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At least 973 records · Page 54Linked to original sources
PubMed2006

What is the future of oncology? National Cancer Institute initiatives to improve research, development, and implementation in cancer prevention and treatment.

To improve the efficiency and effectiveness with which we bring novel cancer treatment and prevention strategies into routine clinical use, the National Cancer Institute has commissioned the Clinical Trials Working Group to restructure its activities related to clinical trials. A total of 22 initiatives have been developed and are being implemented under the rubrics of Coordination, Prioritization/Scientific Quality, Standardization, Operational Efficiency, and Integrated Management. A similar model was recently applied to the newly formed Translational Research Working Group, which will focus on more efficient translation of scientific discoveries arising from the laboratory, clinic, or population into early phase clinical testing.

Biomedical Research↗
PubMed2002

Conceptual framework of public health surveillance and action and its application in health sector reform.

BACKGROUND: Because both public health surveillance and action are crucial, the authors initiated meetings at regional and national levels to assess and reform surveillance and action systems. These meetings emphasized improved epidemic preparedness, epidemic response, and highlighted standardized assessment and reform. METHODS: To standardize assessments, the authors designed a conceptual framework for surveillance and action that categorized the framework into eight core and four support activities, measured with indicators. RESULTS: In application, country-level reformers measure both the presence and performance of the six core activities comprising public health surveillance (detection, registration, reporting, confirmation, analyses, and feedback) and acute (epidemic-type) and planned (management-type) responses composing the two core activities of public health action. Four support activities - communications, supervision, training, and resource provision - enable these eight core processes. National, multiple systems can then be concurrently assessed at each level for effectiveness, technical efficiency, and cost. CONCLUSIONS: This approach permits a cost analysis, highlights areas amenable to integration, and provides focused intervention. The final public health model becomes a district-focused, action-oriented integration of core and support activities with enhanced effectiveness, technical efficiency, and cost savings. This reform approach leads to sustained capacity development by an empowerment strategy defined as facilitated, process-oriented action steps transforming staff and the system.

Africa↗
PubMed1998

Methodology of quality improvement projects for the Texas Medicare population.

The Texas Medical Foundation, the quality improvement organization for the state of Texas, develops local quality improvement projects for the Medicare population. These projects are developed as part of the Health Care Quality Improvement Program undertaken by the Health Care Financing Administration. The goal of a local quality improvement project is to collaborate with providers to identify and reduce the incidence of unintentional variations in the delivery of care that negatively impact outcomes. Two factors are critical to the success of a quality improvement project. First, as opposed to peer review that is based on implicit criteria, quality improvement must be based on explicit criteria. These criteria represent key steps in the delivery of care that have been shown to improve outcomes for a specific disease. Second, quality improvement must be performed in partnership with the health care community. As such, the health care community must play an integral role in the design and evaluation of a quality improvement project and in the design and implementation of the resulting quality improvement plan. Specifically, this article provides a historical perspective for the transition from peer review to quality improvement. It discusses key steps used in developing and implementing local quality improvement projects including topic selection, quality indicator development, collaborator recruitment, and measurement of performance/improvement. Two Texas Medical Foundation projects are described to highlight the current methodology and to illustrate the impact of quality improvement projects.

Angina Pectoris↗
PubMed2006

Implementing chlamydia screening: what do women think? A systematic review of the literature.

BACKGROUND: Chlamydia trachomatis is a common sexually transmitted infection that can have serious consequences. It is universally agreed that screening for chlamydia infection should be offered to sexually active young women. We undertook a literature review to document the views, attitudes and opinions of women about being screened, tested and diagnosed with Chlamydia trachomatis. METHODS: Online databases (MEDLINE, Meditext, PsycINFO, Web of Science) and reference lists searched up to August 2005. Search terms: chlamydia, attitude, attitude to health, interview, qualitative, women. ELIGIBILITY CRITERIA: about chlamydia, included women, involved interviews/surveys/focus groups, looked at women's views/opinions/attitudes, published in English. Thematic analysis identified the main and recurrent themes emerging from the literature. We compared our thematic analysis with the Theory of Planned Behaviour to provide a model that could assist in planning chlamydia screening programs. RESULTS: From 561 identified articles, 25 fulfilled inclusion criteria and were reviewed. 22: USA, UK; 3: Holland, Sweden, Australia. Major themes identified: need for knowledge and information, choice and support; concerns about confidentiality, cost, fear, anxiety and stigma. Women are more likely to find chlamydia screening/testing acceptable if they think chlamydia is a serious, common condition which can cause infertility and if they understand that chlamydia infection can be asymptomatic. Women want a range of options for chlamydia testing including urine tests, self-administered swabs, pelvic exams and clinician-collected swabs, home-testing and community-based testing. Tests should be free, easy and quick. Women want support for dealing with the implications of a chlamydia diagnosis, they feel chlamydia diagnoses need to be normalised and destigmatised and they want assistance with partner notification. Women need to know that their confidentiality will be maintained. CONCLUSION: Our review found that women from various countries and ethnic backgrounds share similar views regarding chlamydia screening, testing and diagnosis. The acknowledged importance of women's views in planning an effective chlamydia screening program is expanded in this review which details the nature and complexity of such views and considers their likely impact.

Attitude to Health↗
PubMed1998

ISO 9000 model ideally suited for quality plan at blood centers.

BACKGROUND: The development of a quality plan is essential for organizations involved in manufacturing, trade, and services. The International Organization for Standardization (ISO) has established a common set of manufacturing, trade, and communications standards that are applicable worldwide and that provide the basis of a quality plan for institutions such as blood centers. STUDY DESIGN AND METHODS: The ISO 9002 conformance model and a registrar were selected to guide a core management team in establishing a superior quality plan for a blood center. The initial phase required that an analysis of the existing quality and document systems be performed, utilizing a 20-element "status of readiness" ISO assessment audit (gap analysis). Weaknesses in the quality systems were targeted and progress was evaluated by the registrar and an outside facilitator. RESULTS: Full implementation of ISO principles was achieved within the established timeline. Standard operating procedures were reviewed, supplemented, and expanded in every department, thereby ensuring consistent quality throughout the organization. Improvements in management, training, inspections, and statistical reporting were soon apparent during regular departmental audits. CONCLUSION: The ISO 9000 model is ideally suited for use by blood centers to establish a quality plan as required by the American Association of Blood Banks.

Blood Banks↗
PubMed2001

Judging outcomes in psychosocial interventions for dementia caregivers: the problem of treatment implementation.

PURPOSE: In published dementia caregiver intervention research, there is widespread failure to measure the level at which treatment was implemented as intended, thereby introducing threats to internal and external validity. The purpose of this article is to discuss the importance of inducing and assessing treatment implementation (TI) strategies in caregiving trials and to propose Lichstein's TI model as a potential guide. DESIGN AND METHODS: The efforts of a large cooperative research study of caregiving interventions, Resources for Enhancing Alzheimer's Caregiver Health (REACH), illustrates induction and assessment of the three components of TI: delivery, receipt, and enactment. RESULTS: The approaches taken in REACH vary with the intervention protocols and include using treatment manuals, training and certification of interventionists, and continuous monitoring of actual implementation. IMPLICATIONS: Investigation and description of treatment process variables allows researchers to understand which aspects of the intervention are responsible for therapeutic change, potentially resulting in development of more efficacious and efficient interventions.

Adaptation, Psychological↗
PubMed1999

Strategies for improving health plan member retention.

Member retention is an increasingly important issue for health plans to address. It costs health plans $75 to $200 to acquire a commercial member and $400 to $800 to acquire a Medicare member. If members leave the plan within the first year or so, up to half of this investment is lost. Health plans should implement several strategies, therefore, to improve member retention. They should communicate the value of retention throughout the organization, use a cross-functional team approach to retention, analyze who is disenrolling and why, improve access to referral providers, and extend the retention effort until a relationship exists, evaluate and strengthen member orientation efforts. Other ways to enhance member retention are to improve access to health and service information, improve provider-staff interaction and communication skills, implement relationship-enhancing communication campaigns, manage expectations about treatment, and create personal relationships at the plan-purchaser level.

Economic Competition↗
PubMed1999

[Implementation of intensive follow-up in the community: lessons to be considered].

OBJECTIVE: To examine various issues concerning the implementation of a program for assertive community treatment (ACT). METHOD: In-depth interviews were conducted with participants of an ACT project implemented in the 1970s. A quality analysis was undertaken, assessing the issues that prevented the expansion of such an approach as well as issues to be considered in future implementation of ACT. RESULTS: Social, cultural, organizational, professional, and economic factors were identified that will continue to play decisive roles in the integration of such a program. The ACT implementation in question occurred at the same time as the shift to community psychiatry, without having been linked to that approach. Currently, social factors such as self-help groups and parents foster the implementation of such programs. The organizational factors include the importance of linking ACT to existing health care services, as well as adapting ACT to these services. The association of this type of project with a research team did not ensure a successful implementation. A third factor is the psychiatrist's training and motivation with respect to the practice of this approach. Finally, economic issues are playing a larger role in the implementation of this approach. CONCLUSION: This study relates different issues regarding the implementation of an ACT. The results represent assumptions that need to be confirmed by assessing ACT implementation in Quebec as well as in the rest of Canada.

Community Mental Health Services↗
PubMed1998

Toward implementation of an urban health agenda: the role of government.

Government has several essential roles in the implementation of an urban health agenda. Government acts as a direct agent in the financing and delivery of services, as a rule maker for the financing and provision of care by others, and as a forum for political debate. Discussions of access to care, control of health care costs, and the maintenance of quality all include a role for government. A period of apparent rejection of comprehensive governmental health care policy has nevertheless included numerous examples of the persistence of government's many roles.

Delivery of Health Care↗
PubMed2006

The general picture of supportive health environments for persons with intellectual disabilities among 121 disability welfare institutions in Taiwan.

BACKGROUND: Little information is available on the provision of supportive health environments for persons with intellectual disabilities (ID) in institutions. The aim of this study was to present an overview of supportive environments for health in institutions in Taiwan. METHODS: A cross-sectional survey was conducted to examine the perceptions of 121 Taiwanese Institutional Directors on their setting's implementation of supportive healthy physical, social, and economic environments. RESULTS: Analyses showed that first-aid kits (97.5%) and medicine cabinets (85.5%) were the most common health facilities in institutions. Seventy-three per cent of institutions had set up specific areas to be used for rehabilitation practice, while only 43.1% thought their rehabilitation equipment/devices adequate for their real needs. Eighty-eight per cent of institutions implemented health promotion plans for people with ID, while 76.6% had appropriated specific health promotion plans. Sixty-three institutions (52.1%) reported employment of skilled nurses to serve people with ID, and these institutions showed statistically significant differences in implementation of each health facility. CONCLUSIONS: The present paper is the first to analyze supportive environments for health in disability institutions in Taiwan. An important focus of future research will be the extension of the present findings to consider the appropriateness of each area of supportive environments for improving the quality of institutional care for people with ID.

Attitude of Health Personnel↗
PubMed2006

The last Senior Medical Inspector of Factories and his place in the history of occupational health.

BACKGROUND: Apart from a few industrialists with senses of enlightened self-interest and of ethics, 19th century Occupational Health (OH) in the United Kingdom was essentially in the care of Her Majesty's Factory Inspectorate (HMFI). Two World Wars drew attention to the special health and efficiency needs of workers in the armaments industry, but it required the climate of a Welfare State after the Second for more general provision to be considered. A number of committees made recommendations for enhancing OH that were not implemented, and it was not until 1972 that a political will developed to enhance the State's provision. As a result of a far-sighted senior civil servant, a remarkable Senior Medical Inspector was in post, ready and willing to assist in bringing about change. METHODS: Published official materials have been reviewed in the light of the author's observation of events and persons from 1967 onwards. RESULTS: For a few years, as a consequence of a political will, academic, corporate, and governmental OH burgeoned in Britain, but with a decline in the economy and political change favoring deregulation, it underwent regression. CONCLUSIONS: Any number of committees may meet to discuss OH provision but their reports will moulder until there is a will for implementing their recommendations, at which the requisite funds and persons materialize to establish institutions. When the political climate changes, it will not be difficult to find persons who for a consideration will assist in their demolition.

Health Plan Implementation↗
PubMed1995

[Quality assurance in psychiatry. Concept--methodology--implementation].

Quality assurance is the corrective action applied to any observed discrepancy between optimal and actual level of medical care requiring continuous quality control. According to the German health act "Gesundheitsreformgesetz" introduced in 1989 [46], involvement in quality assurance is mandatory for all health professionals. Obviously, quality assurance is of utmost importance in psychiatric practice. Quality care as defined by the degree of adherence to standards and guidelines can be measured in terms of structural, process and outcome characteristics referring to inpatient, outpatient and complementary services. To promote the implementation of practice guidelines into psychiatric care conceptual, methodological, political, financial, and organizational requirements must be taken into account.

Cost-Benefit Analysis↗
PubMed2006

Approaching the CDC's guidelines on the HIV testing of inpatients: physician-referral versus nonreferral-based testing.

Despite ongoing evidence that one quarter of HIV-infected people in the United States are unaware of their infection, widespread implementation of the Centers for Disease Control and Prevention's 1993 recommendations regarding routine inpatient HIV testing has not occurred. This study compares two HIV testing strategies: the initial phase of inpatient HIV testing (1999-2001) utilized a physician-referral-based system. The second phase (2001-2003) included the first 2 years' experience with having trained HIV counselors directly approach inpatients regarding their willingness to undergo voluntary HIV counseling and testing (VCT) without physician referral. This latter phase was prompted by a patient attitude survey demonstrating favorable responses to unsolicited approaches by staff regarding HIV testing. Barriers to implementing the latter strategy are discussed and initial experience with rapid HIV testing on this service is also presented. Referral-based testing yielded 2.3 patient referrals (6.4% of total admissions) resulting in 1.2 HIV tests and 0.7 counseling only sessions per day. Nonreferral based testing resulted 6.2 HIV tests and another 3.0 counseling-only sessions per day. HIV VCT on an inpatient service is feasible but challenging. Most patients respond favorably to being approached for VCT. Routinely offering HIV tests to inpatients yields higher testing rates than physician referral-based systems and increases the number of patients who know their HIV status. Recommendations for implementing routing HIV testing on an inpatient service are made.

AIDS Serodiagnosis↗
PubMed1999

The African American church and university partnerships: establishing lasting collaborations.

This article highlights the experiences of the Health Wise Church Project, a community outreach initiative between a diverse group of African American churches and a university health education program. The objective of the program was to develop early detection and illness prevention networks among older church members. Not all partnerships results in long-term collaborations, and this article makes a clear distinction between different types of "working together" arrangements. The project discussed in this article presents a four-stage model to illustrate how organizations achieve collaborative partnerships. Involving community partners in the early phase of project planning contributed to the success of the church-university collaboration. This type of shared planning helped to sustain community interest during the project's implementation.

Black or African American↗
PubMed2004

[The legal system and health: obstacles and supportive areas for intersectorial action].

Article 8 of the Act Respecting the Protection of Persons Whose Mental State Presents a Danger to Themselves or to Others (Québec, 1997) introduced a new legal framework requiring a linkage between police departments and crisis intervention services to prevent involuntary hospitalizations. Through telephone interviews, observation sessions, and documentary analysis, the authors studied the implementation of article 8 in 16 Québec administrative regions. Results pertain to organizational consequences for the health and police sectors and methods of collaboration between the two sectors. They cast light on the difficulties of implementing article 8 and suggest conditions for the success of initiatives aimed at reducing unjustified recourse to the legal system and hospitalization in cases of persons with mental health problems.

Commitment of Persons with Psychiatric Disorders↗