SEARCH · PubMed Health

Results for “Implementation challenges”

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 1,261 records · Page 70Linked to original sources

PubMed1991

Antidepressant challenge tests: the interface of pharmacokinetics and pharmacodynamics.

Antidepressant compounds have been used as probes in neuroendocrine challenge tests designed to assess the functional responsivity of central neurotransmitter systems. Neurohormonal responses to the antidepressants desipramine and clomipramine, for example, can provide information regarding noradrenergic and serotonergic function, respectively. Pharmacokinetic factors can affect these antidepressant challenge tests. Proper attention to pharmacokinetic issues in the design, implementation, and analysis of data obtained with these probes will provide a more clear understanding of the pharmacodynamic meaning of the results from studies that apply antidepressant challenges.

Antidepressive Agents↗

PubMedDate not supplied

Assessing the implementation of clinical process innovations: a cross-case comparison.

Clinical process innovations (CPI) are central to the ability of organizations to negotiate the challenges of cost containment and quality improvement, yet many CPI have not met expectations. Perhaps most alarming is that the dissemination and implementation of CPI is not well understood. This is the second of two articles addressing the dissemination and use of CPI in integrated delivery systems. This article discusses those factors that have been identified as either facilitating or impeding the various stages in implementing CPI and suggests some intervention strategies to enhance opportunities for continuous CPI. Identifying the process and the factors driving the implementation of CPI is only part of the challenge. The development of CPI adequate to fully meet current challenges will require managers to re-examine existing paradigms and values influencing their actions to date. Within this context, the necessary staging of the innovation process within the life cycle, developing partnerships both within and outside the organization to gather the necessary resources and support, and multidimensional performance monitoring and feedback can prepare organizations and managers to better face the reality of managing the innovation process.

Communication↗

PubMed1997

Outreach services: issues and challenges.

Tompkins-McCaw Library of Virginia Commonwealth University has planned and implemented four one-year outreach service projects during the past two years. These projects were funded by the National Library of Medicine and the National Network of Libraries of Medicine Southeastern/Atlantic Region. The projects focus on information access for public health nurses, HIV/AIDS information access, and circuit librarian services in rural Southern Virginia. This article documents issues and challenges which have been identified from these projects and suggests ways to resolve them.

Academic Medical Centers↗

PubMedDate not supplied

A strategic response to the challenges presented by older patients with Alzheimer's disease and other types of dementia.

Clinical dementia has become one of the most serious and persistent health problems affecting persons over the age of 65. Efforts to find a cure for Alzheimer's disease and other causes of dementia are ongoing, while healthcare executives continue to face a number of challenges. Access to targeted programs and services for persons with dementia is lacking. The costs of program development and service delivery are substantial. Persons with dementia who do use services often do not receive the most effective and efficient care, and their providers often do not receive sufficient payment. Because few examples exist of how healthcare executives can appropriately respond to these challenges, we created an operational planning strategy. This strategy defines the challenges presented by persons with dementia, identifies four viable responses, and describes two factors that will contribute to successful implementation of these responses. If healthcare executives begin planning now, then the challenges presented by one of the more serious health problems of the next 20 years can be mitigated.

Aged↗

PubMed2003

Tackling health inequalities in the United Kingdom: the progress and pitfalls of policy.

GOAL: Assess the progress and pitfalls of current United Kingdom (U.K.) policies to reduce health inequalities. OBJECTIVES: (1) Describe the context enabling health inequalities to get onto the policy agenda in the United Kingdom. (2) Categorize and assess selected current U.K. policies that may affect health inequalities. (3) Apply the "policy windows" model to understand the issues faced in formulating and implementing such policies. (4) Examine the emerging policy challenges in the U.K. and elsewhere. DATA SOURCES: Official documents, secondary analyses, and interviews with policymakers. STUDY DESIGN: Qualitative, policy analysis. DATA COLLECTION: 2001-2002. The methods were divided into two stages. The first identified policies which were connected with individual inquiry recommendations. The second involved case-studies of three policies areas which were thought to be crucial in tackling health inequalities. Both stages involved interviews with policymakers and documentary analysis. PRINCIPAL FINDINGS: (1) The current U.K. government stated a commitment to reducing health inequalities. (2) The government has begun to implement policies that address the wider determinants. (3) Some progress is evident but many indicators remain stubborn. (4) Difficulties remain in terms of coordinating policies across government and measuring progress. (5) The "policy windows" model explains the limited extent of progress and highlights current and possible future pitfalls. (6) The U.K.'s experience has lessons for other governments involved in tackling health inequalities. CONCLUSIONS: Health inequalities are on the agenda of U.K. government policy and steps have been made to address them. There are some signs of progress but much remains to be done including overcoming some of the perverse incentives at the national level, improving joint working, ensuring appropriate measures of performance/progress, and improving monitoring arrangements. A conceptual policy model aids understanding and points to ways of sustaining and extending the recent progress and overcoming pitfalls.

Health Plan Implementation↗

PubMed1995

Implementation of a regional pediatric trauma center.

Today's hospitals face unique challenges in the treatment of pediatric trauma patients. With the advent of more sophisticated regional trauma systems, there is a growing awareness that children are not "little adults," but are a special component of the trauma patient population. As few communities can provide pediatric health care facilities committed to trauma care, regional pediatric trauma centers need to be developed and implemented so hospitals can provide pediatric trauma patients with comprehensive and age-appropriate care. This article describes the steps taken by the Children's Hospital Medical Center, Cincinnati, to develop a regional pediatric trauma center according to the guidelines set forth by the American College of Surgeons committee on trauma.

Child↗

PubMedDate not supplied

Innovative approaches to inservice education.

The many challenges facing nursing educators today include meeting the regulatory agency education standards while reaching staff on a variety of shifts/schedules. This article describes a model for the development, implementation, and evaluation of required inservice education that meets this challenge. Creative teaching strategies are discussed that facilitate learning at the individual level, encourage staff participation at the unit level, and contain costs at the department level.

Education, Nursing, Continuing↗

PubMed1998

The challenge of integrating clinical information systems in an integrated delivery system.

The development and implementation of the information systems necessary to support an effective and efficient continuum of care and to measure the quality and cost of that care present complex information systems integration challenges. The article discusses the integration challenges and concludes with a review of strategies that an integrated delivery system can adopt to begin to address them.

Computer Systems↗

PubMed2005

Process evaluation of a store-based environmental obesity intervention on two American Indian Reservations.

Obesity and other diet-related chronic diseases are widespread in American Indian communities. Inadequate access to healthy food on many reservations has led to a high-fat, high-sugar diet. The purpose of this paper is to report on the results of the process evaluation of a food store-based program to improve diet on two American Indian reservations. Process data were collected from 11 intervention stores to document the implementation of the Apache Healthy Stores (AHS) program. Process evaluation instruments recorded the stocking of promoted foods, presence of in-store communication materials, implementation of and participation in the cooking demonstrations and taste tests, and the transmission of mass-media messages. At the store level, the program was implemented with a high level of dose and reach, and a moderate to high level of fidelity. At the community level, the AHS program was implemented with a moderate degree of fidelity and dose. At the individual level, the cooking demonstrations and taste tests reached a large number of community members with a high dose. Implementing the AHS program on multiple levels (store, community, individual) was challenging, and differed between levels. Overall, improvements were seen from start to finish as program staff monitored, documented and responded to barriers to implementation. Process data will be tied to outcomes and will be useful for the planning of future store-based programs.

Arizona↗

PubMedDate not supplied

Implementing evidence-based practice in clinical situations.

Many nurses in a variety of clinical settings are facing the challenges posed by incorporating evidence-based practice in health care. Some of the steps involved in implementing evidence-based care in clinical practice are discussed and a two-step framework to assist practitioners in implementing evidence-based practice is outlined. Factors such as the relevance of specific guidelines or research, generalisability of research findings, the strength of the evidence relative to the risks and benefits of treatment, and patient preferences are discussed in terms of evidence-based decision making.

Benchmarking↗

PubMed1996

Challenges for the urban home health care provider. The New York City experience.

This article describes the development and implementation of the AIDS home care program at the Visiting Nurse Service of New York (VNSNY). The challenges to VNSNY staff are diverse and include (1) dealing with staff who are infected or affected by HIV in their own families; (2) working with other community-based case managers; (3) working in high crime areas and dealing with substance abuse; (4) managing families in crisis; (5) dealing with violence and abuse in the home, including staff abuse; (6) managing problems with informal caregivers; (7) managing clients who participate in unsafe sexual activities; and (8) dealing with issues of HIV confidentiality.

Community Health Nursing↗

PubMed1991

Implementing information systems.

Effective implementation and system selection are equally important for a successful information system. Many new challenges exist in laboratory management and information system operations. Philosophy, strategy, and selected details of system implementation are presented in the context of practical examples of implementation issues.

Clinical Laboratory Information Systems↗

PubMedDate not supplied

A discharge planning program in orthopaedics: experiences in implementation and evaluation.

The acute care orthopaedic registered nurse plays a key role in assessing and communicating the continuing care needs of patient's and their families, coordinating community resources, and formulating a timely discharge plan to maximize rehabilitation and recovery. Developing and maintaining a staff nurse's discharge planning knowledge and skills can be a challenging endeavor. Discharge Planning Coordinators at a tertiary medical center developed and implemented a Discharge Planning Mentorship Program, an educational pilot program designed to enhance the knowledge and skill level of select nurses in the orthopaedic specialty practice, thus maximizing expert resources at the bedside. Program implementation and evaluation of role preparation, practice changes, and actualization challenges are discussed in this article. Overall, participants demonstrated increased skill in articulating and problem solving a patient's postdischarge needs, devised creative strategies to enhance communication between multiple levels of care, and developed a greater knowledge of community resources and reimbursement mechanisms for continuing care.

Clinical Competence↗

PubMed1999

Using disease-state management as the key to promoting employer sponsorship of medical nutrition therapy (continuing education credit).

The purpose of this project was to design, implement, and improve a nationwide medical nutrition therapy (MNT) intervention program for nutritionally at-risk employees and their dependents and retirees (hereinafter referred to as clients) with a Fortune 100 company (Texas Instruments, Dallas, Tex) with a dispersed population of 80,000. Preferred Nutrition Therapists (PNT), a network of registered dietitians, with the assistance of the Texas Instruments Health Promotion and Benefits Department, identified International Classification of Diseases, 9th ed (ICD-9), codes for which MNT intervention was appropriate. PNT then negotiated a contract with the Texas Instruments Health Promotion and Benefits Department and implemented clients' self-referral process. The main challenge was to promote utilization of a new service from an outside vendor (PNT) and to measure outcomes in meaningful ways. The goal was to use MNT as a tool to prevent the progression of clients' diseases to states that require more costly treatments. PNT used a continuous quality improvement process to refine the system and improve information gathering and reporting, by providing quarterly reports to the Health Promotion and Benefits Department. These reports summarized the outcomes for all clients seen at least 3 times during the quarter. The cost was less than $0.35 per member per month (less than the employer spent on advertising the program), and 0.5% of the population requested MNT during the first year of implementation (about what was expected for a new carveout benefit).

Aged↗

PubMed2004

[IKOP-Infection control in the operating theatreConsensus on the theme "Barrier measures during operations and invasive procedures"].

Postoperative surgical site infections remain frequent despite intensive control programs. With rising numbers of operations and invasive procedures in the outpatient setting and in immunocompromised patients, the prevention of wound infections presents a rapidly growing challenge to the medical community. Barrier measures including drapes and surgical gowns to prevent wound contamination, have clearly reduced the rate of wound infections. The optimal material characteristics for operating gowns and drapes are well defined, but there is still a long running controversy on the use of single-use versus reusable materials. We review the efficacy and ecological impacts of these different approaches. Currently no superiority of any of these approaches with regard to either efficacy or ecological impact can be found. The European Union has recently published a series of mandatory standards to specify material characteristics of barrier materials used in operating theatres (EN 13795). Their scope include production standards of these materials as well as specific processes in auditing their characteristics. The implementation of these norms will clearly present a challenge to European hospitals but will lead to better material characteristics in the end.

Europe↗

PubMedDate not supplied

Outcome based management.

This article describes a conceptual framework for implementation of outcomes driven management. The framework is defined in terms of strategic and financial planning, and quality management. The concept of value for investment is explored and definitions are presented in the introduction. Background information provides an overview of the literature with an emphasis on management challenges and quality management. The methodology is described including implementation and evaluation. Experiential examples of implementation techniques and global outcomes in the three domains of service, service provider and service manager are presented. The article is concluded with advantages, disadvantages and summative remarks.

Decision Trees↗

PubMed2000

Security model for picture archiving and communication systems.

The modern information revolution has facilitated a metamorphosis of health care delivery wrought with the challenges of securing patient sensitive data. To accommodate this reality, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). While final guidance has not fully been resolved at this time, it is up to the health care community to develop and implement comprehensive security strategies founded on procedural, hardware and software solutions in preparation for future controls. The Virtual Radiology Environment (VRE) Project, a landmark US Army picture archiving and communications system (PACS) implemented across 10 geographically dispersed medical facilities, has addressed that challenge by planning for the secure transmission of medical images and reports over their local (LAN) and wide area network (WAN) infrastructure. Their model, which is transferable to general PACS implementations, encompasses a strategy of application risk and dataflow identification, data auditing, security policy definition, and procedural controls. When combined with hardware and software solutions that are both non-performance limiting and scalable, the comprehensive approach will not only sufficiently address the current security requirements, but also accommodate the natural evolution of the enterprise security model.

Computer Communication Networks↗

PubMedDate not supplied

Non-governmental organizations in international health: past successes, future challenges.

Non-governmental organizations, or NGOs, are increasingly instrumental to the implementation of international health programs. Following an overview of current conditions in global health and the problems that could be targeted by NGOs, this article describes the activities and philosophies of several representative approaches in this sector. The attributes of NGOs that increase their potential effectiveness are discussed, including ability to reach areas of severe need, promotion of local involvement, low cost of operations, adaptiveness and innovation, independence, and sustainability. A summary is provided of major future challenges in international health that may be addressed by NGOs, with particular emphasis on tobacco-related disease, communicable diseases and the AIDS epidemic, maternal mortality and women's health, injury prevention and control, and the need to secure durable financial support.

Acquired Immunodeficiency Syndrome↗