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PubMed2006

An audit of the quality and content of periodontal referrals and the effect of implementing referral criteria.

AIMS: This audit aimed to assess the effect of implementing referral criteria on the quality and content of referral letters sent by general dental practitioners (GDPs) to the periodontal department of a teaching hospital. METHODS: Retrospective data were collected from a total of 450 referrals made in: (i) 1997, prior to any changes; (ii) 2000/2001, after referral guidelines were implemented; and (iii) 2004/2005, after referral criteria were redefined and circulated via Primary Care Trusts. A standardised data-collection form was used to record the information that was provided in the referral letters. This information was also compared to the findings at initial hospital consultations. RESULTS: There was a small improvement in the administrative details provided in the referral communications in 2000/2001 and 2004/2005. Medical history was often incomplete and was mentioned in 31-34% of referral letters. Use of the Basic Periodontal Examination (BPE) score increased from 17% (1997) to 57% (2004/2005). The information on clinical details otherwise increased in 2000/2001 with a tendency to decrease in 2004/2005. There was little agreement between the clinical details in the referral communications and the findings at consultation in the periodontal department. CONCLUSIONS: Following implementation of referral criteria, there was an increase in the clinical details provided in referral letters. However, the validity of the information provided by the GDPs was often questionable. The number of referrals that provided medical history details remained unchanged. Use of a pro forma was not associated with an improvement in the quality of referrals in this audit.

Communication↗

PubMedDate not supplied

Implementing HIPAA privacy regulations in pharmacy practice.

A worthy goal of HIPAA is to protect the privacy of patient health information. Final regulations for achieving this goal have been issued, and all covered entities, including all pharmacies that transmit health information electronically, must comply with these regulations by April 14, 2003. Pharmacists are strongly advised to begin educating themselves about the HIPAA privacy regulations and taking steps toward implementation as soon as possible. Because of the complexity of the privacy rule and the lingering ambiguities about how to implement the regulations, pharmacies also are encouraged to obtain expert guidance and stay up-to-date with the regulations and implementation recommendations posted by OCR.

Confidentiality↗

PubMedDate not supplied

Community and ambulatory pharmacy: evaluation of patient care services and billing patterns before implementation of Medicare part D.

OBJECTIVE: To provide a summary of community and ambulatory pharmacy practice and billing patterns for medication therapy management services before implementation of Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). DESIGN: Cross-sectional survey. SETTING: Ambulatory care and community pharmacy practice settings in the United States in January 2004. PARTICIPANTS: Members of the American College of Clinical Pharmacy Ambulatory Practice and Research Network, preceptors of the American Pharmacists Association (APhA) Community Pharmacy Residency Programs, and participants in the APhA Immunizing Pharmacist listserv. INTERVENTIONS: E-mail invitations to participate in a Web-based survey. MAIN OUTCOME MEASURES: Practice setting; pharmacy services performed; whether pharmacists were billing for pharmacy services; if billing, the billing technique used; if not billing, the reason for not billing. RESULTS: Of 349 respondents, 127 (36.4%) were practicing within a physician office, while 121 (34.7%) were practicing in community pharmacies. Diabetes, anticoagulation, dyslipidemia, hypertension, and smoking cessation management services were performed significantly more often in physician offices. Immunization delivery and diabetes, dyslipidemia, and osteoporosis screenings were performed significantly more often in community settings. A total of 190 (54.5%) pharmacists stated that they were billing for pharmacy services. More community pharmacists were billing for services compared with other combined practice settings (69.2% versus 46.7%, P < .001). Top reasons identified for not billing for services were salaried position, indigent population, and discomfort with the billing process. CONCLUSION: Valuable baseline data are provided regarding pharmacy services that have been successfully implemented in ambulatory and community practice settings and which billing techniques were used to receive reimbursement before the implementation of MMA.

Ambulatory Care↗

PubMed2002

Burnout and self-efficacy: a study on teachers' beliefs when implementing an innovative educational system in the Netherlands.

BACKGROUND: In the Netherlands, secondary education has seen radical changes that originated with the national authorities, including the Study-home system, a pupil-centred approach in which teachers help develop pupils' independent working and creative thinking in order to get them to take responsibility for their own academic achievements. As educational innovations are more often than not accompanied by stress, the present study focuses on the onset of burnout among teachers who recently implemented this innovative system in the Netherlands. AIMS: To test hypotheses that the extent to which teachers have a negative attitude towards the new instructional practices relates positively to their level of burnout, and that their self-efficacy beliefs regarding implementation of the practices and coping with stress involved in this relate negatively to their burnout levels. SAMPLE: A random sample of 490 teachers employed in the Study-home system participated in this study. METHODS: Three questionnaires were used. The Dutch version of the Maslach Burnout Inventory for teachers (Schaufeli & Van Horn, 1995) was used to assess the teachers' burnout level. Second, a specially developed self-efficacy questionnaire relating to the domains of: (1) guiding groups of students using the principle of differentiation, (2) involving pupils with tasks and (3) use of innovative educational practices. Last, a questionnaire on the teachers' attitudes concerning the usefulness and effectiveness of the Study-home as an educational innovation. RESULTS: Regression analyses showed that the self-efficacy beliefs for each of the three domains were significantly and negatively related to the depersonalisation and emotional exhaustion dimensions of burnout, and significantly positively related to the personal accomplishment dimension. Furthermore, the more negative the teachers' attitudes towards the Study-home appeared to be, the more they appeared to suffer from depersonalisation and emotional exhaustion, and the lower they scored on the personal accomplishment dimension of burnout. CONCLUSIONS: The study's results indicate that teachers' self-efficacy beliefs are related to their burnout level. Teachers with strong self-efficacy beliefs seem to be more prepared to experiment with, and later also to implement new educational practices.

Adolescent↗

PubMed2005

Anti-bullying intervention: implementation and outcome.

BACKGROUND: The participant role approach represents a view of bullying as a group process in which bystanders often encourage the bullying or silently witness it, while little support is given to the victim (e.g. Salmivalli, Lagerspetz, Björkqvist, Osterman, & Kaukiainen, 1996). There is a discrepancy between students' attitudes (which are often against bullying) and their actual behaviour in bullying situations, and this may be an important factor contributing to the persistence of the problem. AIM: The aim of the present study was to evaluate the effects of an anti-bullying intervention programme targeting the group as a whole. Class teachers who attended a 1-year training course carried out the interventions in school classes. The present evaluation of the project is based on multi-level modelling, assessing the programme effects after 12 months of intervention, utilizing a cohort longitudinal design with adjacent cohorts (Olweus & Alsaker, 1991) also taking into account the degree of implementation of the programme. SAMPLE: The intervention was implemented in 48 school classes (Grades 4, 5, and 6) from 16 Finnish schools, involving 1,220 children (600 girls and 620 boys). METHOD: The present report is based on questionnaire data collected at two assessment points during the project, assessing the frequencies of bullies and victims, the extent of observed and experienced bullying, students' attitudes and efficacy beliefs related to bullying, and their participant role behaviours (self- and peer-reported). Reports were collected from teachers about the concrete actions taken in order to compare the actual content of the intervention to what had been planned. RESULTS: A positive impact of the intervention programme was found on several outcome variables (e.g. frequencies of bullies and victims, observed and experienced bullying, attitudes and efficacy beliefs, and to some extent, participant role behaviours). The intervention effects were found more often in Grade 4 than in Grade 5, and often only in schools with a high degree of implementation of the programme.

Aggression↗

PubMed2002

Combining motivational and volitional interventions to promote exercise participation: protection motivation theory and implementation intentions.

OBJECTIVE: This study compared a motivational intervention based on protection motivation theory (PMT, Rogers, 1975, 1983) with the same motivational intervention augmented by a volitional intervention based on implementation intentions (Gollwitzer, 1993). DESIGN: The study had a longitudinal design, involving three waves of data collection over a 2-week period, incorporating an experimental manipulation of PMT variables at Time 1 and a volitional, implementation intention intervention at Time 2. METHOD: Participants (N=248) were randomly allocated to a control group or one of two intervention groups. Cognitions and exercise behaviour were measured at three time-points over a 2-week period. RESULTS: The motivational intervention significantly increased threat and coping appraisal and intentions to engage in exercise but did not bring about a significant increase in subsequent exercise behaviour. In contrast, the combined protection motivation theory/implementation intention intervention had a dramatic effect on subsequent exercise behaviour. This volitional intervention did not influence behavioural intention or any other motivational variables. CONCLUSIONS: It is concluded that supplementing PMT with implementation intentions strengthens the ability of the model to explain behaviour. This has implications for health education programmes, which should aim to increase both participants' motivation and their volition.

Clinical Trial↗

PubMed2006

A customer service approach to implementing a best practice at community health centers.

It is important that strategies for implementing evidence-based best practices into clinical care are developed and tested. This is particularly true for community health centers (CHCs), which are a primary source of care for low-income patients. This article focuses on a customer service approach to implementing best practices in CHCs. The approach was designed to be responsive to the tremendous demands on and limited resources of CHC staff. The CHC staff were the customers of the project while the project team played a supportive role, acting as a full-service vendor to identify and meet staff needs. Although a tobacco system was the focus of this project, it is applicable to implementing in clinical settings generally, regardless of the particular health topic.

Benchmarking↗

PubMed2002

Image preprocessing for improving computational efficiency in implementation of restoration and superresolution algorithms.

Computational complexity is a major impediment to the real-time implementation of image restoration and superresolution algorithms in many applications. Although powerful restoration algorithms have been developed within the past few years utilizing sophisticated mathematical machinery (based on statistical optimization and convex set theory), these algorithms are typically iterative in nature and require a sufficient number of iterations to be executed to achieve the desired resolution improvement that may be needed to meaningfully perform postprocessing image exploitation tasks in practice. Additionally, recent technological breakthroughs have facilitated novel sensor designs (focal plane arrays, for instance) that make it possible to capture megapixel imagery data at video frame rates. A major challenge in the processing of these large-format images is to complete the execution of the image processing steps within the frame capture times and to keep up with the output rate of the sensor so that all data captured by the sensor can be efficiently utilized. Consequently, development of novel methods that facilitate real-time implementation of image restoration and superresolution algorithms is of significant practical interest and is the primary focus of this study. The key to designing computationally efficient processing schemes lies in strategically introducing appropriate preprocessing steps together with the superresolution iterations to tailor optimized overall processing sequences for imagery data of specific formats. For substantiating this assertion, three distinct methods for tailoring a preprocessing filter and integrating it with the superresolution processing steps are outlined. These methods consist of a region-of-interest extraction scheme, a background-detail separation procedure, and a scene-derived information extraction step for implementing a set-theoretic restoration of the image that is less demanding in computation compared with the superresolution iterations. A quantitative evaluation of the performance of these algorithms for restoring and superresolving various imagery data captured by diffraction-limited sensing operations are also presented.

Journal Article↗

PubMed2004

Quantum-implementable selective reconstruction of high-resolution images.

This paper, written for interdisciplinary audience, presents computational image reconstruction implementable by quantum optics. The input-triggered selection of a high-resolution image among many stored ones, and its reconstruction if the input is occluded or noisy, has been successfully simulated. The original algorithm, based on the Hopfield associative neural net, was transformed in order to enable its quantum-wave implementation based on holography. The main limitations of the classical Hopfield net are much reduced with the simulated new quantum-optical implementation.

Journal Article↗

PubMed1988

Edge-detection schemes highly suitable for hardware implementation.

Two schemes for edge detection of real images based on gradient maxima are presented. Images are filtered with narrow filters to increase localization. Experimental results and theoretical considerations suggest that the exact shape of the filter is not critical for good performance of the algorithm. Therefore a filter can be chosen to allow for a highly efficient hardware implementation, for example, a binary filter or a 4-bit finite-impulse-response filter. Because the digitized values of a binary filter are powers of 2, the hardware implementation does not require time-consuming computations, such as multiplication and time shift, but just appropriate addressings. The performance of this scheme, or a similar scheme using 4-bit filters, is as satisfactory as that of more sophisticated schemes. Therefore these low-cost schemes are likely to be more suitable for hardware implementation.

Algorithms↗

PubMedDate not supplied

Care quality and implementation of the chronic care model: a quantitative study.

PURPOSE: We wanted to test whether improvements in care quality were correlated with changes in the Chronic Care Model (CCM) in a large medical group that attempted to implement the CCM. METHODS: The leaders of 17 primary care clinics in this medical group completed the Assessing Chronic Illness Care (ACIC) survey measure of CCM implementation before and after care system changes were made. We used administrative data to measure care quality changes for yearly samples of patients with diabetes, coronary heart disease, or depression. RESULTS: The total ACIC score for the CCM increased by an overall average of 1.4 points (from 5.8 to 7.2 on a scale of 1 to 11, P = .02) and significant increases occurred for 3 of the 6 components of the CCM. During this time, patients experienced a significant increase in the proportion meeting a composite outcome measure for low-density lipoprotein (LDL) and glycated hemoglobin levels (from 15.7% to 25.5%, P = .001). Heart disease patients meeting a composite measure for LDL values increased from 46.8% to 57.8%, and the percentage of patients with 1 or more cardiac events dropped from 17.2% to 11.4% (P = .001 for each). Persistent use of new antidepressants did not change, but more of these patients had follow-up visits (P = .02). Only the diabetes measure was significantly correlated with 2 CCM elements-clinical information systems and decision support. CONCLUSION: Despite implementation of the CCM and improvements in quality measures for 3 chronic diseases, there were few significant correlations between these changes. Showing such a relationship may require larger changes, a larger number of clinics, changes in other CCM elements, or a more-sensitive measurement tool.

Ambulatory Care Facilities↗

PubMed2006

Outcomes of Project Wall Talk: an HIV/AIDS peer education program implemented within the Texas State Prison system.

We report select outcomes from an evaluation of Project Wall Talk, a community-based, peer-led HIV prevention education program implemented in 36 Texas State prison units. Peer educators completed questionnaires prior to receipt of a 40-hour intensive training (N = 590) and at 9-month follow-up (N = 257). Students (N = 2506) completed questionnaires pre- and post-receipt of peer educator-led HIV education sessions. Peer educators and their students showed significant increases in HIV-related knowledge. Peer educators showed significant increases in assessment of their skills as educators. For both peer educators and students, significant differences in HIV-related knowledge were indicated across categories of prior educational level attained and race/ethnicity; no such differences were indicated at follow-up. Compared with baseline, a significantly greater proportion of peer educators reported ever having had an HIV test. After receiving peer-led education, a significantly smaller proportion of students reported they knew their HIV status and more indicated plans to take an HIV test. Additionally, in months 12 and 18 following program implementation, the numbers of HIV tests at the five units that implemented the peer education program were roughly twice that of five, matched comparison units without the peer education program. Based on peer educator reports, we projected that peer educators (N = 257) may have as many as 84,000 or more annual opportunities to share HIV-related knowledge with other prisoners outside the classroom.

Adult↗

PubMed2006

Adaptation and implementation of an evidence-based prevention counseling intervention in Texas.

HIV prevention counseling linked with testing has been shown to reduce high-risk behaviors and new sexually transmitted diseases in public clinic settings. However, few studies have been conducted evaluating the implementation of such models outside a research setting. This study sought to determine the extent to which the introduction of a standard protocol based on Project RESPECT improves the achievement of HIV prevention counseling goals of existing counseling and testing programs. Four prevention counseling programs contracting with the Texas Department of State Health Services completed a standardized 5-day training and implemented the protocols, counseling tools, and quality assurance (QA) procedures developed for the project. Introduction of the protocol was accomplished with existing program resources and significantly improved prevention counseling. Direct observation of counseling sessions demonstrated a significant improvement in attainment for eight of the nine counseling goals of initial sessions and for all counseling goals of follow-up sessions after the protocol was introduced. Client exit questionnaires reinforced this finding. Significant improvement was also found in use of counseling skills, with improvements in 6 of 10 skills observed in initial sessions and 4 of 10 skills in follow-up sessions. Challenges identified through semistructured interviews with counselors and supervisors included serving non-English-speaking and low-risk clients, mastery of the protocol, the amount of time required for QA, and implementation in settings with severe time constraints.

Counseling↗

PubMed2006

Translating research into practice: the dissemination and initial implementation of an evidence-based HIV prevention program.

Substantial effort has gone into scientifically developing and evaluating HIV prevention interventions. These programs make only minor contributions to HIV prevention efforts until they are widely put into practice; however, little research has been conducted to study how evidence-based, community-level HIV prevention interventions diffuse from research into practice. This article explores how one such evidence-based intervention for young MSM, the Mpowerment Project (MP), is scaling up in the US. The goals of this article are threefold: (a) to describe our longitudinal study, currently underway, concerning issues regarding translating research to practice; (b) present detailed data from 69 CBOs that are implementing the MP regarding characteristics of their communities, agencies, and target populations; and (c) to present baseline data on how these agencies are attempting to implement the MP, focusing on which intervention components CBOs decided to implement, modify, or delete and the implications of these modifications.

Community Networks↗

PubMed2006

The VOICES/VOCES success story: effective strategies for training, technical assistance and community-based organization implementation.

The Centers for Disease Control and Prevention's Diffusion of Effective Behavioral Interventions (DEBI) project successfully disseminated VOICES/VOCES, a brief video-based HIV risk reduction intervention targeting African American and Latino heterosexual men and women at risk for HIV infection. Elements of the dissemination strategy included a comprehensive and user-friendly intervention kit, comprising (a) an implementationmanual and othermaterials necessary for conducting the intervention (b) a Training of Facilitators (TOF) curriculum used to teach agency staff how to implement the EBI in their setting, (c) a network of expert trainers who attend a training institute to become adept at using the TOF curriculum to train facilitators, (d) a comprehensive training coordination center to plan and deliver TOF trainings, (e) proactive technical assistance to trainers, and (f) post-TOF technical assistance for local implementers. This article reports on those strategies and a local CBO's successful participation in DEBI, resulting implementation of VOICES/VOCES, with unique approaches to adaptation and tailoring.

Black or African American↗

PubMed2006

An empirical assessment of implementation, adaptation, and tailoring: the evaluation of CDC's National Diffusion of VOICES/VOCES.

The Centers for Disease Control and Prevention (CDC), through its Diffusion of Effective Behavioral Interventions (DEBI) program, trained over 260 agencies on VOICES/VOCES between August 2003 and April 2005. ORC Macro conducted interviews with agency staff 3 months after receiving VOICES/VOCES training. This article discusses the diffusion of VOICES/VOCES; agencies' adoption, adaptation, and implementation of this intervention; and needs for ongoing proactive technical assistance (TA) for agencies to successfully integrate behavioral interventions into their programs. The vastmajority of agencies implemented VOICES/VOCES with fidelity to the core elements, and agencies successfully adapted the intervention to make it more appealing to target populations. TA is needed for interventions to be successfully adapted and implemented with fidelity to the core elements, and to ensure program sustainability. More effective interventions of short duration and minimum complexity to easily match with existing resources and conditions of agency capacity among HIV prevention providers in the community are needed.

Black or African American↗

PubMed2006

Assessing community needs and agency capacity--an integral part of implementing effective evidence-based interventions.

Community-based organizations and public health departments have historically applied for and received funding to implement a variety of HIV prevention interventions, but it is unclear how they make decisions regarding which interventions to implement or whether their agency has sufficient capacity and/or resources to effectively carry them out. Assessment activities can play a valuable role in helping agencies make these decisions by providing information to better target services. Recent funding efforts supporting the Diffusion of Effective Behavioral Interventions Project and other evidence-based approaches for HIV prevention require that agencies possess basic skills to effectively conduct individual-, group-, or community-level interventions, as well as the specific activities associated with an evidence-based intervention (EBI). We examine the link among community assessment, agency capacity, and intervention effectiveness, and provide resources to better guide programs in assessing their communities and organizations in order to implement the most effective EBI.

Efficiency, Organizational↗

PubMed2006

The diffusion of effective behavioral interventions project: development, implementation, and lessons learned.

Implementation of evidence-based HIV/STD prevention interventions can play an important role in reducing HIV and sexually transmitted diseases. This article describes the development, implementation, and lessons learned of the Diffusion of Effective Behavioral Interventions (DEBI) project, a strategy funded by the Centers for Disease Control and Prevention to diffuse evidence-based, group- and community-level HIV/STD prevention interventions to health departments and community-based organizations nationwide. The article specifically provides an overview of the rationale, description, and theoretical foundation of the project; a review of marketing efforts, including assessment of interests, needs, and capacities relative to the project; a description of project products, their purpose, approach employed to develop them, and their use by implementers; a description of the project's training coordination functions and activities; technical assistance issues; an overview of process and outcome evaluation components; new developments in response to feedback; and a discussion of future directions for DEBI. Project successes and challenges are addressed to inform future efforts to diffuse prevention interventions.

Diffusion of Innovation↗