is our hope that increased awareness of cancer screening recommendations will initiate a dialogue between individuals and their health care providers. Organizational screening recommendations differ as a result of evolving technology, financial and ethical considerations, and impact on mortality. It is through discussions with informed health care providers that patients and families will determine the most effective personal cancer screening strategies. We are hopeful that this discussion of cancer screening recommendations will encourage other oncology nurses to identify their provincial screening guidelines and to address them in discussions with people living with cancer, family members, community groups, and friendship circles. For those cancers where early detection correlates with improved survival, regular screening may have a direct impact on individual lives. We challenge you to implement strategies to incorporate cancer screening information in your professional and personal relationships.

Breast Neoplasms↗

PubMed2004

The report of the Blue Ribbon Task Force: challenges and opportunities.

The BRTF report can serve as a catalyst for change in health services management and accreditation. Many of their recommendations should be widely endorsed by our professional community; others demand careful consideration and will promote a useful dialog. There are a good many challenges involved with implementing these changes, and they will require time, creativity and a great deal of hard work. Only time will tell if history affords the Blue Ribbon Task Force's Report the same stature as the Prall, Olsen, and Dixon reports. Other position papers will no doubt follow that extend as well as refute its recommendations. The real value of this report will be in the dialog and change process it promotes.

Accreditation↗

PubMed2004

Evidence-based medicine in managed care: a survey of current and emerging strategies.

BACKGROUND: Evidence-based medicine is the "conscientious application of scientific best practice by clinicians in concert with patient understanding and values." Recent studies by the Institute of Medicine, RAND, and others have called attention to the gap between scientifically supported approaches to care and day-to-day practice by clinicians. Compounding the problem of non-adherence by providers, researchers have observed that patient compliance also falls short. As a result, avoidable costs from inappropriate variability in practice patterns coupled with patient noncompliance are a significant focus of managed care. Managed care plans play a key role in the selection of providers by consumers and in the design of benefits programs by employers. Avoidable costs from misuse, overuse, and under-use of care from clinicians is a strategic focus for health plans. The evidence upon which a plan makes coverage decisions and the incorporation of evidence in programs targeting providers, employers, and consumers was a focus of this study. METHODOLOGY: A Delphi survey and 2-day interactive sessions with 128 clinical program directors and medical officers from 89 health plans were the primary methods used in this descriptive analysis. To test participant applications of evidence-based medicine in health plan medical management strategy, 3 conditions were used for illustrative purpose: managing rheumatoid arthritis, increasing remission in depression, and reducing heart disease among diabetics. Each provided a unique challenge to plans in terms of condition prevalence, strength of evidence, and cost. KEY FINDINGS: Health plans incorporate evidence-based medicine in 5 areas overseen by medical management: (1) coverage decisions wherein improvements in pharmaceutical and therapeutic review processes are sought, (2) disease management efforts wherein increased attention to secondary prevention is desirable, (3) provider profiling wherein increased use of adherence measures comparing practices is a focus, (4) pay-for-performance programs linking physician adherence to financial incentives, and (5) consumer-directed care programs wherein patient compliance to evidence-based treatment directives is the focus. Factors that influence a plan's approach to a patient population include prevalence of the condition, the strength of evidence about a particular diagnostic or prognostic strategy, costs associated with the condition, and the influence of employers in coverage decisions. CONCLUSION: Evidence-based medicine is the foundation for significant activity among plans to increase physician and patient adherence. There remain significant challenges in the implementation of evidence-based care management by plans, including the willingness of plans to agree on evidence-based guidelines, the willingness of employers to pay for evidence-based interventions, the balance of short- and long-term benefits for evidence-based interventions where secondary prevention is a consideration, and substantial distrust among providers.

Data Collection↗

PubMed1989

Health maintenance.

"Health maintenance" includes screening procedures, risk assessment, early intervention, and prevention--primary, secondary, and anticipatory. Guidelines for health maintenance in some age groups are quite well established, especially for children. Although recommendations for older adults may lack complete consensus, there are many activities that are widely accepted and can be employed in every primary care physician's practice. In the words of Anne Somers: "Postponement of dependency and promotion of vitality may be the most important public health challenges of the next two decades." Primary care physicians have the greatest opportunity to meet this challenge through the implementation of specific strategies for health maintenance with patients at every stage of life.

Aged↗

PubMedDate not supplied

Use of a statewide Maternal and Child Health Information Network.

The Maternal and Child Health Information Network (MATCH) contains numerous data elements. The process of converting these data into information is an essential component of comprehensive management information system planning. This process must address not only the end-user mechanics of data retrieval, but also the framework for how data can be used in program administration. Although potential data use contributes to and may in fact drive system design, the reality of integrating computer and data usage into daily activities presents a different set of challenges in system implementation. For both state and local end-users, barriers to system use had to be addressed. In terms of directing system use, it was helpful to provide a format for categorizing data needs. The broad categories of data needs identified for program administration were planning, research, evaluation, management, and collaboration. Numerous initiatives have evolved for each of these categories.

Child↗

PubMedDate not supplied

Collaborative care: a professional model that influences job satisfaction.

At Overland Park Regional Medical Center/Columbia/HCA, Inc., the challenge was to implement a new patient care delivery model and measure the effect of this model on job satisfaction. In reviewing the literature, experts on case management/managed care noted a relationship between this form of practice model and high levels of job satisfaction. However, this relationship was not well illustrated through research studies. Analysis of this implementation plan demonstrated that managed care had a positive impact on job satisfaction.

Humans↗

PubMedDate not supplied

Making policy and procedure systems work effectively.

Policy and procedure manuals can be cumbersome to keep current and updated. One approach to meet this challenge is by implementing a decentralized system to develop, review, revise and approve policies and procedures. Mechanisms to operationalize such a system involve sharing of responsibility and accountability of specified policies and procedures by various existing committees and development of coordinating systems and support mechanisms. Other key attributes of a decentralized system included collaboration and extensive communication strategies.

Humans↗

PubMed1997

Collaborative care: improving patient outcomes in cardiovascular surgery.

Collaborative care, a multidisciplinary process to standardize and streamline care for selected case types, has gained momentum as a care delivery system in health care settings. The major goals of these programs are to improve the quality and continuity of care, while decreasing length of stay and cost. This article will describe key components, issues and challenges of developing, implementing and evaluating a collaborative care program for cardiovascular patients. The initial clinical path focused on bypass surgery, incorporating many of the aggressive bypass surgery recovery guidelines, such as short-acting anesthesia, same-day extubation and decreased laboratory blood analyses and test utilization. Issues that arose focused on patient selection, documentation, determining appropriateness for discontinuing paths and patient/family education. In regard to clinical outcomes, no significant differences were found in mortality or complication rates, such as postoperative bleeding, dysrhythmias and infection rates, between the clinical path group and a comparable group of non-path patients. Both intensive care unit (ICU) and overall hospital length of stay were concomitantly reduced. Other examples of program evaluation are also described, such as variation and patient follow-up data, to highlight quality improvement initiatives that further improve quality of care and reduce length of stay for this patient population.

Coronary Artery Bypass↗

PubMed2005

Implementing a national treatment service for dependent smokers: initial challenges and solutions.

BACKGROUND: Before 1999, few treatment services for nicotine-addicted smokers existed in England. When national treatment services were introduced, those responsible for setting them up liaised closely with primary care health services. Setting up an entirely new national service, treating a new category of patient (smokers motivated to stop) was an ambitious aim and this paper documents the problems encountered in the early stages of this process. OBJECTIVES: To describe the principal challenges encountered and solutions employed by those setting up the services during the initial period of smoking cessation service implementation. METHODS: Qualitative, semistructured interviews with 50 smoking cessation staff in two former English health regions conducted in autumn 2001. FINDINGS: Two principal factors which slowed the initial development of smoking cessation services were: (i) the lack of a work-force with experience in smoking cessation methods and (ii) the fact that services were set up outside existing primary and secondary care health services in England. As few training courses in smoking cessation were available, many services provided their own in-house training for staff appointed as smoking cessation advisers. Consequently, senior service staff devoted a lot of effort to training new staff which meant that they had less time to spend on other important tasks which were necessary for service implementation. Smoking cessation services needed to develop relationships with primary care health services in order to generate referrals and find venues for the delivery of smoking cessation interventions. Liaising with primary care physicians was time-consuming, however, and some primary care physicians were opposed to the ideas that service staff had for the interface between primary care and smoking cessation services. As new smoking cessation services were not set up within existing primary or secondary health care services, service staff had to spend large amounts of time on this process of negotiation and overcoming scepticism from some primary health care physicians. CONCLUSIONS: If smoking cessation services are set up in other countries, rapid implementation would be facilitated by ensuring that adequate numbers of health professionals trained in smoking cessation methods are available to staff services. Additionally, locating new smoking cessation services within existing health providers' services may speed up service implementation, but this option may not suit all health systems.

Humans↗

PubMed2002

Guidelines for the management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a respiratory condition characterized by progressive decline in lung function. It imposes a considerable burden on patients, healthcare services and society that is likely to increase in the future. It is, therefore, important to ensure that this disease is managed as effectively as possible. In many therapeutic areas, management guidelines have been developed in an attempt to ensure that physicians are aware of optimal disease management and cost-effective use of healthcare resources. Such guidelines are usually prepared by consensus among clinical experts or following a systematic review of the evidence. However, there are a number of barriers to the implementation of treatment guidelines, including the sheer weight of guidelines in all therapeutic areas, a focus on scientific knowledge rather than on clinical practice, lack of trust in the recommendations, practical considerations (e.g. time, resources, budget) and failure to include the perspective of patients. The management guidelines most likely to be implemented are those that are quick and easy to use, relevant to the user's practice and from a credible source. In COPD, over 40 guidelines have been developed, mainly by local respiratory societies as a result of local expert consensus. The guidelines developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) are evidence-based and have the backing of international experts. Local implementation plans have been developed to help ensure that GOLD recommendations are implemented in practice. In all COPD guidelines, however, lung function measures feature prominently with limited reference to outcome measures of interest to patients and healthcare payers (e.g. frequency of exacerbations requiring hospitalization). Low expectations among physicians and patients may also impair implementation. In conclusion, guidelines may improve the management of COPD, but the main challenge is to ensure implementation.

Communication↗

PubMed2001

An evaluative study of the effects of the implementation of UBSG on nurses' perceptions of professional governance.

Health care reform has been a major economic and political challenge in Taiwan. Successful implementation of change in hospitals requires managers to learn new skills. Unit-based shared governance (UBSG) is one innovation used to restructure health care organizations to promote the performance of professionals and to achieve goals for organizations. This research, conducted in a 150-bed community hospital, was a quasi-experimental study designed to evaluate the effectiveness of implementing UBSG. This article describes and compares the degree of nurses' perceptions of professional governance between a UBSG group (n = 29) and a control group (n = 24). The findings of this study indicate that the majority of UBSG respondents scored at a high level of participation in decision-making and professional practice (p < .05). Nurses in the UBSG group shared more in professional governance activities (p < .05). It is suggested that decentralized UBSG within a division of nursing can empower nurses. The study provides an empirical basis for implementing UBSG.

Adult↗

PubMedDate not supplied

Effects of the purchaser/provider split on research implementation.

The issues surrounding the use of research to inform practice and the potential problems involved in this process have been the subject of debate within nursing for many years. The purchaser/provider relationship has led to an increase in the number of challenges nursing encounters regarding the implementation of research. These challenges and relationships, which will either promote or prevent the implementation of research in nursing practice, are explored using Nolan and Grant's (1993) framework. The analysis concludes that implementation of nursing research needs to be part of the contracting process involving shared dialogue between purchasers and providers. Discussions on clinical effectiveness need to include nursing evidence as part of the health-care contracting process. Professionals involved in contracting require equal knowledge about research and joint professional values in order to support its implementation within contracting appropriately.

Contract Services↗

PubMed2005

The role of research in international tobacco control.

The future of the tobacco-produced disease epidemic rests in low- and middle-income countries, where cigarette sales are growing-the result of rising incomes, trade liberalization, liberalization of the treatment of women, and the introduction of Western-style advertising. Research on disease causation, epidemiology, and educational and policy interventions has contributed significantly to reducing smoking rates in developed countries. A similar contribution is needed in less affluent nations, but severe challenges are involved in implementing a robust research program in such countries. In an attempt to understand these challenges and begin to conceptualize an approach to overcoming them, I examine the need for and methods to achieve a program of meaningful research on tobacco and health, as well as health policy, in the developing world.

Biomedical Research↗