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At least 1,297 records · Page 72Linked to original sources

PubMed1997

Disease management: program design, development, and implementation.

Disease management is an emerging approach to patient management, customer satisfaction, and cost containment that comprises disease modeling; patient segmentation and risk assessment; clinical protocols; and wellness, self-management, and education. Implementing a disease management program poses significant challenges to healthcare organizations. To successfully implement a disease management program, a tightly integrated continuum of care, sophisticated information systems, and disease management support systems must be in place. Strategic partnerships with outside vendors may speed program implementation and provide opportunities to develop risk-sharing relationships.

Costs and Cost Analysis↗

PubMed1997

Growth hormone coverage policy and implementation: a four-year experience.

Expenditures for growth hormone (GH) in the United States approximates 400 million dollars annually. There is considerable controversy and variation around both the indications for GH treatment and insurance coverage decisions involving GH treatment. To address these issues, Harvard Community Health Plan (HCHP), now merged with Pilgrim Health Care to form Harvard Pilgrim Health Care (HPHC), developed a policy and implementation plan in 1992 which limited access to GH to those conditions for which GH has been shown to be effective. The 4-year experience of the HPHC Growth Hormone Review Committee, which determines by case review whether criteria for GH coverage are met, is described. The result has been a more rational, equitable approach to decisions about GH treatment coverage, and significant cost reductions. Caution is warranted in expanding access to GH because the potential for serious side effects has not been completely eliminated. Four years after the inception of the policy and approval process (1992-1995), it is estimated that savings have exceeded 1 million dollars. Growth hormone prescribing costs decreased from 13.4% of total to 4.4% of total drug costs 4 years after the new policy was implemented. This approach to policy development and implementation may be applicable to managing high-cost pharmaceuticals and advanced technology in other settings.

Child↗

PubMed1997

Implementation of standardized nursing languages (NIC, NOC) in on-line care planning and documentation.

At the University of Iowa Hospitals and Clinics (UIHC), the Standardized Nursing Languages (SNLs) of Nursing Interventions Classification (NIC) and Nursing-sensitive Outcomes Classification (NOC) are being implemented in on-line care planning and documentation. NIC and NOC are being integrated in the INFORMM NIS (Information Network For Retrieval & Medical Management Nursing Information System). The implementation process for SNLs includes six components: objectives, programming, database content, education, utilization, and evaluation. This process has been used successfully in NIC implementation and will be applied in NOC field testing.

Humans↗

PubMed1997

Implementation of a patient management system in a children's hospital.

Implementing systems to the clinical areas within the hospital setting, is increasing as rapidly as technology is changing. This paper describes the requirements and problems identified during an implementation of a patient management system to a major Paediatric Hospital. The system implemented was developed within the I.S. Department of the hospital and provides a high degree of functionality and ease of use for clinical and clerical staff. It also offers case-based interfaces to clinical and business management systems outside the patient care setting.

Case Management↗

PubMedDate not supplied

Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program.

OBJECTIVE: To evaluate changes in antimicrobial use and expenditures and the rates of selected nosocomial infections due to resistant organisms associated with implementation of an antimicrobial-prescribing improvement program. DESIGN: Before-after trial comparing 1992 (pre-program), 1993 (a transition year), and 1994 (after full implementation of the program). SETTING AND PARTICIPANTS: Academic medical center, all patients and physicians. INTERVENTION: An antimicrobial-prescribing improvement program with prior approval requirement for use of restricted agents. MAIN OUTCOME MEASURES: Antimicrobial use and expenditures, rates of selected nosocomial infection marker events. RESULTS: Between 1992 and 1994, there were substantial decreases in antimicrobial use, from 158,107 to 137,364 defined daily doses, and in expenditures from $2,486,902 ($24.01 per patient day) to $1,701,522 ($18.49 per patient day). After adjusting for changes in purchase prices and census days, we estimated savings attributable to the program of $279,573 in 1993 and $389,814 in 1994. In addition, we found significant decreases between 1992 and 1994 in the rates of enterococcal bacteremia (.34 vs .16 events per 1,000 patient days; P = .016), selected gram-negative bacteremia (.26 vs .11; P = .015), methicillin-resistant Staphylococcus aureus colonization or infection (.66 vs .20; P < .0001), and Stenotrophomonas colonization or infection (.35 vs .17; P = .019). No significant change occurred in rates of nosocomial candidemia or Clostridium difficile toxin-positive diarrhea. Values for 1993 were intermediate between those of 1992 and 1994. CONCLUSION: Implementation of an antimicrobial-prescribing improvement program was associated with substantial savings in antimicrobial use and expenditures and significant decreases in rates of selected nosocomial infections due to resistant organisms.

Anti-Infective Agents↗

PubMed1998

Implementation of outcomes measurement in performance improvement efforts.

The development of conceptual models is a necessary step in the implementation of outcomes-based statistical models in health information management departments. The article provides a step-by-step method of systematically implementing outcomes-based statistical process control methods in health information management departments. It is suggested that, to create an atmosphere conducive to the implementation of statistical process control techniques, health information management directors must be systematic in the application of these techniques, focus on personal and professional opportunities and not on the fear of numbers, provide training and resources, and celebrate success.

Data Interpretation, Statistical↗

PubMed1998

Implementation of Section 255 of the Telecommunications Act of 1996: access to telecommunications services, telecommunications equipment, and customer premises equipment by persons with disabilities--FCC. Notice of proposed rulemaking.

This Notice of Proposed Rulemaking (NPRM) is an important step in the Commission's effort to increase the accessibility of telecommunications services and equipment to Americans with disabilities. The NPRM proposes a framework for implementing section 255 of the Communications Act of 1934 (Act), which requires telecommunications equipment manufacturers and service providers to ensure that their equipment and services are accessible to persons with disabilities, to the extent it is readily achievable to do so. In addition, if accessibility is not readily achievable, section 255 requires manufacturers and service providers to ensure compatibility with existing peripheral devices or specialized customer premises equipment commonly used by individuals with disabilities to achieve access, to the extent it is readily achievable to do so. The NPRM first explores the Commission's legal authority to establish rules implementing section 255. The NPRM then seeks comment on the interpretation of specific statutory terms that are relevant to the proceeding. Finally, the NPRM seeks comment on proposals to implement and enforce the requirement that telecommunications equipment and services be made accessible to the extent readily achievable. The actions proposed in the NPRM are needed to ensure that people with disabilities are not left behind in the telecommunications revolution and consequently isolated from contemporary life.

Communication Devices for People with Disabilities↗

PubMed1998

Implementation of the Medical Device Directive in Italy.

The implementation of the European medical devices Directives by Member States is introducing a significant regulatory uniformity to the European regulation of medical devices. However, Member States are not required to implement the Directives in an identical manner. As a result, it is important to be aware of national variations. This article will discuss the implementation of the Medical Device Directive in Italy.

Durable Medical Equipment↗

PubMed1998

Implementing enterprisewide databases: a challenge that can be overcome.

The evolving health care industry is placing new demands on its participants. Traditional institutional boundaries are being replaced by the need to cooperate, collaborate, and share increasingly scarce resources to provide high-quality care to patients. Information, which historically was coveted and protected, must now be shared by the multiple providers and organizations that together provide services. This need to share information has brought on the need for organizations to build common databases from which reports can be run, trends can be noted, and patient information can be drawn. Data warehouses and clinical data repositories are being recognized as solutions to issues of segregation of information. Both solutions are relatively new to health care, and there is acknowledgment that neither is simple to implement and that both represent new challenges to health care organizations. The article provides working definitions of the two solutions, describes at a high level some of the challenges associated with their implementation, and provides some of the key steps required to develop, implement, and realize the benefits of the clinical data repository or data warehouse.

Computer User Training↗

PubMedDate not supplied

Successful implementation of a comprehensive computer-based patient record system in Kaiser Permanente Northwest: strategy and experience.

Kaiser Permanente Northwest (KPNW) has implemented a computer-based patient record (CPR) system for outpatients. Clinicians at KPNW use this comprehensive CPR to electronically document patient encounters; code diagnoses and procedures; maintain problem lists; order laboratory tests, radiology tests, and prescriptions; and send patient-specific messages and referrals to other medical providers. More than 700 clinicians, representing more than 20 medical and surgical specialties, and 2600 support staff in 31 geographically separate sites use this system as the information foundation of delivery and documentation of health care for KPNW's membership of 430,000. As of May 1998, more than four million visits and two million telephone calls had been processed and documented into the system. More than 5000 outpatient visits are processed and documented each weekday. From an integrated clinical workstation, clinicians also access e-mail, an extensive results-reporting system, and sites on both the internet and KPNW's intranet. This article describes a strategy for and experience with the implementation of a large-scale, comprehensive CPR in an integrated HMO. This information may be useful for persons attempting to implement CPRs in their own institutions.

Ambulatory Care Information Systems↗

PubMed1999

No impact from active dissemination of the Ottawa Ankle Rules: further evidence of the need for local implementation of practice guidelines.

BACKGROUND: Local implementation strategies are often required to promote consistent adherence to clinical guidelines, but they are time consuming and expensive. The authors tested an educational intervention designed to increase use of the Ottawa Ankle Rules, a widely publicized set of clinical guidelines previously shown to reduce the use of radiography for diagnosis of acute ankle injuries. METHODS: The study consisted of a quasi-experimental, before-and-after comparative analysis. Trained experts provided 1-hour educational sessions and supplied resource materials on the Ottawa Ankle Rules to health care professionals from 63 Ontario hospitals. Participants were asked to evaluate the intervention. The authors then compared, for periods before and after the educational sessions, the use of ankle radiography for adults with acute ankle injury in 10 hospitals that received the educational intervention and reported no (n = 5) or some (n = 5) prior use of the rules and in 5 control hospitals, which declined the educational intervention because they were already implementing the rules. RESULTS: Although participants gave highly positive appraisals of the Ottawa Ankle Rules and the educational sessions, there was no reduction in the use of ankle radiography for the 10 hospitals that received the educational sessions (73% before and 78% after the intervention, p = 0.11). In contrast, use of radiography decreased significantly, from 75% to 65%, in the 5 control hospitals (p = 0.022). INTERPRETATION: Even when a dissemination strategy is well received and involves a widely accepted clinical guideline, the impact on behaviour in clinical practice may be small. In addition to broad dissemination, an active local implementation strategy is necessary to encourage physicians to adopt clinical guidelines.

Acute Disease↗

PubMed1980

Implementation of a unit dose distribution system for respiratory therapy medications.

The development and implementation of a comprehensive unit dose distribution system for respiratory medications is described. Initially, an evaluation of carts and unit dose packaging materials for respiratory medications was conducted. Subsequent to the selection, a unit dose processing and packaging program was developed in accordance with the Respiratory Therapy Medical Director's Standard Treatment Orders. A 24-hour exchange system, separate but paralleling the already operational unit dose system, was implemented. The primary advantages attributed to the implementation of this system were 1) a decrease in potential respiratory medication order interpretation/transcription errors; 2) a decrease in the waste of medication solutions; 3) a decrease in potential preparation errors by the respiratory therapists; 4) standardization and accuracy of respiratory medication dosages; and 5) a more equitable method of charging patients.

Aerosols↗

PubMed1987

A successful implementation of a hospital pharmacy computer module.

The Mississauga Hospital Pharmacy Department recently implemented the unit dose dispensing portion of a hospital-wide computer system. Initially, a pharmacist was assigned to the position of Computer Preceptor to build the data base and help coordinate the implementation process. A joint management/staff Computer Advisory Committee was also formed. This group revised job descriptions, workload priorities and the physical layout of the department and directed the implementation plan. Staff training was conducted at first on a "volunteer" basis, followed by a formal program, using a training manual developed by a staff pharmacist. Staff concerns were constantly monitored and various "morale boosters" were utilized. The computerized dispensing was run parallel with the manual system on two nursing units for one week prior to undertaking a step-by-step conversion of the hospital. Following the "break-in" period, procedures will be formalized and quality assurance programs established.

Hospital Bed Capacity, 500 and over↗

PubMed1989

Implementation issues in addictions day treatment.

Innovative treatment programs can be implemented successfully in hospitals only if key actors take on leadership responsibility for the new programs. Implementation of an innovative Addictions Day Treatment Program (ADT) for alcohol and substance abusers in a 156-bed community hospital is reported. Implementation issues for staff psychiatrists, psychologists, psychiatric nurses, and hospital administrators are the primary subject of this article. Participation of these professional groups depended on their treatment ideology, the threat they perceived the program to be to patients, the time demanded of them, whether they would be reimbursed for providing care by the program, and the changes the program introduced in provider-patient interaction. The way shared responsibility among key hospital and unit leaders made it possible to overcome resistance to the program and to develop a positive consensus about day treatment is shown.

Alcoholism↗

PubMed1998

Design and implementation of a multi-institution immunization registry.

One of every four children in the USA is underimmunized. Surveys of children in New York City have documented rates of appropriate immunization as low as 37% in certain populations in northern Manhattan. In response to this, government and private agencies have undertaken efforts to improve immunization rates. As part of one such multiinstitution effort in northern Manhattan, we have begun implementation of a computer-based immunization registry. Key features of this registry system include adaptation of legacy software in order to perform initial capture of data in electronic format; design of a user interface using a World Wide Web server that provides data review and capture functions with appropriate security; implementation of a registry database with links to the server, communication links between hospital registration systems, a Master Patient Index, community providers and the central registry; and integration of decision support in the form of Medical Logic Modules encoded in the Arden Syntax. We discuss our design of this multi-institution immunization registry and implementation efforts to date.

Child↗

PubMed1998

Implementation of a database on drugs into a university hospital Intranet.

Several databases on drugs have been developed worldwide for drug information functions whose sources are now electronically available. Our objective was to implement one of them in our University hospitals information system. Thériaque is a database which contains information on all the drugs available in France. Before its implementation we modeled its content (chemical classes, active components, excipients, indications, contra-indications, side effects, and so on) following an object-oriented method. From this model we designed dynamic HTML pages according to the Microsoft's Internet Database Connector (IDC) technics. This allowed a fast implementation and does not imply to port a client application on the thousands of workstations over the network of the University hospitals. This interface provides end-users with an easy-to-use and natural way to access information related to drugs in an Intranet environment.

Computer Communication Networks↗

PubMed1999

An object-oriented framework for the development of computer-based guideline implementations.

Clinical practice guidelines provide a means of directing medical care towards clinically appropriate and cost-effective interventions. A direct relationship exists between the integration of a guideline into clinical workflow and the effectiveness of the guideline in influencing clinicians' behavior. Computer-based guideline implementations, used at the point-of-care, accomplish this integration. Employing object-oriented technologies, we propose a framework of reusable components for the development of guideline implementation systems. We have identified eight information management services that are common to such systems. Our framework integrates these services and their respective reusable components into clinical workflow to promote the development of comprehensive guideline implementation systems, which should ultimately enhance guideline compliance and the overall quality of care.

Guideline Adherence↗

PubMedDate not supplied

A survey measuring the degree of model compliance plan for clinical laboratories implementation in small/rural hospital laboratories.

The Office of the Inspector General published the Model Compliance Plan for Clinical Laboratories (MCPL) in February 1997. In March and April 1998, a survey of 200 Midwest hospital laboratory managers (hospital size < or = 200 beds) was performed to determine the degree to which their laboratories had implemented the various recommendations of the MCPL. Of the 200 surveys sent out, 76 were returned--a 38% response rate. Aspects of the survey were broken down into two categories: "Laboratory Manager Responsibility," those items that can be implemented independently by the laboratory manager; and "Administration Responsibility," those items requiring administration's direction. With the exception of rewriting job descriptions to include compliance issues, > or = 75% of the laboratory managers have implemented the items within their power.

Data Collection↗