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 757 records · Page 42Linked to original sources

PubMed2004

Strengthening early warning function of surveillance in the Republic of Serbia: lessons learned after a year of implementation.

The Republic of Serbia, with WHO support, has implemented an early warning system (ALERT) for priority communicable diseases, to complement the routine surveillance system which notifies individual confirmed cases. The results of its evaluation, conducted one year after implementation is presented here. ALERT relies on notification of 11 syndromes by primary care facilities. Data is analysed weekly at district level and transmitted to national epidemiologists. ALERT is perceived to be a simple and flexible tool. Acceptability is higher at national level than at district level. Some districts perceive ALERT as a parallel system poorly connected to control measures. Sensitivity of ALERT in detecting cases of meningitis is 93%, and 37% for cases of hepatitis. Retrospective analysis of ALERT data identified 9 outbreaks, 5 of which had been recognized by epidemiologists. ALERT was the timeliest system for detecting 4 outbreaks identified by both systems. ALERT was useful for triggering timely investigation and control of outbreaks of hantavirus and salmonellosis and for detecting the start of the influenza season. However, ALERT did not detect clusters of brucellosis and tularaemia targeted by the unexplained fever syndrome. This evaluation underlined the need for a global review of surveillance activities when implementing new components such as ALERT. While control measures based on notification of individual confirmed cases are well understood and implemented, the investigation and verification process that should result from an increase in ALERT syndromes is not fully understood. Field epidemiology training programmes, such as the EPIET programme, are best suited to bring about this change of perspective.

Communicable Disease Control↗

PubMed1992

Implementation and financial analysis of an operating room satellite pharmacy.

The rationale and implementation of an operating room (OR) pharmacy satellite is described, and the first-year savings are evaluated. The OR in an 874-bed university teaching hospital, consisting of 17 rooms for inpatients, 6 rooms for ambulatory patients, and a postanesthesia care unit, lacked comprehensive pharmacy services; this resulted in poor drug-use control and accountability, varied controlled-substance audit trails, and suboptimal patient services. A task force examined other institutions' OR pharmacy satellites and chose to implement a satellite that provides all pharmaceuticals and i.v. admixtures by using case trays for each surgical patient. One year after implementation of the satellite, inventory in the operating-room areas was reduced by 56.5%, annual pharmaceutical costs by 2.6% (adjusted for inflation), and average cost per patient by 8.0% (adjusted for inflation). First-year cost reductions and revenue identification exceeded operating costs for materials, supplies, and labor by $271,755. Implementation of an OR pharmacy satellite reduced the net cost of providing pharmaceutical services to the OR.

Ambulatory Care↗

PubMed2004

Counselling, HIV testing and adjunctive cotrimoxazole for TB patients in Malawi: from research to routine implementation.

SETTING: Fifteen hospitals in Malawi that offer voluntary counselling and testing (VCT) for the human immunodeficiency virus (HIV) for tuberculosis (TB) patients and cotrimoxazole (CTX) for patients found to be HIV-positive. OBJECTIVES: 1) To describe the process of developing a national TB-HIV plan, conducting a country-wide situational assessment, and producing national guidelines on VCT and CTX for TB patients, and 2) to assess the implementation of VCT and CTX for TB patients registered between July and September 2003. DESIGN: A descriptive study. RESULTS: The 3-year HIV-TB plan was finalised in 2002. Between January and March 2003, an assessment was carried out of HIV/AIDS and joint HIV-TB services in Malawi and a decision made to support 15 hospitals in implementing VCT and CTX for TB patients. Between April and June 2003, national guidelines on VCT and CTX were developed through a consultative process, and treatment units were prepared for implementation. Between July and September 2003, 2397 TB patients were registered, and 1404 (59%) accepted VCT; 956 (68%) were HIV-positive, of whom 927 (97%) started CTX. Deficiencies in the registration process and in patient understanding about VCT and CTX were identified. CONCLUSION: The results show that it is feasible to routinely implement VCT and CTX for TB patients.

AIDS Serodiagnosis↗

PubMed2004

Implementation, uptake, and impact of a provincial postpartum program.

This paper examines implementation and uptake of the Hospital Stay and Postpartum Home Visiting Program at 5 sites in the Canadian province of Ontario using a cross-sectional survey. It also examines concomitant changes in satisfaction with services and maternal and infant health indicators by comparing the findings of this survey, administered after policy implementation, with those of a previous survey. In both surveys, data were collected via a self-administered in-hospital questionnaire and a structured telephone interview at 4 weeks post-discharge. There were statistically significant differences in implementation of the 60-hour hospital-stay option across sites, with between 11.7% and 81.2% of women having been offered an extended stay. However, there were no significant differences in acceptance rates (21.1-39.4%) among those women given this option. There were no statistically significant differences in the offer of a home visit by a public health nurse (91.5-96.6%), but there were significant differences in uptake of a visit. Between 21.1% and 39.4% of those women who were offered a home visit accepted. When compared to the previous survey findings, there were few changes in client satisfaction with services and health indicators following program implementation.This study raises questions about the utility of the postpartum program as currently implemented and highlights the need for further research.

Adult↗

PubMed2004

Continuity through best practice: design and implementation of a nurse-led community leg-ulcer service.

The design of the new service was intended to facilitate continuity. The results after the first year of the new service revealed that care was both more effective and more efficient for all types of leg ulcers (Harrison, Graham, Friedberg, & Lorimer, 2003). Healing rates had dramatically improved, the frequency of nursing visits decreased, and supply costs declined. With the new service, comprehensive standardized assessments are made at baseline on all new admissions for home leg-ulcer care, and reassessments are regularly scheduled if the condition does not improve. With the evidence-based protocol, all providers and sectors of care are "working from the same script." Specific information is obtained on the client's health history, leg-ulcer history, preferences, and social context. Continuity is further facilitated through implementation of the primary nurse model, whereby one provider is responsible for developing the care plan and for subsequent evaluation and revision. Management continuity is advanced through health-care reorganization, with the development of an expert, dedicated nursing team, a consistent approach to training and skill development, improved coordination, an interdisciplinary approach for referral and consultation, and continuous quality improvement measures for education and practice audit. A number of strategies tailored to the new service have been highly effective. Strategic alliances among the researchers, home-care authority, nursing agency, nurses, and physicians are essential to the success of both design and implementation. Ongoing interdisciplinary and intersectoral communication expedites the referral process and helps to resolve issues as they develop. The majority of physicians have been very supportive of the use of the protocol and the evidence-based service. Surveys of care recipients have been mostly positive. Nurses who have been surveyed concerning the supports to implementation of the evidence-based service have indicated the following supports: ongoing education, nursing knowledge, a supportive clinical leader, support from two specialist physicians (a dermatologist and a vascular surgeon), a dedicated nursing team, positive outcomes (improved healing rates), and regional home care and agency support. The greatest challenge has been establishing and maintaining the dedicated nursing team. Continuity is served when nurses are assigned exclusively to the leg-ulcer team, where they can continue to build expertise and skills. The nursing agency was initially reluctant to embrace the concept of a dedicated team, as it viewed wound care as a general function of all nurses. Many of the nurses trained in leg-ulcer care fulfilled a number of other specialized nursing functions. This had resource implications for the nursing agency, as other nurses needed training in various other specialized skills. There should be a balance between the size of the population being served and the size of the team, in order to maintain efficiency and sufficient exposure to skilful assessment and management of leg-ulcer care. During the first year of the leg-ulcer service a number of nurses were lost from the team for various reasons, including: outside opportunities for career advancement, the physical demands of this type of care, retirement, moving from the area, and lack of job security. In addition, the volume of nursing visits was decreased because of Ontario government cutbacks in the area of home-care services. New staff members on the team were laid off in the context of a unionized environment. The lack of long-term security and the reality of lower wages in the community sector have played havoc with recruitment and retention. A recently formed committee at the nursing agency on continuity of care, with representation from nursing, management, and administration, has identified a number of further barriers to continuity. These include fluctuating caseloads, difficulty attracting nurses to the community sector, and a unionized environment in which senior nurses displace junior nurses on low-caseload days. Strategies aimed at overcoming the barriers to continuity have been identified and are being implemented. Our experience confirms the need for evidence-based planning in order to understand the needs of the population with leg ulcers, current practices, and the organization of care prior to the restructuring of service delivery. The extensive needs assessment indicated the need for broad system changes in addition to adjustments in clinical care in order to meet best-practice guidelines. Despite ongoing barriers, the service model has improved continuity and dramatically increased the effectiveness and efficiency of leg-ulcer care in one community.

Benchmarking↗

PubMed2004

Lessons learned in implementing SCI clinical practice guidelines.

While clinical practice guidelines (CPGs) were designed as a tool to improve patient outcomes, decrease practice variation, and optimize resource utilization, providers often encounter significant barriers to integrating these into clinical practice. A study was conducted at six spinal cord injury (SCI) centers in the Department of Veterans Affairs (VA) to improve provider adherence and patient outcomes of two CPGs: Prevention of Thromboembolism in Spinal Cord Injury and Neurogenic Bowel Management in Adults With Spinal Cord Injury. To design effective implementation strategies, focus groups were conducted to identify provider-perceived barriers and facilitators to implementing recommendations for each of the SCI guidelines. Based on this information, four guideline implementation strategies were designed: (a) use of local opinion leaders ("clinical champions"), (b) patient-mediated interventions, (c) standardized documentation template/standing orders, and (d) social marketing/outreach visits. These strategies were implemented at each site. This article identifies "lessons learned" during the process of trying to get these CPGs embedded into clinical practice.

Attitude of Health Personnel↗

PubMedDate not supplied

The relationship between planned change and successful implementation of computer assisted instruction.

The purpose of this study was to examine planning for the implementation of computer assisted instruction (CAI). The sample consisted of 77 nursing programs representing 35 states. A mail survey method was used to collect the data from 278 nurse faculty employed by the nursing programs in the sample. The first hypothesis predicted a relationship between planned change and successful implementation of CAI and was supported (r = .86, p less than .001). Testing of the second hypothesis with multiple regression analysis revealed that continued faculty support, continued adequate resources, and administrative support (R = .68, p less than .0001), account for 46.5% of the variance within successful implementation of CAI. The findings of this study have the potential to assist nurse educators and those who award grant money for CAI use to better predict success with the implementation of CAI.

Attitude to Computers↗

PubMed2002

The development and implementation of patients' rights: Dutch experience of the right to information.

Many initiatives have been taken to advocate, develop and emphasize patients' rights. The existence of legislation, case law or charters in the area of patients' rights does not guarantee that these rights are or will be successfully implemented in everyday practice. The implementation of patients' rights requires specific actions and expertise. It is important to develop strategies to enhance the successful implementation of patients' rights. This is illustrated by using the example of the developments in the Netherlands regarding the patient's right to information. This development shows that legal interventions, such as legislation, will always have to be embedded in and/or supplemented by non-legal policy measures. This calls for a broad and well-considered implementation policy, including items at various levels (legislation, patient and patient organizations, health providers and health institutions, contextual conditions). Such a strategy calls for a multidisciplinary approach, involving input from the areas of law, ethics, medicine, the sciences etc.

Access to Information↗

PubMed2004

Development and implementation of the Dutch protocol for rehabilitative management in amyotrophic lateral sclerosis.

INTRODUCTION: In the Netherlands, rehabilitation care plays an important role in the symptomatic and palliative treatment of ALS patients. However, until 1999 there were no guidelines or practice parameters available for the management of ALS. Therefore, the Dutch protocol for rehabilitative management in ALS was developed. We describe the development process, the outcome and implementation of the protocol. METHODS: A concept management protocol was written and the Delphi method was selected to develop the protocol further. This method comprises repetitive discussion sessions from postulates, using a combination of written questionnaires and work-conferences. Between 80 and 90 persons (rehabilitation team members of different professional backgrounds and neurologists) were involved in this process. The protocol was implemented by sending it to all consultants in rehabilitation medicine in the Netherlands; they were asked to inform all the treatment team members about the final protocol and to implement it in their treatment of ALS patients. RESULTS: The protocol was developed in 1999, implemented in 2000 and evaluated in 2001. Recommendations for improvement were made during the evaluation and improvements are currently being developed by an expert group. The protocol is widely used (88.9%) by consultants in rehabilitation medicine and their treatment teams in the Netherlands. CONCLUSIONS: The Dutch protocol for rehabilitative management was developed to provide an optimal and adequate care plan for patients with ALS. It is widely used in the Netherlands.

Activator Appliances↗

PubMed2005

Rapid implementation of an electronic health record in an academic setting.

One of the sources of resistance to the implementation of electronic health records is that it often takes years to roll out a fully functional system. The George Washington University Medical Faculty Associates (MFA) has set a new standard for rapid EHR implementation by bringing 99 physicians and 130 residents and interns live in less than 30 days in a complex academic setting. MFA leveraged a rapid implementation process based on study of previous successful implementations. The rollout plan incorporated aggressive hands-on education, in-person and virtual training modules for self-review, and a leadership triad of physicians, administrators, and information technology experts.

Academic Medical Centers↗

PubMed2003

The implementation of a quality assurance procedure for the Veterinary Services of France.

Due to the increasing complexity of food production systems and the concerns that these systems raise, there has been increasing demand from the general public for more State control of these processes. In France, it is the official Veterinary Services who are responsible for food safety and who must respond to these demands. The Veterinary Service is formulating a quality assurance procedure in accordance with standard EN 45004-ISO 17020, which determines the requirements that inspection bodies must follow to be recognised, at national, European and international level, as competent and reliable. As part of this procedure, the Veterinary Service will review requirements in terms of organisation, functions, qualifications and resources. The progress of inspection service orders, from their conception by the Central Administration, to their implementation by decentralised services, must be carefully managed. It is essential that service orders be implemented effectively and systematically by using recognised methods and issuing adequate inspection reports. The training and qualifications of inspectors are very important: their skills must remain up-to-date so that there is always a network of qualified staff, that is, staff who have an understanding of production processes and who have recognised competences in terms of initial training, continuous professional development and adequate experience. The quality systems implemented will only meet expectations if they are continuously monitored by means of regular evaluations. For this reason, both internal and external audits are performed. These new practices contribute to establishing a basis for the improvement of internal evaluation. In order to facilitate the implementation of a quality assurance procedure for inspection services, several tools, that are linked with the information system of the government department responsible for food, are, or will be, at the disposal of the decentralised Veterinary Services, i.e. a national database, mail and service order processing software, and inspection procedures.

Animals↗

PubMedDate not supplied

[Implementation of an assisted electronic prescription system applied to parenteral nutrition in a general hospital].

Integrated and shared information systems allow obtaining a high degree of information about processes, costs and outcomes, and considerably reducing prescription errors. Assisted electronic prescription, in the setting of total parenteral nutrition, integrated with other hospital databases and with the hospital drugs management system, is a tool that allows increasing patient' safety (by reducing prescription errors), improving quality assistance, improving information systems and information management and the efficiency of used resources. In this work, implementation of an assisted electronic prescription system applied to parenteral nutrition in a hospital and processes reengineering performed in the nutrition setting are described. This implementation was performed by medical staff from the Nutrition and Diet Department and pharmacists from the Pharmacy Department of Ramón y Cajal Hospital using "Nutriwin" computer software. For two months prior and after its implementation, a follow-up of time consumed in the circuit prescription-validation-elaboration-dispensation of parenteral nutrition formulas has been performed. After implementation, treatment orders reach on average 1 h and 15 minutes sooner the Pharmacy Department; by avoiding transcription, a saving of 3 min per nutrition formula calculations is achieved, besides reducing potential errors; elaboration of nutrition formulas can be started on average 1 h and 20 minutes sooner as compared to manual prescription. Besides, the staff that writes down the prescription may know in real time the nutritional profile for each patient in the current episode and the patient's historic. Electronic prescription of treatment orders in this area has represented for our hospital an optimization of the employed resources, a reduction of potential errors that may occur, an improvement in consumption management, and an increase in the whole process quality.

Drug Prescriptions↗

PubMed2005

Implementing the water framework directive in Bulgaria: Integrated river basin management on the Black Sea coast.

EC member states and candidate countries are in the process of implementing the requirements of the EC Water Framework Directive 2000/60, which came into force on 22 December 2000. At the core of the Directive is an integrated approach for sustainable water management in river basin districts. The overall objective is to reach good water status for all waters by the year 2015. The challenges for countries implementing the Directive are substantial not least for the River Basin Management Authorities who will be the implementing unit at the regional level. The Black Sea River Basin Directorate in Varna is one of four Directorates established in Bulgaria in 2002 in accordance with the Bulgarian Water Act and is the regional operational unit under the Ministry of Environment and Water for the Black Sea Basin catchment area. The catchment area covers 20% of Bulgaria and 100% of the Bulgarian Black Sea coast. Current implementation activities in the Black Sea Basin Directorate and also at the national level are supported by the Danish EPA through its DANCEE programme in collaboration with the Ministry of Environment and Water. This paper highlights the main activities and outputs of the technical and institutional undertakings in the Black Sea Basin Directorate focusing on the preparation of the River Basin Overview by Dec. 2004.

Bulgaria↗

PubMed2005

Obstacles to Implementing an Execution Engine for Clinical Guidelines Formalized in GLIF.

This article is on obstacles we faced when developing an executable representation of guidelines formalized the Guideline Interchange Format (GLIF). The GLIF does not fully specify the representation of guidelines at the implementation level as it is focused mainly on the description of guideline's logical structure. Our effort was to develop an executable representation of guidelines formalized in GLIF and to implement a pilot engine, which will be able to process such guidelines. The engine has been designed as a component of the MUltimedia Distributed Record system version 2 (MUDR(2)). When developing executable representation of guidelines we paid special attention to utilisation of existing technologies to achieve the highest reusability.Main implementation areas, which are not fully covered by GLIF, are a data model and an execution language. Concerning the data model we have decided to use MUDR(2)'s native data model for this moment and to keep watching the standardisation of a virtual medical record to implement it in execution engine in the near future. When developing the execution language, first of all we have specified necessities, which the execution language ought to meet. Then we have considered some of the most suitable candidates: Guideline Execution Language (GEL), GELLO, Java and Python. Finally we have chosen GELLO although it does not completely cover all required areas. The main GELLO's advantage is that it is a proposed HL7 standard. In this paper we show some of the most important disadvantages of GELLO as an executable language and how we have solved them.

Decision Making, Computer-Assisted↗

PubMed2005

[Medico-economic assessment of two methods for implementing thyroid testing guidelines].

BACKGROUND: To compare independent and combined effectiveness and cost-effectiveness of two implementation interventions of guidelines for ordering thyroid function tests. The two implementation interventions were a Memorandum Pocket Card (MPC) and a Test Request Form (TRF). Intervention groups were wards. METHODS: The study used an experimental 2*2 factorial design with matching hospitals according to size and activity and wards according to pre-intervention appropriateness for test ordering. Four ward groups were established: the dual intervention group, the order form group, the pocket card group and the control group. Physicians in all groups received guidelines and were invited to a local information meeting. The main outcome measure of effectiveness was the Guideline Conformity Rate (GCR). The cost-effectiveness ratio was the cost difference between the tested intervention and the control intervention upon effectiveness difference between the tested intervention and the control intervention. RESULTS: Six hospitals participated in the study (two middle-sized hospitals, two small-sized hospitals and two psychiatric hospitals). A total of 1412 orders for thyroid function tests were collected. GCR was 78% in the dual intervention group, 83% in the order form group, 73% in the pocket card group and 62% in the control group. The interaction between TRF and MPC was not significant (B=-0.70, p=0.21). Compared to simple information, TRF was effective in increasing GCR (OR=2.65, 95% Confidence Interval [CI]: 1.52-4.62), unlike MPC (OR=1.28, CI: 0.75-2.19). TRF was the less expensive and the most effective intervention. CONCLUSION: Using a robust design, our study shows a greater effectiveness of TRF than MPC and their association in implementing thyroid function test guidelines. The development of clinical practice improvement projects through the second procedure of accreditation in France is a good opportunity to develop a guidelines implementation research project.

Cost-Benefit Analysis↗

PubMed2005

Effectiveness of measures and implementation strategies in reducing physical work demands due to manual handling at work.

This review aimed at producing insight into the effectiveness of interventions to reduce the physical work demands associated with manual (materials) handling in the work situation and musculoskeletal symptoms in the longer-term. A systematic electronic literature search between 1990 and February 2003 was performed in the following databases: Embase, Medline, HSE-line, Nioshtic, and Nioshtic-2. Three inclusion criteria were applied, and altogether 44 studies were included for review. The interventions were divided into two categories, (ergonomic) measures and implementation strategies. One randomized controlled field study was found that established a causal effect for a combination of implementation strategies in reducing the physical work demands associated with manual handling and reducing acute musculoskeletal symptoms. All four of the controlled field studies showed a significant reduction in the physical work demands when lifting devices were part of the intervention. Two of these studies measured a significant reduction in low-back disorders in the longer term. Several uncontrolled pre-post studies showed effects in the same direction. Of the 26 implementation strategies, 21 that measured an improvement in the process variables (eg, aimed behavioral variables) used a participatory ergonomics approach, an education (or training) program or both with the direct involvement of workers. It was concluded that significant reductions in physical work demands and musculoskeletal symptoms were found when (mechanical) lifting devices were part of the intervention. The higher quality studies that showed improvement in behavior indicate the importance of using facilitating and educational strategies in the implementation of ergonomic measures.

Humans↗

PubMedDate not supplied

The long-term health and economic benefits of DOTS implementation in Ecuador.

BACKGROUND: Between April 2001 and March 2004, the Directly Observed Therapy-Short course (DOTS) program was successfully implemented by the National Tuberculosis control program, with assistance from the Canadian Lung Association, in three provinces of Ecuador, where 52% of the population of the country reside. METHODS: Markov modelling was used to project TB-related morbidity, mortality and costs if the former TB control program (status quo) had continued or if the newly expanded DOTS program is maintained over 20 years. Extensive sensitivity analyses were used to determine the effect on projected outcomes of varying key assumptions. RESULTS: If DOTS is maintained over the next 20 years, we predict that 18,760 cases and 15,812 TB-related deaths will be prevented, resulting in societal savings of dollars 203 million and government savings of dollars 7.1 million (all costs in dollars US). These findings were robust in extensive sensitivity analyses. Given the initial investment of dollars 3 million for DOTS implementation, this would mean a cost of dollars 190 per life saved. CONCLUSIONS: Implementation of DOTS could yield very substantial public health and economic benefits for Ecuador. These results demonstrate the benefits from Canadian government support for DOTS implementation in low- and middle-income countries.

Canada↗

PubMed2006

Swimming upstream: faculty and staff members from urban middle schools in low-income communities describe their experience implementing nutrition and physical activity initiatives.

INTRODUCTION: Addressing childhood overweight has become a top priority in the United States. Modification of school policies and practices has been used in an attempt to address the overweight epidemic among children and adolescents. Culturally diverse urban schools in low-income communities attempting to improve nutrition and increase physical activity may face unique challenges in the school environment. A better understanding is needed about school environments and how they may affect the implementation, efficacy, and sustainability of initiatives designed to improve nutrition and physical activity. METHODS: We carried out a qualitative study in five urban middle schools in low-income communities that had recently implemented Planet Health, a nutrition and physical activity intervention, to assess which aspects of the schools' physical, social, and policy environments were facilitating or impeding the implementation of health promotion initiatives. Thirty-five faculty and staff members participated. We conducted one focus group per school, with an average of seven participants per group. We analyzed focus group transcripts using the thematic analysis technique to identify key concepts, categories, and themes. RESULTS: Teachers and staff members in our study identified many school-related environmental barriers to successful implementation of nutrition and physical activity initiatives in their schools. School personnel recommended that classroom-based nutrition interventions such as Planet Health be coordinated with school food services so that the healthy messages taught in the classroom are reinforced by the availability of healthy, culturally appropriate cafeteria food. They identified household food insufficiency and overly restrictive eligibility criteria of the federally subsidized meal program as critical barriers to healthy nutritional behaviors. They also identified weight-related teasing and bullying and unhealthy weight-control behaviors as challenges to promotion of healthy nutrition and physical activity. CONCLUSION: To maximize intervention efforts, researchers and practitioners must consider the effects of school environments on nutrition and physical activity initiatives.

Adolescent↗