Health care models for nursing practice

The focus of this study is the development and the choice of nursing models. It doesn't intend to discuss all the aspects involved in the development of models, but to emphasize the importance of choosing one to use in nursing clinical practice.     

The case for integrating behavior change, client-centered practice and other evidence-based models into geriatric care management

This paper describes the complexities of engaging a frail, elderly population in the process of behavior change to improve daily functioning. Implementation of a brief Purchase of Services (POS) benefit supplementing usual geriatric care management in an integrated, not-for-profit HMO environment is used to illustrate these complexities. Findings from the first two years of the four-year study of the intervention showed that one-third of the group of 541 study participants who were randomized as eligible to participate refused these free, enhanced services. The reasons for these refusals are examined, and a case is made for incorporating behavior change theory into traditional geriatric care management practice for cognitively intact clients in order to facilitate acceptance of needed services and increased patient autonomy.     

Between evidence-based practice and total quality management: the implementation of cost-effective care.

There is an increasing number of studies showing that patients often do not receive necessary care or receive care that is not needed, inefficient or even damaging. There is no lack of ideas and approaches on how to improve practice. In the last decades we have seen the rise of fascinating models for quality improvement, for instance Evidence Based Medicine, Total Quality Management and Patient Partnership. These models are interesting and potentially very valuable in improving patient care. However, the evidence for their (cost-) effectiveness is very limited. The challenge for the years to come is to design strategies for quality improvement that integrate elements from the different models and to set the step from anecdotal evidence for these strategies to systematic evaluation in order to distinguish between faith and fact in the field of improving care.     

Health care reform and management models]

This article tries to indicate the direction of progress in management being taken in health sector reforms in Latin America. The piece first discusses the tension between local forces and international neoliberal trends being manifested in the reform in various countries. The article next looks at the distinction between the tools and the management models that are being applied, presenting a taxonomy of three management levels: macromanagement (national health systems), midlevel management (hospitals, insurers, and other such institutions) and micromanagement (clinics). The piece concludes by reflecting on the future of management in the health sector in Latin America, where health systems are overadministered and undermanaged. Their future depends on multiple factors, most of which are outside the health care field itself. Better management of policies, institutions, and patients would be a tremendous tool in directing the future. Management is here to stay, with greater emphasis on either supply--hospitals and physicians--or demand--citizens or clients. For both the public and private sectors, health management is central to health sector reforms in Latin America.     

Research utilization models: frameworks for implementing evidence-based occupational therapy practice

Evidence-based practice is an important step in the professional evolution of occupational therapy and also provides the means for state-of-the-art innovative clinical service for clients. An essential step in incorporating innovations and developments into clinical practice is through research utilization. Nine models of research utilization developed in the literature are reviewed and critiqued. These are: (1) the Conduct and Utilization of Research in Nursing (CURN) Project; (2) the Stetler-Marram Model; (3) the University of North Carolina Approach; (4) the Innovation Diffusion Process Model; (5) Killeen's Matrix of Research Activity; (6) the Iowa Model of Research In Practice; (7) the Western Interstate Commission for Higher Education In Nursing Project; (8) the Nursing Child Assessment Satellite Training Project; and (9) the Linkage Model. Research utilization models provide a framework for collaboration and the necessary conditions for research utilization activities to be successful. Copyright © 1999 Whurr Publishers Ltd.     

健康素养与健康信息传播利用的国家战略研究

健康信息素养是人们在对健康信息的需求到获取并应用的过程中表现出来的综合能力水平,评价工具必须全面的评估其内涵的几个方面。目前国内外对健康信息素养评价方法较多,但是尚未形成统一的评价标准。本文综述了国内外学者对健康信息素养的评价方法,并提出接下来深入研究健康信息素养亟需解决的问题。     

Depression care for the elderly: reducing barriers to evidence-based practice

This paper provides an overview of five key bodies of evidence identifying: (1) Characteristics of depression among older adults -- its prevalence, risk factors and illness course, and impact on functional status, mortality, use of health services, and health care costs; (2) Effective Interventions, including pharmacologic, psychotherapies, care management, and combined intervention models; (3) Known Barriers to depression care including patient, provider and service system barriers; (4) Effective Organizational and Educational Strategies to reduce barriers to depression care; and (5) Key Factors in Translating Research into Practice. There is strong empirical support for implementing strategies to improve depression care for older adults.     

Making evidence-based management usable in practice

I applaud doctors Kovner and Rundall for attempting to address the critical management principle of evidence-based management, but encourage them to further study why this principle has not been used more extensively in healthcare organizations. The lack of application calls for new and creative approaches to developing evidence-based management research and for increasing the availability to healthcare managers. The process to access the research must not be excessively time-consuming or difficult if it is going to be integrated into the day-to-day culture of organizations. Healthcare needs to focus on how to integrate evidence-based management into the culture of healthcare organizations.     

Changing clinical practice: evidence-based primary care in Australia

Evidence-based health care (EBHC) is a concept which in the past decade has gained momentum internationally. Its emphasis on linking practice and policy more closely to evidence from research and literature has challenged many assumptions and established practices in health care, whilst helping the move away from an over-reliance on medical authority and accumulated wisdom. Since the concepts of EBHC were first introduced their relevance for primary care has been examined and there has been active debate over the extent to which primary care should be restructured to accommodate these new concepts. Many argue, for example, that they devalue important but less measurable aspects of primary care. Furthermore, little is known about whether EBHC has changed practice in primary care, despite a range of implementation strategies having been put in place. This paper focuses on the response of primary care practitioners and policy makers to the challenges of EBHC in Australia. Government investment in EBHC infrastructure is detailed, and the implementation of EBHC is described from the perspective of primary care providers, individuals with chronic illnesses and other consumers of primary care services. Current issues facing Australian primary care in implementing EBHC include the relative paucity of direction from a policy framework, the dearth of multi-disciplinary primary care teams and the lack of experience in Australia of primary care health service reform.     

Advancing evidence-based care for diabetes: lessons from the Veterans Health Administration

The Veterans Health Administration (VHA) is a unique laboratory for using the electronic health record (EHR) to transform health care and accelerate discovery. This is particularly evident in the care of veterans with diabetes, who constitute a quarter of those served by the VHA. Although EHRs have enabled rapid learning, additional factors were necessary, including the lead participation of clinician-investigators, accountability through performance measurement, a delivery system focused on population health, and favorable economic externalities. "Off-the-shelf" technology is unlikely to generate similar benefits if these attributes are not in place.     

Turning research into practice: cases on adopting evidence-based innovations for everyday care

Turning clinical research and innovations into actual practices that enhance quality care--at both the hospital level and the health system level--can be challenging. But many organizations are finding creative ways to get those ideas on the front line.     

Patient focused care. Health management guide

Finding the holy grail which will deliver high quality care at lower cost is every NHS manager's dream, especially during times of severe resource constraint and intense competition. Reorganising units to provide 'patient-focused care' can, it has been claimed, make them simpler and slimmer, cutting costs and wasted time, while increasing patient and staff satisfaction. How is patient-focused care being implemented in the NHS, and how successful has it proved so far? Could it help your unit? This Health Management Guide looks at how patient-focused care originated and how it works, exploring a number of sites where it is in use, and identifying key points to consider before adopting a 'patient-focused' approach.     

Health policy issues and applications for evidence-based medicine and clinical practice guidelines

Evidence-based medicine and clinical practice guidelines have become increasingly salient to the international health care community in the 1990s. Key issues in health policy in this period can be categorised as costs and access to care, quality of and satisfaction with care, accountability for value in health care, and public health and education. This paper presents a brief overview of evidence-based medicine and clinical practice guidelines and describes how they are likely to influence health policy. Evidence-based medicine focuses on the use of the best available clinical (efficacy) evidence to inform decisions about patient care; guidelines are statements systematically developed from efficacy and effectiveness research and clinical consensus for practitioners and patients to use in making decisions about appropriate care under different clinical circumstances. Both fields have developed methods for evaluating and synthesising available evidence about the outcomes of alternative health care interventions. They have clear implications for health policy analysts: greater reliance should be placed on scientific evidence, policy decisions should be derived systematically, and health care decisionmaking must allow for the active participation of health care providers, policy makers, and patients or their advocates. The methods and information generated from evidence-based guidelines efforts are critical inputs into health policy analysis and decision-making.