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PubMed1984

Estimating supply requirements for implementing a laboratory information system.

The implementation of a new laboratory information system requires the total commitment of all laboratory personnel. Difficulties both within and external to the lab are to be expected as the lab and the hospital staff learn to use the system. Proper planning prior to implementation will avert additional problems that can arise due to an inadequate supply inventory. The purpose of this paper is to discuss methods of estimating supply requirements, as well as to point out other operational considerations related to system start-up.

Computers↗

PubMedDate not supplied

Building resilience in children of mothers who have co-occurring disorders and histories of violence: intervention model and implementation issues.

Historically, children of parents with co-occurring substance abuse and mental health disorders and histories of violence/trauma have been overlooked in behavioral health treatment systems. The Women, Co-occurring Disorders and Violence Study (WCDVS) was a 5-year initiative funded by the United States Substance Abuse and Mental Health Services Administration (SAMHSA) that included a Children's Study that explored the treatment needs of children of women with these multiple disorders. This article describes the development of the Children's Study intervention that included clinical assessment, group intervention, and resource coordination/advocacy for children aged 5-10 to build resilience through increasing coping skills, improving interpersonal relationships, and helping coalesce positive identity and self-esteem. Innovative procedures, including the participation of consumer/survivor/recovering women and mothers, in the planning, implementation, and administrative applications of this intervention and study are also highlighted. It is recommended that programs begin to implement family-focused integrated treatment approaches that can potentially increase protective factors for children affected by parental mental illness, substance abuse, and violence.

Adaptation, Psychological↗

PubMedDate not supplied

Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment.

Despite growing interest in assessment of program implementation, little is known about the best way to evaluate whether a particular program has implemented the intended service to a level that is minimally acceptable to a funding source, such as a state mental health authority. Such is the case for assertive community treatment (ACT), an evidence-based practice being widely disseminated. Using an exploratory, actuarial approach to defining program standards, this study applies different statistical criteria for determining whether or not a program meets ACT standards using the 28-item Dartmouth Assertive Community Treatment Scale. The sample consists of 51 ACT programs, 25 intensive case management programs, and 11 brokered case management programs which were compared to identify levels of fidelity that discriminated between programs, but were still attainable by the majority of ACT programs. A grading system based on mean total score for a reduced set of 21 items appeared to be most attainable, but still discriminated ACT programs from other forms of case management. Implications for setting and evaluating ACT program standards are discussed.

Case Management↗

PubMedDate not supplied

Identifying factors critical to implementation of integrated mental health services in rural VA community-based outpatient clinics.

The purpose of this study was to gain a better understanding of the critical components associated with implementing integrated mental health care services in rural VA community-based outpatient clinics (CBOCs). In-person semi-structured interviews were conducted with 20 health care providers and staff within a year after placing a trained advanced practice nurse (APN) to provide mental health/substance abuse (MH/SA) care at 2 rural CBOCs in the southeastern United States. Four raters independently evaluated interview transcripts and conducted content analysis to summarize the interview results. The results indicate that key contextual factors related to leadership, staff attitudes and beliefs, and unique organizational factors of the clinic and the community can affect the success of such clinical innovations. In addition to providing descriptive information about the attitudes, beliefs, and experiences of CBOC personnel regarding implementation of integrated MH/SA services using APNs, the study findings suggest several domains that could be explored in future studies of integrated mental health service delivery to rural veterans through primary care.

Attitude of Health Personnel↗

PubMed1999

Implementing outcome systems: lessons from a test of the BASIS-32 and the SF-36.

With increasing pressure from third-party payers to assess client outcomes, clinical programs want to know how to implement outcome systems. This article focuses on practical and logistic questions involved in implementing an outcome assessment system in ambulatory behavioral healthcare settings. Study questions addressed outcome systems in general and the use of the Behavior and Symptom Identification Scale (BASIS-32) and the Short Form Health Status Profile (SF-36) in particular. General questions focused on obtaining provider buy-in, client consent and confidentiality, data collection methods, sampling, time points, maximizing client participation, clinical utility of outcome data, and resources needed for outcome assessment. Measure-specific questions focused on client acceptability of the instruments and applicability of measures to diverse populations. The article suggests several strategies for enhancing outcome assessment efforts and concludes that there remains a need for further understanding of ways to maximize the utility and value of outcome measurement.

Behavior Therapy↗

PubMed2000

Implementing capitation of Medicaid mental health services in Colorado: is "readiness" a necessary condition?

Two consortia of community mental health centers in Colorado varied in their administrative readiness for changing to a capitated system and, ultimately, implemented capitation using different organizational arrangements. The objective was to assess the impact of this natural experiment on administrative change, costs, and utilization of services during the first two years postcapitation. Prior to capitation, one was rated as having greater "readiness" than the other and received a capitation contract from the state, while the other did not. A private, for-profit managed behavioral health organization was awarded a contract and formed a joint venture with the less "ready" consortium, providing managed care expertise to complement the consortium's expertise in delivering mental health services. Two years later, these consortia do not look different either administratively or in their patterns of service utilization and costs. These findings suggest alternative ways of successfully implementing a capitated public mental health system.

Capitation Fee↗

PubMed1993

MicroPACS: a PC-based small PACS implementation.

To make picture archiving and communication systems (PACS) a practical reality for small-scale structures, it appears necessary to build a network that integrates and optimises production management, analysis and storage of images, and to include the ability to communicate with other similar remote structures. To solve the various technical problems related to small-scale PACS implementation, MicroPACS, a local area network, was developed around PC-like microcomputers. Every necessary function is assessed and implemented, including a centralised data-base, a distributed image bank, different storage levels and a specific task for image exchanges. An additional protocol was also developed for remote consultation through ISDN. Standardisation of image encapsulation and a point-to-point link between remote sites ensure easy transfers between heterogeneous local networks or bases and integrity of local databases.

Computer Communication Networks↗

PubMed1998

Implementation and application of real-time motion analysis based on passive markers.

A method for real-time motion analysis based on passive markers is presented. An opto-electronic automatic motion analyser was used as hardware platform and the real-time operation was based on the interfacing between two levels of the system architecture. True real-time acquisition, processing and representation of two-dimensional and three-dimensional kinematics data were implemented through a newly conceived data acquisition procedure and high speed optimisation of the kinematics data processing. The method allows one to operate the motion analysis system in real-time; even when the data elaboration unit is required to perform other processing functions, the only consequence is a decrease in system sampling rate. The maximum number of processed and plotted markers in three dimensions at the highest system sampling rate (100 Hz) turned out to be suitable for the implementation of analytical and visual kinematics biofeedback. An example of the achievable level of complexity in terms of marker disposition model and graphic representation is reported by describing a demonstration of the real-time representation of human face movements. A clinical application of the method for patient position definition and control at radiotherapy units is presented.

Biomechanical Phenomena↗

PubMed1995

Implementing psychosocial rehabilitation in long-term inpatient psychiatric facilities.

Using the focus group methodology, data were gathered from the initial experiences of Missouri's four long-term psychiatric facilities with psychosocial rehabilitation (PSR). Significant implementation factors include the establishment of a firm PSR philosophical base; extensive staff training in PSR values, technologies, and the skills necessary to implement the technologies; support for staff as their roles change with the adoption of PSR; adaptation of PSR for use with forensic clients; use of community resources while clients are still inpatients; maintenance of PSR values and skills learned after clients are released into the community; and the establishment of a program evaluation system that assesses both outcome and process. Clients residing in long-term, public psychiatric facilities also can receive substantial benefits from this approach to service delivery.

Community-Institutional Relations↗

PubMed1994

Implementation of directional Doppler techniques using a digital signal processor.

Three methods of deriving directional signals from phase quadrature Doppler signals, using digital techniques, are described. These are the phasing-filter technique, the Weaver receiver technique and the complex FFT. The basic theory behind the three methods is presented, together with the results of digital simulations. Each of the methods has been implemented in real time using a commercially available digital signal-processing board, and their relative processing times are compared. All the methods work well, and the decision to implement one or other in a specific application is likely to rest on secondary factors, such as the need to tape-record the time domain output.

Humans↗

PubMed1994

Implementation issues in generalist education.

Devising a strategy for the implementation of a generalist medical educational program can be aided by grouping the many issues to be addressed into developmental stages. In this way, problems can be anticipated and resources marshalled. Initially, leadership and institutional support for the program must be developed. Next, detailed financial, curricular, and site planning must be undertaken. Implementation of the program must contend with faculty, site, and trainee concerns while consolidating financial and institutional support. Finally, in institutionalizing the program, financing must be secured and ongoing evaluation should provide information necessary to regularly reassess the program and renew its goals.

Adult↗

PubMed1996

Implementation of local guidelines for cost-effective management of hypertension. A trial of the firm system.

OBJECTIVE: To evaluate the effects of an intensive intervention to implement guidelines for cost-effective management of hypertension on medication use and cost, blood pressure control, and other resource use. DESIGN: Retrospective cohort trial based on the Cleveland Veterans' Affairs Medical Center Firm System. SETTING: General internal medicine teaching clinic in a large university-affiliated Department of Veterans Affairs Medical Center. PARTICIPANTS: All patients seen in the intervention firm (n = 1273) and control firm (n = 884) clinics in the 3-month period following the introduction of the guidelines. INTERVENTIONS: The control firm received guidelines and usual education for the cost-effective outpatient management of hypertension. The intervention firm received guidelines plus intensive guideline-based education and supervision. MEASUREMENTS AND MAIN RESULTS: The use of guideline medications was greater in the intervention firm as compared with the control. The intervention firm initiated more hydrochlorothiazide (HCTZ), 17.4% (95% confidence interval [CI] 14.8, 20.1) of patients versus 11.9% (CI 9.3, 14.8) in the control firm (p = .002). Atenolol was initiated in 7.2% (CI 5.6, 9.0) in intervention firm versus 4.7% (CI 3.2, 6.6) in the control (p = .03). In addition, the use of nonguideline medications was less in the intervention firm. The intervention firm initiated less long-acting nifedipine, 7.8% (CI 6.0, 9.8) versus 10.6% (CI 8.2, 13.5) in the control (p = .04). Blood pressure control demonstrated greater improvement in the intervention firm (p = .02). Use of guidelines was associated with decreased costs for antihypertensive medications in the intervention firm as a whole as compared with the control firm. There was no increased use in other measured resources in the intervention firm including the number of outpatient laboratory services obtained, clinic visits, emergency room visits, or hospitalizations. CONCLUSIONS: Intensive implementation of guideline-based education and supervision was associated with an increased use of guideline medications, decreased use of costly alternative agents, and no decrement in the measured outcomes of care.

Antihypertensive Agents↗

PubMed2003

Successful implementation of perioperative beta-blockade utilizing a multidisciplinary approach.

PURPOSE: To describe how we implemented a protocol for perioperative beta-blockade in patients with or at risk of coronary artery disease (CAD) undergoing major non-cardiac surgery and to present our results. METHODS: After institutional approval, from May 1999 to April 2001, patients with surgical and medical indications (CAD as indicated by previous myocardial infarction, typical angina or atypical angina with a positive stress test or at least two risk factors for CAD: age 65 yr, hypertension, smoking, high cholesterol, diabetes mellitus) for perioperative beta-blockade were identified preoperatively by anesthesiology and referred to the General Internal Medicine Service (MED). MED initiated patients on outpatient beta-blockers. The intraoperative anesthetic management was left to the discretion of the anesthesiologist. In the postanesthesia care unit (PACU), patients received iv metoprolol according to hemodynamic criteria. Postoperatively, patients were followed by MED for adverse cardiac events. RESULTS: Sixty-nine patients received perioperative beta-blockade. Preoperatively, 60% were started on metoprolol, 39% on atenolol and 1% on propranolol. In PACU, 42%, 9% and 38% of patients were given iv metoprolol 0, 5 and 10 mg respectively. One patient was given glycopyrrolate in the PACU for bradycardia and none received vasoactive or inotropic agents. Three patients (4.3%) had postoperative cardiac events. CONCLUSIONS: With close collaboration between anesthesiologists, internists, PACU nurses and family physicians, a strategy for perioperative beta-blockade was implemented successfully in patients with cardiac risks. Beta-blockade was associated with few side effects and morbidities.

Adrenergic beta-Antagonists↗

PubMed2000

User acceptability--a critical success factor for picture archiving and communication system implementation.

The Department of Diagnostic Imaging at the Hospital for Sick Children (HSC), Toronto, implemented a picture archiving and communication system (PACS) during the last year. This report describes our experience from the point of view of user acceptability. Based on objective data, the following key success factors were identified: user involvement in PACS planning, training, technical support, and rollout of pilot projects. Although technical factors are critical and must be addressed, the main conclusion of our study is that other nontechnical factors need to be recognized and resolved. Recognition of the importance of these factors to user acceptance and clear communication and consultation will help reduce negative user attitudes and increase the chance of a successful PACS implementation.

Academic Medical Centers↗

PubMed2000

Implementing a Java-based image and report distribution system in a non-picture archiving and communication system environment.

The benefits and pitfalls of implementing a Java-based system to distribute results and images to referring physicians are addressed. The basic requirements for and barriers to implementing this system in a non-picture archiving and communication system (PACS) environment will also be discussed. The majority of radiology information systems (RIS) and hospital information systems (HIS) currently only distribute the text data for radiology examinations. This is generally adequate for low-acuity exams in a relatively healthy patient; however, many clinicians prefer to review images so they can correlate the reported findings with the image data, as well as review the exam themselves. A web-based solution eliminates the need for specialized review software and/or hardware at each review site. In addition, there is no need for support personnel to travel to each site to set up and upgrade software.

Data Display↗

PubMed1996

Design and implementation of a picture archiving and communication system: the second time.

This report describes the authors' experience in the design and implementation of two large scale picture archiving and communication systems (PACS) during the past 10 years. The first system, which is in daily clinical operation was developed at University of California, Los Angeles from 1983 to 1992. The second system, which continues evolving, has been in development at University of California, San Francisco (UCSF) since 1992. The report highlights the differences between the two systems and points out the gradual change in the PACS design concept during the past 10 years from a closed architecture to an open hospital-integrated system. Both systems focus on system reliability and data integrity, with 24-hour on-line service and no loss of images. The major difference between the two systems is that the UCSF PACS infrastructure design is a completely open architecture and the system implementation uses more advanced technologies in computer software, digital communication, system interface, and stable industry standards. Such a PACS can withstand future technology changes without rendering the system obsolete, an essential criterion in any PACS design.

Diagnostic Imaging↗

PubMed2001

The Legnano radiology picture archiving and communication system/radiology information system project implementation.

The necessity to meet the ever-increasing diagnostic and interventional demands in the most cost-effective and efficient way led to the decision to turn the Department of Radiology at Legnano City Hospital nearly filmless. Crucial for the implementation of this challenging project was the development of a sophisticated and efficient digital architecture along with a nearly global renovation of the whole department, connecting it in the meantime to the hospital asynchronous transfer mode (ATM) backbone. The highlights and drawbacks faced in the implementation of the project are described and discussed.

Computer Systems↗

PubMed2003

[Incompatibility reactions in the intensive care unit. Five years after the implementation of a simple "colour code system"].

In intensive care units (ICU) most of the drugs have to be administered by y-piece infusions or admixtures. Drug stability and compatibility are critical elements in the accurate and appropriate delivery of drug therapies to patients. Five years after the implementation of a simple "colour code system" in an attempt to minimize the number of incompatibilities, the situation has been re-examined. The clinical pharmacist collected 78 different medication regimes and the compatibility and incompatibilities were evaluated based on the available literature. Before initiating the "colour code system" in the ICU, 15% of the administered drugs were incompatible and afterwards the number decreased to 2%. This rate could be kept at 2%, even 5 years after the implementation of the system,without any further intervention. As a result of teamwork between nurses, doctors and clinical pharmacy a simple "colour system" was established to minimize incidences of drug incompatibility in the ICU. The system is highly accepted because the degree of uncertainty has been considerably reduced.

Color↗