Staff Development in the Implementation of a Schoolwide Writing Program.

ERIC Educational Resources Information Center

Knudson, Ruth

A case study examined the implementation of a schoolwide writing program established in a California middle school through a district sponsored school improvement program (SIP). Conducted at an urban sprawl southern California school of approximately 900 students in grades seven and eight, the program was directed and implemented by the English…

Introduction of a quality improvement program in a children's hospital in Tehran: design, implementation, evaluation and lessons learned.

PubMed

Mohammadi, S Mehrdad; Mohammadi, S Farzad; Hedges, Jerris R; Zohrabi, Morteza; Ameli, Omid

2007-08-01

Reports addressing continuous quality improvement (CQI) methods in developing countries are scant and there are questions about the applicability of quality improvement methods in such settings. The structure and output of a formal quality improvement program implemented in a teaching hospital affiliated with the Tehran University of Medical Sciences is presented. OBJECTIVE METHOD: During a nine-month period, a multi-stage quality improvement program was implemented. It comprised: (i) training workshops; (ii) a steering committee; (iii) weekly consultation and facilitation of improvement projects; and (iv) a day-long demonstration and recognition meeting. Four cycles of workshops were held in which 132 employees were trained in the basics of CQI. Thirty improvement projects were initiated. Twenty-five of the projects were completed. In an evaluation survey more than 70% of respondents assessed a 'positive impact' on organizational culture, work efficiency and quality of services. More than 90% believed that the changes were sustained, and more than 60% reported that they have implemented additional improvement projects. Our quality improvement package supported rapid implementation of multiple projects. The underlying 'change structure' comprised the improvement teams, top management and the university's quality improvement office; it integrated project management, support and facilitation functions by the respective participant. Organization-wide change was more limited than anticipated. To institutionalize the program and ensure sustainability, a local structure for change should be organized, management coaching should be sustained, local facilitators should be developed, incentives should be established and physician involvement should be emphasized.

APhA 2011 REMS white paper: Summary of the REMS stakeholder meeting on improving program design and implementation.

PubMed

American Pharmacists Association; Bough, Marcie

2011-01-01

To develop an improved risk evaluation and mitigation strategies (REMS) system for maximizing effective and safe patient medication use while minimizing burden on the health care delivery system. 34 stakeholders gathered October 6-7, 2010, in Arlington, VA, for the REMS Stakeholder Meeting, convened by the American Pharmacists Association (APhA). Participants included national health care provider associations, including representatives for physicians, physician assistants, nurses, nurse practitioners, and pharmacists, as well as representatives for patient advocates, drug distributors, community pharmacists (chain and independent), drug manufacturer associations (brand, generic, and biologic organizations), and health information technology, standards, and safety organizations. Staff from the Food and Drug Administration (FDA) Center for Drug Evaluation and Research participated as observers. The meeting built on themes from the APhA's 2009 REMS white paper. The current REMS environment presents many challenges for health care providers due to the growing number of REMS programs and the lack of standardization or similarities among various REMS programs. A standardized REMS process that focuses on maximizing patient safety and minimizing impacts on patient access and provider implementation could offset these challenges. A new process that includes effective provider interventions and standardized tools and systems for implementing REMS programs may improve patient care and overcome some of the communication issues providers and patients currently face. Metrics could be put in place to evaluate the effectiveness of REMS elements. By incorporating REMS program components into existing technologies and data infrastructures, achieving REMS implementation that is workflow neutral and minimizes administrative burden may be possible. An appropriate compensation model could ensure providers have adequate resources for patient care and REMS implementation. Overall, stakeholders should continue to work collaboratively with FDA and manufacturers to improve REMS program design and implementation issues. A workable REMS system will require effective patient interventions, standardized elements that limit barriers to implementation for both patients and providers, standardized yet flexible implementation strategies, use of existing technologies in practice settings, increased opportunities for provider input early in REMS design processes, improved communication strategies and awareness of program requirements, and viable provider compensation models needed to offset costs to implement and comply with REMS program requirements.

Utilizing Quality Improvement Methods to Improve Patient Care Outcomes in a Pediatric Residency Program

PubMed Central

Akins, Ralitsa B.; Handal, Gilbert A.

2009-01-01

Objective Although there is an expectation for outcomes-oriented training in residency programs, the reality is that few guidelines and examples exist as to how to provide this type of education and training. We aimed to improve patient care outcomes in our pediatric residency program by using quality improvement (QI) methods, tools, and approaches. Methods A series of QI projects were implemented over a 3-year period in a pediatric residency program to improve patient care outcomes and teach the residents how to use QI methods, tools, and approaches. Residents experienced practice-based learning and systems-based assessment through group projects and review of their own patient outcomes. Resident QI experiences were reviewed quarterly by the program director and were a mandatory part of resident training portfolios. Results Using QI methodology, we were able to improve management of children with obesity, to achieve high compliance with the national patient safety goals, improve the pediatric hotline service, and implement better patient flow in resident continuity clinic. Conclusion Based on our experiences, we conclude that to successfully implement QI projects in residency programs, QI techniques must be formally taught, the opportunities for resident participation must be multiple and diverse, and QI outcomes should be incorporated in resident training and assessment so that they experience the benefits of the QI intervention. The lessons learned from our experiences, as well as the projects we describe, can be easily deployed and implemented in other residency programs. PMID:21975995

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2011-10-01 2011-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality improvement...

Scaling Up a Water, Sanitation, and Hygiene Program in Rural Bangladesh: The Role of Program Implementation.

PubMed

Benjamin-Chung, Jade; Sultana, Sonia; Halder, Amal K; Ahsan, Mohammed Ali; Arnold, Benjamin F; Hubbard, Alan E; Unicomb, Leanne; Luby, Stephen P; Colford, John M

2017-05-01

To evaluate whether the quality of implementation of a water, sanitation, and hygiene program called SHEWA-B and delivered by UNICEF to 20 million people in rural Bangladesh was associated with health behaviors and sanitation infrastructure access. We surveyed 33 027 households targeted by SHEWA-B and 1110 SHEWA-B hygiene promoters in 2011 and 2012. We developed an implementation quality index and compared the probability of health behaviors and sanitation infrastructure access in counterfactual scenarios over the range of implementation quality. Forty-seven percent of households (n = 14 622) had met a SHEWA-B hygiene promoter, and 47% of hygiene promoters (n = 527) could recall all key program messages. The frequency of hygiene promoter visits was not associated with improved outcomes. Higher implementation quality was not associated with better health behaviors or infrastructure access. Outcomes differed by only 1% to 3% in scenarios in which all clusters received low versus high implementation quality. SHEWA-B did not meet UNICEF's ideal implementation quality in any area. Improved implementation quality would have resulted in marginal changes in health behaviors or infrastructure access. This suggests that SHEWA-B's design was suboptimal for improving these outcomes.

The intention of North-Western Ethiopian dairy farmers to control mastitis

PubMed Central

Koop, Gerrit; Lam, Theo J. G. M.; Hogeveen, Henk

2017-01-01

Understanding the intentions of dairy farmers towards mastitis control is important to design effective udder health control programs. We used the Theory of Planned Behavior (TPB) to explore the intentions of North-Western Ethiopian dairy farmers towards implementing non-specified mastitis control measures (nsMCMs) and towards implementing 4 specific MCMs. Face to face interviews were held with 134 dairy farmers to study associations between their intentions and any of three factors (attitude, subjective norm and perceived behavioral control) that, according to the TPB, determine intentions. The majority of the farmers (93%) had a positive intention to implement nsMCMs, whereas a smaller majority of farmers had the intention to implement the specific MCMs to improve udder cleaning (87%), to improve stall hygiene (78%), to improve feeding of cows (76%), and to perform foremilk stripping (74%). Farmers had a more positive attitude, but lower subjective norm and lower perceived behavioural control towards implementing nsMCMs compared with implementing most specific MCMs, although the subjective norms for stall hygiene and perceived behavioural control for improving feeding of cows were also low. Attitude was positively associated with intentions to implement nsMCMs, to improve cleaning of the udders, to improve stall hygiene and to implement foremilk stripping. Both the intention to improve udder cleaning and to implement foremilk stripping, were positively associated to subjective norms towards these MCMs. Our data can help tailor intervention programs aiming to increase the intention of Ethiopian dairy farmers to implement MCMs and thus to improve udder health in this country. We show that such programs should primarily focus on changing attitude and secondarily on improving the farmers’ subjective norms. PMID:28787018

The intention of North-Western Ethiopian dairy farmers to control mastitis.

PubMed

Mekonnen, Sefinew Alemu; Koop, Gerrit; Lam, Theo J G M; Hogeveen, Henk

2017-01-01

Understanding the intentions of dairy farmers towards mastitis control is important to design effective udder health control programs. We used the Theory of Planned Behavior (TPB) to explore the intentions of North-Western Ethiopian dairy farmers towards implementing non-specified mastitis control measures (nsMCMs) and towards implementing 4 specific MCMs. Face to face interviews were held with 134 dairy farmers to study associations between their intentions and any of three factors (attitude, subjective norm and perceived behavioral control) that, according to the TPB, determine intentions. The majority of the farmers (93%) had a positive intention to implement nsMCMs, whereas a smaller majority of farmers had the intention to implement the specific MCMs to improve udder cleaning (87%), to improve stall hygiene (78%), to improve feeding of cows (76%), and to perform foremilk stripping (74%). Farmers had a more positive attitude, but lower subjective norm and lower perceived behavioural control towards implementing nsMCMs compared with implementing most specific MCMs, although the subjective norms for stall hygiene and perceived behavioural control for improving feeding of cows were also low. Attitude was positively associated with intentions to implement nsMCMs, to improve cleaning of the udders, to improve stall hygiene and to implement foremilk stripping. Both the intention to improve udder cleaning and to implement foremilk stripping, were positively associated to subjective norms towards these MCMs. Our data can help tailor intervention programs aiming to increase the intention of Ethiopian dairy farmers to implement MCMs and thus to improve udder health in this country. We show that such programs should primarily focus on changing attitude and secondarily on improving the farmers' subjective norms.

Beyond Strength: Participant Perspectives on the Benefits of an Older Adult Exercise Program.

PubMed

Kohn, Marlana; Belza, Basia; Petrescu-Prahova, Miruna; Miyawaki, Christina E

2016-06-01

This study examines the expected and experienced benefits among participants in Enhance®Fitness (EF), an evidence-based group physical activity program for older adults. We also describe the implications for program dissemination (reach, implementation, and maintenance) within the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Twenty semistructured interviews were conducted with EF participants enrolled from 2005 to 2012. Interviews were digitally recorded, professionally transcribed, and analyzed using a deductive approach. Participants were motivated to join EF for expected physical benefits and the social environment of a group-based class. Actualized benefits of participation included physical, social, functional, and improved self-image/sense of well-being. Participants valued the practical application of class exercises to daily activities that support independent living, such as lifting objects and completing household chores. Organizations looking to implement EF or improve existing EF classes can improve program reach, implementation, and maintenance by incorporating participants' expressed motivations and valued benefits in program marketing and by improving organizational support to meet participant needs. EF class instructors can tailor their classes to engage participants based on their motivations. Understanding participants' motivations and valued benefits can improve EF dissemination by meeting participant needs with tailored class offerings and organizational needs informed by participant insights that aid program sustainability. © 2015 Society for Public Health Education.

Evaluating the Implementation of a Training Program for Improving Quality Service: An Action Research Study

ERIC Educational Resources Information Center

Pierre, Ketly Dieudonne

2014-01-01

There is a need to implement a comprehensive training program to build employees' knowledge, skills, and attitudes in order to improve quality service at ABC Restaurant because of a surge in customer complaints. The purpose of this study was to develop a training program that included an employee handbook as a training tool, a handbook designed…

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis.

PubMed

Montroy, Joshua; Breau, Rodney H; Cnossen, Sonya; Witiuk, Kelsey; Binette, Andrew; Ferrier, Taylor; Lavallée, Luke T; Fergusson, Dean A; Schramm, David

2016-01-01

The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72-0.91), deep (pRR 0.82; 95% CI0.64-1.05) and organ space (pRR 1.15; 95% CI 0.96-1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39-0.77; deep pRR 0.61, 95% CI 0.50-0.75, and organ space pRR 0.60, 95% CI 0.50-0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities.

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis

PubMed Central

Montroy, Joshua; Breau, Rodney H.; Cnossen, Sonya; Witiuk, Kelsey; Binette, Andrew; Ferrier, Taylor; Lavallée, Luke T.; Fergusson, Dean A.; Schramm, David

2016-01-01

Background The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. Study Design A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Results Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72–0.91), deep (pRR 0.82; 95% CI0.64–1.05) and organ space (pRR 1.15; 95% CI 0.96–1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. Conclusions These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities. PMID:26812596

Pathways to Program Success: A Qualitative Comparative Analysis (QCA) of Communities Putting Prevention to Work Case Study Programs

PubMed Central

Kane, Heather; Hinnant, Laurie; Day, Kristine; Council, Mary; Tzeng, Janice; Soler, Robin; Chambard, Megan; Roussel, Amy; Heirendt, Wendy

2016-01-01

Objective To examine the elements of capacity, a measure of organizational resources supporting program implementation that result in successful completion of public health program objectives in a public health initiative serving 50 communities. Design We used crisp set Qualitative Comparative Analysis (QCA) to analyze case study and quantitative data collected during the evaluation of the Communities Putting Prevention to Work (CPPW) program. Setting CPPW awardee program staff and partners implemented evidence-based public health improvements in counties, cities, and organizations (eg, worksites, schools). Participants Data came from case studies of 22 CPPW awardee programs that implemented evidence-based, community-and organizational-level public health improvements. Intervention Program staff implemented a range of evidence-based public health improvements related to tobacco control and obesity prevention. Main Outcome Measure The outcome measure was completion of approximately 60% of work plan objectives. Results Analysis of the capacity conditions revealed 2 combinations for completing most work plan objectives: (1) having experience implementing public health improvements in combination with having a history of collaboration with partners; and (2) not having experience implementing public health improvements in combination with having leadership support. Conclusion Awardees have varying levels of capacity. The combinations identified in this analysis provide important insights into how awardees with different combinations of elements of capacity achieved most of their work plan objectives. Even when awardees lack some elements of capacity, they can build it through strategies such as hiring staff and engaging new partners with expertise. In some instances, lacking 1 or more elements of capacity did not prevent an awardee from successfully completing objectives. Implications for Policy & Practice These findings can help funders and practitioners recognize and assemble different aspects of capacity to achieve more successful programs; awardees can draw on extant organizational strengths to compensate when other aspects of capacity are absent. PMID:27598714

Changes in quality of care and costs induced by implementation of a diabetes program in a social security entity of Argentina.

PubMed

González, Lorena; Elgart, Jorge F; Calvo, Héctor; Gagliardino, Juan J

2013-01-01

To measure the impact of a diabetes and cardiovascular risk factors program implemented in a social security institution upon short- and long-term clinical/metabolic outcomes and costs of care. Observational longitudinal cohort analysis of clinical/metabolic data and resource use of 300 adult male and female program participants with diabetes before (baseline) and 1 and 3 years after implementation of the program. Data were obtained from clinical records (Qualidiab) and the administration's database. The implementation of the program in "real world" conditions resulted in an immediate and sustainable improvement of the quality of care provided to people with diabetes incorporated therein. We also recorded a more appropriate oral therapy prescription for hyperglycemia and cardiovascular risk factors (CVRFs), as well as a decrease of events related to chronic complications. This improvement was associated with an increased use of diagnostic and therapeutic resources, particularly those related to pharmacy prescriptions, not specifically used for the control of hyperglycemia and other CVRFs. The implementation of a diabetes program in real-world conditions results in a significant short- and long-term improvement of the quality of care provided to people with diabetes and other CVRFs, but simultaneously increased the use of resources and the cost of diagnostic and therapeutic practices. Since controlled studies have shown improvement in quality of care without increasing costs, our results suggest the need to include management-control strategies in these programs for appropriate medical and administrative feedback to ensure the simultaneous improvement of clinical outcomes and optimization of the use of resources.

Dissemination and Implementation Strategies of Lower Extremity Preventive Training Programs in Youth: A Clinical Review.

PubMed

DiStefano, Lindsay J; Frank, Barnett S; Root, Hayley J; Padua, Darin A

Neuromuscular preventive training programs effectively reduce injury and improve performance in youth athletes. However, program effectiveness is directly linked to program compliance, fidelity, and dosage. Preventive training programs are not widely adopted by youth sport coaches. One way to promote widespread dissemination and compliance is to identify implementation strategies that influence program adoption and maintenance. It is unknown how previously published programs have followed the elements of an implementation framework. The objective of this review was to evaluate how elements of the 7 steps of implementation, developed by Padua et al, have been performed in the evidence of lower extremity preventive training programs. A systematic review of the literature from 1996 through September 2016 was conducted using electronic databases. Investigations that documented implementation of a sport team-based neuromuscular preventive training program in youth athletes and measured lower extremity injury rates were included. Clinical review. Level 4. A total of 12 studies met the inclusion criteria and were reviewed. Information regarding the completion of any of the 7 steps within the implementation framework developed by Padua et al was extracted. None of the 12 articles documented completion of all 7 steps. While each study addressed some of the 7 steps, no study addressed maintenance or an exit strategy for youth athletes. Program implementation appears limited in obtaining administrative support, utilizing an interdisciplinary implementation team, and monitoring or promoting fidelity of the intervention. Despite strong evidence supporting the effectiveness of preventive training programs in youth athletes, there is a gap between short-term improvements and long-term implementation strategies. Future interventions should include all 7 steps of the implementation framework to promote transparent dissemination of preventive training programs.

Implementation of a hospital-based quality assessment program for rectal cancer.

PubMed

Hendren, Samantha; McKeown, Ellen; Morris, Arden M; Wong, Sandra L; Oerline, Mary; Poe, Lyndia; Campbell, Darrell A; Birkmeyer, Nancy J

2014-05-01

Quality improvement programs in Europe have had a markedly beneficial effect on the processes and outcomes of rectal cancer care. The quality of rectal cancer care in the United States is not as well understood, and scalable quality improvement programs have not been developed. The purpose of this article is to describe the implementation of a hospital-based quality assessment program for rectal cancer, targeting both community and academic hospitals. We recruited 10 hospitals from a surgical quality improvement organization. Nurse reviewers were trained to abstract rectal cancer data from hospital medical records, and abstracts were assessed for accuracy. We conducted two surveys to assess the training program and limitations of the data abstraction. We validated data completeness and accuracy by comparing hospital medical record and tumor registry data. Nine of 10 hospitals successfully performed abstractions with ≥ 90% accuracy. Experienced nurse reviewers were challenged by the technical details in operative and pathology reports. Although most variables had less than 10% missing data, outpatient testing information was lacking from some hospitals' inpatient records. This implementation project yielded a final quality assessment program consisting of 20 medical records variables and 11 tumor registry variables. An innovative program linking tumor registry data to quality-improvement data for rectal cancer quality assessment was successfully implemented in 10 hospitals. This data platform and training program can serve as a template for other organizations that are interested in assessing and improving the quality of rectal cancer care. Copyright © 2014 by American Society of Clinical Oncology.

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2014-10-01 2014-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality...

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2012-10-01 2012-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality...

42 CFR 422.152 - Quality improvement program.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... 42 Public Health 3 2013-10-01 2013-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality...

Scenario Decomposition for 0-1 Stochastic Programs: Improvements and Asynchronous Implementation

DOE PAGES

Ryan, Kevin; Rajan, Deepak; Ahmed, Shabbir

2016-05-01

We recently proposed scenario decomposition algorithm for stochastic 0-1 programs finds an optimal solution by evaluating and removing individual solutions that are discovered by solving scenario subproblems. In our work, we develop an asynchronous, distributed implementation of the algorithm which has computational advantages over existing synchronous implementations of the algorithm. Improvements to both the synchronous and asynchronous algorithm are proposed. We also test the results on well known stochastic 0-1 programs from the SIPLIB test library and is able to solve one previously unsolved instance from the test set.

The Council of Academic Hospitals of Ontario (CAHO) Adopting Research to Improve Care (ARTIC) Program: Reach, Sustainability, Spread and Lessons Learned from an Implementation Funding Model.

PubMed

Moore, Julia E; Grouchy, Michelle; Graham, Ian D; Shandling, Maureen; Doyle, Winnie; Straus, Sharon E

2016-05-01

Despite evidence on what works in healthcare, there is a significant gap in the time it takes to bring research into practice. The Council of Academic Hospitals of Ontario's Adopting Research to Improve Care program addresses this research-to-practice gap by incorporating the following components into its funding program: strategic selection of evidence for implementation, education and training for implementation, implementation supports, executive champions and governance, and evaluation. Funded projects have been sustained (76% reported full sustainability) and spread to over 200 new sites. Lessons learned include the following: assess readiness, develop tailored implementation materials, consider characteristics of implementation supports, protect champion time and consider evaluation feasibility. Copyright © 2016 Longwoods Publishing.

The Council of Academic Hospitals of Ontario (CAHO) Adopting Research to Improve Care (ARTIC) Program: Reach, Sustainability, Spread and Lessons Learned from an Implementation Funding Model

PubMed Central

Grouchy, Michelle; Graham, Ian D.; Shandling, Maureen; Doyle, Winnie; Straus, Sharon E.

2016-01-01

Despite evidence on what works in healthcare, there is a significant gap in the time it takes to bring research into practice. The Council of Academic Hospitals of Ontario's Adopting Research to Improve Care program addresses this research-to-practice gap by incorporating the following components into its funding program: strategic selection of evidence for implementation, education and training for implementation, implementation supports, executive champions and governance, and evaluation. Funded projects have been sustained (76% reported full sustainability) and spread to over 200 new sites. Lessons learned include the following: assess readiness, develop tailored implementation materials, consider characteristics of implementation supports, protect champion time and consider evaluation feasibility. PMID:27232234

Mathematics: Program Assessment and Improvement Planning Manual.

ERIC Educational Resources Information Center

Whitman, Nancy C.; And Others

This document provides a model for assessing a school's mathematics program and planning for program improvement. A systematic process for instructional improvement focuses upon students' needs and the identification of successful instructional strategies to meet these needs. The improvement plan and the implementation of intervention strategies…

Perspectives of HIV Clinic Staff on the Implementation of a Client Financial Incentives Program Targeting Viral Suppression.

PubMed

Anderson, Susannah; Jenner, Eric; Lass, Katherine; Burgess, Samuel

We present perspectives of health care providers and clinic staff on the implementation of a financial incentive program for clients living with HIV in three Louisiana clinics. Interviews were conducted in May-June 2015 with 27 clinic staff to assess their perspectives on implementation of the Health Models financial incentive program, which was initiated in September 2013. Many providers and staff welcomed the program, but some were concerned about sustainability and the ethics of a program that paid patients to receive care. Most said they eventually found the program to be helpful for patients and clinic operations in general, by facilitating partnerships between providers and patients, improving appointment keeping, providing opportunities for patient education, engaging patients in care, and helping patients form new prevention habits. The findings can improve understanding of staff and leadership perceptions of incentive programs and can inform planning and implementation of these programs in the future. Copyright © 2017 Association of Nurses in AIDS Care. All rights reserved.

Scaling Up a Water, Sanitation, and Hygiene Program in Rural Bangladesh: The Role of Program Implementation

PubMed Central

Sultana, Sonia; Halder, Amal K.; Ahsan, Mohammed Ali; Arnold, Benjamin F.; Hubbard, Alan E.; Unicomb, Leanne; Luby, Stephen P.; Colford, John M.

2017-01-01

Objectives. To evaluate whether the quality of implementation of a water, sanitation, and hygiene program called SHEWA-B and delivered by UNICEF to 20 million people in rural Bangladesh was associated with health behaviors and sanitation infrastructure access. Methods. We surveyed 33 027 households targeted by SHEWA-B and 1110 SHEWA-B hygiene promoters in 2011 and 2012. We developed an implementation quality index and compared the probability of health behaviors and sanitation infrastructure access in counterfactual scenarios over the range of implementation quality. Results. Forty-seven percent of households (n = 14 622) had met a SHEWA-B hygiene promoter, and 47% of hygiene promoters (n = 527) could recall all key program messages. The frequency of hygiene promoter visits was not associated with improved outcomes. Higher implementation quality was not associated with better health behaviors or infrastructure access. Outcomes differed by only 1% to 3% in scenarios in which all clusters received low versus high implementation quality. Conclusions. SHEWA-B did not meet UNICEF’s ideal implementation quality in any area. Improved implementation quality would have resulted in marginal changes in health behaviors or infrastructure access. This suggests that SHEWA-B’s design was suboptimal for improving these outcomes. PMID:28323462

FFY 2012-2015 transportation improvement program for the Dubuque, Iowa, Illinois and Wisconsin urbanized area.

DOT National Transportation Integrated Search

2011-08-18

"A Transportation Improvement Program (TIP) is the Dubuque Metropolitan Area : Transportation Study (DMATS) 4- year financial implementation program listing of : transportation improvement projects eligible for Federal funding. It is DMATS : transpor...

Designing, testing, and implementing a sustainable nurse home visiting program: right@home.

PubMed

Goldfeld, Sharon; Price, Anna; Kemp, Lynn

2018-05-01

Nurse home visiting (NHV) offers a potential platform to both address the factors that limit access to services for families experiencing adversity and provide effective interventions. Currently, the ability to examine program implementation is hampered by a lack of detailed description of actual, rather than expected, program development and delivery in published studies. Home visiting implementation remains a black box in relation to quality and sustainability. However, previous literature would suggest that efforts to both report and improve program implementation are vital for NHV to have population impact and policy sustainability. In this paper, we provide a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. We address existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of our evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence-based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to and embedded within existing service delivery systems. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of The New York Academy of Sciences.

Key Informants' Perceptions on the Implementation of a National Program for Improving Nutritional Status of Children in Iran.

PubMed

Ghodsi, Delaram; Omidvar, Nasrin; Rashidian, Arash; Raghfar, Hossein; Eini-Zinab, Hassan; Ebrahimi, Marziyeh

2016-01-01

Childhood malnutrition is a major public health issue. Multidisciplinary approach for Improvement of Nutritional Status of Children in Iran was implemented in order to reduce malnutrition among children. This study aimed to evaluate the implementation aspect of the program and to explore key informants' perceptions and experience regarding the factors affected its implementation. Data were collected through the review of secondary data and semistructured interviews at national, province, and local levels. Four layers of key informants were selected purposefully for interviewing, including policymakers, senior nutrition officers, head of Hygiene, Remedy and Insurance Affairs in Imam Khomeini Relief Foundation, and community health workers. Qualitative content analysis was carried out based on Supporting the Use of Research Evidence framework and Tailored Implementation for Chronic Diseases' checklist to interpret the viewpoints of the study participants. Results showed that the program had successes in improving mother's knowledge on health, nutrition, and child care through health system and increased families' access to food, but there were some aspects that affected program's implementation. Some of these factors are the lack of clarity in the program's protocol and indicators, human shortage and inadequate financial resources, poor facilities, inattention to staff motivation, insufficient commitment among different sections, poor communication and supervision among different executive sections, and program protocols designing regardless of practical condition. Based on the results, top-down approach in policymaking and inadequate financial and human resources were responsible for most of the challenges encountered in the implementation.

2011 John M. Eisenberg Patient Safety and Quality Awards. Mentored implementation: building leaders and achieving results through a collaborative improvement model. Innovation in patient safety and quality at the national level.

PubMed

Maynard, Gregory A; Budnitz, Tina L; Nickel, Wendy K; Greenwald, Jeffrey L; Kerr, Kathleen M; Miller, Joseph A; Resnic, JoAnne N; Rogers, Kendall M; Schnipper, Jeffrey L; Stein, Jason M; Whitcomb, Winthrop F; Williams, Mark V

2012-07-01

The Society of Hospital Medicine (SHM) created "Mentored Implementation" (MI) programs with the dual aims of educating and mentoring hospitalists and their quality improvement (QI) teams and accelerating improvement in the inpatient setting in three signature programs: Venous Thromboembolism (VTE) Prevention, Glycemic Control, and Project BOOST (Better Outcomes for Older adults through Safe Transitions). More than 300 hospital improvement teams were enrolled in SHM MI programs in a series of cohorts. Hospitalist mentors worked with individual hospitals/health systems to guide local teams through the life cycle of a QI project. Implementation Guides and comprehensive Web-based "Resource Rooms," as well as the mentor's own experience, provided best-practice definitions, practical implementation tips, measurement strategies, and other tools. E-mail interactions and mentoring were augmented by regularly scheduled teleconferences; group webinars; and, in some instances, a site visit. Performance was tracked in a centralized data tracking center. Preliminary data on all three MI programs show significant improvement in patient outcomes, as well as enhancements of communication and leadership skills of the hospitalists and their QI teams. Although objective data on outcomes and process measures for the MI program's efficacy remain preliminary at this time, the maturing data tracking system, multiple awards, and early results indicate that the MI programs are successful in providing QI training and accelerating improvement efforts.

40 CFR 93.101 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Implementation Plans of Transportation Plans, Programs, and Projects Developed, Funded or Approved Under Title 23.... Transportation improvement program (TIP) means a transportation improvement program developed by a metropolitan... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) DETERMINING...

The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program.

PubMed

Scovil, Carol Y; Flett, Heather M; McMillan, Lan T; Delparte, Jude J; Leber, Diane J; Brown, Jacquie; Burns, Anthony S

2014-09-01

To implement pressure ulcer (PU) prevention best practices in spinal cord injury (SCI) rehabilitation using implementation science frameworks. Quality improvement. SCI Rehabilitation Center. Inpatients admitted January 2012 to July 2013. Implementation of two PU best practices were targeted: (1) completing a comprehensive PU risk assessment and individualized interprofessional PU prevention plan (PUPP); and (2) providing patient education for PU prevention; as part of the pan-Canadian SCI Knowledge Mobilization Network. At our center, the SCI Pressure Ulcer Scale replaced the Braden risk assessment scale and an interprofessional PUPP form was implemented. Comprehensive educational programing existed, so efforts focused on improving documentation. Implementation science frameworks provided structure for a systematic approach to best practice implementation (BPI): (1) site implementation team, (2) implementation drivers, (3) stages of implementation, and (4) improvement cycles. Strategies were developed to address key implementation drivers (staff competency, organizational supports, and leadership) through the four stages of implementation: exploration, installation, initial implementation, and full implementation. Improvement cycles were used to address BPI challenges. Implementation processes (e.g. staff training) and BPI outcomes (completion rates). Following BPI, risk assessment completion rates improved from 29 to 82%. The PUPP completion rate was 89%. PU education was documented for 45% of patients (vs. 21% pre-implementation). Implementation science provided a framework and effective tools for successful pressure ulcer BPI in SCI rehabilitation. Ongoing improvement cycles will target timeliness of tool completion and documentation of patient education.

Implementing an anti-smoking program in rural-remote communities: challenges and strategies.

PubMed

Tall, Julie A; Brew, Bronwyn K; Saurman, Emily; Jones, Therese C

2015-01-01

Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

Reductions in employee productivity impairment observed after implementation of web-based worksite health promotion programs.

PubMed

Silberman, Jordan; Schwartz, Steven; Giuseffi, Danielle L; Wang, Chun; Nevedal, Dana; Bedrosian, Richard

2011-12-01

To assess changes in employee productivity impairment observed after the implementation of several Web-based health promotion programs. Health risk assessments and self-report measures of productivity impairment were administered on-line to more than 43,000 participants of Web-based health promotion programs. Reductions in productivity impairment were observed after 1 month of program utilization. Productivity impairment at 90- and 180-day follow-ups also decreased relative to baseline. Improvements in employee health were associated with reductions in employee productivity impairment. The use of Web-based health promotion programs was associated with reductions in productivity impairment and improvements in employee health. After the implementation of Web-based health promotion programs, reductions in productivity impairment may be observed before reductions in direct health care costs.

Empowering families by engaging and relating Murri way: a grounded theory study of the implementation of the Cape York Baby Basket program.

PubMed

McCalman, Janya; Searles, Andrew; Bainbridge, Roxanne; Ham, Rachael; Mein, Jacki; Neville, Johanna; Campbell, Sandra; Tsey, Komla

2015-05-21

Evaluating program outcomes without considering how the program was implemented can cause misunderstandings and inefficiencies when initiating program improvements. In conjunction with a program evaluation, reported elsewhere, this paper theorises the process of implementing an Indigenous Australian maternal and child health program. The Baby Basket program was developed in 2009 for the remote Cape York region and aimed to improve the attendance and engagement of Indigenous women at antenatal and postnatal clinics through providing three baskets of maternal and baby goods and associated health education. Constructivist grounded theory methods were used to generate and analyse data from qualitative interviews and focus groups with Indigenous women who received the baskets, their extended family members, and healthcare workers who delivered them. Data was coded in NVivo with concepts iteratively compared until higher order constructs and their relationships could be modelled to explain the common purpose for participants, the process involved in achieving that purpose, key strategies, conditions and outcomes. Theoretical terms are italicised. Program implementation entailed empowering families through a process of engaging and relating Murri (Queensland Indigenous) way. Key influencing conditions of the social environment were the remoteness of communities, keeping up with demand, families' knowledge, skills and roles and organisational service approaches and capacities. Engaging and relating Murri way occurred through four strategies: connecting through practical support, creating a culturally safe practice, becoming informed and informing others, and linking at the clinic. These strategies resulted in women and families taking responsibility for health through making healthy choices, becoming empowered health consumers and advocating for community changes. The theoretical model was applied to improve and revise Baby Basket program implementation, including increased recognition of the importance of empowering families by extending the home visiting approach up to the child's third birthday. Engaging and relating Murri way was strengthened by formal recognition and training of Indigenous health workers as program leaders. This theoretical model of program implementation was therefore useful for guiding program improvements, and could be applicable to other Indigenous maternal and child health programs.

Umatilla River Subbasin Fish Habitat Improvement Program, 1996-2003 Summary Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

St. Hilaire, Danny R.; Montgomery, Michael; Bailey, Timothy D.

This annual report is in fulfillment of contractual obligations with Bonneville Power Administration (BPA), which is the funding source for the Oregon Department of Fish and Wildlife's (ODFW), Umatilla River Subbasin Fish Habitat Improvement Program (Program). The last Annual Program Report was submitted in 1997, and described projects undertaken in 1995. This report describes Program activities carried out in 2003, along with a summary of projects undertaken during the years 1996 through 2002. The Program works cooperatively with private landowners to develop long-term restoration agreements, under which, passive and active Habitat Improvement Projects are conducted. Historically, projects have included livestockmore » exclusion fencing (passive restoration) to protect riparian habitats, along with the installation of instream structures (active restoration) to address erosion and improve fish habitat. In recent years, the focus of active restoration has shifted to bioengineering treatments and, more recently, to channel re-design and re-construction aimed at improving fish habitat, by restoring stable channel function. This report provides a summary table of past projects (1996-2002), along with a text description of more extensive habitat improvement projects, including: (1) Implementation of a four-phased project on the Lobato property (Birch Creek) beginning in 1996 and involving a demonstration bioengineering site and riparian improvements (fencing, planting), (2) Implementation of stable channel design/instream structure placement on the Houser property, East Birch Creek, beginning in 1998, an (3) Implementation of a joint, US Army Corps of Engineers/ODFW (cost share) project beginning in 2001 on the Brogoitti property, East Birch Creek, which involved implementation of stable channel design/construction and riparian improvement treatments.« less

School-based sleep education program improves sleep and academic performance of school-age children.

PubMed

Gruber, Reut; Somerville, Gail; Bergmame, Lana; Fontil, Laura; Paquin, Soukaina

2016-05-01

The objective of this study was to develop and evaluate the effectiveness of a school-based sleep education program aimed at improving the sleep and academic performance of school-age children. Using a community-based participatory research approach, we created a school-based sleep education program, "Sleep for Success"™ (SFS), composed of four distinct modules that addressed the children, their family and community, the school staff, and decision makers within the school setting. Implementation was carried out in three elementary schools. Seventy-one students participated in the evaluation of the program. The effectiveness of the SFS program was evaluated using non-randomized controlled before-and-after study groups (intervention and control) assessed over two time points (pre- and post-program implementation). Before (baseline) and after implementation, sleep and academic performance were measured using actigraphy and report card marks, respectively. In the intervention group, true sleep was extended by 18.2 min per night, sleep efficiency improved by 2.3%, and sleep latency was shortened by 2.3 min, and report card grades in mathematics and English improved significantly. No changes were noted in the control group. Participation in the sleep education program was associated with significant improvements in children's sleep and academic performance. Copyright © 2016 Elsevier B.V. All rights reserved.

Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care.

PubMed

Hoekstra, Femke; van Offenbeek, Marjolein A G; Dekker, Rienk; Hettinga, Florentina J; Hoekstra, Trynke; van der Woude, Lucas H V; van der Schans, Cees P

2017-12-01

Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior. This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes. Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p < .05). Qualitative data showed that the stable high fidelity organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613) = - 1032, p = .303). Differences in organizational-level implementation fidelity trajectories did not result in outcome differences at patient-level. This suggests that an effective implementation fidelity trajectory is contingent on the local organization's conditions. More specifically, achieving stable high implementation fidelity required the management of tensions: realizing a localized change vision, while safeguarding the program's standardized core components and engaging the scarce physicians throughout the process. When scaling up evidence-informed health promotion programs, we propose to tailor the management of implementation tensions to local organizations' starting position, size, and circumstances. The Netherlands National Trial Register NTR3961 . Registered 18 April 2013.

A Checklist-based Intervention to Improve Surgical Outcomes in Michigan: Evaluation of the Keystone Surgery Program

PubMed Central

Reames, Bradley N.; Krell, Robert W.; Campbell, Darrell A.; Dimick, Justin B.

2015-01-01

Importance Previous studies of checklist-based quality improvement interventions have reported mixed results. Objective To evaluate whether implementation of a checklist-based quality improvement intervention, Keystone Surgery, was associated with improved outcomes in patients undergoing general surgery in large statewide population. Design, Setting and Exposure Retrospective longitudinal study examining surgical outcomes in Michigan patients using Michigan Surgical Quality Collaborative clinical registry data from the years 2006–2010 (n=64,891 patients in 29 hospitals). Multivariable logistic regression and difference-in-differences analytic approaches were used to evaluate whether Keystone Surgery program implementation was associated with improved surgical outcomes following general surgery procedures, apart from existing temporal trends toward improved outcomes during the study period. Main Outcome Measures Risk-adjusted rates of superficial surgical site infection, wound complications, any complication, and 30-day mortality. Results Implementation of Keystone Surgery in participating centers (n=14 hospitals) was not associated with improvements in surgical outcomes during the study period. Adjusted rates of superficial surgical site infection (3.2 vs. 3.2%, p=0.91), wound complications (5.9 vs. 6.5%, p=0.30), any complication (12.4 vs. 13.2%, p=0.26), and 30-day mortality (2.1 vs. 1.9%, p=0.32) at participating hospitals were similar before and after implementation. Difference-in-differences analysis accounting for trends in non-participating centers (n=15 hospitals), and sensitivity analysis excluding patients receiving surgery in the first 6- or 12-months after program implementation yielded similar results. Conclusions and Relevance Implementation of a checklist-based quality improvement intervention did not impact rates of adverse surgical outcomes among patients undergoing general surgery in participating Michigan hospitals. Additional research is needed to understand why this program was not successful prior to further dissemination and implementation of this model to other populations. PMID:25588183

The Collier Chautauqua program: A formative evaluation of the implementation of the Iowa Chautauqua model of professional development and its effectiveness in improving science teaching

NASA Astrophysics Data System (ADS)

Dass, Pradeep Maxwell

1997-11-01

A formative evaluation of the implementation of the Iowa Chautauqua model of professional development in Collier County, Florida, was conducted during 1995-97, focusing on implementation issues and teacher enhancement. Major findings are as follows: Implementation issues. (1) Development of a shared vision through collaborative interaction between teachers, school administrators, and district administrators is critical to successful program implementation. (2) When a new program is implemented on a district-wide basis, the success of implementation depends upon how well the program matches local goals and needs and how ready the district and teachers are to make changes necessary for implementing the tenets of the program. (3) Development of proper understanding of desired pedagogical approaches requires modeling of these approaches in program activities, with explicit attention drawn to the modeling. (4) Successful implementation of desired pedagogical approaches in the classroom is critically influenced by the support and continual feedback teachers receive from district administrators, building administrators, and their peers. (5) Unwavering commitment of district and school administrators is essential for encouraging more teachers to participate in the program, leading to district-wide implementation without making it mandatory. Teacher Enhancement. (1) Participants developed leadership skills in mentorship, teamwork, presenting at professional meetings, and assuming responsibility within the program. (2) Participants learned to focus more on student questions and concerns, value prior conceptions of students, and develop instructional activities accordingly. They grew in their understanding and use of the constructivist pedagogy. (3) Participants attitude toward teaching in general and science in particular improved markedly, leading to new excitement and enthusiasm toward their profession. (4) Participants became more confident about teaching science. Elementary teachers reported spending more time on science activities and integrating science topics more with other curricular areas. (5) Participants collaborated more with their peers, administrators, and local community resources in improving instructional activities, providing more meaningful learning experiences for their students. (6) Participants integrated more technological resources than they did formerly, helping students explore avenues otherwise inaccessible. This investigation reveals that teacher enhancement is closely related to changed practice, which is critically influenced by implementation issues at broader levels.

Implementing a Portfolio Assessment System for Chapter 1 Program Improvement: A Case Study.

ERIC Educational Resources Information Center

Leitner, David; Trevisan, Mike

This paper presents findings of a case study that documented the implementation of a portfolio assessment system in response to mandated program improvement and assessed its impact on teacher and student behaviors. The sample included elementary and middle school teachers and students from three Chapter 1 schools in a rural California school…

23 CFR 1200.25 - Improvement plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Implementation and Management of the Highway Safety Program § 1200.25 Improvement plan. If a review of the Annual... improvement plan. This plan will detail strategies, program activities, and funding targets to meet the...

Taking a unified approach to teaching and implementing quality improvements across multiple residency programs: the Atlantic Health experience.

PubMed

Daniel, Donna M; Casey, Donald E; Levine, Jeffrey L; Kaye, Susan T; Dardik, Raquel B; Varkey, Prathibha; Pierce-Boggs, Kimberly

2009-12-01

The Accreditation Council for Graduate Medical Education recently emphasized the importance of systems-based practice and systems-based learning; however, successful models of collaborative quality improvement (QI) initiatives in residency training curricula are not widely available. Atlantic Health successfully conceptualized and implemented a QI collaborative focused on medication safety across eight residency training programs representing 219 residents. During a six-month period, key faculty and resident leaders from 8 (of 10) Atlantic Health residency training programs participated in three half-day collaborative learning sessions focused on improving medication reconciliation. Each session included didactic presentations from a multidisciplinary team of clinical experts as well as the application of principles that identified challenges, barriers, and solutions to QI initiatives. The learning sessions emphasized the fundamental principles of medication reconciliation, its critical importance as a vital part of patient handoff in all health care settings, and the challenges of achieving successful medication reconciliation improvement in light of work hours restrictions and patient loads. Each residency program developed a detailed implementation and measurement plan for individual "action learning" projects, using the Plan-Do-Study-Act method of improvement. Each program then implemented its QI project, and expert faculty (e.g., physicians, nurses, pharmacists, QI staff) provided mentoring between learning sessions. Several projects resulted in permanent changes in medication reconciliation processes, which were then adopted by other programs. The structure, process, and outcomes of this effort are described in detail.

American Historical Association Faculty Development Program: Planning and Implementation.

ERIC Educational Resources Information Center

Hoffmann, Charles

The planning and implementation processes of the Long Island Faculty Development Program are described. Originally sponsored by the American Historical Association's Faculty Development Program to improve history instruction, this project includes faculty representatives from four Long Island universities, colleges, and junior colleges. The…

The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program

PubMed Central

Scovil, Carol Y.; Flett, Heather M.; McMillan, Lan T.; Delparte, Jude J.; Leber, Diane J.; Brown, Jacquie; Burns, Anthony S.

2014-01-01

Objectives To implement pressure ulcer (PU) prevention best practices in spinal cord injury (SCI) rehabilitation using implementation science frameworks. Design Quality improvement. Setting SCI Rehabilitation Center. Participants Inpatients admitted January 2012 to July 2013. Interventions Implementation of two PU best practices were targeted: (1) completing a comprehensive PU risk assessment and individualized interprofessional PU prevention plan (PUPP); and (2) providing patient education for PU prevention; as part of the pan-Canadian SCI Knowledge Mobilization Network. At our center, the SCI Pressure Ulcer Scale replaced the Braden risk assessment scale and an interprofessional PUPP form was implemented. Comprehensive educational programing existed, so efforts focused on improving documentation. Implementation science frameworks provided structure for a systematic approach to best practice implementation (BPI): (1) site implementation team, (2) implementation drivers, (3) stages of implementation, and (4) improvement cycles. Strategies were developed to address key implementation drivers (staff competency, organizational supports, and leadership) through the four stages of implementation: exploration, installation, initial implementation, and full implementation. Improvement cycles were used to address BPI challenges. Outcome Measures Implementation processes (e.g. staff training) and BPI outcomes (completion rates). Results Following BPI, risk assessment completion rates improved from 29 to 82%. The PUPP completion rate was 89%. PU education was documented for 45% of patients (vs. 21% pre-implementation). Conclusion Implementation science provided a framework and effective tools for successful pressure ulcer BPI in SCI rehabilitation. Ongoing improvement cycles will target timeliness of tool completion and documentation of patient education. PMID:25029674

Safe patient handling in diagnostic imaging.

PubMed

Murphey, Susan L

2010-01-01

Raising awareness of the risk to diagnostic imaging personnel from manually lifting, transferring, and repositioning patients is critical to improving workplace safety and staff utilization. The aging baby boomer generation and growing bariatric population exacerbate the problem. Also, legislative initiatives are increasing nationwide for hospitals to implement safe patient handling programs. A management process designed to improve working conditions through implementing ergonomic programs can reduce losses and improve productivity and patient care outcome measures for imaging departments.

Improving Transfer of Learning: An Innovative Comentoring Program to Enhance Workplace Implementation After an Occupational Therapy Course on Autism Spectrum Disorders.

PubMed

Ashburner, Jill; Ziviani, Jenny; Rodger, Sylvia; Hinder, Elizabeth A; Cartmill, Linda; White, Jessica; Vickerstaff, Sandy

2015-01-01

Research suggests that learning gained through training is infrequently implemented in the workplace. A short-term postcourse comentoring program was developed with the aim of facilitating workplace implementation of learning after a 3-day course for occupational therapists. The program was evaluated for usefulness, successes, challenges, recommended improvements, and associations with changes in self-rated knowledge and confidence. Two months after the course, 42 participants completed an evaluation of the comentoring program with closed- and open-ended questions addressing usefulness, successes, challenges, pairing preferences, and recommendations. They also completed a record on whether or not they had worked on goals nominated in their comentoring contract. Before and 2 months after the course, they completed a self-rated questionnaire on knowledge and confidence. The comentoring program was recommended by 80% of participants. Benefits included opportunities for information and resource sharing, debriefing, problem solving, reassurance, and implementation of ideas. Ninety-five percent of participants worked on some or all their comentoring goals. Although there were significant improvements in knowledge (P < 0.001) and confidence (P < 0.001), the total comentoring evaluation score was not significantly associated with these changes. It is therefore possible that these improvements related to the course itself rather than the comentoring program. Challenges related to time, scheduling, distance, and pairing of comentors. Reported benefits of the program included enhanced psychosocial support and prompting to trial newly learned strategies. Effectiveness may be improved by setting aside time for comentoring in the workplace and better matching of comentors.

Evaluating the Implementation of Performance Improvement Training: The E[superscript 3] Process for Success

ERIC Educational Resources Information Center

Larbi-Apau, Josephine A.; Moseley, James L.

2008-01-01

This article provides a comprehensive approach to careful review and evaluation of the implementation of performance training intervention. It discusses the E[superscript 3] process for success, a basic framework for evaluating the implementation phase of a training program implemented as a broad-based performance improvement strategy. The intent…

The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care.

PubMed

Ouslander, Joseph G; Bonner, Alice; Herndon, Laurie; Shutes, Jill

2014-03-01

Interventions to Reduce Acute Care Transfers (INTERACT) is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and accountable care organizations, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust quality assurance performance improvement program, which is being rolled out by the federal government over the next year. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Improving the Nurse–Family Partnership in Community Practice

PubMed Central

Donelan-McCall, Nancy; O’Brien, Ruth; MacMillan, Harriet; Jack, Susan; Jenkins, Thomas; Dunlap, Wallace P.; O’Fallon, Molly; Yost, Elly; Thorland, Bill; Pinto, Francesca; Gasbarro, Mariarosa; Baca, Pilar; Melnick, Alan; Beeber, Linda

2013-01-01

BACKGROUND: Evidence-based preventive interventions are rarely final products. They have reached a stage of development that warrant public investment but require additional research and development to strengthen their effects. The Nurse-Family Partnership (NFP), a program of nurse home visiting, is grounded in findings from replicated randomized controlled trials. OBJECTIVE: Evidence-based programs require replication in accordance with the models tested in the original randomized controlled trials in order to achieve impacts comparable to those found in those trials, and yet they must be changed in order to improve their impacts, given that interventions require continuous improvement. This article provides a framework and illustrations of work our team members have developed to address this tension. METHODS: Because the NFP is delivered in communities outside of research contexts, we used quantitative and qualitative research to identify challenges with the NFP program model and its implementation, as well as promising approaches for addressing them. RESULTS: We describe a framework used to address these issues and illustrate its use in improving nurses’ skills in retaining participants, reducing closely spaced subsequent pregnancies, responding to intimate partner violence, observing and promoting caregivers’ care of their children, addressing parents’ mental health problems, classifying families’ risks and strengths as a guide for program implementation, and collaborating with indigenous health organizations to adapt and evaluate the program for their populations. We identify common challenges encountered in conducting research in practice settings and translating findings from these studies into ongoing program implementation. CONCLUSIONS: The conduct of research focused on quality improvement, model improvement, and implementation in NFP practice settings is challenging, but feasible, and holds promise for improving the impact of the NFP. PMID:24187112

Implementation Science in Cancer Prevention and Control: A framework for research and programs in low and middle-income countries

PubMed Central

Sanchez, Michael A.; Rimer, Barbara K.; Samet, Jonathan M.; Glasgow, Russell E.

2014-01-01

Implementation Science is a set of tools, principles and methodologies that can be used to bring scientific evidence into action, improve health care quality and delivery and improve public health. As the burden of cancer increases in low- and middle-income countries, it is important to plan cancer control programs that are both evidence-based and delivered in ways that are feasible, cost-effective, contextually appropriate and sustainable. This review presents a framework for using implementation science for cancer control planning and implementation and discusses potential areas of focus for research and programs in low and middle-income countries interested in integrating research into practice and policy. PMID:25178984

Implementation of Total Employee Involvement as Part of a Continuous Improvement Program at a Fortune 500 Company

ERIC Educational Resources Information Center

Carlson, Kathy Lynn

2012-01-01

Over the last several decades, Continuous Improvement (CI) type initiatives have been implemented in companies across the United States to improve quality, reduce process variation, eliminate waste and ultimately reduce costs. Approximately five years ago, one particular Fortune 500 company implemented CI in its manufacturing facilities. A key…

Planning, Implementation, and Evaluation of AIDS Education Programs for Dentists.

ERIC Educational Resources Information Center

Gerbert, Barbara; And Others

1991-01-01

An office-based continuing education program on acquired immune deficiency syndrome (AIDS) for dentists is described, including needs assessment, model development, local piloting, national implementation with 119 dentists, and evaluation phases. Program evaluation indicated an improvement in risk perception, knowledge, and practice resulted, but…

Energy Efficiency Programs in K-12 Schools: A Guide to Developing and Implementing Greenhouse Gas Reduction Programs. Local Government Climate and Energy Strategy Series

ERIC Educational Resources Information Center

US Environmental Protection Agency, 2011

2011-01-01

Saving energy through energy efficiency improvements can cost less than generating, transmitting, and distributing energy from power plants, and provides multiple economic and environmental benefits. Local governments can promote energy efficiency in their jurisdictions by developing and implementing strategies that improve the efficiency of…

All That Glitters Isn't Gold--Four Steps to School Improvement.

ERIC Educational Resources Information Center

Huddle, Eugene

1987-01-01

Outlines findings from a study by the United States Department of Education's Office of Educational Research and Improvement of successful school improvement programs. The findings are categorized under four stages: initiation, initial implementation, full implementation, and institutionalization. (MD)

Youth empowerment solutions for violence prevention.

PubMed

Reischl, Thomas M; Zimmerman, Marc A; Morrel-Samuels, Susan; Franzen, Susan P; Faulk, Monique; Eisman, Andria B; Roberts, Everett

2011-12-01

The limited success of youth violence prevention interventions suggests that effective prevention needs to address causes at multiple levels of analysis and empower youth in developing and implementing prevention programs. In this article, we review published studies of youth violence prevention efforts that engage youth in developing or implementing violence prevention activities. The reviewed studies suggest the promise of youth empowerment strategies and the need for systematic outcome studies of empowerment programs. After reviewing empowerment theory applied to youth violence prevention programs, we present a case study of the Youth Empowerment Solutions (YES) for Peaceful Communities program. YES engages middle-school youth in an after-school and summer program that includes a culturally tailored character development curriculum and empowers the youth to plan and implement community improvement projects with assistance from adult neighborhood advocates. The case study focuses on outcome evaluation results and presents evidence of the YES program effects on community-level outcomes (eg, property improvements, violent crime incidents) and on individual-level outcomes (eg, conflict avoidance, victimization). The literature review and the case study suggest the promise of engaging and empowering youth to plan and implement youth violence prevention programs.

The University of North Carolina Medical Center pharmacy resident leadership certificate program.

PubMed

Lyons, Kayley; Griggs, Danielle; Lebovic, Rachel; Roth, Mary E; South, David A; Hatfield, Chad

2017-03-15

The development and implementation of a certificate program for pharmacy residents are described. University of North Carolina (UNC) Medical Center met the call for increased efforts in the area of pharmacy residency leadership training through the design, implementation, and evaluation of a leadership certificate program. The purpose of the UNC certificate program is to develop leaders who will serve others, improve their communities, and advance the profession. The program is designed to (1) foster self-awareness, social awareness, and altruism, (2) provide transferable and individualized leadership experiences, (3) enrich other residency components through integration of leadership development opportunities, and (4) create role models for departmental leadership. A team of preceptors and residents implemented the certificate program by integrating program components into the existing pharmacy residency infrastructure. The certificate program includes required and flexible components to allow residents to set and achieve their determined leadership development goals. Overall, residents are satisfied with the program and perceive it as worthwhile. During the first 3 years since implementation of the certification initiative, program facilitators improved the feasibility of, participant engagement in, and sustainability of the program. Future directions include an effectiveness evaluation and a "scale-up" to other institutions. The need for a pharmacy residency leadership certificate was met by designing, implementing, and evaluating such a program at UNC. Through its first 3 years, the program was feasible, sustainable, and valued by program participants. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

A benchmarking program to reduce red blood cell outdating: implementation, evaluation, and a conceptual framework.

PubMed

Barty, Rebecca L; Gagliardi, Kathleen; Owens, Wendy; Lauzon, Deborah; Scheuermann, Sheena; Liu, Yang; Wang, Grace; Pai, Menaka; Heddle, Nancy M

2015-07-01

Benchmarking is a quality improvement tool that compares an organization's performance to that of its peers for selected indicators, to improve practice. Processes to develop evidence-based benchmarks for red blood cell (RBC) outdating in Ontario hospitals, based on RBC hospital disposition data from Canadian Blood Services, have been previously reported. These benchmarks were implemented in 160 hospitals provincewide with a multifaceted approach, which included hospital education, inventory management tools and resources, summaries of best practice recommendations, recognition of high-performing sites, and audit tools on the Transfusion Ontario website (http://transfusionontario.org). In this study we describe the implementation process and the impact of the benchmarking program on RBC outdating. A conceptual framework for continuous quality improvement of a benchmarking program was also developed. The RBC outdating rate for all hospitals trended downward continuously from April 2006 to February 2012, irrespective of hospitals' transfusion rates or their distance from the blood supplier. The highest annual outdating rate was 2.82%, at the beginning of the observation period. Each year brought further reductions, with a nadir outdating rate of 1.02% achieved in 2011. The key elements of the successful benchmarking strategy included dynamic targets, a comprehensive and evidence-based implementation strategy, ongoing information sharing, and a robust data system to track information. The Ontario benchmarking program for RBC outdating resulted in continuous and sustained quality improvement. Our conceptual iterative framework for benchmarking provides a guide for institutions implementing a benchmarking program. © 2015 AABB.

National Assessment of School Resource Officer Programs. Final Project Report. Document Number 209273

ERIC Educational Resources Information Center

Finn, Peter; McDevitt, Jack

2005-01-01

There has been a growing interest in placing sworn police officers in schools as SROs to improve school safety. The purpose of the National Assessment was to identify what program "models" have been implemented, how programs have been implemented, and what the programs' possible effects may be. To obtain this information, Abt Associates conducted…

Development and Implementation of a Bus Driver Training Program.

ERIC Educational Resources Information Center

Buchovecky, John G.

A bus driver training program was developed and implemented in a rural school district in an effort to improve the driving skills of the bus drivers. The program was tailored to meet the needs of the bus drivers and utilized various community agencies for demonstration and teaching purposes. The subject areas included in the program were driver…

A community-based hip-hop dance program for youth in a disadvantaged community in Ottawa: implementation findings.

PubMed

Beaulac, Julie; Olavarria, Marcela; Kristjansson, Elizabeth

2010-05-01

Participation in physical activity is important for the positive development and well-being of youth. A community- academic partnership was formed to improve access to physical activity for youth in one disadvantaged community in Ottawa, Canada. After consulting this community, a new hip-hop dance intervention was implemented. Adolescents aged 11 to 16 years participated in one of two 3-month sessions. A girls-only and a boys-and-girls format were offered both sessions. This article investigates the implementation of the intervention from the perspective of the youth participants, parents, staff, and researchers. Multiple methods were used, including document review, observation, questionnaire, focus groups, and interviews. Overall, the consistency and quality of program implementation were moderately satisfactory; however, important concerns were noted and this program appeared to be only partially delivered as planned. These findings will be discussed in terms of suggestions for improving the implementation of this intervention and similar recreation programs prioritizing disadvantaged communities.

Rockfall Hazard Process Assessment : Implementation Report

DOT National Transportation Integrated Search

2017-10-01

The Montana Department of Transportation (MDT) commissioned a new research program to improve assessment and management of its rock slope assets. The Department implemented a Rockfall Hazard Rating System (RHRS) program in 2005 and wished to add valu...

Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review.

PubMed

Candas, Bernard; Jobin, Gilles; Dubé, Catherine; Tousignant, Mario; Abdeljelil, Anis Ben; Grenier, Sonya; Gagnon, Marie-Pierre

2016-02-01

Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists' perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers.

Using a Mixed-Methods RE-AIM Framework to Evaluate Community Health Programs for Older Latinas.

PubMed

Schwingel, Andiara; Gálvez, Patricia; Linares, Deborah; Sebastião, Emerson

2017-06-01

This study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate a promotora-led community health program designed for Latinas ages 50 and older that sought to improve physical activity, nutrition, and stress management. A mixed-methods evaluation approach was administered at participant and organizational levels with a focus on the efficacy, adoption, implementation, and maintenance components of the RE-AIM theoretical model. The program was shown to be effective at improving participants' eating behaviors, increasing their physical activity levels, and lowering their depressive symptoms. Promotoras felt motivated and sufficiently prepared to deliver the program. Some implementation challenges were reported. More child care opportunities and an increased focus on mental well-being were suggested. The promotora delivery model has promise for program sustainability with both promotoras and participants alike expressing interest in leading future programs.

The Data-to-Action Framework: A Rapid Program Improvement Process.

PubMed

Zakocs, Ronda; Hill, Jessica A; Brown, Pamela; Wheaton, Jocelyn; Freire, Kimberley E

2015-08-01

Although health education programs may benefit from quality improvement methods, scant resources exist to help practitioners apply these methods for program improvement. The purpose of this article is to describe the Data-to-Action framework, a process that guides practitioners through rapid-feedback cycles in order to generate actionable data to improve implementation of ongoing programs. The framework was designed while implementing DELTA PREP, a 3-year project aimed at building the primary prevention capacities of statewide domestic violence coalitions. The authors describe the framework's main steps and provide a case example of a rapid-feedback cycle and several examples of rapid-feedback memos produced during the project period. The authors also discuss implications for health education evaluation and practice. © 2015 Society for Public Health Education.

Service Learning for At-Risk Student Populations: The Contextual Dynamism of Implementation

ERIC Educational Resources Information Center

Akin, Jacob T.; Vesely, Randall S.

2016-01-01

The central purpose of this article is to explore research, issues, and perspectives on the implementation of service learning programs to improve student achievement in at-risk student populations. The implementation of service learning programs takes place within multiple contexts and across several terrains. The complexities of implementing…

Conducting a SWOT Analysis for Program Improvement

ERIC Educational Resources Information Center

Orr, Betsy

2013-01-01

A SWOT (strengths, weaknesses, opportunities, and threats) analysis of a teacher education program, or any program, can be the driving force for implementing change. A SWOT analysis is used to assist faculty in initiating meaningful change in a program and to use the data for program improvement. This tool is useful in any undergraduate or degree…

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... projects, develop and implement an information technology system explicitly designed to improve patient... program that shows measurable improvement in indicators for which there is evidence that it will improve... learning throughout the hospital. (3) The hospital must take actions aimed at performance improvement and...

Stark County Area Transportation Study - Transportation Improvement Program 1997-2000

DOT National Transportation Integrated Search

1996-05-01

The Transportation Improvement Program (TIP) is the schedule of highway and transit improvements recommended for implementation within the next four years. It is, therefore, the end product of the transportation planning process. The TIP originates f...

23 CFR 924.7 - Program structure.

Code of Federal Regulations, 2011 CFR

2011-04-01

... HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HIGHWAY SAFETY HIGHWAY SAFETY IMPROVEMENT PROGRAM... implementation through highway safety improvement projects. The HSIP includes construction and operational improvements on high risk rural roads, and elimination of hazards at railway-highway grade crossings. (b) The...

23 CFR 924.7 - Program structure.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HIGHWAY SAFETY HIGHWAY SAFETY IMPROVEMENT PROGRAM... implementation through highway safety improvement projects. The HSIP includes construction and operational improvements on high risk rural roads, and elimination of hazards at railway-highway grade crossings. (b) The...

Design and implementation of an integrated, continuous evaluation, and quality improvement system for a state-based home-visiting program.

PubMed

McCabe, Bridget K; Potash, Dru; Omohundro, Ellen; Taylor, Cathy R

2012-10-01

To describe the design and implementation of an evaluation system to facilitate continuous quality improvement (CQI) and scientific evaluation in a statewide home visiting program, and to provide a summary of the system's progress in meeting intended outputs and short-term outcomes. Help Us Grow Successfully (HUGS) is a statewide home visiting program that provides services to at-risk pregnant/post-partum women, children (0-5 years), and their families. The program goals are to improve parenting skills and connect families to needed services and thus improve the health of the service population. The evaluation system is designed to: (1) integrate evaluation into daily workflow; (2) utilize standardized screening and evaluation tools; (3) facilitate a culture of CQI in program management; and, (4) facilitate scientifically rigorous evaluations. The review of the system's design and implementation occurred through a formative evaluation process (reach, dose, and fidelity). Data was collected through electronic and paper surveys, administrative data, and notes from management meetings, and medical chart review. In the design phase, four process and forty outcome measures were selected and are tracked using standardized screening and monitoring tools. During implementation, the reach and dose of training were adequate to successfully launch the evaluation/CQI system. All staff (n = 165) use the system for management of families; the supervisors (n = 18) use the system to track routine program activities. Data quality and availability is sufficient to support periodic program reviews at the region and state level. In the first 7 months, the HUGS evaluation system tracked 3,794 families (7,937 individuals). System use and acceptance is high. A successful implementation of a structured evaluation system with a strong CQI component is feasible in an existing, large statewide program. The evaluation/CQI system is an effective mechanism to drive modest change in management of the program.

23 CFR 924.7 - Program structure.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 23 Highways 1 2012-04-01 2012-04-01 false Program structure. 924.7 Section 924.7 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HIGHWAY SAFETY HIGHWAY SAFETY IMPROVEMENT PROGRAM... implementation through highway safety improvement projects. The HSIP includes construction and operational...

23 CFR 924.7 - Program structure.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 23 Highways 1 2014-04-01 2014-04-01 false Program structure. 924.7 Section 924.7 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HIGHWAY SAFETY HIGHWAY SAFETY IMPROVEMENT PROGRAM... implementation through highway safety improvement projects. The HSIP includes construction and operational...

Improving low-wage, midsized employers' health promotion practices: a randomized controlled trial.

PubMed

Hannon, Peggy A; Harris, Jeffrey R; Sopher, Carrie J; Kuniyuki, Alan; Ghosh, Donetta L; Henderson, Shelly; Martin, Diane P; Weaver, Marcia R; Williams, Barbara; Albano, Denise L; Meischke, Hendrika; Diehr, Paula; Lichiello, Patricia; Hammerback, Kristen E; Parks, Malcolm R; Forehand, Mark

2012-08-01

The Guide to Community Preventive Services (Community Guide) offers evidence-based intervention strategies to prevent chronic disease. The American Cancer Society (ACS) and the University of Washington Health Promotion Research Center co-developed ACS Workplace Solutions (WPS) to improve workplaces' implementation of Community Guide strategies. To test the effectiveness of WPS for midsized employers in low-wage industries. Two-arm RCT; workplaces were randomized to receive WPS during the study (intervention group) or at the end of the study (delayed control group). Forty-eight midsized employers (100-999 workers) in King County WA. WPS provides employers one-on-one consulting with an ACS interventionist via three meetings at the workplace. The interventionist recommends best practices to adopt based on the workplace's current practices, provides implementation toolkits for the best practices the employer chooses to adopt, conducts a follow-up visit at 6 months, and provides technical assistance. Employers' implementation of 16 best practices (in the categories of insurance benefits, health-related policies, programs, tracking, and health communications) at baseline (June 2007-June 2008) and 15-month follow-up (October 2008-December 2009). Data were analyzed in 2010-2011. Intervention employers demonstrated greater improvement from baseline than control employers in two of the five best-practice categories; implementing policies (baseline scores: 39% program, 43% control; follow-up scores: 49% program, 45% control; p=0.013) and communications (baseline scores: 42% program, 44% control; follow-up scores: 76% program, 55% control; p=0.007). Total best-practice implementation improvement did not differ between study groups (baseline scores: 32% intervention, 37% control; follow-up scores: 39% intervention, 42% control; p=0.328). WPS improved employers' health-related policies and communications but did not improve insurance benefits design, programs, or tracking. Many employers were unable to modify insurance benefits and reported that the time and costs of implementing best practices were major barriers. This study is registered at clinicaltrials.gov NCT00452816. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Implementation and quality assessment of a pharmacy services call center for outpatient pharmacies and specialty pharmacy services in an academic health system.

PubMed

Rim, Matthew H; Thomas, Karen C; Chandramouli, Jane; Barrus, Stephanie A; Nickman, Nancy A

2018-05-15

The implementation and quality assessment of a pharmacy services call center (PSCC) for outpatient pharmacies and specialty pharmacy services within an academic health system are described. Prolonged wait times in outpatient pharmacies or hold times on the phone affect the ability of pharmacies to capture and retain prescriptions. To support outpatient pharmacy operations and improve quality, a PSCC was developed to centralize handling of all outpatient and specialty pharmacy calls. The purpose of the PSCC was to improve the quality of pharmacy telephone services by (1) decreasing the call abandonment rate, (2) improving the speed of answer, (3) increasing first-call resolution, (4) centralizing all specialty pharmacy and prior authorization calls, (5) increasing labor efficiency and pharmacy capacities, (6) implementing a quality evaluation program, and (7) improving workplace satisfaction and retention of outpatient pharmacy staff. The PSCC centralized pharmacy calls from 9 pharmacy locations, 2 outpatient clinics, and a specialty pharmacy. Since implementation, the PSCC has achieved and maintained program goals, including improved abandonment rate, speed of answer, and first-call resolution. A centralized 24-7 support line for specialty pharmacy patients was also successfully established. A quality calibration program was implemented to ensure service quality and excellent patient experience. Additional ongoing evaluations measure the impact of the PSCC on improving workplace satisfaction and retention of outpatient pharmacy staff. The design and implementation of the PSCC have significantly improved the health system's patient experiences, efficiency, and quality. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Implementation of an ergonomics program for the welding department inside a car assembly company.

PubMed

Francisco, Caceres; Edwin, Troya

2012-01-01

The premise for this project is to implement an ergonomics program for the welding department of a car assembly company, considering that this area represents the highest occupational risk in relation to musculoskeletal injuries. The project also allows the demonstration of the different implementation processes of an ergonomics program; it also permits the determination of individual risks faced by workers of the welding department, and finally gives a chance of improving common injuries using the sentinel system. The main challenge is to reduce musculoskeletal injuries and absenteeism among welders through actions implemented by the ergonomics program.

Geriatric hip fracture management: keys to providing a successful program.

PubMed

Basu, N; Natour, M; Mounasamy, V; Kates, S L

2016-10-01

Hip fractures are a common event in older adults and are associated with significant morbidity, mortality and costs. This review examines the necessary elements required to implement a successful geriatric fracture program and identifies some of the barriers faced when implementing a successful program. The Geriatric Fracture Center (GFC) is a treatment model that standardizes the approach to the geriatric fracture patient. It is based on five principles: surgical fracture management; early operative intervention; medical co-management with geriatricians; patient-centered, standard order sets to employ best practices; and early discharge planning with a focus on early functional rehabilitation. Implementing a geriatric fracture program begins with an assessment of the hospital's data on hip fractures and standard care metrics such as length of stay, complications, time to surgery, readmission rates and costs. Business planning is essential along with the medical planning process. To successfully develop and implement such a program, strong physician leadership is necessary to articulate both a short- and long-term plan for implementation. Good communication is essential-those organizing a geriatric fracture program must be able to implement standardized plans of care working with all members of the healthcare team and must also be able to foster relationships both within the hospital and with other institutions in the community. Finally, a program of continual quality improvement must be undertaken to ensure that performance outcomes are improving patient care.

Training community health promoters to implement diabetes self-management support programs for urban minority adults.

PubMed

Comellas, Mariceli; Walker, Elizabeth A; Movsas, Sharon; Merkin, Sheryl; Zonszein, Joel; Strelnick, Hal

2010-01-01

To develop, implement, and evaluate a peer-led diabetes self-management support program in English and Spanish for a diverse, urban, low-income population. The program goals and objectives were to improve diabetes self-management behaviors, especially becoming more physically active, healthier eating, medication adherence, problem solving, and goal setting. After a new training program for peers led by a certified diabetes educator (CDE) was implemented with 5 individuals, this pilot evaluation study was conducted in 2 community settings in the East and South Bronx. Seventeen adults with diabetes participated in the new peer-led 5-session program. Survey data were collected pre- and postintervention on diabetes self-care activities, quality of well-being, and number of steps using a pedometer. This pilot study established the acceptance and feasibility of both the peer training program and the community-based, peer-led program for underserved, minority adults with diabetes. Significant improvements were found in several physical activity and nutrition activities, with a modest improvement in well-being. Feedback from both peer facilitators and participants indicated that a longer program, but with the same educational materials, was desirable. To reduce health disparities in urban communities, it is essential to continue program evaluation of the critical elements of peer-led programs for multiethnic adults with diabetes to promote self-management support in a cost-effective and culturally appropriate manner. Practice Implications A diabetes self-management support program can be successfully implemented in the community by peers, within a model including remote supervision by a CDE.

Development of an Enhanced Payback Function for the Superior Energy Performance Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Therkelsen, Peter; Rao, Prakash; McKane, Aimee

2015-08-03

The U.S. DOE Superior Energy Performance (SEP) program provides recognition to industrial and commercial facilities that achieve certification to the ISO 50001 energy management system standard and third party verification of energy performance improvements. Over 50 industrial facilities are participating and 28 facilities have been certified in the SEP program. These facilities find value in the robust, data driven energy performance improvement result that the SEP program delivers. Previous analysis of SEP certified facility data demonstrated the cost effectiveness of SEP and identified internal staff time to be the largest cost component related to SEP implementation and certification. This papermore » analyzes previously reported and newly collected data of costs and benefits associated with the implementation of an ISO 50001 and SEP certification. By disaggregating “sunk energy management system (EnMS) labor costs”, this analysis results in a more accurate and detailed understanding of the costs and benefits of SEP participation. SEP is shown to significantly improve and sustain energy performance and energy cost savings, resulting in a highly attractive return on investment. To illustrate these results, a payback function has been developed and is presented. On average facilities with annual energy spend greater than $2M can expect to implement SEP with a payback of less than 1.5 years. Finally, this paper also observes and details decreasing facility costs associated with implementing ISO 50001 and certifying to the SEP program, as the program has improved from pilot, to demonstration, to full launch.« less

Dilemmas of Prescriptive Practices and Perceived Alignment in Program Implementation

ERIC Educational Resources Information Center

Rubin, Mollie; Patrick, Susan Kemper; Goldring, Ellen B.

2017-01-01

This paper studies the early implementation of a school improvement effort in two high schools. We examine what explains variation in the teacher adoption of program practices. Our findings highlight the tension between encouraging immediate adoption of program practices and the longer term goals of schoolwide culture change. We find that highly…

Implementation and Early Outcomes of the Comprehensive School Reform Demonstration (CSRD) Program. Doc # 2004-15

ERIC Educational Resources Information Center

LaPointe, Michelle; Stullich, Stephanie

2004-01-01

The Comprehensive School Reform (CSR) program provides financial assistance to help schools develop and implement systematic approaches to schoolwide improvement that are grounded in scientifically based research and effective practices. The goal of the program is to enable all children to meet challenging state academic content and achievement…

Implementation of an Entry-Level Retention Program for High-Risk College Freshmen.

ERIC Educational Resources Information Center

Zanoni, Candido

The specially funded program described in this report was implemented at the University of Minnesota's General College in Fall 1979 to promote the academic improvement and long-range retention of high-risk Black, Hispanic, and Native American students. After introductory material discussing the process involved in securing program funds from the…

A crisis management quality improvement initiative in a children's psychiatric hospital: design, implementation, and outcome.

PubMed

Paccione-Dyszlewski, Margaret R; Conelea, Christine A; Heisler, Walter C; Vilardi, Jodie C; Sachs, Henry T

2012-07-01

Behavioral crisis management, including the use of seclusion and restraint, is the most high risk process in the psychiatric care of children and adolescents. The authors describe hospital-wide programmatic changes implemented at a children's psychiatric hospital that aimed to improve the quality of crisis management services. Pre/post quantitative and qualitative data suggest reduced restraint and seclusion use, reduced patient and staff injury related to crisis management, and increased patient satisfaction during the post-program period. Factors deemed beneficial in program implementation are discussed.

Report: EPA Can Improve Implementation of the Risk Management Program for Airborne Chemical Releases

EPA Pesticide Factsheets

Report #09-P-0092, February 10, 2009. EPA can improve its program management and oversight to better assure that facilities covered by the Clean Air Act’s Risk Management Program submit or re-submit an RMP.

A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success.

PubMed

Olvera, David J; Stuhlmiller, David F E; Wolfe, Allen; Swearingen, Charles F; Pennington, Troy; Davis, Daniel P

2018-02-21

Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success. The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation. A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p < 0.01) and first-attempt success without desaturation (84% to 94%, p < 0.01) were observed. Overall intubation success increased from 95% to 99% over the study period, but the trend was not statistically significant (p = 0.311). An integrated advanced airway management program was successful in improving RSI intubation performance in a large air medical company.

[The two-year post graduate training program for nurses: implementation status and personal perspectives].

PubMed

Yin, Yu-Chun

2013-06-01

The Taiwan Joint Commission on Hospital Accreditation (TJCHA) authorized the Teaching Quality Improvement Program for Teaching Hospitals as a way for the Department of Health to plan and implement improvements. The program assists medical and paramedical professionals to establish a postgraduate clinical training system. The two-year postgraduate training program for nurses is one of the program's regular activities, divided into three phases that include location-based curriculum training (3 months), core curriculum training (9 months), and professional courses training (12 months). This paper describes the origin, current implementation status, and efficacy / key problems of this two-year post graduate training program, Information regarding the opinions of new nurses, preceptors, and nursing managers on the three aspects is drawn from the author's relevant professional experience, interactions with nurses, and a review of the literature. Findings include: (1) nursing departments should operate in accordance with TJCHA guidelines; (2) department training should be adequate to promote the ability and willingness of nurses to train a new generation of clinical preceptors; and (3) participant opinions on project execution progress and difficulties. Findings may be referenced to better achieve Teaching Quality Improvement Program for Teaching Hospital objectives.

How to improve patient retention in an antiretroviral treatment program in Ethiopia: a mixed-methods study

PubMed Central

2014-01-01

Background Patient retention, defined as continuous engagement of patients in care, is one of the crucial indicators for monitoring and evaluating the performance of antiretroviral treatment (ART) programs. It has been identified that suboptimal patient retention in care is one of the challenges of ART programs in many settings. ART programs have, therefore, been striving hard to identify and implement interventions that improve their suboptimal levels of retention. The objective of this study was to develop a framework for improving patient retention in care based on interventions implemented in health facilities that have achieved higher levels of retention in care. Methods A mixed-methods study, based on the positive deviance approach, was conducted in Ethiopia in 2011/12. Quantitative data were collected to estimate and compare the levels of retention in care in nine health facilities. Key informant interviews and focus group discussions were conducted to identify a package of interventions implemented in the health facilities with relatively higher or improving levels of retention. Results Retention in care in the Ethiopian ART program was found to be variable across health facilities. Among hospitals, the poorest performer had 0.46 (0.35, 0.60) times less retention than the reference; among health centers, the poorest performers had 0.44 (0.28, 0.70) times less retention than the reference. Health facilities with higher and improving patient retention were found to implement a comprehensive package of interventions: (1) retention promoting activities by health facilities, (2) retention promoting activities by community-based organizations, (3) coordination of these activities by case manager(s), and (4) patient information systems by data clerk(s). On the contrary, such interventions were either poorly implemented or did not exist in health facilities with lower retention in care. A framework to improve retention in care was developed based on the evidence found by applying the positive deviance approach. Conclusion A framework for improving retention in care of patients on ART was developed. We recommend that health facilities implement the framework, monitor and evaluate their levels of retention in care, and, if necessary, adapt the framework to their own contexts. PMID:24475889

Attendance Improvement and Dropout Prevention (AIDP) Demonstration and Replication Program 1989. OREA Evaluation Section Report.

ERIC Educational Resources Information Center

New York City Board of Education, Brooklyn, NY. Office of Research, Evaluation, and Assessment.

Each of the 1989 dropout prevention programs funded under the New York City Attendance Improvement Dropout Prevention (AIDP) Demonstration and Replication Program was successful in meeting some of its objectives, and all of the programs were viewed as valuable by principals and teachers. The program encourages the design and implementation of…

Implementation successes and challenges in participating in a pragmatic study to improve colon cancer screening: perspectives of health center leaders.

PubMed

Coronado, Gloria D; Schneider, Jennifer L; Petrik, Amanda; Rivelli, Jennifer; Taplin, Stephen; Green, Beverly B

2017-09-01

Little is known about the challenges faced by community clinics who must address clinical priorities first when participating in pragmatic studies. We report on implementation challenges faced by the eight community health centers that participated in Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), a large comparative effectiveness cluster-randomized trial to evaluate a direct-mail program to increase the rate of colorectal cancer (CRC) screening. We conducted interviews, at the onset of implementation and 1 year later, with center leaders to identify challenges with implementing and sustaining an electronic medical record (EMR)-driven mailed program to increase CRC screening rates. We used the Consolidated Framework for Implementation Research to thematically analyze the content of meeting discussions and identify anticipated and experienced challenges. Common early concerns were patients' access to colonoscopy, patients' low awareness of CRC screening, time burden on clinic staff to carry out the STOP CRC program, inability to accurately identify eligible patients, and incompatibility of the program's approach with the patient population or organizational culture. Once the program was rolled out, time burden remained a primary concern and new organizational capacity and EMR issues were raised (e.g., EMR staffing resources and turnover in key leadership positions). Cited program successes were improved CRC screening processes and rates, more patients reached, reduced costs, and improved patient awareness, engagement, or satisfaction. These findings may inform any clinic considering mailed fecal testing programs and future pragmatic research efforts in community health centers.

Implementing cognitive remediation and social cognitive interaction training into standard psychosis care.

PubMed

Dark, Frances; Harris, Meredith; Gore-Jones, Victoria; Newman, Ellie; Whiteford, Harvey

2018-06-15

To evaluate the planned implementation of group based Cognitive Remediation therapy (CR) and Social Cognitive Interaction Training (SCIT) into routine psychosis care in a mental health service in Australia. The study was conducted over 3 years in a mental health service in a metropolitan city in Australia. Participants were 22 program facilitators and 128 patients attending the programs. Implementation outcomes were assessed using administrative data, staff surveys and program audits. There was fidelity to the particular therapies at a program level. Programs were assessed as being feasible within the study setting with each hospital district developing a capacity to run CR and SCIT. The establishment of new programs improved the reach, but waiting lists indicate a need to expand capacity. There was a relatively high dropout and several factors impacted on completion of the programs - notably, acute exacerbation of psychosis. Once initiated the therapies were acceptable with no-one ceasing SCIT due to loss of interest and only 10% of participants ceasing CR due to loss of interest. Annual audits of programs found programs established were maintained and facilitators were retained. SCIT and CR programs were successfully implemented in three hospital districts. Several factors impeded participants receiving the recommended "dose" of the programs. The maintenance of the programs in the short term is encouraging in regards to organisational fit. Dissemination of cognitive rehabilitation programs to a service population takes planning. An implementation plan is essential for guiding development and maintenance of programs. These therapies are best suited to people in a stable phase of illness. Service user co-production is recommended to improve recruitment in future studies.

Improving implementation of mental health services for trauma in multicultural elementary schools: stakeholder perspectives on parent and educator engagement.

PubMed

Langley, Audra; Santiago, Catherine DeCarlo; Rodríguez, Adriana; Zelaya, Jennifer

2013-07-01

Although more schools are offering mental health programs, few studies have involved the school community in research to improve their successful implementation. In this community-partnered study, focus groups were conducted with school staff and parents to explore issues related to community engagement and feasibility of a mental health intervention for elementary school students exposed to trauma. Four educator focus groups, including 23 participants, and 2 parent focus groups, consisting of 9 Spanish-speaking and 7 English-speaking parents were conducted. Participants discussed facilitators and barriers to successful implementation of the program. Participants identified the importance of pre-implementation parent education, raising awareness of the impact of student mental health among educators, maintaining ongoing communication during the intervention, and addressing logistical concerns. Participants described clear considerations for parent and educator engagement, both at the pre-implementation phase and during implementation of the program. Implications for next steps of this community-partnered approach are described.

Improving Implementation of Mental Health Services for Trauma in Multicultural Elementary Schools: Stakeholder Perspectives on Parent and Educator Engagement

PubMed Central

Santiago, Catherine DeCarlo; Rodríguez, Adriana; Zelaya, Jennifer

2013-01-01

Although more schools are offering mental health programs, few studies have involved the school community in research to improve their successful implementation. In this community partnered study, focus groups were conducted with school staff and parents to explore issues related to community engagement and feasibility of a mental health intervention for elementary school students exposed to trauma. Four educator focus groups, including 23 participants, and 2 parent focus groups, consisting of 9 Spanish-speaking and 7 English-speaking parents were conducted. Participants discussed facilitators and barriers to successful implementation of the program. Participants identified the importance of pre-implementation parent education, raising awareness of the impact of student mental health among educators, maintaining ongoing communication during the intervention, and addressing logistical concerns. Participants described clear considerations for parent and educator engagement both at the pre implementation phase and during implementation of the program. Implications for next steps of this community partnered approach are described. PMID:23576136

Evaluation of an implementation model: a national investigation of VA residential programs.

PubMed

Cook, Joan M; Dinnen, Stephanie; Coyne, James C; Thompson, Richard; Simiola, Vanessa; Ruzek, Josef; Schnurr, Paula P

2015-03-01

This national investigation utilizes qualitative data to evaluate an implementation model regarding factors influencing provider use of two evidence-based treatments for posttraumatic stress disorder (PTSD). Semi-structured qualitative interviews with 198 mental health providers from 38 Department of Veterans Affairs' (VA) residential treatment programs were used to explore these issues regarding prolonged exposure (PE) and cognitive processing therapy (CPT) in VA residential PTSD programs. Several unique and some overlapping predictors emerged. Leadership was viewed as an influence on implementation for both CPT and PE, while a lack of dedicated time and resources was viewed as a deterrent for both. Compatibility of CPT with providers' existing practices and beliefs, the ability to observe noticeable patient improvement, a perceived relative advantage of CPT over alternative treatments, and the presence of a supportive peer network emerged as influential on CPT implementation. Leadership was associated with PE implementation. Implications for the design and improvement of training and implementation efforts are discussed.

Introducing an accountability framework for polio eradication in Ethiopia: results from the first year of implementation 2014-2015

PubMed Central

Kassahun, Aron; Braka, Fiona; Gallagher, Kathleen; Gebriel, Aregai Wolde; Nsubuga, Peter; M’pele-Kilebou, Pierre

2017-01-01

Introduction the World Health Organization (WHO), Ethiopia country office, introduced an accountability framework into its Polio Eradication Program in 2014 with the aim of improving the program's performance. Our study aims to evaluate staff performance and key program indicators following the introduction of the accountability framework. Methods the impact of the WHO accountability framework was reviewed after its first year of implementation from June 2014 to June 2015. We analyzed selected program and staff performance indicators associated with acute flaccid paralysis (AFP) surveillance from a database available at WHO. Data on managerial actions taken were also reviewed. Performance of a total of 38 staff was evaluated during our review. Results our review of results for the first four quarters of implementation of the polio eradication accountability framework showed improvement both at the program and individual level when compared with the previous year. Managerial actions taken during the study period based on the results from the monitoring tool included eleven written acknowledgments, six discussions regarding performance improvement, six rotations of staff, four written first-warning letters and nine non-renewal of contracts. Conclusion the introduction of the accountability framework resulted in improvement in staff performance and overall program indicators for AFP surveillance. PMID:28890753

Social network analysis for program implementation.

PubMed

Valente, Thomas W; Palinkas, Lawrence A; Czaja, Sara; Chu, Kar-Hai; Brown, C Hendricks

2015-01-01

This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach.

Social Network Analysis for Program Implementation

PubMed Central

Valente, Thomas W.; Palinkas, Lawrence A.; Czaja, Sara; Chu, Kar-Hai; Brown, C. Hendricks

2015-01-01

This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach. PMID:26110842

Software Engineering Program: Software Process Improvement Guidebook

NASA Technical Reports Server (NTRS)

1996-01-01

The purpose of this document is to provide experience-based guidance in implementing a software process improvement program in any NASA software development or maintenance community. This guidebook details how to define, operate, and implement a working software process improvement program. It describes the concept of the software process improvement program and its basic organizational components. It then describes the structure, organization, and operation of the software process improvement program, illustrating all these concepts with specific NASA examples. The information presented in the document is derived from the experiences of several NASA software organizations, including the SEL, the SEAL, and the SORCE. Their experiences reflect many of the elements of software process improvement within NASA. This guidebook presents lessons learned in a form usable by anyone considering establishing a software process improvement program within his or her own environment. This guidebook attempts to balance general and detailed information. It provides material general enough to be usable by NASA organizations whose characteristics do not directly match those of the sources of the information and models presented herein. It also keeps the ideas sufficiently close to the sources of the practical experiences that have generated the models and information.

Using Promotores Programs to Improve Latino Health Outcomes: Implementation Challenges for Community-based Nonprofit Organizations

PubMed Central

Twombly, Eric C.; Holtz, Kristen D.; Stringer, Kimberly

2012-01-01

Promotores are community lay health workers, who provide outreach and services to Latinos. Little research on the promotores programs exists and the focus of this article is to identify the challenges faced by community-based nonprofits when implementing promotores programs. To explore this type of program telephone interviews were conducted with ten promotores academic experts and nonprofit executives. The results suggest that implementation challenges fall into three major categories: the lack of standardized information on promotores programs, labor issues, and organizational costs. Future recommendations are made which highlight promotores recruitment and retention strategies, and the development of a clearinghouse of programmatic implementation information for community-based nonprofits. PMID:23188929

An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes

PubMed Central

2013-01-01

Background Studies have shown that communities have not always been able to implement evidence-based prevention programs with quality and achieve outcomes demonstrated by prevention science. Implementation support interventions are needed to bridge this gap between science and practice. The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention. AGTO is an implementation support intervention that consists of: a manual of text and tools; face-to-face training, and onsite technical assistance, focused on activities shown to be associated with obtaining positive results across any prevention program. Methods This study uses a nested and cross-sectional, cluster randomized controlled design. Participants were coalition members and program staff from 12 communities in Maine. Each coalition nominated up to five prevention programs to participate. At random, six coalitions and their respective 30 programs received the two-year AGTO intervention and the other six maintained routine operations. The study assessed prevention practitioner capacity (efficacy and behaviors), practitioner exposure to and use of AGTO, practitioner perceptions of AGTO, and prevention program performance. Capacity of coalition members and performance of their programs were compared between the two groups across the baseline, one-, and two-year time points. Results We found no significant differences between AGTO and control group’s prevention capacity. However, within the AGTO group, significant differences were found between those with greater exposure to and use of AGTO. Programs that received the highest number of technical assistance hours showed the most program improvement. Conclusions This study is the first of its kind to show that use of an implementation support intervention-AGTO -yielded improvements in practitioner capacity and consequently in program performance on a large sample of practitioners and programs using a randomized controlled design. ClinicalTrials.gov identifier NCT00780338 PMID:23924279

Office of Student Financial Aid Quality Improvement Program: Design and Implementation Plan.

ERIC Educational Resources Information Center

Advanced Technology, Inc., Reston, VA.

The purpose and direction of the quality improvement program of the U.S. Department of Education's Office of Student Financial Aid (OSFA) are described. The improvement program was designed to develop a systematic approach to identify, measure, and correct errors in the student aid delivery system. Information is provided on the general approach…

After-School Toolkit: Tips, Techniques and Templates for Improving Program Quality

ERIC Educational Resources Information Center

Gutierrez, Nora; Bradshaw, Molly; Furano, Kathryn

2008-01-01

This toolkit offers program managers a hands-on guide for implementing quality programming in the after-school hours. The kit includes tools and techniques that increased the quality of literacy programming and helped improve student reading gains in the Communities Organizing Resources to Advance Learning (CORAL) initiative of The James Irvine…

Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER): a protocol for a program of research.

PubMed

Hamilton, Alison B; Farmer, Melissa M; Moin, Tannaz; Finley, Erin P; Lang, Ariel J; Oishi, Sabine M; Huynh, Alexis K; Zuchowski, Jessica; Haskell, Sally G; Bean-Mayberry, Bevanne

2017-11-07

The Enhancing Mental and Physical health of Women through Engagement and Retention or EMPOWER program represents a partnership with the US Department of Veterans Health Administration (VA) Health Service Research and Development investigators and the VA Office of Women's Health, National Center for Disease Prevention and Health Promotion, Primary Care-Mental Health Integration Program Office, Women's Mental Health Services, and the Office of Patient Centered Care and Cultural Transformation. EMPOWER includes three projects designed to improve women Veterans' engagement and retention in evidence-based care for high-priority health conditions, i.e., prediabetes, cardiovascular, and mental health. The three proposed projects will be conducted in VA primary care clinics that serve women Veterans including general primary care and women's health clinics. The first project is a 1-year quality improvement project targeting diabetes prevention. Two multi-site research implementation studies will focus on cardiovascular risk prevention and collaborative care to address women Veterans' mental health treatment needs respectively. All projects will use the evidence-based Replicating Effective Programs (REP) implementation strategy, enhanced with multi-stakeholder engagement and complexity theory. Mixed methods implementation evaluations will focus on investigating primary implementation outcomes of adoption, acceptability, feasibility, and reach. Program-wide organizational-, provider-, and patient-level measures and tools will be utilized to enhance synergy, productivity, and impact. Both implementation research studies will use a non-randomized stepped wedge design. EMPOWER represents a coherent program of women's health implementation research and quality improvement that utilizes cross-project implementation strategies and evaluation methodology. The EMPOWER Quality Enhancement Research Initiative (QUERI) will constitute a major milestone for realizing women Veterans' engagement and empowerment in the VA system. EMPOWER QUERI will be conducted in close partnership with key VA operations partners, such as the VA Office of Women's Health, to disseminate and spread the programs nationally. The two implementation research studies described in this protocol have been registered as required: Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans: Trial registration NCT02991534 , registered 9 December 2016. Implementation of Tailored Collaborative Care for Women Veterans: Trial registration NCT02950961 , registered 21 October 2016.

Scaling and Sustaining Effective Early Childhood Programs Through School-Family-University Collaboration.

PubMed

Reynolds, Arthur J; Hayakawa, Momoko; Ou, Suh-Ruu; Mondi, Christina F; Englund, Michelle M; Candee, Allyson J; Smerillo, Nicole E

2017-09-01

We describe the development, implementation, and evaluation of a comprehensive preschool to third grade prevention program for the goals of sustaining services at a large scale. The Midwest Child-Parent Center (CPC) Expansion is a multilevel collaborative school reform model designed to improve school achievement and parental involvement from ages 3 to 9. By increasing the dosage, coordination, and comprehensiveness of services, the program is expected to enhance the transition to school and promote more enduring effects on well-being in multiple domains. We review and evaluate evidence from two longitudinal studies (Midwest CPC, 2012 to present; Chicago Longitudinal Study, 1983 to present) and four implementation examples of how the guiding principles of shared ownership, committed resources, and progress monitoring for improvement can promote effectiveness. The implementation system of partners and further expansion using "Pay for Success" financing shows the feasibility of scaling the program while continuing to improve effectiveness. © 2017 The Authors. Child Development published by Wiley Periodicals, Inc. on behalf of Society for Research in Child Development.

Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review

PubMed Central

Candas, Bernard; Jobin, Gilles; Dubé, Catherine; Tousignant, Mario; Abdeljelil, Anis Ben; Grenier, Sonya; Gagnon, Marie-Pierre

2016-01-01

Background and aim: Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. Methods: We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. Results: We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists’ perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. Conclusion: Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers. PMID:26878037

Optimizing the performance and structure of the D0 Collie confidence limit evaluator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fishchler, Mark; /Fermilab

2010-07-01

D0 Collie is a program used to perform limit calculations based on ensembles of pseudo-experiments ('PEs'). Since the application of this program to the crucial Higgs mass limit is quite CPU intensive, it has been deemed important to carefully review this program, with an eye toward identifying and implementing potential performance improvements. At the same time, we identify any coding errors or opportunities for potential structural (or algorithm) improvement discovered in the course of gaining sufficient understanding of the workings of Collie to sensibly explore for optimizations. Based on a careful analysis of the program, a series of code changesmore » with potential for improving performance has been identified. The implementation and evaluation of the most important parts of this series has been done, with gratifying speedup results. The bottom line: We have identified and implemented changes leading to a factor of 2.19 speedup in the example program provided, and expected to translate to a factor of roughly 4 speedup in typical realistic usage.« less

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples

PubMed Central

Selker, Harry P.; Leslie, Laurel K.

2015-01-01

Abstract There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in‐person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. PMID:26332869

Umatilla River Subbasin Fish Habitat Improvement Program, 2004-2005 Annual Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

St. Hilaire, Danny R.

This annual report is in fulfillment of contractual obligations with Bonneville Power Administration (BPA), which is the funding source for the Oregon Department of Fish and Wildlife's (ODFW), Umatilla River Subbasin Fish Habitat Improvement Program (Program). The Program works cooperatively with private landowners to develop long-term restoration, under which, passive and active Habitat Improvement Projects are conducted. Historically, projects have included livestock exclusion fencing (passive restoration) to protect riparian habitats, along with the installation of instream structures (active restoration) to address erosion and improve fish habitat. In recent years, the focus of active restoration has shifted to bioengineering treatments and,more » more recently, to channel re-design and reconstruction aimed at improving fish habitat, by restoring stable channel function. This report provides a summary of Program activities for the 2004 calendar year (January 1 through December 31, 2004), within each of the four main project phases, including: (1) Implementation--Pre-Work, (2) Implementation--On Site Development, (3) Operation and Maintenance, and (4) Monitoring and Evaluation. This report also summarizes Program Administrative, Interagency Coordination, and Public Education activities.« less

The Implementation and Evaluation of Health Promotion Services and Programs to Improve Cultural Competency: A Systematic Scoping Review.

PubMed

Jongen, Crystal Sky; McCalman, Janya; Bainbridge, Roxanne Gwendalyn

2017-01-01

Cultural competency is a multifaceted intervention approach, which needs to be implemented at various levels of health-care systems to improve quality of care for culturally and ethnically diverse populations. One level of health care where cultural competency is required is in the provision of health promotion services and programs targeted to diverse patient groups who experience health-care and health inequalities. To inform the implementation and evaluation of health promotion programs and services to improve cultural competency, research must assess both intervention strategies and intervention outcomes. This scoping review was completed as part of a larger systematic literature search conducted on evaluations of cultural competence interventions in health care in Canada, the United States, Australia, and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched. Overall, 64 studies on cultural competency interventions were found, with 22 being health promotion programs and services. A process of thematic analysis was utilized to identify key intervention strategies and outcomes reported in the literature. The review identified three overarching strategies utilized in health promotion services and programs to improve cultural competency: community-focused strategies, culturally focused strategies, and language-focused strategies. Studies took different approaches to delivering culturally competent health interventions, with the majority incorporating multiple strategies from each overarching category. There were various intermediate health-care and health outcomes reported across the included studies. Most commonly reported were positive reports of patient satisfaction, patient/participant service access, and program/study retention rates. The health outcome results indicate positive potential of health promotion services and programs to improve cultural competency to impact cardiovascular disease and mental health outcomes. However, due to measurement and study quality issues, it is difficult to determine the extent of the impacts. Examined together, these intervention strategies and outcomes provide a framework that can be used by service providers and researchers in the implementation and evaluation of health promotion services and programs to improve cultural competency. While there is evidence indicating the effectiveness of such health promotion interventions in improving intermediate and health outcomes, further attention is needed to issues of measurement and study quality.

Implementation of a Learning Program To Train Adolescent Mothers To Live Independently.

ERIC Educational Resources Information Center

Brown, Kathie

Because of a lack of training, most adolescent mothers are not prepared to live independently. Accordingly, a learning program was designed to improve training for adolescent mothers to better prepare them for living independently. The learning program, implemented in 10 weeks, consisted of eight training sessions geared to the areas of basic life…

The implementation of an integrated information system for substance use screening in general medical settings.

PubMed

Shanahan, C W; Sorensen-Alawad, A; Carney, B L; Persand, I; Cruz, A; Botticelli, M; Pressman, K; Adams, W G; Brolin, M; Alford, D P

2014-01-01

The Massachusetts Screening, Brief Intervention and Referral to Treatment (MASBIRT) Program, a substance use screening program in general medical settings, created a web-based, point-of-care (POC), application--the MASBIRT Portal (the "Portal") to meet program goals. We report on development and implementation of the Portal. Five year program process outcomes recorded by an independent evaluator and an anonymous survey of Health Educator's (HEs) adoption, perceptions and Portal use with a modified version of the Technology Readiness Index are described. [8] Specific management team members, selected based on their roles in program leadership, development and implementation of the Portal and supervision of HEs, participated in semi-structured, qualitative interviews. At the conclusion of the program 73% (24/33) of the HEs completed a survey on their experience using the Portal. HEs reported that the Portal made recording screening information easy (96%); improved planning their workday (83%); facilitated POC data collection (84%); decreased time dedicated to data entry (100%); and improved job satisfaction (59%). The top two barriers to use were "no or limited wireless connectivity" (46%) and "the tablet was too heavy/bulky to carry" (29%). Qualitative management team interviews identified strategies for successful HIT implementation: importance of engaging HEs in outlining specifications and workflow needs, collaborative testing prior to implementation and clear agreement on data collection purpose, quality requirements and staff roles. Overall, HEs perceived the Portal favorably with regard to time saving ability and improved workflow. Lessons learned included identifying core requirements early during system development and need for managers to institute and enforce consistent behavioral work norms. Barriers and HEs' views of technology impacted the utilization of the MASBIRT Portal. Further research is needed to determine best approaches for HIT system implementation in general medical settings.

ThermoData Engine (TDE): software implementation of the dynamic data evaluation concept. 9. Extensible thermodynamic constraints for pure compounds and new model developments.

PubMed

Diky, Vladimir; Chirico, Robert D; Muzny, Chris D; Kazakov, Andrei F; Kroenlein, Kenneth; Magee, Joseph W; Abdulagatov, Ilmutdin; Frenkel, Michael

2013-12-23

ThermoData Engine (TDE) is the first full-scale software implementation of the dynamic data evaluation concept, as reported in this journal. The present article describes the background and implementation for new additions in latest release of TDE. Advances are in the areas of program architecture and quality improvement for automatic property evaluations, particularly for pure compounds. It is shown that selection of appropriate program architecture supports improvement of the quality of the on-demand property evaluations through application of a readily extensible collection of constraints. The basis and implementation for other enhancements to TDE are described briefly. Other enhancements include the following: (1) implementation of model-validity enforcement for specific equations that can provide unphysical results if unconstrained, (2) newly refined group-contribution parameters for estimation of enthalpies of formation for pure compounds containing carbon, hydrogen, and oxygen, (3) implementation of an enhanced group-contribution method (NIST-Modified UNIFAC) in TDE for improved estimation of phase-equilibrium properties for binary mixtures, (4) tools for mutual validation of ideal-gas properties derived through statistical calculations and those derived independently through combination of experimental thermodynamic results, (5) improvements in program reliability and function that stem directly from the recent redesign of the TRC-SOURCE Data Archival System for experimental property values, and (6) implementation of the Peng-Robinson equation of state for binary mixtures, which allows for critical evaluation of mixtures involving supercritical components. Planned future developments are summarized.

CM Process Improvement and the International Space Station Program (ISSP)

NASA Technical Reports Server (NTRS)

Stephenson, Ginny

2007-01-01

This viewgraph presentation reviews the Configuration Management (CM) process improvements planned and undertaken for the International Space Station Program (ISSP). It reviews the 2004 findings and recommendations and the progress towards their implementation.

Evaluation of the Corridor Safety Improvement Program : phase 1 final report.

DOT National Transportation Integrated Search

1997-09-01

This project is an analysis of Oregon's Corridor Safety Improvement Programs implemented on Oregon Route 22 and Oregon Route 34. Improvements were : made along each corridor in 1993. : The project used a mail-out survey to determine the level of awar...

Quality assurance programs for pressure ulcers.

PubMed

Xakellis, G C

1997-08-01

Traditional medical quality assurance programs are beginning to incorporate the principles of continuous quality improvement pioneered by Juran and Deming. Strategies for incorporating these principles into a long-term care facility are described, and two examples of successful implementation of continuous quality improvement programs for pressure ulcers are presented.

A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan

PubMed Central

Yokoo, Kyoko; Funaba, Yuuki; Fukushima, Sayo; Fukuhara, Rie; Uchida, Mieko; Aiba, Satoru; Doi, Miki; Nishimura, Akira; Hayakawa, Masahiro; Nishimura, Yutaka; Oohira, Mitsuko

2017-01-01

Background: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. Purpose: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). Methods: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). Findings: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. Implications for Practice: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. Implications for Research: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting. PMID:28114148

Qualitative evaluation: A critical and interpretative complementary approach to improve health programs and services

PubMed Central

Tayabas, Luz María Tejada; León, Teresita Castillo; ESPINO, JOEL MONARREZ

2014-01-01

This short essay aims at commenting on the origin, development, rationale, and main characteristics of qualitative evaluation (QE), emphasizing the value of this methodological tool to evaluate health programs and services. During the past decades, different approaches have come to light proposing complementary alternatives to appraise the performance of public health programs, mainly focusing on the implementation process involved rather than on measuring the impact of such actions. QE is an alternative tool that can be used to illustrate and understand the process faced when executing health programs. It can also lead to useful suggestions to modify its implementation from the stakeholders’ perspectives, as it uses a qualitative approach that considers participants as reflective subjects, generators of meanings. This implies that beneficiaries become involved in an active manner in the evaluated phenomena with the aim of improving the health programs or services that they receive. With this work we want to encourage evaluators in the field of public health to consider the use of QE as a complementary tool for program evaluation to be able to identify areas of opportunity to improve programs’ implementation processes from the perspective of intended beneficiaries. PMID:25152220

Prevalence and Implementation of IAQ Programs in U.S. Schools

PubMed Central

Moglia, Dena; Smith, Alisa; MacIntosh, David L.; Somers, Jennifer L.

2006-01-01

In this study, we determined the extent to which U.S. schools are implementing indoor air quality (IAQ) programs. We administered a questionnaire on IAQ programs and practices to a representative sample of schools. Participants were asked to provide information on the use, administration, implementation, challenges, and benefits of the IAQ program in their school. We developed an IAQ Practice Index to determine the level of activity directed toward IAQ in schools. The index was computed based on responses to specific survey questions and was normalized to a range of 0 to 100. Each question was weighted qualitatively according to its contribution to strong IAQ management practices. Forty-two percent of schools in the United States have an IAQ management program, and there has been sustained growth from 1998 through 2002 in the number of schools that have such programs. Nearly half of those schools use the U.S. Environmental Protection Agency’s IAQ Tools for Schools program. The IAQ Practice Index scores varied widely for schools with an IAQ management program, suggesting that having a program is not equivalent to implementing effective IAQ policies and procedures. Respondents indicated that their IAQ programs led to improved workplace satisfaction, fewer asthma attacks, fewer visits to the school nurse, and lower absenteeism. When actively supported by the school administration, an IAQ program appears to be a valuable factor in improving the learning environment for U.S. schoolchildren. PMID:16393672

Prevalence and implementation of IAQ programs in U.S. schools.

PubMed

Moglia, Dena; Smith, Alisa; MacIntosh, David L; Somers, Jennifer L

2006-01-01

In this study, we determined the extent to which U.S. schools are implementing indoor air quality (IAQ) programs. We administered a questionnaire on IAQ programs and practices to a representative sample of schools. Participants were asked to provide information on the use, administration, implementation, challenges, and benefits of the IAQ program in their school. We developed an IAQ Practice Index to determine the level of activity directed toward IAQ in schools. The index was computed based on responses to specific survey questions and was normalized to a range of 0 to 100. Each question was weighted qualitatively according to its contribution to strong IAQ management practices. Forty-two percent of schools in the United States have an IAQ management program, and there has been sustained growth from 1998 through 2002 in the number of schools that have such programs. Nearly half of those schools use the U.S. Environmental Protection Agency's IAQ Tools for Schools program. The IAQ Practice Index scores varied widely for schools with an IAQ management program, suggesting that having a program is not equivalent to implementing effective IAQ policies and procedures. Respondents indicated that their IAQ programs led to improved workplace satisfaction, fewer asthma attacks, fewer visits to the school nurse, and lower absenteeism. When actively supported by the school administration, an IAQ program appears to be a valuable factor in improving the learning environment for U.S. schoolchildren.

The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program

PubMed Central

Lang, Jason; Cluff, Laurie; Payne, Julianne; Matson-Koffman, Dyann; Hampton, Joel

2017-01-01

Objective To evaluate employers’ implementation of evidence-based interventions, and changes in employees’ behaviors associated with participating in the national healthy worksite program (NHWP). Methods NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later. Results The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight. Conclusions Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes. PMID:28594703

The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program.

PubMed

Lang, Jason; Cluff, Laurie; Payne, Julianne; Matson-Koffman, Dyann; Hampton, Joel

2017-07-01

To evaluate employers' implementation of evidence-based interventions, and changes in employees' behaviors associated with participating in the national healthy worksite program (NHWP). NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later. The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight. Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes.

A Program Manager’s Guide for Program Improvement in Ongoing Psychological Health and Traumatic Brain Injury Programs. The RAND Toolkit, Volume 4

DTIC Science & Technology

2014-01-01

Hughes EFX, Boerstler H, O’Connor EJ. “Assessing the Impact of Continuous Quality Improvement/ Total Quality Management : Concept versus...facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity. Gery...RAND Program Manager’s Guide helps managers assess program performance, consider options for improvement, implement solutions, then assess whether the

Process Evaluation of Two Participatory Approaches: Implementing Total Worker Health® Interventions in a Correctional Workforce

PubMed Central

Dugan, Alicia G.; Farr, Dana A.; Namazi, Sara; Henning, Robert A.; Wallace, Kelly N.; El Ghaziri, Mazen; Punnett, Laura; Dussetschleger, Jeffrey L.; Cherniack, Martin G.

2018-01-01

Background Correctional Officers (COs) have among the highest injury rates and poorest health of all the public safety occupations. The HITEC-2 (Health Improvement Through Employee Control-2) study uses Participatory Action Research (PAR) to design and implement interventions to improve health and safety of COs. Method HITEC-2 compared two different types of participatory program, a CO-only “Design Team” (DT) and “Kaizen Event Teams” (KET) of COs and supervisors, to determine differences in implementation process and outcomes. The Program Evaluation Rating Sheet (PERS) was developed to document and evaluate program implementation. Results Both programs yielded successful and unsuccessful interventions, dependent upon team-, facility-, organizational, state-, facilitator-, and intervention-level factors. Conclusions PAR in corrections, and possibly other sectors, depends upon factors including participation, leadership, continuity and timing, resilience, and financial circumstances. The new PERS instrument may be useful in other sectors to assist in assessing intervention success. PMID:27378470

Process evaluation of two participatory approaches: Implementing total worker health® interventions in a correctional workforce.

PubMed

Dugan, Alicia G; Farr, Dana A; Namazi, Sara; Henning, Robert A; Wallace, Kelly N; El Ghaziri, Mazen; Punnett, Laura; Dussetschleger, Jeffrey L; Cherniack, Martin G

2016-10-01

Correctional Officers (COs) have among the highest injury rates and poorest health of all the public safety occupations. The HITEC-2 (Health Improvement Through Employee Control-2) study uses Participatory Action Research (PAR) to design and implement interventions to improve health and safety of COs. HITEC-2 compared two different types of participatory program, a CO-only "Design Team" (DT) and "Kaizen Event Teams" (KET) of COs and supervisors, to determine differences in implementation process and outcomes. The Program Evaluation Rating Sheet (PERS) was developed to document and evaluate program implementation. Both programs yielded successful and unsuccessful interventions, dependent upon team-, facility-, organizational, state-, facilitator-, and intervention-level factors. PAR in corrections, and possibly other sectors, depends upon factors including participation, leadership, continuity and timing, resilience, and financial circumstances. The new PERS instrument may be useful in other sectors to assist in assessing intervention success. Am. J. Ind. Med. 59:897-918, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Impact of a daily 10-minute strength and flexibility program in a manufacturing plant.

PubMed

Pronk, S J; Pronk, N P; Sisco, A; Ingalls, D S; Ochoa, C

1995-01-01

In summary, employees' flexibility and mood showed modest improvements following the implementation of a plant-wide, 10-minute, daily flexibility and strength program. The initial six-week pilot study, administered prior to the plant-wide program implementation, successfully assessed program feasibility, assessed the efficiency of program implementation, identified administrative and logistical concerns, and generated pilot data needed to secure managerial support. Despite the noted significant increases in grip strength in the pilot study, no increases were observed following the six months of plant-wide implementation. This may be related to the differences in low average pretest grip strength for the pilot study compared to the higher scores for the main study population. The pilot study subjects may have received a sufficient exercise stimulus to increase grip strength over the course of six weeks. In contrast, this may not have been the case for the main study subjects due to their higher initial mean grip strength. An increased number of exercises designed to directly impact grip strength may be needed to improve this parameter.

Peer Mentor Program for the General Chemistry Laboratory Designed to Improve Undergraduate STEM Retention

ERIC Educational Resources Information Center

Damkaci, Fehmi; Braun, Timothy F.; Gublo, Kristin

2017-01-01

We describe the design and implementation of an undergraduate peer mentor program that can overlay an existing general chemistry laboratory and is designed to improve STEM student retention. For the first four freshman cohorts going through the program, year-to-year retention improved by a four-year average of 20% for students in peer-mentored…

Maintaining the Fire but Avoiding Burnout: Implementation and Evaluation of a Resident Well-Being Program.

PubMed

Riall, Taylor S; Teiman, Joshua; Chang, Michelle; Cole, Denzel; Leighn, Tambre; McClafferty, Hilary; Nfonsam, Valentine N

2018-04-01

There have been few programs designed to improve surgical resident well-being, and such efforts often lack formal evaluation. General surgery residents participated in the Energy Leadership Well-Being and Resiliency Program. They were assessed at baseline and 1 year after implementation using the Energy Leadership Index (measures emotional intelligence), Maslach Burnout Inventory General Survey, Perceived Stress Scale, the Beck Depression Inventory, and the annual required ACGME resident survey. Scores before and after implementation were compared using paired t-tests for continuous variables and chi-square tests for categorical variables. Forty-nine general surgery residents participate in the program. One year after implementation, resident score on the Energy Leadership Index improved (from 3.16 ± 0.24 to 3.24 ± 0.32; p = 0.03). Resident perceived stress decreased from baseline (Perceived Stress Scale score, from 17.0 ± 7.2 to 15.7 ± 6.2; p = 0.05). Scores on the emotional exhaustion scale of the Maslach Burnout Inventory decreased (from 16.8 ± 8.4 to 14.4 ± 8.5; p = 0.04). Resident-reported satisfaction improved in many areas; satisfaction with leadership skills, work relationships, communication skills, productivity, time management, personal freedom, and work-life balance, increased during the 1-year intervention (p = NS). On the annual ACGME resident survey, residents' evaluation of the program as positive or very positive increased from 80% to 96%. This study demonstrates that formal implementation of a program to improve resident well-being positively impacted residents' perceived stress, emotional exhaustion, emotional intelligence, life satisfaction, and their perception of the residency program. Formal evaluation and reporting of such efforts allow for reproducibility and scalability, with the potential for widespread impact on resident well-being. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Caring Wisely: A Program to Support Frontline Clinicians and Staff in Improving Healthcare Delivery and Reducing Costs.

PubMed

Gonzales, Ralph; Moriates, Christopher; Lau, Catherine; Valencia, Victoria; Imershein, Sarah; Rajkomar, Alvin; Prasad, Priya; Boscardin, Christy; Grady, Deborah; Johnston, S

2017-08-01

We describe a program called "Caring Wisely"®, developed by the University of California, San Francisco's (UCSF), Center for Healthcare Value, to increase the value of services provided at UCSF Health. The overarching goal of the Caring Wisely® program is to catalyze and advance delivery system redesign and innovations that reduce costs, enhance healthcare quality, and improve health outcomes. The program is designed to engage frontline clinicians and staff-aided by experienced implementation scientists-to develop and implement interventions specifically designed to address overuse, underuse, or misuse of services. Financial savings of the program are intended to cover the program costs. The theoretical underpinnings for the design of the Caring Wisely® program emphasize the importance of stakeholder engagement, behavior change theory, market (target audience) segmentation, and process measurement and feedback. The Caring Wisely® program provides an institutional model for using crowdsourcing to identify "hot spot" areas of low-value care, inefficiency and waste, and for implementing robust interventions to address these areas. © 2017 Society of Hospital Medicine.

Improving Mathematics Teacher Education in Germany: Empirical Results from a Longitudinal Evaluation of Innovative Programs

ERIC Educational Resources Information Center

Buchholtz, Nils; Kaiser, Gabriele

2013-01-01

Innovative programs for restructuring the entry phase of mathematics teacher education programs have been implemented at various German universities within the last few years. This article reports about the design and the results of a longitudinal evaluation study of the effectiveness of two of these programs aiming to improve mathematics teacher…

Leveraging Competency Framework to Improve Teaching and Learning: A Methodological Approach

ERIC Educational Resources Information Center

Shankararaman, Venky; Ducrot, Joelle

2016-01-01

A number of engineering education programs have defined learning outcomes and course-level competencies, and conducted assessments at the program level to determine areas for continuous improvement. However, many of these programs have not implemented a comprehensive competency framework to support the actual delivery and assessment of an…

Quality Enhancement: An Overview. Program Services Papers.

ERIC Educational Resources Information Center

North Carolina Partnership for Children, Raleigh.

Leading a series of in-depth technical assistance papers on improving the quality in early care and education programs, this brochure is designed to help local communities consider the most effective strategies in designing and implementing programs that improve child care quality. A quality enhancement approach is taken whereby communities begin…

Using health promotion guidelines for persons with disabilities to develop and evaluate a physical activity program for individuals with multiple sclerosis: A feasibility study.

PubMed

Dixon-Ibarra, Alicia; Nery-Hurwit, Mara; Driver, Simon; MacDonald, Megan

2017-04-01

The Health Education for Persons with Multiple Sclerosis (HEMS) program was developed in response to the need for interventions aimed at increasing physical activity for individuals with Multiple Sclerosis (MS). It was developed and evaluated using Drum and colleagues (2009) guidelines for implementing health promotion programs for individuals with disabilities. The purpose of this feasibility study is to describe the development, implementation, and evaluation of the HEMS program. Thirteen individuals with MS completed the 8-week health education program. A mixed method approach for evaluation was implemented (i.e., survey and focus groups). Process and resource feasibility demonstrated that over half of the participants attended at least 80% of the weekly sessions. Focus group data provided valuable feedback for future iterations of the program including critiques on the delivery, content, and group support provided. Outcome evaluation showed increases in self-efficacy (survey), improvements in theoretical constructs (focus groups), and increased physical activity (focus groups). Results show that health promotion programs for persons with MS can improve physical activity and related constructs. Next steps will be to revise, implement, and reevaluate the HEMS program in a larger randomized control trial. Published by Elsevier Ltd.

Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI.

PubMed

Weir, Charlene; Brunker, Cherie; Butler, Jorie; Supiano, Mark A

2017-07-01

This paper evaluates the role of facilitation in the successful implementation of Computerized Decision Support (CDS). Facilitation processes include education, specialized computerized decision support, and work process reengineering. These techniques, as well as modeling and feedback enhance self-efficacy, which we propose is one of the factors that mediate the effectiveness of any CDS. In this study, outpatient clinics implemented quality improvement (QI) projects focused on improving geriatric care. Quality Improvement is the systematic process of improving quality through continuous measurement and targeted actions. The program, entitled "Advancing Geriatric Education through Quality Improvement" (AGE QI), consisted of a 6-month, QI based, intervention: (1) 2h didactic session, (2) 1h QI planning session, (3) computerized decision support design and implementation, (4) QI facilitation activities, (5) outcome feedback, and (6) 20h of CME. Specifically, we examined the impact of the QI based program on clinician's perceived self-efficacy in caring for older adults and the relationship of implementation support and facilitation on perceived success. The intervention was implemented at 3 institutions, 27 community healthcare system clinics, and 134 providers. This study reports the results of pre/post surveys for the forty-nine clinicians who completed the full CME program. Self-efficacy ratings for specific clinical behaviors related to care of older adults were assessed using a Likert based instrument. Self-ratings of efficacy improved across the following domains (depression, falls, end-of-life, functional status and medication management) and specifically in QI targeted domains and were associated with overall clinic improvements. Published by Elsevier Inc.

A Case Study of the Implementation of Conflict Resolution in a Second Grade Classroom.

ERIC Educational Resources Information Center

LeBlanc, Patrice R.; Lacey, Candace; Adler, Alison

This case study evaluated a second grade teacher and her students and the implementation of a conflict resolution program in the classroom; the goals of the evaluation were to provide descriptive data on the success or failure of the program and why those results occurred, and to make recommendations for program improvement. The study used…

A hospital discharge summary quality improvement program featuring individual and team-based feedback and academic detailing.

PubMed

Axon, Robert N; Penney, Fletcher T; Kyle, Thomas R; Zapka, Jane; Marsden, Justin; Zhao, Yumin; Mauldin, Patrick D; Moran, William P

2014-06-01

Discharge summaries are an important component of hospital care transitions typically completed by interns in teaching hospitals. However, these documents are often not completed in a timely fashion or do not include pertinent details of hospitalization. This report outlines the development and impact of a curriculum intervention to improve the quality of discharge summaries by interns and residents in Internal Medicine. A previous study demonstrated that a discharge summary curriculum featuring individualized feedback was associated with improved summary quality, but few subsequent studies have described implementation of similar curricula. No information exists on the utility of other strategies such as team-based feedback or academic detailing. Study participants were 96 Internal Medicine intern and resident physicians at an academic medical center-based training program. A comprehensive evidence-based discharge summary quality improvement program was developed and implemented that featured a discharge summary template to facilitate summary preparation, individual feedback, team-based feedback, academic detailing and an objective discharge summary evaluation instrument. The discharge summary evaluation instrument had moderate interrater reliability (κ = 0.72). Discharge summary scores improved from mean score of 70% to 82% (P = 0.05). Interns and residents participating in this program also reported increased confidence in producing and critiquing summaries. A comprehensive discharge summary curriculum can be feasibly implemented within the context of a residency program. Team-based feedback and academic detailing may serve to reinforce individual feedback and extend program reach.

Integrating Health Education in Core Curriculum Classrooms: Successes, Challenges, and Implications for Urban Middle Schools.

PubMed

Rajan, Sonali; Roberts, Katherine J; Guerra, Laura; Pirsch, Moira; Morrell, Ernest

2017-12-01

School-based health education efforts can positively affect health behaviors and learning outcomes; however, there is limited available time during the school day for separate health education classes. The purpose of this study was to assess the feasibility and sustainability of implementing a classroom-based health education program that integrates skill development with health learning. A wait-list control study design was conducted among 168 6th graders in 2 urban schools. Data on program implementation, feasibility, and health outcomes were collected from students at 3 time points and from 5 teachers across the implementation of the 10-week program. There were barriers to implementation, including time limitations, unexpected school-wide disruptions, and variations in student reading ability and teacher preparedness. However, analyses revealed there were significant increases in self-efficacy regarding fruit and vegetable consumption and outcome expectations following program implementation, which were also sustained post-program implementation. Despite inconsistent implementation in the wait-list control school, small gains were also noted following the completion of the program. Integrating health education efforts within core curricula classes can lead to favorable outcomes. However, implementation barriers must be actively addressed by schools and program developers to improve program fidelity and maximize the sustainability of program gains. © 2017, American School Health Association.

Collaborative evaluation of a high school prevention curriculum: How methods of collaborative evaluation enhanced a randomized control trial to inform program improvement.

PubMed

Orsini, Muhsin Michael; Wyrick, David L; Milroy, Jeffrey J

2012-11-01

Blending high-quality and rigorous research with pure evaluation practice can often be best accomplished through thoughtful collaboration. The evaluation of a high school drug prevention program (All Stars Senior) is an example of how perceived competing purposes and methodologies can coexist to investigate formative and summative outcome variables that can be used for program improvement. Throughout this project there were many examples of client learning from evaluator and evaluator learning from client. This article presents convincing evidence that collaborative evaluation can improve the design, implementation, and findings of the randomized control trial. Throughout this paper, we discuss many examples of good science, good evaluation, and other practical benefits of practicing collaborative evaluation. Ultimately, the authors created the term pre-formative evaluation to describe the period prior to data collection and before program implementation, when collaborative evaluation can inform program improvement. Copyright © 2012 Elsevier Ltd. All rights reserved.

Improving patient care through implementation of an antimicrobial stewardship program.

PubMed

Palmer, Hannah R; Weston, Jaye; Gentry, Layne; Salazar, Miguel; Putney, Kimberly; Frost, Craig; Tipton, Joyce A; Cottreau, Jessica; Tam, Vincent H; Garey, Kevin W

2011-11-15

The implementation of an antimicrobial stewardship program at a health system is described. In 2008, the Center for Antimicrobial Stewardship and Epidemiology (CASE) was formed at St. Luke's Episcopal Hospital (SLEH) to improve the quality of care for patients as it related to antimicrobial therapy. The charter of CASE contained specific aims for improving patient care, furthering clinical research, and training the next generation of clinical infectious diseases pharmacists. The CASE team consists of at least two infectious diseases pharmacists and one physician (the medical director) who provide direct oversight for antimicrobial utilization within the hospital. The CASE medical director, an infectious diseases physician, is responsible for overseeing the activities of the center. With the oversight of the CASE advisory board, the medical director develops and implements the antimicrobial stewardship and management policies for SLEH. Another key innovative feature of CASE is its extensive involvement in training new infectious diseases pharmacists and conducting research. CASE uses a model in which a clinical scenario or problem is identified, a research project is undertaken to further elucidate the problem, and policy changes are made to improve patient outcomes. The CASE team is supported by a CASE advisory board, a CASE research collaborative including university faculty, and a dedicated training program for pharmacy fellows, residents, and students. Implementation of an antimicrobial stewardship program at a health system helped decrease the inappropriate use of antibiotics, improve patient care and outcomes, further clinical research, and increase training opportunities for future clinical infectious diseases pharmacists.

Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study

PubMed Central

2013-01-01

Background Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. Objectives Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? Study design Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. Results Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space. The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses. Conclusions The model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases. PMID:24010683

Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study.

PubMed

Shaw, Ryan J; Kaufman, Miriam A; Bosworth, Hayden B; Weiner, Bryan J; Zullig, Leah L; Lee, Shoou-Yih Daniel; Kravetz, Jeffrey D; Rakley, Susan M; Roumie, Christianne L; Bowen, Michael E; Del Monte, Pamela S; Oddone, Eugene Z; Jackson, George L

2013-09-08

Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space.The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses. The model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases.

Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation.

PubMed

Manca, Donna Patricia; Aubrey-Bassler, Kris; Kandola, Kami; Aguilar, Carolina; Campbell-Scherer, Denise; Sopcak, Nicolette; O'Brien, Mary Ann; Meaney, Christopher; Faria, Vee; Baxter, Julia; Moineddin, Rahim; Salvalaggio, Ginetta; Green, Lee; Cave, Andrew; Grunfeld, Eva

2014-10-08

The objectives of this paper are to describe the planned implementation and evaluation of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER 2) program which originated from the BETTER trial. The pragmatic trial, informed by the Chronic Care Model, demonstrated the effectiveness of an approach to Chronic Disease Prevention and Screening (CDPS) involving the use of a new role, the prevention practitioner. The desired goals of the program are improved clinical outcomes, reduction in the burden of chronic disease, and improved sustainability of the health-care system through improved CDPS in primary care. The BETTER 2 program aims to expand the implementation of the intervention used in the original BETTER trial into communities across Canada (Alberta, Ontario, Newfoundland and Labrador, the Northwest Territories and Nova Scotia). This proactive approach provides at-risk patients with an intervention from the prevention practitioner, a health-care professional. Using the BETTER toolkit, the prevention practitioner determines which CDPS actions the patient is eligible to receive, and through shared decision-making and motivational interviewing, develops a unique and individualized 'prevention prescription' with the patient. This intervention is 1) personalized; 2) addressing multiple conditions; 3) integrated through linkages to local, regional, or national resources; and 4) longitudinal by assessing patients over time. The BETTER 2 program brings together primary care providers, policy/decision makers and researchers to work towards improving CDPS in primary care. The target patient population is adults aged 40-65. The reach, effectiveness, adoption, implementation, maintain (RE-AIM) framework will inform the evaluation of the program through qualitative and quantitative methods. A composite index will be used to quantitatively assess the effectiveness of the prevention practitioner intervention. The CDPS actions comprising the composite index include the following: process measures, referral/treatment measures, and target/change outcome measures related to cardiovascular disease, diabetes, cancer and associated lifestyle factors. The BETTER 2 program is a collaborative approach grounded in practice and built from existing work (i.e., integration not creation). The program evaluation is designed to provide an understanding of issues impacting the implementation of an effective approach for CDPS within primary care that may be adapted to become sustainable in the non-research setting.

Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program.

PubMed

McHugh, Megan; Brown, Tiffany; Liss, David T; Walunas, Theresa L; Persell, Stephen D

2018-04-01

Practice facilitation is a promising approach to helping practices implement quality improvements. Our purpose was to describe practice facilitators' and practice leaders' perspectives on implementation of a practice facilitator-supported quality improvement program and describe where their perspectives aligned and diverged. We conducted interviews with practice leaders and practice facilitators who participated in a program that included 35 improvement strategies aimed at the ABCS of heart health (aspirin use in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation). Rapid qualitative analysis was used to collect, organize, and analyze the data. We interviewed 17 of the 33 eligible practice leaders, and the 10 practice facilitators assigned to those practices. Practice leaders and practice facilitators both reported value in the program's ability to bring needed, high-quality resources to practices. Practice leaders appreciated being able to set the schedule for facilitation and select among the 35 interventions. According to practice facilitators, however, relying on practice leaders to set the pace of the intervention resulted in a lower level of program intensity than intended. Practice leaders preferred targeted assistance, particularly electronic health record documentation guidance and linkages to state smoking cessation programs. Practice facilitators reported that the easiest interventions were those that did not alter care practices. The dual perspectives of practice leaders and practice facilitators provide a more holistic picture of enablers and barriers to program implementation. There may be greater opportunities to assist small practices through simple, targeted practice facilitator-supported efforts rather than larger, comprehensive quality improvement projects. © 2018 Annals of Family Medicine, Inc.

Quality improvement in neonatal digital radiography: implementing the basic quality improvement tools.

PubMed

Eslamy, Hedieh K; Newman, Beverley; Weinberger, Ed

2014-12-01

A quality improvement (QI) program may be implemented using the plan-do-study-act cycle (as a model for making improvements) and the basic QI tools (used to visually display and analyze variation in data). Managing radiation dose has come to the forefront as a safety goal for radiology departments. This is especially true in the pediatric population, which is more radiosensitive than the adult population. In this article, we use neonatal digital radiography to discuss developing a QI program with the principle goals of decreasing the radiation dose, decreasing variation in radiation dose, and optimizing image quality. Copyright © 2014 Elsevier Inc. All rights reserved.

A Framework for Implementing TQM in Higher Education Programs

ERIC Educational Resources Information Center

Venkatraman, Sitalakshmi

2007-01-01

Purpose: This paper aims to provide a TQM framework that stresses continuous improvements in teaching as a plausible means of TQM implementation in higher education programs. Design/methodology/approach: The literature survey of the TQM philosophies and the comparative analysis of TQM adoption in industry versus higher education provide the…

Joining Forces. A Team Approach to Secondary School Development.

ERIC Educational Resources Information Center

Miller, Rima; Corcoran, Thomas B.

This manual is designed to guide the implementation of the Joining Forces Program, a comprehensive improvement process for secondary schools. Implementation of the program requires the cooperative effort of the local school district, state and local education associations, and the administration and staff of participating schools. Joining Forces…

Do Incentive-Based Programs Improve Teacher Quality and Student Achievement? An Analysis of Implementation in 12 Urban Charter Schools

ERIC Educational Resources Information Center

Kaimal, Girija; Jordan, Will J.

2016-01-01

Context: Policymakers have increasingly advocated for incentive-based approaches for improving urban schools. Purpose of the study: Few studies have examined the implementation of incentive based approaches in the urban charter school context. This paper presents research findings from a 4-year longitudinal study of the implementation of a…

Improving efficiency and access to mental health care: combining integrated care and advanced access.

PubMed

Pomerantz, Andrew; Cole, Brady H; Watts, Bradley V; Weeks, William B

2008-01-01

To provide an example of implementation of a new program that enhances access to mental health care in primary care. A general and specialized mental health service was redesigned to introduce open access to comprehensive mental health care in a primary care clinic. Key variables measured before and after implementation of the clinic included numbers of completed referrals, waiting time for appointments and clinic productivity. Workload and pre/post-implementation waiting time data were gathered through a computerized electronic monitoring system. Waiting time for new appointments was shortened from a mean of 33 days to 19 min. Clinician productivity and evaluations of new referrals more than doubled. These improvements have been sustained for 4 years. Moving mental health services into primary care, initiating open access and increasing use of technological aids led to dramatic improvements in access to mental health care and efficient use of resources. Implementation and sustainability of the program were enhanced by using a quality improvement approach.

Measuring the implementation of early childhood development programs.

PubMed

Aboud, Frances E; Prado, Elizabeth L

2018-05-01

In this paper we describe ways to measure variables of interest when evaluating the implementation of a program to improve early childhood development (ECD). The variables apply to programs delivered to parents in group sessions and home or clinic visits, as well as in early group care for children. Measurements for four categories of variables are included: training and assessment of delivery agents and supervisors; program features such as quality of delivery, reach, and dosage; recipients' acceptance and enactment; and stakeholders' engagement. Quantitative and qualitative methods are described, along with when measures might be taken throughout the processes of planning, preparing, and implementing. A few standard measures are available, along with others that researchers can select and modify according to their goals. Descriptions of measures include who might collect the information, from whom, and when, along with how information might be analyzed and findings used. By converging on a set of common methods to measure implementation variables, investigators can work toward improving programs, identifying gaps that impede the scalability and sustainability of programs, and, over time, ascertain program features that lead to successful outcomes. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.

Identifying gaps, barriers, and solutions in implementing pressure ulcer prevention programs.

PubMed

Jankowski, Irene M; Nadzam, Deborah Morris

2011-06-01

Patients continue to suffer from pressure ulcers (PUs), despite implementation of evidence-based pressure ulcer (PU) prevention protocols. In 2009, Joint Commission Resources (JCR) and Hill-Rom created the Nurse Safety Scholar-in-Residence (nurse scholar) program to foster the professional development of expert nurse clinicians to become translators of evidence into practice. The first nurse scholar activity has focused on PU prevention. Four hospitals with established PU programs participated in the PU prevention implementation project. Each hospital's team completed an inventory of PU prevention program components and provided copies of accompanying documentation, along with prevalence and incidence data. Site visits to the four participating hospitals were arranged to provide opportunities for more in-depth analysis and support. Following the initial site visit, the project team at each hospital developed action plans for the top three barriers to PU program implementation. A series of conference calls was held between the site visits. Pressure Ulcer Program Gaps and Recommendations. The four hospitals shared common gaps in terms of limitations in staff education and training; lack of physician involvement; limited involvement of unlicensed nursing staff; lack of plan for communicating at-risk status; and limited quality improvement evaluations of bedside practices. Detailed recommendations were identified for addressing each of these gaps. these Recommendations for eliminating gaps have been implemented by the participating teams to drive improvement and to reduce hospital-acquired PU rates. The nurse scholars will continue to study implementation of best practices for PU prevention.

An educational program to promote positive communication and collaboration between nurses and medical staff.

PubMed

McCaffrey, Ruth G; Hayes, RoseMarie; Stuart, Wendy; Cassel, Asenath; Farrell, Cheryl; Miller-Reyes, Sharmin; Donaldson, Audeanne

2011-01-01

An educational program was implemented for nurses and medical residents to improve communication and collaboration. It has been noted that communication and collaboration between members of the healthcare team improve patient outcomes and job satisfaction among nurses. In this article, the program is outlined and outcomes are presented.

Implementing a lessons learned process at Sandia National Laboratories

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fosshage, Erik D.; Drewien, Celeste A.; Eras, Kenneth

2016-01-01

The Lessons Learned Process Improvement Team was tasked to gain an understanding of the existing lessons learned environment within the major programs at Sandia National Laboratories, identify opportunities for improvement in that environment as compared to desired attributes, propose alternative implementations to address existing inefficiencies, perform qualitative evaluations of alternative implementations, and recommend one or more near-term activities for prototyping and/or implementation. This report documents the work and findings of the team.

Implementation Measurement for Evidence-Based Violence Prevention Programs in Communities.

PubMed

Massetti, Greta M; Holland, Kristin M; Gorman-Smith, Deborah

2016-08-01

Increasing attention to the evaluation, dissemination, and implementation of evidence-based programs (EBPs) has led to significant advancements in the science of community-based violence prevention. One of the prevailing challenges in moving from science to community involves implementing EBPs and strategies with quality. The CDC-funded National Centers of Excellence in Youth Violence Prevention (YVPCs) partner with communities to implement a comprehensive community-based strategy to prevent violence and to evaluate that strategy for impact on community-wide rates of violence. As part of their implementation approach, YVPCs document implementation of and fidelity to the components of the comprehensive youth violence prevention strategy. We describe the strategies and methods used by the six YVPCs to assess implementation and to use implementation data to inform program improvement efforts. The information presented describes the approach and measurement strategies employed by each center and for each program implemented in the partner communities. YVPCs employ both established and innovative strategies for measurement and tracking of implementation across a broad range of programs, practices, and strategies. The work of the YVPCs highlights the need to use data to understand the relationship between implementation of EBPs and youth violence outcomes.

Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals.

PubMed

Blando, James; Ridenour, Marilyn; Hartley, Daniel; Casteel, Carri

2015-01-01

Effective workplace violence (WPV) prevention programs are essential, yet challenging to implement in healthcare. The aim of this study was to identify major barriers to implementation of effective violence prevention programs. After reviewing the related literature, the authors describe their research methods and analysis and report the following seven themes as major barriers to effective implementation of workplace violence programs: a lack of action despite reporting; varying perceptions of violence; bullying; profit-driven management models; lack of management accountability; a focus on customer service; and weak social service and law enforcement approaches to mentally ill patients. The authors discuss their findings in light of previous studies and experiences and offer suggestions for decreasing WPV in healthcare settings. They conclude that although many of these challenges to effective implementation of workplace violence programs are both within the program itself and relate to broader industry and societal issues, creative innovations can address these issues and improve WPV prevention programs.

Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals.

PubMed

Blando, James; Ridenour, Marilyn; Hartley, Daniel; Casteel, Carri

2014-12-04

Effective workplace violence (WPV) prevention programs are essential, yet challenging to implement in healthcare. The aim of this study was to identify major barriers to implementation of effective violence prevention programs. After reviewing the related literature, the authors describe their research methods and analysis and report the following seven themes as major barriers to effective implementation of workplace violence programs: a lack of action despite reporting; varying perceptions of violence; bullying; profit-driven management models; lack of management accountability; a focus on customer service; and weak social service and law enforcement approaches to mentally ill patients. The authors discuss their findings in light of previous studies and experiences and offer suggestions for decreasing WPV in healthcare settings. They conclude that although many of these challenges to effective implementation of workplace violence programs are both within the program itself and relate to broader industry and societal issues, creative innovations can address these issues and improve WPV prevention programs.

The BetterBirth Program: Pursuing Effective Adoption and Sustained Use of the WHO Safe Childbirth Checklist Through Coaching-Based Implementation in Uttar Pradesh, India.

PubMed

Kara, Nabihah; Firestone, Rebecca; Kalita, Tapan; Gawande, Atul A; Kumar, Vishwajeet; Kodkany, Bhala; Saurastri, Rajiv; Pratap Singh, Vinay; Maji, Pinki; Karlage, Ami; Hirschhorn, Lisa R; Semrau, Katherine Ea

2017-06-27

Shifting childbirth into facilities has not improved health outcomes for mothers and newborns as significantly as hoped. Improving the quality and safety of care provided during facility-based childbirth requires helping providers to adhere to essential birth practices-evidence-based behaviors that reduce harm to and save lives of mothers and newborns. To achieve this goal, we developed the BetterBirth Program, which we tested in a matched-pair, cluster-randomized controlled trial in Uttar Pradesh, India. The goal of this intervention was to improve adoption and sustained use of the World Health Organization Safe Childbirth Checklist (SCC), an organized collection of 28 essential birth practices that are known to improve the quality of facility-based childbirth care. Here, we describe the BetterBirth Program in detail, including its 4 main features: implementation tools, an implementation strategy of coaching, an implementation pathway (Engage-Launch-Support), and a sustainability plan. This coaching-based implementation of the SCC motivates and empowers care providers to identify, understand, and resolve the barriers they face in using the SCC with the resources already available. We describe important lessons learned from our experience with the BetterBirth Program as it was tested in the BetterBirth Trial. For example, the emphasis on relationship building and respect led to trust between coaches and birth attendants and helped influence change. In addition, the cloud-based data collection and feedback system proved a valuable asset in the coaching process. More research on coaching-based interventions is required to refine our understanding of what works best to improve quality and safety of care in various settings.Note: At the time of publication of this article, the results of evaluation of the impact of the BetterBirth Program were pending publication in another journal. After the impact findings have been published, we will update this article with a reference to the impact findings. © Kara et al.

Needs assessment and implementation of an employee assistance program: promoting a healthier work force.

PubMed

Monfils, M K

1995-05-01

1. The functions of a continuous quality improvement tool used by Deming--the Plan, Do, Check, Act Cycle--can be applied to the assessment, implementation, and ongoing evaluation of an Employee Assistance Program (EAP). 2. Various methods are available to assess the need for an EAP. As much data as possible should be collected to qualify and quantify the need so that management can make an informed decision and develop measures to determine program effectiveness. 3. Once an EAP is implemented, it should be monitored continually against the effectiveness measures initially developed. Using a continuous quality improvement process, the occupational health nurse and the EAP provider can establish a dynamic relationship that allows for growth beyond the original design and increased effectiveness of service to employees.

Spanish-language community-based mental health treatment programs, policy-required language-assistance programming, and mental health treatment access among Spanish-speaking clients.

PubMed

Snowden, Lonnie R; McClellan, Sean R

2013-09-01

We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California's Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997-2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P < .05). However, the increase was insufficient to significantly reduce language-related disparities. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services.

Spanish-Language Community-Based Mental Health Treatment Programs, Policy-Required Language-Assistance Programming, and Mental Health Treatment Access Among Spanish-Speaking Clients

PubMed Central

McClellan, Sean R.

2013-01-01

Objectives. We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California’s Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Methods. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997–2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. Results. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P < .05). However, the increase was insufficient to significantly reduce language-related disparities. Conclusions. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services. PMID:23865663

Learnings From the Pilot Implementation of Mobile Medical Milestones Application.

PubMed

Page, Cristen P; Reid, Alfred; Coe, Catherine L; Carlough, Martha; Rosenbaum, Daryl; Beste, Janalynn; Fagan, Blake; Steinbacher, Erika; Jones, Geoffrey; Newton, Warren P

2016-10-01

Implementation of the educational milestones benefits from mobile technology that facilitates ready assessments in the clinical environment. We developed a point-of-care resident evaluation tool, the Mobile Medical Milestones Application (M3App), and piloted it in 8 North Carolina family medicine residency programs. We sought to examine variations we found in the use of the tool across programs and explored the experiences of program directors, faculty, and residents to better understand the perceived benefits and challenges of implementing the new tool. Residents and faculty completed presurveys and postsurveys about the tool and the evaluation process in their program. Program directors were interviewed individually. Interviews and open-ended survey responses were analyzed and coded using the constant comparative method, and responses were tabulated under themes. Common perceptions included increased data collection, enhanced efficiency, and increased perceived quality of the information gathered with the M3App. Residents appreciated the timely, high-quality feedback they received. Faculty reported becoming more comfortable with the tool over time, and a more favorable evaluation of the tool was associated with higher utilization. Program directors reported improvements in faculty knowledge of the milestones and resident satisfaction with feedback. Faculty and residents credited the M3App with improving the quality and efficiency of resident feedback. Residents appreciated the frequency, proximity, and specificity of feedback, and faculty reported the app improved their familiarity with the milestones. Implementation challenges included lack of a physician champion and competing demands on faculty time.

Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs.

PubMed

Hofler, Lisa G; Cordes, Sarah; Cwiak, Carrie A; Goedken, Peggy; Jamieson, Denise J; Kottke, Melissa

2017-01-01

To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program. This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences. At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed. Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.

Implementation of a Mentor-Protege Program by a Major Department of Defense Contractor

DTIC Science & Technology

1991-06-01

Department of Defense contractors to furnish disadvantaged small business concerns with assistance designed to enhance their capabilities to perform...implementation by analyzing the perceptions of one large DoD contractor and the small disadvantaged business community regarding the Mentor-Protege program...offered by this program would be effective in improving the capabilities of small disadvantaged businesses. There are, however, several barriers present

Using a mentoring approach to implement an inpatient glycemic control program in United States hospitals.

PubMed

Rushakoff, Robert J; Sullivan, Mary M; Seley, Jane Jeffrie; Sadhu, Archana; O'Malley, Cheryl W; Manchester, Carol; Peterson, Eric; Rogers, Kendall M

2014-09-01

establishing an inpatient glycemic control program is challenging, requires years of work, significant education and coordination of medical, nursing, dietary, and pharmacy staff, and support from administration and Performance Improvement departments. We undertook a 2 year quality improvement project assisting 10 medical centers (academic and community) across the US to implement inpatient glycemic control programs. the project was comprised of 3 interventions. (1) One day site visit with a faculty team (MD and CDE) to meet with key personnel, identify deficiencies and barriers to change, set site specific goals and develop strategies and timelines for performance improvement. (2) Three webinar follow-up sessions. (3) Web site for educational resources. Updates, challenges, and accomplishments for each site were reviewed at the time of each webinar and progress measured at the completion of the project with an evaluation questionnaire. as a result of our intervention, institutions revised and simplified formularies and insulin order sets (with CHO counting options); implemented glucometrics and CDE monitoring of inpatient glucoses (assisting providers with orders); added new protocols for DKA and perinatal treatment; and implemented nursing, physician and patient education initiatives. Changes were institution specific, fitting the local needs and cultures. As to the extent to which Institution׳s goals were satisfied: 2 reported "completely", 4 "mostly," 3 "partially," and 1 "marginally". Institutions continue to move toward fulfilling their goals. an individualized, structured, performance improvement approach with expert faculty mentors can help facilitate change in an institution dedicated to implementing an inpatient glycemic control program. Copyright © 2014 Elsevier Inc. All rights reserved.

Alberta: evaluation of nursing retention and recruitment programs.

PubMed

Weidner, Arlene; Graham, Carol; Smith, Jennifer; Aitken, Julia; Odell, Jill

2012-03-01

Retention and recruitment strategies are essential to address nursing workforce supply and ensure the viability of healthcare delivery in Canada. Knowledge transfer between experienced nurses and those new to the profession is also a focus for concern. The Multi-Employer/United Nurses of Alberta Joint Committee attempted to address these issues by introducing a number of retention and recruitment (R&R) initiatives for nurses in Alberta: in total, seven different programs that were introduced to some 24,000 nurses and employers across the province of Alberta in 2001 (the Transitional Graduate Nurse Recruitment Program) and 2007 (the remaining six R&R programs). Approximately 1,600 nurses participated in the seven programs between 2001 and 2009. Of the seven strategies, one supported entry into the workplace, two were pre-retirement strategies and four involved flexible work options. This project entailed a retrospective evaluation of the seven programs and differed from the other Research to Action (RTA) projects because it was solely concerned with evaluation of pre-existing initiatives. All seven programs were launched without a formal evaluation component, and the tracking of local uptake varied throughout the province. The union and various employers faced challenges in implementing these strategies in a timely fashion, as most were designed at the bargaining table during negotiations. As a result, systems, policy and procedural changes had to be developed to support their implementation after they became available.Participants in the programs indicated improvements over time in several areas, including higher levels of satisfaction with work–life balance, hours worked and their current practice and profession. The evaluation found that participation led to perceived improvements in nurses' confidence, greater control over their work environment, decreased stress levels, increased energy and morale and perceived improved ability to provide high-quality care. However, no formal implementation plan had been developed or made available to assist employers with implementation of the programs. The findings highlight the need for more discipline in communicating, implementing and evaluating initiatives such as those evaluated retrospectively in this project. In particular, key performance indicators, baseline data, monitoring mechanisms and an evaluation plan need to be developed prior to implementation.

Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program.

PubMed

Tappen, Ruth M; Wolf, David G; Rahemi, Zahra; Engstrom, Gabriella; Rojido, Carolina; Shutes, Jill M; Ouslander, Joseph G

Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.

What works in implementation of integrated care programs for older adults with complex needs? A realist review

PubMed Central

Kirst, Maritt; Im, Jennifer; Burns, Tim; Baker, G. Ross; Goldhar, Jodeme; O'Campo, Patricia; Wojtak, Anne; Wodchis, Walter P

2017-01-01

Abstract Purpose A realist review of the evaluative evidence was conducted on integrated care (IC) programs for older adults to identify key processes that lead to the success or failure of these programs in achieving outcomes such as reduced healthcare utilization, improved patient health, and improved patient and caregiver experience. Data sources International academic literature was searched in 12 indexed, electronic databases and gray literature through internet searches, to identify evaluative studies. Study selection Inclusion criteria included evaluative literature on integrated, long-stay health and social care programs, published between January 1980 and July 2015, in English. Data extraction Data were extracted on the study purpose, period, setting, design, population, sample size, outcomes, and study results, as well as explanations of mechanisms and contextual factors influencing outcomes. Results of data synthesis A total of 65 articles, representing 28 IC programs, were included in the review. Two context-mechanism-outcome configurations (CMOcs) were identified: (i) trusting multidisciplinary team relationships and (ii) provider commitment to and understanding of the model. Contextual factors such as strong leadership that sets clear goals and establishes an organizational culture in support of the program, along with joint governance structures, supported team collaboration and subsequent successful implementation. Furthermore, time to build an infrastructure to implement and flexibility in implementation, emerged as key processes instrumental to success of these programs. Conclusions This review included a wide range of international evidence, and identified key processes for successful implementation of IC programs that should be considered by program planners, leaders and evaluators. PMID:28992156

Igniting interest in prevention: using firefighter focus groups to inform implementation and enhancement of an urban canvassing program.

PubMed

Frattaroli, Shannon; McDonald, Eileen M; Tran, Nhan T; Trump, Alison R; OʼBrocki, Raymond C; Gielen, Andrea C

2012-01-01

Smoke alarm canvassing is recognized as an empirically based, effective intervention for increasing access to and the presence of smoke alarms in homes. We sought to inform the implementation of an intervention designed to enhance an existing fire department smoke alarm canvassing program through an empirically grounded, participatory process. We conducted a series of focus groups with fire union leaders and firefighters involved with the canvassing program in 1 US city, shared the results with the participants, and presented the resulting recommendations to fire department leadership. This research occurred in Baltimore, Maryland. Focus group participants included firefighters who participate in the Fire Department's smoke alarm canvassing program and representatives from the local firefighters' union. The focus groups sought to capture firefighters' experiences with and opinions about the canvassing program and how to improve it as well as challenges to canvassing work. We conducted 10 focus groups with 65 participants. Firefighters' perspectives on the canvassing program and their recommendations for improving it were expressed through 3 categories of themes concerning program management, canvassing challenges, and attitudes about the program and the community. We also discuss the process of presenting these findings and recommendations to the participants and the fire department leadership, and describe how implementation of some of the recommendations has progressed. Both the process and outcomes of this formative work inform how to develop and implement community-based public health interventions in real-world settings through academic-community partnerships. The findings also have implications for how canvassing programs are being implemented.

Effect of six sigma program on the number of surgeries cancellation.

PubMed

Gheysari, Esmat; Yousefi, Hojatollah; Soleymani, Hossain; Mojdeh, Soheila

2016-01-01

Today, the rate of surgeries is increasing, but surgeries are canceled due to various reasons. Unexpected cancellation of surgeries not only results in disorder in the operating room schedule, but also causes stress for patients and their family and increases costs. We determined the number and causes of surgery cancellations and areas for improvement. This outcome evaluation of Six Sigma program was conducted on 850 cases after the implementation of the program and compared to that of 850 cases which received routine care before the program. Cases were selected through easy sampling during the study. Before the implementation, the number of cancellations was recorded daily and their reasons were investigated. Then, Six Sigma program was implemented in accordance with the reasons for each category and necessary steps were taken to prevent the cancellation of surgeries. Data were collected for 3 months using a three-section data collection form. For data analysis, distribution and relative frequency and chi-square test were used. The three categories of patient, physician, and hospital system were identified as the main causes. The highest rate of cancellation was related to ENT surgeries (74.19%). No cancellations were made in orology surgeries. The implementation of the Six Sigma program caused a significant difference in surgery cancellation (P = 0.003); 31 (3.6%) cases of cancellation were reduced to 12 (1.4%) cases. The results showed that Six Sigma program is a pre-surgery care quality improvement program. Patient education and the implementation of the 6 sigma program can be effective in reducing the rate of cancellation of operations.

Clinical performance improvement series. Classic CQI integrated with comprehensive disease management as a model for performance improvement.

PubMed

Joshi, M S; Bernard, D B

1999-08-01

In recent years, health and disease management has emerged as an effective means of delivering, integrating, and improving care through a population-based approach. Since 1997 the University of Pennsylvania Health System (UPHS) has utilized the key principles and components of continuous quality improvement (CQI) and disease management to form a model for health care improvement that focuses on designing best practices, using best practices to influence clinical decision making, changing processes and systems to deploy and deliver best practices, and measuring outcomes to improve the process. Experience with 28 programs and more than 14,000 patients indicates significant improvement in outcomes, including high physician satisfaction, increased patient satisfaction, reduced costs, and improved clinical process and outcome measures across multiple diseases. DIABETES DISEASE MANAGEMENT: In three months a UPHS multidisciplinary diabetes disease management team developed a best practice approach for the treatment of all patients with diabetes in the UPHS. After the program was pilot tested in three primary care physician sites, it was then introduced progressively to additional practice sites throughout the health system. The establishment of the role of the diabetes nurse care managers (certified diabetes educators) was central to successful program deployment. Office-based coordinators ensure incorporation of the best practice protocols into routine flow processes. A disease management intranet disseminates programs electronically. Outcomes of the UPHS health and disease management programs so far demonstrate success across multiple dimensions of performance-service, clinical quality, access, and value. The task of health care leadership today is to remove barriers and enable effective implementation of key strategies, such as health and disease management. Substantial effort and resources must be dedicated to gain physician buy-in and achieve compliance. The challenge is to provide leadership support, to reward and recognize best practice performers, and to emphasize the use of data for feedback and improvement. As these processes are implemented successfully, and evidence of improved outcomes is documented, it is likely that this approach will be more widely embraced and that organizationwide performance improvement will increase significantly. Health care has traditionally invested extraordinary resources in developing best practice approaches, including guidelines, education programs, or other tangible products and services. Comparatively little time, effort, and resources have been targeted to implementation and use, the stage at which most efforts fail. CQI's emphasis on data, rapid diffusion of innovative programs, and rapid cycle improvements enhance the implementation and effectiveness of disease management.

A program for thai rubber tappers to improve the cost of occupational health and safety.

PubMed

Arphorn, Sara; Chaonasuan, Porntip; Pruktharathikul, Vichai; Singhakajen, Vajira; Chaikittiporn, Chalermchai

2010-01-01

The purposes of this research were to determine the cost of occupational health and safety and work-related health problems, accidents, injuries and illnesses in rubber tappers by implementing a program in which rubber tappers were provided training on self-care in order to reduce and prevent work-related accidents, injuries and illnesses. Data on costs for healthcare, the prevention and the treatment of work-related accidents, injuries and illnesses were collected by interview using a questionnaire. The findings revealed that there was no relationship between what was spent on healthcare and the prevention of work-related accidents, injuries and illnesses and that spent on the treatment of work-related accidents, injuries and illnesses. The proportion of the injured subjects after the program implementation was significantly less than that before the program implementation (p<0.001). The level of pain after the program implementation was significantly less than that before the program implementation (p<0.05). The treatment costs incurred after the program implementation were significantly less than those incurred before the program implementation (p<0.001). It was demonstrated that this program raised the health awareness of rubber tappers. It strongly empowered the leadership in health promotion for the community.

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples.

PubMed

Daudelin, Denise H; Selker, Harry P; Leslie, Laurel K

2015-12-01

There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in-person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. © 2015 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc.

Timeliness and access to healthcare services via telemedicine for adolescents in state correctional facilities.

PubMed

Fox, Karen C; Somes, Grant W; Waters, Teresa M

2007-08-01

The aim of this study was to examine the effectiveness of a telemedicine program in improving timeliness of and access to healthcare services in adolescent correctional facilities. This study is a pre/post quasi-experimental design comparing time to treatment and healthcare use in the year preceding and the 2 years after the implementation of a telemedicine program in four facilities housing adolescents from 12 to 19. Timeliness of care is measured by time from referral to date of service (for behavioral healthcare only). Access to care is measured by use of outpatient care, emergency department (ED) visits, and inpatient visits. Two of the four state correctional facilities had a significant decrease (24%) in time from referral to treatment after the implementation of the telemedicine intervention. The facilities not showing significant improvements in timeliness experienced difficulty implementing the telemedicine program. The telemedicine program was also associated with significant improvements in access to care. Outpatient visits increased by 40% in the 2 years after implementation of telemedicine. For each 1% increase in telemedicine usage, outpatient visits increased by 1%, whereas emergency room visits decreased by 7%. Telemedicine can have a positive impact on timeliness of and access to care for youth in correctional facilities.

76 FR 27986 - Funding for the Conservation Loan Program; Farm Loan Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-13

... of water conservation measures; establishment or improvement of permanent pastures; implementation of... for the Conservation Loan Program; Farm Loan Programs AGENCY: Farm Service Agency, USDA. ACTION... or guaranteed loan applications for the Conservation Loan (CL) Program because of lack of program...

A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.

PubMed

Honda, Hitoshi; Sato, Yumiko; Yamazaki, Akinori; Padival, Simi; Kumagai, Akira; Babcock, Hilary

2013-11-01

Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult. Before-and-after trial. Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan. We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution. With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study. Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

Organizational Implementation of Evidence-Based Substance Abuse Treatment in Racial and Ethnic Minority Communities

PubMed Central

He, Amy; Kim, Ahraemi; Aarons, Gregory A.

2013-01-01

We evaluated organizational factors associated with the implementation of contingency management treatment (CMT) and medication-assisted treatment (MAT) in substance abuse treatment (SAT) programs serving racial and ethnic minority communities. Analysis of cross-sectional data collected in 2010–2011 from a random sample of 148 publicly funded SAT programs showed that accepting private insurance was positively associated with CMT and MAT implementation, whereas larger programs were associated with greater implementation of MAT. Supervisorial openness to and expectations about implementing evidence-based practices (EBPs) and attributes for change were strongly associated with CMT, whereas the interactions between openness to EBPs and programs that accept private insurance and that are governed by parent organizations were positively associated with MAT. These external expectations and managerial attitudes supported the implementation of psychosocial and pharmacotherapy treatments in SAT. Implications for improving standards of care in minority communities are discussed. PMID:24046236

Implementation of the thinking skills for work program in a psychosocial clubhouse.

PubMed

McGurk, Susan R; Schiano, Diane; Mueser, Kim T; Wolfe, Rosemarie

2010-01-01

Cognitive remediation programs aimed at improving role functioning have been implemented in a variety of different mental health treatment settings, but not in psychosocial clubhouses. This study sought to determine the feasibility and preliminary outcomes of providing a cognitive remediation program (the Thinking Skills for Work program), developed and previously implemented in supported employment programs at mental health agencies, in a psychosocial club-house. Twenty-three members with a history of difficulties getting or keeping jobs, who were participating in a supported employment program at a psychosocial clubhouse, were enrolled in the Thinking Skills for Work program. A neurocognitive battery was administered at baseline and 3 months later after completion of the computer cognitive training component of the program. Hours of competitive work were tracked for the 2 years before enrollment and 2 years following enrollment. Other work-related activities (school, volunteer) were also tracked for 2 years following enrollment. Twenty-one members (91%) completed 6 or more computer cognitive training sessions. Participants demonstrated significant improvements on neurocognitive measures of processing speed, verbal learning and memory, and executive functions. Sixty percent of the members obtained a competitive job during the 2-year follow-up, and 74% were involved in some type of work-related activity. Participants worked significantly more competitive hours over the 2 years after joining the Thinking Skills for Work program than before. The findings support the feasibility and promise of implementing the Thinking Skills for Work program in the context of supported employment provided at psychosocial clubhouses.

Identifying Elementary School Student Opinion Leaders for Engagement in Evidence-Based Program Adaptation and Implementation

ERIC Educational Resources Information Center

Reiger, Christopher J.; Gibson, Jennifer E.; Passarelli, Rebecca E.; Flaspohler, Paul D.

2017-01-01

Evidence-based programs, such as bullying prevention, often demonstrate disappointing outcomes when widely disseminated. Engaging opinion leaders--those individuals whom others emulate and go to for advice--in the process of adaptation and implementation may improve outcomes. However, opinion leaders have the most influence on individuals who are…

76 FR 31416 - Federal Acquisition Regulation; Oversight of Contractor Ethics Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

...-AL92 Federal Acquisition Regulation; Oversight of Contractor Ethics Programs AGENCY: Department of... that contractors have implemented the mandatory contractor business ethics program requirements. DATES... to Improve DoD's Oversight of Contractor Ethics Programs. The ethics program requirement flows from...

Dissemination and implementation science in program evaluation: A telemental health clinical consultation case example.

PubMed

Arora, Prerna G; Connors, Elizabeth H; Blizzard, Angela; Coble, Kelly; Gloff, Nicole; Pruitt, David

2017-02-01

Increased attention has been placed on evaluating the extent to which clinical programs that support the behavioral health needs of youth have effective processes and result in improved patient outcomes. Several theoretical frameworks from dissemination and implementation (D&I) science have been put forth to guide the evaluation of behavioral health program implemented in the context of real-world settings. Although a strong rationale for the integration of D&I science in program evaluation exists, few examples exist available to guide the evaluator in integrating D&I science in the planning and execution of evaluation activities. This paper seeks to inform program evaluation efforts by outlining two D&I frameworks and describing their integration in program evaluation design. Specifically, this paper seeks to support evaluation efforts by illustrating the use of these frameworks via a case example of a telemental health consultation program in pediatric primary care designed to improve access to behavioral health care for children and adolescents in rural settings. Lessons learned from this effort, as well as recommendations regarding the future evaluation of programs using D&I science to support behavioral health care in community-based settings are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.

PubMed

Agwu, Allison L; Lee, Carlton K K; Jain, Sanjay K; Murray, Kara L; Topolski, Jason; Miller, Robert E; Townsend, Timothy; Lehmann, Christoph U

2008-09-15

Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World Wide Web-based antimicrobial approval program, will effectively enhance antimicrobial stewardship programs.

A comparative analysis of the implementation of the Mais Médicos (More Doctors) Program in municipalities in the State of Rio Grande do Sul, Brazil.

PubMed

Miranda, Alcides Silva de; Melo, Diego Azevedo

2016-09-01

The Mais Médicos (More Doctors) Program has led to an increase in the number of doctors and medical treatment in primary health care services across Brazil. This article presents the results of a case-control study of groups of municipalities based on secondary data sources. It aims to explore and discuss a set of indicators of primary health care service delivery. An improvement in performance against structural indicators was observed in municipalities where the program was implemented. With respect to the outcome indicators, a slight improvement in service delivery was observed in municipalities where the program was implemented. However, no difference was observed in impacts between the case and control municipalities. These results may have been influenced by the fact that the program has only been underway for a limited time, by underreporting of doctors by the National Health Facilities Register (CNES, acronym in Portuguese), and the predominantly substitutive nature of the allocation of medical professionals under the program in the selected municipalities.

Introductory Computer Programming Course Teaching Improvement Using Immersion Language, Extreme Programming, and Education Theories

ERIC Educational Resources Information Center

Velez-Rubio, Miguel

2013-01-01

Teaching computer programming to freshmen students in Computer Sciences and other Information Technology areas has been identified as a complex activity. Different approaches have been studied looking for the best one that could help to improve this teaching process. A proposed approach was implemented which is based in the language immersion…

Design and Implementation of Training to Improve Management of Pediatric Overweight

ERIC Educational Resources Information Center

Beno, Luke; Hinchman, Josephine; Kibbe, Debra; Trowbridge, Frederick

2005-01-01

Introduction: Clinicians report a low proficiency in treating overweight children and using behavioral management strategies. This paper documents the design and implementation of a training program to improve clinicians' skills in the assessment and behavioral management of pediatric overweight. Methods: Two one-hour CME trainings were designed…

Continuous Improvement and Employee Engagement, Part 2: Design, Implementation, and Outcomes of a Daily Management System.

PubMed

Maurer, Marsha; Browall, Pamela; Phelan, Cynthia; Sanchez, Sandra; Sulmonte, Kimberlyann; Wandel, Jane; Wang, Allison

2018-04-01

A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or work flow and to address them on a daily basis. Through a DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 2 describes the implementation and outcomes of the program.

Implementation of a Systematic Accountability Framework in 2014 to Improve the Performance of the Nigerian Polio Program

PubMed Central

Tegegne, Sisay G.; MKanda, Pascal; Yehualashet, Yared G.; Erbeto, Tesfaye B.; Touray, Kebba; Nsubuga, Peter; Banda, Richard; Vaz, Rui G.

2016-01-01

Background. An accountability framework is a central feature of managing human and financial resources. One of its primary goals is to improve program performance through close monitoring of selected priority activities. The principal objective of this study was to determine the contribution of a systematic accountability framework to improving the performance of the World Health Organization (WHO)–Nigeria polio program staff, as well as the program itself. Methods. The effect of implementation of the accountability framework was evaluated using data on administrative actions and select process indicators associated with acute flaccid paralysis (AFP) surveillance, routine immunization, and polio supplemental immunization activities. Data were collected in 2014 during supportive supervision, using Magpi software (a company that provides service to collect data using mobile phones). A total of 2500 staff were studied. Results. Data on administrative actions and process indicators from quarters 2–4 in 2014 were compared. With respect to administrative actions, 1631 personnel (74%) received positive feedback (written or verbal commendation) in quarter 4 through the accountability framework, compared with 1569 (73%) and 1152 (61%) during quarters 3 and 2, respectively. These findings accorded with data on process indicators associated with AFP surveillance and routine immunization, showing statistically significant improvements in staff performance at the end of quarter 4, compared with other quarters. Conclusions. Improvements in staff performance and process indicators were observed for the WHO-Nigeria polio program after implementation of a systematic accountability framework. PMID:26823334

Organizational learning and continuous quality improvement: examining the impact on nursing home performance.

PubMed

Rondeau, Kent V; Wagar, Terry H

2002-01-01

Interest is growing in learning more about the ability of total quality management and continuous quality improvement (TQM/CQI) initiatives to contribute to the performance of healthcare organizations. A major factor in the successful implementation of TQM/CQI is the seminal contribution of an organization's culture. Many implementation efforts have not succeeded because of a corporate culture that failed to stress broader organizational learning. This may help to explain why some TQM/CQI programs have been unsuccessful in improving healthcare organization performance. Organizational performance variables and organizational learning orientation were assessed in a sample of 181 Canadian long-term care organizations that had implemented a formal TQM/CQI program. Categorical regression analysis shows that, in the absence of a strong corporAte culture that stresses organizational learning and employee development, few performance enhancements are reported. The results of the assessment suggest that a TQM/CQI program without the backing of a strong organizational learning culture may be insufficient to achieve augmented organizational performance.

Institutional transformation: An analysis of change initiatives at NSF ADVANCE institutions

NASA Astrophysics Data System (ADS)

Plummer, Ellen W.

The purpose of this study was to examine how institutional culture promoted or impeded the implementation of round one and two NSF ADVANCE initiatives designed to improve academic climates for women in science and engineering. This study was conducted in two phases. In phase one, 35 participants from 18 institutions were interviewed to answer three research questions. Participants identified a policy, process, or program designed to improve academic cultures for women in science and engineering fields. Participants also identified strategies that promoted the implementation of these efforts, and discussed factors that impeded these efforts. In phase two, site visits were conducted at two institutions to answer a fourth research question. How did institutional culture shape the design and implementation of faculty search processes? Policies, processes, and programs were implemented by participants at the institutional, departmental, and individual levels and included family friendly and dual career policies at the institutional level, improved departmental faculty search and climate improvement processes, and mentoring programs and training for department heads at the individual level. Communication and leadership strategies were key to the successful implementation of policies, processes, and programs designed to achieve institutional transformation. Communication strategies involved shaping change messages to reach varied audiences often with the argument that change efforts would improve the climate for everyone not just women faculty members. Administrative and faculty leaders from multiple levels proved important to change efforts. Institutional Transformation Institutional culture shaped initiatives to improve faculty search processes. Faculty leaders in both settings used data to persuade faculty members of the need for change. At one site, data that included national availability information was critical to advancing the change agenda. At the other site, social science data that illustrated gender bias was persuasive. Faculty members who were effective as change agents were those who were credible with their peers in that setting.

Evaluation of a TB infection control implementation initiative in out-patient HIV clinics in Zambia and Botswana.

PubMed

Emerson, C; Lipke, V; Kapata, N; Mwananyambe, N; Mwinga, A; Garekwe, M; Lanje, S; Moshe, Y; Pals, S L; Nakashima, A K; Miller, B

2016-07-01

Out-patient human immunodeficiency virus (HIV) care and treatment clinics in Zambia and Botswana, countries with a high burden of HIV and TB infection. To develop a tuberculosis infection control (TB IC) training and implementation package and evaluate the implementation of TB IC activities in facilities implementing the package. Prospective program evaluation of a TB IC training and implementation package using a standardized facility risk assessment tool, qualitative interviews with facility health care workers and measures of pre- and post-test performance. A composite measure of facility performance in TB IC improved from 32% at baseline to 50% at 1 year among eight facilities in Zambia, and from 27% to 80% at 6 months among 10 facilities in Botswana. Although there was marked improvement in indicators of managerial, administrative and environmental controls, key ongoing challenges remained in ensuring access to personal protective equipment and implementing TB screening in health care workers. TB IC activities at out-patient HIV clinics in Zambia and Botswana improved after training using the implementation package. Continued infrastructure support, as well as monitoring and evaluation, are needed to support the scale-up and sustainability of TB IC programs in facilities in low-resource countries.

Implementing a mental health ministry committee in faith-based organizations: the promoting emotional wellness and spirituality program.

PubMed

Williams, Laverne; Gorman, Robyn; Hankerson, Sidney

2014-01-01

Social workers have successfully collaborated with African-American faith-based organizations to improve health outcomes for numerous medical conditions. However, the literature on Faith-Based Health Promotion for major depression is sparse. Thus, the authors describe a program used to implement a Mental Health Ministry Committee in African-American churches. Program goals are to educate clergy, reduce stigma, and promote treatment seeking for depression. Key lessons learned are to initially form partnerships with church staff if there is not a preexisting relationship with the lead pastor, to utilize a community-based participatory approach, and to have flexibility in program implementation.

State Fiscal Years 1997-2000 Transportation Improvement Program for Green, Miami and Montgomery Counties, Ohio - June 1996

DOT National Transportation Integrated Search

1996-06-01

The Transportation Improvement Program, often referred to as the TIP, is a four-year implementation schedule for transportation projects within the Greene, Miami and Montgomery County Region. The locally developed State Fiscal Year 1997 through Fisca...

Improving resident engagement in quality improvement and patient safety initiatives at the bedside: the Advocate for Clinical Education (ACE).

PubMed

Schleyer, Anneliese M; Best, Jennifer A; McIntyre, Lisa K; Ehrmantraut, Ross; Calver, Patty; Goss, J Richard

2013-01-01

Quality improvement (QI) and patient safety (PS) are essential competencies in residency training; however, the most effective means to engage physicians remains unclear. The authors surveyed all medicine and surgery physicians at their institution to describe QI/PS practices and concurrently implemented the Advocate for Clinical Education (ACE) program to determine if a physician-centered program in the context of educational structures and at the point of care improved performance. The ACE rounded with medicine and surgery teams and provided individual and team-level education and feedback targeting 4 domains: professionalism, infection control, interpreter use, and pain assessment. In a pilot, the ACE observed 2862 physician-patient interactions and 178 physicians. Self-reported compliance often was greater than the behaviors observed. Following ACE implementation, observed professionalism behaviors trended toward improvement; infection control also improved. Physicians were highly satisfied with the program. The ACE initiative is one coaching/feedback model for engaging residents in QI/PS that may warrant further study.

Improving quality management systems of laboratories in developing countries: an innovative training approach to accelerate laboratory accreditation.

PubMed

Yao, Katy; McKinney, Barbara; Murphy, Anna; Rotz, Phil; Wafula, Winnie; Sendagire, Hakim; Okui, Scolastica; Nkengasong, John N

2010-09-01

The Strengthening Laboratory Management Toward Accreditation (SLMTA) program was developed to promote immediate, measurable improvement in laboratories of developing countries. The laboratory management framework, a tool that prescribes managerial job tasks, forms the basis of the hands-on, activity-based curriculum. SLMTA is implemented through multiple workshops with intervening site visits to support improvement projects. To evaluate the effectiveness of SLMTA, the laboratory accreditation checklist was developed and subsequently adopted by the World Health Organization Regional Office for Africa (WHO AFRO). The SLMTA program and the implementation model were validated through a pilot in Uganda. SLMTA yielded observable, measurable results in the laboratories and improved patient flow and turnaround time in a laboratory simulation. The laboratory staff members were empowered to improve their own laboratories by using existing resources, communicate with clinicians and hospital administrators, and advocate for system strengthening. The SLMTA program supports laboratories by improving management and building preparedness for accreditation.

State of the science on implementation research in early child development and future directions.

PubMed

Aboud, Frances E; Yousafzai, Aisha K; Nores, Milagros

2018-05-01

We summarize the state of the field of implementation research and practice for early child development and propose recommendations. First, conclusions are drawn regarding what is generally known about the implementation of early childhood development programs, based on papers and discussions leading to a published series on the topic. Second, recommendations for short-term activities emphasize the use of newly published guidelines for reporting data collection methods and results for implementation processes; knowledge of the guidelines and a menu of measures allows for planning ahead. Additional recommendations include careful documentation of early-stage implementation, such as adapting a program to a different context and assessing feasibility, as well as the process of sustaining and scaling up a program. Using existing implementation information by building on and improving past programs and translating them into policy are recommended. Longer term goals are to identify implementation characteristics of effective programs and determinants of these characteristics. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of The New York Academy of Sciences.

Remote sensing inputs to National Model Implementation Program for water resources quality improvement

NASA Technical Reports Server (NTRS)

Eidenshink, J. C.; Schmer, F. A.

1979-01-01

The Lake Herman watershed in southeastern South Dakota has been selected as one of seven water resources systems in the United States for involvement in the National Model Implementation Program (MIP). MIP is a pilot program initiated to illustrate the effectiveness of existing water resources quality improvement programs. The Remote Sensing Institute (RSI) at South Dakota State University has produced a computerized geographic information system for the Lake Herman watershed. All components necessary for the monitoring and evaluation process were included in the data base. The computerized data were used to produce thematic maps and tabular data for the land cover and soil classes within the watershed. These data are being utilized operationally by SCS resource personnel for planning and management purposes.

Aligning Needs, Expectations, and Learning Outcomes to Sustain Self-Efficacy through Transfer Learning Community Programs

ERIC Educational Resources Information Center

Leptien, Jennifer R.

2015-01-01

This chapter addresses strengths and difficulties encountered in implementing transfer learning community models and how efficacy is supported through transfer learning community programming. Transfer programming best practices and recommendations for program improvements are presented.

A House Staff Training Program to Improve the Clinical Instruction of Medical Students.

ERIC Educational Resources Information Center

Meleca, C. Benjamin; Schimpfhauser, Frank T.

A demonstrated model for effective instructional skill improvement in the medical clinical sciences is described. A two-year project was funded by the National Fund for Medical Education to design and implement a program to assist house staff in the improvement of clinical instruction. A total of 148 medical residents were surveyed about their…

Office of Student Financial Aid Quality Improvement Program: Design and Implementation Plan.

ERIC Educational Resources Information Center

Advanced Technology, Inc., Reston, VA.

The purpose and direction of the Office of Student Financial Aid (OSFA) quality improvement program are described. The background and context for the Pell Grant quality control (QC) design study and the meaning of QC are reviewed. The general approach to quality improvement consists of the following elements: a strategic approach that enables OSFA…

School Improvement Plans and Student Learning in Jamaica

ERIC Educational Resources Information Center

Lockheed, Marlaine; Harris, Abigail; Jayasundera, Tamara

2010-01-01

A school improvement program that provided support to poor-performing schools on the basis of needs identified in a school improvement plan was implemented in 72 government schools in Jamaica, from 1998 to 2005. In this independent evaluation of the program, we use propensity score matching to create, post hoc, a control group of schools that were…

Implementation of a diabetes self-management education program in primary care for adults using shared medical appointments.

PubMed

Sanchez, Iris

2011-01-01

The purpose of this study was to implement diabetes self-management education in primary care using the Chronic Care Model and shared medical appointments (SMA) to provide evidence-based interventions to improve process and measure outcomes. A quality improvement project using the Plan-Do-Check-Act cycle was implemented in a primary care setting in South Texas to provide diabetes self-management education for adults. Biological measures were evaluated in 70 patients at initiation of the project and thereafter based on current practice guidelines. The results of the project were consistent with the literature regarding the benefits, sustainability, and viability of SMA. As compared with that in studies presented in the literature, the patient population who participated in SMA had similar outcomes regarding improvement in A1C, self-management skills, and satisfaction. SMA are an innovative system redesign concept with the potential to provide comprehensive and coordinated care for patients with multiple and chronic health conditions while still being an efficient, effective, financially viable, and sustainable program. As the incidence and prevalence of diabetes increase, innovative models of care can meet the growing demand for access and utilization of diabetes self-management education programs. Programs focusing on chronic conditions to improve outcomes can be replicated by health care providers in primary care settings. SMA can increase revenue and productivity, improve disease management, and increase provider and patient satisfaction.

New York State Educational Programs That Work. Sharing Successful Programs, 1990 Edition.

ERIC Educational Resources Information Center

New York State Education Dept., Albany.

Sharing Successful Programs (SSP) is a national dissemination process for validating, sharing, and implementing successful educational programs. It offers effective strategies for educational improvement by sharing validated programs and provides a cost-effective way for school districts to duplicate validated programs in accordance with their…

The West African Health Organization's experience in improving the health research environment in the ECOWAS region.

PubMed

Aidam, Jude; Sombié, Issiaka

2016-04-20

The West African Health Organization (WAHO) implemented a research development program in West Africa during 2009-2013 using the Knowledge for Better Health Research Capacity Development Framework, developed by Pang et al. (Bull World Health Organ 81(11):815-820, 2003), on strategies used to improve the research environment. The framework has the following components: stewardship, financing, sustainable resourcing and research utilization. This paper describes how WAHO implemented this research development program in the West African region to help improve the research environment and lessons learnt. This is a retrospective review of the regional research development program using a triangulation of activity reports, an independent evaluation and the authors' experiences with stakeholders. This program was designed to address gaps along the components of the framework and to improve partnership. The activities, results and challenges are summarised for each component of the framework. The independent evaluation was conducted using over 180 semi-structured interviews of key stakeholders in the West African region and activity reports. WAHO and major stakeholders validated these findings during a regional meeting. All 15 ECOWAS countries benefited from this regional research development program. WAHO provided technical and financial support to eight countries to develop their policies, priorities and plans for research development to improve their research governance. WAHO, along with other technical and financial partners, organised many capacity-strengthening trainings in health systems research methodology, resource mobilization, ethical oversight and on HRWeb, a research information management platform. WAHO helped launch a regional network of health research institutions to improve collaboration between regional participating institutions. Further, WAHO developed strategic research partnerships and mobilised additional funding to support the program. The program supported 24 health research projects. High staff turnover, weak institutional capacities and ineffective collaboration were some of the challenges encountered during program activity implementation. The regional collaborative approach to health research development using this framework was effective given the challenges in the West African region. The achievements particularly with improved research partnerships and funding helped strengthen local health research environments. This highlights WAHO's role and the common experiences in the West African region in improving health research.

Practice-based learning and improvement: a curriculum in continuous quality improvement for surgery residents.

PubMed

Canal, David F; Torbeck, Laura; Djuricich, Alexander M

2007-05-01

Surgery residents can learn continuous quality improvement (CQI) principles within a structured curriculum and propose quality improvement projects. Curriculum within a surgical residency program. A university surgical residency program with multiple hospital training sites. Fifteen surgical residents during the dedicated research year. A curriculum in CQI that focuses on devising a quality improvement project. Resident self-reported attitudes about quality improvement and implementation of resident-initiated quality improvement projects. Resident survey data demonstrated an improvement in knowledge, self-efficacy, and experiences within CQI. Fifteen individual residents, within smaller teams, created 4 quality improvement projects worthy of implementation. A structured CQI curriculum can be successfully integrated into a general surgery residency program. Residents can learn the skill of constructing CQI project ideas within the framework of the plan-do-study-act cycle. Residents are eager to make improvements in their local system of residency. By giving them the tools to critically investigate systems improvement and a much needed ear to hear their concerns and suggestions for improvement, we found ways to potentially enhance patient care and developed ideas to improve the education of future surgeons. In doing so, we provided the residents with "buy-in" into their residency program, while addressing the competency of practice-based learning and improvement required by the Accreditation Council for Graduate Medical Education for resident education.

Federal Aviation Administration weather program to improve aviation safety

NASA Technical Reports Server (NTRS)

Wedan, R. W.

1983-01-01

The implementation of the National Airspace System (NAS) will improve safety services to aviation. These services include collision avoidance, improved landing systems and better weather data acquisition and dissemination. The program to improve the quality of weather information includes the following: Radar Remote Weather Display System; Flight Service Automation System; Automatic Weather Observation System; Center Weather Processor, and Next Generation Weather Radar Development.

Development, implementation, and evaluation of a community- and hospital-based respiratory syncytial virus prophylaxis program.

PubMed

Bracht, Marianne; Heffer, Michael; O'Brien, Karel

2005-02-01

To implement and deliver a respiratory syncytial virus prophylaxis (RSVP) program in response to the Canadian Pediatric Society recommendations. A novel program was designed to provide inpatient RSVP for at-risk infants cared for in 1 tertiary care newborn intensive care unit (NICU). This inpatient program was part of a coordinated approach to RSVP, designed and implemented by 3 hospitals. An RSVP program logic model was created and used by a multidisciplinary team to evaluate the in-house program and identify areas of program activity requiring improvement. Following the 2000 to 2001 RSV season, a compliance and outcomes audit was performed in the tertiary center; 193 infants were enrolled in the RSVP program and 162 infants had received RSVP in the NICU [Mean = 1.64 doses]. Telephone follow-up with the parents of discharged infants identified that 159 infants (98%) had successfully completed their full course of RSVP. Using the RSVP program logic model, 5 areas for program improvement were identified including infant recruitment, patient transfer/discharge processes, product procurement, preparation/distribution/administration of doses, and healthcare team communication. Interdisciplinary collaboration is an important factor in the success of the RSVP program and has supported a consistent model of care for the delivery of RSVP. The program logic model provided a useful structure to systematically review the RSVP program in this organization.

Template for success: using a resident-designed sign-out template in the handover of patient care.

PubMed

Clark, Clancy J; Sindell, Sarah L; Koehler, Richard P

2011-01-01

Report our implementation of a standardized handover process in a general surgery residency program. The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System. Nonprofit, tertiary referral teaching hospital. General surgery residents, residency faculty, patient care providers, and hospital administration. After instruction in quality improvement initiatives, a team of general surgery residents designed a sign-out process using an electronic template and standard procedures. The initial implementation phase resulted in 73% compliance. Using resident-driven continuous quality improvement processes, real-time feedback enabled residents to modify and improve this process, eventually attaining 100% compliance and acceptance by residents. The creation of a standardized template and protocol for patient handovers might eliminate communication failures. Encouraging residents to participate in this process can establish the groundwork for successful implementation of a standardized handover process. Integrating a continuous quality-improvement process into such an initiative can promote active participation of busy general surgery residents and lead to successful implementation of standard procedures. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Acquiring Science and Social Studies Knowledge in Kindergarten Through Fourth Grade: Conceptualization, Design, Implementation, and Efficacy Testing of Content-Area Literacy Instruction (CALI).

PubMed

Dombek, Jennifer; Crowe, Elizabeth C; Spencer, Mercedes; Tighe, Elizabeth L; Coffinger, Sean; Zargar, Elham; Wood, Taffeta; Petscher, Yaacov

2017-04-01

With national focus on reading and math achievement, science and social studies have received less instructional time. Yet, accumulating evidence suggests that content knowledge is an important predictor of proficient reading. Starting with a design study, we developed Content Area Literacy Instruction (CALI), as an individualized (or personalized) instructional program for kindergarteners through fourth graders to build science and social studies knowledge. We developed CALI to be implemented in general education classrooms, over multiple iterations (n=230 students), using principles of design-based implementation research. The aims were to develop CALI as a usable and feasible instructional program that would, potentially, improve science and social studies knowledge, and could be implemented during the literacy block without negatively affecting students' reading gains (i.e., no opportunity cost). We then evaluated the efficacy of CALI in a randomized controlled field trial with 418 students in kindergarten through fourth grade. Results reveal that CALI demonstrates promise as a useable and feasible instructional individualized general education program, and is efficacious in improving social studies ( d =2.2) and science ( d =2.1) knowledge, with some evidence of improving oral and reading comprehension skills ( d =.125).

Effect of six sigma program on the number of surgeries cancellation

PubMed Central

Gheysari, Esmat; Yousefi, Hojatollah; Soleymani, Hossain; Mojdeh, Soheila

2016-01-01

Background: Today, the rate of surgeries is increasing, but surgeries are canceled due to various reasons. Unexpected cancellation of surgeries not only results in disorder in the operating room schedule, but also causes stress for patients and their family and increases costs. We determined the number and causes of surgery cancellations and areas for improvement. Materials and Methods: This outcome evaluation of Six Sigma program was conducted on 850 cases after the implementation of the program and compared to that of 850 cases which received routine care before the program. Cases were selected through easy sampling during the study. Before the implementation, the number of cancellations was recorded daily and their reasons were investigated. Then, Six Sigma program was implemented in accordance with the reasons for each category and necessary steps were taken to prevent the cancellation of surgeries. Data were collected for 3 months using a three-section data collection form. For data analysis, distribution and relative frequency and chi-square test were used. Results: The three categories of patient, physician, and hospital system were identified as the main causes. The highest rate of cancellation was related to ENT surgeries (74.19%). No cancellations were made in orology surgeries. The implementation of the Six Sigma program caused a significant difference in surgery cancellation (P = 0.003); 31 (3.6%) cases of cancellation were reduced to 12 (1.4%) cases. Conclusions: The results showed that Six Sigma program is a pre-surgery care quality improvement program. Patient education and the implementation of the 6 sigma program can be effective in reducing the rate of cancellation of operations. PMID:27095994

Introducing a laparoscopic simulation training and credentialing program in gynaecology: an observational study.

PubMed

Janssens, Sarah; Beckmann, Michael; Bonney, Donna

2015-08-01

Simulation training in laparoscopic surgery has been shown to improve surgical performance. To describe the implementation of a laparoscopic simulation training and credentialing program for gynaecology registrars. A pilot program consisting of protected, supervised laparoscopic simulation time, a tailored curriculum and a credentialing process, was developed and implemented. Quantitative measures assessing simulated surgical performance were measured over the simulation training period. Laparoscopic procedures requiring credentialing were assessed for both the frequency of a registrar being the primary operator and the duration of surgery and compared to a presimulation cohort. Qualitative measures regarding quality of surgical training were assessed pre- and postsimulation. Improvements were seen in simulated surgical performance in efficiency domains. Operative time for procedures requiring credentialing was reduced by 12%. Primary operator status in the operating theatre for registrars was unchanged. Registrar assessment of training quality improved. The introduction of a laparoscopic simulation training and credentialing program resulted in improvements in simulated performance, reduced operative time and improved registrar assessment of the quality of training. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Virtual Breakthrough Series, Part 2: Improving Fall Prevention Practices in the Veterans Health Administration.

PubMed

Zubkoff, Lisa; Neily, Julia; Quigley, Pat; Soncrant, Christina; Young-Xu, Yinong; Boar, Shoshana; Mills, Peter D

2016-11-01

The Veterans Health Administration (VHA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help prevent falls and fall-related injuries. This project enabled teams to expand program infrastructure, redesign improvement strategies, and enhance program evaluation. A VBTS collaborative involves prework, action, and continuous improvement. Actions included educational calls, monthly reports, coaching, and feedback. Evaluation included assessment of interventions, team capacity and infrastructure changes, and rates of falls and fall-related major injuries. Fifty-nine teams completed the project. The majority submitted monthly reports. The average number of interventions per team was 6.66 (range, 1-12; mode = 6). The most frequently implemented changes were staff education; post-fall huddles; data tracking; and classifying falls, handoff communication, and intentional rounding. On a program questionnaire aggregated average summary scores improved from 136.54 (baseline) to 58.26 (follow-up; range, 0-189; p < 0.0001). The mean aggregated fall-related major injury rate for participants decreased from 6.8 to 4.8 per 100,000 bed-days of care (p = 0.02), or 5 major injuries avoided per month. No statistically significant changes occurred for nonparticipants. The mean aggregated fall rate did not change significantly from baseline to follow-up for participants (p = 0.42) or nonparticipants (p = 0.21). Teams submitted reports and implemented changes resulting in decreased major injuries related to falls for participating units. Teams also made changes in their fall prevention programs such as classifying how they analyze falls and implementing injury reduction strategies. The approaches used show promise for reducing fall-related harm for inpatients, as well as assisting teams in implementing changes. Copyright 2016 The Joint Commission.

Randomized Trial of Two Dissemination Strategies for a Skin Cancer Prevention Program in Aquatic Settings

PubMed Central

Escoffery, Cam; Elliott, Tom; Nehl, Eric J.

2015-01-01

Objectives. We compared 2 strategies for disseminating an evidence-based skin cancer prevention program. Methods. We evaluated the effects of 2 strategies (basic vs enhanced) for dissemination of the Pool Cool skin cancer prevention program in outdoor swimming pools on (1) program implementation, maintenance, and sustainability and (2) improvements in organizational and environmental supports for sun protection. The trial used a cluster-randomized design with pools as the unit of intervention and outcome. The enhanced group received extra incentives, reinforcement, feedback, and skill-building guidance. Surveys were collected in successive years (2003–2006) from managers of 435 pools in 33 metropolitan areas across the United States participating in the Pool Cool Diffusion Trial. Results. Both treatment groups improved their implementation of the program, but pools in the enhanced condition had significantly greater overall maintenance of the program over 3 summers of participation. Furthermore, pools in the enhanced condition established and maintained significantly greater sun-safety policies and supportive environments over time. Conclusions. This study found that more intensive, theory-driven dissemination strategies can significantly enhance program implementation and maintenance of health-promoting environmental and policy changes. Future research is warranted through longitudinal follow-up to examine sustainability. PMID:25521872

Implementation and Evaluation of a Smartphone-Based Telemonitoring Program for Patients With Heart Failure: Mixed-Methods Study Protocol.

PubMed

Ware, Patrick; Ross, Heather J; Cafazzo, Joseph A; Laporte, Audrey; Seto, Emily

2018-05-03

Meta-analyses of telemonitoring for patients with heart failure conclude that it can lower the utilization of health services and improve health outcomes compared with the standard of care. A smartphone-based telemonitoring program is being implemented as part of the standard of care at a specialty care clinic for patients with heart failure in Toronto, Canada. The objectives of this study are to (1) evaluate the impact of the telemonitoring program on health service utilization, patient health outcomes, and their ability to self-care; (2) identify the contextual barriers and facilitators of implementation at the physician, clinic, and institutional level; (3) describe patient usage patterns to determine adherence and other behaviors in the telemonitoring program; and (4) evaluate the costs associated with implementation of the telemonitoring program from the perspective of the health care system (ie, public payer), hospital, and patient. The evaluation will use a mixed-methods approach. The quantitative component will include a pragmatic pre- and posttest study design for the impact and cost analyses, which will make use of clinical data and questionnaires administered to at least 108 patients at baseline and 6 months. Furthermore, outcome data will be collected at 1, 12, and 24 months to explore the longitudinal impact of the program. In addition, quantitative data related to implementation outcomes and patient usage patterns of the telemonitoring system will be reported. The qualitative component involves an embedded single case study design to identify the contextual factors that influenced the implementation. The implementation evaluation will be completed using semistructured interviews with clinicians, and other program staff at baseline, 4 months, and 12 months after the program start date. Interviews conducted with patients will be triangulated with usage data to explain usage patterns and adherence to the system. The telemonitoring program was launched in August 2016 and patient enrollment is ongoing. The methods described provide an example for conducting comprehensive evaluations of telemonitoring programs. The combination of impact, implementation, and cost evaluations will inform the quality improvement of the existing program and will yield insights into the sustainability of smartphone-based telemonitoring programs for patients with heart failure within a specialty care setting. ©Patrick Ware, Heather J Ross, Joseph A Cafazzo, Audrey Laporte, Emily Seto. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 03.05.2018.

Implementation and Evaluation of a Smartphone-Based Telemonitoring Program for Patients With Heart Failure: Mixed-Methods Study Protocol

PubMed Central

Ross, Heather J; Cafazzo, Joseph A; Laporte, Audrey; Seto, Emily

2018-01-01

Background Meta-analyses of telemonitoring for patients with heart failure conclude that it can lower the utilization of health services and improve health outcomes compared with the standard of care. A smartphone-based telemonitoring program is being implemented as part of the standard of care at a specialty care clinic for patients with heart failure in Toronto, Canada. Objective The objectives of this study are to (1) evaluate the impact of the telemonitoring program on health service utilization, patient health outcomes, and their ability to self-care; (2) identify the contextual barriers and facilitators of implementation at the physician, clinic, and institutional level; (3) describe patient usage patterns to determine adherence and other behaviors in the telemonitoring program; and (4) evaluate the costs associated with implementation of the telemonitoring program from the perspective of the health care system (ie, public payer), hospital, and patient. Methods The evaluation will use a mixed-methods approach. The quantitative component will include a pragmatic pre- and posttest study design for the impact and cost analyses, which will make use of clinical data and questionnaires administered to at least 108 patients at baseline and 6 months. Furthermore, outcome data will be collected at 1, 12, and 24 months to explore the longitudinal impact of the program. In addition, quantitative data related to implementation outcomes and patient usage patterns of the telemonitoring system will be reported. The qualitative component involves an embedded single case study design to identify the contextual factors that influenced the implementation. The implementation evaluation will be completed using semistructured interviews with clinicians, and other program staff at baseline, 4 months, and 12 months after the program start date. Interviews conducted with patients will be triangulated with usage data to explain usage patterns and adherence to the system. Results The telemonitoring program was launched in August 2016 and patient enrollment is ongoing. Conclusions The methods described provide an example for conducting comprehensive evaluations of telemonitoring programs. The combination of impact, implementation, and cost evaluations will inform the quality improvement of the existing program and will yield insights into the sustainability of smartphone-based telemonitoring programs for patients with heart failure within a specialty care setting. PMID:29724704

Strengthening Capstone Skills in STEM Programs

ERIC Educational Resources Information Center

Eppes, Tom A.; Milanovic, Ivana; Sweitzer, H. Fredrick

2012-01-01

In this article we describe a curricular strategy that improves the full range of skillsets critical to capstone success. Improved Capstone (ICap) was developed and implemented across the thermo-fluids topical area in the undergraduate Mechanical Engineering Technology Program at the University of Hartford. ICap experiential courses sequentially…

Praises & Nudges: A Case of District-Wide Change.

ERIC Educational Resources Information Center

Doyle, Richard; And Others

This paper describes the processes and outcomes experienced by the Marshalltown Community School District (Iowa) as it implemented a shared decision-making, school-improvement program. A district Shared Decision Making (SDM) Team and School Improvement Program (SIP) teams were trained to facilitate greater staff participation in the…

Individualization and quality improvement: two new scales to complement measurement of program fidelity.

PubMed

Bond, Gary R; Drake, Robert E; Rapp, Charles A; McHugo, Gregory J; Xie, Haiyi

2009-09-01

Fidelity scales have been widely used to assess program adherence to the principles of an evidence-based practice, but they do not measure important aspects of quality of care. Pragmatic scales measuring clinical quality of services are needed to complement fidelity scales measuring structural aspects of program implementation. As part of the instrumentation developed for the National Implementing Evidence-Based Practices Project, we piloted a new instrument with two 5-item quality scales, Individualization (a client-level quality scale) and Quality Improvement (an organizational-level quality scale). Pairs of independent fidelity assessors conducted fidelity reviews in 49 sites in 8 states at baseline and at four subsequent 6-month intervals over a 2-year follow-up period. The assessors followed a standardized protocol to administer these quality scales during daylong site visits; during these same visits they assessed programs on fidelity to the evidence-based practice that the site was seeking to implement. Assessors achieved acceptable interrater reliability for both Individualization and Quality Improvement. Principal components factor analysis confirmed the 2-scale structure. The two scales were modestly correlated with each other and with the evidence-based practice fidelity scales. Over the first year, Individualization and Quality Improvement improved, but showed little or no improvement during the last year of follow-up. The two newly developed scales showed adequate psychometric properties in this preliminary study, but further research is needed to assess their validity and utility in routine clinical practice.

Change Management Model for Implementing an Effective First-Year Experience Program in the Community College Setting

ERIC Educational Resources Information Center

Tucker, Joy C.

2015-01-01

This study provides evidence that systematic management of change can facilitate the implementation of first-year experience programming that leads to improved results in retention and student success for community college students. The study includes four major themes: (a) first-year experience, (b) change management, (c) change leadership, and…

Evaluation in the Seventies: What We Have Learned About Program Development and Implementation.

ERIC Educational Resources Information Center

Holley, Freda M.

This paper, generated by the Austin, Texas, Independent School District's Office of Research and Evaluation, offers a set of working hypotheses about what a school district must do in the implementation of programs to improve the cost/effectiveness ratio of educational innovations. The author draws on three years of the Austin school district's…

Implementation of a Learning Assistant Program Improves Student Performance on Higher-Order Assessments

ERIC Educational Resources Information Center

Sellami, Nadia; Shaked, Shanna; Laski, Frank A.; Eagan, Kevin M.; Sanders, Erin R.

2017-01-01

Learning assistant (LA) programs have been implemented at a range of institutions, usually as part of a comprehensive curricular transformation accompanied by a pedagogical switch to active learning. While this shift in pedagogy has led to increased student learning gains, the positive effect of LAs has not yet been distinguished from that of…

The Effects of an Orientation Program on Quality of Life of Patients with Thalassemia: a Quasi-Experimental Study.

PubMed

Rafii, Zahra; Ahmadi, Fazlollah; Nourbakhsh, Sayed Mohamad Kazem; Hajizadeh, Ebrahim

2016-09-01

Introduction: Medical advances have improved life expectancy and survival of patients with thalassemia. However, as getting older, patients with thalassemia experience different complications which impair their quality of life. The aim of this study was to examine the effects of a nurse-implemented orientation program on quality of life in patients with thalassemia. Methods: A convenience sample of 55 patients with thalassemia were recruited in this quasi-experimental study. Patients were randomly allocated to control or experimental groups. A demographic questionnaire, Thalassemia quality of life questionnaire, and 36-item short form health survey were used for data collection before and one month after the intervention. In the intervention group, 1.5-month orientation program including of the three steps of inauguration, implementation, and closure was implemented, while the control group received routine care. The Chi-square, independent t-test and paired-samples t-test were used for data analysis by using SPSS ver.13 software. Results: The intervention and control group did not differ significantly from each other regarding demographic characteristics. Moreover, no significant difference was observed between the two groups regarding the quality of life scores after the implementation of orientation program. Conclusion: Implementing a short-term orientation program was not effective in enhancing the quality of life in patients with thalassemia; hence, developing long-term multimodal strategies may result in better improvement.

Development and Implementation of Worksite Health and Wellness Programs: A Focus on Non-Communicable Disease.

PubMed

Cahalin, Lawrence P; Kaminsky, Leonard; Lavie, Carl J; Briggs, Paige; Cahalin, Brendan L; Myers, Jonathan; Forman, Daniel E; Patel, Mahesh J; Pinkstaff, Sherry O; Arena, Ross

2015-01-01

The development and implementation of worksite health and wellness programs (WHWPs) in the United States (US) hold promise as a means to improve population health and reverse current trends in non-communicable disease incidence and prevalence. However, WHWPs face organizational, economic, systematic, legal, and logistical challenges which have combined to impact program availability and expansion. Even so, there is a burgeoning body of evidence indicating WHWPs can significantly improve the health profile of participating employees in a cost effective manner. This foundation of scientific knowledge justifies further research inquiry to elucidate optimal WHWP models. It is clear that the development, implementation and operation of WHWPs require a strong commitment from organizational leadership, a pervasive culture of health and availability of necessary resources and infrastructure. Since organizations vary significantly, there is a need to have flexibility in creating a customized, effective health and wellness program. Furthermore, several key legal issues must be addressed to facilitate employer and employee needs and responsibilities; the US Affordable Care Act will play a major role moving forward. The purposes of this review are to: 1) examine currently available health and wellness program models and considerations for the future; 2) highlight key legal issues associated with WHWP development and implementation; and 3) identify challenges and solutions for the development and implementation of as well as adherence to WHWPs. Copyright © 2015 Elsevier Inc. All rights reserved.

Implementation of herd health program to improve survival of Boer goats in Malaysia.

PubMed

Salisi, Mohd Shahrom; Saad, Mohd Zamri; Kasim, Azhar

2012-02-01

A Boer goat breeding farm with 800 heads of breeder females, 50 breeder males, and 400 growing goats of various ages in Sabah, Malaysia was selected to study the effect of implementing herd health program. This included vaccination program against pneumonic mannheimiosis; fecal monitoring for helminthiasis, coccidiosis, and colibacillosis; and introduction of modified feeding regime comprised of day-time grazing and feeding of cut grass and supplemented feed. The herd health program was implemented in September 2007 and the impact was observed on body weight gains, body scoring, and annual mortality among adults and kids. It was found that implementation of herd health program significantly (p < 0.05) increased the average body weight gains in both adults and kids from 1.8 g per kid and 0.6 g per adult in 2006 to 3.7 g per kid and 2.2 g per adult in 2008. The percentage of adults with body scoring of <3 was significantly (p < 0.05) reduced from 82.3% in 2006 to 77.6% in 2007 and 4% in 2008. Similarly, the annual mortality rate was significantly (p < 0.05) reduced from 6.5% among kids and 58.2% among adults in 2006 to 12.1% among kids and 10.4% among adults in 2007, and to 9.1% among kids and 1.1% among adults in 2008. Therefore, it was concluded that implementation of herd health program significantly improved the survival and performance of goats.

ASE Program Certification Standards for Automobile Technician Training Programs.

ERIC Educational Resources Information Center

National Automotive Technicians Education Foundation, Herndon, VA.

This document presents and explains the development and application of the National Institute for Automotive Service Excellence (ASE) program certification standards that were developed to improve the quality of secondary- and postsecondary-level automobile technician training by implementing a certification program that certifies programs in…

Pilot Implementation of the Improving Children's Health through Farming, Food, and Fitness Program in Select California Schools

ERIC Educational Resources Information Center

Heneman, Karrie; Junge, Sharon K.; Schneider, Connie; Zidenberg-Cherr, Sheri

2008-01-01

Objectives: The purpose of this pilot project was to evaluate the effect of the Improving Children's Health through Farming, Food, and Fitness Program (CHF3) on the dietary knowledge and habits of participating children. Methods: The CHF3 program aims to 1) establish salad bars and integrate nutrition messages into cafeteria activities; 2) develop…

Involvement of Higher Education in Building Human Resources Character in the Era of Globalization

ERIC Educational Resources Information Center

Ishomuddin

2015-01-01

In general, the objectives of this study were to explain the role played by universities in improving its human resources are office holders, lecturers, and students, explain the program what is being done related to the improvement of human resources, and explains the non-academic program to support the implementation of a program that has been…

Peer-Mediated Multimodal Intervention Program for the Treatment of Children with ADHD in India: One-Year Followup

PubMed Central

Mehta, Sagar; Shah, Devesh; Shah, Kushal; Mehta, Sanjiv; Mehta, Neelam; Mehta, Vivek; Mehta, Vijay; Mehta, Vaishali; Motiwala, Smita; Mehta, Naina; Mehta, Devendra

2012-01-01

The objective was to assess the efficacy of a one-year, peer-mediated interventional program consisting of yoga, meditation and play therapy maintained by student volunteers in a school in India. The population consisted of 69 students between the ages of 6 and 11 years, previously identified as having attention deficit hyperactivity disorder (ADHD). A program, known as Climb-Up, was initially embedded in the school twice weekly. Local high school student volunteers were then trained to continue to implement the program weekly over the period of one year. Improvements in ADHD symptoms and academic performance were assessed using Vanderbilt questionnaires completed by both parents and teachers. The performance impairment scores for ADHD students assessed by teachers improved by 6 weeks and were sustained through 12 months in 46 (85%) of the enrolled students. The improvements in their Vanderbilt scores assessed by parents were also seen in 92% (P < 0.0001, Wilcoxon). The Climb-Up program resulted in remarkable improvements in the students' school performances that were sustained throughout the year. These results show promise for a cost-effective program that could easily be implemented in any school. PMID:23316384

Improving glycemic control with the adjunct use of a data management software program.

PubMed

Reed, Charles C; Richa, Jacqueline M; Berndt, Andrea E; Beadle, Randy D; Gerhardt, Susan D; Stewart, Ronald; Corneille, Michael

2012-01-01

Published studies have supported the implementation of tight glucose control (TGC) programs to improve patient outcomes and reduce mortality rates. However, measuring a program's efficiency is challenging, because of a lack of systems that capture data, allow access to data, and support analysis and interpretation in a near prospective time frame. We hypothesized that providing clinicians access to real-time blood glucose (BG) results reports could improve the efficacy of our TGC program. We performed a retrospective review of BG data during a 12-month period in a surgical trauma intensive care unit at a level I trauma center. A unit-specific insulin algorithm was used throughout the study. We compared BG values before and after the implementation of a data management software program that allowed clinicians access to real-time BG results reports. Reports were run daily and weekly to monitor the unit's TGC program. A total of 70 616 BG values from 1044 patients were analyzed. An overall decrease was observed in the BG level mean, from 121 mg/dL to 112 mg/dL (P < .001), as well as a decrease in the aggregated mean across patients, from 132 mg/dL to 119 mg/dL (P < .001), after implementation of the software. The percentage of values within the target range of 80 to 110 mg/dL increased from 38.9% to 50.4% (P < .001). The percentage of BG values less than 70 increased from 2.7% to 3.4% (P < .001). However, the percentage of severe hypoglyce-mic episodes (≤ 40 mg/dL) remained unchanged. Access to real-time aggregated BG data reports through the use of a data management software program improved the efficacy of our TGC program.

Implementing Cognitive Remediation Programs in France: The "Secret Sauce".

PubMed

Amado, Isabelle; Sederer, Lloyd I

2016-07-01

Cognitive remediation (CR) is a psychosocial therapy that seeks to restore patients' cognitive abilities by providing strategies to improve functioning in cognitive domains and helping them transfer acquired capabilities to everyday life. Since 2008, CR programs have been introduced in several regional health ministry areas in France. This column describes that implementation initiative, which includes creation of a network of the most active CR programs to conduct multicenter trials; establishment of a university degree in CR, awarded after completion of a one-year clinical training program; and implementation activities of regional health agencies. The authors describe three core elements of a "secret sauce"-a common language, timing, and leadership-that has helped ensure the success of the implementation efforts and that may be useful in other countries.

From Programs to Systems: Deploying Implementation Science and Practice for Sustained Real World Effectiveness in Services for Children and Families.

PubMed

Ghate, Deborah

2016-01-01

The transfer of knowledge of effective practice, especially into "usual care" settings, remains challenging. This article argues that to close this gap we need to recognize the particular challenges of whole-system improvement. We need to move beyond a limited focus on individual programs and experimental research on their effectiveness. The rapidly developing field of implementation science and practice (ISP) provides a particular lens and a set of important constructs that can helpfully accelerate progress. A review of selected key constructs and distinctive features of ISP, including recognizing invisible system infrastructure, co-construction involving active collaboration between stakeholders, and attention to active implementation, supports for providers beyond education and training. Key aspects of an implementation lens likely to be most helpful in sustaining effectiveness include assisting innovators to identify and accommodate the architecture of existing systems, understand the implementation process as a series of distinct but nonlinear stages, identify implementation outcomes as prerequisites for treatment outcomes, and analyse implementation challenges using frameworks of implementation drivers. In complex adaptive systems, how services are implemented may matter more than their specific content, and how services align and adapt to local context may determine their sustained usefulness. To improve implementation-relevant research, we need better process evaluation and cannot rely on experimental methods that do not capture complex systemic contexts. Deployment of an implementation lens may perhaps help to avoid future "rigor mortis," enabling more productively flexible and integrative approaches to both program design and evaluation.

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries.

PubMed

Leyvraz, Magali; Aaron, Grant J; Poonawala, Alia; van Liere, Marti J; Schofield, Dominic; Myatt, Mark; Neufeld, Lynnette M

2017-05-01

Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d'Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap.

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries123

PubMed Central

Aaron, Grant J; Poonawala, Alia; van Liere, Marti J; Schofield, Dominic; Myatt, Mark

2017-01-01

Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d’Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap. PMID:28404839

Optimizing Implementation of Obesity Prevention Programs: A Qualitative Investigation Within a Large-Scale Randomized Controlled Trial.

PubMed

Kozica, Samantha L; Teede, Helena J; Harrison, Cheryce L; Klein, Ruth; Lombard, Catherine B

2016-01-01

The prevalence of obesity in rural and remote areas is elevated in comparison to urban populations, highlighting the need for interventions targeting obesity prevention in these settings. Implementing evidence-based obesity prevention programs is challenging. This study aimed to investigate factors influencing the implementation of obesity prevention programs, including adoption, program delivery, community uptake, and continuation, specifically within rural settings. Nested within a large-scale randomized controlled trial, a qualitative exploratory approach was adopted, with purposive sampling techniques utilized, to recruit stakeholders from 41 small rural towns in Australia. In-depth semistructured interviews were conducted with clinical health professionals, health service managers, and local government employees. Open coding was completed independently by 2 investigators and thematic analysis undertaken. In-depth interviews revealed that obesity prevention programs were valued by the rural workforce. Program implementation is influenced by interrelated factors across: (1) contextual factors and (2) organizational capacity. Key recommendations to manage the challenges of implementing evidence-based programs focused on reducing program delivery costs, aided by the provision of a suite of implementation and evaluation resources. Informing the scale-up of future prevention programs, stakeholders highlighted the need to build local rural capacity through developing supportive university partnerships, generating local program ownership and promoting active feedback to all program partners. We demonstrate that the rural workforce places a high value on obesity prevention programs. Our results inform the future scale-up of obesity prevention programs, providing an improved understanding of strategies to optimize implementation of evidence-based prevention programs. © 2015 National Rural Health Association.

Re-evaluation of Montana's air quality program.

DOT National Transportation Integrated Search

2013-08-01

This project examined the Montana DOTs current methods for determining projects for the Montana Air and Congestion Initiative (MACI) program, and made recommendations to improve and implement this program. A major project objective was to keep the...

The effectiveness of state-level tobacco control interventions: a review of program implementation and behavioral outcomes.

PubMed

Siegel, Michael

2002-01-01

In 2001, nearly one billion dollars will be spent on statewide tobacco control programs, including those in California, Massachusetts, Arizona, and Oregon, funded by cigarette tax revenues, and the program in Florida, funded by the state's settlement with the tobacco industry. With such large expenditures, it is imperative to find out whether these programs are working. This paper reviews the effectiveness of the statewide tobacco control programs in California, Massachusetts, Arizona, Oregon, and Florida. It focuses on two aspects of process evaluation--the funding and implementation of the programs and the tobacco industry's response, and four elements of outcome evaluation--the programs' effects on cigarette consumption, adult and youth smoking prevalence, and protection of the public from secondhand smoke. The paper formulates general lessons learned from these existing programs and generates recommendations to improve and inform the development and implementation of these and future programs.

Challenges and Opportunities for Developing and Implementing Incentives to Improve Health-Related Behaviors in Older Adults

PubMed Central

Klein, Eran; Karlawish, Jason

2010-01-01

There is growing interest in using patient-directed incentives to change health-related behaviors. Advocates of incentive programs have proposed an ambitious research agenda for moving patient incentive programs forward. Older adults may pose a challenge to such a research agenda. The cognitive and psychological features of this population, in particular, age-related changes in emotional regulation, executive function and cognitive capacities, and a preference for collaborative decision-making raise questions about the suitability of these programs, particularly the structure of current financial incentives, to older adults. Differences in decision-making in older adults need to be accounted for in the design and implementation of financial incentive programs. Financial incentive programs tailored to characteristics of older adult populations may be more likely to improve the lives of older persons and the economic success of programs that serve them. PMID:20863335

A theory-informed approach to mental health care capacity building for pharmacists.

PubMed

Murphy, Andrea L; Gardner, David M; Kutcher, Stan P; Martin-Misener, Ruth

2014-01-01

Pharmacists are knowledgeable, accessible health care professionals who can provide services that improve outcomes in mental health care. Various challenges and opportunities can exist in pharmacy practice to hinder or support pharmacists' efforts. We used a theory-informed approach to development and implementation of a capacity-building program to enhance pharmacists' roles in mental health care. Theories and frameworks including the Consolidated Framework for Implementation Research, the Theoretical Domains Framework, and the Behaviour Change Wheel were used to inform the conceptualization, development, and implementation of a capacity-building program to enhance pharmacists' roles in mental health care. The More Than Meds program was developed and implemented through an iterative process. The main program components included: an education and training day; use of a train-the-trainer approach from partnerships with pharmacists and people with lived experience of mental illness; development of a community of practice through email communications, a website, and a newsletter; and use of educational outreach delivered by pharmacists. Theories and frameworks used throughout the program's development and implementation facilitated a means to conceptualize the component parts of the program as well as its overall presence as a whole from inception through evolution in implementation. Using theoretical foundations for the program enabled critical consideration and understanding of issues related to trialability and adaptability of the program. Theory was essential to the underlying development and implementation of a capacity-building program for enhancing services by pharmacists for people with lived experience of mental illness. Lessons learned from the development and implementation of this program are informing current research and evolution of the program.

Data warehousing in disease management programs.

PubMed

Ramick, D C

2001-01-01

Disease management programs offer the benefits of lower disease occurrence, improved patient care, and lower healthcare costs. In such programs, the key mechanism used to identify individuals at risk for targeted diseases is the data warehouse. This article surveys recent warehousing techniques from HMOs to map out critical issues relating to the preparation, design, and implementation of a successful data warehouse. Discussions of scope, data cleansing, and storage management are included in depicting warehouse preparation and design; data implementation options are contrasted. Examples are provided of data warehouse execution in disease management programs that identify members with preexisting illnesses, as well as those exhibiting high-risk conditions. The proper deployment of successful data warehouses in disease management programs benefits both the organization and the member. Organizations benefit from decreased medical costs; members benefit through an improved quality of life through disease-specific care.

Improved Equivalent Linearization Implementations Using Nonlinear Stiffness Evaluation

NASA Technical Reports Server (NTRS)

Rizzi, Stephen A.; Muravyov, Alexander A.

2001-01-01

This report documents two new implementations of equivalent linearization for solving geometrically nonlinear random vibration problems of complicated structures. The implementations are given the acronym ELSTEP, for "Equivalent Linearization using a STiffness Evaluation Procedure." Both implementations of ELSTEP are fundamentally the same in that they use a novel nonlinear stiffness evaluation procedure to numerically compute otherwise inaccessible nonlinear stiffness terms from commercial finite element programs. The commercial finite element program MSC/NASTRAN (NASTRAN) was chosen as the core of ELSTEP. The FORTRAN implementation calculates the nonlinear stiffness terms and performs the equivalent linearization analysis outside of NASTRAN. The Direct Matrix Abstraction Program (DMAP) implementation performs these operations within NASTRAN. Both provide nearly identical results. Within each implementation, two error minimization approaches for the equivalent linearization procedure are available - force and strain energy error minimization. Sample results for a simply supported rectangular plate are included to illustrate the analysis procedure.

Training Employers to Implement Health Promotion Programs: Results From the CDC Work@Health® Program.

PubMed

Cluff, Laurie A; Lang, Jason E; Rineer, Jennifer R; Jones-Jack, Nkenge H; Strazza, Karen M

2018-05-01

Centers for Disease Control and Prevention (CDC) initiated the Work@Health Program to teach employers how to improve worker health using evidence-based strategies. Program goals included (1) determining the best way(s) to deliver employer training, (2) increasing employers' knowledge of workplace health promotion (WHP), and (3) increasing the number of evidence-based WHP interventions at employers' worksites. This study is one of the few to examine the effectiveness of a program designed to train employers how to implement WHP programs. Pre- and posttest design. Training via 1 of 3 formats hands-on, online, or blended. Two hundred six individual participants from 173 employers of all sizes. Eight-module training curriculum to guide participants through building an evidence-based WHP program, followed by 6 to 10 months of technical assistance. The CDC Worksite Health ScoreCard and knowledge, attitudes, and behavior survey. Descriptive statistics, paired t tests, and mixed linear models. Participants' posttraining mean knowledge scores were significantly greater than the pretraining scores (61.1 vs 53.2, P < .001). A year after training, employers had significantly increased the number of evidence-based interventions in place (47.7 vs 35.5, P < .001). Employers' improvements did not significantly differ among the 3 training delivery formats. The Work@Health Program provided employers with knowledge to implement WHP interventions. The training and technical assistance provided structure, practical guidance, and tools to assess needs and select, implement, and evaluate interventions.

The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model.

PubMed

Berkel, Cady; Mauricio, Anne M; Sandler, Irwin N; Wolchik, Sharlene A; Gallo, Carlos G; Brown, C Hendricks

2017-12-14

This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents' competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.

Instructional Improvement in Maryland: Impact on Educators and Students.

ERIC Educational Resources Information Center

Roberts, Jane M. E.; Kenney, Jane L.

The impact of the School Improvement Through Instructional Process (SITIP) program in Maryland schools was evaluated. The program encourages application of research on planned change to implement one or more of four instructional models: (1) Active Teaching--emphasis on direct instruction, review and discussion of homework, individually supervised…

Inviting the "Outsiders" In: Local Efforts to Improve Adjunct Working Conditions

ERIC Educational Resources Information Center

Schreyer, Jessica

2012-01-01

An adjunct turned writing program administrator reflects on her professional journey and describes efforts to improve the teaching environment amongst composition faculty--primarily part-time--within her department. Based on a local program review, a pilot faculty relations plan was implemented that addressed two major areas: offering more…

The Evolution of Improved Baghouse Filter Media as Observed in the Environmental Technology Verification Program

EPA Science Inventory

The U.S. EPA implemented the Environmental Technology Verification (ETV) program in 1995 to generate independent and credible data on the performance of innovative technologies that have the potential to improve protection of public health and the environment. Results are publicl...

Profiles of Change: Lessons for Improving High School Physical Education

ERIC Educational Resources Information Center

Doolittle, Sarah

2014-01-01

This feature has told stories of high school physical educators who have refused to accept the status quo of high school physical education programs. They have identified problems, initiated innovations in their own classes, implemented changes beyond their classes, and moved toward institutionalizing improvements throughout their programs and…

Web-Based Certification Courses: The Future of Teacher Preparation in Special Education?

ERIC Educational Resources Information Center

Sun, Ling; Bender, William N.; Fore, Cecil, III

2003-01-01

This article describes development and implementation of the Western Carolina University Teacher Support Program, a multi-component Web-based special education teacher development course. The program is intended to reduce stress and burnout, improve retention, develop problem solving strategies, and improve the effectiveness of teachers.…

Multilevel Design of School Effectiveness Studies in Sub-Saharan Africa

ERIC Educational Resources Information Center

Kelcey, Ben; Shen, Zuchao

2016-01-01

School-based improvement programs represent a core strategy in improving education because they can leverage pre-existing social and organizational structures to promote coordinated and comprehensive change across multiple facets of schooling. School-based programs are generally designed to be implemented by intact schools/districts, frequently…

75 FR 43510 - Office of Innovation and Improvement; Overview Information; Charter Schools Program (CSP) Grants...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-26

... Schools Program (CSP) Grants to Non-State Educational Agencies for Planning, Program Design, and..., program design, and implementation, and non-SEA grants for dissemination provide funds for these purposes.... Non-SEA eligible applicants that propose to use grant funds for planning, program design, and...

9 CFR 149.9 - Pilot program sites.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Pilot program sites. 149.9 Section 149... LIVESTOCK IMPROVEMENT VOLUNTARY TRICHINAE CERTIFICATION PROGRAM § 149.9 Pilot program sites. Pork production sites participating in an APHIS-approved trichinae pilot program at the time of implementation of the...

9 CFR 149.9 - Pilot program sites.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Pilot program sites. 149.9 Section 149... LIVESTOCK IMPROVEMENT VOLUNTARY TRICHINAE CERTIFICATION PROGRAM § 149.9 Pilot program sites. Pork production sites participating in an APHIS-approved trichinae pilot program at the time of implementation of the...

Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives.

PubMed

Byron, Gerard; Ziedonis, Douglas M; McGrath, Caroline; Frazier, Jean A; deTorrijos, Fernando; Fulwiler, Carl

2015-08-01

Occupational stress and burnout adversely impacts mental health care staff well-being and patient outcomes. Mindfulness training reduces staff stress and may improve patient care. However, few studies explore mental health setting implementation. This qualitative study used focus groups to evaluate stakeholders' perceptions of organizational factors affecting implementation of an adapted version of Mindfulness-Based Stress Reduction (MBSR) for staff on adolescent mental health units. Common facilitators included leadership securing buy-in with staff, allocating staff time to participate, and quiet space for training and practice. Other facilitators were past staff knowledge of mindfulness, local champions, and acculturating staff with mindfulness through a non-mandatory training attendance policy. Common barriers were limited staff time to attend training sessions and insufficient training coverage for some staff. Staff also reported improved focus when interacting with adolescents and improved social cohesion on the units. We conclude that a mindfulness-based program for reducing occupational stress can be successfully implemented on adolescent mental health units. Implementation appeared to change the social context of the units, including staff and patient interactions. More broadly, our findings highlight the importance of environmental factors in shaping attitudes, diffusion of innovation, and acculturation of wellness program implementations.

Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives

PubMed Central

Byron, Gerard; Ziedonis, Douglas M.; McGrath, Caroline; Frazier, Jean A.; deTorrijos, Fernando

2014-01-01

Occupational stress and burnout adversely impacts mental health care staff well-being and patient outcomes. Mindfulness training reduces staff stress and may improve patient care. However, few studies explore mental health setting implementation. This qualitative study used focus groups to evaluate stakeholders’ perceptions of organizational factors affecting implementation of an adapted version of Mindfulness-Based Stress Reduction (MBSR) for staff on adolescent mental health units. Common facilitators included leadership securing buy-in with staff, allocating staff time to participate, and quiet space for training and practice. Other facilitators were past staff knowledge of mindfulness, local champions, and acculturating staff with mindfulness through a non-mandatory training attendance policy. Common barriers were limited staff time to attend training sessions and insufficient training coverage for some staff. Staff also reported improved focus when interacting with adolescents and improved social cohesion on the units. We conclude that a mindfulness-based program for reducing occupational stress can be successfully implemented on adolescent mental health units. Implementation appeared to change the social context of the units, including staff and patient interactions. More broadly, our findings highlight the importance of environmental factors in shaping attitudes, diffusion of innovation, and acculturation of wellness program implementations. PMID:26500708

Role of a center of excellence program in improving the quality of peritoneal dialysis--a Chinese experience.

PubMed

Yao, Qiang; Zhou, George

2014-06-01

Improving the quality of peritoneal dialysis (PD) in areas with a rapid increase in PD patient numbers constitutes the most significant PD challenge in China. Here, we share our experience of implementing a quality improvement program in 8 PD centers, with guidance from matched experienced centers. Copyright © 2014 International Society for Peritoneal Dialysis.

The Productive Ward Program™: A Two-Year Implementation Impact Review Using a Longitudinal Multilevel Study.

PubMed

Van Bogaert, Peter; Van Heusden, Danny; Verspuy, Martijn; Wouters, Kristien; Slootmans, Stijn; Van der Straeten, Johnny; Van Aken, Paul; White, Mark

2017-03-01

Aim To investigate the impact of the quality improvement program "Productive Ward - Releasing Time to Care™" using nurses' and midwives' reports of practice environment, burnout, quality of care, job outcomes, as well as workload, decision latitude, social capital, and engagement. Background Despite the requirement for health systems to improve quality and the proliferation of quality improvement programs designed for healthcare, the empirical evidence supporting large-scale quality improvement programs impacting patient satisfaction, staff engagement, and quality care remains sparse. Method A longitudinal study was performed in a large 600-bed acute care university hospital at two measurement intervals for nurse practice environment, burnout, and quality of care and job outcomes and three measurement intervals for workload, decision latitude, social capital, and engagement between June 2011 and November 2014. Results Positive results were identified in practice environment, decision latitude, and social capital. Less favorable results were identified in relation to perceived workload, emotional exhaustion. and vigor. Moreover, measures of quality of care and job satisfaction were reported less favorably. Conclusion This study highlights the need to further understand how to implement large-scale quality improvement programs so that they integrate with daily practices and promote "quality improvement" as "business as usual."

A quality improvement approach to capacity building in low- and middle-income countries.

PubMed

Bardfield, Joshua; Agins, Bruce; Akiyama, Matthew; Basenero, Apollo; Luphala, Patience; Kaindjee-Tjituka, Francina; Natanael, Salomo; Hamunime, Ndapewa

2015-07-01

To describe the HEALTHQUAL framework consisting of the following three components: performance measurement, quality improvement and the quality management program, representing an adaptive approach to building capacity in national quality management programs in low and middle-income countries. We present a case study from Namibia illustrating how this approach is adapted to country context. HEALTHQUAL partners with Ministries of Health to build knowledge and expertise in modern improvement methods, including data collection, analysis and reporting, process analysis and the use of data to implement quality improvement projects that aim to improve systems and processes of care. Clinical performance measures are selected in each country by the Ministry of Health on the basis of national guidelines. Patient records are sampled using a standardized statistical table to achieve a minimum confidence interval of 90%, with a spread of ±8% in participating facilities. Data are routinely reviewed to identify gaps in patient care, and aggregated to produce facility mean scores that are trended over time. A formal organizational assessment is conducted at facility and national levels to review the implementation progress. Aggregate mean rates of performance for 10 of 11 indicators of HIV care improved for adult HIV-positive patients between 2008 and 2013. Quality improvement is an approach to capacity building and health systems strengthening that offers adaptive methodology. Synergistic implementation of elements of a national quality program can lead to improvements in care, in parallel with systematic capacity development for measurement, improvement and quality management throughout the healthcare delivery system.

[Pay for performance (P4P). Long-term effects and perspectives].

PubMed

Schrappe, M; Gültekin, N

2011-02-01

After 10 years of experience and research, a wide array of results on evaluation and long-term effects of pay for performance (P4P) programs have been published. These data do not only give insight into most of the problems of implementation, but also into aspects which, in part, may attenuate the high expectations at the beginning of the discussion. P4P programs exhibit a ceiling effect, some improvements are reversed after incentives are cancelled, and improvements show opportunity costs as absent improvements for indicators, which are not object to financial incentives (in some cases for the same disease). These observations can be explained by the hypothesis that P4P programs have characteristics of fee-for-service reimbursement, if symmetric information is available for insurance and provider. P4P programs are local instruments. While integration of healthcare is considered as an important issue, they should be combined with programs and incentives which foster further vertical and horizontal integration. For Germany, further research in the implementation and effects of P4P programs is necessary.

Applying the RE-AIM Framework to Evaluate Integrative Medicine Group Visits Among Diverse Women with Chronic Pelvic Pain.

PubMed

Chao, Maria T; Abercrombie, Priscilla D; Santana, Trilce; Duncan, Larissa G

2015-12-01

The purpose of this study was to evaluate group medical visits using an integrative health approach for underserved women with chronic pelvic pain (CPP). We implemented an integrative medicine program to improve quality of life among women with CPP using Centering, a group-based model that combines healthcare assessment, education, and social support. Patients were from university-affiliated and public hospital-affiliated clinics. We evaluated the program with qualitative and quantitative data to address components of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Participants of the Centering CPP Program participants (n = 26) were demographically similar to a sample of women with CPP who sought care at Bay Area hospitals (n = 701). Participants were on average 40 years of age, a majority of whom were racial/ethnic minorities with low household income (76%). Women who attended four or more sessions (n = 16) had improved health-related quality of life, including decreases in average number of unhealthy days in the past month (from 24 to 18, p < .05), depressive symptoms (from 11.7 to 9.0, p < .05), and symptom severity (from 4.2 to 3.1, p < .01). Sexual health outcomes also improved (30.5 to 50.3, p = .02). No improvements were observed for pain catastrophizing. Our pilot program provides preliminary data that an integrative health approach using a group-based model can be adapted and implemented to reach diverse women with CPP to improve physical and psychological well-being. Given these promising findings, rigorous evaluation of implementation and effectiveness of this approach compared with usual care is warranted. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study.

PubMed

Cantrell, Jennifer; Shelley, Donna

2009-12-17

Fax referral services that connect smokers to state quitlines have been implemented in 49 U.S. states and territories and promoted as a simple solution to improving smoker assistance in medical practice. This study is an in-depth examination of the systems-level changes needed to implement and sustain a fax referral program in primary care. The study involved implementation of a fax referral system paired with a chart stamp prompting providers to identify smoking patients, provide advice to quit and refer interested smokers to a state-based fax quitline. Three focus groups (n = 26) and eight key informant interviews were conducted with staff and physicians at two clinics after the intervention. We used the Chronic Care Model as a framework to analyze the data, examining how well the systems changes were implemented and the impact of these changes on care processes, and to develop recommendations for improvement. Physicians and staff described numerous benefits of the fax referral program for providers and patients but pointed out significant barriers to full implementation, including the time-consuming process of referring patients to the Quitline, substantial patient resistance, and limitations in information and care delivery systems for referring and tracking smokers. Respondents identified several strategies for improving integration, including simplification of the referral form, enhanced teamwork, formal assignment of responsibility for referrals, ongoing staff training and patient education. Improvements in Quitline feedback were needed to compensate for clinics' limited internal information systems for tracking smokers. Establishing sustainable linkages to quitline services in clinical sites requires knowledge of existing patterns of care and tailored organizational changes to ensure new systems are prioritized, easily integrated into current office routines, formally assigned to specific staff members, and supported by internal systems that ensure adequate tracking and follow up of smokers. Ongoing staff training and patient self-management techniques are also needed to ease the introduction of new programs and increase their acceptability to smokers.

Using distance technologies to facilitate a learning collaborative to implement stagewise treatment.

PubMed

Covell, Nancy H; Foster, Forrest P; Margolies, Paul J; Lopez, Luis O; Dixon, Lisa B

2015-06-01

This report describes experiences and outcomes of an online learning collaborative focused on implementation of stagewise treatment. Eleven participating programs convened online monthly for a year. Between meetings, program staff created an implementation plan and programs collected performance indicator data, including assessment of staff knowledge of integrated treatment for people with co-occurring disorders, whether a person's current stage of treatment was documented in his or her chart, and whether the treatments were appropriate for the stage of treatment. Descriptive statistics were used to characterize performance indicators and feedback. Wilcoxon matched-pairs signed-rank tests examined changes in performance indicators over time. Program staff generally demonstrated significant improvements in performance indicators over time and rated the distance learning collaborative favorably. Distance learning collaboratives can be structured to provide opportunities for program staff to interact and learn from one another and to implement and sustain changes.

Implementing a Mental Health Ministry Committee in Faith-Based Organizations: The Promoting Emotional Wellness and Spirituality Program

PubMed Central

Williams, Laverne; Gorman, Robyn; Hankerson, Sidney

2014-01-01

Social workers have successfully collaborated with African American faith-based organizations to improve health outcomes for numerous medical conditions. However, the literature on Faith-Based Health Promotion for major depression is sparse. Thus, the authors describe a program used to implement a Mental Health Ministry Committee in African American churches. Program goals are to educate clergy, reduce stigma, and promote treatment seeking for depression. Key lessons learned are to initially form partnerships with church staff if there is not a pre-existing relationship with the lead pastor, to utilize a community-based participatory approach, and to have flexibility in program implementation. PMID:24717187

Outcomes Assessment in Dental Hygiene Programs.

ERIC Educational Resources Information Center

Grimes, Ellen B.

1999-01-01

A survey of 22 dental-hygiene-program directors found that programs routinely and effectively assess student outcomes and use the information for program improvements and to demonstrate accountability. Both policy and faculty/administrative support were deemed important to implementation. Time constraints were a major barrier. Outcomes-assessment…

Implementation of sustainable evidence-based practice for the assessment and management of pain in residential aged care facilities.

PubMed

Savvas, Steven; Toye, Christine; Beattie, Elizabeth; Gibson, Stephen J

2014-12-01

Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Usability evaluation of user interface of thesis title review system

NASA Astrophysics Data System (ADS)

Tri, Y.; Erna, A.; Gellysa, U.

2018-03-01

Presentation of programs with user interface that can be accessed online through the website of course greatly provide user benefits. User can easily access the program they need. There are usability values that serve as a benchmark for the success of a user accessible program, ie efficiency, effectiveness, and convenience. These usability values also determine the development of the program for the better use. Therefore, on the review title thesis program that will be implemented in STT Dumai was measured usability evaluation. It aims to see which sides are not yet perfect and need to be improved to improve the performance and utilization of the program. Usability evaluation was measured by using smartPLS software. Database used was the result of respondent questionnaires that include questions about the experience when they used program. The result of a review of thesis title program implemented in STT Dumai has an efficiency value of 22.615, the effectiveness of 20.612, and satisfaction of 33.177.

Quality improvement program reduces perioperative dental injuries - A review of 64,718 anesthetic patients.

PubMed

Kuo, Yi-Wei; Lu, I-Cheng; Yang, Hui-Ying; Chiu, Shun-Li; Hsu, Hung-Te; Cheng, Kuang-I

2016-12-01

Perioperative dental injury (PDI) is a common adverse event associated with anesthesia that can easily lead to medicolegal litigation. A quality improvement program was conducted with the electronic, standardized dental chart to document dentition before anesthesia and dentist consultation when necessary. This study aimed to reduce PDIs through execution of a quality improvement program. We reviewed the 42-month interval anesthetic records of 64,718 patients who underwent anesthesia. A standardized electronic dental chart was designed to identify any dental prosthetics, fixed and removable dentures, and degree of loose teeth. The incidence of dental injuries associated with anesthesia was separated into three time periods: baseline, initiative (Phase I), and execution (Phase II). Primary outcome measurement was the incidence of PDIs related to anesthesia. The overall incidence of dental injury related to anesthesia was 0.059% (38/64,718 patients). During the baseline period, the dental injury rate was 0.108% (26/24,137 patients), and it decreased from 0.051% in the initiative period (10/19,711 patients) to 0.009% in the execution period (2/20,870 patients) during implementation of the quality improvement program. Most dental injuries were associated with laryngeal mask airway (42.1%) and laryngoscopy (28.9%). The most commonly involved teeth were the upper incisors. Dental injury incidence was significantly reduced and remained at low levels after implementation of the quality improvement program. We suggest the implementation of a standardized dental examination into the preoperative evaluation system adding pathologic teeth fixed or protected devices to minimize dental injury associated with anesthesia. Copyright © 2016. Published by Elsevier Taiwan LLC.

Use of Joint Commission International Standards to Evaluate and Improve Pediatric Oncology Nursing Care in Guatemala

PubMed Central

Day, Sara W.; McKeon, Leslie M.; Garcia, Jose; Wilimas, Judith A.; Carty, Rita M.; de Alarcon, Pedro; Antillon, Federico; Howard, Scott C.

2017-01-01

Background Inadequate nursing care is a major impediment to development of effective programs for treatment of childhood cancer in low-income countries. When the International Outreach Program at St. Jude Children’s Research Hospital established partner sites in low-income countries, few nurses had pediatric oncology skills or experience. A comprehensive nursing program was developed to promote the provision of quality nursing care, and in this manuscript we describe the program’s impact on 20 selected Joint Commission International (JCI) quality standards at the National Pediatric Oncology Unit in Guatemala. We utilized JCI standards to focus the nursing evaluation and implementation of improvements. These standards were developed to assess public hospitals in low-income countries and are recognized as the gold standard of international quality evaluation. Methods We compared the number of JCI standards met before and after the nursing program was implemented using direct observation of nursing care; review of medical records, policies, procedures, and job descriptions; and interviews with staff. Results In 2006, only 1 of the 20 standards was met fully, 2 partially, and 17 not met. In 2009, 16 were met fully, 1 partially, and 3 not met. Several factors contributed to the improvement. The pre-program quality evaluation provided objective and credible findings and an organizational framework for implementing change. The medical, administrative, and nursing staff worked together to improve nursing standards. Conclusion A systematic approach and involvement of all hospital disciplines led to significant improvement in nursing care that was reflected by fully meeting 16 of 20 standards. PMID:23015363

The Safer Delivery of Surgical Services Program (S3): Explaining Its Differential Effectiveness and Exploring Implications for Improving Quality in Complex Systems.

PubMed

Flynn, Lorna C; McCulloch, Peter G; Morgan, Lauren J; Robertson, Eleanor R; New, Steve J; Stedman, Francesca E; Martin, Graham P

2016-12-01

To analyze the challenges encountered during surgical quality improvement interventions, and explain the relative success of different intervention strategies. Understanding why and how interventions work is vital for developing improvement science. The S3 Program of studies tested whether combining interventions addressing culture and system was more likely to result in improvement than either approach alone. Quantitative results supported this theory. This qualitative study investigates why this happened, what aspects of the interventions and their implementation most affected improvement, and the implications for similar programs. Semistructured interviews were conducted with hospital staff (23) and research team members (11) involved in S3 studies. Analysis was based on the constant comparative method, with coding conducted concurrently with data collection. Themes were identified and developed in relation to the program theory behind S3. The superior performance of combined intervention over single intervention arms appeared related to greater awareness and ability to act, supporting the S3 hypothesis. However, we also noted unforeseen differences in implementation that seemed to amplify this difference. The greater ambition and more sophisticated approach in combined intervention arms resulted in requests for more intensive expert support, which seemed crucial in their success. The contextual challenges encountered have potential implications for the replicability and sustainability of the approach. Our findings support the S3 hypothesis, triangulating with quantitative results and providing an explanatory account of the causal relationship between interventions and outcomes. They also highlight the importance of implementation strategies, and of factors outside the control of program designers.

Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care.

PubMed

Sopcak, Nicolette; Aguilar, Carolina; O'Brien, Mary Ann; Nykiforuk, Candace; Aubrey-Bassler, Kris; Cullen, Richard; Grunfeld, Eva; Manca, Donna Patricia

2016-12-01

BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) is a patient-based intervention to improve chronic disease prevention and screening (CDPS) for cardiovascular disease, diabetes, cancer, and associated lifestyle factors in patients aged 40 to 65. The key component of BETTER is a prevention practitioner (PP), a health care professional with specialized skills in CDPS who meets with patients to develop a personalized prevention prescription, using the BETTER toolkit and Brief Action Planning. The purpose of this qualitative study was to understand facilitators and barriers of the implementation of the BETTER 2 program among clinicians, patients, and stakeholders in three (urban, rural, and remote) primary care settings in Newfoundland and Labrador, Canada. We collected and analyzed responses from 20 key informant interviews and 5 focus groups, as well as memos and field notes. Data were organized using Nvivo 10 software and coded using constant comparison methods. We then employed the Consolidated Framework for Implementation Research (CFIR) to focus our analysis on the domains most relevant for program implementation. The following key elements, within the five CFIR domains, were identified as impacting the implementation of BETTER 2: (1) intervention characteristics-complexity and cost of the intervention; (2) outer setting-perception of fit including lack of remuneration, lack of resources, and duplication of services, as well as patients' needs as perceived by physicians and patients; (3) characteristics of prevention practitioners-interest in prevention and ability to support and motivate patients; (4) inner setting-the availability of a local champion and working in a team versus working as a team; and (5) process-planning and engaging, collaboration, and teamwork. The implementation of a novel CDPS program into new primary care settings is a complex, multi-level process. This study identified key elements that hindered or facilitated the implementation of the BETTER approach in three primary care settings in Newfoundland and Labrador. Employing the CFIR as an overarching typology allows for comparisons with other contexts and settings, and may be useful for practices, researchers, and policy-makers interested in the implementation of CDPS programs.

"Compassion, pleasantry, and hope": a process evaluation of a volunteer-based nonprofit.

PubMed

Mye, Sarah C; Moracco, Kathryn E

2015-06-01

As funders continue to emphasize the importance of documented results, nonprofit organizations must work to complete program evaluations that are both valuable and feasible. The purpose of this paper is to document a practical process evaluation of a southeastern nonprofit, a local Meals on Wheels. Using a mixed methods approach, we sought to answer four evaluation questions: (1) What are the essential program components, as identified by key stakeholders; (2) To what extent are volunteers implementing the identified essential components as intended; (3) What is the level of volunteer satisfaction with the program; and (4) What suggestions do stakeholders have for improving the program? Our findings indicate that most aspects of the program were implemented as intended, but inconsistencies occurred when volunteers were unsure of their assigned duties. In addition, volunteers had high levels of satisfaction and specific suggestions for improvement. From these results, we developed a conceptual model of factors contributing to quality of implementation and volunteer satisfaction that may be generalizable to other volunteer-based nonprofits. Specifically, we identified three factors that helped to facilitate satisfaction and performance: leadership, social contact, and fulfillment. Finally, this process evaluation demonstrates the feasibility of developing and implementing evaluation tools in similar organizations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Peer support to improve diabetes care: an implementation evaluation of the Australasian Peers for Progress Diabetes Program.

PubMed

Aziz, Zahra; Riddell, Michaela A; Absetz, Pilvikki; Brand, Margaret; Oldenburg, Brian

2018-02-17

Several studies have now demonstrated the benefits of peer support in promoting diabetes control. The aim of this study is to evaluate the implementation of a cluster randomised controlled trial of a group-based, peer support program to improve diabetes self-management and thereby, diabetes control in people with Type 2 Diabetes in Victoria, Australia. The intervention program was designed to address four key peer support functions i.e. 1) assistance in daily management, 2) social and emotional support, 3) regular linkage to clinical care, and 4) ongoing and sustained support to assist with the lifelong needs of diabetes self-care management. The intervention participants attended monthly group meetings facilitated by a trained peer leader for 12 months. Data was collected on the intervention's reach, participation, implementation fidelity, groups' effectiveness and participants' perceived support and satisfaction with the intervention. The RE-AIM and PIPE frameworks were used to guide this evaluation. The trial reached a high proportion (79%) of its target population through mailed invitations. Out of a total of 441 eligible individuals, 273 (61.9%) were willing to participate. The intervention fidelity was high (92.7%). The proportion of successful participants who demonstrated a reduction in 5 years cardiovascular disease risk score was 65.1 and 44.8% in the intervention and control arm respectively. Ninety-four percent (94%) of the intervention participants stated that the program helped them manage their diabetes on a day to day basis. Overall, attending monthly group meetings provided 'a lot of support' to 57% and 'moderate' support to 34% of the participants. Peer support programs are feasible, acceptable and can be used to supplement treatment for patients motivated to improve behaviours related to diabetes. However, program planners need to focus on the participation component in designing future programs. The use of two evaluation frameworks allowed a comprehensive evaluation of the trial from the provider-, participant- and public health perspective. The learnings gained from this evaluation will guide and improve future implementation by improving program feasibility for adoption and acceptability among participants, and will ultimately increase the likelihood of program effectiveness for the participants. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000469213 . Registered 16 June 2009.

A case study on building capacity to improve clinical mentoring and maternal child health in rural Tanzania: the path to implementation.

PubMed

Ojemeni, Melissa T; Niles, Paulomi; Mfaume, Salum; Kapologwe, Ntuli A; Deng, Linda; Stafford, Renae; Voeten, Marie Jose; Theonestina, Kokusiima; Budin, Wendy; Chhun, Nok; Squires, Allison

2017-01-01

Tanzania is a low income, East African country with a severe shortage of human resources for health or health workers. This shortage threatens any gains the country is making in improving maternal health outcomes. This paper describes a partnership between Touch Foundation and NYU Rory Meyers College of Nursing - Global, aimed at improving clinical mentorship and capacity among nurses and midwives at two rural hospitals in the Tanzanian Lake Zone Region. Clinical mentoring capacity building and supportive supervision of staff has been shown to be a facilitator of retaining nurses and would be possible to acquire and implement quickly, even in a context of low resources and limited technology. A case study approach structures this program implementation analysis. The NYU Meyers team conducted a 6-day needs assessment at the two selected hospitals. A SWOT analysis was performed to identify needs and potential areas for improvement. After the assessment, a weeklong training, tailored to each hospitals' specific needs, was designed and facilitated by two NYU Meyers nursing and midwifery education specialists. The program was created to build on the clinical skills of expert nurse and midwife clinicians and suggested strategies for incorporating mentoring and preceptorship as a means to enhance clinical safety and promote professional communication, problem solving and crisis management. Nineteen participants from both hospitals attended the training. Fourteen of 19 participants completed a post training, open ended questionnaire for a 74% response rate. Fifty-seven percent of participants were able to demonstrate and provide examples of the concepts of mentorship and supervision 4 and 11 months' post training. Participants indicated that while confidence in skills was not lacking, barriers to quality care lay mostly in understaffing. Implementation also offered multiple insights into contextual factors affecting sustainable program implementation. Three recommendations from this training include: 1) A pre-program assessment should be conducted to ascertain contextual relevance to curriculum development; 2) flexibility and creativity in teaching methods are essential to engage students; and 3) access to participants a priori to program implementation may facilitate a more tailored approach and lead to greater participant engagement.

Initiating Improvements: The HR Department as the Architect of Quality-of-Life Initiatives.

ERIC Educational Resources Information Center

Reis, Frank William

2002-01-01

Describes how a wellness program, campus safety and security program, and institutional knowledge management program are succeeding at Cuyahoga Community College after the human resources (HR) department won administrative support for their implementation. (EV)

Interprofessional development and implementation of a pharmacist professional advancement and recognition program.

PubMed

Hager, David; Chmielewski, Eric; Porter, Andrea L; Brzozowski, Sarah; Rough, Steve S; Trapskin, Philip J

2017-11-15

The interprofessional development, implementation, and outcomes of a pharmacist professional advancement and recognition program (PARP) at an academic medical center are described. Limitations of the legacy advancement program, in combination with low rates of employee engagement in peer recognition and professional development, at the UW Health department of pharmacy led to the creation of a task force comprising pharmacists from all practice areas to develop a new pharmacist PARP. Senior leadership within the organization expanded the scope of the project to include an interprofessional work group tasked to develop guidelines and core principles that other professional staff could use to reduce variation across advancement and recognition programs. Key program design elements included a triennial review of performance against advancement standards and the use of peer review to supplement advancement decisions. The primary objective was to meaningfully improve pharmacists' engagement as measured through employee engagement surveys. Secondary outcomes of interest included the results of pharmacist and management satisfaction surveys and the program's impact on the volume and mix of pharmacist professional development activities. Of the 126 eligible pharmacists, 93 participated in the new program. The majority of pharmacists was satisfied with the program. For pharmacists who were advanced as part of the program, meaningful increases in employee engagement scores were observed, and a mean of 95 hours of professional development and quality-improvement activities was documented. Implementation of a PARP helped increase pharmacist engagement through participation in quality-improvement and professional development activities. The program also led to the creation of organizationwide interprofessional guidelines for advancement programs within various healthcare disciplines. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Public health interventions, barriers, and opportunities for improving maternal nutrition in India.

PubMed

Ramakrishnan, Usha; Lowe, Alyssa; Vir, Sheila; Kumar, Shuba; Mohanraj, Rani; Chaturvedi, Anuraag; Noznesky, Elizabeth A; Martorell, Reynaldo; Mason, John B

2012-06-01

Inadequate nutrient intake, early and multiple pregnancies, poverty, caste discrimination, and gender inequality contribute to poor maternal nutrition in India. While malnutrition is seen throughout the life cycle, it is most acute during childhood, adolescence, pregnancy, and lactation. Although nutrition policies are on the books and interventions are in place, child malnutrition and maternal undernutrition persist as severe public health problems. To evaluate the implementation of maternal nutrition programs in India. The research was conducted in two phases. Phase 1 consisted of a desk review of national and state policies pertinent to maternal nutrition and national-level key informant interviews with respondents who have a working knowledge of relevant organizations and interventions. Phase 2 utilized in-depth interviews and focus group discussions at the state, district, and community levels in eight districts of two states: Tamil Nadu and Uttar Pradesh. All data were analyzed thematically. India has a rich portfolio of programs and policies that address maternal health and nutrition; however, systematic weaknesses, logistical gaps, resource scarcity, and poor utilization continue to hamper progress. Elevating the priority given to maternal nutrition in government health programs and implementing strategies to improve women's status will help to address many of the challenges facing India's nutrition programs. Programs can be strengthened by promoting integration of services, ensuring effective procurement mechanisms for micronutrient and food supplements, establishing regional training facilities for improved program implementation, and strengthening program monitoring and evaluation.

Implementation of a drug-use and disease-state management program.

PubMed

Skledar, S J; Hess, M M

2000-12-15

A drug-use and disease-state management (DUDSM) program was instituted in 1996 at a teaching hospital associated with a large nonprofit health care system. The program's goals are to optimize pharmacotherapeutic regimens, evaluate health outcomes of identified disease states, and evaluate the economic impact of pharmacotherapeutic options for given disease states by developing practice guidelines. Through a re-engineering process, resources within the pharmacy department were identified that could be devoted to the DUDSM program, including the use of clinical pharmacy specialists, promotion of staff pharmacists into the DUDSM program, a pharmacy technician, and information systems support. A strength of the program is its systematic approach for developing and implementing new initiatives, as well as monitoring compliance with all initiatives on an ongoing basis. The initiative-design process incorporates continuous quality improvement principles, outcome design and evaluation, competency assessment for all pharmacists, multidisciplinary collaboration, and sophisticated information systems. Seventy-five initiatives have been implemented, ranging from simple dose-optimization strategies for specific drugs to complicated practice guidelines for managing specific disease states. Improved patient outcomes have been documented, including reduced length of stay, postsurgical wound infection, adverse drug reactions, and medication errors. Documented cost savings exceeded $4 million annually for fiscal years 1996-97 through 1999-2000. Overall compliance with DUDSM initiatives exceeds 80%, and physician service profiling has been initiated to monitor variant prescribing. The DUDSM program has successfully integrated practice guidelines into therapeutic decision-making, resulting in improved patient-care outcomes and cost savings.

Enhancing outreach for persons with serious mental illness: 12-month results from a cluster randomized trial of an adaptive implementation strategy.

PubMed

Kilbourne, Amy M; Almirall, Daniel; Goodrich, David E; Lai, Zongshan; Abraham, Kristen M; Nord, Kristina M; Bowersox, Nicholas W

2014-12-28

Few implementation strategies have been empirically tested for their effectiveness in improving uptake of evidence-based treatments or programs. This study compared the effectiveness of an immediate versus delayed enhanced implementation strategy (Enhanced Replicating Effective Programs (REP)) for providers at Veterans Health Administration (VA) outpatient facilities (sites) on improved uptake of an outreach program (Re-Engage) among sites not initially responding to a standard implementation strategy. One mental health provider from each U.S. VA site (N = 158) was initially given a REP-based package and training program in Re-Engage. The Re-Engage program involved giving each site provider a list of patients with serious mental illness who had not been seen at their facility for at least a year, requesting that providers contact these patients, assessing patient clinical status, and where appropriate, facilitating appointments to VA health services. At month 6, sites considered non-responsive (N = 89, total of 3,075 patients), defined as providers updating documentation for less than <80% of patients on their list, were randomized to two adaptive implementation interventions: Enhanced REP (provider coaching; N = 40 sites) for 6 months followed by Standard REP for 6 months; versus continued Standard REP (N = 49 sites) for 6 months followed by 6 months of Enhanced REP for sites still not responding. Outcomes included patient-level Re-Engage implementation and utilization. Patients from sites that were randomized to receive Enhanced REP immediately compared to Standard REP were more likely to have a completed contact (adjusted OR = 2.13; 95% CI: 1.09-4.19, P = 0.02). There were no differences in patient-level utilization between Enhanced and Standard REP sites. Enhanced REP was associated with greater Re-Engage program uptake (completed contacts) among sites not responding to a standard implementation strategy. Further research is needed to determine whether national implementation of Facilitation results in tangible changes in patient-level outcomes. ISRCTN21059161.

The Boston Middle School-Corner Store Initiative: Development, Implementation, and Initial Evaluation of a Program Designed to Improve Adolescents' Beverage-Purchasing Behaviors

ERIC Educational Resources Information Center

Hoffman, Jessica A.; Morris, Vivien; Cook, John

2009-01-01

The Boston Middle School Corner Store Initiative (CSI) brought together schools, businesses, and community partners to develop, implement, and evaluate a multicomponent pilot program designed to promote healthier beverage purchasing at corner stores among 3,500 middle school students living in Boston, Massachusetts. Healthy drinks were defined for…

West Virginia Safe and Supportive (S3) Schools Project: Year 2 Implementation Evaluation Report

ERIC Educational Resources Information Center

Whisman, Andy

2013-01-01

The 4-year federal Safe and Supportive Schools (S3) program supports targeted interventions to improve and measure conditions for learning at the high school level. For 2011-2012 (Year 2), two evaluation questions were investigated: (EQ1) To what extent do participating schools implement the program with fidelity relative to the WV Model for…

A New Vision for Integrated Breast Care.

DTIC Science & Technology

1998-09-01

Analysis tools to Mapping; and established counseling methods to Debriefing. We are now investigating how Neurolinguistic Programming to may help... programs and services for the benefit of the patient. Our Continuous Quality Improvement, Informatics and Education Cores are working together to help...streamline implementation of programs . This enables us to identify the quality improvements we hope to gain by changing a service and the quality

Making Work Pay: How To Design and Implement Financial Work Supports To Improve Family and Child Well-Being and Reduce Poverty. How-To Guide: Technical Assistance for States and Localities.

ERIC Educational Resources Information Center

Greenberger, Debbie; Anselmi, Robert

This guide explains how to design and implement financial work supports in order to improve family and child well-being. The information provided draws heavily from the study of these three programs that increased employment and earnings while improving employment stability, boosting income, and reducing poverty: Minnesota Family Investment…

Medical student mental health 3.0: improving student wellness through curricular changes.

PubMed

Slavin, Stuart J; Schindler, Debra L; Chibnall, John T

2014-04-01

Medical education can have significant negative effects on the well-being of medical students. To date, efforts to improve student mental health have focused largely on improving access to mental health providers, reducing the stigma and other barriers to mental health treatment, and implementing ancillary wellness programs. Still, new and innovative models that build on these efforts by directly addressing the root causes of stress that lie within the curriculum itself are needed to properly promote student wellness. In this article, the authors present a new paradigm for improving medical student mental health, by describing an integrated, multifaceted, preclinical curricular change program implemented through the Office of Curricular Affairs at the Saint Louis University School of Medicine starting in the 2009-2010 academic year. The authors found that significant but efficient changes to course content, contact hours, scheduling, grading, electives, learning communities, and required resilience/mindfulness experiences were associated with significantly lower levels of depression symptoms, anxiety symptoms, and stress, and significantly higher levels of community cohesion, in medical students who participated in the expanded wellness program compared with those who preceded its implementation. The authors discuss the utility and relevance of such curricular changes as an overlooked component of change models for improving medical student mental health.

Incorporating health literacy in education for socially disadvantaged adults: an Australian feasibility study.

PubMed

Muscat, Danielle M; Smith, Sian; Dhillon, Haryana M; Morony, Suzanne; Davis, Esther L; Luxford, Karen; Shepherd, Heather L; Hayen, Andrew; Comings, John; Nutbeam, Don; McCaffery, Kirsten

2016-06-04

Adult education institutions have been identified as potential settings to improve health literacy and address the health inequalities that stem from limited health literacy. However, few health literacy interventions have been tested in this setting. Feasibility study for an RCT of the UK Skilled for Health Program adapted for implementation in Australian adult education settings. Implementation at two sites with mixed methods evaluation to examine feasibility, test for change in participants' health literacy and pilot test health literacy measures. Twenty-two socially disadvantaged adults with low literacy participated in the program and received 80-90 hours of health literacy instruction. The program received institutional support from Australia's largest provider of vocational education and training and was feasible to implement (100 % participation; >90 % completion; high teacher satisfaction). Quantitative results showed improvements in participants' health literacy skills and confidence, with no change on a generic measure of health literacy. Qualitative analysis identified positive student and teacher engagement with course content and self-reported improvements in health knowledge, attitudes, and communication with healthcare professionals. Positive feasibility results support a larger RCT of the health literacy program. However, there is a need to identify better, multi-dimensional measures of health literacy in order to be able to quantify change in a larger trial. This feasibility study represents the first step in providing the high quality evidence needed to understand the way in which health literacy can be improved and health inequalities reduced through Australian adult education programs.

Barriers and Potential Improvements for Needle and Syringe Exchange Programs (NSPs) in China: A Qualitative Study from Perspectives of Both Health and Public Security Sectors

PubMed Central

Chow, Eric P. F.; Jing, Jun; Zheng, Jun; Zhao, Junshi; Zhang, Lei

2015-01-01

This study explores the acceptability, the barriers to the implementation of needle and syringe exchange programs (NSPs) and the potential improvement strategies in China from the perspectives of governmental health and public security officials. Purposive sampling was used for recruitment of participants who had been involved in NSPs implementation. Semi-Structured individual interviews were conducted in Mandarin to address three aspects of NSPs: (1) participants’ attitudes towards NSPs, (2) participants’ opinions on the effectiveness and barriers of NSPs, and (3) suggestions for improving the program. Content analysis was used to analyse the translated interview data. A total of 68 participants from 12 Hunan counties were interviewed (34 from each of the Bureau of Health and the Narcotic Division). Both groups recognised the importance and effectiveness of NSPs in HIV prevention, but public security officials regarded NSPs as a temporary intervention in place of punitive measures. Most health officials (32/34) regarded the main barriers to its implementation as administrative and structural, whereas participants from Narcotics Division (n=24) questioned the legitimacy of NSPs and concerned about the poor management of drug users’ risk behaviours. Close cooperation between the health and public security sectors, engagement of the drug user community and an enabling policy environment were reportedly to be critical for potential improvements of NSPs in China. Misconceptions about NSPs encourage drug users’ addictive behaviour, and an unclear leadership and insufficient support de-motivate the participants from the Bureau of Health and the Narcotics Division to actively support the program implementation. PMID:26114556

Estuary ecosystem restoration: implementing and institutionalizing adaptive management: Institutionalizing adaptive management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ebberts, Blaine D.; Zelinsky, Ben D.; Karnezis, Jason P.

We successfully implemented and institutionalized an adaptive management (AM) process for the Columbia Estuary Ecosystem Restoration Program, which is a large-scale restoration program focused on improving ecosystem conditions in the 234-km lower Columbia River and estuary. For our purpose, “institutionalized” means the AM process and restoration program are embedded in the work flow of the implementing agencies and affected parties. While plans outlining frameworks, processes, or approaches to AM of ecosystem restoration programs are commonplace, establishment for the long term is not. This paper presents the basic AM framework and explains how AM was implemented and institutionalized. Starting with amore » common goal, we pursued included a well-understood governance and decision-making structure, routine coordination and communication activities, data and information sharing, commitment from partners and upper agency management to the AM process, and meaningful cooperation among program managers and partners. The overall approach and steps to implement and institutionalize AM for ecosystem restoration explained here are applicable to situations where it has been less than successful or, as in our case, the restoration program is just getting started.« less

Implementing an Evidence-Based Fall Prevention Intervention in Community Senior Centers.

PubMed

Li, Fuzhong; Harmer, Peter; Fitzgerald, Kathleen

2016-11-01

To evaluate the impact of implementing an evidence-based fall prevention intervention in community senior centers. We used a single-group design to evaluate the Tai Ji Quan: Moving for Better Balance (TJQMBB) program's adoption, population reach, implementation, effectiveness, and maintenance among 36 senior centers in 4 Oregon counties between 2012 and 2016. The primary outcome measure, as part of the effectiveness evaluation, was number of falls as ascertained by self-report. Trained TJQMBB instructors delivered the program to community-dwelling older adults for 48 weeks, with a 6-month postintervention follow-up. TJQMBB was adopted by 89% of the senior centers approached and reached 90% of the target population. The program resulted in a 49% reduction in the total number of falls and improved physical performance. Participation was well maintained after the program's completion. The average cost-effectiveness ratio for the 48-week program implementation was $917 per fall prevented and $676 per fall prevented for multiple falls. TJQMBB is an effective public health program that can be broadly implemented in community senior centers for primary prevention of falls among community-dwelling older adults.

[Implementation and evaluation of case management in Catalonia: the ISP-SMD program].

PubMed

Balsera Gómez, J; Rodríguez Medina, C; Caba Calvet, R; Vega Prada, R; Ruiz Ureña, H; Berruezo Ortiz, L; Clusa Gironella, D; Rodríguez Montes, M J; Haro Abad, J M

2002-01-01

The pilot study of the Individualized Service Program for people with Severe Mental Disorders (ISP-SMD) consists of the implementation of case management services in Catalonia. The ISP-SMD has been implemented in two health care sectors and will be expanded to the rest of Catalonia in the next years. The program serves people with persistent mental disorders who have serious social or family problems and/or who have inadequate mental health service use (high use of inpatient services, no use of community services). The ISP-SMD is a community intervention program that focuses its activities on direct care and coordination between services. Thirty patients have been included in the evaluation. The results of the pilot study have shown that, compared to the year before entering the program, the patients show better clinical status, they decrease their unmet need level, they have more appropriate use of health services and have lower treatment costs. Satisfaction of the patients, family members and professionals with the program is very high. It is possible to adapt and implement case management services in Catalonia. When implemented, they improve patient quality of life.

Washington State Guide to Planning, Implementing and Improving Work-based Learning. A Guide for Educators at All Levels.

ERIC Educational Resources Information Center

Highline Community Coll., Des Moines, WA.

This guide, which is intended primarily for school and college personnel interested in initiating or improving work-based learning, examines the development and implementation of work-based education programs in Washington. The following topics are discussed: the rationale for work-based learning (legislative and educational change information,…

Efficient implementation of the 3D-DDA ray traversal algorithm on GPU and its application in radiation dose calculation.

PubMed

Xiao, Kai; Chen, Danny Z; Hu, X Sharon; Zhou, Bo

2012-12-01

The three-dimensional digital differential analyzer (3D-DDA) algorithm is a widely used ray traversal method, which is also at the core of many convolution∕superposition (C∕S) dose calculation approaches. However, porting existing C∕S dose calculation methods onto graphics processing unit (GPU) has brought challenges to retaining the efficiency of this algorithm. In particular, straightforward implementation of the original 3D-DDA algorithm inflicts a lot of branch divergence which conflicts with the GPU programming model and leads to suboptimal performance. In this paper, an efficient GPU implementation of the 3D-DDA algorithm is proposed, which effectively reduces such branch divergence and improves performance of the C∕S dose calculation programs running on GPU. The main idea of the proposed method is to convert a number of conditional statements in the original 3D-DDA algorithm into a set of simple operations (e.g., arithmetic, comparison, and logic) which are better supported by the GPU architecture. To verify and demonstrate the performance improvement, this ray traversal method was integrated into a GPU-based collapsed cone convolution∕superposition (CCCS) dose calculation program. The proposed method has been tested using a water phantom and various clinical cases on an NVIDIA GTX570 GPU. The CCCS dose calculation program based on the efficient 3D-DDA ray traversal implementation runs 1.42 ∼ 2.67× faster than the one based on the original 3D-DDA implementation, without losing any accuracy. The results show that the proposed method can effectively reduce branch divergence in the original 3D-DDA ray traversal algorithm and improve the performance of the CCCS program running on GPU. Considering the wide utilization of the 3D-DDA algorithm, various applications can benefit from this implementation method.

A framework for learning about improvement: embedded implementation and evaluation design to optimize learning

PubMed Central

Barry, Danika; Kimble, Leighann E; Nambiar, Bejoy; Parry, Gareth; Jha, Ashish; Chattu, Vijay Kumar; Massoud, M Rashad; Goldmann, Don

2018-01-01

Abstract Improving health care involves many actors, often working in complex adaptive systems. Interventions tend to be multi-factorial, implementation activities diverse, and contexts dynamic and complicated. This makes improvement initiatives challenging to describe and evaluate as matching evaluation and program designs can be difficult, requiring collaboration, trust and transparency. Collaboration is required to address important epidemiological principles of bias and confounding. If this does not take place, results may lack credibility because the association between interventions implemented and outcomes achieved is obscure and attribution uncertain. Moreover, lack of clarity about what was implemented, how it was implemented, and the context in which it was implemented often lead to disappointment or outright failure of spread and scale-up efforts. The input of skilled evaluators into the design and conduct of improvement initiatives can be helpful in mitigating these potential problems. While evaluation must be rigorous, if it is too rigid necessary adaptation and learning may be compromised. This article provides a framework and guidance on how improvers and evaluators can work together to design, implement and learn about improvement interventions more effectively. PMID:29873794

Building an Ecosystem for a New Engineering Program

NASA Astrophysics Data System (ADS)

Grebski, Wieslaw; Grebski, Michalene Eva

2018-06-01

Penn State Hazleton has recently developed and implemented a new Engineering program with a focus on energy efficiency and energy sustainability. To accelerate the implementation cycle of the program, it was necessary to very rapidly create and establish the components of an ecosystem needed for the Engineering program to prosper and grow. This paper describes the individual components of the ecosystem as well as the methods used to establish them. The paper also discusses the different initiatives to increase enrollment as well as placement rates for graduates. Continuous quality improvement procedure applied to maintain the quality of the program is also being discussed.

Translation of an Effective Tai Chi Intervention Into a Community-Based Falls-Prevention Program

PubMed Central

Li, Fuzhong; Harmer, Peter; Glasgow, Russell; Mack, Karin A.; Sleet, David; Fisher, K. John; Kohn, Melvin A.; Millet, Lisa M.; Mead, Jennifer; Xu, Junheng; Lin, Mei-Li; Yang, Tingzhong; Sutton, Beth; Tompkins, Yvaughn

2008-01-01

Tai Chi—Moving for Better Balance, a falls-prevention program developed from a randomized controlled trial for community-based use, was evaluated with the RE-AIM framework in 6 community centers. The program had a 100% adoption rate and 87% reach into the target older adult population. All centers implemented the intervention with good fidelity, and participants showed significant improvements in health-related outcome measures. This evidence-based tai chi program is practical to disseminate and can be effectively implemented and maintained in community settings. PMID:18511723

48 CFR 313.301 - Government-wide commercial purchase card.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., Appendix B, “Improving the Management of Government Charge Card Programs;” GSA's SmartPay Program guidance; and HHS Purchase Card program standards. (2) The OPDIVs, through their designated Agency/Organization... training requirements to ensure effective implementation of the HHS purchase card program. (3) OPDIVs shall...

The San Francisco Joint Institutional Transportation Systems Management Program.

ERIC Educational Resources Information Center

Fink, Ira; LaPointe, Robert

1981-01-01

Transportation systems management (TSM) programs are discussed, particularly the 1977 program of the University of California, San Francisco, which led to traffic reduction and improved vehicle flow. The city's implementation plan for a similar TSM program for 14 educational institutions and hospitals is described. (MLW)

Duke University's Quality Appearance Program

ERIC Educational Resources Information Center

Jackson, Joe

2008-01-01

The Grounds Services Unit at Duke University has implemented a new program that involves a process of self evaluation, which embraces the concept of perpetual and continuous improvement. The Quality Appearance Program (QAP) embellishes and expands upon the Quality Assurance Program concept, but with a twist to grounds management improvement…

Putting It All Together: A Minority Transition Program.

ERIC Educational Resources Information Center

Sacramento City Coll., CA.

Sacramento City College (SCC) created a transfer opportunity program to implement joint activities with four-year colleges and high schools, establish an academic skills program for potential minority transfers, improve telecommunications with local four-year institutions, expand its existing junior high school program. and continue its formalized…

Mentoring Human Performance - 12480

DOE Office of Scientific and Technical Information (OSTI.GOV)

Geis, John A.; Haugen, Christian N.

2012-07-01

Although the positive effects of implementing a human performance approach to operations can be hard to quantify, many organizations and industry areas are finding tangible benefits to such a program. Recently, a unique mentoring program was established and implemented focusing on improving the performance of managers, supervisors, and work crews, using the principles of Human Performance Improvement (HPI). The goal of this mentoring was to affect behaviors and habits that reliably implement the principles of HPI to ensure continuous improvement in implementation of an Integrated Safety Management System (ISMS) within a Conduct of Operations framework. Mentors engaged with personnel inmore » a one-on-one, or one-on-many dialogue, which focused on what behaviors were observed, what factors underlie the behaviors, and what changes in behavior could prevent errors or events, and improve performance. A senior management sponsor was essential to gain broad management support. A clear charter and management plan describing the goals, objectives, methodology, and expected outcomes was established. Mentors were carefully selected with senior management endorsement. Mentors were assigned to projects and work teams based on the following three criteria: 1) knowledge of the work scope; 2) experience in similar project areas; and 3) perceived level of trust they would have with project management, supervision, and work teams. This program was restructured significantly when the American Reinvestment and Recovery Act (ARRA) and the associated funding came to an end. The program was restructured based on an understanding of the observations, attributed successes and identified shortfalls, and the consolidation of those lessons. Mentoring the application of proven methods for improving human performance was shown effective at increasing success in day-to-day activities and increasing confidence and level of skill of supervisors. While mentoring program effectiveness is difficult to measure, and return on investment is difficult to quantify, especially in complex and large organizations where the ability to directly correlate causal factors can be challenging, the evidence presented by Sydney Dekker, James Reason, and others who study the field of human factors does assert managing and reducing error is possible. Employment of key behaviors-HPI techniques and skills-can be shown to have a significant impact on error rates. Our mentoring program demonstrated reduced error rates and corresponding improvements in safety and production. Improved behaviors are the result, of providing a culture with consistent, clear expectations from leadership, and processes and methods applied consistently to error prevention. Mentoring, as envisioned and executed in this program, was effective in helping shift organizational culture and effectively improving safety and production. (authors)« less

Implementation of Age-Specific Services for Transition-Age Youths in California.

PubMed

Ojeda, Victoria D; Hiller, Sarah P; Hurst, Samantha; Jones, Nev; McMenamin, Sara; Burgdorf, James; Gilmer, Todd P

2016-09-01

This study examined the implementation of age-specific services for transition-age youths in California under the Mental Health Services Act (MHSA). This study employed a sequential, exploratory mixed-methods design. Qualitative interviews with 39 mental health service area administrators in California were analyzed to develop an understanding of how the MHSA has facilitated the development of youth-specific programs or services. A quantitative survey of 180 youth-focused programs was also used to describe the range of services that were implemented, the use of evidence-based and promising practices, and the role of youths in the design, planning, delivery, and evaluation of services. Administrators described the MHSA as providing a programmatic focus and financial support for youth-specific services, outlining a stakeholder process to create buy-in and develop a vision for services, and emphasizing the role of youths in service delivery and planning. Youth-specific programs implemented a diverse array of services, including general medical care; employment and education support; housing placement and support; and family, mentoring, and social support. Programs described implementing evidence-based and promising practices and involving youths in service planning, implementation, or quality improvement activities. The MHSA has had a substantial impact on the landscape of youth-specific services in California by expanding both the number of programs and the diversity in types of services and by promoting the engagement of youths in the planning and delivery of services. Additional efforts are necessary to determine the extent to which youth-specific services yield greater improvements in youths' outcomes compared with services designed for adults.

NURSING 911: an orientation program to improve retention of online RN-BSN students.

PubMed

Gilmore, Melanie; Lyons, Evadna M

2012-01-01

This article describes the implementation and evaluation of an eight-hour, comprehensive, face-to-face orientation program designed to improve student retention in a newly developed online RN to BSN program. A total of 179 newly enrolled RN to BSN students participated in the orientation program and evaluated the process. Student attrition decreased from 20 percent to less than 1 percent after the orientation program was extended and improved to include a technology assessment and an online practice course. A quality online program requires a well-designed orientation that includes technological assessments and hands-on, active participation by the learner. The newly improved and designed course has become effective in student retention and transition into the online learning environment.

Near-miss incident management in the chemical process industry.

PubMed

Phimister, James R; Oktem, Ulku; Kleindorfer, Paul R; Kunreuther, Howard

2003-06-01

This article provides a systematic framework for the analysis and improvement of near-miss programs in the chemical process industries. Near-miss programs improve corporate environmental, health, and safety (EHS) performance through the identification and management of near misses. Based on more than 100 interviews at 20 chemical and pharmaceutical facilities, a seven-stage framework has been developed and is presented herein. The framework enables sites to analyze their own near-miss programs, identify weak management links, and implement systemwide improvements.

Improved productivity through interactive communication

NASA Technical Reports Server (NTRS)

Marino, P. P.

1985-01-01

New methods and approaches are being tried and evaluated with the goal of increasing productivity and quality. The underlying concept in all of these approaches, methods or processes is that people require interactive communication to maximize the organization's strengths and minimize impediments to productivity improvement. This paper examines Bendix Field Engineering Corporation's organizational structure and experiences with employee involvement programs. The paper focuses on methods Bendix developed and implemented to open lines of communication throughout the organization. The Bendix approach to productivity and quality enhancement shows that interactive communication is critical to the successful implementation of any productivity improvement program. The paper concludes with an examination of the Bendix methodologies which can be adopted by any corporation in any industry.

Protocole of a controlled before-after evaluation of a national health information technology-based program to improve healthcare coordination and access to information.

PubMed

Saillour-Glénisson, Florence; Duhamel, Sylvie; Fourneyron, Emmanuelle; Huiart, Laetitia; Joseph, Jean Philippe; Langlois, Emmanuel; Pincemail, Stephane; Ramel, Viviane; Renaud, Thomas; Roberts, Tamara; Sibé, Matthieu; Thiessard, Frantz; Wittwer, Jerome; Salmi, Louis Rachid

2017-04-21

Improvement of coordination of all health and social care actors in the patient pathways is an important issue in many countries. Health Information (HI) technology has been considered as a potentially effective answer to this issue. The French Health Ministry first funded the development of five TSN ("Territoire de Soins Numérique"/Digital health territories) projects, aiming at improving healthcare coordination and access to information for healthcare providers, patients and the population, and at improving healthcare professionals work organization. The French Health Ministry then launched a call for grant to fund one research project consisting in evaluating the TSN projects implementation and impact and in developing a model for HI technology evaluation. EvaTSN is mainly based on a controlled before-after study design. Data collection covers three periods: before TSN program implementation, during early TSN program implementation and at late TSN program implementation, in the five TSN projects' territories and in five comparison territories. Three populations will be considered: "TSN-targeted people" (healthcare system users and people having characteristics targeted by the TSN projects), "TSN patient users" (people included in TSN experimentations or using particular services) and "TSN professional users" (healthcare professionals involved in TSN projects). Several samples will be made in each population depending on the objective, axis and stage of the study. Four types of data sources are considered: 1) extractions from the French National Heath Insurance Database (SNIIRAM) and the French Autonomy Personalized Allowance database, 2) Ad hoc surveys collecting information on knowledge of TSN projects, TSN program use, ease of use, satisfaction and understanding, TSN pathway experience and appropriateness of hospital admissions, 3) qualitative analyses using semi-directive interviews and focus groups and document analyses and 4) extractions of TSN implementation indicators from TSN program database. EvaTSN is a challenging French national project for the production of evidenced-based information on HI technologies impact and on the context and conditions of their effectiveness and efficiency. We will be able to support health care management in order to implement HI technologies. We will also be able to produce an evaluation toolkit for HI technology evaluation. ClinicalTrials.gov ID: NCT02837406 , 08/18/2016.

Disease management: findings from leading state programs.

PubMed

Wheatley, Ben

2002-12-01

Disease management programs are designed to contain costs by improving health among the chronically ill. More than 20 states are now engaged in developing and implementing Medicaid disease management programs for their primary care case management and fee-for-service populations.

Barriers to the implementation and uptake of simulation-based training programs in general surgery: a multinational qualitative study.

PubMed

Hosny, Shady G; Johnston, Maximilian J; Pucher, Philip H; Erridge, Simon; Darzi, Ara

2017-12-01

Despite evidence demonstrating the advantages of simulation training in general surgery, it is not widely integrated into surgical training programs worldwide. The aim of this study was to identify barriers and facilitators to the implementation and uptake of surgical simulation training programs. A multinational qualitative study was conducted using semi-structured interviews of general surgical residents and experts. Each interview was audio recorded, transcribed verbatim, and underwent emergent theme analysis. All data were anonymized and results pooled. A total of 37 individuals participated in the study. Seventeen experts (Program Directors and Surgical Attendings with an interest in surgical education) and 20 residents drawn from the United States, Canada, United Kingdom, France, and Japan were interviewed. Barriers to simulation-based training were identified based on key themes including financial cost, access, and translational benefit. Participants described cost (89%) and access (76%) as principal barriers to uptake. Common facilitators included a mandatory requirement to complete simulation training (78%) and on-going assessment of skills (78%). Participants felt that simulation training could improve patient outcomes (76%) but identified a lack of evidence to demonstrate benefit (38%). There was a consensus that simulation training has not been widely implemented (70%). There are multiple barriers to the implementation of surgical simulation training programs, however, there is agreement that these programs could potentially improve patient outcomes. Identifying these barriers enable the targeted use of facilitators to deliver simulation training programs. Copyright © 2017 Elsevier Inc. All rights reserved.

Development and implementation of a pharmacist-run comprehensive medication review program in Wisconsin.

PubMed

Schoenrock, Danielle L; Hartkopf, Katherine; Boeckelman, Carrie

2016-12-01

The development and implementation of a centralized, pharmacist-run population health program were pursued within a health system to increase patient exposure to comprehensive medication reviews (CMRs) and improve visit processes. Program implementation included choosing appropriate pilot pharmacy locations, developing a feasible staffing model, standardizing the workflow, and creating a patient referral process. The impact on patient exposure, specific interventions, and the sustainability of the program were evaluated over a seven-month period. A total of 96 CMRs were scheduled during the data collection period. Attendance at scheduled CMRs was 54% (52 visits); there were 25 cancellations (26%) and 19 no-shows (20%). Since program implementation, there has been more than a twofold increase (2.08) in the number of CMRs completed within the health system. On average, all aspects of each patient visit took 1.78 hours to complete. Pharmacists spent 28% of scheduled time on CMR tasks and 72% of time on telephone calls and technical tasks to maintain appointments. A pharmacist-run CMR program helped to elevate the role of the community pharmacist in a health system and to improve patient exposure to CMRs. Sustaining a centralized CMR program requires support from other members of the health-system team so that pharmacists can spend more time providing patient care and less time on the technical tasks involved. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Implementation of a Clinical Documentation Improvement Curriculum Improves Quality Metrics and Hospital Charges in an Academic Surgery Department.

PubMed

Reyes, Cynthia; Greenbaum, Alissa; Porto, Catherine; Russell, John C

2017-03-01

Accurate clinical documentation (CD) is necessary for many aspects of modern health care, including excellent communication, quality metrics reporting, and legal documentation. New requirements have mandated adoption of ICD-10-CM coding systems, adding another layer of complexity to CD. A clinical documentation improvement (CDI) and ICD-10 training program was created for health care providers in our academic surgery department. We aimed to assess the impact of our CDI curriculum by comparing quality metrics, coding, and reimbursement before and after implementation of our CDI program. A CDI/ICD-10 training curriculum was instituted in September 2014 for all members of our university surgery department. The curriculum consisted of didactic lectures, 1-on-1 provider training, case reviews, e-learning modules, and CD queries from nurse CDI staff and hospital coders. Outcomes parameters included monthly documentation completion rates, severity of illness (SOI), risk of mortality (ROM), case-mix index (CMI), all-payer refined diagnosis-related groups (APR-DRG), and Surgical Care Improvement Program (SCIP) metrics. Financial gain from responses to CDI queries was determined retrospectively. Surgery department delinquent documentation decreased by 85% after CDI implementation. Compliance with SCIP measures improved from 85% to 97%. Significant increases in surgical SOI, ROM, CMI, and APR-DRG (all p < 0.01) were found after CDI/ICD-10 training implementation. Provider responses to CDI queries resulted in an estimated $4,672,786 increase in charges. Clinical documentation improvement/ICD-10 training in an academic surgery department is an effective method to improve documentation rates, increase the hospital estimated reimbursement based on more accurate CD, and provide better compliance with surgical quality measures. Copyright © 2016 American College of Surgeons. All rights reserved.

5-SPICE: the application of an original framework for community health worker program design, quality improvement and research agenda setting

PubMed Central

Palazuelos, Daniel; DaEun Im, Dana; Peckarsky, Matthew; Schwarz, Dan; Farmer, Didi Bertrand; Dhillon, Ranu; Johnson, Ari; Orihuela, Claudia; Hackett, Jill; Bazile, Junior; Berman, Leslie; Ballard, Madeleine; Panjabi, Raj; Ternier, Ralph; Slavin, Sam; Lee, Scott; Selinsky, Steve; Mitnick, Carole Diane

2013-01-01

Introduction Despite decades of experience with community health workers (CHWs) in a wide variety of global health projects, there is no established conceptual framework that structures how implementers and researchers can understand, study and improve their respective programs based on lessons learned by other CHW programs. Objective To apply an original, non-linear framework and case study method, 5-SPICE, to multiple sister projects of a large, international non-governmental organization (NGO), and other CHW projects. Design Engaging a large group of implementers, researchers and the best available literature, the 5-SPICE framework was refined and then applied to a selection of CHW programs. Insights gleaned from the case study method were summarized in a tabular format named the ‘5×5-SPICE chart’. This format graphically lists the ways in which essential CHW program elements interact, both positively and negatively, in the implementation field. Results The 5×5-SPICE charts reveal a variety of insights that come from a more complex understanding of how essential CHW projects interact and influence each other in their unique context. Some have been well described in the literature previously, while others are exclusive to this article. An analysis of how best to compensate CHWs is also offered as an example of the type of insights that this method may yield. Conclusions The 5-SPICE framework is a novel instrument that can be used to guide discussions about CHW projects. Insights from this process can help guide quality improvement efforts, or be used as hypothesis that will form the basis of a program's research agenda. Recent experience with research protocols embedded into successfully implemented projects demonstrates how such hypothesis can be rigorously tested. PMID:23561023

Translation of tobacco control programs in schools: findings from a rapid review of systematic reviews of implementation and dissemination interventions.

PubMed

Wolfenden, L; Carruthers, J; Wyse, R; Yoong, S

2014-08-01

School-based programs targeting the prevention of tobacco use are a key strategy for reducing the overall tobacco-related mortality and morbidity in the community. While substantial research investment has resulted in the identification of various effective tobacco prevention interventions in schools, this research investment will not result in public health benefits, unless effectively disseminated and implemented. This rapid review aimed to identify effective implementation or dissemination interventions, targeting the adoption of school-based tobacco prevention programs. A systematic search was conducted to identify published systematic reviews that examined the effectiveness of implementation and dissemination strategies for facilitating the adoption of tobacco policies or programs in schools from 1992 to 2012. The search yielded 1028 results, with one relevant systematic review being identified. The review included two controlled studies examining the implementation and dissemination of tobacco prevention programs and guidelines. The two randomised trials examined the delivery of active face-to-face training to implement a school-based curriculum compared with video-delivered or mail-based training. Improvements in the implementation of the programs were reported for the face-to-face training arm in both trials. Little rigorous evidence exists to guide the implementation and dissemination of tobacco prevention programs in schools. SO WHAT? Few systematic reviews exist to inform the implementation of evidence-based tobacco prevention programs in schools. In the absence of a strong evidence base, health care policymakers and practitioners may need to draw on setting-based frameworks or parallel evidence from other settings to design strategies to facilitate the adoption of tobacco prevention initiatives.

CDC Activities for Improving Implementation of Human Papillomavirus Vaccination, Cervical Cancer Screening, and Surveillance Worldwide.

PubMed

Senkomago, Virginia; Duran, Denise; Loharikar, Anagha; Hyde, Terri B; Markowitz, Lauri E; Unger, Elizabeth R; Saraiya, Mona

2017-12-01

Cervical cancer incidence and mortality rates are high, particularly in developing countries. Most cervical cancers can be prevented by human papillomavirus (HPV) vaccination, screening, and timely treatment. The US Centers for Disease Control and Prevention (CDC) provides global technical assistance for implementation and evaluation of HPV vaccination pilot projects and programs and laboratory-related HPV activities to assess HPV vaccines. CDC collaborates with global partners to develop global cervical cancer screening recommendations and manuals, implement screening, create standardized evaluation tools, and provide expertise to monitor outcomes. CDC also trains epidemiologists in cancer prevention through its Field Epidemiology Training Program and is working to improve cancer surveillance by supporting efforts of the World Health Organization in developing cancer registry hubs and assisting countries in estimating costs for developing population-based cancer registries. These activities contribute to the Global Health Security Agenda action packages to improve immunization, surveillance, and the public health workforce globally.

Evaluating the impact of implementation factors on family-based prevention programming: methods for strengthening causal inference.

PubMed

Crowley, D Max; Coffman, Donna L; Feinberg, Mark E; Greenberg, Mark T; Spoth, Richard L

2014-04-01

Despite growing recognition of the important role implementation plays in successful prevention efforts, relatively little work has sought to demonstrate a causal relationship between implementation factors and participant outcomes. In turn, failure to explore the implementation-to-outcome link limits our understanding of the mechanisms essential to successful programming. This gap is partially due to the inability of current methodological procedures within prevention science to account for the multitude of confounders responsible for variation in implementation factors (i.e., selection bias). The current paper illustrates how propensity and marginal structural models can be used to improve causal inferences involving implementation factors not easily randomized (e.g., participant attendance). We first present analytic steps for simultaneously evaluating the impact of multiple implementation factors on prevention program outcome. Then, we demonstrate this approach for evaluating the impact of enrollment and attendance in a family program, over and above the impact of a school-based program, within PROSPER, a large-scale real-world prevention trial. Findings illustrate the capacity of this approach to successfully account for confounders that influence enrollment and attendance, thereby more accurately representing true causal relations. For instance, after accounting for selection bias, we observed a 5% reduction in the prevalence of 11th grade underage drinking for those who chose to receive a family program and school program compared to those who received only the school program. Further, we detected a 7% reduction in underage drinking for those with high attendance in the family program.

Program and Teacher Characteristics Predicting the Implementation of Banking Time with Preschoolers Who Display Disruptive Behaviors.

PubMed

Williford, Amanda P; Wolcott, Catherine Sanger; Whittaker, Jessica Vick; Locasale-Crouch, Jennifer

2015-11-01

This study examined the relationship among baseline program and teacher characteristics and subsequent implementation of Banking Time. Banking Time is a dyadic intervention intended to improve a teacher's interaction quality with a specific child. Banking Time implementation was examined in the current study using a sample of 59 teachers and preschool children displaying disruptive behaviors in the classroom (~three children per classroom). Predictors included preschool program type, teacher demographic characteristics (personal and professional), and teacher beliefs (self-efficacy, authoritarian beliefs, and negative attributions about child disruptive behavior). Multiple measures and methods (i.e., teacher report, consultant report, independent observations) were used to assess implementation. We created three implementation composite measures (dosage, quality, and generalized practice) that had high internal consistencies within each composite but were only modestly associated with one another, suggesting unique constructs of implementation. We found that type of preschool program was associated with dosage and quality. Aspects of teacher demographics related to all three implementation composites. Teacher beliefs predicted dosage and generalized practice. Results suggest that the factors that predict the implementation of Banking Time vary as a function of the type of implementation being assessed.

Design and implementation of population-based specialty care programs.

PubMed

Botts, Sheila R; Gee, Michael T; Chang, Christopher C; Young, Iris; Saito, Logan; Lyman, Alfred E

2017-09-15

The development, implementation, and scaling of 3 population-based specialty care programs in a large integrated healthcare system are reviewed, and the role of clinical pharmacy services in ensuring safe, effective, and affordable care is highlighted. The Kaiser Permanente (KP) integrated healthcare delivery model allows for rapid development and expansion of innovative population management programs involving pharmacy services. Clinical pharmacists have assumed integral roles in improving the safety and effectiveness of high-complexity, high-cost care for specialty populations. These roles require an appropriate practice scope and are supported by an advanced electronic health record with disease registries and electronic surveillance tools for care-gap identification. The 3 specialty population programs described were implemented to address variation or unrecognized gaps in care for at-risk specialty populations. The Home Phototherapy Program has leveraged internal partnerships with clinical pharmacists to improve access to cost-effective nonpharmacologic interventions for psoriasis and other skin disorders. The Multiple Sclerosis Care Program has incorporated clinical pharmacists into neurology care in order to apply clinical guidelines in a systematic manner. The KP SureNet program has used clinical pharmacists and data analytics to identify opportunities to prevent drug-related adverse outcomes and ensure timely follow-up. Specialty care programs improve quality, cost outcomes, and the patient experience by appropriating resources to provide systematic and targeted care to high-risk patients. KP leverages an integration of people, processes, and technology to develop and scale population-based specialty care. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Designing for Scale: Reflections on Rolling Out Reading Improvement in Kenya and Liberia.

PubMed

Gove, Amber; Korda Poole, Medina; Piper, Benjamin

2017-03-01

Since 2008, the Ministries of Education in Liberia and Kenya have undertaken transitions from small-scale pilot programs to improve reading outcomes among primary learners to the large-scale implementation of reading interventions. The effects of the pilots on learning outcomes were significant, but questions remained regarding whether such large gains could be sustained at scale. In this article, the authors dissect the Liberian and Kenyan experiences with implementing large-scale reading programs, documenting the critical components and conditions of the program designs that affected the likelihood of successfully transitioning from pilot to scale. They also review the design, deployment, and effectiveness of each pilot program and the scale, design, duration, enabling conditions, and initial effectiveness results of the scaled programs in each country. The implications of these results for the design of both pilot and large-scale reading programs are discussed in light of the experiences of both the Liberian and Kenyan programs. © 2017 Wiley Periodicals, Inc.

Development of an asthma disease management program in a children's hospital.

PubMed

Miller, Kelly; Ward-Smith, Peggy; Cox, Karen; Jones, Erika M; Portnoy, Jay M

2003-11-01

The incidence, morbidity, and mortality of asthma have been increasing at an alarming rate, making asthma the most common chronic illness of childhood. An asthma disease management program was developed to improve the care and management of patients with asthma--a comprehensive health care delivery model that was designed to improve the management of patients with asthma was designed and implemented. The goal of the program was to provide high-quality interventions for those children diagnosed with asthma. The asthma disease management program at Children's Mercy Hospital improved the care received, decreased costs, and improved the quality of life for those children with asthma.

Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities.

PubMed

Wells, Kenneth B; Jones, Loretta; Chung, Bowen; Dixon, Elizabeth L; Tang, Lingqi; Gilmore, Jim; Sherbourne, Cathy; Ngo, Victoria K; Ong, Michael K; Stockdale, Susan; Ramos, Esmeralda; Belin, Thomas R; Miranda, Jeanne

2013-10-01

Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors. To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients' mental health-related quality of life (HRQL) and services use. Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles. From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up. Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use. CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p < 0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each p > 0.05). Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.

Data Analysis and Data-Driven Decision-Making Strategies Implemented by Elementary Teachers in Selected Exited Program Improvement Safe Harbor Schools in Southern California

ERIC Educational Resources Information Center

Senger, Karen

2012-01-01

Purpose: The purposes of this study were to investigate and describe how elementary teachers in exited Program Improvement-Safe Harbor schools acquire student achievement data through assessments, the strategies and reflections utilized to make sense of the data to improve student achievement, ensure curriculum and instructional goals are aligned,…

School Improvement Grants: Early Implementation under Way, but Reforms Affected by Short Time Frames. Report to Congressional Requesters. GAO-11-741

ERIC Educational Resources Information Center

Scott, George A.

2011-01-01

The School Improvement Grants (SIG) program, which was created in 2002, funds reforms in the country's lowest-performing schools with the goal of improving student outcomes, such as standardized test scores and graduation rates. Congress greatly increased SIG program funding from $125 million available in fiscal year 2007--the first year the…

Directions in implementation research methods for behavioral and social science.

PubMed

Irwin, Molly; Supplee, Lauren H

2012-10-01

There is a growing interest, by researchers, policymakers, and practitioners, in evidence-based policy and practice. As a result, more dollars are being invested in program evaluation in order to establish "what works," and in some cases, funding is specifically tied to those programs found to be effective. However, reproducing positive effects found in research requires more than simply adopting an evidence-based program. Implementation research can provide guidance on which components of an intervention matter most for program impacts and how implementation components can best be implemented. However, while the body of rigorous research on effective practices continues to grow, research on implementation lags behind. To address these issues, the Administration for Children and Families and federal partners convened a roundtable meeting entitled, Improving Implementation Research Methods for Behavioral and Social Science, in the fall of 2010. This special section of the Journal of Behavioral Health Services & Research includes papers from the roundtable and highlights the role implementation science can play in shedding light on the difficult task of taking evidence-based practices to scale.

The power of engagement: implementation of a career ladder program.

PubMed

Bourgeault, Robert; Newmark, Jason

2012-01-01

At Baystate Health in Massachusetts, the development and implementation of a career ladder program was implemented to reduce turnover and to improve employee satisfaction, morale, and recruitment efforts. There was significant initial expenditure in the program, as a result of promoting the large number of employees with significant experience and seniority. A smaller number of staff are expected to apply for advancement during successive cycles, allowing for decreased incremental expense going forward. Critical to the success of the program was understanding the time commitment, getting senior organizational support and staff buy-in, and justifying the associated expenses. The development and initiation of the program has done much to support a positive work environment with increased morale and higher performance among significant numbers of staff at all levels.

Needs Assessment of Parents of Typical Children Ages 4 to 5 Years Old

ERIC Educational Resources Information Center

Brady, Deon LaMount

2010-01-01

Parent education programs have been very successful in meeting the pre-established goals and expectations of their program without the input of parent participants prior to program implementation. Although programs continue to improve, it is important that programs begin to consider the specific needs of their target population. One parent…

Minnesota 4-H Youth Program Quality Improvement Model

ERIC Educational Resources Information Center

Herman, Margo; Grant, Samantha

2015-01-01

The University of Minnesota Extension Center for Youth Development made an organizational decision in 2011 to invest in a system-wide approach to implement youth program quality into the 4-H program using the Youth Program Quality Assessment (YPQA) tool. This article describes the four key components to the Minnesota Youth Program Quality…

Options and Opportunities: A Community College Educator's Guidebook for Nontraditional Vocational Program Improvement.

ERIC Educational Resources Information Center

Carvell, Fred; And Others

Based upon data collected in a survey of students (N=500) and administrators (N=100) at 12 California community colleges, this guidebook provides background information and implementation strategies for the improved recruitment, retention, and placement of male and female students in non-traditional vocational programs. Part I examines legislation…

78 FR 21908 - Request for Nominations of Members To Serve on the National Advisory Committee on Racial, Ethnic...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-12

... impacting Census survey design and implementation. The Advisory Committee discusses census policies... to the Director of the Census Bureau on the full spectrum of Census surveys and programs. The... communication strategies to reduce program/survey costs, improve coverage and operational efficiency, improve...

The Development and Implementation of an Absentee Improvement Program.

ERIC Educational Resources Information Center

Callahan, Robert K.

For decades, educators have been concerned with the problem of truancy. Accordingly, this report focuses on an absentee improvement program at a rural, lower-middle class, predominantly white elementary school with 722 students that had a history of high truancy, as verified by teachers, the administration, the school counselor, staff, and…

A PLAN FOR EVALUATING MAJOR ACTIVITIES IN GREAT CITIES SCHOOL IMPROVEMENT PROGRAM.

ERIC Educational Resources Information Center

MARBURGER, CARL L.; RASSCHAERT, WILLIAM M.

THE GUIDE IS INTENDED TO ASSIST PROJECT DIRECTORS IN THEIR EFFORTS TO DEVELOP MORE SYSTEMATIC AND THOROUGH EVALUATION DESIGNS FOR THE GREAT CITIES SCHOOL IMPROVEMENT PROGRAM. MAJOR DIMENSIONS OF TEACHING-LEARNING, SCHOOL-COMMUNITY, AND PUPIL-PARENT-TEACHER ACTIVITIES ARE LISTED. MAJOR EVALUATION AREAS ARE IN PUPIL ACHIEVEMENT, IMPLEMENTED BY GROUP…

A Therapeutic Program To Improve the Body Image of Pre-Puberty Exceptional Education Girls.

ERIC Educational Resources Information Center

Pfeiffer, Linda Jo

This practicum designed and implemented a body image improvement program for seven severely emotionally disturbed latency-aged girls. Students participated once per week for 12 weeks in individual art therapy and in group sessions. The practicum incorporated therapeutic art activities with verbal interactions and utilized human growth films,…

Implementation of Lifestyle Modification Program Focusing on Physical Activity and Dietary Habits in a Large Group, Community-Based Setting.

PubMed

Stoutenberg, Mark; Falcon, Ashley; Arheart, Kris; Stasi, Selina; Portacio, Francia; Stepanenko, Bryan; Lan, Mary L; Castruccio-Prince, Catarina; Nackenson, Joshua

2017-06-01

Lifestyle modification programs improve several health-related behaviors, including physical activity (PA) and nutrition. However, few of these programs have been expanded to impact a large number of individuals in one setting at one time. Therefore, the purpose of this study was to determine whether a PA- and nutrition-based lifestyle modification program could be effectively conducted using a large group format in a community-based setting. One hundred twenty-one participants enrolled in a 16-week, community-based lifestyle modification program and separated in small teams of 13 to 17 individuals. Height, weight, fruit and vegetable (FAV) consumption, physical fitness, and several psychosocial measures were assessed before and after the program. Significant improvements in 6-minute walk distance (+68.3 m; p < .001), chair stands (+6.7 repetitions; p < .001), FAV servings (+1.8 servings/day; p < .001), body weight (-3.2 lbs; p < .001), as well as PA social support and eating habits self-efficacy were observed. Our lifestyle modification program was also successful in shifting participants to higher levels of stages of change for nutrition and PA, increasing overall levels of self-efficacy for healthy eating, and improving levels of social support for becoming more active. A lifestyle modification program can be successfully implemented in a community setting using a large group format to improve PA and FAV attitudes and behaviors.

Texas Pulse Oximetry Project: A Multicenter Educational and Quality Improvement Project for Implementation of Critical Congenital Heart Disease Screening Using Pulse Oximetry.

PubMed

Guillory, Charleta; Gong, Alice; Livingston, Judith; Creel, Liza; Ocampo, Elena; McKee-Garrett, Tiffany

2017-07-01

Objective  Critical congenital heart disease (CCHD) is a leading cause of death in infants. Newborn screening (NBS) by pulse oximetry allows early identification of CCHD in asymptomatic newborns. To improve readiness of hospital neonatal birthing facilities for mandatory screening in Texas, an educational and quality improvement (QI) project was piloted to identify an implementation strategy for CCHD NBS in a range of birthing hospitals. Study Design  Thirteen Texas hospitals implemented standardized CCHD screening by pulse oximetry. An educational program was devised and a tool kit was created to facilitate education and implementation. Newborn nursery nurses' knowledge was assessed using a pre- and posttest instrument. Results  The nurses' knowledge assessment improved from 71 to 92.5% ( p  < 0.0001). Of 11,322 asymptomatic newborns screened after 24 hours of age, 11 had a positive screen, with 1 confirmed case of CCHD. Pulse oximetry CCHD NBS had sensitivity of 100%, specificity of 99.91%, false-positive rate of 0.088%, positive predictive value of 9.09%, and negative predictive value of 100%. Conclusion  Our educational program, including a tool kit, QI processes, and standardized pulse oximetry CCHD NBS, is applicable for a range of hospital birthing facilities and may facilitate wide-scale implementation, thereby improving newborn health. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Breathe Easy at Home

PubMed Central

Rosofsky, Anna; Reid, Margaret; Sandel, Megan; Zielenbach, Molly; Murphy, Johnna; Scammell, Madeleine K.

2016-01-01

The Breathe Easy at Home Program enables clinicians to refer asthmatic patients to Boston Inspectional Services Department (ISD) if they suspect housing conditions trigger symptoms. The authors conducted one-on-one interviews with clinicians (n = 10) who referred patients, and focus groups with inspectors from the ISD (n = 9) and a variety of stakeholders (n = 13), to gain insight into program function and implementation. Clinician interviews revealed inconsistencies in enrollment approaches, dissatisfaction with the web-based system, and patient follow-up difficulties. Inspectors identified barriers to working effectively with residents and landlords, and the stakeholder focus group highlighted successes of an unusual institutional collaboration. Interviews and focus groups identified strong and personal rapport between clinicians, inspectors, and patients as key to program retention, and that participating families required additional support throughout the process. Despite recommendations for improvement in program implementation, clinicians, inspectors, and stakeholders felt that the program overall improved both the home environment and asthma outcomes. PMID:28462348

Improving Programs and Outcomes: Implementation Frameworks and Organization Change

ERIC Educational Resources Information Center

Bertram, Rosalyn M.; Blase, Karen A.; Fixsen, Dean L.

2015-01-01

This article presents recent refinements to implementation constructs and frameworks. It updates and clarifies the frequently cited study conducted by the National Implementation Research Network that introduced these frameworks for application in diverse endeavors. As such, it may serve as a historical marker in the rapidly developing science and…

Integrating Program Theory and Systems-Based Procedures in Program Evaluation: A Dynamic Approach to Evaluate Educational Programs

ERIC Educational Resources Information Center

Grammatikopoulos, Vasilis

2012-01-01

The current study attempts to integrate parts of program theory and systems-based procedures in educational program evaluation. The educational program that was implemented, called the "Early Steps" project, proposed that physical education can contribute to various educational goals apart from the usual motor skills improvement. Basic…

Implementing Quality Improvement in Small, Autonomous Primary Care Practices: Implications for the Patient Centered Medical Home

PubMed Central

Arar, Nedal H.; Noel, Polly H.; Leykum, Luci; Zeber, John E.; Romero, Raquel; Parchman, Michael L.

2012-01-01

Background Implementing improvement programs to enhance quality of care within primary care clinics is complex, with limited practical guidance available to help practices during the process. Understanding how improvement strategies can be implemented in primary care is timely given the recent national movement towards transforming primary care into patient-centered medical homes (PCMH). This study examined practice members’ perceptions of the opportunities and challenges associated with implementing changes in their practice. Methods Semi-structured interviews were conducted with a purposive sample of 56 individuals working in 16 small, community-based primary care practices. The interview consisted of open-ended questions focused on participants’ perceptions of: (1) practice vision, (2) perceived need for practice improvement, and (3) barriers that hinder practice improvement. The interviews were conducted at the participating clinics and were tape-recorded, transcribed, and content analyzed. Results Content analysis identified two main domains for practice improvement related to: (1) the process of care, and (2) patients’ involvement in their disease management. Examples of desired process of care changes included improvement in patient tracking/follow-up system, standardization of processes of care, and overall clinic documentations. Changes related to the patients’ involvement in their care included improving (a) health education, and (b) self care management. Among the internal barriers were: staff readiness for change, poor communication, and relationship difficulties among team members. External barriers were: insurance regulations, finances and patient health literacy. Practice Implications Transforming their practices to more patient-centered models of care will be a priority for primary care providers. Identifying opportunities and challenges associated with implementing change is critical for successful improvement programs. Successful strategy for enhancing the adoption and uptake of PCMH elements should leverage areas of concordance between practice members’ perceived needs and planned improvement efforts. PMID:22186171

Employee Development Programs: A Lateral Look at Workplace Learning.

ERIC Educational Resources Information Center

McKenzie, Ann; Hodge, Robyn

1999-01-01

Employee development programs (EDPs) are workplace adult education programs which focus on encouraging personal growth and improving confidence and self-esteem through the provision of leisure-based programs. EDPs are determined by employee needs, offered free of charge, and conducted outside working hours. EDPs were first implemented in the…

Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs

PubMed Central

Freeman, Richard K.; Krasna, Mark J.

2015-01-01

Three models of care are described, including two models of multidisciplinary care for thoracic malignancies. The pros and cons of each model are discussed, the evidence supporting each is reviewed, and the need for more (and better) research into care delivery models is highlighted. Key stakeholders in thoracic oncology care delivery outcomes are identified, and the need to consider stakeholder perspectives in designing, validating and implementing multidisciplinary programs as a vehicle for quality improvement in thoracic oncology is emphasized. The importance of reconciling stakeholder perspectives, and identify meaningful stakeholder-relevant benchmarks is also emphasized. Metrics for measuring program implementation and overall success are proposed. PMID:26380186

Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs.

PubMed

Osarogiagbon, Raymond U; Freeman, Richard K; Krasna, Mark J

2015-08-01

Three models of care are described, including two models of multidisciplinary care for thoracic malignancies. The pros and cons of each model are discussed, the evidence supporting each is reviewed, and the need for more (and better) research into care delivery models is highlighted. Key stakeholders in thoracic oncology care delivery outcomes are identified, and the need to consider stakeholder perspectives in designing, validating and implementing multidisciplinary programs as a vehicle for quality improvement in thoracic oncology is emphasized. The importance of reconciling stakeholder perspectives, and identify meaningful stakeholder-relevant benchmarks is also emphasized. Metrics for measuring program implementation and overall success are proposed.

Acquiring Science and Social Studies Knowledge in Kindergarten Through Fourth Grade: Conceptualization, Design, Implementation, and Efficacy Testing of Content-Area Literacy Instruction (CALI)

PubMed Central

Dombek, Jennifer; Crowe, Elizabeth C.; Spencer, Mercedes; Tighe, Elizabeth L.; Coffinger, Sean; Zargar, Elham; Wood, Taffeta; Petscher, Yaacov

2016-01-01

With national focus on reading and math achievement, science and social studies have received less instructional time. Yet, accumulating evidence suggests that content knowledge is an important predictor of proficient reading. Starting with a design study, we developed Content Area Literacy Instruction (CALI), as an individualized (or personalized) instructional program for kindergarteners through fourth graders to build science and social studies knowledge. We developed CALI to be implemented in general education classrooms, over multiple iterations (n=230 students), using principles of design-based implementation research. The aims were to develop CALI as a usable and feasible instructional program that would, potentially, improve science and social studies knowledge, and could be implemented during the literacy block without negatively affecting students' reading gains (i.e., no opportunity cost). We then evaluated the efficacy of CALI in a randomized controlled field trial with 418 students in kindergarten through fourth grade. Results reveal that CALI demonstrates promise as a useable and feasible instructional individualized general education program, and is efficacious in improving social studies (d=2.2) and science (d=2.1) knowledge, with some evidence of improving oral and reading comprehension skills (d=.125). PMID:28479610

36 CFR 230.3 - National program administration.

Code of Federal Regulations, 2011 CFR

2011-07-01

... implementation of such policy and procedure over the life of the Program. (b) The Chief shall annually distribute... State foresters. (c) Tree planting, tree maintenance, and tree improvement are national priorities for...

36 CFR 230.3 - National program administration.

Code of Federal Regulations, 2010 CFR

2010-07-01

... implementation of such policy and procedure over the life of the Program. (b) The Chief shall annually distribute... State foresters. (c) Tree planting, tree maintenance, and tree improvement are national priorities for...

Air quality management in Mexico.

PubMed

Fernández-Bremauntz, Adrián

2008-01-01

Several significant program and policy measures have been implemented in Mexico over the past 15 yr to improve air quality. This article provides an overview of air quality management strategies in Mexico, including (1) policy initiatives such as vehicle use restrictions, air quality standards, vehicle emissions, and fuel quality standards, and (2) supporting programs including establishment of a national emission inventory, an air pollution episodes program, and the implementation of exposure and health effects studies. Trends in air pollution episodes and ambient air pollutant concentrations are described.

Financial incentives: only one piece of the workplace wellness puzzle comment on "corporate wellness programs: implementation challenges in the modern american workplace".

PubMed

Busum, Kristin Van; Mattke, Soeren

2013-11-01

In this commentary, we argue that financial incentives are only one of many key components that employers should consider when designing and implementing a workplace wellness program. Strategies such as social encouragement and providing token rewards may also be effective in improving awareness and engagement. Should employers choose to utilize financial incentives, they should tailor them to the goals for the program as well as the targeted behaviors and health outcomes.

Implementation of a worksite educational program focused on promoting healthy eating habits.

PubMed

Tanagra, Dimitra; Panidis, Dimitris; Tountas, Yannis; Remoudaki, Elina; Alexopoulos, Evangelos C

2013-01-01

To estimate the effectiveness of a short-term educational-counseling worksite program focused on lipid intake, by monitoring the possible change on nutrition knowledge and eating habits. an 8-week educational program based on the Health Belief Model was implemented in a honey packaging and sales company in Greece. 20 out of the 29 employees initially enrolled completed the program. Knowledge level and eating habits were evaluated prior and after the intervention by the "Nutrition Knowledge Questionnaire" and the "Food Habits Questionnaire". ANOVA, Spearman rho test and paired Wilcoxon test were employed in statistical analysis. Non smokers and those with higher educational level had healthier eating habits. Knowledge following the intervention was significantly improved concerning recommendations and basic food ingredients but as far as eating habits were concerned, scores were not improved significantly, while intake of fried food was increased. Short-term interventions may produce substantial improvement in knowledge but not necessarily modifications in unhealthy eating habits.

Combating Obesity at Community Health Centers (COACH): A Quality Improvement Collaborative for Weight Management Programs

PubMed Central

Wilkes, Abigail E.; John, Priya M.; Vable, Anusha M.; Campbell, Amanda; Heuer, Loretta; Schaefer, Cynthia; Vinci, Lisa; Drum, Melinda L.; Chin, Marshall H.; Quinn, Michael T.; Burnet, Deborah L.

2013-01-01

Community health centers (CHCs) seek effective strategies to address obesity. MidWest Clinicians’ Network partnered with [an academic medical center] to test feasibility of a weight management quality improvement (QI) collaborative. MidWest Clinicians’ Network members expressed interest in an obesity QI program. This pilot study aimed to determine whether the QI model can be feasibly implemented with limited resources at CHCs to improve weight management programs. Five health centers with weight management programs enrolled with CHC staff as primary study participants; this study did not attempt to measure patient outcomes. Participants attended learning sessions and monthly conference calls to build QI skills and share best practices. Tailored coaching addressed local needs. Topics rated most valuable were patient recruitment/retention strategies, QI techniques, evidence-based weight management, motivational interviewing. Challenges included garnering provider support, high staff turnover, and difficulty tracking patient-level data. This paper reports practical lessons about implementing a weight management QI collaborative in CHCs. PMID:23727964

Group cognitive behavioral therapy to improve the quality of care to opioid-treated patients with chronic noncancer pain: a practice improvement project.

PubMed

Whitten, Stacey K; Stanik-Hutt, Julie

2013-07-01

To enhance outcomes of patients with chronic noncancer pain (CNCP) treated with opioids in a primary care setting by implementing an evidence-based quality improvement project. The project consisted of the implementation of a 6-week cognitive behavioral therapy (CBT) program. Twenty-two patients with CNCP completed the program. Impact of the project was evaluated by comparing pre- and postintervention participant self-reports of mood on the Beck Depression Inventory and functional status on the Brief Pain Inventory and Short Form-36. Patient perception of treatment benefit was also measured using the Patient Global Impression of Change. Qualitative provider perceptions of the program were also collected. Paired t-test statistics were used to analyze the data. Mood (including negative attitude, performance difficulty, and physical complaints), and patient impression of treatment benefit improved significantly after CBT was added. Primary care providers reported that the CBT supported their overall management of these complex patients. The addition of a CBT program improved selected outcomes in this self-selected sample of patients with CNCP treated with opioids. ©2012 The Author(s) ©2012 American Association of Nurse Practitioners.

Eat Smart! Ontario's Healthy Restaurant Program: a survey of participating restaurant operators.

PubMed

Macaskill, Lesley A; Dwyer, John J M; Uetrecht, Connie L; Dombrow, Carol

2003-01-01

Eat Smart! Ontario's Healthy Restaurant Program is a standard provincial health promotion program. Public health units grant an award of excellence to restaurants that meet designated standards in nutrition, food safety, and non-smoking seating. The purpose of this study was to assess whether program objectives for participating restaurant operators were achieved during the first year of program implementation, and to obtain operators' recommendations for improving the program. Dillman's tailored design method was used to design a mail survey and implement it among participating operators (n = 434). The design method, which consisted of four mail-outs, yielded a 74% response rate. Fifty percent of respondents operated family-style or quick-service restaurants, and 82% of respondents learned about the program from public health inspectors. Almost all respondents (98%) participated in the program mainly to have their establishments known as clean and healthy restaurants, 65% received and used either point-of-purchase table stands or postcards to promote the program, and 98% planned to continue participating. The respondents' suggestions for improving the program were related to the award ceremony and program materials, media promotion, communication, education, and program standards. Program staff can use the findings to enhance the program.

Will the 'principles of effectiveness' improve prevention practice? Early findings from a diffusion study.

PubMed

Hallfors, D; Godette, D

2002-08-01

This study examines adoption and implementation of the US Department of Education's new policy, the 'Principles of Effectiveness', from a diffusion of innovations theoretical framework. In this report, we evaluate adoption in relation to Principle 3: the requirement to select research-based programs. Results from a sample of 104 school districts in 12 states indicate that many districts appear to be selecting research-based curricula, but that the quality of implementation is low. Only 19% of the responding district coordinators indicated that schools were implementing a research-based curriculum with fidelity. Common problems included lack of teacher training, lack of requisite materials, use of some but not all of the required lessons and teaching strategies, and failure to deliver lessons to age-appropriate student groups. This study represents the first attempt to assess the quality of implementation of research-based programs as required by the Principles of Effectiveness. We conclude that low levels of funding, inadequate infrastructure, decentralized decision making and lack of program guidance have contributed to the slow progress in improving school-based prevention.

Improving Processual Quality in Early Education and Care: Process Findings from the Evaluation of the Benevolent Society's Partnerships in Early Education Program

ERIC Educational Resources Information Center

Valentine, Kylie; Thomson, Cathy

2009-01-01

This paper describes the facilitators and barriers to implementing an attachment-based intervention in early education and care settings, the Partnerships in Early Childhood program (PIEC), based on findings from the process evaluation of its first year of implementation. The paper focuses on four areas: the nature of the partnership and program…

Implementing Task-Based Language Teaching to Integrate Language Skills in an EFL Program at a Colombian University

ERIC Educational Resources Information Center

Córdoba Zúñiga, Eulices

2016-01-01

This article reports the findings of a qualitative research study conducted with six first semester students of an English as a foreign language program in a public university in Colombia. The aim of the study was to implement task-based language teaching as a way to integrate language skills and help learners to improve their communicative…

Undergraduate International Studies and Foreign Language Program

ERIC Educational Resources Information Center

Office of Postsecondary Education, US Department of Education, 2012

2012-01-01

The Undergraduate International Studies and Foreign Language Program provides funds to institutions of higher education, a consortia of such institutions, or partnerships between nonprofit organizations and institutions of higher education to plan, develop, and implement programs that strengthen and improve undergraduate instruction in…

Integrated Analysis Tools for the NERRS System-Wide Monitoring Program Data

EPA Science Inventory

Standardized monitoring programs have vastly improved the quantity and quality of data that form the basis of environmental decision-making. One example is the NOAA-funded National Estuarine Research Reserve System (NERRS) System-wide Monitoring Program (SWMP) that was implement...

Evaluating School Violence Programs. Urban Diversity Series.

ERIC Educational Resources Information Center

Flaxman, Erwin, Ed.

The essays in this collection review information, resources, and guidelines on the basic principles of internal evaluations of school violence programs. This information can help staff with program definition, planning, implementation, continuous improvement, and measurement of outcomes. "Introduction" (Erwin Flaxman) examines types of…

77 FR 70409 - System Safety Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-26

...-0060, Notice No. 2] 2130-AC31 System Safety Program AGENCY: Federal Railroad Administration (FRA... passenger railroads to develop and implement a system safety program (SSP) to improve the safety of their... Division, U.S. Department of Transportation, Federal Railroad Administration, Office of Railroad Safety...

The Dutch 'Focus on Strength' intervention study protocol: programme design and production, implementation and evaluation plan.

PubMed

Ten Hoor, G A; Kok, G; Rutten, G M; Ruiter, R A C; Kremers, S P J; Schols, A M J W; Plasqui, G

2016-06-10

Overweight youngsters are better in absolute strength exercises than their normal-weight counterparts; a physiological phenomenon with promising psychological impact. In this paper we describe the study protocol of the Dutch, school-based program 'Focus on Strength' that aims to improve body composition of 11-13 year old students, and with that to ultimately improve their quality of life. The development of this intervention is based on the Intervention Mapping (IM) protocol, which starts from a needs assessment, uses theory and empirical research to develop a detailed intervention plan, and anticipates program implementation and evaluation. This novel intervention targets first year students in preparatory secondary vocational education (11-13 years of age). Teachers are the program implementers. One part of the intervention involves a 30 % increase of strength exercises in the physical education lessons. The other part is based on Motivational Interviewing, promoting autonomous motivation of students to become more physically active outside school. Performance and change objectives are described for both teachers and students. The effectiveness of the intervention will be tested in a Randomized Controlled Trial in 9 Dutch high schools. Intervention Mapping is a useful framework for program planning a school-based program to improve body composition and motivation to exercise in 11-13 year old adolescents by a "Focus on Strength". NTR5676 , registered 8 February 2016 (retrospectively registered).

Napa River Sediment TMDL Implementation and Habitat Enhancement Project

EPA Pesticide Factsheets

Information about the SFBWQP Napa River Sediment TMDL Implementation and Habitat Enhancement Project, part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

Affecting culture change and performance improvement in Medicaid nursing homes: the Promote Understanding, Leadership, and Learning (PULL) Program.

PubMed

Eliopoulos, Charlotte

2013-01-01

A growing number of nursing homes are implementing culture change programming to create a more homelike environment in which residents and direct care staff are empowered with greater participation in care activities. Although nursing homes that have adopted culture change practices have brought about positive transformation in their settings that have improved quality of care and life, as well as increased resident and staff satisfaction, they represent a minority of all nursing homes. Nursing homes that serve primarily a Medicaid population without supplemental sources of funding have been limited in the resources to support such change processes. The purpose of this project was to gain insight into effective strategies to provide culture change and quality improvement programming to low-performing, under-resourced nursing homes that represent the population of nursing homes least likely to have implemented this programming. Factors that interfered with transformation were identified and insights were gained into factors that need to be considered before transformational processes can be initiated. Effective educational strategies and processes that facilitate change in these types of nursing homes were identified. Despite limitations to the study, there was evidence that the experiences and findings can be of value to other low-performing, under-resourced nursing homes. Ongoing clinical work and research are needed to refine the implementation process and increase the ability to help these settings utilize resources and implement high quality cost effective care to nursing home residents. Copyright © 2013 Mosby, Inc. All rights reserved.

Antimicrobial stewardship programs: how to start and steer a successful program.

PubMed

Drew, Richard H

2009-03-01

Antimicrobial stewardship programs (ASPs) promote the appropriate use of antimicrobials by selecting the appropriate dose, duration, and route of administration. The appropriate use of antimicrobials has the potential to improve efficacy, reduce treatment-related costs, minimize drug-related adverse events, and limit the potential for emergence of antimicrobial resistance. To summarize ASP tactics that can improve the appropriate use of antimicrobials in the hospital setting. Several measures can be used to implement such programs and gain multidisciplinary support while addressing common barriers. Implementation of an ASP requires a multidisciplinary approach with an infectious diseases physician and a clinical pharmacist with infectious diseases training as its core team members. As identified by recently published guidelines, 2 proactive strategies for promoting antimicrobial stewardship include: (1) formulary restriction and pre-authorization, and (2) prospective audit with intervention and feedback. Other supplemental strategies involve education, guidelines and clinical pathways, antimicrobial order forms, de-escalation of therapy, intravenous-to-oral (IV-to-PO) switch therapy, and dose optimization. Several barriers exist to successful implementation of ASPs. These include obtaining adequate administrative support and compensation for team members. Gaining physician acceptance can also be challenging if there is a perceived loss of autonomy in clinical decision making. ASPs have the potential to reduce antimicrobial resistance, health care costs, and drug-related adverse events while improving clinical outcomes. The efforts and expense required to implement and maintain ASPs are more than justified given their potential benefits to both the hospital and the patient.

Developments in Assisting Countries in Implementing the IAEA Additional Protocol

DOE Office of Scientific and Technical Information (OSTI.GOV)

Killinger, Mark H.; Hansen, Linda H.; Cain, Ronald A.

In 2008, the U.S. Department of Energy (DOE) began assisting selected non-nuclear weapon states in planning and preparing for implementation of the International Atomic Energy Agency’s Additional Protocol (AP). Since then, the AP international implementation program has contributed to the substantial progress made by Vietnam, Thailand, Iraq, and Malaysia in preparing for entry-into-force of the AP. An overall engagement plan has been developed with components designed to train government AP implementing agencies, inform policy makers, conduct outreach to industry and universities, make AP reporting software available and useful, and plan a detailed approach for implementing the declaration and complementary accessmore » provisions of the AP. DOE recently began collaborating with Indonesia, which has already entered the AP into force, requiring a second method of engagement somewhat different from that taken with countries that have not entered the AP into force. The AP international implementation program, administered by the International Nuclear Safeguards and Engagement Program, is working more closely with DOE’s International Nonproliferation Export Control Program to ensure countries are aware of and prepared to implement the export/import provisions of the AP. As the AP implementation program matures and helps move countries closer to entry-into-force or improved AP implementation, it is identifying characteristics of a country’s “end-state” that indicate that DOE assistance is no longer required. The U.S. AP Implementation Act and Senate Resolution of Ratification require the Administration to report annually to Congress on measures taken to achieve the adoption of the AP in non-nuclear weapon states. DOE’s AP international implementation program is a significant part of these measures. This paper describes recent developments to increase the scope and effectiveness of the program.« less

Critical Care Statistics

MedlinePlus

... A, Huang SA, Murthy P, et.al. Quality improvement and cost savings after implementation of the Leapfrog ... Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med . 2010 ...

Mindfulness-Based Stress Release Program for University Employees: A Pilot, Waitlist-Controlled Trial and Implementation Replication.

PubMed

Koncz, Rebecca; Wolfenden, Fiona; Hassed, Craig; Chambers, Richard; Cohen, Julia; Glozier, Nicholas

2016-10-01

The aim of this study was to evaluate the effectiveness of a 6-week mindfulness-based stress release program (SRP) on stress and work engagement in fulltime university employees. Perceived stress, workplace wellbeing, and engagement were measured at baseline and within 1 week of the SRP completion, and contemporaneously 6 weeks apart for a waitlist control group. A second program was implemented to examine reproducibility of results. Fifty participants undertook the SRPs, and 29 participants were waitlisted. A significant improvement in distress, workplace wellbeing, and vigor was observed within the first SRP group, when compared with the control group. The improvement in distress and wellbeing was reproduced in the second SRP group. This study adds to the growing body of research that mindfulness may be an effective method for reducing workplace stress, improving employee wellbeing, and enhancing work engagement.

Laboratory quality improvement in Tanzania.

PubMed

Andiric, Linda R; Massambu, Charles G

2015-04-01

The article describes the implementation and improvement in the first groups of medical laboratories in Tanzania selected to participate in the training program on Strengthening Laboratory Management Toward Accreditation (SLMTA). As in many other African nations, the selected improvement plan consisted of formalized hands-on training (SLMTA) that teaches the tasks and skills of laboratory management and provides the tools for implementation of best laboratory practice. Implementation of the improvements learned during training was verified before and after SLMTA with the World Health Organization African Region Stepwise Laboratory Improvement Process Towards Accreditation checklist. During a 4-year period, the selected laboratories described in this article demonstrated improvement with a range of 2% to 203% (cohort I) and 12% to 243% (cohort II) over baseline scores. The article describes the progress made in Tanzania's first cohorts, the obstacles encountered, and the lessons learned during the pilot and subsequent implementations. Copyright© by the American Society for Clinical Pathology.

An Overview of Modifications Applied to a Turbulence Response Analysis Method for Flexible Aircraft Configurations

NASA Technical Reports Server (NTRS)

Funk, Christie J.

2013-01-01

A software program and associated methodology to study gust loading on aircraft exists for a classification of geometrically simplified flexible configurations. This program consists of a simple aircraft response model with two rigid and three flexible symmetric degrees of freedom and allows for the calculation of various airplane responses due to a discrete one-minus-cosine gust as well as continuous turbulence. Simplifications, assumptions, and opportunities for potential improvements pertaining to the existing software program are first identified, then a revised version of the original software tool is developed with improved methodology to include more complex geometries, additional excitation cases, and output data so as to provide a more useful and accurate tool for gust load analysis. Revisions are made in the categories of aircraft geometry, computation of aerodynamic forces and moments, and implementation of horizontal tail mode shapes. In order to improve the original software program to enhance usefulness, a wing control surface and horizontal tail control surface is added, an extended application of the discrete one-minus-cosine gust input is employed, a supplemental continuous turbulence spectrum is implemented, and a capability to animate the total vehicle deformation response to gust inputs in included. These revisions and enhancements are implemented and an analysis of the results is used to validate the modifications.

The impact of parity on major depression treatment quality in the Federal Employees' Health Benefits Program after parity implementation.

PubMed

Busch, Alisa B; Huskamp, Haiden A; Normand, Sharon-Lise T; Young, Alexander S; Goldman, Howard; Frank, Richard G

2006-06-01

Since the 1990s, parity laws have been implemented to reduce inequities in mental health coverage compared with that for general medical conditions. It is unclear if parity under managed care is associated with improvements in mental health treatment quality. Major depressive disorder (MDD) is a prevalent but often undetected and undertreated and thus could potentially benefit from parity implementation. The objective of this study was to examine the association between parity implementation and changes in MDD treatment quality in the Federal Employees' Health Benefits (FEHB) Program. We conducted retrospective analyses of insurance claims data. Logistic regression models estimated quality changes for MDD-diagnosed enrollees from pre- to postparity. Subjects included MDD-diagnosed FEHB insured enrollees, aged 18-64, across multiple states and 6 FEHB plans before (1999-2000) and after (2001-2002) parity implementation. Measures included receipt of any antidepressant or psychotherapy within a given calendar year of diagnosis; receipt of appropriate psychotherapy frequency/intensity and duration; and pharmacotherapy duration during acute-phase treatment episodes. Postparity, several plans improved significantly in the likelihood of receiving antidepressant medication. In the acute-phase episodes, the greatest improvement was seen in the likelihood of follow up >or=4 months. Few or no other changes were observed in the acute-phase treatment intensity or duration quality measures. Parity under managed care was associated with modest improvements. The observed improvements were consistent with secular trends in MDD treatment. Whereas mental health parity is an important policy goal, these results highlight its limitations: improving the financing of care may not be sufficient to improve quality.

A truly healthy bottom line: improving financial results through effective health and productivity programs.

PubMed

Wolff, Shelly

2008-01-01

Financially speaking, an effective, comprehensive, properly executed health and productivity (H&P) program can drive significant business results. Unfortunately, many companies are not getting the same return on their investments in H&P programs as their peers. This article defines program effectiveness and describes the specific activities of employers that have implemented successful H&P strategies leading to improved health, increased productivity and lower benefit costs-and, in turn, higher levels of performance, returns to shareholders and market premium.

Integrated mass transportation system study/definition/implementation program definition

NASA Technical Reports Server (NTRS)

Ransone, R. K.; Deptula, D. A.; Yorke, G. G.

1975-01-01

Specific actions needed to plan and effect transportation system improvements are identified within the constraints of limited financial, energy and land use resources, and diverse community requirements. A specific program is described which would develop the necessary generalized methodology for devising improved transportation systems and evaluate them against specific criteria for intermodal and intramodal optimization. A consistent, generalized method is provided for study and evaluation of transportation system improvements.

Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program--IQIC.

PubMed

Sciarra, Adilia Maria Pires; Croti, Ulisses Alexandre; Batigalia, Fernando

2014-01-01

Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases.

Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program - IQIC

PubMed Central

Sciarra, Adilia Maria Pires; Croti, Ulisses Alexandre; Batigalia, Fernando

2014-01-01

Introduction Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. Objective To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. Methods The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Results Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. Conclusion It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases. PMID:24896168

The tools of an evidence-based culture: implementing clinical-practice guidelines in an Israeli HMO.

PubMed

Kahan, Natan R; Kahan, Ernesto; Waitman, Dan-Andrei; Kitai, Eliezer; Chintz, David P

2009-09-01

Although clinical-practice guidelines (CPGs) are implemented on the assumption that they will improve the quality, efficiency, and consistency of health care, they generally have limited effect in changing physicians' behavior. The purpose of this study was to design and implement an effective program for formulating, promulgating, and implementing CPGs to foster the development of an evidence-based culture in an Israeli HMO. The authors implemented a four-stage program of stepwise collaborative efforts with academic institutions composed of developing quantitative tools to evaluate prescribing patterns, updating CPGs, collecting MDs' input via focus groups and quantitative surveys, and conducting a randomized controlled trial of a two-stage, multipronged intervention. The test case for this study was the development, dissemination, and implementation of CPG for the treatment of acute uncomplicated cystitis in adult women. Interventions in the form of a lecture at a conference and a letter with personalized feedback were implemented, both individually and combined, to improve physicians' rates of prescribing the first-line drug, nitrofurantoin, and, in the absence of nitrofurantoin, adhering to the recommended duration of three days of treatment with ofloxacin. The tools and data-generating capabilities designed and constructed in Stage I of the project were integral components of all subsequent stages of the program. Personalized feedback alone was sufficient to improve the rate of adherence to the guidelines by 19.4% (95% CI = 16.7, 22.1). This study provides a template for introducing the component of experimentation essential for cultivating an evidence-based culture. This process, composed of collaborative efforts between academic institutions and a managed care organization, may be beneficial to other health care systems.

Sequential Multiple Assignment Randomized Trial (SMART) with Adaptive Randomization for Quality Improvement in Depression Treatment Program

PubMed Central

Chakraborty, Bibhas; Davidson, Karina W.

2015-01-01

Summary Implementation study is an important tool for deploying state-of-the-art treatments from clinical efficacy studies into a treatment program, with the dual goals of learning about effectiveness of the treatments and improving the quality of care for patients enrolled into the program. In this article, we deal with the design of a treatment program of dynamic treatment regimens (DTRs) for patients with depression post acute coronary syndrome. We introduce a novel adaptive randomization scheme for a sequential multiple assignment randomized trial of DTRs. Our approach adapts the randomization probabilities to favor treatment sequences having comparatively superior Q-functions used in Q-learning. The proposed approach addresses three main concerns of an implementation study: it allows incorporation of historical data or opinions, it includes randomization for learning purposes, and it aims to improve care via adaptation throughout the program. We demonstrate how to apply our method to design a depression treatment program using data from a previous study. By simulation, we illustrate that the inputs from historical data are important for the program performance measured by the expected outcomes of the enrollees, but also show that the adaptive randomization scheme is able to compensate poorly specified historical inputs by improving patient outcomes within a reasonable horizon. The simulation results also confirm that the proposed design allows efficient learning of the treatments by alleviating the curse of dimensionality. PMID:25354029

The Business Value of Superior Energy Performance

DOE Office of Scientific and Technical Information (OSTI.GOV)

McKane, Aimee; Scheihing, Paul; Evans, Tracy

Industrial facilities participating in the U.S. Department of Energy’s (US DOE) Superior Energy Performance (SEP) program are finding that it provides them with significant business value. This value starts with the implementation of ISO 50001-Energy management system standard, which provides an internationally-relevant framework for integration of energy management into an organization’s business processes. The resulting structure emphasizes effective use of available data and supports continual improvement of energy performance. International relevance is particularly important for companies with a global presence or trading interests, providing them with access to supporting ISO standards and a growing body of certified companies representing themore » collective knowledge of communities of practice. This paper examines the business value of SEP, a voluntary program that builds on ISO 50001, inviting industry to demonstrate an even greater commitment through third-party verification of energy performance improvement to a specified level of achievement. Information from 28 facilities that have already achieved SEP certification will illustrate key findings concerning both the value and the challenges from SEP/ISO 50001 implementation. These include the facilities’ experience with implementation, internal and external value of third-party verification of energy performance improvement; attractive payback periods and the importance of SEP tools and guidance. US DOE is working to bring the program to scale, including the Enterprise-Wide Accelerator (SEP for multiple facilities in a company), the Ratepayer-Funded Program Accelerator (supporting tools for utilities and program administrators to include SEP in their program offerings), and expansion of the program to other sectors and industry supply chains.« less

Design of a continuous quality improvement program to prevent falls among community-dwelling older adults in an integrated healthcare system.

PubMed

Ganz, David A; Yano, Elizabeth M; Saliba, Debra; Shekelle, Paul G

2009-11-16

Implementing quality improvement programs that require behavior change on the part of health care professionals and patients has proven difficult in routine care. Significant randomized trial evidence supports creating fall prevention programs for community-dwelling older adults, but adoption in routine care has been limited. Nationally-collected data indicated that our local facility could improve its performance on fall prevention in community-dwelling older people. We sought to develop a sustainable local fall prevention program, using theory to guide program development. We planned program development to include important stakeholders within our organization. The theory-derived plan consisted of 1) an initial leadership meeting to agree on whether creating a fall prevention program was a priority for the organization, 2) focus groups with patients and health care professionals to develop ideas for the program, 3) monthly workgroup meetings with representatives from key departments to develop a blueprint for the program, 4) a second leadership meeting to confirm that the blueprint developed by the workgroup was satisfactory, and also to solicit feedback on ideas for program refinement. The leadership and workgroup meetings occurred as planned and led to the development of a functional program. The focus groups did not occur as planned, mainly due to the complexity of obtaining research approval for focus groups. The fall prevention program uses an existing telephonic nurse advice line to 1) place outgoing calls to patients at high fall risk, 2) assess these patients' risk factors for falls, and 3) triage these patients to the appropriate services. The workgroup continues to meet monthly to monitor the progress of the program and improve it. A theory-driven program development process has resulted in the successful initial implementation of a fall prevention program.

Increasing Retention of Women in Engineering at WSU: A Model for a Women's Mentoring Program

ERIC Educational Resources Information Center

Poor, Cara J.; Brown, Shane

2013-01-01

Concerns with the retention of women in engineering have led to the implementation of numerous programs to improve retention, including mentoring programs. The college of engineering at Washington State University (WSU) started a novel women's mentoring program in 2008, using professional engineers who graduated from WSU as mentors. The program is…

Enhancing the Programming Experience for First-Year Engineering Students through Hands-On Integrated Computer Experiences

ERIC Educational Resources Information Center

Canfield, Stephen L.; Ghafoor, Sheikh; Abdelrahman, Mohamed

2012-01-01

This paper describes the redesign and implementation of the course, "Introduction to Programming for Engineers" using microcontroller (MCU) hardware as the programming target. The objective of this effort is to improve the programming competency for engineering students by more closely relating the initial programming experience to the student's…

Promoting Teachers' Implementation of Classroom-Based Prevention Programming Through Coaching: The Mediating Role of the Coach-Teacher Relationship.

PubMed

Johnson, Stacy R; Pas, Elise T; Bradshaw, Catherine P; Ialongo, Nicholas S

2018-05-01

There is growing awareness of the importance of implementation fidelity and the supports, such as coaching, to optimize it. This study examined how coaching activities (i.e., check-ins, needs assessment, modeling, and technical assistance) related directly and indirectly to implementation dosage and quality of the PAX Good Behavior Game, via a mediating pathway through working relationship. Mediation analyses of 138 teachers revealed direct effects of modeling and working relationship on implementation dosage, whereas needs assessment was associated with greater dosage indirectly, by higher ratings of the working relationship. Understanding how coaching activities promote implementation fidelity elements has implications for improving program effectiveness.

Development and Evaluation of the Curriculum for BOLD (Bronx Oncology Living Daily) Healthy Living: a Diabetes Prevention and Control Program for Underserved Cancer Survivors.

PubMed

Conlon, Beth A; Kahan, Michelle; Martinez, Melissa; Isaac, Kathleen; Rossi, Amerigo; Skyhart, Rebecca; Wylie-Rosett, Judith; Moadel-Robblee, Alyson

2015-09-01

Underserved minority communities have few resources for addressing comorbidity risk reduction among long-term cancer survivors. To address this community need, we developed and piloted the Bronx Oncology Living Daily (BOLD) Healthy Living program, the first known diabetes prevention and control program to target cancer survivors and co-survivors in Bronx County, NY. The program aimed to facilitate lifestyle change and improve health-related quality of life (HRQoL) through weekly group nutrition education (60-90 min) and exercise (60 min) classes. We examined baseline characteristics of participants using simple descriptive statistics and evaluated program implementation and impact using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. The curriculum, which drew from the social-ecological framework and motivational and cognitive behavioral strategies, consisted of 12 culturally and medically tailored modules with options for implementation as a 12- or 4-week program. Seven programs (four 12 weeks and three 4 weeks in length, respectively) were implemented at five community site locations. Sixty-six cancer survivors and 17 cancer co-survivors (mean age 60.5 ± 10.2 years) enrolled in one of the programs. Most participants were female (95.2 %) minority (55.4 % black, 26.5 % Hispanic/Latino) breast cancer survivors (75.7 %). Median program attendance was 62.5 % and did not significantly differ by program length; however, 67.3 % of participants achieved ≥60 % attendance among the 12-week programs, compared to 41.9 % among the 4-week programs, and this difference was statistically significant (p = 0.02). Overall, participants reported significant pre/post improvements in perceived health as good/excellent (66.0 to 75.5 %; p = 0.001) and borderline significant decreases in perceived pain as moderate/severe (45.5 to 38.2 %; p = 0.05). More than 90 % of participants reported that the program helped them to achieve their short-term goals, motivated them to engage in healthier behaviors, and felt that the nutrition and exercise classes were relevant to their needs. These results indicate that a short-term lifestyle intervention program for adult cancer survivors was acceptable in our community and motivated cancer survivors to improve their HRQoL. The curriculum can be used as a tool to facilitate development of similar programs in the future.

QRIS and Inclusion: Do State QRIS Standards Support the Learning Needs of All Children? CEELO FastFact

ERIC Educational Resources Information Center

Horowitz, Michelle; Squires, Jim

2014-01-01

As the country quickly builds its efforts to enhance quality in early education and care classrooms, states are implementing Quality Rating and Improvement Systems (QRIS) to recognize and improve the quality of programs. QRIS also provides technical support and increased financial benefits for participating programs to attain higher levels of…

A.I.D.P. Part Time Jobs 1988-89. OREA Report.

ERIC Educational Resources Information Center

Mei, Dolores M.; And Others

The Part-Time Jobs portion of the Attendance Improvement Dropout Prevention (AIDP) Program in New York City provided job-readiness training and job placements in an effort to motivate students to improve academic achievement and school attendance. Programs were implemented at schools with a student attendance rate at or below the citywide median…

Developing a Quality Improvement Process to Optimize Faculty Success

ERIC Educational Resources Information Center

Merillat, Linda; Scheibmeir, Monica

2016-01-01

As part of a major shift to embed quality improvement processes within a School of Nursing at a medium-sized Midwestern university, a faculty enrichment program using a Plan-Do-Act-Study design was implemented. A central focus for the program was the development and maintenance of an online faculty resource center identified as "My Faculty…

Effectiveness of Tutoring to Improve Academic Performance in Nursing Students at the University of Seville

ERIC Educational Resources Information Center

Guerra-Martín, María Dolores; Lima-Serrano, Marta; Lima-Rodríguez, Joaquín Salvador

2017-01-01

In response to the increase of Higher Education support provided to tutoring programs, this paper presents the design, implementation and evaluation of a tutoring program to improve the academic performance of at-risk students enrolled in the last year of a nursing degree characterized by academic failure (failed courses). A controlled…

Teacher Reflection in Indonesia: Lessons Learnt from a Lesson Study Program

ERIC Educational Resources Information Center

Suratno, Tatang; Iskandar, Sofyan

2010-01-01

Although reflection is seen as a means to improve teacher professionalism, its practice in Indonesia has a scant regard until the lesson study program was implemented around the year 2005. In Indonesian context, lesson study is a process by which teachers and teacher educators work together to critically improve the quality of classroom practice…

Improving School Leadership through Support, Evaluation, and Incentives: The Pittsburgh Principal Incentive Program. Monograph

ERIC Educational Resources Information Center

Hamilton, Laura S.; Engberg, John; Steiner, Elizabeth D.; Nelson, Catherine Awsumb; Yuan, Kun

2012-01-01

In 2007, the Pittsburgh Public Schools (PPS) received funding from the U.S. Department of Education's Teacher Incentive Fund (TIF) program to implement the Pittsburgh Urban Leadership System for Excellence (PULSE), a set of reforms designed to improve the quality of school leadership throughout the district. A major component of PULSE is the…

Analyzing the Correlation between Data Usage and Student Performance on the Missouri Assessment Program

ERIC Educational Resources Information Center

Cooper, Melissa A.

2012-01-01

School districts are charged with the task of improving standardized test scores and closing the gaps between specific groups of students. Numerous programs, school improvement strategies, changes in instruction and leadership have been implemented to close the gap. Data are becoming more abundant at the state, district, and school levels. Many…

Word Study: A Look at Improving Learning and Retention of Spelling

ERIC Educational Resources Information Center

Dew, Tracy

2012-01-01

The purpose of this paper is to share the effectiveness of the word study program "Words Their Way" (Bear et. al., 2008) to improve spelling retention of first graders in a regular education classroom in the Spring of 2012. After implementing a traditional spelling program and seeing students continuously spell previous spelling words…

Improving Behavior through Differential Reinforcement: A Praise Note System for Elementary School Students

ERIC Educational Resources Information Center

Wheatley, Rikki K.; West, Richard P.; Charlton, Cade T.; Sanders, Richard B.; Smith, Tim G.; Taylor, Matthew J.

2009-01-01

Schools are often in need of low-cost, high-impact strategies to improve student behavior in school common areas. While many behavior management programs exist, there are few resources available to guide the implementation of these programs and ensure they are grounded in evidence-based strategies. Therefore, the current study had two primary…

Variation in the Implementation of California's Full Service Partnerships for Persons with Serious Mental Illness

PubMed Central

Gilmer, Todd P; Katz, Marian L; Stefancic, Ana; Palinkas, Lawrence A

2013-01-01

Objective. This study examined variation in the implementation of California's Full Service Partnerships (FSPs), which are supported housing programs that do “whatever it takes” to improve outcomes among persons with serious mental illness who are homeless or at risk of homelessness. Data Sources/Setting. Ninety-three FSPs in California. Study Design. A mixed methods approach was selected to develop a better understanding of the complexity of the FSP programs. The design structure was a combined explanatory and exploratory sequential design (qual→QUAN→qual) where a qualitative focus group was used to develop a quantitative survey that was followed by qualitative site visits. The survey was used to describe the breadth of variation based on fidelity to the Housing First model, while the site visits were used to provide a depth of information on high- versus low-fidelity programs. Principal Findings. We found substantial variation in implementation among FSPs. Fidelity was particularly low along domains related with housing and service philosophy, indicating that many FSPs implemented a rich array of services but applied housing readiness requirements and did not adhere to consumer choice in housing. Conclusions. There remains room for improvement in the recovery-orientation of FSPs. Fortunately, we have identified several processes by which program managers and counties can increase the fidelity of their programs. PMID:24138021

Cockpit resource management training at People Express

NASA Technical Reports Server (NTRS)

Bruce, Keith D.; Jensen, Doug

1987-01-01

In January 1986 in a continuing effort to maintain and improve flight safety and solve some Cockpit Resource Management (CRM) problems, People Express implemented a new CRM training program. It is a continuously running program, scheduled over the next three years and includes state-of-the-art full-mission simulation (LOFT), semi-annual seminar workshops and a comprehensive academic program authored by Robert W. Mudge of Cockpit Management Resources Inc. That program is outlined and to maximize its contribution to the workshop's goals, is organized into four topic areas: (1) Program content: the essential elements of resource management training; (2) Training methods: the strengths and weaknesses of current approaches; (3) Implementation: the implementation of CRM training; and (4) Effectiveness: the effectiveness of training. It is confined as much as possible to concise descriptions of the program's basic components. Brief discussions of rationale are included, however no attempt is made to discuss or review popular CRM tenets or the supporting research.

Teacher perspectives on implementing and sustaining a handwashing promotion intervention in Western Kenyan primary schools.

PubMed

Graves, Janessa M; Finsness, Erica D; Quick, Robert; Nyando Integrated Child Health And Education Project Niche Study Team; Harris, Julie R; Daniell, William E

School-based handwashing programs are challenging to establish and sustain, especially in low-resource settings. This qualitative study described teacher perspectives associated with implementing and sustaining a handwashing program in primary schools participating in the Nyando Integrated Child Health and Education (NICHE) project. Structured key informant interviews were conducted with teachers. Prevalent concepts and themes were grouped into themes and topic areas using an iterative, open coding approach. Forty-one teacher respondents reported favorable expectations and benefits of handwashing programs. The importance of available resources (e.g., reliable water) was cited as a primary concern. Other challenges included time and personal or institutional financial commitment necessary to ensure program sustainability. Handwashing programs in low-income, rural schools, where infrastructure is lacking and "student ambassadors" extend the intervention to the surrounding community, hold great promise to improve community health. Teachers must have adequate support and resources to implement and sustain the programs.

A Community-Based Sensory Training Program Leads to Improved Experience at a Local Zoo for Children with Sensory Challenges.

PubMed

Kong, Michele; Pritchard, Mallory; Dean, Lara; Talley, Michele; Torbert, Roger; Maha, Julian

2017-01-01

Sensory processing difficulties are common among many special needs children, especially those with autism spectrum disorder (ASD). The sensory sensitivities often result in interference of daily functioning and can lead to social isolation for both the individual and family unit. A quality improvement (QI) project was undertaken within a local zoo to systematically implement a sensory training program targeted at helping special needs individuals with sensory challenges, including those with ASD, Down's syndrome, attention-deficit/hyperactivity disorder, and speech delay. We piloted the program over a 2-year period. The program consisted of staff training, provision of sensory bags and specific social stories, as well as creation of quiet zones. Two hundred family units were surveyed before and after implementation of the sensory training program. In this pilot QI study, families reported increased visitation to the zoo, improved interactions with staff members, and the overall quality of their experience. In conclusion, we are able to demonstrate that a sensory training program within the community zoo is feasible, impactful, and has the potential to decrease social isolation for special needs individuals and their families.

A Community-Based Sensory Training Program Leads to Improved Experience at a Local Zoo for Children with Sensory Challenges

PubMed Central

Kong, Michele; Pritchard, Mallory; Dean, Lara; Talley, Michele; Torbert, Roger; Maha, Julian

2017-01-01

Sensory processing difficulties are common among many special needs children, especially those with autism spectrum disorder (ASD). The sensory sensitivities often result in interference of daily functioning and can lead to social isolation for both the individual and family unit. A quality improvement (QI) project was undertaken within a local zoo to systematically implement a sensory training program targeted at helping special needs individuals with sensory challenges, including those with ASD, Down’s syndrome, attention-deficit/hyperactivity disorder, and speech delay. We piloted the program over a 2-year period. The program consisted of staff training, provision of sensory bags and specific social stories, as well as creation of quiet zones. Two hundred family units were surveyed before and after implementation of the sensory training program. In this pilot QI study, families reported increased visitation to the zoo, improved interactions with staff members, and the overall quality of their experience. In conclusion, we are able to demonstrate that a sensory training program within the community zoo is feasible, impactful, and has the potential to decrease social isolation for special needs individuals and their families. PMID:28966920

Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury.

PubMed

Sekhon, Mypinder S; Gooderham, Peter; Toyota, Brian; Kherzi, Navid; Hu, Vivien; Dhingra, Vinay K; Hameed, Morad S; Chittock, Dean R; Griesdale, Donald E

2017-07-01

Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients. We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.

Participatory Training to Improve Safety and Health in Small Construction Sites in Some Countries in Asia: Development and Application of the WISCON Training Program.

PubMed

Kawakami, Tsuyoshi

2016-08-01

A participatory training program, Work Improvement in Small Construction Sites, was developed to provide practical support measures to the small construction sector. Managers and workers from selected small sites were interviewed about their occupational safety and health risks. The Work Improvement in Small Construction Sites training program comprised a 45-item action checklist, photos, and illustrations showing local examples and group work methods. Pilot training workshops were carried out with workers and employers in Cambodia, Laos, Mongolia, Thailand, and Vietnam. Participants subsequently planned, and using locally available low-cost materials, implemented their own improvements such as hand-made hand trucks to carry heavy materials, removal of projecting nails from timber materials, and fences to protect roof workers from falling. Local Work Improvement in Small Construction Sites trainers consisting of government officials, workers, employers, and nongovernment organization representatives were then trained to implement the Work Improvement in Small Construction Sites training widely. Keys to success were easy-to-apply training tools aiming at immediate, low-cost improvements, and collaboration with various local people's networks. © The Author(s) 2016.

Implementation Science: Understanding and Finding Solutions to Variation in Program Implementation

ERIC Educational Resources Information Center

Nordstrum, Lee E.; LeMahieu, Paul G.; Berrena, Elaine

2017-01-01

Purpose: This paper is one of seven in this volume elaborating upon different approaches to quality improvement in education. This paper aims to delineate a methodology called Implementation Science, focusing on methods to enhance the reach, adoption, use and maintenance of innovations and discoveries in diverse education contexts.…

Fall Prevention for Older Adults Receiving Home Healthcare.

PubMed

Bamgbade, Sarah; Dearmon, Valorie

2016-02-01

Falls pose a significant risk for community-dwelling older adults. Fall-related injuries increase healthcare costs related to hospitalization, diagnostic procedures, and/or surgeries. This article describes a quality improvement project to reduce falls in older adults receiving home healthcare services. The fall prevention program incorporated best practices for fall reduction, including fall risk assessment, medication review/management, home hazard and safety assessment, staff and patient fall prevention education, and an individualized home-based exercise program. The program was implemented and evaluated during a 6-month time frame. Fewer falls occurred post implementation of the falls prevention program with no major injuries.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Simpson, L.; Britt, J.; Birkmire, R.

ITN Energy Systems, Inc., and Global Solar Energy, Inc., assisted by NREL's PV Manufacturing R&D program, have continued to advance CIGS production technology by developing trajectory-oriented predictive/control models, fault-tolerance control, control platform development, in-situ sensors, and process improvements. Modeling activities included developing physics-based and empirical models for CIGS and sputter-deposition processing, implementing model-based control, and applying predictive models to the construction of new evaporation sources and for control. Model-based control is enabled by implementing reduced or empirical models into a control platform. Reliability improvement activities include implementing preventive maintenance schedules; detecting failed sensors/equipment and reconfiguring to tinue processing; and systematicmore » development of fault prevention and reconfiguration strategies for the full range of CIGS PV production deposition processes. In-situ sensor development activities have resulted in improved control and indicated the potential for enhanced process status monitoring and control of the deposition processes. Substantial process improvements have been made, including significant improvement in CIGS uniformity, thickness control, efficiency, yield, and throughput. In large measure, these gains have been driven by process optimization, which in turn have been enabled by control and reliability improvements due to this PV Manufacturing R&D program.« less

77 FR 14726 - Information Collection Request; Economic Assessment of Conservation Reserve Program Lands for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-13

... improve CRP selection criteria and program implementation. Having information on recreation-related jobs... Hunting. OMB Control Number: 0560-NEW. Type of Request: New. Abstract: As specified in the Food...

Attrition in Chronic Disease Self-Management Programs and Self-Efficacy at Enrollment

ERIC Educational Resources Information Center

Verevkina, Nina; Shi, Yunfeng; Fuentes-Caceres, Veronica Alejandra; Scanlon, Dennis Patrick

2014-01-01

Among other goals, the Chronic Disease Self-Management Program (CDSMP) is designed to improve self-efficacy of the chronically ill. However, a substantial proportion of the enrollees often leave CDSMPs before completing the program curriculum. This study examines factors associated with program attrition in a CDSMP implemented in a community…

Using Robotics to Improve Retention and Increase Comprehension in Introductory Programming Courses

ERIC Educational Resources Information Center

Pullan, Marie

2013-01-01

Several college majors, outside of computer science, require students to learn computer programming. Many students have difficulty getting through the programming sequence and ultimately change majors or drop out of college. To deal with this problem, active learning techniques were developed and implemented in a freshman programming logic and…

A Curriculum Program for Infants Six to Twelve Months.

ERIC Educational Resources Information Center

Dickinson, Barbara Gibello

This curriculum program was developed to serve as a guide or reference for those professionals wishing to implement or improve upon a current participation program for parents of 6- to 12-month-old infants. The curriculum program covers such topics as the importance of early stimulation, infants' gross and fine motor development, social/emotional…

76 FR 50969 - Further Inquiry Into Four Issues in the Universal Service Lifeline/Link Up Reform and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... Commission structure the pilot program so that each individual participant tests multiple design elements (e...: designing and implementing a Lifeline/Link Up broadband pilot program to evaluate whether and how Lifeline...; control the size of the program; strengthen program administration and accountability; improve enrollment...

More than attendance: the importance of after-school program quality.

PubMed

Hirsch, Barton J; Mekinda, Megan A; Stawicki, Julieann

2010-06-01

A central theme of the articles featured in this issue is the need to improve the quality of after-school programs. In this commentary, we discuss why student engagement, program characteristics and implementation, staff training, and citywide policy are key considerations in the effort to define and achieve high quality programs for youth.

Evaluating the Impact of Implementation Factors on Family-Based Prevention Programming: Methods for Strengthening Causal Inference

PubMed Central

Crowley, D. Max; Coffman, Donna L.; Feinberg, Mark; Greenberg, Mark; Spoth, Richard

2013-01-01

Despite growing recognition of the important role implementation plays in successful prevention efforts, relatively little work has sought to demonstrate a causal relationship between implementation factors and participant outcomes. In turn, failure to explore the implementation-to-outcome link limits our understanding of the mechanisms essential to successful programming. This gap is partially due to the inability of current methodological procedures within prevention science to account for the multitude of confounders responsible for variation in implementation factors (i.e., selection bias). The current paper illustrates how propensity and marginal structural models can be used to improve causal inferences involving implementation factors not easily randomized (e.g., participant attendance). We first present analytic steps for simultaneously evaluating the impact of multiple implementation factors on prevention program outcome. Then we demonstrate this approach for evaluating the impact of enrollment and attendance in a family program, over and above the impact of a school-based program, within PROSPER, a large scale real-world prevention trial. Findings illustrate the capacity of this approach to successfully account for confounders that influence enrollment and attendance, thereby more accurately representing true causal relations. For instance, after accounting for selection bias, we observed a 5% reduction in the prevalence of 11th grade underage drinking for those who chose to receive a family program and school program compared to those who received only the school program. Further, we detected a 7% reduction in underage drinking for those with high attendance in the family program. PMID:23430578

Improving Outcomes for New York City's Disconnected Youth: Lessons from the Implementation of the Young Adult Literacy Program

ERIC Educational Resources Information Center

Hossain, Farhana; Terwelp, Emily

2015-01-01

In 2008, New York City's Center for Economic Opportunity (CEO) launched the Young Adult Literacy (YAL) program to improve the academic and work-readiness skills of youth who are not in school, do not have a job, and have very low literacy skills. The YAL program targets 16- to 24-year-old young adults who read at the fourth-through eighth-grade…

Assessment of the Housing Improvement Program for Chagas Disease Control in the Northwestern municipalities of Rio Grande do Sul, Brazil.

PubMed

Santos, Cibele Velleda Dos; Bedin, Clenonara; Wilhelms, Tania Stasiak; Villela, Marcos Marreiro

2016-01-01

The Housing Improvement Program for Chagas Disease Control (HIPCDC) was established in 2001 in Northwestern Rio Grande do Sul State, aiming to improve the conditions of the domiciliary and peridomiciliary environments to make them resistant to triatomine colonization. This study aimed to assess the impact of the HIPCDC on triatomine control by developing local population and authority awareness on the issue. The study was conducted by means of questionnaires applied to local authorities and the program beneficiaries. Three municipalities - Ajuricaba, Coronel Barros, and Crissiumal - were visited. A program coordinator from each municipality and 62 individuals from selected households were interviewed. The authorities reported difficulties in the implementation of the program due to differences between the project development period and financial resource availability, in addition to a lack of understanding by the community not included in the program. As for the houses, most improvements were made in the peridomiciliary environments; moreover, construction of 4 new residences, as well as the renovation of others, was also reported. Regarding suggestions to the program, requests for better planning (44.9%) and renovation quality (36.7%) were highlighted. With reference to the presence of triatomine bugs, prior to the HIPCDC adaptations, 12.9% of the respondents reported coming across at least one specimen at home, as compared to 22.6% who found these insects in peridomiciliary areas. Despite reports of difficulties in carrying out the HIPCDC, there was an improvement in the housing conditions, with no triatomine occurrence reports after the program implementation.

What Will Be the Impact of Programs of Study? A Preliminary Assessment Based on Similar Previous Initiatives, State Plans for Implementation, and Career Development Theory

ERIC Educational Resources Information Center

Lewis, Morgan V.; Kosine, Natalie R.

2008-01-01

This publication provides background to inform the implementation of Programs of Study (POS) as required by grantees of funds authorized under the Carl D. Perkins Career and Technical Education Improvement Act of 2006. The report is a review of the evidence on the effectiveness of previous similar initiatives and an examination of the implications…

Quality improvement nursing facilities: a nursing leadership perspective.

PubMed

Adams-Wendling, Linda; Lee, Robert

2005-11-01

The purposes of this study were to characterize the state of quality improvement (QI) in nursing facilities and to identify barriers to improvement from nursing leaders' perspectives. The study employed a non-experimental descriptive design, using closed- and open-ended survey questions in a sample of 51 nursing facilities in a midwestern state. Only two of these facilities had active QI programs. Furthermore, turnover and limited training among these nursing leaders represented major barriers to rapid implementation of such programs. This study is consistent with earlier findings that QI programs are limited in nursing homes.

A training program for anthropometric measurements by a dedicated nutrition support team improves nutritional status assessment of the critically ill child.

PubMed

Valla, Frederic V; Ford-Chessel, Carole; Meyer, Rosan; Berthiller, Julien; Dupenloup, Christine; Follin-Arbelet, Nathalie; Hubert, Anna; Javouhey, Etienne; Peretti, Noel

2015-03-01

The cornerstone of an optimal nutrition approach in PICUs is to evaluate the nutritional status of any patient. Anthropometric measurements and nutritional indices calculation allow for nutritional status assessment, which is not often part of routine management, as it is considered difficult to perform in this setting. We designed a study to evaluate the impact of a training program by the PICU nutritional support team on the implementation of routine anthropometric measurements on our PICU. A prospective study was performed over a 2-year period, which included: a baseline evaluation of nutritional assessment, knowledge, anthropometric measurements (weight, height, and head and mid upper arm circumferences), and nutritional indices calculation in patient files. This was followed by a training program to implement the newly developed nutrition assessment guidelines, which included anthropometrical measurements and also the interpretation of these. The impact of this nutritional assessment program was reviewed annually for 2 years after the implementation. PICU--Lyon, France. PICU nursing and medical staff, and patients admitted in February 2011, 2012, and 2013. Training program. Ninety-nine percent of staff (n = 145) attended the individual teaching. We found significant progress in nutritional awareness and confidence about nutritional assessment following the teaching program. In addition, an improvement in staff knowledge about undernutrition and its consequences were found. We enrolled 41, 55, and 91 patients in 2011, 2012, and 2013, respectively. There was a significant increase in anthropometric measurements during this time: 32%, 65% (p = 0.002), and 96% in 2013 (p < 0.001). Nutritional indices were calculated in 20%, 74% (p < 0.001), and 96% (p < 0.001) of cases. This is the first study, showing that a targeted nutritional assessment teaching program that highlights both the importance and techniques of anthropometrical measurements has successfully been implemented in a PICU. It managed to improve staff knowledge and nutritional practice.

Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives.

PubMed

Whellan, David J; Reed, Shelby D; Liao, Lawrence; Gould, Stuart D; O'connor, Christopher M; Schulman, Kevin A

2007-01-15

Although heart failure disease management (HFDM) programs improve patient outcomes, the implementation of these programs has been limited because of financial barriers. We undertook the present study to understand the economic incentives and disincentives for adoption of disease management strategies from the perspectives of a physician (group), a hospital, an integrated health system, and a third-party payer. Using the combined results of a group of randomized controlled trials and a set of financial assumptions from a single academic medical center, a financial model was developed to compute the expected costs before and after the implementation of a HFDM program by 3 provider types (physicians, hospitals, and health systems), as well as the costs incurred from a payer perspective. The base-case model showed that implementation of HFDM results in a net financial loss to all potential providers of HFDM. Implementation of HFDM as described in our base-case analysis would create a net loss of US dollars 179,549 in the first year for a physician practice, US dollars 464,132 for an integrated health system, and US dollars 652,643 in the first year for a hospital. Third-party payers would be able to save US dollars 713,661 annually for the care of 350 patients with heart failure in a HFDM program. In conclusion, although HFDM programs may provide patients with improved clinical outcomes and decreased hospitalizations that save third-party payers money, limited financial incentives are currently in place for healthcare providers and hospitals to initiate these programs.

Improving clinician confidence and skills: piloting a web-based learning program for clinicians in supportive care screening of cancer patients.

PubMed

Beattie, Jill; Brady, Lisa; Tobias, Tracey

2014-03-01

Lean thinking and quality improvement processes identified a need to develop and implement a short concise web-based program for clinicians to increase their confidence and skills in supportive care screening of cancer patients. An independent pretest-posttest design evaluated the program which consisted of three modules, a self-directed learning quiz, and multimedia. Questionnaires were completed anonymously via SurveyMonkey®. There was an increase in mean scores from pre- to post-program in perceived knowledge (pre M = 1.97 SD = .847; post M = 3.05 SD = .486; 3 months M = 2.72 SD = .575), educational preparedness (pre M = 2.33 SD = .957; post M = 3.45 SD = .510; 3 months M = 3.05 SD = .486), and confidence (pre M = 2.39 SD = .998; post M = 3.32 SD = .646; 3 months M = 3.28 SD = .826), indicating improvement in readiness to implement supportive care screening. The number of participants using the tool increased from 57.57% pre-program to 77.78% 3 months post-program. Overall, participants agreed that screening elicited more patient information (post M = 3.82 SD = 1.006; 3 months M = 3.83 SD = .786) and would assist in addressing patients' supportive care needs (post M = 4.00 SD.926; 3 months M = 3.94 SD = .998). It was unclear whether they had made more appropriate referrals as a result of their participation in the program (post M = 3.29 SD = 1.102; 3 months M = 3.11 SD = .963). The majority of participants agreed that the web-based program provided the required information to implement supportive care screening (post M = 3.83 SD = 1.032; 3 months M = 3.61 SD = .702), and that the quiz helped their learning (post M = 3.68 SD = 1.041; 3 months M = 3.65 SD = .702). This pilot indicates that provision of a short concise web-based program may improve clinicians' confidence and skills to implement supportive care screening with cancer patients. A larger matched-group pretest-posttest study is recommended.

A narrative account of implementation lessons learnt from the dissemination of an up-scaled state-wide child obesity management program in Australia: PEACH™ (Parenting, Eating and Activity for Child Health) Queensland.

PubMed

Croyden, Debbie L; Vidgen, Helen A; Esdaile, Emma; Hernandez, Emely; Magarey, Anthea; Moores, Carly J; Daniels, Lynne

2018-03-13

PEACH™QLD translated the PEACH™ Program, designed to manage overweight/obesity in primary school-aged children, from efficacious RCT and small scale community trial to a larger state-wide program. This paper describes the lessons learnt when upscaling to universal health coverage. The 6-month, family-focussed program was delivered in Queensland, Australia from 2013 to 2016. Its implementation was planned by researchers who developed the program and conducted the RCT, and experienced project managers and practitioners across the health continuum. The intervention targeted parents as the agents of change and was delivered via parent-only group sessions. Concurrently, children attended fun, non-competitive activity sessions. Sessions were delivered by facilitators who received standardised training and were employed by a range of service providers. Participants were referred by health professionals or self-referred in response to extensive promotion and marketing. A pilot phase and a quality improvement framework were planned to respond to emerging challenges. Implementation challenges included engagement of the health system; participant recruitment; and engagement. A total of 1513 children (1216 families) enrolled, with 1122 children (919 families) in the face-to-face program (105 groups in 50 unique venues) and 391 children (297 families) in PEACH™ Online. Self-referral generated 68% of enrolments. Unexpected, concurrent and, far-reaching public health system changes contributed to poor program uptake by the sector (only 56 [53%] groups delivered by publicly-funded health organisations) requiring substantial modification of the original implementation plan. Process evaluation during the pilot phase and an ongoing quality improvement framework informed program adaptations that included changing from fortnightly to weekly sessions aligned with school terms, revision of parent materials, modification of eligibility criteria to include healthy weight children and provision of services privately. Comparisons between pilot versus state-wide waves showed comparable prevalence of families not attending any sessions (25% vs 28%) but improved number of sessions attended (median = 5 vs 7) and completion rates (43% vs 56%). Translating programs developed in the research context to enable implementation at scale is complex and presents substantial challenges. Planning must ensure there is flexibility to accommodate and proactively manage the system changes that are inevitable over time. ACTRN12617000315314 . This trial was registered retrospectively on 28 February, 2017.

The Computer in Performance and Instruction: Or, How to Tell the True Color of a Chameleon.

ERIC Educational Resources Information Center

Davis, Richard

1979-01-01

Discusses such potential uses for the computer in employee training programs as management support for training and performance, training project control, improved design and development methods, training program implementation and delivery, and program evaluation, revision, and maintenance. (JEG)

78 FR 57845 - Notice of Availability (NOA) for Strategic Network Optimization (SNO) Program Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-20

... (NOA) for Strategic Network Optimization (SNO) Program Environmental Assessment AGENCY: Defense Logistics Agency, DoD. ACTION: Notice of Availability (NOA) for Strategic Network Optimization (SNO) Program... implement the SNO initiative for improvements to material distribution network for the Department of Defense...

A Sawmill Manager Adapts To Change With Linear Programming

Treesearch

George F. Dutrow; James E. Granskog

1973-01-01

Linear programming provides guidelines for increasing sawmill capacity and flexibility and for determining stumpagepurchasing strategy. The operator of a medium-sized sawmill implemented improvements suggested by linear programming analysis; results indicate a 45 percent increase in revenue and a 36 percent hike in volume processed.

Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?

PubMed

Lyon, Cheryl

2007-12-01

Background  Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. Objectives  The objectives of the study were to document implementation of best practice in advance care planning in a residential aged care facility using a cycle of audit, feedback and re-audit cycle audit with a clinical audit software program, the Practical Application of Clinical Evidence System. The evidence-based guidelines found in 'Guidelines for a Palliative Approach in Residential Aged Care' were used to inform the process of clinical practice review and to develop a program to implement advance care planning. Results  The pre-implementation audit results showed that advance care planning practice was not based on high level evidence as initial compliance with five audit criteria was 0%. The barriers to implementation that became apparent during the feedback stage included the challenge of creating a culture where advance care planning policy, protocols and guidelines could be implemented, and advance care planning discussions held, by adequately prepared health professionals and carers. Opportunities were made to equip the resident to discuss their wishes with family, friends and healthcare staff. Some residents made the decision to take steps to formally document those wishes and/or appoint a Medical Enduring Power of Attorney to act on behalf of the resident when they are unable to communicate wishes. The post-implementation audit showed a clear improvement as compliance ranged from 15-100% for the five audit criteria. Strong leadership by the project team was effective in engaging staff in this quality improvement program. Conclusion  The outcomes of the project were extremely positive and demonstrate a genuine improvement in practice. All audit criteria indicate that the Manningham Centre is now positively working towards improved practice based on the best available evidence. It is hoped that as the expertise developed during this project is shared, other areas of gerontological practice will be similarly improved and more facilities caring for the older person will embrace evidence-based practice.

Enhanced Recovery After Surgery: A Review.

PubMed

Ljungqvist, Olle; Scott, Michael; Fearon, Kenneth C

2017-03-01

Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient. The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis. The ERAS Society conducts structured implementation programs that are currently in use in more than 20 countries. Local ERAS teams from hospitals are trained to implement ERAS processes. Audit of process compliance and patient outcomes are important features. Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties. Enhanced Recovery After Surgery is an evidence-based care improvement process for surgical patients. Implementation of ERAS programs results in major improvements in clinical outcomes and cost, making ERAS an important example of value-based care applied to surgery.

Resource-stratified implementation of a community-based breast cancer management programme in Peru.

PubMed

Duggan, Catherine; Dvaladze, Allison L; Tsu, Vivien; Jeronimo, Jose; Constant, Tara K Hayes; Romanoff, Anya; Scheel, John R; Patel, Shilpen; Gralow, Julie R; Anderson, Benjamin O

2017-10-01

Breast cancer incidence and mortality rates continue to rise in Peru, with related deaths projected to increase from 1208 in 2012, to 2054 in 2030. Despite improvements in national cancer control plans, various barriers to positive breast cancer outcomes remain. Multiorganisational stakeholder collaboration is needed for the development of functional, sustainable early diagnosis, treatment and supportive care programmes with the potential to achieve measurable outcomes. In 2011, PATH, the Peruvian Ministry of Health, the National Cancer Institute in Lima, and the Regional Cancer Institute in Trujillo collaborated to establish the Community-based Program for Breast Health, the aim of which was to improve breast health-care delivery in Peru. A four-step, resource-stratified implementation strategy was used to establish an effective community-based triage programme and a practical early diagnosis scheme within existing multilevel health-care infrastructure. The phased implementation model was initially developed by the Breast Cancer Initiative 2·5: a group of health and non-governmental organisations who collaborate to improve breast cancer outcomes. To date, the Community-based Program for Breast Health has successfully implemented steps 1, 2, and 3 of the Breast Cancer Initiative 2·5 model in Peru, with reports of increased awareness of breast cancer among women, improved capacity for early diagnosis among health workers, and the creation of stronger and more functional linkages between the primary levels (ie, local or community) and higher levels (ie, district, region, and national) of health care. The Community-based Program for Breast Health is a successful example of stakeholder and collaborator involvement-both internal and external to Peru-in the design and implementation of resource-appropriate interventions to increase breast health-care capacity in a middle-income Latin American country. Copyright © 2017 Elsevier Ltd. All rights reserved.

Fifteen years of sector-wide approach (SWAp) in Bangladesh health sector: an assessment of progress

PubMed Central

Ahsan, Karar Zunaid; Streatfield, Peter Kim; Ijdi, Rashida -E-; Escudero, Gabriela Maria; Khan, Abdul Waheed; Reza, M M

2016-01-01

The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh embarked on a sector-wide approach (SWAp) modality for the health, nutrition and population (HNP) sector in 1998. This programmatic shift initiated a different set of planning disciplines and practices along with institutional changes in the MOHFW. Over the years, the SWAp modality has evolved in Bangladesh as the MOHFW has learnt from its implementation and refined the program design. This article explores the progress made, both in terms of achievement of health outcomes and systems strengthening results, since the implementation of the SWAp for Bangladesh’s health sector. Secondary analyses of survey data from 1993 to 2011 as well as a literature review of published and grey literature on health SWAp in Bangladesh was conducted for this assessment. Results of the assessment indicate that the MOHFW made substantial progress in health outcomes and health systems strengthening. SWAps facilitated the alignment of funding and technical support around national priorities, and improved the government’s role in program design as well as in implementation and development partner coordination. Notable systemic improvements have taken place in the country systems with regards to monitoring and evaluation, procurement and service provision, which have improved functionality of health facilities to provide essential care. Implementation of the SWAp has, therefore, contributed to an accelerated improvement in key health outcomes in Bangladesh over the last 15 years. The health SWAp in Bangladesh offers an example of a successful adaptation of such an approach in a complex administrative structure. Based on the lessons learned from SWAp implementation in Bangladesh, the MOHFW needs to play a stronger stewardship and regulatory role to reap the full benefits of a SWAp in its subsequent programming. PMID:26582744

Clean Water Act (CWA) Action Plan Implementation Priorities: Changes to Improve Water Quality, Increase Compliance and Expand Transparency

EPA Pesticide Factsheets

The Clean Water Act (CWA) Action Plan Implementation Priorities describes the new approaches to revamp the National Pollutant Discharge Elimination System (NPDES) permitting, compliance and enforcement program.Issued May 11, 2011

Using a Theory-guided Learning Collaborative Model to Improve Implementation of EBPs in a State Children’s Mental Health System: A Pilot Study

PubMed Central

Nadeem, Erum; Weiss, Dara; Olin, S. Serene; Hoagwood, Kimberly E.; Horwitz, Sarah M.

2016-01-01

Learning collaboratives (LCs) are used widely to promote implementation of evidence-based practices (EBPs). However, there has been limited research on the effectiveness of LCs and models vary widely in their structure, focus and components. The goal of the present study was to develop and field test a theory-based LC model to augment a state-led, evidence-based training program for clinicians providing mental health services to children. Analysis of implementation outcomes contrasted LC sites to matched comparison sites that participated in the clinical training program alone. Results suggested that clinicians from sites participating in the LC were more highly engaged in the state-led clinical training program and were more likely to complete program requirements. PMID:27167744

Using a Theory-Guided Learning Collaborative Model to Improve Implementation of EBPs in a State Children's Mental Health System: A Pilot Study.

PubMed

Nadeem, Erum; Weiss, Dara; Olin, S Serene; Hoagwood, Kimberly E; Horwitz, Sarah M

2016-11-01

Learning collaboratives (LCs) are used widely to promote implementation of evidence-based practices. However, there has been limited research on the effectiveness of LCs and models vary widely in their structure, focus and components. The goal of the present study was to develop and field test a theory-based LC model to augment a state-led, evidence-based training program for clinicians providing mental health services to children. Analysis of implementation outcomes contrasted LC sites to matched comparison sites that participated in the clinical training program alone. Results suggested that clinicians from sites participating in the LC were more highly engaged in the state-led clinical training program and were more likely to complete program requirements.

Improving the Quality of Academic Services through Implementation of Internal Quality Assurance System in State Institute of Islamic Studies STS Jambi

ERIC Educational Resources Information Center

Iskandar

2017-01-01

Implementation of quality assurance systems in IAIN STS Jambi implemented in early 2012, through the build system of internal quality assurance based on ISO 9001: 2008, in the process of implementation required strong reasons behind not growing atmosphere of academic standards of accreditation of study programs and institutions that are reflected…

Design and implementation of an inpatient disease management program.

PubMed

Cooper, G S; Armitage, K B; Ashar, B; Costantini, O; Creighton, F A; Raiz, P; Wong, R C; Carlson, M D

2000-07-01

To describe the development and implementation of an inpatient disease management program. Prospective observational study. On the basis of opportunities for improving quality or efficiency of inpatient and emergency department care, 4 diagnoses, including congestive heart failure (CHF), gastrointestinal hemorrhage, community-acquired pneumonia and sickle-cell crisis were selected for implementation of a disease management program. For each diagnosis, a task force assembled a disease management team led by a "physician champion" and nurse care manager and identified opportunities for improvement through medical literature review and interviews with caregivers. A limited number of disease-specific guidelines and corresponding interventions were selected with consensus of the team and disseminated to caregivers. Physician and nurse team leaders were actively involved in patient care to facilitate adherence to guidelines. For quarter 2 to 4 of 1997, there were improvements in angiotensin-converting enzyme inhibitor use, daily weight compliance, assessment of left ventricular function, hospital costs, and length of stay for care-managed patients with CHF. Differences in utilization-related outcomes persisted even after adjustment for severity of illness. For the other 3 diagnoses, the observational period was shorter (quarter 4 only), and hence preliminary data showed similar hospital costs and length of stay for care-managed and noncare-managed patients. An interdisciplinary approach to inpatient disease management resulted in substantial improvements in both quality and efficiency of care for patients with CHF. Additional data are needed to determine the program's impact on outcomes of other targeted diagnoses.

Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain

PubMed Central

2014-01-01

Background Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of adherence to the national CPG for low back pain by Dutch physical therapists. Methods We systematically developed a program to improve adherence to the Dutch physical therapy guidelines for low back pain. Based on multi-method formative research, we formulated program and change objectives. Selected theory-based methods of change and practical applications were combined into an intervention program. Implementation and evaluation plans were developed. Results Formative research revealed influential determinants for physical therapists and practice quality managers. Self-regulation was appropriate because both the physical therapists and the practice managers needed to monitor current practice and make and implement plans for change. The program stimulated interaction between practice levels by emphasizing collective goal setting. It combined practical applications, such as knowledge transfer and discussion-and-feedback, based on theory-based methods, such as consciousness raising and active learning. The implementation plan incorporated the wider environment. The evaluation plan included an effect and process evaluation. Conclusions Intervention Mapping is a useful framework for formative data in program planning in the field of clinical guideline implementation. However, a decision aid to select determinants of guideline adherence identified in the formative research to analyse the problem may increase the efficiency of the application of the Intervention Mapping process. PMID:24428945

Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain.

PubMed

Rutten, Geert M; Harting, Janneke; Bartholomew, Leona K; Braspenning, Jozé C; van Dolder, Rob; Heijmans, Marcel Fgj; Hendriks, Erik Jm; Kremers, Stef Pj; van Peppen, Roland Ps; Rutten, Steven Tj; Schlief, Angelique; de Vries, Nanne K; Oostendorp, Rob Ab

2014-01-15

Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of adherence to the national CPG for low back pain by Dutch physical therapists. We systematically developed a program to improve adherence to the Dutch physical therapy guidelines for low back pain. Based on multi-method formative research, we formulated program and change objectives. Selected theory-based methods of change and practical applications were combined into an intervention program. Implementation and evaluation plans were developed. Formative research revealed influential determinants for physical therapists and practice quality managers. Self-regulation was appropriate because both the physical therapists and the practice managers needed to monitor current practice and make and implement plans for change. The program stimulated interaction between practice levels by emphasizing collective goal setting. It combined practical applications, such as knowledge transfer and discussion-and-feedback, based on theory-based methods, such as consciousness raising and active learning. The implementation plan incorporated the wider environment. The evaluation plan included an effect and process evaluation. Intervention Mapping is a useful framework for formative data in program planning in the field of clinical guideline implementation. However, a decision aid to select determinants of guideline adherence identified in the formative research to analyse the problem may increase the efficiency of the application of the Intervention Mapping process.

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration

PubMed Central

Sullivan, Jennifer L.; Adjognon, Omonyêlé L.; Engle, Ryann L.; Shin, Marlena H.; Afable, Melissa K.; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

2018-01-01

Background: From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. Purpose: The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Methodology: Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. Results: The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. Discussion: This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Implications: Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges. PMID:28125459

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration.

PubMed

Sullivan, Jennifer L; Adjognon, Omonyêlé L; Engle, Ryann L; Shin, Marlena H; Afable, Melissa K; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges.

Road weather management program performance metrics : implementation and assessment.

DOT National Transportation Integrated Search

2009-08-31

Since the late 1990s, the U.S. Department of Transportation (USDOT), Federal Highway Administration (FHWA) has managed a program dedicated to improving the safety, mobility and productivity of the nations surface transportation modes by integra...

Implementation of Interdisciplinary Cancer Rehabilitation

ERIC Educational Resources Information Center

Cromes, G. Fred, Jr.

1978-01-01

Describes an interdisciplinary cancer-rehabilitation program composed of rehabilitation teams that evaluate patients and suggest or provide treatment with the goal of improved quality of life. Issues, problems, and suggested solutions are discussed with implications for other programs. (Author)

Process evaluation of a multifaceted health program aiming to improve physical activity levels and dietary patterns among construction workers.

PubMed

Viester, Laura; Verhagen, Evert A L M; Bongers, Paulien M; van der Beek, Allard J

2014-11-01

To evaluate the process of a health promotion program, aiming to improve physical activity levels and diet among construction workers. The process evaluation was conducted after the RE-AIM framework for the evaluation of the public health impact of health promotion interventions. Effectiveness was assessed on motivational stage-of-change, self-efficacy, and decisional balance for physical activity and dietary behavior. The external validity of the trial was satisfactory with representative reach of workers and adoption of workplace units in the participating construction company. The extent to which the program was implemented as intended was modest. The intervention was effective on participants' progress through stages of behavior change. Based on the RE-AIM dimensions, it is concluded that for construction workers, the program is feasible and potentially effective, but adjustments are required before widespread implementation.

Juggling Act: Re-Planning and Building on Observatory...Simultaneously!

NASA Technical Reports Server (NTRS)

Zavala, Eddie; Daws, Patricia

2011-01-01

SOFIA (Stratospheric Observatory for Infrared Astronomy) is a major SMD program that has been required to meet several requirements and implement major planning and business initiatives overthe past 1 1/2 years, in the midst of system development and flight test phases. The program was required to implementing JCL and EVM simultaneously, as well as undergo a major replan and Standing Review Board - and all without impacting technical schedule progress. The team developed innovative processes that met all the requirements, and improved Program Management process toolsets. The SOFIA team, being subject to all the typical budget constraints, found ways to leverage existing roles in new ways to meet the requirements without creating unmanageable overhead. The team developed strategies and value added processes - such as improved risk identification, structured reserves management, cost/risk integration - so that the effort expended resulted in a positive return to the program.

Improving preventive health services training in chiropractic colleges part II: enhancing outcomes through improved training and accountability processes.

PubMed

Globe, Gary; Redwood, Daniel; Brantingham, James W; Hawk, Cheryl; Terre, Lisa; Globe, Denise; Mayer, Stephan

2009-01-01

Over the past decade, chiropractic colleges have introduced clinical prevention services (CPS) training. This has included an updated public health curriculum and procedures for student interns to determine the need for preventive services and to provide these services directly or through referral to other health professionals. The purpose of this study was to evaluate the effect of a program to train chiropractic interns to deliver CPS to patients. Program evaluation used retrospective chart review, comparing the proportion of patients receiving CPS recommendations before and after implementation of the program. The main outcome measures were the percentage of appropriate CPS recommendations based upon chart reviews. Chart reviews in 2006 indicated appropriate CPS recommendations in 47.4% of cases (295/623). Chart reviews in 2007, after an additional year of sustained implementation of procedures to ensure intern and faculty accountability, showed appropriate counseling recommendations in 87% of files (137/156). Requiring interns to attend didactic presentations on CPS had no measurable effect on their performance. Major improvements occurred after a series of clinically relevant training interventions; new forms and audit procedures were implemented to increase intern and clinical faculty accountability.

The BetterBirth Program: Pursuing Effective Adoption and Sustained Use of the WHO Safe Childbirth Checklist Through Coaching-Based Implementation in Uttar Pradesh, India

PubMed Central

Kara, Nabihah; Firestone, Rebecca; Kalita, Tapan; Gawande, Atul A; Kumar, Vishwajeet; Kodkany, Bhala; Saurastri, Rajiv; Pratap Singh, Vinay; Maji, Pinki; Karlage, Ami; Hirschhorn, Lisa R; Semrau, Katherine EA

2017-01-01

Shifting childbirth into facilities has not improved health outcomes for mothers and newborns as significantly as hoped. Improving the quality and safety of care provided during facility-based childbirth requires helping providers to adhere to essential birth practices—evidence-based behaviors that reduce harm to and save lives of mothers and newborns. To achieve this goal, we developed the BetterBirth Program, which we tested in a matched-pair, cluster-randomized controlled trial in Uttar Pradesh, India. The goal of this intervention was to improve adoption and sustained use of the World Health Organization Safe Childbirth Checklist (SCC), an organized collection of 28 essential birth practices that are known to improve the quality of facility-based childbirth care. Here, we describe the BetterBirth Program in detail, including its 4 main features: implementation tools, an implementation strategy of coaching, an implementation pathway (Engage-Launch-Support), and a sustainability plan. This coaching-based implementation of the SCC motivates and empowers care providers to identify, understand, and resolve the barriers they face in using the SCC with the resources already available. We describe important lessons learned from our experience with the BetterBirth Program as it was tested in the BetterBirth Trial. For example, the emphasis on relationship building and respect led to trust between coaches and birth attendants and helped influence change. In addition, the cloud-based data collection and feedback system proved a valuable asset in the coaching process. More research on coaching-based interventions is required to refine our understanding of what works best to improve quality and safety of care in various settings. (After publication of this article, the impact results of the BetterBirth intervention were published in the New England Journal of Medicine [volume 377, pages 2313-2324, doi: 10.1056/NEJMoa1701075]. The results showed that the intervention had no significant effect on maternal or perinatal mortality or maternal morbidity, despite having positive effects on essential birth practices.) PMID:28655801

Moving the Needle on Program Quality: An Examination of the Organizational Characteristics That Drive Improvement in Expanded Learning Programs

ERIC Educational Resources Information Center

McCormick, Silvana

2017-01-01

Program evaluation can play a critical role in supporting high quality implementation of social programs to help them achieve their goal of social impact. Evaluation scholars have developed a wide range of strategies to help build programs' internal evaluation capacity in an effort to support meaningful use of evaluation. However, the evaluation…

Implementation of the first wellness-fitness evaluation for the Dallas Fire-Rescue Department

PubMed Central

Seals, Norman; Martin, JoAnn; Russell, Bryan

2010-01-01

More than 100 firefighters lose their lives in the line of duty each year; many of these deaths are caused by cardiovascular events and underlying coronary heart disease. In addition, firefighters are at higher-than-normal risk of developing certain types of cancer. To improve health and fitness among its firefighters, the Dallas Fire-Rescue Department developed and implemented an annual wellness-fitness program in 2008. The program detected and addressed medical issues including coronary disease, hypertension, high triglyceride levels, high cholesterol, high blood glucose levels, and hematuria. Prostate, thyroid, breast, kidney, and bladder cancers were also detected. By identifying these issues, engaging the firefighters' personal physicians, and recommending individualized treatment plans, this program may have extended lives and improved the quality of life for the firefighters. PMID:20671818

Implementation of the first wellness-fitness evaluation for the Dallas Fire-Rescue Department.

PubMed

Winter, F David; Seals, Norman; Martin, Joann; Russell, Bryan

2010-07-01

More than 100 firefighters lose their lives in the line of duty each year; many of these deaths are caused by cardiovascular events and underlying coronary heart disease. In addition, firefighters are at higher-than-normal risk of developing certain types of cancer. To improve health and fitness among its firefighters, the Dallas Fire-Rescue Department developed and implemented an annual wellness-fitness program in 2008. The program detected and addressed medical issues including coronary disease, hypertension, high triglyceride levels, high cholesterol, high blood glucose levels, and hematuria. Prostate, thyroid, breast, kidney, and bladder cancers were also detected. By identifying these issues, engaging the firefighters' personal physicians, and recommending individualized treatment plans, this program may have extended lives and improved the quality of life for the firefighters.

North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.

PubMed

Werth, S Rose; Sachdeva, Nidhi; Roberts, Andrew W; Garrettson, Mariana; Ringwalt, Chris; Moss, Leslie A; Pikoulas, Theodore; Skinner, Asheley Cockrell

2014-11-01

The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits.  To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.  We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability.  Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists.  Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.

Innovative tools and techniques in identifying highway safety improvement projects : technical report.

DOT National Transportation Integrated Search

2017-08-01

The Highway Safety Improvement Program (HSIP) aims to achieve a reduction in the number and severity of fatalities and serious injury crashes on all public roads by implementing highway safety improvement projects. Although the structure and main com...

Developing a pain management program through continuous improvement strategies.

PubMed

Woodward, Dora

2005-01-01

Pain affects more than one third of cancer patients in the early stages of their disease, dramatically rising above 70% in the advanced stages. Numerous studies have been conducted in the pursuit of cancer pain relief, yet the prevalence of pain persists. This article focuses on a pain management program, developed by a performance improvement team, which addressed the inadequacies of current pain management. Performance improvement activities are described through the process of assessment, planning, implementation, and evaluation of the pain management program. This pain management program is uniquely derived from a unit core value that all staff is responsible and accountable for pain management.

Improving Student Reading through Parents' Implementation of a Structured Reading Program

ERIC Educational Resources Information Center

Mitchell, Courtney; Begeny, John C.

2014-01-01

Parent tutoring offers potential as a means for assisting the large percentage of students who need to improve their reading skills. The primary purpose of this study was to examine the impact of a reading fluency intervention program when used by parents in the home during the summer months. Specifically, this study evaluated the effects of the…

The Quality of a "Local Values Based" Fuctional Literacy Program: Its Contribution to the Improvement of the Learner's Basic Competencies

ERIC Educational Resources Information Center

Wahyudin, Uyu

2015-01-01

Literacy facilitators across the archipelago are currently faced with the challenge to integrate local values in functional literacy education programs, because its integration is a new aspect. This makes localized literacy content a hard thing to implement. Yet, if properly conducted, it can lead to improved learner's basic competencies. In an…

Developing the Art of Becoming a Couple: A Grounded Theory Study of the Positive Influence of "Married and Loving It!"[R

ERIC Educational Resources Information Center

Petty, Barbara D.

2010-01-01

Couples can improve their marriages by implementing relationship building skills they learn while participating in a marriage education program. This study addresses how marriages improved as a result of participating in the marriage education program, Married and Loving It![R] and what specific components of the learning experience facilitated…

Improving Students' Word Analysis Skills by Implementing "Working with Words" from the Four Blocks of Literacy Program.

ERIC Educational Resources Information Center

Velasco, Kelly; Zizak, Amanda

This report describes a program for improving word analysis skills in order to increase sight reading, reading accuracy, and fluency. The targeted population consisted of second and third graders in a suburban area close to a large metropolitan city in a Midwestern state. The problems of low word analysis skills were documented through Qualitative…

Extrinsic Motivation for Large-Scale Assessments: A Case Study of a Student Achievement Program at One Urban High School

ERIC Educational Resources Information Center

Emmett, Joshua; McGee, Dean

2013-01-01

The purpose of this case study was to discover the critical attributes of a student achievement program, known as "Think Gold," implemented at one urban comprehensive high school as part of the improvement process. Student achievement on state assessments improved during the period under study. The study draws upon perspectives on…

Effects of a Mathematics Cognitive Acceleration Program on Student Achievement and Motivation

ERIC Educational Resources Information Center

Finau, Teukava; Treagust, David F.; Won, Mihye; Chandrasegaran, A. L.

2018-01-01

This paper presents the effects of a cognitive acceleration program in mathematics classes on Tongan students' achievements, motivation and self-regulation. Cognitive Acceleration in Mathematics Education (CAME) is a program developed at King's College and implemented worldwide with the aim of improving students' thinking skills, mathematics…

Family Night Out: An After School Program.

ERIC Educational Resources Information Center

Boileau, Penny L.

Discovering the value of after-school programs to school improvement initiatives and student achievement, one school district implemented a parent involvement component. Goals identified for the program were: to provide opportunities for parents and school staff to work as partners, and to share information about parent involvement and assets to…

Social Cognitive Theory Recommendations for Improving Modeling in Adolescent Substance Abuse Prevention Programs.

ERIC Educational Resources Information Center

Cleaveland, Bonnie L.

1994-01-01

Current state-of-the-art substance abuse prevention programs are mostly social cognitive theory based. However, there are few publications which review specifically how modeling is applied to adolescent substance abuse prevention programs. This article reviews theoretical considerations for implementing modeling for this purpose. (Author/LKS)

Engagement Theory in Action: An Investigation of Athletic Training Program Directors

ERIC Educational Resources Information Center

Peer, Kimberly S.

2007-01-01

Objective: To examine the use of good practice indicators by athletic training program directors and to provide a theoretical framework using engagement theory, a learner-centered process focusing on program improvement through continuous planning and evaluation, as a foundation for implementing good practices in athletic training education…

Coupons for Success: A Marketing Incentive in Academic Support

ERIC Educational Resources Information Center

Potacco, Donna R.; Chen, Peter; Desroches, Danielle; Chisholm, Daniel R.; De Young, Sandra

2013-01-01

How does a Coupon Incentive Program motivate students to seek academic support in high-risk courses? Results from this study demonstrated that the Coupon Incentive Program was effective in motivating voluntary student attendance and improving student outcomes. Recommendations related to implementation of the Coupon Incentive Program are discussed.…

PEP Up Your PE Program: Writing and Implementing a PEP Grant

ERIC Educational Resources Information Center

McCollum, Starla; Elliott, Steven M.; Burke, Michelle M.; Civalier, Aimee; Pruitt, Wayne; Palmer, Scott

2005-01-01

Physical Education for Progress grants, otherwise known as PEP grants, are part of the Carol M. White Physical Education Program administered by the federal government. PEP grants are available to local educational agencies and community-based organizations to initiate, expand, or improve physical education programs, including after-school…

Understanding How Science Diversity Programs Are Implemented at Two Predominantly White Research Universities

ERIC Educational Resources Information Center

Comella, Bonnie E.

2012-01-01

Over the past 20 years, many colleges and universities have developed diversity support programs aimed at improving underrepresented minority student success in undergraduate science, technology, engineering, and math (STEM) disciplines. Developing such programs is important for facilitating higher minority-graduation rates in STEM and broadening…

Enhancing Student Learning: RN CAT Advisement Program.

ERIC Educational Resources Information Center

Donaldson, Susan K.

This document describes a community college advisement program that was implemented to improve the student pass rate for the national nursing licensure examination. The nursing faculty at Manatee Community College (Florida) recently instituted an advisement system during the final semester of the two-year nursing program. First, students were…

1970-1971 Yearly Report: Consulting Teacher Program; Chittenden South School District.

ERIC Educational Resources Information Center

Vermont Univ., Burlington. Coll. of Education.

Reported are service and research projects which consultants from Vermont's 1970-71 Consulting Teacher Program (Chittenden South) helped teachers to implement to improve the social and academic behaviors of 269 handicapped learners in regular elementary classes. Such program aspects as inservice education, consulting activities, parent…

Challenges and strategies in applying performance measurement to federal public health programs.

PubMed

DeGroff, Amy; Schooley, Michael; Chapel, Thomas; Poister, Theodore H

2010-11-01

Performance measurement is widely accepted in public health as an important management tool supporting program improvement and accountability. However, several challenges impede developing and implementing performance measurement systems at the federal level, including the complexity of public health problems that reflect multiple determinants and involve outcomes that may take years to achieve, the decentralized and networked nature of public health program implementation, and the lack of reliable and consistent data sources and other issues related to measurement. All three of these challenges hinder the ability to attribute program results to specific public health program efforts. The purpose of this paper is to explore these issues in detail and offer potential solutions that support the development of robust and practical performance measures to meet the needs for program improvement and accountability. Adapting performance measurement to public health programs is both an evolving science and art. Through the strategies presented here, appropriate systems can be developed and monitored to support the production of meaningful data that will inform effective decision making at multiple levels. Published by Elsevier Ltd.

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2013 CFR

2013-10-01

... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2014 CFR

2014-10-01

... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

Code of Federal Regulations, 2012 CFR

2012-10-01

... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

Graphics processing unit based computation for NDE applications

NASA Astrophysics Data System (ADS)

Nahas, C. A.; Rajagopal, Prabhu; Balasubramaniam, Krishnan; Krishnamurthy, C. V.

2012-05-01

Advances in parallel processing in recent years are helping to improve the cost of numerical simulation. Breakthroughs in Graphical Processing Unit (GPU) based computation now offer the prospect of further drastic improvements. The introduction of 'compute unified device architecture' (CUDA) by NVIDIA (the global technology company based in Santa Clara, California, USA) has made programming GPUs for general purpose computing accessible to the average programmer. Here we use CUDA to develop parallel finite difference schemes as applicable to two problems of interest to NDE community, namely heat diffusion and elastic wave propagation. The implementations are for two-dimensions. Performance improvement of the GPU implementation against serial CPU implementation is then discussed.

Developing and Implementing Effective Communications Systems: Improving SEA Communication with LEAs, Partners/Vendors, and the Public. Benchmark. No. 2

ERIC Educational Resources Information Center

Brasiel, S.; Nafziger, D.

2013-01-01

State education agencies (SEAs) are central players in initiating and leading new reform efforts and in supporting and implementing Federal initiatives. Traditional approaches to providing public information are not adequate for producing public awareness and support and in supporting program implementation at the local level. With limited…

Development, Validation, and Evaluation of Literacy 3D: A Package Supporting Tier 1 Preschool Literacy Instruction Implementation and Intervention

ERIC Educational Resources Information Center

Greenwood, Charles R.; Abbott, Mary; Beecher, Constance; Atwater, Jane; Petersen, Sarah

2017-01-01

Increasingly, prekindergarten programs with literacy outcome goals are seeking to implement evidence-based practices to improve results. Such efforts require instructional intervention strategies to engage children as well as strategies to support teacher implementation. Reported is the iterative development of Literacy 3D, an enhanced support…

Reproductive Health of Women in Rural Areas of East Azerbaijan - Iran, before and after Implementation of rural Family Physician Program: an Ecologic Study.

PubMed

Alizadeh, Mahasti; Jabbari Birami, Hossein; Moradi, Siavash

2015-12-01

Implementation of rural family physician program in Iran in 2005 has been evaluated and shown that this program has been led to some improvements in health indicators. In this study, some reproductive health (RH) indicators were compared before and after implementation of this program in rural areas of East Azerbaijan, Iran. In this ecologic- time trend study, the data of 191075 births of rural women of East Azerbaijan from 2001 to 2010 was extracted from vital horoscope (ZIJ) and used for calculation of 20 important RH indicators. The paired t-test and correlation analysis wear used for data analysis. Some indicators such as adolescent marriage rate, adolescent birth and over 35 year olds birth rate were increased after rural family physician program implementation in 2005. Also stillbirth rate and unsafe delivery were decreased during this period. There was a significant correlation between increasing adolescent birth rate and increasing low birth weight deliveries (r= 0.911, P= 0.031) and also between increasing over 35 year olds birth rate and increasing neonatal mortality rate in term of prematurity and congenital malformations (r= 0.912, P= 0.031) after program implementation. Perinatal care and safe delivery even for pregnancies outside the typical child-bearing ages are promoting after implementation of rural family physician program in East Azerbaijan. Also decreasing unsafe delivery and stillbirth rate can be considered as achievements of running this program in this province.

An Analysis of Evaluation Plans in a Federally Funded Leadership Preparation Program: Implications for the Improvement of Practice

ERIC Educational Resources Information Center

Sanzo, Karen L.

2012-01-01

This study is a content analysis of selected federally funded leadership preparation program evaluation proposals for the 2008, 2009, and 2010 School Leadership Program grants. The United States Department of Education (USDE) began awarding funding in 2002 to develop and implement preparation programs for aspiring and current assistant principals…

Implementing Welfare-Employment Programs: An Institutional Analysis of the Work Incentive (WIN) Program.

ERIC Educational Resources Information Center

Mitchell, John J.; And Others

Factors that influence the effectiveness of state and local units of the federal Work Incentive (WIN) program were examined to suggest ways to improve the program, which is designed to move recipients of Aid to Families with Dependent Children (AFDC) into productive jobs. Factors studied were organizational, managerial, and service delivery…

STEM Enrichment Programs and Graduate School Matriculation: The Role of Science Identity Salience

ERIC Educational Resources Information Center

Merolla, David M.; Serpe, Richard T.

2013-01-01

Improving the state of science education in the United States has become a national priority. One response to this problem has been the implementation of STEM enrichment programs designed to increase the number of students that enter graduate programs in science. Current research indicates enrichment programs have positive effects for student…

Participants' perceptions of the 1997-1998 Missouri State Parks Passport Program

Treesearch

Yi-Jin Ye; Jaclyn Card

2002-01-01

Service quality is increasingly important to park managers. Recreation and park evaluation measures the implementation and outcome of programs for decision-making. Decisions based on evaluations are often concerned with improving the quality of the program for participants. The purpose of the study was to evaluate the Missouri State Parks Passport Program (MSPPP) by...

The Practice Profile: An All Purpose Tool for Program Communication, Staff Development, Evaluation and Improvement.

ERIC Educational Resources Information Center

Loucks, Susan F.; Crandall, David P.

The practice profile is a standardized, systematic, cost-effective tool for summarizing the components and requirements of a program in a manner that permits comparison with other programs or selection of discrete components from various programs. It provides a component checklist, a precise list of implementation requirements, and a system for…

The Need for Improving Intercultural Collaborative Activities with Structured Institutional Systems of Support

ERIC Educational Resources Information Center

Gahungu, Athanase; Freeman, Karen A.

2015-01-01

Evaluation of an international, grant-funded program must communicate the program's value to a variety of stakeholders: the funder, the agency operating the program and its community, and the citizens of the country where the program is implemented. An intercultural research team can achieve that goal only through a thought-out strategy. This…

Evaluating implementation of the World Health Organization's Strategic Approach to strengthening sexual and reproductive health policies and programs to address unintended pregnancy and unsafe abortion.

PubMed

Rashid, Shusmita; Moore, Julia E; Timmings, Caitlyn; Vogel, Joshua P; Ganatra, Bela; Khan, Dina N; Sayal, Radha; Metin Gülmezoglu, A; Straus, Sharon E

2017-11-21

We conducted a process evaluation to assess how the World Health Organization's (WHO) Strategic Approach to strengthening sexual and reproductive health policies and programs ("the SA") was used in 15 countries that requested WHO's technical support in addressing unintended pregnancy and unsafe abortion. The SA is a three-stage planning, policy, and program implementation process. We used the social ecological model (SEM) to analyze the contextual factors that influenced SA implementation. We used a two-phased sequential approach to data collection and analysis. In Phase A, we conducted a document and literature review and synthesized data thematically. In Phase B, we conducted interviews with stakeholders who used the SA in the countries of interest. We used a qualitative method triangulation technique to analyze and combine data from both phases to understand how the SA was implemented in each country. Data from 145 documents and 19 interviews described the SA process and activities in each country. All 15 countries completed Stage 1 activities. The activities of Stage 1 determined activities in subsequent stages and varied across countries. Following Stage 1, some countries focused on reforming policies to improve access to sexual and reproductive health (SRH) services whereas others focused on improving provider-level capacity to enhance SRH service quality and improving community-level SRH education. We identified factors across SEM levels that affected SA implementation, including individual- and community-level perceptions of using the SA and the recommendations that emerged from its use, organizational capacity to conduct SA activities, and how well these activities aligned with the existing political climate. Stakeholders perceived SA implementation to be country-driven and systematic in bringing attention to important SRH issues in their countries. We identified key success factors for influencing the individual, organization, and system change required for implementing the SA. These include sustaining stakeholder engagement for all SA stages, monitoring and reporting on activities, and leveraging activities and outputs from each SA stage to obtain technical and financial support for subsequent stages. Results may be used to optimize ongoing implementation efforts to improve access to and the quality of SRH services.

Fayette County Better Buildings Initiative

DOE Office of Scientific and Technical Information (OSTI.GOV)

Capella, Arthur

The Fayette County Better Buildings Initiative represented a comprehensive and collaborative approach to promoting and implementing energy efficiency improvements. The initiative was designed to focus on implementing energy efficiency improvements in residential units, while simultaneously supporting general marketing of the benefits of implementing energy efficiency measures. The ultimate goal of Fayette County’s Better Buildings Initiative was to implement a total of 1,067 residential energy efficiency retrofits with a minimum 15% estimated energy efficiency savings per unit. Program partners included: United States Department of Energy, Allegheny Power, and Private Industry Council of Westmoreland-Fayette, Fayette County Redevelopment Authority, and various local partners.more » The program was open to any Fayette County residents who own their home and meet the prequalifying conditions. The level of assistance offered depended upon household income and commitment to undergo a BPI – Certified Audit and implement energy efficiency measures, which aimed to result in at least a 15% reduction in energy usage. The initiative was designed to focus on implementing energy efficiency improvements in residential units, while simultaneously supporting general marketing of the benefits of implementing energy efficiency measures. Additionally, the program had components that involved recruitment and training for employment of persons in the energy sector (green jobs), as well as marketing and implementation of a commercial or community facilities component. The residential component of Fayette County’s Better Buildings Initiative involved a comprehensive approach, providing assistance to low- moderate- and market-rate homeowners. The initiative will also coordinate activities with local utility providers to further incentivize energy efficiency improvements among qualifying homeowners. The commercial component of Fayette County’s Better Building Initiative involved grants and loans to assist up to $15,000 projects per commercial structure with a mixture of a grant and financing at 0% for up to three – (3) years. The maximum award can be a $5,000 grant and a $10,000 loan. For projects less than $15,000, the award will have a ratio of 1/3 grant and 2/3 loan.« less

Antimicrobial Stewardship Program Implementation of a Quality Improvement Intervention Using Real-Time Feedback and an Electronic Order Set for the Management of Staphylococcus aureus Bacteremia.

PubMed

Rosa, Rossana; Zavala, Bruno; Cain, Natalie; Anjan, Shweta; Aragon, Laura; Abbo, Lilian M

2018-03-01

Antimicrobial stewardship programs can optimize the management of Staphylococcus aureus bacteremia by integrating information technology and microbiology laboratory resources. This study describes our experience implementing an intervention consisting of real-time feedback and the use of an electronic order set for the management of S. aureus bacteremia. Infect Control Hosp Epidemiol 2018;39:346-349.

The Effect of a Computer Program Based on Analysis, Design, Development, Implementation and Evaluation (ADDIE) in Improving Ninth Graders' Listening and Reading Comprehension Skills in English in Jordan

ERIC Educational Resources Information Center

Alodwan, Talal; Almosa, Mosaab

2018-01-01

The study aimed to assess the effectiveness of a computer program based on Analysis, Design, Development, Implementation and Evaluation (ADDIE) Model on the achievement of Ninth Graders' listening and Reading Comprehension Skills in English. The study sample comprised 70 ninth graders during the second semester of the academic year 2016/2017. The…

Direct Lending: How To Improve Implementation.

ERIC Educational Resources Information Center

Jepsen, Keith

This evaluation study developed 29 recommendations concerning the implementation of direct loans in providing financial assistance to postsecondary school students. The investigation included examination of a current Department of Education (ED) pilot program, a video teleconference to discuss direct lending with 23 individuals in education…

Evaluation and implementation of highly challenging balance training in clinical practice for people with Parkinson's disease: protocol for the HiBalance effectiveness-implementation trial.

PubMed

Leavy, Breiffni; Kwak, Lydia; Hagströmer, Maria; Franzén, Erika

2017-02-07

If people with progressive neurological diseases are to avail of evidence-based rehabilitation, programs found effective in randomized controlled trials (RCT's) must firstly be adapted and tested in clinical effectiveness studies as a means of strengthening their evidence base. This paper describes the protocol for an effectiveness-implementation trial that will assess the clinical effectiveness of a highly challenging balance training program (the HiBalance program) for people with mild-moderate Parkinson's disease (PD) while simultaneously collecting data concerning the way in which the program is implemented. The HiBalance program is systemically designed to target balance impairments in PD and has been shown effective at improving balance control and gait in a previous RCT. Study aims are to i) determine the effectiveness of the adapted HiBalance program on performance and self-rated outcomes such as balance control, gait and physical activity level ii) conduct a process evaluation of program implementation at the various clinics iii) determine barriers and facilitators to program implementation in these settings. This effectiveness-implementation type 1 hybrid study will use a non-randomized controlled design with consecutive inclusion of people with PD at multiple clinical sites. A mixed method approach will be used to collect clinical effectiveness data and process evaluation data which is both quantitative and qualitative in nature. The consolidated framework for implementation research (CFIR) will be used to guide the planning and collection of data concerning implementation barriers and facilitators. The HiBalance program will be provided by physical therapists as a part of standard rehabilitation care at the clinical sites, while the evaluation of the implementation process will be performed by the research group and funded by research grants. An effectiveness-implementation study design benefits patients by speeding up the process of translating findings from research settings to routine health care. Findings from this study will also be highly relevant for those working with neurological rehabilitation when faced with decisions concerning the translation of training programs from efficacy studies to everyday clinical practice. ClinicalTrials.gov march 2016, NCT02727478 .

Breathe Easy at Home: A Qualitative Evaluation of a Pediatric Asthma Intervention.

PubMed

Rosofsky, Anna; Reid, Margaret; Sandel, Megan; Zielenbach, Molly; Murphy, Johnna; Scammell, Madeleine K

2016-01-01

The Breathe Easy at Home Program enables clinicians to refer asthmatic patients to Boston Inspectional Services Department (ISD) if they suspect housing conditions trigger symptoms. The authors conducted one-on-one interviews with clinicians ( n = 10) who referred patients, and focus groups with inspectors from the ISD ( n = 9) and a variety of stakeholders ( n = 13), to gain insight into program function and implementation. Clinician interviews revealed inconsistencies in enrollment approaches, dissatisfaction with the web-based system, and patient follow-up difficulties. Inspectors identified barriers to working effectively with residents and landlords, and the stakeholder focus group highlighted successes of an unusual institutional collaboration. Interviews and focus groups identified strong and personal rapport between clinicians, inspectors, and patients as key to program retention, and that participating families required additional support throughout the process. Despite recommendations for improvement in program implementation, clinicians, inspectors, and stakeholders felt that the program overall improved both the home environment and asthma outcomes.

A volunteer citizen-servant pilot program using tailored messages to empower Alabamians to live healthier lives.

PubMed

McMillan, Libba R; Smith-Hendricks, Constance; Gore, Teresa

2010-01-01

This study examines the use of tailored messages as a learning tool to volunteer citizen servants to promote health and empower Alabama citizens to live healthier lives. Descriptive data of formative and summative questionnaires were analyzed from convenience sampling in this study, which encompassed 12 months. Researchers formed unique partnerships among community service organizations (CSO), faith-based organizations (FBO), author affiliated school of nursing, and community organizations to implement Healthy People 2010 goals. The program provided "health information stations" to focus on delivery of monthly culturally relevant messages to meet the health needs in the community. This program provided tailored health messages to 11 CSO and FBO. Outcome measures include an increase in health promotion knowledge, desire for furtherance and expansion of programs, and improved contacts within the community. The results from this study provide achievement of overall program goals, suggestions for improved evaluation strategies, implementation plans, and examples of specific topical messages. © 2010 Wiley Periodicals, Inc.

Implementing and Evaluating a Multicomponent Inpatient Diabetes Management Program: Putting Research into Practice

PubMed Central

Munoz, Miguel; Pronovost, Peter; Dintzis, Joanne; Kemmerer, Theresa; Wang, Nae-Yuh; Chang, Yi-Ting; Efird, Leigh; Berenholtz, Sean M.; Golden, Sherita Hill

2013-01-01

Background Strategies for successful implementation of hospitalwide glucose control efforts were addressed in a conceptual model for the development and implementation of an institutional inpatient glucose management program. Conceptual Model Components The Glucose Steering Committee incrementally developed and implemented hospitalwide glucose policies, coupled with targeted education and clinical decision support to facilitate policy acceptance and uptake by staff while incorporating process and outcome measures to objectively assess the effectiveness of quality improvement efforts. The model includes four components: (1) engaging staff and hospital executives in the importance of inpatient glycemic management, (2) educating staff involved in the care of patients with diabetes through structured knowledge dissemination, (3) executing evidence-based inpatient glucose management through development of policies and clinical decision aids, and (4) evaluating intervention effectiveness through assessing process measures, intermediary glucometric outcomes, and clinical and economic outcomes. An educational curriculum for nursing, provider, and pharmacist diabetes education programs and current glucometrics were also developed. Outcomes Overall the average patient-day–weighted mean blood glucose (PDWMBG) was below the currently recommended maximum of 180 mg/dL in patients with diabetes and hyperglycemia, with a significant decrease in PDWMBG of 7.8 mg/dL in patients with hyperglycemia. The program resulted in an 18.8% reduction in hypoglycemia event rates, which was sustained. Conclusion Inpatient glucose management remains an important area for patient safety, quality improvement, and clinical research, and the implementation model should guide other hospitals in their glucose management initiatives. PMID:22649859

Implementing and evaluating a multicomponent inpatient diabetes management program: putting research into practice.

PubMed

Munoz, Miguel; Pronovost, Peter; Dintzis, Joanne; Kemmerer, Theresa; Wang, Nae-Yuh; Chang, Yi-Ting; Efird, Leigh; Berenholtz, Sean M; Golden, Sherita Hill

2012-05-01

Strategies for successful implementation of hospitalwide glucose control efforts were addressed in a conceptual model for the development and implementation of an institutional inpatient glucose management program. CONCEPTUAL MODEL COMPONENTS: The Glucose Steering Committee incrementally developed and implemented hospitalwide glucose policies, coupled with targeted education and clinical decision support to facilitate policy acceptance and uptake by staffwhile incorporating process and outcome measures to objectively assess the effectiveness of quality improvement efforts. The model includes four components: (1) engaging staff and hospital executives in the importance of inpatient glycemic management, (2) educating staff involved in the care of patients with diabetes through structured knowledge dissemination, (3) executing evidence-based inpatient glucose management through development of policies and clinical decision aids, and (4) evaluating intervention effectiveness through assessing process measures, intermediary glucometric outcomes, and clinical and economic outcomes. An educational curriculum for nursing, provider, and pharmacist diabetes education programs and current glucometrics were also developed. Overall the average patient-day-weighted mean blood glucose (PDWMBG) was below the currently recommended maximum of 180 mg/dL in patients with diabetes and hyperglycemia, with a significant decrease in PDWMBG of 7.8 mg/dL in patients with hyperglycemia. The program resulted in an 18.8% reduction in hypoglycemia event rates, which was sustained. Inpatient glucose management remains an important area for patient safety, quality improvement, and clinical research, and the implementation model should guide other hospitals in their glucose management initiatives.

Use of the national surgical quality improvement program to reduce surgical mortality: implementation of intensive preoperative screening and intervention.

PubMed

Konstantinidis, Agathoklis; Fogel, Sandy; Jones, James; Gilliam, Brenda; Kundzins, John; Baker, Christopher

2014-09-01

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data at our institution indicated that surgical mortality was significantly higher than expected. This study examines the effect of implementation of a strict, intensive preoperative screening and intervention process on postoperative mortality at our institution, as measured by the NSQIP. Carilion Roanoke Memorial Hospital (CRMH) is a 763-bed tertiary care hospital serving a population of one million people in southwest Virginia. Data were collected for NSQIP at CRMH from July 2007 to December 2012. In January 2010, a new preoperative process was implemented to include risk assessment and intervention for hypertension, cardiac disease, pulmonary disease, diabetes, renal disease, and obstructive sleep apnea. Before initiation of our preoperative program (July 2007 to January 2010), odds ratios (ORs) for 30-day mortality in general and vascular cases were significantly higher than expected (1.40, 1.43, 1.58, and 1.56 in successive reporting periods). Beginning with the first report after implementation of the preoperative screening program, CRMH showed a progressively decreasing OR for overall 30-day mortality (1.26, 1.19, 1.14, 0.86, 0.82, 0.84, 0.89) with similar reductions in both general (0.92) and vascular (0.92) surgery. The implementation of an intensive preoperative screening and intervention process in our institution was accompanied by a significant decrease in the 30-day mortality for general surgery and vascular procedures, as measured by the NSQIP.

Review Of Implementation In Bunut Shoes Assistance Program In Order Of Micro, Small And Medium Enterprises Economic In Asahan Regency

NASA Astrophysics Data System (ADS)

Saleh Malawat, M.; Putra, M. Umar Maya

2018-03-01

This paper studies the implementation of business opportunities that can improve the revenue of Bunut Shoes Micro, Small and Medium Enterprises. Probit model with E Views 6 program was used to see how far the opportunity of variable efforts to improve the revenue such as education, training, capital assistance, technological procurement of them. The data used was the primary data by conducting a survey using questionnaires to members of them with the observation period from 2013 to 2015. The results showed that all variables of implementation did not have a business opportunity correlation to the increase in revenue and Asahan District Governments are asked to create a creative breakthrough in order to achieve optimal business revenue and cooperate with other private institutions related to increase the business income.

Team Training in the Perioperative Arena: A Methodology for Implementation and Auditing Behavior.

PubMed

Rhee, Amanda J; Valentin-Salgado, Yessenia; Eshak, David; Feldman, David; Kischak, Pat; Reich, David L; LoPachin, Vicki; Brodman, Michael

Preventable medical errors in the operating room are most often caused by ineffective communication and suboptimal team dynamics. TeamSTEPPS is a government-funded, evidence-based program that provides tools and education to improve teamwork in medicine. The study hospital implemented TeamSTEPPS in the operating room and merged the program with a surgical safety checklist. Audits were performed to collect both quantitative and qualitative information on time out (brief) and debrief conversations, using a standardized audit tool. A total of 1610 audits over 6 months were performed by live auditors. Performance was sustained at desired levels or improved for all qualitative metrics using χ 2 and linear regression analyses. Additionally, the absolute number of wrong site/side/person surgery and unintentionally retained foreign body counts decreased after TeamSTEPPS implementation.

Quality of care for patients with type 2 diabetes mellitus in the Netherlands and the United States: a comparison of two quality improvement programs.

PubMed

Valk, Gerlof D; Renders, Carry M; Kriegsman, Didi M W; Newton, Katherine M; Twisk, Jos W R; van Eijk, Jacques Th M; van der Wal, Gerrit; Wagner, Edward H

2004-08-01

To assess differences in diabetes care and patient outcomes by comparing two multifaceted quality improvement programs in two different countries, and to increase knowledge of effective elements of such programs. Primary care in the ExtraMural Clinic (EMC) of the Department of General Practice of the Vrije Universiteit in Amsterdam, the Netherlands, and the Group Health Cooperative (GHC), a group-model health maintenance organization (HMO) in western Washington State in the United States. Data were collected from 1992 to 1997. In this observational study two diabetes cohorts in which a quality improvement program was implemented were compared. Both programs included a medical record system, clinical practice guidelines, physician educational meetings, audit, and feedback. Only the Dutch program (EMC) included guidelines on the structure of diabetes care and a recall system. Only the GHC program included educational outreach visits, formation of multidisciplinary teams, and patient self-management support. Included were 379 EMC patients, and 2,119 GHC patients with type 2 diabetes mellitus. Main process outcomes were: annual number of diabetes visits, and number of HbA1c and blood lipid measurements. Main patient outcomes were HbA1c and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices. In the EMC process outcomes and glycemic control improved more than at GHC, however, GHC had better baseline measures. There were no differences between programs on blood lipid control. During follow-up, intensification of pharmacotherapy was noted at both sites. Differences noted between programs were in line with differences in diabetes guidelines. Following implementation of guidelines and organizational improvement efforts, change occurred primarily in the process outcomes, rather than in the patient outcomes. Although much effort was put into improving process and patient outcomes, both complex programs still showed only moderate effects.

Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative.

PubMed

Haynes, Alex B; Edmondson, Lizabeth; Lipsitz, Stuart R; Molina, George; Neville, Bridget A; Singer, Sara J; Moonan, Aunyika T; Childers, Ashley Kay; Foster, Richard; Gibbons, Lorri R; Gawande, Atul A; Berry, William R

2017-12-01

To determine whether completion of a voluntary, checklist-based surgical quality improvement program is associated with reduced 30-day postoperative mortality. Despite evidence of efficacy of team-based surgical safety checklists in improving perioperative outcomes in research trials, effective methods of population-based implementation have been lacking. The Safe Surgery 2015 South Carolina program was designed to foster state-wide engagement of hospitals in a voluntary, collaborative implementation of a checklist program. We compared postoperative mortality rates after inpatient surgery in South Carolina utilizing state-wide all-payer discharge claims from 2008 to 2013, linked with state vital statistics, stratifying hospitals on the basis of completion of the checklist program. Changes in risk-adjusted 30-day mortality were compared between hospitals, using propensity score-adjusted difference-in-differences analysis. Fourteen hospitals completed the program by December 2013. Before program launch, there was no difference in mortality trends between the completion cohort and all others (P = 0.33), but postoperative mortality diverged thereafter (P = 0.021). Risk-adjusted 30-day mortality among completers was 3.38% in 2010 and 2.84% in 2013 (P < 0.00001), whereas mortality among other hospitals (n = 44) was 3.50% in 2010 and 3.71% in 2013 (P = 0.3281), reflecting a 22% difference between the groups on difference-in-differences analysis (P = 0.0021). Despite similar pre-existing rates and trends of postoperative mortality, hospitals in South Carolina completing a voluntary checklist-based surgical quality improvement program had a reduction in deaths after inpatient surgery over the first 3 years of the collaborative compared with other hospitals in the state. This may indicate that effective large-scale implementation of a team-based surgical safety checklist is feasible.

China's Primary Programs of Terrestrial Ecosystem Restoration: Initiation, Implementation, and Challenges

NASA Astrophysics Data System (ADS)

Yin, Runsheng; Yin, Guiping

2010-03-01

China has undertaken several major programs of terrestrial ecosystem restoration (ERPs) in recent years, including the Natural Forest Protection Program (NFPP) and the Sloping Land Conversion Program (SLCP). There have been reports on the implementation of these programs, their preliminary impacts, and the problems encountered in carrying them out; a great deal has been learned from these studies. Nonetheless, China’s ERPs are not limited to the NFPP and the SLCP. Because a complete documentation and a timely update of these major efforts are still missing from the literature, it is difficult to gauge the scope of these programs and the scale of their impacts. In addition, a more thorough and critical analysis of both the general ERP policy and the specific technical measures used in implementing the ERPs remains urgently needed. The purpose of this article is to tackle these tasks. Overall, with the huge government investments in the ERPs, tremendous progress has been made in implementing them. To complete them successfully and to fundamentally improve the targeted ecosystems, however, it is essential for China to have a more balanced and comprehensive approach to ecological restoration. This approach must include: adopting better planning and management practices; strengthening the governance of program implementation; emphasizing the active engagement of local people; establishing an independent, competent monitoring network; and conducting adequate assessments of program effectiveness and impact.

Integrating Research, Quality Improvement, and Medical Education for Better Handoffs and Safer Care: Disseminating, Adapting, and Implementing the I-PASS Program.

PubMed

Starmer, Amy J; Spector, Nancy D; West, Daniel C; Srivastava, Rajendu; Sectish, Theodore C; Landrigan, Christopher P

2017-07-01

In 2009 the I-PASS Study Group was formed by patient safety, medical education, health services research, and clinical experts from multiple institutions in the United States and Canada. When the I-PASS Handoff Program, which was developed by the I-PASS Study Group, was implemented in nine hospitals, it was associated with a 30% reduction in injuries due to medical errors and significant improvements in handoff processes, without any adverse effects on provider work flow. To effectively disseminate and adapt I-PASS for use across specialties and disciplines, a series of federally and privately funded dissemination and implementation projects were carried out following the publication of the initial study. The results of these efforts have informed ongoing initiatives intended to continue adapting and scaling the program. As of this writing, I-PASS Study Group members have directly worked with more than 50 hospitals to facilitate implementation of I-PASS. To further disseminate I-PASS, Study Group members delivered hundreds of academic presentations, including plenaries at scientific meetings, workshops, and institutional Grand Rounds. Some 3,563 individuals, representing more than 500 institutions in the 50 states in the United States, the District of Columbia, Puerto Rico, and 57 other countries, have requested access to I-PASS materials. Most recently, the I-PASS SM Patient Safety Institute has developed a virtual immersion training platform, mobile handoff observational tools, and processes to facilitate further spread of I-PASS. Implementation of I-PASS has been associated with substantial improvements in patient safety and can be applied to a variety of disciplines and types of patient handoffs. Widespread implementation of I-PASS has the potential to substantially improve patient safety in the United States and beyond. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

A unique funding opportunity for public health in Texas.

PubMed

Schlenker, Thomas; Huber, Carol A

2015-01-01

In addition to the Affordable Care Act, states are more frequently turning to Medicaid waivers to achieve the "Triple Aim" goals of improving the experience of care, improving population health, and reducing per capita costs. These demonstration waivers provide opportunities to test innovative ways to finance and deliver care. Texas is currently implementing a waiver known as the Transformation and Quality Improvement Program. Its inclusion of public health agencies is a unique approach to a system typically limited to traditional providers. San Antonio Metropolitan Health District is one public health agency taking advantage of this new funding opportunity to implement 6 new or expanded programs targeting health issues of highest priority in this south Texas region. This article discusses the use of Medicaid waivers and the advantages and challenges of public health agency participation.

A virtual patient software program to improve pharmacy student learning in a comprehensive disease management course.

PubMed

Douglass, Mark A; Casale, Jillian P; Skirvin, J Andrew; DiVall, Margarita V

2013-10-14

To implement and assess the impact of a virtual patient pilot program on pharmacy students' clinical competence skills. Pharmacy students completed interactive software-based patient case scenarios embedded with drug-therapy problems as part of a course requirement at the end of their third year. Assessments included drug-therapy problem competency achievement, performance on a pretest and posttest, and pilot evaluation survey instrument. Significant improvements in students' posttest scores demonstrated advancement of clinical skills involving drug-therapy problem solving. Students agreed that completing the pilot program improved their chronic disease management skills and the program summarized the course series well. Using virtual patient technology allowed for assessment of student competencies and improved learning outcomes.

Successful international collaboration improves family donation conversations resulting in increased organ donation.

PubMed

Mulvania, P; Mehakovic, E; Wise, C; Cass, Y; Daly, T A; Nathan, H M

2014-01-01

Australian donation leaders recognized that to increase organ donation outcomes, health professionals conducting family donation conversations (FDCs) required support and specialist training. An international training institute with programs based on proven results was engaged to create and implement a customized training program to influence change in FDC practice and culture. The goal was to increase donation rates by developing and implementing a customized, self-sustaining training program to enhance FDC practices of health professionals. Other goals included providing training and communications skills to lead FDC, supporting families in making decisions, and influencing health professionals to adopt FDC practices. To gain support and determine program suitability, two 1-day pilot training sessions were provided to 45 Australian donation leaders in 2011. Training was further customized with an emphasis on creating changes to achieve and sustain desired results. A comprehensive national training plan was implemented over 18 months. Twenty-six 2-day FDC training workshops were held in 8 cities (646 participants). Program evaluations and debriefings showed distinct shifts in perspectives and an enthusiasm to implement new processes. In 2012 to 2013, an instructor program was developed to transition training facilitation. The training institute remains involved in development and training to build and sustain skill and expertise. There was a 58% increase in organ donors in Australia from 2009 to 2013 (data reflect 2013 Australian end-of-year organ donation information). This represents a 36% increase in organ donors (2009-2011); the remaining 22% increase was achieved in the 2 years since the FDC training was implemented in Australia (2011-2013). Improved skills training in the conduct of FDCs seem to have contributed to improved donation outcomes in national identification, request, and consent rates. The integration of another organization's process poses distinct challenges; thoughtful collaboration, sensitive to cultural aspects and family care, communication, and donation practices, can result in successful customized training that shifts perspectives, provides new skills, and achieves and sustains an increase in organ donation rates. Copyright © 2014 Elsevier Inc. All rights reserved.

Development and implementation of a writing program to improve resident authorship rates.

PubMed

Clemmons, Amber Bradley; Hoge, Stephanie C; Cribb, Ashley; Manasco, Kalen B

2015-09-01

The development, implementation, and evaluation of a writing program with a formalized writing project as a component of postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) pharmacy residencies are described. The writing program at Georgia Regents Medical Center/University of Georgia College of Pharmacy, a collaborative and jointly funded program, was initiated in the 2010-11 residency year. The goals of the program are to teach residents to communicate effectively, apply leadership skills, employ project management skills, and provide medication- and practice- related education and training. The program combines both writing experiences and mentorship. At the beginning of the residency year, trainees are presented with opportunities to participate in both research projects and writing projects. Specifically, opportunities within the writing program include involvement in review articles, case reports, drug information rounds, book chapters, letters to the editor, and high-quality medication-use evaluations for potential publication. The writing project is highly encouraged, and completion of a manuscript to be submitted for publication is expected by graduation. Nine papers were published by 8 of 18 PGY1 and PGY2 residents in the four years before program implementation. A total of 23 publications were published by 18 (72%) of the 25 PGY1 and PGY2 residents in the four years after implementation of the writing program. Implementation of a formal writing program increased the overall publication rate of residents. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Chronic disease management in rural and underserved populations: innovation and system improvement help lead to success.

PubMed

Bolin, Jane; Gamm, Larry; Kash, Bita; Peck, Mitchell

2005-03-01

Successful implementation of disease management (DM) is based on the ability of an organization to overcome a variety of barriers to deliver timely, appropriate care of chronic illnesses. Such programs initiate DM services to patient populations while initiating self-management education among medication-resistant patients who are chronically ill. Despite formidable challenges, rural health care providers have been successful in initiating DM programs and have discovered several ways in which these programs benefit their organizations. This research reports on six DM programs that serve large rural and underserved populations and have demonstrated that DM can be successfully implemented in such areas.

Warrior Model for Human Performance and Injury Prevention: Eagle Tactical Athlete Program (ETAP) Part II.

PubMed

Sell, Timothy C; Abt, John P; Crawford, Kim; Lovalekar, Mita; Nagai, Takashi; Deluzio, Jennifer B; Smalley, Brain W; McGrail, Mark A; Rowe, Russell S; Cardin, Sylvain; Lephart, Scott M

2010-01-01

Physical training for United States military personnel requires a combination of injury prevention and performance optimization to counter unintentional musculoskeletal injuries and maximize warrior capabilities. Determining the most effective activities and tasks to meet these goals requires a systematic, research-based approach that is population specific based on the tasks and demands of the Warrior. The authors have modified the traditional approach to injury prevention to implement a comprehensive injury prevention and performance optimization research program with the 101st Airborne Division (Air Assault) at Fort Campbell, KY. This is second of two companion papers and presents the last three steps of the research model and includes Design and Validation of the Interventions, Program Integration and Implementation, and Monitor and Determine the Effectiveness of the Program. An 8-week trial was performed to validate the Eagle Tactical Athlete Program (ETAP) to improve modifiable suboptimal characteristics identified in Part I. The experimental group participated in ETAP under the direction of a ETAP Strength and Conditioning Specialist while the control group performed the current physical training at Fort Campbell under the direction of a Physical Training Leader and as governed by FM 21-20 for the 8-week study period. Soldiers performing ETAP demonstrated improvements in several tests for strength, flexibility, performance, physiology, and the APFT compared to current physical training performed at Fort Campbell. ETAP was proven valid to improve certain suboptimal characteristics within the 8-week trial as compared to the current training performed at Fort Campbell. ETAP has long-term implications and with expected greater improvements when implemented into a Division pre-deployment cycle of 10-12 months which will result in further systemic adaptations for each variable.