A WHO-HPH operational program versus usual routines for implementing clinical health promotion: an RCT in health promoting hospitals (HPH)

Jeff Kirk Svane,Oliver Groene,Tiiu Härm,Yen Ang,Mirna Zagrajski Brkić,Mikkel Østerheden Andersen,Isao Fukuba,Hanne Tønnesen,Shu-Ti Chiou,Milena Kalvachova,Jerneja Farkas

doi:10.1186/s13012-018-0848-0

Abstract

BackgroundImplementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect. CHP focuses on potentially modifiable lifestyle risks such as smoking, alcohol, diet, and physical inactivity. An operational program was created to improve implementation. It included patients, staff, and the organization, and it combined existing standards, indicators, documentation models, a performance recognition process, and a fast-track implementation model.The aim of this study was to evaluate if the operational program improved implementation of CHP in clinical hospital departments, as measured by health status of patients and staff, frequency of CHP service delivery, and standards compliance.MethodsForty-eight hospital departments were recruited via open call and stratified by country. Departments were assigned to the operational program (intervention) or usual routine (control group). Data for analyses included 36 of these departments and their 5285 patients (median 147 per department; range 29–201), 2529 staff members (70; 10–393), 1750 medical records (50; 50–50), and standards compliance assessments.Follow-up was measured after 1 year. The outcomes were health status, service delivery, and standards compliance.ResultsNo health differences between groups were found, but the intervention group had higher identification of lifestyle risk (81% versus 60%, p < 0.01), related information/short intervention and intensive intervention (54% versus 39%, p < 0.01 and 43% versus 25%, p < 0.01, respectively), and standards compliance (95% versus 80%, p = 0.02).ConclusionsThe operational program improved implementation by way of lifestyle risk identification, CHP service delivery, and standards compliance. The unknown health effects, the bias, and the limitations should be considered in implementation efforts and further studies.Trial registrationClinicalTrials.gov: NCT01563575. Registered 27 March 2012. https://clinicaltrials.gov/ct2/show/NCT01563575

Highlights

Implementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect
Participants For our randomized controlled trial with the clinical hospital department as the unit of randomization and analysis, we hypothesized that allocation to the operational program would improve health of patients and staff, increase delivery of CHP services to at risk-patients, and improve World Health Organization (WHO) standards compliance at the department level, compared to the control group departments continuing usual implementation routines
The power calculation was based on a previous study [40], which had shown that baseline CHP service deliveries could be expected to reach no more than 40% of the at-risk patients

Summary

Introduction

Implementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect. Slow implementation occurs with patient-centered activities to modify lifestyle risk factors [4], such as clinical health promotion (CHP) aiming at better health gain for patients, staff, and communities. On short term within pathways, CHP has been shown to improve treatment results and prognoses in surgery [16,17,18,19], obstetrics [20,21,22], internal medicine [23,24,25,26,27], and psychiatry [28] It is cost-effective [29] and well-received by patients [30,31,32]. CHP is rarely implemented [33]

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Results

Conclusion