High Impact Change Research Articles

The establishment, maintenance, and adaptation of high- and low-impact chronic pain: a framework for biopsychosocial pain research.

The establishment, maintenance, and adaptation of high- and low-impact chronic pain: a framework for biopsychosocial pain research.

Variations in the High Impact Change Model for Managing Transfers of Care in England and Their Association With Delayed Discharges

Variations in the High Impact Change Model for Managing Transfers of Care in England and Their Association With Delayed Discharges

VALUE PROPOSITIONS FOR INFORMATION TECHNOLOGY TO IMPROVE HOSPITAL READMISSIONS IN NURSING HOMES

This report details a qualitative study using an iterative group process bringing together 49 interdisciplinary healthcare stakeholders who are part of the Missouri Quality Improvement Initiative (MOQI). Stakeholders were part of a healthcare network (post-acute/acute), using health information technology (HIT) to reduce avoidable hospitalizations in nursing homes (NH). Group process methods included (1) forming 6 groups with 6–8 stakeholders per group, 2) each group identified changes that HIT contributes toward reducing avoidable hospitalizations, 3) changes identified were then separated by change experienced by stakeholder type, finally, 4) through an iterative consensus building process each group ranked changes identified for each stakeholder type by high, medium, low impact. Stakeholders identified eight common areas of change from HIT use to reduce avoidable hospitalizations in MOQI: Access, Safety, Workflow, Partnerships, Quality of Information, Patient/Family Satisfaction, Legal, and Improved Health. Thirteen stakeholder types were identified that benefit from HIT in MOQI. Within these 13 stakeholder types high impact areas of change were experienced by Directors of Nursing: Administrators, IT/Vendors, Charge Nurses, Admissions Coordinators, Physicians, Social Services, Advanced Practice Nurses, and Care Consultants. Stakeholders experienced high impact change in their ability to perform work using IT to reduce avoidable hospitalizations including: “deep dive into admissions,”; “get a true picture of admission”; “Faster feedback, clarification, authorization”; “Reviewing orders for correctness”; “Provide immediate care”. High impact changes contributed to the effectiveness of the MOQI multidimensional intervention including HIT, Advanced Directives, and APRNs working in NH to improve care and help staff better manage resident change in condition.

Discharge planning

A resource to support the High Impact Change Model for Managing Transfers of Care has been developed by the Local Government Association and Association of Directors of Adult Social Services. The online resource provides evidence-based examples of work for the eight system changes that have been identified as having greatest effect on, for example, reducing delayed discharge, early discharge planning, monitoring patient flow, and multidisciplinary or multi-agency discharge teams. It also includes examples of emerging practice, and links to further guidance and information.

P139 To attend or not to attend – “why” is the question?

<h3>Background/introduction</h3> Documents such as “10 high impact changes for genitourinary medicine 48 h access” produced by the Department of Health (DH) in 2006 have helped reduce waiting times and increase capacity. Our service experienced a significant increase in the rate of non-attendance of appointments following a change in service base in February 2014. In response we decided to ascertain whether adopting some or all of the DH’s high impact changes would improve the poor attendance. <h3>Aim(s)/objectives</h3> On review we were already employing most of the recommended changes. One omission was high impact change 5: “Review current access system and make it easier for patients to access the service”, therefore we asked patients their preferred means of attendance (appointment or drop in) and times of attendance. <h3>Methods</h3> 105 services users were questioned over a 4 week period from the 1st until the 31st August 2014. <h3>Results</h3> 44% preferred the option of both appointments and drop in, whilst 28% each favoured either all appointments or drop in access only. There was no preferred time of attendance. <h3>Discussion/conclusion</h3> As the service already provides both appointments and drop in access the audit provided little to no evidence that a change to service delivery would reduce levels of non-attendance. There remains minimal data about how best to fulfil public and individual sexual health obligations, especially to an extensive rural community such as ours. A further audit on actual non-attenders could identify patterns in patient expectation.

IS-016 Asthma Deaths

The UK has the highest Paediatric asthma mortality and morbidity in Western Europe. Data will be reported from a longstanding regional (East of England), and the National Review into Asthma Deaths (NRAD). These data clearly describe the risk factors in the UK for asthma death in childhood. Conversely and arguably the UK produces some of the best evidence based clinical guidance (BTS /SIGN, NICE) in the world, however it is clearly failing to deliver quality and safe care to its asthma populations. This contrast has initiated an NHS England quality improvement program; “Delivering improvements in childhood asthma outcomes; A collaborative approach”, to implement a national high impact change model to improve asthma outcomes for children and young people, using the skills, expertise and resources of the 12 NHS England Strategic Clinical Networks. This aims to nationally improve the education of health workers and the asthma population at large, encourage self-management, standardise materials, and review the commissioning of asthma services. Lastly, in a financially challenged health care economy, are such ideals achievable? Pulmonology Symposium (Supported by and Unrestricted Educational Grant from Chiesi).

Menadžment promenama - implementacija promene visokog uticaja br. 10 u primarnoj zdravstvenoj zaštiti Srbije

Menadžment promenama - implementacija promene visokog uticaja br. 10 u primarnoj zdravstvenoj zaštiti Srbije

Effect of PET/CT on Management of Patients with Non–Small Cell Lung Cancer: Results of a Prospective Study with 5-Year Survival Data

We investigated the incremental management impact and prognostic value of staging with (18)F-FDG PET/CT in patients with non-small cell lung cancer (NSCLC) being considered for potentially curative therapies. Information on 168 consecutive patients with NSCLC being considered for surgery or definitive radiotherapy with curative intent before PET/CT was entered into a prospective database. The pre-PET/CT management plan, based on conventional imaging (conventional CT, appropriately supplemented by bone scintigraphy or other modalities), was defined prospectively by referring clinicians before PET/CT results became available. After PET/CT, actual clinical management was recorded, and patients were followed up until 5 y or death. The appropriateness of PET/CT management plans was assessed by biopsy when available, clinical follow-up, and survival analysis. Stage was discordant on PET/CT and conventional imaging in 50.6% of patients (41.1% upstaged, 9.5% downstaged), with high management impact (change in treatment modality or curative intent) in 42.3% of patients. Both conventional imaging stage and PET/CT stage were strongly predictive of overall survival (OS) but there were greater differences between hazard rates and separations in the OS curves for stage groupings determined using PET/CT. OS was also strongly predicted by PET/CT-directed choice of therapy (P < 0.0001). PET/CT frequently affects patient management and strongly predicts OS in NSCLC, supporting the appropriateness of such changes.

The management impact of clinically significant incidental lesions detected on staging FDG PET-CT in patients with non-small cell lung cancer (NSCLC): An analysis of 649 cases

To evaluate FDG PET-CT in the detection of unexpected pre-malignancy or second malignancy at the initial staging of patients with histologically proven non-small cell lung cancer (NSCLC) and its impact on management. MethodsStaging FDG PET-CT scans acquired between February 2006 and July 2010 in 649 patients (M=389; F=260) with NSCLC were reviewed for the presence of unexpected pre-malignancy or second primary. A “True-Positive” lesion represented a second primary or pre-malignant lesion. A “False-Positive” lesion was due to benign causes or an atypical site of metastasis from NSCLC. Results77 (12%) patients were identified on PET-CT as having a potential pre-malignancy or second primary. 39 out of 77 (51%) patients had diagnostic verification where histopathology served as reference standard in 33 patients (85%) and the rest had endoscopy and progress PET-CT scans. 20 patients (3.1%) had a second primary (n=11) or pre-malignant lesions comprising dysplastic colorectal polyps (n=9), and additional therapy and/or management change for the index tumour was instigated in 17 patients (85%). In patients with a second primary, 3 (27%) patients had a high impact change in management from an initial curative intent to palliative. ConclusionStaging FDG PET-CT is highly valuable in identifying second primary cancers or pre-malignant lesions in patients with NSCLC. When a second primary is detected on PET-CT, there is a high impact change in management in 27% of patients.

Infrastructure optimization and performance monitoring: empirical findings from the water sector in Uganda

There are a number of infrastructure water utilities, especially in developing countries that have tended to use climatic change challenges as scapegoat for unreliable water supply to citizens. In this paper, we argue that there are significant gains that infrastructure managers can realise, in the short to medium term, while addressing water scarcity problems as the wider climatic change challenges are being globally tackled! We single out effective infrastructure optimization through high-impact change management plans and incorporating strong water loss management strategies. In addition, we pinpoint use of economic criteria for plant capacity expansion, raw water source protection and effective stakeholder coordination as key ingredients to infrastructure optimisation. Further, the paper investigates modes of infrastructure performance monitoring. Using a quantitative survey method and empirical data from 14 NWSC water utilities, the paper concludes that both process and output oriented monitoring approaches (measured by attitudinal indicators) are positively correlated with monitoring effectiveness and subsequently the technical efficiency change (catch-up) of infrastructure utilities. This study outlines an important issue that has not been adequately researched: the extent to which feedback and information flows from the principal to the agent could improve the capacity of the agent to conduct business.

Day case surgery: a modern view

For several decades day surgery clinicians have championed the invaluable contribution that can be made to the provision of elective surgical care. It is now acknowledged as high impact change number one: treat day surgery rather than inpatient surgery as the norm for elective surgery. However, the potential is much greater and ambulatory practice will be the vanguard for modernizing the delivery of all surgical services of the future. It has been described as crucial to the future of health care.