Pub Date : 2012-12-01DOI: 10.1177/2040402613479342
S. Naikoba, R. Colebunders, J. V. Geertruyden, K. Willis, S. Kinoti, Milly Namaalwa Kulubya, M. Mbonye, A. Miceli, L. Mpanga-Sebuyira, A. Ronald, M. Scheld, M. Weaver
SummaryTraining mid-level practitioners (MLP), usually nurses or clinical officers, to perform tasks conventionally assigned todoctors increases access to care and addresses health worker shortages in resource-constrained countries. In the face ofthe shortcomings of traditional training approaches, identification of effective training methods that create and maintainhighly competent MLP is a priority. A cluster randomized trial with pre–post components was conducted between Marchand December 2010 at 36 subdistrict health centres in Uganda. Eighteen out of the 36 health centres were randomized tothe intervention (Arm A) to receive sequenced integrated infectious diseases training for two MLPs followed by integratedinfectious diseases on-site support for the health worker teams once a month for nine months and 18 were randomized toreceive only sequenced training for two MLPs but no on-site support (Arm B). Outcomes measured included individualMLP knowledge and competence scores from written and observed clinical assessments; health facility performanceagainst indicators of care for malaria, tuberculosis and HIV as determined from patient care records; and mortalityamong children under five years during the project period measured using survey methods. Trial Registration: ClinicalTrials-NIH NCT01190540.
{"title":"Design of a cluster randomized trial assessing integrated infectious diseases training and on-site support for midlevel practitioners in Uganda","authors":"S. Naikoba, R. Colebunders, J. V. Geertruyden, K. Willis, S. Kinoti, Milly Namaalwa Kulubya, M. Mbonye, A. Miceli, L. Mpanga-Sebuyira, A. Ronald, M. Scheld, M. Weaver","doi":"10.1177/2040402613479342","DOIUrl":"https://doi.org/10.1177/2040402613479342","url":null,"abstract":"SummaryTraining mid-level practitioners (MLP), usually nurses or clinical officers, to perform tasks conventionally assigned todoctors increases access to care and addresses health worker shortages in resource-constrained countries. In the face ofthe shortcomings of traditional training approaches, identification of effective training methods that create and maintainhighly competent MLP is a priority. A cluster randomized trial with pre–post components was conducted between Marchand December 2010 at 36 subdistrict health centres in Uganda. Eighteen out of the 36 health centres were randomized tothe intervention (Arm A) to receive sequenced integrated infectious diseases training for two MLPs followed by integratedinfectious diseases on-site support for the health worker teams once a month for nine months and 18 were randomized toreceive only sequenced training for two MLPs but no on-site support (Arm B). Outcomes measured included individualMLP knowledge and competence scores from written and observed clinical assessments; health facility performanceagainst indicators of care for malaria, tuberculosis and HIV as determined from patient care records; and mortalityamong children under five years during the project period measured using survey methods. Trial Registration: ClinicalTrials-NIH NCT01190540.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130613755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-09-01DOI: 10.1258/jicp.2012.012008
Inge Cleeren, A. Vleugels, F. Weekers, E. Zandijk, K. Magerman, K. Vanhaecht
Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acquired infections and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The ventilator bundle of the Institute of Healthcare Improvement includes five evidence-based guidelines which are proven to be effective in the prevention of VAP. The main purpose of this study is to determine the incidence of VAP at two intensive care units at the Jessa Hospital. In addition, compliance rates with the different elements of the VAP bundle are determined. From 1 January 2011 to 31 March 2011 an explorative study was conducted on a 18-bed surgical intensive care unit (SICU) and a six-bed medical intensive care unit (MICU). VAP was diagnosed using Johanson et al. criteria. Bedside observations and analysis of the electronic patient record were performed in order to determine compliance relative to the VAP bundle. At the SICU 10 VAPs were diagnosed resulting in an incidence of 38.46% and a VAP rate of 22.56. Three VAPs were diagnosed at the MICU. The incidence of VAP at the MICU was 18.75% resulting in a VAP rate of 18.75%. Compliance to all elements of the VAP bundle was observed in 0.52% (SICU) and 19.64% (MICU) of the observations. Compliance at the level of individual elements of the bundle varies between 1.03% and 99.48% (SICU) and 32.14% and 100% (MICU).
{"title":"A quality improvement initiative to reduce ventilator-associated pneumonia at a large regional hospital","authors":"Inge Cleeren, A. Vleugels, F. Weekers, E. Zandijk, K. Magerman, K. Vanhaecht","doi":"10.1258/jicp.2012.012008","DOIUrl":"https://doi.org/10.1258/jicp.2012.012008","url":null,"abstract":"Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acquired infections and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The ventilator bundle of the Institute of Healthcare Improvement includes five evidence-based guidelines which are proven to be effective in the prevention of VAP. The main purpose of this study is to determine the incidence of VAP at two intensive care units at the Jessa Hospital. In addition, compliance rates with the different elements of the VAP bundle are determined. From 1 January 2011 to 31 March 2011 an explorative study was conducted on a 18-bed surgical intensive care unit (SICU) and a six-bed medical intensive care unit (MICU). VAP was diagnosed using Johanson et al. criteria. Bedside observations and analysis of the electronic patient record were performed in order to determine compliance relative to the VAP bundle. At the SICU 10 VAPs were diagnosed resulting in an incidence of 38.46% and a VAP rate of 22.56. Three VAPs were diagnosed at the MICU. The incidence of VAP at the MICU was 18.75% resulting in a VAP rate of 18.75%. Compliance to all elements of the VAP bundle was observed in 0.52% (SICU) and 19.64% (MICU) of the observations. Compliance at the level of individual elements of the bundle varies between 1.03% and 99.48% (SICU) and 32.14% and 100% (MICU).","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124654664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-09-01DOI: 10.1258/jicp.2012.012005
Julie E. Hall
The forensic care pathway that is the focus of this UK regional review has itself seen a considerable amount of change over the last decade, focusing on implementing wide reaching reform within both prison and health care. Reforms have seen a reduction in the number of people in some parts of the care pathway and new interventions and growth in other areas. At the end of 2009, the region that was subject to this review there had seen over 450 people cared for in high, medium or low secure services in that year and had a prison population approaching 10,000. The aim of the review was to understand the impact of these changes with a view to sustaining effective pathways and systems, and to increase impact and ensure value for money in order to improve the efficiency and quality of services. A primary objective was to consider the influence of statutory mental health provision upon the use of high, medium and low secure psychiatric services. It was proposed that from a regional perspective more needed to be understood about the influence of wider services upon the care pathways for people using secure services. This paper considers what is available from primary care locality and its features, alongside the rates of secure service use. It also acknowledges the wider influences upon the use of those services.
{"title":"A review of the factors that influence high, medium and low secure care pathways","authors":"Julie E. Hall","doi":"10.1258/jicp.2012.012005","DOIUrl":"https://doi.org/10.1258/jicp.2012.012005","url":null,"abstract":"The forensic care pathway that is the focus of this UK regional review has itself seen a considerable amount of change over the last decade, focusing on implementing wide reaching reform within both prison and health care. Reforms have seen a reduction in the number of people in some parts of the care pathway and new interventions and growth in other areas. At the end of 2009, the region that was subject to this review there had seen over 450 people cared for in high, medium or low secure services in that year and had a prison population approaching 10,000. The aim of the review was to understand the impact of these changes with a view to sustaining effective pathways and systems, and to increase impact and ensure value for money in order to improve the efficiency and quality of services. A primary objective was to consider the influence of statutory mental health provision upon the use of high, medium and low secure psychiatric services. It was proposed that from a regional perspective more needed to be understood about the influence of wider services upon the care pathways for people using secure services. This paper considers what is available from primary care locality and its features, alongside the rates of secure service use. It also acknowledges the wider influences upon the use of those services.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120961484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-09-01DOI: 10.1258/jicp.2012.012007
M. Herrera, A. García, Julia Rosa Martínez García
The objective of this study was to conduct a literature review to assess the importance of teacher training on the economic assessment for professionals working in the Cuban National Health Service (NHS). The assessment will be used as a working tool to guide the process of decision-making in the health sector and to increase the efficiency of different actions to be undertaken in the country. We conducted a literature review to search comprehensive information about this topic at the national and international levels with the intention of incorporating this discipline as a component of crucial importance for the pursuit of efficiency in the Cuban health-care system. Teacher training in economic evaluation applied to the field of health is considered an aspect that improves the rational use of different health technologies, which implies an efficient use of resources for the NHS in Cuba. Although the costs of these therapies are becoming more substantial, their assessment in terms of efficiency allows us to identify effective and less costly interventions for the health sector in Cuba by defining the best strategies to support the process of decision-making. We can confirm that the teacher training in economic evaluation of health professionals for the NHS has been a pressing need. The goal is to develop an economic culture that enables the personnel to show an increased efficiency in performing their normal duties and tasks when developing health interventions that are organized and developed in the country.
{"title":"Experiences of teacher training in economic evaluation for health professionals in Cuba","authors":"M. Herrera, A. García, Julia Rosa Martínez García","doi":"10.1258/jicp.2012.012007","DOIUrl":"https://doi.org/10.1258/jicp.2012.012007","url":null,"abstract":"The objective of this study was to conduct a literature review to assess the importance of teacher training on the economic assessment for professionals working in the Cuban National Health Service (NHS). The assessment will be used as a working tool to guide the process of decision-making in the health sector and to increase the efficiency of different actions to be undertaken in the country. We conducted a literature review to search comprehensive information about this topic at the national and international levels with the intention of incorporating this discipline as a component of crucial importance for the pursuit of efficiency in the Cuban health-care system. Teacher training in economic evaluation applied to the field of health is considered an aspect that improves the rational use of different health technologies, which implies an efficient use of resources for the NHS in Cuba. Although the costs of these therapies are becoming more substantial, their assessment in terms of efficiency allows us to identify effective and less costly interventions for the health sector in Cuba by defining the best strategies to support the process of decision-making. We can confirm that the teacher training in economic evaluation of health professionals for the NHS has been a pressing need. The goal is to develop an economic culture that enables the personnel to show an increased efficiency in performing their normal duties and tasks when developing health interventions that are organized and developed in the country.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130761127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-09-01DOI: 10.1258/jicp.2012.012006
K. Cheng, C. Chan, R. Wong, K. Leung, J. Mui, W. Chui, E. Cheung
We developed an integrated care pathway for the personalized care programme, a community mental health service using a multidisciplinary case management approach for patients with severe mental illness in Hong Kong, China. The pathway started from the point of referral to exit of service and covered acknowledgement of referral, triage and contact, and formulation, endorsement and review of individual service plan (ISP). The first audit showed a high compliance rate except endorsement of ISP. The improvement initiative was successful in raising the compliance rate. The integrated care pathway proved to be a useful tool in driving service development and continuous quality improvement.
{"title":"Integrated care pathway for the personalized care programme for patients with severe mental illness in Hong Kong","authors":"K. Cheng, C. Chan, R. Wong, K. Leung, J. Mui, W. Chui, E. Cheung","doi":"10.1258/jicp.2012.012006","DOIUrl":"https://doi.org/10.1258/jicp.2012.012006","url":null,"abstract":"We developed an integrated care pathway for the personalized care programme, a community mental health service using a multidisciplinary case management approach for patients with severe mental illness in Hong Kong, China. The pathway started from the point of referral to exit of service and covered acknowledgement of referral, triage and contact, and formulation, endorsement and review of individual service plan (ISP). The first audit showed a high compliance rate except endorsement of ISP. The improvement initiative was successful in raising the compliance rate. The integrated care pathway proved to be a useful tool in driving service development and continuous quality improvement.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133541560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M13
M. Nyadzayo, J. Rutter
{"title":"Adopting service improvement from industry at Imperial","authors":"M. Nyadzayo, J. Rutter","doi":"10.1258/JICP.2012.012M13","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M13","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121810171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M10
M. Mariscal-Crespo, D. M. Navarro, R. Camacho-Bejarano
{"title":"Evaluation of the care pathways: a teaching experience","authors":"M. Mariscal-Crespo, D. M. Navarro, R. Camacho-Bejarano","doi":"10.1258/JICP.2012.012M10","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M10","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129585797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M16
R. Vanwersch, K. Shahzad, K. Vanhaecht, P. Grefen, L. Pintelon, G. Merode, H. Reijers
{"title":"Business process redesign in health care: towards a comprehensive methodological framework","authors":"R. Vanwersch, K. Shahzad, K. Vanhaecht, P. Grefen, L. Pintelon, G. Merode, H. Reijers","doi":"10.1258/JICP.2012.012M16","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M16","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130420169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M14
T. Paetorius
{"title":"Clinical pathways as an organizational phenomenon","authors":"T. Paetorius","doi":"10.1258/JICP.2012.012M14","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M14","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133277806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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