The accessibility of research-based knowledge for nurses in United Kingdom acute care settings

Background. The successful dissemination of the results of the National Health Service (NHS) research and development strategy and the development of evidence based approaches to health care rely on clinicians having access to the best available evidence; evidence fit for the purpose of reducing the uncertainties associated with clinical decisions. Aim. To reveal the accessibility of those sources of information actually used by nurses, as well as those which they say they use. Design. Mixed method case site, using interview, observational, Q sort and documentary audit data in medical, surgical and coronary care units (CCUs) in three acute hospitals. Results. Three perspectives on accessibility were identified: (a) the humanist-in which human sources of information were the most accessible; (b) local information for local needs-in which locally produced resources were seen as the most accessible and (c) moving towards technology-in which information technology begins to be seen as accessible. Nurses' experience in a clinical specialty is positively associated with a perception that human sources such clinical nurse specialists, link nurses, doctors and experienced clinical colleagues are more accessible than text based sources. Clinical specialization is associated with different approaches to accessing research knowledge. Coronary care unit nurses were more likely perceive local guidelines, protocols and on-line databases as more accessible than their counterparts in general medical and surgical wards. Only a third of text-based resources available to nurses oil the wards had any explicit research base. These, and the remainder were Out of date (mean age of textbooks 11 years), and authorship hard to ascertain. Conclusion. A strategy to increase the use of research evidence by nurses should harness the influence of clinical nurse specialists, link nurses and those engaged in practice development. These roles Could act as 'conduits' through which research-based messages for practice, and information for clinical decision making, could flow. This role should be explored and enhanced

Users and Suppliers of Physician Services: A Tale of Two Populations

Physician shortages and their implications for required increases in the physician population are matters of considerable interest in many health care systems, in light especially of the widespread phenomenon of population ageing. To determine the extent to which shortages exist one needs to study the population of users of physician services as well as that of the physicians themselves. In this paper we study both, using the province of Ontario, Canada, as an example. The user population is projected and the implications for requirements calculated, conditional on given utilization rates. On the supplier side, the age and other characteristics of the (active) physician population are examined and patterns of withdrawal investigated. The necessary future growth of supply is calculated, assuming alternative levels of present shortages. The effects of population change on requirements are found to be smaller in the future than in the decade 1981- 1991, in the aggregate, not far from the effects in 1991-2001, but highly variable among different categories of physicians.physician shortages, physician requirements, population aging

Massachusetts' Proposed Demonstration to Integrate Care for Dual Eligibles

Outlines the current service delivery model for those eligible for both Medicaid and Medicare, key design elements of the proposed integrated care organizations, revisions made in response to stakeholder comments, and considerations for evaluation

Integrating Research and Quality Improvement Using TeamSTEPPS: A Health Team Communication Project to Improve Hospital Discharge

Purpose/Objectives: The purpose of this article is to describe an innovative approach to the integration of quality improvement and research processes. A project with the objective of improving health team communication about hospital discharge provides an exemplar case. Description of the Project/Program: The TeamSTEPPS 10-step action planning guide provided the structure for planning, developing, and evaluating a redesign of interprofessional health team communication to improve hospital discharge led by 2 clinical nurse specialists. The redesign involved development of processes for team bedside rounding, registered nurse bedside shift reports, and briefing tools to support the rounding processes. Outcome: Using the TeamSTEPPS process, a 4-phase combined quality improvement and research project was designed and implemented. Implementation is ongoing, supported by process evaluation for continuing process improvement. Longitudinal analysis of research outcomes will follow in the future. Conclusions: Led by unit-based clinical nurse specialists, use of an integrated process of quality improvement and research creates evidence-based innovation to solve interprofessional practice problems. Incorporating research within the project design allows for data-based decisions to inform the clinical process improvement, as well as documentation of both the processes and outcomes of the local improvements that can inform replications in other sites

Users and Suppliers of Physician Services: A Tale of Two Populations

Physician shortages and their implications for required increases in the physician population are matters of considerable interest in many health care systems, in light especially of the widespread phenomenon of population ageing. To determine the extent to which shortages exist one needs to study the population of users of physician services as well as that of the physicians themselves. In this paper we study both, using the province of Ontario, Canada, as an example. The user population is projected and the implications for requirements calculated, conditional on given utilization rates. On the supplier side, the age and other characteristics of the (active) physician population are examined and patterns of withdrawal investigated. The necessary future growth of supply is calculated, assuming alternative levels of present shortages. The effects of population change on requirements are found to be smaller in the future than in the decade 1981- 1991, in the aggregate, not far from the effects in 1991-2001, but highly variable among different categories of physicians.physician shortages, physician requirements, population aging

Genesys HealthWorks: Pursuing the Triple Aim Through a Primary Care-Based Delivery System, Integrated Self-Management Support, and Community Partnerships

Details Triple Aim pilot programs to engage primary care doctors in care coordination, prevention, and efficient use of specialty care through a physician-hospital organization; promote healthy behaviors; and extend access for the poor and uninsured

Reviving Full-Service Family Practice in British Columbia

Describes innovative operational reforms made in the province's fee-for-service system to improve quality of care and reduce costs, including incentive payments for chronic disease management and enhanced training. Outlines lessons learned and challenges

The Prescription Opioid Epidemic: an Evidence-Based Approach

A group of experts, led by researchers at the Johns Hopkins Bloomberg School of Public Health, issued this report aimed at stemming the prescription opioid epidemic, a crisis that kills an average of 44 people a day in the U.S. The report calls for changes to the way medical students and physicians are trained, prescriptions are dispensed and monitored, first responders are equipped to treat overdoses, and those with addiction are identified and treated. The report grew out of discussions that began last year at a town hall co-hosted by the Bloomberg School and the Clinton Health Matters Initiative, an initiative of the Clinton Foundation. The recommendations were developed by professionals from medicine, pharmacy, injury prevention and law. Patient representatives, insurers and drug manufacturers also participated in developing the recommendations. The report breaks its recommendations into seven categories:Prescribing GuidelinesPrescription Drug Monitoring Programs (PDMPs)Pharmacy Benefit Managers (PBMs) and PharmaciesEngineering Strategies (i.e., packaging)Overdose Education and Naloxone Distribution ProgramsAddiction TreatmentCommunity-Based Prevention Strategie

Strengthening Primary and Chronic Care: State Innovations to Transform and Link Small Practices

Presents case studies of state policies for reorganizing and improving primary and chronic care delivery among small practices, including leadership and convening, payment incentives, infrastructure support, feedback and monitoring, and certification

THE "ENHANCING RURAL ECONOMIES" PROJECT: CONTEXT AND PURPOSE, TECHNIQUES AND PROCEDURES, AND EXPERIENCE TO DATE

This paper is a part of a series of reports of the activities conducted under a grant from the Fund for Rural America, U.S. Department of Agriculture. Funds for the three year grant entitled "Enhancing Rural Economies Through Comprehensive Extension, Research & Partnering Approaches Using Multi-County Clusters in Michigan With Application to National Rural Settings" were received by Michigan State University's Department of Agricultural Economics in March, 1998. The major goal of the grant is to increase economic development activity in four clusters of rural counties in Michigan through the utilization of the resources of the Michigan State University Extension Service, Michigan Agricultural Experiment Station, and other resources of Michigan State University. Various local, state, and federal public partners as well as the private sector are to co-sponsor projects. This paper represents an overview of some of the project activities undertaken by December, 1999.Community/Rural/Urban Development,