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Lessons learned about implementing research evidence into clinical practice. Experiences from VA QUERI 下载免费PDF全文
Hagedorn H Hogan M Smith JL Bowman C Curran GM Espadas D Kimmel B Kochevar L Legro MW Sales AE 《Journal of general internal medicine》2006,21(Z2):S21-S24
The mission of the Veterans Health Administration's (VHA) quality enhancement research initiative (QUERI) is to enhance the quality of VHA health care by implementing clinical research findings into routine care. This paper presents lessons that QUERI investigators have learned through their initial attempts to pursue the QUERI mission. The lessons in this paper represent those that were common across multiple QUERI projects and were mutually agreed on as having substantial impact on the success of implementation. While the lessons are consistent with commonly recognized ingredients of successful implementation efforts, the examples highlight the fact that, even with a thorough knowledge of the literature and thoughtful planning, unexpected circumstances arise during implementation efforts that require flexibility and adaptability. The findings stress the importance of utilizing formative evaluation techniques to identify barriers to successful implementation and strategies to address these barriers. 相似文献
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Ruba A. Abdelhadi MD CNSC Sandra Bouma MS RDN Sigrid Bairdain MD Jodi Wolff MS RDN Amanda Legro MS RD Steve Plogsted PharmD BCNSP Peggi Guenter PhD RN Helaine Resnick PhD Jaime C. Slaughter‐Acey PhD Mark R. Corkins MD CNSC the ASPEN Malnutrition Committee 《JPEN. Journal of parenteral and enteral nutrition》2016,40(5):623-635
Introduction: Malnutrition is common in hospitalized patients in the United States. In 2010, 80,710 of 6,280,710 hospitalized children <17 years old had a coded diagnosis of malnutrition (CDM). This report summarizes nationally representative, person‐level characteristics of hospitalized children with a CDM. Methods: Data are from the 2010 Healthcare Cost and Utilization Project, which contains patient‐level data on hospital inpatient stays. When weighted appropriately, estimates from the project represent all U.S. hospitalizations. The data set contains up to 25 ICD‐9‐CM diagnostic codes for each patient. Children with a CDM listed during hospitalization were identified. Results: In 2010, 1.3% of hospitalized patients <17 years had a CDM. Since the data include only those with a CDM, malnutrition's true prevalence may be underrepresented. Length of stay among children with a CDM was almost 2.5 times longer than those without a CDM. Hospital costs for children with a CDM were >3 times higher than those without a CDM. Hospitalized children with a CDM were less likely to have routine discharge and almost 3.5 times more likely to require postdischarge home care. Children with a CDM were more likely to have multiple comorbidities. Conclusions: Hospitalized children with a CDM are associated with more comorbidities, longer hospital stay, and higher healthcare costs than those without this diagnosis. These undernourished children may utilize more healthcare resources in the hospital and community. Clinicians and policymakers should factor this into healthcare resource utilization planning. Recognizing and accurately coding malnutrition in hospitalized children may reveal the true prevalence of malnutrition. 相似文献
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Ewens KG Jones MR Ankener W Stewart DR Urbanek M Dunaif A Legro RS Chua A Azziz R Spielman RS Goodarzi MO Strauss JF 《Fertility and sterility》2011,95(8):2538-2541
Two cohorts of women with polycystic ovary syndrome (PCOS), comprising 400 probands and affected sisters in 365 families and a case-control group including 395 women with PCOS and 171 healthy women with regular menstrual cycles, were studied to determine whether single-nucleotide polymorphisms (SNPs) identified as susceptibility loci in genomewide association studies of type 2 diabetes are also associated with PCOS. None of the 18 allelic variants in 10 genes previously shown to be associated with type 2 diabetes were found to be associated with PCOS, but some were associated with indices of beta cell function. 相似文献
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