First Year Of Implementation Research Articles

Budget Impact Analysis of Implementing Antenatal Care Recommendations for Positive Pregnancy Outcomes at Public Primary Facilities in Tanzania.

Tanzania recently changed its antenatal care (ANC) guidelines to reduce perinatal mortality and improve the experience of pregnancy care. The new guideline recommends increasing the number of ANC visits from four to eight and introducing one routine ultrasound scan, among other recommendations. We estimated the budget impact of implementing the new guideline compared to the previous focused ANC guideline at public dispensaries and health centers. In a dynamic Markov model, we prospectively followed annual cohorts of between 2.3 and 2.6 million pregnant women who will be attending ANC at dispensaries and health centers for 5years. We allowed a population of pregnant women into the model every year and women exit the model at delivery. We calculated the cost of medicines, medical supplies, and laboratory supplies required to produce services from a public health system perspective. Our model neither estimated condition-related costs nor health effects. The budget impact was calculated as the difference in the estimated costs between the two guidelines. We conducted scenario analyses to explore attending more visits and different assumptions to calculate the target population. We estimated that implementing the new ANC guideline would have a cumulative budget impact of around US$154 million over 5years. The budget required will increase from US$137 million under the focused ANC guideline to US$291 million under the new guideline. Laboratory supplies will consume 47% of the estimated budget under the new guideline. We expect the annual budget impact to be US$38 million in the first year of implementation and US$32 million in the fifth year. We assumed that by the fifth year, 82% of all pregnant women would have had four or more visits. The budget impact would increase to US$214 million, with the proportion of pregnant women attending four or more ANC visits reaching 90% within 5years. Scaling up the implementation of the new ANC guideline at public dispensaries and health centers may substantially increase the supplies required to produce ANC services, particularly laboratory supplies. Studies on the health impact of the new guideline are warranted to estimate the value for money.

Implementing a School-Wide Trauma-Informed Education Approach: An Evaluation of Student-Outcomes during the First Year of Implementation

Implementing a School-Wide Trauma-Informed Education Approach: An Evaluation of Student-Outcomes during the First Year of Implementation

Experiences and attitudes of nurses with the legislation on assisted suicide in Austria.

In 2022, assisted suicide (AS) was legalized in Austria. We aimed to investigate the experiences and attitudes of palliative care (PC) and hospice nurses toward AS in Austria after the first year of implementation of the new law. A cross-sectional survey was distributed online to nurses in every known specialized and general hospice and PC units in Austria (n = 255 units). The questionnaire included sociodemographic characteristics, the Assisted Suicide Attitude Scale, the Comfort Discussing Assisted Suicide Scale, and questions on recent experiences with AS requests. We used Spearman's correlation coefficient for determining associations between sociodemographic characteristics and attitudes toward AS, as well as comfort discussing AS. For comparison of frequencies, we applied ꭓ2 tests. We computed a linear regression model to examine predictors for attitudes toward AS. The total sample were N = 280 nurses. More than half (61.2%) indicated that they had cared for a patient who expressed a wish for AS within the first year of implementation. Though responses varied widely, more nurses expressed support for AS than those were opposed (50.36% and 31.75%, respectively). Factors that statistically contributed to more reluctance toward AS in the regression model were older age, religiousness, and experience of working with patients expressing a wish for AS. This work provides valuable insight into nurses' perceptions toward the legislation of AS in the first year since the new law was passed. The results can inform the future development of the AS system and support for nurses in end-of-life care, and critically contribute to international discussions on this controversial topic.

Stakeholder Experiences and Perspectives on the Nueva Escuela Mexicana Reform in Mexican Primary Education

Mexico has recently introduced the Nueva Escuela Mexicana (NEM) in Basic Education, which aims to create a more meaningful, contextualised, inclusive learning environment. This study examined stakeholder experiences and perspectives on the NEM in its first year of implementation. A total of 79 semi-structured individual and group interviews were conducted in 12 primary schools in three Mexican states. A total of 168 participants were interviewed: learners, teachers, head teachers, teacher trainers, and local and regional supervisors. This study found that stakeholders held a range of positive and negative views about the NEM reform. Participants reported several concerns, such as the lack of foundational knowledge developed through the new approach, doubts about certain curricular content (e.g., gender and sexuality), and a lack of explicit guidance and training. This paper offers policy recommendations, which may also be relevant to policymakers in other countries. Limitations of this study and recommendations for future studies are discussed.

Новые песни о старом. К вопросу о первых итогах реализации пилотного проекта, направленного на преобразование системы высшего образования

Purpose. To analyze in a discussion form the results of the first year of implementation of the pilot project of reforming the structure of Russian higher education. Methodology: in the process of writing the following methods were used: analysis, synthesis, system approach, formal-legal. Conclusions. Weighty conclusions on the results of functioning of the experimental model of higher education can be made only after the first graduation, including on the basis of employers› assessment of the quality of graduates› training and the results of their professional activity. It is impossible to involve all higher education institutions of the country in the next reorganization of higher education on the basis of a speculative model that has not been experimentally tested at the practical level and in full. The system of domestic higher education is already significantly disorganized by the previous permanent reorganizations, the chaos with educational standards. Scientific and practical relevance. The conducted study allows us to draw attention to the problem of Russian higher education reform and the search for a truly sovereign, nationally-oriented education system model.

Implementing a Population-Based Social Determinants of Health Intervention: Early Lessons Learned from Collaboration between Clinical and Community Organizations

Abstract: The purpose of this study was to understand the barriers and facilitators among diverse health care and community organization stakeholders implementing a populationbased social determinants of health (SDOH) intervention. The SDOH intervention included three core programs: SDOH screening, a community health worker program, and a digital referral platform. After one year of implementation, we conducted semi-structured qualitative interviews with clinical and community-based organization stakeholders about (1) the three SDOH programs, (2) organizational implementation strategies, (3) interactions with partner organizations, and (4) perceived target population needs. Findings from the first year of implementation highlighted several factors to consider when designing and implementing SDOH programming, including (1) the successful features of the three SDOH programs, (2) the local implementation strategies and challenges across organizations, (3) the impact of broader community needs and resource availability on implementation, and (4) the importance of intentionally fostering relationships and collaboration among partner organizations.

Impact of an enhanced sobriety checkpoints programme and publicity campaign on motor vehicle collisions, injuries and deaths in Leon, MX: a synthetic control study

ObjectiveDrunk driving is a major cause of road traffic injuries and deaths in Latin America. We evaluated the impact of a drunk driving intervention in Leon, Mexico on road traffic...

Automated Discontinuation of Isolation Precautions with the Use of Electronic Health Record Tools

Background: At a comprehensive cancer center, hundreds of patients are screened daily for infections requiring the implementation of isolation precautions. Discontinuation of precautions is determined by negative testing, resolution of infection, or other criteria. Determining appropriate discontinuation of isolation precautions is labor intensive for Infection Preventionists (IPs). An unintended consequence of manual discontinuation is that numerous patients remain on isolation indefinitely. This was amplified during the COVID-19 pandemic when thousands of patients were placed on isolation precautions. Using electronic health record (EHR) tools, opportunities for process improvements were developed. Our goal was to establish an automated method to resolve isolation precautions. We aimed to decrease the number of manually resolved precautions by 25% each fiscal year (FY), compared to our baseline of activity in FY 2019 (FY19). Our secondary aim was to automate adding and resolving precautions when testing is initiated for suspected transmissible conditions (rule-out testing features).Methods: Infection Control (IC) collaborated with EHR analysts to build tools to automate a process for appropriate isolation discontinuation. We reviewed our internal data in conjunction with evidence-based guidelines and started with acute, short-term infections that do not require repeat testing or cultures. Expiration dates were established for these infections to resolve automatically after meeting criteria. A secondary review determined that additional infections could be added safely to this process. The secondary aim of establishing rule-out testing was implemented for respiratory viral panels (including SARS-COV-2) and C. difficile testing. When testing was ordered for these conditions, a suspect-infection status and alert for precautions were automatically added to patients’ EHR banners. If the assay resulted negative, the suspect-infection status was automatically removed from their chart. Results: Our baseline of active infections in FY19 was approximately 2,700 cases. From FY19 through FY23, 123,115 infections were added to our patients, and 128,422 infections were resolved. In the first year of implementation, there was a 58% decrease in the number of manually resolved cases. From the initiation of our project through the end of FY23, manual discontinuation of precautions has decreased by 88%. Conclusions: We successfully implemented a process improvement project to appropriately remove patients from isolation precautions automatically using EHR tools, which resulted in reduced labor on our IPs and patient time spent on isolation restrictions. Additional benefits from this process improvement extend to decreasing unnecessary costs to the patient and the organization, better stewardship of supply/resources, and improving patient satisfaction.

Feasibility and Effectiveness of the Implementation of Anxiety Screening for Adolescents in a Primary Care Setting.

The United States Preventive Services Task Force recommended routine anxiety screening for children and adolescents in 2022. This study describes the feasibility of routine anxiety screening in a primary care practice.It further examines the effects of routine anxiety screening on anxiety diagnoses and provider behavior in a setting in which anxiety screening was implemented five years in advance of the national guidelines. During the first year of implementation, approximately 80% of patients were screened, and 17% of screens were positive.A retrospective chart review of patients with positive screens found that the majority of positive screens led to a new diagnosis of anxiety and that half of newly diagnosed patients were prescribed an intervention. Screening was associated with an increase in diagnoses of anxiety disorders in the studied population from 9.6% to 13.3% (p<0.0001). Following the initial implementation, screening rates continued to rise, with an eventual plateau of >90%. Anxiety screening in the pediatric primary care setting is feasible and sustainable and led to increased provider recognition of anxiety and meaningful clinical action.

Evaluasi Peran Otoritas Jasa Keuangan dalam Pengawasan Implementasi Standar Audit 701 (2021)

The objectives of this study are to provide an overview of the benefits of communicating key audit matters (KAM) for OJK's oversight function, to identify findings related to KAM in United Kingdom and Malaysia, and how those regulators have responded to those findings, and to evaluate OJK's response related to KAM. This research is carried out by in-depth interviews with supervisors and analysts from the Directorate of Regulation and Development of the OJK Capital Market Sector. KAM communication provided benefits in OJK's supervisory function, among others, in determining the items to be reviewed in the Issuer's financial statements and in reviewing the audit responses stated in the auditor's report have been supported by the auditor's working papers. In carrying out their oversight function, the United Kingdom and Malaysia found, among others, that the average number of KAM and words in communicating KAM in the auditor's report continued to decline, the content of KAM of companies audited by Big 4 audit firms had more words for the same number of KAM, and the benefits of communicating KAM decreased because KAM disclosures were boilerplate. OJK's response in relation to the implementation of SA 701 (2021) is to draft OJK regulations related to KAM and to prepare a study related to the first-year implementation of SA 701 (2021). Based on these responses, it is reflected that OJK has an important role in the implementation support stage to ensure that the policy implementation runs well in the long term.

Implementation of a Multifaceted Program to Improve the Rational Use of Antibiotics in Children under 3 Years of Age in Primary Care.

A multifaceted, participatory, open program based on a qualitative and quantitative approach was developed in the Region of Murcia (Spain) aimed to reduce antibiotic use in children under 3 years of age diagnosed with upper respiratory tract infections (acute otitis media, pharyngitis, and common cold). Antibiotic consumption was measured using the defined daily dose per 1000 inhabitants per day (DHD). Pre-intervention data showed a prevalence of antibiotic prescriptions in the primary care setting of 45.7% and a DHD of 19.05. In 2019, after the first year of implementation of the program, antibiotic consumption was 10.25 DHD with an overall decrease of 48% as compared with 2015. Although antibiotic consumption decreased in all health areas, there was a large variability in the magnitude of decreases across health areas (e.g., 12.97 vs. 4.77 DHD). The intervention program was effective in reducing the use of antibiotics in children under 3 years of age with common upper respiratory diseases, but reductions in antibiotic consumption were not consistent among all health areas involved.

Evaluation of the First Approach Skills Training (FAST) Integrated Pediatric Primary Care Program: Implementation and Clinical Effectiveness

ABSTRACT The current study evaluated the clinical effectiveness and implementation of a brief integrated pediatric primary care program, First Approach Skills Training (FAST). We analyzed clinical retrospective data during the first year of implementation of FAST. Patients and parents completed symptom measures as part of standard clinical care. Integrated behavioral health providers completed measures regarding the FAST program's usability, feasibility, effectiveness, and cultural responsiveness. Patients and parents reported significant improvement in anxiety symptoms, depression symptoms, and disruptive behaviors. Clinicians rated FAST as highly usable, feasible, effective, and culturally responsive. The FAST program demonstrates preliminary clinical effectiveness for common youth mental health problems in pediatric primary care.

Strengthening and utilizing response groups for emergencies flagship: a narrative review of the roll out process and lessons from the first year of implementation.

The World Health Organization Regional Office for Africa (WHO/AFRO) faces members who encounter annual disease epidemics and natural disasters that necessitate immediate deployment and a trained health workforce to respond. The gaps in this regard, further exposed by the COVID-19 pandemic, led to conceptualizing the Strengthening and Utilizing Response Group for Emergencies (SURGE) flagship in 2021. This study aimed to present the experience of the WHO/AFRO in the stepwise roll-out process and the outcome, as well as to elucidate the lessons learned across the pilot countries throughout the first year of implementation. The details of the roll-out process and outcome were obtained through information and data extraction from planning and operational documents, while further anonymized feedback on various thematic areas was received from stakeholders through key informant interviews with 60 core actors using open-ended questionnaires. In total, 15 out of the 47 countries in WHO/AFRO are currently implementing the initiative, with a total of 1,278 trained and validated African Volunteers Health Corps-Strengthening and Utilizing Response Groups for Emergencies (AVoHC-SURGE) members in the first year. The Democratic Republic of Congo (DRC) has the highest number (214) of trained AVoHC-SURGE members. The high level of advocacy, the multi-sectoral-disciplinary approach in the selection process, the adoption of the one-health approach, and the uniqueness of the training methodology are among the best practices applauded by the respondents. At the same time, financial constraints were the most reported challenge, with ongoing strategies to resolve them as required. Six countries, namely Botswana, Mauritania, Niger, Rwanda, Tanzania, and Togo, have started benefiting from their trained AVoHC-SURGE members locally, while responders from Botswana and Rwanda were deployed internationally to curtail the recent outbreaks of cholera in Malawi and Kenya.

Reorientación comunitaria de la atención primaria en un área de salud: proyecto ROCAP

AimEvaluate the effectiveness of an intervention to incorporate group and community activities on a sustained basis in all the Basic Health Zones (ZBS) of a health area. DesignDuring January and February 2019, two members of the research team traveled to each ZBS to interview the medical and nursing coordinators who had previously received an ad hoc initial assessment questionnaire (QAI) by email. PlaceThe scope is the 11 ZBS of a health area. ParticipantsThe study population is the ZBS and the respective teams represented by the medical and nursing coordinations. InterventionsPromote a community health commission, carry out training actions, record activities in clinical history and incorporate management objectives. Main measurementsQuantitative and qualitative analysis was carried out pre and post after the first year of intervention. ResultsIn the pre-evaluation: 6 primary care teams (EAP) reported having group activities, 4 were participating in local action projects, 4 had a professional referent for community activities, 3 participated in projects with populations in vulnerable situations and 4 stated have specific meetings on community health. After the intervention: 11 EAPs had group activities, 8 had a reference professional, 6 were participating in local action projects, 4 collaborated in projects with vulnerable populations and 5 held meetings on community health. ConclusionsThe intervention proved effective after its first year of implementation, since all the EAPs carried out group activities and collaborated with the local councils in the area; the majority had leading professionals in community care and, to a lesser extent, participation in local action projects and in vulnerable populations increased.

RESET Alcohol: A Global Alcohol Policy Initiative

RESET Alcohol: A Global Alcohol Policy Initiative

Implementation of endometrial cancer molecular subtyping into a hybrid community-academic practice.

We sought to confirm utility of our institution's modified Proactive Molecular Risk Classifier for Endometrial Cancer protocol in our daily practice, which includes mismatch repair (MMR), p53, and L1 cell adhesion molecule (L1CAM) immunohistochemistry with in-house next-generation sequencing for POLE, TP53, and CTNNB1. We conducted a retrospective review of all patients in our institution who underwent primary endometrial carcinoma resection from the year prior to protocol implementation (PRE; October 1, 2020, to September 30, 2021) through first year of implementation (POST; October 1, 2021, to September 30, 2022) to compare the distribution of molecular and traditional staging factors using GOG-249 criteria to assign clinical risk. In total, 136 of 260 PRE patients were classified as clinically low risk (LR), of whom 31 were MMR deficient. Of the 157 LR POST patients with endometrioid-type carcinoma, 45 were MMR deficient, 5 were POLE mutant, 5 were TP53 mutant, 56 were of no specific molecular profile (NSMP), and 46 did not receive full protocol testing. Of all 79 POST NSMP endometrioid-type cases, 18 were CTNNB1 mutated and 8 showed L1CAM expression. Our protocol identified 22 (14%) of 157 LR tumors that harbored incipient intermediate- to high-risk molecular aberrations in TP53, CTNNB1, or L1CAM. Moving forward, results of ongoing trials assessing adjuvant therapy decisions based on molecular classification are necessary to confirm protocol utility and identify appropriate modifications.

Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries.

Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the "Children's Comfort Promise", includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the "Global Comfort Promise" was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children's Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child's pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.

Citizen scientists’ engagement in flood risk-related data collection: a case study in Bui River Basin, Vietnam

Time constraints, financial limitations, and inadequate tools restrict the flood data collection in undeveloped countries, especially in the Asian and African regions. Engaging citizens in data collection and contribution has the potential to overcome these challenges. This research demonstrates the applicability of citizen science for gathering flood risk-related data on residential flooding, land use information, and flood damage to paddy fields for the Bui River Basin in Vietnam. Locals living in or around flood-affected areas participated in data collection campaigns as citizen scientists using self-investigation or investigation with a data collection app, a web form, and paper forms. We developed a community-based rainfall monitoring network in the study area using low-cost rain gauges to draw locals’ attention to the citizen science program. Fifty-nine participants contributed 594 completed questionnaires and measurements for four investigated subjects in the first year of implementation. Five citizen scientists were active participants and contributed more than 50 completed questionnaires or measurements, while nearly 50% of citizen scientists participated only one time. We compared the flood risk-related data obtained from citizen scientists with other independent data sources and found that the agreement between the two datasets on flooding points, land use classification, and the flood damage rate to paddy fields was acceptable (overall agreement above 73%). Rainfall monitoring activities encouraged the participants to proactively update data on flood events and land use situations during the data collection campaign. The study’s outcomes demonstrate that citizen science can help to fill the gap in flood data in data-scarce areas.

Sustainability of Evidence-Based Practices: Risk-Need-Responsivity in Probation 7 Years Later

This quasi-experimental, pre-post study investigated the sustainability of risk-needs assessment (RNA) and the risk-need-responsivity (RNR) practices in five juvenile probation offices across two states 7 years after rigorous implementation. The study evaluated adherence to practices and facilitators of sustainability via interviews with leadership ( N = 10) and probation officers ( N = 84) and a seventh-year cohort of youth propensity score matched to a cohort from the first year of implementation ( n = 730 per state cohort). Probation officers in both states reported relatively high adherence to RNR-based practices, and one state significantly improved adherence to its RNA administration policies and the risk principle. Adherence to the risk principle in placement and service referral decisions regressed in the other state. Essential ingredients for sustainment included maintaining staff training and monitoring, evolving RNR practices through the adoption of complementary evidence-based practices, and having court personnel who enable best practices.

Healthcare payment mechanism: Execution results of bundled payment program for bariatric surgery diagnosis in its first year of implementation in Chile.

More than 600 thousand people in Chile live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for healthcare systems and insurance schemes. In 2022, two bundled payment codes for bariatric surgery (gastric bypass and gastric sleeve) were incorporated into the National Health Fund's free-choice modality fee scheme. The objective was to characterize the execution of this payment mechanism program associated with bariatric surgery diagnosis in its first year of implementation.More than six hundred thousand people in Chile are estimated to live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for health systems and insurance schemes. In 2022, FONASA incorporated two Bariatric Surgery codes into the Free Choice Modality: Gastric Bypass and Sleeve Gastrectomy. Our objective was to characterize the execution of the Bariatric Surgery Bundled Payment Program in its first year of implementation. Descriptive and observational study of the pragmatic approach of the national execution of the payment associated with diagnosis in bariatric surgery. We examined sociodemographic variables (sex, age brackets, and National Health Fund tranches) and characterization of surgeries by code broken down by public or private provider, period of issue, unit cost, co-payment, and medical loans between March and December 2022. We recorded n = 13 118 surgeries (45.81% bypass versus 54.19% sleeve), of which n = 2424 (18.48%) used medical loans. A total of 85.01% (p = 0.01) of the procedures were in women, in people between 35 and 39 years of age (20.15%), and 45.12% in beneficiaries of tranche B. Private providers performed a total of 99.21% of the surgeries. Ten accounted for 50% of the activity (range n = 1200 to 426 surgeries per year; n = 4.8 to 1.7 surgeries per working day). Total program expenditure was $71 626 948 350 CLP, accounting for 5.04% of the total activity of the national Diagnosis Associated Payment Program. The implementation of this bariatric surgery voucher benefited more than 13 thousand people living with obesity, mostly women of productive ages and with purchasing capacity. As an equity strategy, regardless of the access route through the voucher, it will be important to safeguard the activity in the public network.