AMA aims to pilot RTC project in four sites.
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American Medical Association↗
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Methodological limitations of the ESRD Core Indicators Project: an ESRD network's experience with implementing an ESRD quality survey. Medical Review Board of the ESRD Network of New England.
ESRD Network Number 1, composed of Maine, New Hampshire, Vermont, Massachusetts, Connecticut, and Rhode Island, developed a Network Core Indicator Pilot Project using the dialysis units represented on the Medical Review Board. Network 1's Core Indicator Pilot Project aimed to (1) estimate the proportion of end-stage renal disease (ESRD) patients in Network 1 receiving hemodialysis treatments associated with a urea reduction ratio less than 60% to 65%, (2) elucidate the patient characteristics associated with a hemodialysis dose less than 65%, (3) define the processes in the delivery of hemodialysis that limit the provision of an adequate dialysis dose, and (4) initiate the routine collection of measures of dialysis dose, the analysis of those data, and feedback to the participating dialysis units. In the course of the Core Indicator Pilot Project, we observed little uniformity in the sampling method for the postdialysis blood urea nitrogen sample. Thirty-three percent of the hemodialysis units reported that this critical blood sample was drawn immediately before the dialysis treatment was terminated; 25% were obtained immediately at the end of the dialysis treatment and 42% drew the sample > or = 5 minutes after all blood was reinfused to the patient. Especially in the presence of unappreciated blood recirculation in the angioaccess or postdialysis urea rebound, the lack of standardization in obtaining this critical blood sample to support the urea reduction ratio calculation greatly compromises any comparisons of performance across dialysis facilities and may jeopardize patient care. Future ESRD quality improvement efforts must focus not only on the results of the outcome measure but also on the process by which the measure is achieved. These fundamental principles of quality assessment should be considered by policy specialists, payers, providers, and developers of clinical practice guidelines.
Adolescent↗
Clinical pathways in primary dental care in Malaysia: clinicians' knowledge, perceptions and barriers faced.
The Oral Health Division, Ministry of Health in Malaysia piloted clinical pathways (cpath) in primary care in early 2003. This study investigated the knowledge, perception of cpaths and barriers faced by the clinicians involved in the pilot project. Self-administered questionnaires were sent to the clinicians (n=191). Dentists (67.9%) and dental nurses (70.6%) had good overall knowledge of cpaths. The majority of the clinicians (67.9% to 95.6%) perceived cpath positively in all areas. Only 9.2% of dentists encountered difficulties in using cpath forms compared to 28.4% of dental nurses. A higher proportion of dental nurses (73.5%) compared to dentists (64.8%) were willing to continue using cpath. The majority of dentists (76.7%) and dental nurses (73.1%) were willing to participate in future development of cpaths. Overall, there was evidence of managerial support for the pilot project. A follow-up of the pilot project was somewhat lacking as less than half (43.3%) of the clinicians reported that the state coordinator obtained feedback from them. The findings auger well for the future implementation of cpath should the Oral Health Division decide to adopt cpath routinely in the public oral health care service.
Clinical Competence↗
Attitudes to computers in a teaching hospital.
The importance of a positive attitude to computers was recognised as a crucial element in the success of any project to introduce computerisation to the ward areas of a major teaching hospital. Nurses, ward clerks and doctors were expected to enter and/or access information on ward terminals. A study was designed to identify their concerns and attitudes towards the introduction of ward terminals prior to the beginning of a pilot project. Intervention to address these concerns and education to train staff took place during the trial. A post-trial questionnaire to assess the success of the pilot project and changes in attitudes was completed and analysed. The pilot project was deemed successful and full implementation in all ward areas is planned.
Attitude of Health Personnel↗
Summary of a project comparing student performance forms.
This paper is a summary of a pilot project designed to provide data which would lead to more effective methods of evaluating field work performance of occupational therapy students in Canada. Three evaluation forms were selected for comparison. A quantitative-descriptive type of research was utilized and a questionnaire to occupational therapy clinicians and students was the method used for data collection. The three major findings were: i) that the American Occupational Therapy Association Field Work Performance Report Form was the most complete form in evaluating student performance in specific skill areas; ii) the Queen's University Occupational Therapy Clinical Training Report Form contained essential components concerning interaction skills; and iii) the Canadian Association of Occupational Therapy Report of Clinical Training was in need of major revisions if its use was to be continued. This paper includes an outline of the results and the major limitations of the pilot project; however, the conclusions and recommendations arising from the project are the main focus of discussion.
Canada↗
Indian Health Service; method for evaluating and establishing reimbursement rates for health care services authorized under the Indian Health Service contract health service regulations--Portland area--PHS. General notice.
Indian Health Service (IHS) issues this General Notice to inform the public that IHS will conduct a pilot project in the Portland Area, IHS, to determine whether an alternative method of evaluating and establishing reimbursement rates for contract health services (CHS) will result in greater participation by health care providers and lower costs to IHS. The pilot project is limited to the Portland Area, and does not affect the present methods of evaluating and establishing reimbursements rates and awarding contracts for health care services in other IHS Areas. In addition, the pilot project does not change the current IHS payment policy requirement that health care services be procured at rates which do not exceed prevailing Medicare rates.
Contract Services↗
The Alaska Trauma Registry.
Recognizing that injury is the leading cause of death and disability for virtually all age groups in Alaska, a trauma task force was developed in the Anchorage area in the early 1980s. This task force established the trauma registry pilot project in the state of Alaska. The Emergency medical Services Section, Department of Health and Social Services provided the funding to the Southern Region Emergency Medical Services Council, Inc. and the Alaska Chapter of the American College of Surgeons Committee on Trauma to develop this pilot project. The funding originated from a federal grant from the National Highway Traffic Safety Administration. Seven hospital participated in the pilot project which lasted approximately two and one half years. There were 5,087 entries into the registry with information on 4,860 patients. The rationale, methodology, and development of the registry, as well as some of the data accumulated is presented. The potential usefulness of the registry as a quality improvement tool and as an extensive data base for injury prevention and trauma care research also is discussed.
Adolescent↗
Use of interdisciplinary education to foster familiarization among health professionals.
This paper describes a pilot interdisciplinary experience between the dental hygiene and medical technology programs at Marquette University. It was designed, in part, to familiarize dental hygiene students with the medical technology profession. Comments solicited from students on the final evaluation form indicated that this pilot project was highly successful and met the objectives. Affective, multiple-choice questions on pretests and posttests showed a positive change in attitude, but this change was not statistically significant. Possible reasons for this are discussed. Benefits of this pilot project were an improved understanding of medical technology on the part of the dental hygiene students, enhanced interdepartmental communication, and plans to develop a reciprocal interdisciplinary experience for the medical technology students. It is hoped that this pilot project will serve as a stimulus for similar experiences among other health science programs.
Attitude of Health Personnel↗
The Croatian telemedicine.
Telemedicine developed in Croatia in two phases. The first phase during the 1970s was limited because of insufficient technology and scarce resources. But that phase was important as a learning process and the preparatory stage for the promising future. The communications infrastructure was heavily destroyed during the 1991-92 war but it was reconstructed and rebuilt as a modern technology based on optical fibres. The new technical and technological infrastructure was the base for the development of CARNet (Croatian Academic and Research Network). CARNet was linked to the Internet and enabled the international exchange of information for the scientific community. Telemedicine projects started firstly as pilot projects around the same time as in other countries. They were financially covered mostly by the Ministry of Science either directly or through the CARNet. The telemedicine projects, like telepathology, teleradiology, teleneurosurgery, teleeducation, developed in a very sophisticated way and are now in the phase of implementation into the routine health practice. Some projects are still in the pilot phase, but thanks to highly trained professionals, they are promising and it can be expected that with the growing economic stuation they will be implemented soon.
Computer Communication Networks↗
The strategic approach of managing healthcare data exchange in Austria.
OBJECTIVES: The exchange of electronic medical data between healthcare providers constitutes an integral part of modern medicine, and its importance is growing. Efficient application on a national level requires a uniform approach to the management of healthcare data exchange, avoiding isolated solutions that are expensive and also incompatible. METHODS: In this communication we explain the basic concepts of establishing a nationwide framework to guide healthcare data exchange in Austria. To achieve this goal, a three-step approach was adopted: (i) creating general guidelines to direct electronic medical data exchange; (ii) defining detailed standards for electronic messages; (iii) organizing pilot projects to implement these standards, and further improving the general guidelines based on the results of the pilot projects. RESULTS: We present the MAGDA-LENA framework which guides healthcare data exchange in Austria, and compare it with the US framework HIPAA. We describe several communication scenarios for which concrete message standards were developed in recent years, based on the MAGDA-LENA framework. We further discuss the implementation of these standards in four pilot projects. CONCLUSIONS: The strategic approach of managing healthcare data exchange presented in this paper is expected to have a substantial impact on medical informatics in Austria over the next few years.
Austria↗
Telemedicine information analysis center.
Congress mandated a pilot project to demonstrate the feasibility of establishing a Department of Defense (DoD) telemedicine information analysis center (TIAC). The project developed a medical information support system to show the core capabilities of a TIAC. The productivity and effectiveness of telemedicine researchers and clinical practitioners can be enhanced by the existence of an information analysis center (IACs) devoted to the collection, analysis, synthesis, and dissemination of worldwide scientific and technical information related to the field of telemedicine. The work conducted under the TIAC pilot project establishes the basic IAC functions and assesses the utility of the TIAC to the military medical departments. The pilot project capabilities are Web-based and include: (1) applying the science of classification (taxonomy) to telemedicine to identify key words; (2) creating a relational database of this taxonomy to a bibliographic database using these key words; (3) developing and disseminating information via a public TIAC Web site; (4) performing a specific baseline technical area task for the U.S. Army Medical Command; and (5) providing analyses by subject matter experts.
Computer Communication Networks↗
Development and deployment of a health information system in transitional countries (croatian experience).
Croatian Primary Health Care Information System pilot project, conducted between 2001 and 2003, aimed to develop and deploy a health information system based on the latest technologies which would improve the quality of primary health care and rationalise the consumption. 60 primary health care teams (physician and nurse) were equipped with PCs and connected via central server to the main national health insurer, state treasury and public health institute. Developed information system enabled rapid retrieval of documents, replacement of manual data input and a real-time insight into needed information as well as prompt interventions within the system. The project also introduced electronic smart cards for physicians and nurses, so that at each medical check-up the information system verified both the ensuree's and the physician's or nurse's status and rights.Based on the experiences from the pilot project, plan has been made for comprehensive health information system at national level which would connect primary health care teams, hospitals, laboratories, dentistries, health insurance companies, state treasury, public health institutes and electronic health records database. Its major goals are more rapid diagnostics, accuracy in prescribing therapy, standardisation of the good practice as well as better utilisation of capacities, shorter waiting times and shorter stays in hospitals, which would lead to improvement in overall health care quality and better control over the health care consumption. Estimated 5-year investment for installing such system would be 125 million EUR. However, information system could save substantially more and yield a return of investment in only two years.As information system for primary health care should be a strategic component of every health care reform and development plan, we can recommend our model, based on the results of the pilot project, to other transitional countries.
Delivery of Health Care↗
Integration of midwives into the Quebec health care system. L'Equipe d'Evaluation des Projets-Pilotes Sages-Femmes.
This paper reports on one aspect of the evaluation of the midwifery pilot projects in Quebec: the identification of the professional and organizational factors, as well as the mode of integrating midwives into the maternity care system, that would promote the best outcomes and the autonomy of midwives. The research strategy involved a multiple-case study, in which each midwifery pilot project represented a case. Based on a qualitative approach, the study employed various sources of data: individual interviews and focus groups with key informants, site observations and analyses of written documents. Results show that midwives were poorly integrated into the health care system during the evaluation. Four main reasons were identified: lack of knowledge about the practice of midwifery on the part of other health care providers; deficiencies in the legal and organizational structure of the pilot projects; competition over professional territories; and gaps between the midwives' and other providers' professional cultures. Recommendations are provided to facilitate the integration of midwives into the health care system.
Attitude of Health Personnel↗
Satisfaction and anxiety for women during investigation of an abnormal screening mammogram.
Five community-designed pilot projects were undertaken to reduce the time to diagnosis following an abnormal mammogram. One thousand five hundred and seventy-eight women with abnormal mammograms completed a self-administered questionnaire (71% response) which inquired about experiences and satisfaction with time delay from screening to diagnosis, the information received and support given by health professionals, and measures of anxiety and stress during this time interval. Four of the five pilot project initiatives shortened the time interval from screening to diagnosis, the greatest improvement occurring with facilitated referral from screening to diagnostic breast imaging. There was little difference among the pilot projects and control for most measures of client satisfaction and anxiety. Differences were found between biopsied and nonbiopsied women for several of these measures. Shortening the time to diagnosis positively influenced the client's perception of unnecessary delay.
Adult↗
A resume of some pilot control projects carried out in Egypt in the past 20 years.
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Adult↗
Scoliosis screening pilot project-A. Preliminary report to development of a statewide school program.
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Adolescent↗
Developing regional workplace health and hazard surveillance in the Americas.
An objective of the Workers' Health Program at the Pan American Health Organization (PAHO) is to strengthen surveillance in workers' health in the Region of the Americas in order to implement prevention and control strategies. To date, four phases of projects have been organized to develop multinational workplace health and hazard surveillance in the Region. Phase 1 was a workshop held in 1999 in Washington, D.C., for the purpose of developing a methodology for identifying and prioritizing the top three occupational sentinel health events to be incorporated into the surveillance systems in the Region. Three surveillance protocols were developed, one each for fatal occupational injuries, pesticide poisoning, and low back pain, which were identified in the workshop as the most important occupational health problems. Phase 2 comprised projects to disseminate the findings and recommendations of the Washington Workshop, including publications, pilot projects, software development, electronic communication, and meetings. Phase 3 was a sub-regional meeting in 2000 in Rosario, Argentina, to follow up on the progress in carrying out the recommendations of the Washington workshop and to create a Virtual Regional Center for Latin America that could coordinate the efforts of member countries. Currently phase 4 includes a number of projects to achieve the objectives of this Center, such as pilot projects, capacity building, editing a compact disk, analyzing legal systems and intervention strategies, software training, and developing an internet course on surveillance. By documenting the joint efforts made to initiate and develop Regional multinational surveillance of occupational injuries and diseases in the Americas, this paper aims to provide experience and guidance for others wishing to initiate and develop regional multinational surveillance for other diseases or in other regions.
Accidents, Occupational↗
[Telemedicine in sparsely populated areas yields satisfied patients and better competence].
A telemedical pilot-project involving two rural primary health care centers in Tärnaby/Storuman in Southern Lappland and the University Hospital of Umeå was carried out during the period Sept. 1, 1996-Dec. 31, 1998. Out of 169 consultations in all, 40 pertained to dermatology, 50 to ENT, 40 to orthopedics, and a further 27 to other specialties (surgery, medicine and gynecology). Among the 169, 47 cases were successfully managed via telemedicine. 30% of consultations were made in order to secure a second opinion. The remaining 70% were made in order to seek advice concerning a possible referral. At the telemedical visit, patients indicated a satisfaction score of 5.5 on a scale up to 6.0. The GP's rated the educational value at 4.4. After completion of the pilot-project, a survey of acceptance and ratings of the future potential of telemedicine for the health care system was carried out among 191 doctors and other health care workers in Västerbotten county. Using a similar graded scale up to 6.0, physicians rated telemedicine as regards utility for patients and quality of care at 4.6 and 4.5 respectively, somewhat higher than they rated the consequences of telemedical consulting for their working conditions and health care organizations, at 3.8 and 4.1 respectively. Despite a low volume of patients in the pilot project, we can conclude that telemedical consultations seem to reduce the number of referrals and raise the level of competency of the GP's. It's important to find further fields of application, as well as further ways of working and organizing the communication network in order to increase volume.
Clinical Competence↗