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 739 records · Page 41Linked to original sources

PubMed2001

[Integrating non-university institutions into clinical research. The example of implementing the concept of quality of life into regional management of cancer patients].

Implementation is the stepwise introduction of a concept with the goal to change the behaviour of health care providers. The concept of quality of life (QL) was implemented in order to improve the regional care for cancer patients. The following steps were taken: creating a quality circle, teaching the concept QL, listing QL-enhancing therapy options, graphically presenting individual patients in the form of QL-profiles. In the course of an implementation study QL-profiles of individual patients were sent to their respective practitioners. Doctors judged these profiles as comprehensible (100%) and informative (55%). QL-profiles influenced doctor-patient communication (42%), but had no impact on therapeutic decisions (0%). Acceptance of QL-profiles was higher in doctors treating breast cancer patients (67% response rate) than in doctors treating rectal cancer patients (25%). Reasons for this difference as well as driving and restraining forces for implementing the QL-concept were analysed through a barrier analysis.

Academies and Institutes↗

PubMed2001

Measuring the success of electronic medical record implementation using electronic and survey data.

Computerization of physician practices is increasing. Stakeholders are demanding demonstrated value for their Electronic Medical Record (EMR) implementations. We developed survey tools to measure medical office processes, including administrative and physician tasks pre- and post-EMR implementation. We included variables that were expected to improve with EMR implementation and those that were not expected to improve, as controls. We measured the same processes pre-EMR, at six months and 18 months post-EMR. Time required for most administrative tasks decreased within six months of EMR implementation. Staff time spent on charting increased with time, in keeping with our anecdotal observations that nurses were given more responsibility for charting in many offices. Physician time to chart increased initially by 50%, but went down to original levels by 18 months. However, this may be due to the drop-out of those physicians who had a difficult time charting electronically.

Attitude of Health Personnel↗

PubMed2002

Influence of implementation parameters on registration of MR and SPECT brain images by maximization of mutual information.

UNLABELLED: Mutual-information maximization is one of the most popular algorithms for automatic image registration. However, many implementation issues have not been evaluated in a single, coherent context. METHODS: Twenty-one registrations between MR and SPECT brain images (8 patients) were achieved by mutual-information maximization with different implementation strategies. The results of a popular strategy were chosen as the standard. All other results were compared with the standard, and the statistics of misregistrations were computed. The registration speed, accuracy, precision, and success rate were assessed. RESULTS: Compared with trilinear interpolation, nearest-neighbor interpolation slightly sped the registration process, but with a lower success rate. The number of bins used to estimate the probability density function (pdf) affects the speed and robustness. Using fewer bins yielded a less robust registration. Adaptively changing the number of bins increased the registration speed and robustness. Simplex optimization increased the registration speed considerably, with a slightly degraded success rate. Simplex optimization with adaptive bin strategy improved the success rate and further decreased the registration time. Multiresolution optimization yielded a better success rate, with little effect on the accuracy and precision of registration. An increase in the number of resolution levels increased the success rate. Multisampling optimization also improved the success rate, but the results were less accurate and precise than those obtained with multiresolution optimization, with an increase in the number of levels decreasing the performance. Segmentation affected the registration speed and success rate. Because segmentation is problem specific, the effects were not conclusive. CONCLUSION: Different implementation strategies considerably affect the performance of automatic image registration by mutual-information maximization. On the basis of the experimental findings, we suggest that the best implementation strategy would include trilinear interpolation, adaptive change of the number of bins when estimating pdf, and exploitation of a simplex optimization algorithm with a multiresolution scheme.

Adult↗

PubMed2002

Attaining personal goals: self-concordance plus implementation intentions equals success.

The present article includes separate meta-analyses showing that self-concordance and implementation intentions are significantly positively associated with goal progress. Study 1 confirmed the positive relations of both self-concordance and implementation intentions to weekend goal progress. Study 2 confirmed the positive relation of self-concordance with monthly progress on New Year's resolutions but failed to find a direct benefit for implementation intentions. Both studies, however, obtained a significant interaction effect indicating that goal self-concordance and implementation intentions combined synergistically to facilitate goal progress. The article also reports a meta-analysis and results from the 2 studies that demonstrated that goal progress was associated with improved affect over time.

Achievement↗

PubMed2002

Radata - implementation of resistance analysis and expert advice for optimized HAART switches in general practice of HIV-infected individuals via a compiling internet presence.

BACKGROUND: HIV-infected patients fail viral load suppression, because resistance against antiretroviral drugs arises or for other reasons. HIV-resistance analyses can aid to achieve effective HAART regimen. Furthermore, clinical benefits from genotyping in study settings are significantly higher for treating physicians, who can include external advice from HIV-experts into HAART switch. OBJECTIVE: To develop a compiling internet presence to provide expert advice for HAART switch in general practice of HIV-infected individuals after therapy failure. - DESIGN: A multifactorial (genotyping, drug monitoring, adherence, expert advice) interdisciplinary internet service (www.radata.de) with an associated server hosted database. PATIENTS AND METHODS: HIV-infected patients after failure to HAART are eligible for registration to the Radata project. Genotyping is performed according to protocols specific for each participating institution. Therapeutic drug monitoring (NNRTIs, PIs) follows setting for drug level detection by mass spectrometry. An adherence self-report is completed by every patient. Clinical documentation is provided by the treating Primary Care Physician. Clinical expert advice for implementation into HAART switch in daily clinical practice for treating physicians is provided by HIV-experts according to data obtained. Clinical and laboratory follow-up visits are scheduled firstly 4 weeks after HAART switch and three monthly afterwards, over a period of one year. RESULTS: Technical resources and a compiling internet presence for generation of resistance analysis based expert advice were developed. Initially, 7 HIV-treatment centres, 7 laboratories and 17 HIV advisors contribute to Radata database project. 15 patients were enrolled during test period. 30 expert advices were generated during the test phase. Expert advice was provided in 6 weeks median for implementation into HAART switch. 13 out of 15 expert advices were implemented into HAART switch by treating Primary Care Physicians. CONCLUSIONS: Radata is a novel database concept with features to generate expert advice for implementation into HAART switch of HIV-infected subjects. A test period has shown, that the concept is technically approved to fit all requirements with regard to data collection, evaluation and to generate expert advice for therapy switch in daily clinical practice.

Adult↗

PubMedDate not supplied

Role of external management consultants in health-care organizations implementing TQM.

The reliance of organizations on consultants generally is increasing. Although the efficacy of the use of consultants in implementing change programs has been questioned, there have been limited attempts to systematically analyze the contribution of consultants. This article reports observations on the use of consultants in health-care organizations implementing total quality management (TQM). The relationship between the use of external management consultants and successful TQM implementation is not simple. There appears to be a difference in the way consultants are used by the public and private sectors, with the private organizations forming long-term relationships with their consultants. The perceived value of consultants to the private organizations was higher. Consultants are not a substitute for leadership, and the success of outside consultants probably depends on the commitment of senior management. External management consultants appeared to be linked to the successful implementation of TQM. Further, despite the conventional wisdom to the contrary, some prepackaged programs may be beneficial for the introduction of TQM into an organization.

Consultants↗

PubMedDate not supplied

[Implementation and evaluation of case management in Catalonia: the ISP-SMD program].

INTRODUCTION: The pilot study of the Individualized Service Program for people with Severe Mental Disorders (ISP-SMD) consists of the implementation of case management services in Catalonia. METHODOLOGY: The ISP-SMD has been implemented in two health care sectors and will be expanded to the rest of Catalonia in the next years. The program serves people with persistent mental disorders who have serious social or family problems and/or who have inadequate mental health service use (high use of inpatient services, no use of community services). The ISP-SMD is a community intervention program that focuses its activities on direct care and coordination between services. Thirty patients have been included in the evaluation. RESULTS: The results of the pilot study have shown that, compared to the year before entering the program, the patients show better clinical status, they decrease their unmet need level, they have more appropriate use of health services and have lower treatment costs. Satisfaction of the patients, family members and professionals with the program is very high. CONCLUSION: It is possible to adapt and implement case management services in Catalonia. When implemented, they improve patient quality of life.

Adult↗

PubMed1999

Implementation of a national guideline on prophylaxis of venous thromboembolism: a survey of acute services in Scotland. Thromboembolism Prevention Evaluation Study Group.

BACKGROUND: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are major complications for hospital patients in developed countries. In 1995, the Scottish Intercollegiate Guidelines Network (SIGN) published an evidence-based guideline to encourage the appropriate use of prophylaxis for DVT among hospitalised patients at risk. The guideline was widely distributed within the NHS in Scotland; however, it is not clear what actions trusts have taken to implement it. OBJECTIVE: To investigate the type and extent of DVT guideline implementation activities in acute trusts in Scotland. METHOD: A semi-structured telephone interview with senior clinical audit staff in those trusts with acute services in Scotland. RESULTS: Twenty-nine of the 30 trusts approached participated in the survey (97%). A range of responses to the guideline were reported, including development of local protocols (n = 20), audit of DVT prophylaxis (n = 19), patient specific reminders (n = 13) and provision of a specialist DVT adviser (n = 3). Overall, 25 of the trusts had undertaken guideline development and dissemination activities, and 17 were involved in more active guideline implementation strategies. CONCLUSIONS: The majority of acute trusts in Scotland have responded to the SIGN guideline, usually through the development of local protocols. Strategies to implement the guideline or local protocol are less common. Further guidance is needed on this in the next edition of the guideline.

Clinical Protocols↗

PubMed2003

Implementation of the DOTS strategy for tuberculosis control in rural Kiboga District, Uganda, offering patients the option of treatment supervision in the community, 1998-1999.

SETTING: Kiboga District, a rural district in central Uganda. OBJECTIVE: As part of routine tuberculosis control programme operations, to measure the effectiveness and acceptability of community-based tuberculosis (TB) care using the directly observed treatment, short-course (DOTS) strategy for TB control. The implementation of the DOTS strategy with active participation of local communities in providing the option of treatment supervision in the community is known in Uganda as community-based DOTS (CB-DOTS). DESIGN: Effectiveness was measured by comparing TB case-finding and treatment outcomes before and after the introduction of CB-DOTS in 1998. Acceptability was measured by administering a knowledge, attitudes and beliefs questionnaire to community members, health care workers and TB patients before and after the intervention. RESULTS: A total of 540 TB patients were registered in the control period (1995-1997) before the introduction of CB-DOTS, and 450 were registered in the intervention period (1998-1999) after the implementation of CB-DOTS. Following the implementation of CB-DOTS, treatment success among new smear-positive pulmonary TB cases increased from 56% to 74% (RR 1.3, 95%CI 1.2-1.5, P < 0.001) and treatment interruption decreased from 23% to 1% (RR 16.5, 95%CI 6.1-44.7, P < 0.001). There was no significant difference in the proportion of deaths before and after the implementation of CB-DOTS (15% vs. 14% for new smear-positive pulmonary, and 38% vs. 29% for new smear-negative and extra-pulmonary TB cases). The acceptability of CB-DOTS was very high among those interviewed, mainly because CB-DOTS improved access to TB care, decreased costs and enabled patients to stay with their families. CONCLUSIONS: In enabling patients to choose TB treatment supervision in the community, CB-DOTS provided a highly effective and acceptable additional option to conventional TB care. Efforts are underway to address the high case fatality rates in both study groups before and after the introduction of CB-DOTS. CB-DOTS is an example of shared responsibility between health services and communities in tackling a major public health priority.

Community Health Services↗

PubMed2003

[Physicians and the internet--a cross-sectional study against the background of guideline implementation].

The internet is an innovative medium for the implementation of current recommendations for diagnosis and therapy, e.g. by means of guidelines. In this context, evaluation of the internet is very important because traditional ways of implementation have been proved less effective. Therefore, we investigated the frequency of online access and individual utilisation of the internet among 13,547 family practitioners, internists and general practitioners using a questionnaire procedure. Furthermore, we asked for a personal grading of its current relevance in their daily practice. Out of 2,786 responders (20.6% response rate) 79% reported personal online access. 40% had online computer access in their office and 71% at home. 45% of the internists had online access in their office compared to 34% of general practitioners. Almost all physicians under the age of 40 years (94%) had personal online access in comparison to only 49% of those over 60 years. The average daily duration of internet usage was up to ten minutes in 61%, and 1.5% use the internet more than one hour per day. 46% of responders believe that the internet is an appropriate source for professional education, whereas it has little professional relevance for 38%. We conclude that the internet appears to be a useful medium for the implementation of guidelines. However, in subgroups with the most urgent need for current medical information the internet seems to be unsuitable as an implementation tool.

Cross-Sectional Studies↗

PubMed2001

Strategies for the implementation of new shift systems.

Implementation barriers may be caused by deficiencies in the knowledge, skills, motivation, or support of those involved in the process of implementation of a new shift system. There is no 'one and only' way of planning and implementing a new shift system. However, if the following factors of success are taken into consideration there is a better chance that workers will accept a new shift system: worker participation, information, communication, training, promoter commitment, professional project management, tailor-made solutions and an adequate organizational framework. These factors are particularly relevant in addressing barriers to the implementation of new shift systems. The most important measures to cope with resistance to change of shift systems are: worker participation, information, communication, training, promoter commitment, professional project management, tailor-made solutions and an adequate organizational framework.

Adaptation, Psychological↗

PubMed2003

[Analysis of possibilities of pharmaceutical care elements implementation in Lithuanian community pharmacies].

OBJECTIVE: Objective of this survey--possibilities of implementation of pharmaceutical care elements in daily work of Lithuanian community pharmacies. All pharmacists have to ensure the best quality of pharmaceutical services which they render to their patients. Pharmacists also must improve the quality of pharmaceutical services, according to recommendations of pharmaceutical care. For a start they should implement at least separate elements of pharmaceutical care if they are going to provide pharmaceutical care services in their community pharmacies in the future. That's why this survey was designed to clarify the possibilities of implementation of separate pharmaceutical care elements in to daily work of community pharmacies. MATERIAL AND METHODS: Material of this survey--pharmaceutical services rendered in Lithuanian community pharmacies. This survey has an analytical character and was accomplished with questionnaire. Chiefs of community pharmacies were asked to complete of questionnaire. We gave 150 questionnaires and received answers from 128 pharmacists. RESULTS: After gathered data analysis we found out that only 2% of pharmacies are almost prepared and well equipped for provision of pharmaceutical care services; however, they still have to rearrange their facilities. CONCLUSIONS: Lithuanian community pharmacies are not ready to work according to recommendations of pharmaceutical care today. Some elements of pharmaceutical care (such as blood pressure measurement, provision of written information for patient, etc.) are already implemented by almost all Lithuanian community pharmacies. If pharmacists want to provide pharmaceutical care services they should create a database of patient medication records in pharmacy. Unfortunately Lithuanian pharmacists do not have such databases today. Only with such databases there is a possibility to render pharmaceutical services of the best quality.

Community Pharmacy Services↗

PubMed2003

Implementation challenges of a renal nursing professional practice model.

A city-wide steering-committee developed and introduced a program wide renal nursing professional practice model (PPM) using a variety of strategies. The PPM outlines values, practice guidelines, professional relationships, and the care delivery model. Challenges are inherent when implementing changes on multiple sites amidst a city-wide merger. Key challenges included maintenance of the model and measurement of its impact on practice. This paper summarizes the leadership team s learning regarding both the support required to successfully implement the model and the developments that competed against a successful implementation. The authors also discuss qualitative evaluation of the nurses experiences during model implementation.

Continuity of Patient Care↗

PubMedDate not supplied

Teachers' perspective on barriers to implementing physical activity curriculum guidelines for school children in Toronto.

BACKGROUND: Teachers in Ontario are expected to implement the physical activity guidelines in the health and physical education (HPE) curriculum document that was introduced in 1998. This study examined Toronto teachers' perspective on barriers to implementing these guidelines. METHODS: Forty-five teachers from five Toronto elementary schools in which generalist classroom teachers provide physical education classes participated in focus groups. An experienced moderator facilitated each session. Themes were inductively generated from the data. RESULTS: Participants reported that children were not engaged in moderate or vigorous physical activity daily and for the expected duration. Participants identified three categories of barriers to implementing the curriculum guidelines: lower priority for HPE, lack of performance measures for physical activity, and lack of sufficient infrastructure. First, they reported that the new curriculum expectations for other subjects were demanding, which left little time to focus on physical education. They felt that resource support for the HPE curriculum was not sufficient and that physical education specialists were necessary but unavailable to implement the curriculum. Second, participants felt accountable to both government and parents for high student performance on standardized tests in subjects deemed to be of higher priority. Third, participants reported inadequate facilities and equipment, use of portables for classrooms, cancelling physical education to have events in the gymnasium, and unavailability of teachers to supervise off-school physical activity. CONCLUSION: The study suggests that participating teachers perceive physical education to be a low priority in the educational system, making it difficult for them to meet the HPE curriculum expectations.

Curriculum↗

PubMed2003

A method for subdividing clinical guidelines into process modules with associated triggers and objectives to facilitate implementation.

Representation of multi-step clinical guidelines (CG) and their implementation in computerized decision support (DS) systems are complex and logistically challenging tasks. However, many simple rules based on CGs (e.g., medical logic modules), have been successfully implemented through a few popular DS models (e.g., prevention reminders, order entry systems). To facilitate mapping of CGs to practical DS models, we propose an empirical method for sub-dividing CGs into modules according to the locus in a clinical process flow model where implementation would be most effective (e.g., post-encounter provider order entry). We further propose a classification of triggers and objectives for CG modules that provides a framework for a DS system to implement the module Successful application of the method to ten diverse CGs in the outpatient setting is described.

Decision Support Systems, Clinical↗

PubMed2003

Evaluation of the implementation of an electronic medical record.

University of Minnesota Physicians, the faculty clinical practice organization of the Medical School, is implementing an Electronic Medical Record (EMR). During this process, we anticipated the need for an evaluative study of the implementation to examine process and satisfaction. This was in order to monitor the ability of the physicians to use the EMR effectively. The use of these data to evaluate the implementation and user-acceptance of change of process presents a unique research opportunity. The study of the impact of the EMR implementation on patient care, education, and other issues of academic interest make this research study valuable.

Attitude of Health Personnel↗

PubMed2004

The evolution and implementation of a pediatric computerized order entry system: a case study.

Implementing CPOE is not an easy undertaking. Designing and implementing a pediatric-focused CPOE presented a unique challenge because of the age and weight considerations inherent with a pediatric patient population. Through the experiences involved in an implementation, key elements of a successful implementation include high-level sponsorship, involvement of clinicians up-front in the process, excellent communication and round-the-clock support. When everyone works together with common objectives, milestones are met, and goals are realized.

Decision Support Systems, Clinical↗

PubMed1992

Survey of the implementation of workplace alcohol and smoking policies among employers in Fife.

A survey of major employers in Fife shows that at present 33% of respondents have implemented written alcohol policies, while 40% have implemented written smoking policies. A total of 19% have both alcohol and smoking policies in place. The initiative for policy development appears to have arisen mainly from management, but trade unions and management have co-operated well during policy formulation. The majority of policies have been implemented for more than three years. A small number of companies in Fife appear to be interested in the development and implementation of written alcohol and smoking policies in the workplace.

Alcohol Drinking↗