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At least 1,333 records · Page 74Linked to original sources

PubMed2001

Reduced length of stay by implementation of a clinical pathway for bariatric surgery in an academic health care center.

Bariatric surgery is being performed in increasing numbers in an era when reimbursements are being reduced. Academic health centers bear the responsibility for training surgeons to perform these operations yet must keep costs to a minimum and retain high quality. The UCLA Bariatric Surgery Program developed a clinical pathway for the pre- and postoperative management for gastric bypass patients to achieve these goals. Medical records for 182 consecutive gastric bypass patients were retrospectively reviewed before implementation of the pathway (Group I) during the fiscal year of 1998/1999. Data on average length of stay, average intensive care unit length of stay, average standard variable cost, percentage readmission rate, and percentage return to the operating room were collected. This information was compared with the data collected prospectively from 182 patients after implementation of the pathway in July of 1999 (Group II) during the fiscal year of 1999/2000. Hospital cost per admission was reduced by 40 per cent in Group II compared with Group I (P < 0.02). The average length of stay was reduced from 4.05 days in Group I to 3.17 days in Group II (P < 0.033). Overall readmission rate was decreased from 4.2 per cent in Group I to 3.2 per cent in Group II (P < 0.05). There were no differences in morbidities between both groups. The pathway reduced costs by reducing the hospital length of stay, intensive care unit utilization, and readmission rates. Quality was maintained as evidenced by a similar pattern of postoperative morbidities yet readmission rates were reduced. Our results indicate that implementation of a clinical pathway for bariatric surgery reduces cost and improves quality of care in an academic institution.

Academic Medical Centers↗

PubMedDate not supplied

[Migration policies and population distribution in Mexico: regional implementation and impact].

The author begins by analyzing the legal framework of migration and population redistribution policies in Mexico since 1973, when the General Law on Population was passed. In that framework, she points out several institutional deficiencies and contradictions. In the second section, she discusses demographic planning in this field, and conducts a follow-up on implementation based on reports from the institutions involved and official documents. To conclude, she examines practical applications of policy instruments, comparing the behavior of governmental variables that had a bearing on the phenomenon before and after the implementation of said policy (1970 to 1990). One of her findings is that the basic elements making population policies on migration operational did not move in the desired direction, i.e., to modify migratory and population distribution so as to achieve expected goals. Despite the continuity of population policies on migration, the implementation of such policies still poses diverse obstacles.

Americas↗

PubMed2002

The gap between exposure and implementation of computer workstation ergonomics in the workplace.

The population of people using computers is increasing in home, school and work environments [20,21]. Research suggests that more computer usage may lead to increased incidence of upper extremity cumulative trauma disorder (UECTD) and other work related musculoskeletal injuries [8]. Yet, proper computer workstation ergonomics training is not readily available. This pilot study attempts to better understand the gap between ergonomic interventions and the initiation of work-practice change. The pilot study used self-report through an anonymous Internet survey to explore university faculty and staff training in computer workstation ergonomics, assess UECTD and other computer-use related symptoms, and learn about the respondents' success implementing their knowledge of computer workstation ergonomics. The 55 respondents ranged in age from 21 to 65, and spent an average of 5.3 hours at the computer during a typical workday. Over 70% of respondents experienced symptoms associated with excessive computer use. Although 60% of respondents had exposure to computer workstation ergonomics information, less than 10% reported implementing their knowledge of computer workstation ergonomics in their tasks. This paper looks at organizational and individual issues preventing the implementation of computer workstation ergonomics in the workplace. The Transtheoretical Model for Health Behavior Change [25,27] is used to further evaluate effectiveness of ergonomic interventions. Recommendations for interventions and future evaluations are presented.

Adult↗

PubMed2002

Health care system and insurer support for smoking cessation guideline implementation.

Physician use of clinical practice guidelines (CPGs) is disappointingly low in the United States. Much emphasis historically has been placed on the individual clinician to implement use of guidelines in practice. Recently, the Public Health Service issued an updated set of smoking cessation guidelines that include recommendations not only for patients and physicians, but also for health care administrators, insurers, and purchasers. A random sample of Missouri family physicians and general internists was used to determine, for the first time empirically, whether physicians receiving external support for guideline implementation were more likely to adopt and adhere to guidelines in practice. Fewer than 20 percent of physicians receive system support consistent with the updated guideline for smoking cessation. Only 32 percent of physicians who are unaware of the guidelines receive any of the recommended external support, while nearly 60 percent of physicians who adhere to the guidelines in practice are receiving some form of external support. Thus, the fundamental issue that requires national attention is that successful guideline implementation is highly dependent on administrative supports from health care organizations and insurers.

Financial Support↗

PubMed2002

Software engineering risk factors in the implementation of a small electronic medical record system: the problem of scalability.

The successful implementation of clinical information systems is difficult. In examining the reasons and potential solutions for this problem, the medical informatics community may benefit from the lessons of a rich body of software engineering and management literature about the failure of software projects. Based on previous studies, we present a conceptual framework for understanding the risk factors associated with large-scale projects. However, the vast majority of existing literature is based on large, enterprise-wide systems, and it unclear whether those results may be scaled down and applied to smaller projects such as departmental medical information systems. To examine this issue, we discuss the case study of a delayed electronic medical record implementation project in a small specialty practice at Columbia-Presbyterian Medical Center. While the factors contributing to the delay of this small project share some attributes with those found in larger organizations, there are important differences. The significance of these differences for groups implementing small medical information systems is discussed.

Computer Systems↗

PubMed2002

Implementing outpatient order entry to support medical necessity using the patient's electronic past medical history.

Physician order entry is difficult to implement, both in inpatient and outpatient settings. Such systems must integrate conveniently into clinical workflows, and provide sufficient benefit to offset the burden of system use. For outpatient order entry, significant advantages can accrue when systems incorporate medical necessity guidelines - improved billing and adherence to governmental policies. The authors developed and implemented an outpatient order entry system that utilizes an electronically accessible history of patient, provider, and clinic-related diagnoses in assisting providers (when possible and appropriate) to select compliant justifications for tests and procedures. The pilot implementation site, active for more than six months, has been the Vanderbilt University Page Campbell Cardiology Clinic, with 34 providers.

Ambulatory Care↗

PubMed2002

Implementation of an automated guideline monitor for secondary prevention of acute myocardial infarction.

Clinical practice guidelines can be used to help improve health care quality, but they are often not optimally implemented. Practice enabling and reinforcing techniques, such as clinical reminders and academic detailing are effective methods for translating guidelines into practice. Following a study showing that we could improve adherence to secondary prevention guidelines for acute myocardial infarction (AMI) using computerized alerts and academic detailing, we implemented an automated monitor to accomplish the same goal in a less labor-intensive manner. This paper describes the implementation of this production application.

Drug Therapy, Computer-Assisted↗

PubMed2002

Using the urine dipstick to screen out unnecessary urine cultures: implementation at one facility.

This study examined the utility of performing urine cultures on biochemically negative urine specimens and details the implementation of a policy to cancel these cultures. Four reactions of the Multistix SG (Bayer, Elkhart IN) urine dipstick (protein, occult blood, leukocyte esterase, and nitrite) were used as biochemical indicators. A three-month retrospective study examining the results of 843 urinalysis/ urine culture pairs indicated that one-third of these cultures were probably unnecessary (negative dipstick/negative culture). Based on these results, a policy was implemented to screen those urine samples having both a urinalysis and urine culture ordered. Over a six-month period, 6,192 urine specimens were evaluated. Of these, 36% (2,260 cultures) were cancelled. Of the 3,932 samples cultured 22.4% (883) were true positives (positive dipstick/positive culture) while 31.6% (1245) had a positive dipstick but grew organisms considered contaminants. The false positive rate was 40% (positive dipstick/negative culture), and the false negative rate was 6%. Implementation of this policy reduced the number of urines cultured by 36%.

Algorithms↗

PubMedDate not supplied

Implementation of a nursing home urinary incontinence management program with and without tolterodine.

OBJECTIVE: To evaluate the implementation of a nursing home urinary incontinence management program. DESIGN: A prospective field trial of the program incorporating practice guidelines and principles of continuous quality improvement. SETTING: Five nursing homes in New York, Virginia, and Georgia PARTICIPANTS: One hundred fifty-one residents identified as being incontinent of urine and who met inclusion criteria for ongoing participation in the program. INTERVENTION: Key multidisciplinary staff from the five nursing homes were trained in the program and assumed responsibility for implementing it in their facilities. The program consisted of a clinical assessment, toileting protocols, and the addition of the antimuscarinic drug tolterodine in selected residents who did not respond well to toileting alone. Data on dryness rates during the 60-day toileting protocols, collected by nursing home staff, were analyzed on a weekly basis by an overall project coordinator who sent data back to the nursing homes in an easy-to-read graphical format. MEASURES: (1) The dryness rate, defined as the number of times the resident was dry divided by the number of times the resident was checked (every 2 hours from 7 a.m. to 7 p.m.); and (2) adverse events (eg, dry mouth, increased confusion, need for dosage reduction). RESULTS: Of 645 residents in the 5 nursing homes, 377 (58%) were identified as incontinent of urine, of whom 151 (40%) were placed on an ongoing toileting program. Of these 151 residents, 48 (32%) were prescribed tolterodine, and 117 (78%) completed the 60-day trial. The initial dryness rate was 57%, and for the group as a whole remained essentially unchanged (increase in dryness 1%, P = 0.50). Among 50 clinically stable residents on a toileting program alone, the increase in the dryness rate was 16% (P = 0.001), and for 31 clinically stable residents prescribed tolterodine, the increase in the dryness rate was 29% (P = 0.012). Two residents had their dosage of tolterodine reduced because of dry mouth and nausea,one resident was taken off the drug because of increased pain in the back and legs and increased confusion. CONCLUSIONS: Overall, this program resulted in significant increases in dryness rates for clinically stable incontinent nursing home residents. These residents represented 22% of the total number of residents identified as incontinent in the five participating nursing homes. Tolterodine was prescribed for approximately one-third of incontinent residents as a supplement to a toileting program, and was well tolerated. Nursing homes should be encouraged to implement similar urinary incontinence programs, target toileting protocols to the most responsive residents, and maintain the program using principles of continuous quality improvement.

Journal Article↗

PubMed2003

Development of a conceptual tool for the implementation of kangaroo mother care.

AIM: To develop a conceptual tool to assist healthcare workers and management in the implementation of a kangaroo mother care programme. METHODS: A qualitative research approach was followed and methods included on-site observations and informal conversational interviews, as well as unstructured, in-depth interviews with senior managers, doctors and nurses at two large training hospitals in the north of South Africa. A consultative process was used to refine the tool. RESULTS: The patterns that emerged from the data were captured in a diagram, entitled: "Main issues in the establishment of kangaroo mother care". In addition, a set of core questions was developed to assist in decision-making at institutional level. CONCLUSION: The diagram and questions contain concepts that could be adapted and used by a healthcare facility's multidisciplinary team in planning the implementation of kangaroo mother care and in reviewing the progress made in the implementation and the quality of the kangaroo mother care provided.

Allied Health Personnel↗

PubMedDate not supplied

Implementation of a computerized information system in a long-term care facility.

The successful implementation of computerized nursing information systems requires the completion of many tasks and the participation of many persons. In 1989, Pulliam and Boettcher described a six-step process for introducing computerized information systems into long-term care facilities. This article describes the process, particularly the implementation phase, as it actually happened in a 124-bed facility in a mid-Atlantic state. This facility found that successful implementation requires a systems coordinator who is a professional nurse who understands the needs of the patients, can integrate information with the computer system, and can provide on-going support for the users.

Delaware↗

PubMed2003

Smoking status identification: two managed care organizations' experiences with a pilot project to implement identification systems in independent practice associations.

OBJECTIVE: To determine whether managed care organizations (MCOs) can effectively promote the sustained use of smoking status identification systems among independent practice associations. STUDY DESIGN: Quasi-experimental design measuring smoking status documentation before and after an intervention. METHODS: A chart review of the MCOs' patients at 4 participating primary care clinics determined the baseline for smoking status documentation before intervention. Baseline data were unavailable from a fifth participating clinic. Two quality improvement personnel were sent by the MCOs to help the clinics chose and implement a system for identifying smoking status. All of the clinics chose a sticker system. The change in smoking status documentation was assessed by chart reviews of patients enrolled in the MCOs who were seen during the period between 3 and 16 months after implementation of the system. RESULTS: Following the intervention, a significant increase in smoking status documentation was noted among participating clinics. The proportion of patients whose smoking status was identified and documented by any method increased from 50% to 87% (P < .01) at the 4 clinics with baseline data. By clinic, the increase varied from 6% to 60%. The sticker system was the method by which most patients' smoking status was documented (77%). There were no controls, so the influence of outside factors, including a regional smoking cessation campaign that coincided with this study, cannot be quantified. CONCLUSIONS: Managed care organizations may be an effective change agent for implementing the guidelines for tobacco use and dependence treatment.

Blue Cross Blue Shield Insurance Plans↗

PubMed2003

Role of WHO recruited consultants in successful implementation and expansion of the DOTS programme in India.

For successful implementation of DOTS in India, many factors have played important part and one of which is the use of WHO-contracted local consultants. WHO had recruited consultants known as RNTCP Medical Consultants (RMCs) and assigned them to States and districts to provide technical assistance to the State and District TB Officers. In the districts the RMCs assist in preparation of action plans and interact with district and State authorities. The RMC network is funded by WHO and the Canadian International Development Agency. The assignment of RMCs has resulted in much more rapid implementation of the DOTS strategy with sustainable improvement in the quality of the programme in implementing districts.

Antitubercular Agents↗

PubMed2003

Why does economic analysis in health care not get implemented more? Towards a greater understanding of the rules of the game and the costs of decision making.

Despite recent initiatives across a number of countries to institutionalise the use of economic evaluation in the assessment of new technologies, the evidence suggests that, to date, the impact of economic analysis on health sector decision making in practice has been low. This paper proposes that incentive compatibility problems associated with much of the decision making that economics is meant to inform is a major factor in this. The argument involves recognition that economic priority setting tends to create winners and losers and, as a consequence, any change in the status quo will tend to impose direct costs on those decision makers required to implement them. At the same time, such individuals often lack any stake over the benefits of such decisions. In this type of institutional setting, the prospects of achieving the necessary cooperation for implementation are likely to be low, particularly if it is viewed as being part of a 'one-off' initiative. Conventional health economic analysis and agency theory are limited in the extent to which they can address this problem. Such forms of analyses tend to lack an appreciation of broader institutional characteristics, including the prevailing values and norms within a decision making context that are potentially important in promoting cooperation and thus the prospects of implementation.

Decision Making, Organizational↗

PubMed2003

Critical response time (time available to implement effective measures for epidemic control): model building and evaluation.

The time available to implement successful control measures against epidemics was estimated. Critical response time (CRT), defined as the time interval within which the number of epidemic cases remains stationary (so that interventions implemented within CRT may be the most effective or least costly), was assessed during the early epidemic phase, when the number of cases grows linearly over time. The CRT was calculated from data of the 2001 foot-and-mouth disease (FMD) epidemic that occurred in Uruguay. Significant regional CRT differences (ranging from 1.4 to 2.7 days) were observed. The CRT may facilitate selection of control measures. For instance, a CRT equal to 3 days would support the selection of measures, such as stamping-out, implementable within 3 days, but rule out measures, such as post-outbreak vaccination, because intervention and immunity building require more than 3 days. Its use in rapidly disseminating diseases, such as FMD, may result in regionalized decision-making.

Animals↗

PubMed2003

[Implementation of integrated mental health care in an urban district of Tokyo].

Japan had a long history of long-term hospital care and is now trying to change it into community-based psychiatry. Implementing comprehensive approach that has already been proven effective through evidence based data in one particular community, one has to overcome several local barriers, if the same approach is to be implemented in different situations, such as differences in socio-cultural background and health care system. This is a report of the activities of Minato Net 21 pointing out the "local barriers" on implementing comprehensive approach in an urban district of Tokyo.

Community Mental Health Services↗

PubMed2003

Modeling and implementing a health information provider on the Internet.

OBJECTIVES: To model and implement a medical web portal providing access to well qualified and high-quality information. MATERIAL AND METHODS: The Unified Medical Language System (UMLS) knowledge sources of the U.S. National Library of Medicine and an Information Sources Catalog (ISC) resulting from the ARIANE project are described. The XML technology that allows files transformations by the means of XSLT is briefly presented. RESULTS: The design and implementation of software modules that exploit knowledge sources, operate the translation of a user's query to selected information sources, and wrap obtained results are detailed. DISCUSSION: Current implementation and wrapping perspectives are discussed in terms of integration and interoperability of health information resources.

Humans↗

PubMed2003

An implementation of a virtual patient record using Web services.

Virtual patient records provide a means for integrated access to patient information that may be scattered around different healthcare settings. Within the boundaries of a health district providing all levels of care, this concept can be implemented in a corporate Intranet environment to support longitudinal patient care activities across the participating healthcare providers. In this context, a virtual patient record implementation enables autonomous healthcare providers to operate in a cooperative working environment and apply continuity of care. Workflow and web services technologies provide an appropriate infrastructure for satisfying collaboration and coordination requirements by integrating heterogeneous healthcare applications and by automatically routing the medical information needed to authorized actors in a healthcare process. This paper presents a virtual patient record architecture that allows integrating geographically dispersed medical information within a health district and enhancing collaboration and coordination of authorized workgroups using workflow and web services technologies. An implementation of the proposed architecture is also presented.

Efficiency, Organizational↗