Service Demonstration Project Research Articles

Improving Communication in Nursing Homes Using Plan-Do-Study-Act Cycles of an SBAR Training Program.

Incomplete communication between staff and providers may cause adverse outcomes for nursing home residents. The Situation-Background-Assessment-Recommendation (SBAR) tool is designed to improve communication around changes in condition (CIC). An adapted SBAR was developed for the Centers for Medicare and Medicaid Services demonstration project, OPTIMISTIC, to increase its use during a resident CIC and to improve documentation. Four Plan-Do-Study-Act (PDSA) cycles to develop and refine successive protocol implementation of the OPTIMISTIC SBAR were deployed in four Indiana nursing homes. Use of SBAR, documentation quality, and participant surveys were assessed pre- and post-intervention implementation. OPTIMISTIC SBAR use and documentation quality improved in three of the four buildings. Participants reported improved collaboration between nurses and providers after SBAR intervention. Successive PDSA cycles implementing changes in an OPTIMISTIC SBAR protocol for resident CIC led to an increase in SBAR use, improved documentation, and better collaboration between nursing staff and providers.

A Position Auction Demonstration Project for Lowering Reference + Biosimilar Drug Prices in Medicare Part B

We outline below a proposal for a Center for Medicaid and Medicare Services (CMS) demonstration project involving a position auction overlay to the existing reimbursement system for Medicare Part B.

Adherence to PrEP Among Young Men Who Have Sex With Men Participating in a Sexual Health Services Demonstration Project in Alameda County, California.

Young men of color who have sex with men face a continual increase in rates of HIV infection. Pre-exposure prophylaxis (PrEP) is an important prevention method for these young men. The Connecting Resources for Urban Sexual Health (CRUSH) demonstration project provided sexual health services, including PrEP, to young men who have sex with men aged 18-29 years. We report on adherence and factors influencing it. Participants were offered HIV and sexually transmitted infection testing, prevention counseling, PrEP, and when appropriate, sexually transmitted infection treatment and postexposure prophylaxis. Participants taking PrEP had erythrocyte tenofovir diphosphate and emtricitabine levels measured through dried blood spot testing at 4, 12, and 24 weeks to estimate medication adherence. Participants also completed surveys to assess demographic and psychosocial measures. From February 2014 to November 2015, CRUSH enrolled 257 participants. Ninety-three percent started PrEP, 81% of whom initiated it at their first visit. Twelve percent required postexposure prophylaxis before starting PrEP. Adherence at protective levels was initially high with 87% demonstrating levels consistent with at least 4 doses per week at week 4, compared with 77% at the 48-week follow-up. African American race, exposure to violence, and having survival needs were associated with significantly lower levels of adherence [odds ratio (OR): 0.33; confidence interval (CI): 0.11 to 0.97, P < 0.04; OR: 0.79; CI: 0.59 to 1.04, P < 0.10; OR: 0.51; CI: 0.24 to 1.05, P < 0.07]. Most young men who initiate PrEP adhere at levels that confer protection against HIV infection. Interventions should account for differences in life experiences, particularly addressing the structural challenges facing young African American men.

학대피해아동보호 전문서비스의 지역사회 협력 경험 -아동보호 통합지원 전문서비스 시범 사업을 중심으로-

학대피해아동보호 전문서비스의 지역사회 협력 경험 -아동보호 통합지원 전문서비스 시범 사업을 중심으로-

An Implementation Framework for Municipal “Internet + Government Service”

The way to promote Internet + government is to build an Internet-based e-government platform, which can overcome the encountered bottlenecks, such as heterogeneous system, data barriers and standards are not unified. In view of the above situation, the objective of this paper is to propose an implementation framework for municipal e-government platform to provide services in a model based on unified standards, unified access and scheduling, unified data sharing and unified identity authentication. The framework consists of user layer, application layer, support layer, resource layer and infrastructure layer. As a national Internet + government service demonstration project, the framework is being implemented in Foshan city.

优质护理服务对骨科空巢患者心理障碍的应用效果

Objective: To investigate the effect of high quality nursing service in empty-nest patients of psychological barriers among orthopedic ward. Methods: 60 empty-nester patients were chosen from orthopedic ward, 30 patients treated with high quality care demonstration were the observation group and 30 patients treated with conventional care demonstration were the control group, 30 patients in control group were given the conventional nursing methods during hospitalization, observation group given the high quality nursing service, observe the nursing satisfaction in two groups. Results: Observation group nursing care and nurses job satisfaction are higher than the control group and the depression, psychological mood of anxiety in observation patients are lower than the control group，the difference was statistically significant ( P <0.05). Conclusion: Using the high quality nursing service in empty-nest patients among orthopedic ward, could effectively relieve patients' anxiety and other negative emotions, improve patients care satisfaction experience of nursing care and nurses job satisfaction, help to promote the high quality nursing service demonstration project.

ESA Activities in Earth Observation for Cultural Heritage Applications

An overview is provided of the activities of the European Space Agency, ESA, to support the documentation, monitoring and management of Cultural Heritage through the use of Earth Observation, EO. These activities include: participation in international agreements; funding of service demonstration projects and support to researchers through the provision of data, training courses and the hosting of research students at the ESA European Space Research Institute, ESRIN, establishment. Since ESA and the United Nations Educational, Scientific and Cultural Organisation, UNESCO, signed the “Open Initiative on the Use of Space Technologies to Support the World Heritage Convention”, world heritage has become increasingly prominent in ESA as an emerging application area. Various demonstration projects have successfully revealed the potential to bridge the gap between research and operational service delivery. These projects include Heritage Observation and Retrieval Under Sand, HORUS, which used radar to document archaeological structures buried beneath the sand in Egypt, and ArchEO, a project recently kicked-off, aimed at demonstrating optical Earth observation techniques for the detection of archaeological structures in Poland. An increasing number of research projects are exploiting ESA and Third Party Mission, TPM, data for cultural heritage applications. Some of these include a project using radar remote sensing for subsurface archaeological feature detection, a project focussing on monitoring land subsidence over Syrian archaeological sites using Interferometric Synthetic Aperture Radar, InSAR, and a project documenting archaeological structures over the Silk Road in China. In addition to the provision of data and processing tools, ESA supports the heritage research and user community through training courses that focus on the application of EO for cultural heritage. Finally, ESA contributes to workshops to provide a forum for the heritage and remote sensing communities to exchange ideas, and provide insights into evolving user needs and technological achievements. ESA activities are driven by user requirements. The increasing involvement of ESA in EO related activities in cultural heritage is indicative of the emerging awareness of the benefits of EO on the part of the heritage community, and their growing interest in its integration into their activities. In order to most efficiently channel resources and plan future EO developments to meet this increased demand, interdisciplinary dialogue is essential between the heritage and remote sensing communities.

Cost-Effectiveness Analysis of a Capitated Patient Navigation Program for Medicare Beneficiaries with Lung Cancer.

To assess the cost-effectiveness of implementing a patient navigation (PN) program with capitated payment for Medicare beneficiaries diagnosed with lung cancer. Cost-effectiveness analysis. A Markov model to capture the disease progression of lung cancer and characterize clinical benefits of PN services as timeliness of treatment and care coordination. Taking a payer's perspective, we estimated the lifetime costs, life years (LYs), and quality-adjusted life years (QALYs) and addressed uncertainties in one-way and probabilistic sensitivity analyses. Model inputs were extracted from the literature, supplemented with data from a Centers for Medicare and Medicaid Services demonstration project. Compared to usual care, PN services incurred higher costs but also yielded better outcomes. The incremental cost and effectiveness was $9,145 and 0.47 QALYs, respectively, resulting in an incremental cost-effectiveness ratio of $19,312/QALY. One-way sensitivity analysis indicated that findings were most sensitive to a parameter capturing PN survival benefit for local-stage patients. CE-acceptability curve showed the probability that the PN program was cost-effective was 0.80 and 0.91 at a societal willingness-to-pay of $50,000 and $100,000/QALY, respectively. Instituting a capitated PN program is cost-effective for lung cancer patients in Medicare. Future research should evaluate whether the same conclusion holds in other cancers.

Impact of a telehealth and care management program for patients with chronic obstructive pulmonary disease.

Improving outcomes and health resource use for patients with chronic obstructive pulmonary disease (COPD) care is a priority for health systems. The Health Buddy Program, a content-driven telehealth system coupled with care management, is designed to enhance patient education, self-management, and timely access to care. To examine the effects of the Health Buddy Program on resource use among Medicare patients with COPD who participated in a Centers for Medicare and Medicaid Services demonstration project from 2006 to 2010. Medicare fee-for-service beneficiaries with COPD who enrolled in the intervention at two participating clinics were propensity-score matched to similar patients with COPD identified from a 5% random sample of Medicare patients. Difference-in-difference analyses descriptively compared the program's effect on quarterly healthcare resource use over the 3-year study period compared with baseline. Negative binomial models estimated the association of the program with healthcare resource outcomes adjusting for significant (P<0.05) baseline differences post matching. The effect of the Health Buddy Program on quarterly all-cause and respiratory-related hospital admissions, hospital admissions for COPD exacerbations, and all-cause emergency department use was assessed after matching. Intervention (n=619) and matched control subjects (n=619) had similar baseline characteristics after matching. The Health Buddy Program was associated with 23% lower quarterly all-cause hospital admissions and 40% lower quarterly respiratory-related hospital admissions compared with baseline for intervention beneficiaries versus control subjects. In subgroup analyses, patients who engaged in the intervention during the study period (n=247) demonstrated significantly lower quarterly hospital admissions for COPD exacerbations. The Health Buddy Program was not associated with reductions in quarterly emergency department use. Results were robust in analyses that adjusted for significant differences in baseline characteristics after matching. A content-driven telehealth system combined with care management has the potential to improve health outcomes in Medicare beneficiaries with COPD.

Survey of the nursing ethics cognition status after carrying out the "High quality nursing service demonstration project" in Guangxi Zhuang Autonomous Region

Objective We aimed to investigate the nurses' ethics cognition status and its influencing factors after carrying out the High quality nursing service demonstration project in Guangxi Zhuang Autonomous Region. Methods From May to June 2014, 379 clinical nurses from 59 hospitals of different grades in Guangxi Zhuang Autonomous Region were investigated with the self-designed questionnaire. Results After carrying out the High quality nursing service demonstration project , the total score of the nurses' ethics cognition were (51.29±3.46), which was higher than those in 2010. There was no statistical difference in cognition of medical confidentiality between 2014 and 2010, but it showed significant statistical differences in dimensions of medical optimization, informed consent, the value of life, t value was 11.389, 7.448 and 2.126, P<0.05. The multiple linear regression analysis showed that nurse-job seniority and hospital hierarchy of clinical nurses were influencing factors of nurses' ethics cognition; educational levels, professional title and nurse-job seniority of clinical nurses were influencing factors of medical optimization; nurses' professional title was influencing factor of informed consent; nurse-job seniority, department and hospital hierarchy of clinical nurses were influencing factors of medical confidentiality; nurses' educational level was influencing factor of life value. Conclusions The High quality nursing service demonstration project contributes to improve the level of nurses' ethics cognition. We should strengthen the nursing ethics continuing education system, in order to improve the nurses' comprehensive ethics cognition. Key words: High quality nursing care; Clinical nurse; Ethics; Cognition

Application of“high quality nursing service demonstration project”in nursing management

Objective To explore the application effect of “high quality nursing service demonstration project” in nursing management .Methods This study was a non-experimental design using data analysis method.The total of 262 clinical nurses and 10 000 patients with their permission were included in this research.The Nurses Job Satisfaction Scale （NJSS）, Chinese Nurse Job Stressors Questionnaire （CNJSQ）, and Self-Rating Anxiety Scale （ SAS ） were collected from the nurses whereas Patient Satisfaction Questionnaire （ PSQ） was collected from the patients at pre and post of the administration of the “high quality nursing service demonstration project”.Results After carried out the “Quality care demonstration project”, the patient satisfaction increased from 84.2%to 95.6%.There was significant difference （χ2 =2.14,P〈0.05）.Positive evaluation was above 90%.Nurse job satisfaction scores, wages, benefits, rewards approach, the relationship between colleagues, work nature, desire to communicate were significantly improved （t =2.99,2.18,3.24, 2.44,2.41,2.25, respectively;P〈0.05）.Nurse job stress scores, nursing profession and work issues, time allocation and workload issues , working conditions and equipment problems , patient care problems caused by stress were significantly reduced （t=2.65,3.17,1.75,3.36, respectively;P〈0.05）.After the intervention, the mean score of positive assessment of SAS , negative assessment of SAS and the total score were significantly decreased （t=1.15,1.73,1.24, respectively;P〈0.05）.Conclusions Evidence from the study suggests the meaningful effectiveness of the “Quality care demonstration project” and there is a strong need of continuous promotion based on the research outcomes . Key words: Nursing management; Patients’ satisfaction; Work stress; Anxiety; High quality nursing service demonstration project

Review of high quality nursing implementation

Since 2010,the activities of quality nursing service demonstration project were carried out in the national health system,its main purpose is to strengthen the nursing foundation,and provide satisfactory service.By conducting these activities,significant achievements have been made,such as improved nursing quality,reduced nurse-patient disputes.However,in the process of implementation,there are stillsome problems for us to think about and solve.In this paper,there is a brief commentary about the results of high quality nursing implementation and related issues. Key words: High quality nursing; Current situation; Review

By the "high quality nursing service demonstration project" as a turning point, exploring the application of implementing accountability nursing mode in pediatric surgical ward

Objective To explore the application effect of implementing the accountability nursing mode in pediatric surgical ward.Methods On the basis of the transformation of nursing concept and the improving of understanding of High Quality Nursing Service Demonstration Project activities,strengthening basic nursing,establishing two-level nurse management framework,implementing the accountability nursing mode.The satisfaction degree of children's parents before and after the implementation was compared.Results The satisfaction degree of children's parents after the implementation of accountability nursing mode significantly improved.Conclusions After implementing accountability nursing mode in pediatric surgical ward,the satisfaction degree of children's parents improved,the harmonious development of nurse-patient relationship was promoted,the professional identity of nursing personnel was enhanced,and guaranteed the continuous improvement of quality of care. Key words: High quality nursing service demonstration project; Accountability nursing mode; Pediatric surgical ward

Investigation of sources of work stress of neurology nurses in new work pattern and its influence factors

Objective To investigation work stress and its influence factors of neurology nurses in new work pattern.Methods 90 neurology nurses in a grade Ⅲ class A hospital was picked with the convenience sampling method and surveyed with a questionnaire for basic information,nurses stressor,social support and coping styles.Results The overall score work stress of neurology nurses was (2.41±0.43).Major sources of work stress were nursing profession and work (3.03 ± 0.58),work load and time allocation the social support (2.90 ± 0.64 ),working environment and resources (2.53 ± 0.86 ),patients caring ( 2.36 ± 0.54 ) and management and interpersonal relationships ( 1.67 ±0.57).Social support and coping styles scored as (43.94 ±6.22) and (54.43 ± 9.92) respectively.Both social support and coping styles showed positively correlation with the work stress of the neurology nurses( t=7.187,7.071,respectively ;P ＜ 0.01).Better support from the society reduced the stress of the nurses.Conclusions Quality of nursing care services demonstration project is a good starting point for reforming the nursing work.Managers should seize this opportunity to fully understand the work stress status of neurology nurses and effectively provide measures to ease the pressure of nurses,improve the of care,and ensure the sustainability quality care service. Key words: Work stress; Nurses; Neurology; High nursing service demonstration project

Application of critical thinking teaching in the responsibility nursing rounds

Objective To explore the effect of critical thinking teaching in the responsibility nursing rounds on the nurses' critical thinking abilities.Methods Sixty nurses were recruited,and applied the critical thinking teaching in the responsibility nursing rounds,before and after the implementation,nurses were investigated with the CTDI-CV.Results Before and after the implementation,the average score of searching truth,open mind,analysis ability,total score of nurses [(37.21 ±6.23) vs (41.31 ±6.40),(32.14 ±5.28)vs (37.63±4.41),(38.69±5.29) vs (42.78±5.15),(255.65±27.17) vs (288.06 ±25.25)] were significantly different (t =3.63,6.12,5.34,6.65,respectively;P ＜ 0.05 ).Conclusions Application of critical thinking teaching in the responsibility nursing rounds can improve the nurses' critical thinking abilities. Key words: Nursing education; Critical thinking; Responsibility nursing rounds; High quality service demonstration project

Significance of the 686 Program for China and for global mental health.

Quietly, with little apparent notice from even the strongest advocates for global mental health, China is undertaking the world’s largest – and arguably most important – mental health services demonstration project, a project focused on providing comprehensive care for persons with severe mental illnesses. As Professor Ma indicates in her short report,

Effect of the high quality nursing service demonstration project on the doctor-patient relationship

Objective To discuss the influence of the high quality nursing service demonstration project on the doctor-patient relationship.Methods Retrospective study was adopt to compare the nursing service,accompanying rate and patient's satisfaction rate before and after taking the high quality care service demonstration project.Results Nursing service had been improved,with accompanying rate falling from 100.0％to 70.0％ ( x2 =1 116.3,P ＜ 0.05),patients' satisfaction rate increasing from 92.0％ to 99.0％ ( x2 =180.3,P ＜ 0.05 ),the doctors' satisfaction rate increasing from 96.0％ to 100.0％ ( x2 =2.8,P ＜ 0.05 ),and nursing quality control deficiency rate decreasing from 25.0％ to 12.0％ ( x2 =5.6,P ＜ 0.05 ).Conclusions The nursing service demonstration project can ameliorate the doctor-patient relationship by carrying out humanized service. Key words: Coordination of doctors and nurses; High quality nursing service; Doctor-patient relationship

Problems and countermeasures during the enforcement of high quality nursing service

Objective To investigate the problems and countermeasures during the course of start-up and sustainability of demonstration project on high quality nursing service in neurosurgery department.Methods The actions we took to deal with these problems were:to let the head nurse play the most important role to convert the perspective of all employees,to change the working mode based on effective management and to consummate training measures to improve the competency of nurses.Results After the conduct of the project,patient satisfaction with nursing service was higher than before and the nurses made fewer mistakes at service as well.Conclusions The enforcement of high quality nursing service demonstration project may improve the nursing service,standardize nursing acts and increase nursing quality and patient satisfaction. Key words: Nursing management; Patient satisfaction; High quality nursing service

Practice and experience of "high-quality nursing services demonstration project" activities

Objective To carry out high-quality nursing services demonstration project, fully fulfill duties of nursing staff to provide quality care. Methods The high-quality nursing services demonstration project was first carried out in 4 pilot ward. The pilot ward studied and discussed carefully, receiving standard training, changing concepts, reasonable adjusting schedule mode, carrying out level use of nurses,responsibility to the group and responsibility to the people, and using nursing records in table format, freeing nurses from complex care record, returning the time to nurses and to patients. Results Nursing quality dramatically improved than before. Conclusions To strengthen basic nursing, make nurses change ideas,improve service consciousness, enhance the sense of responsibility, so that the nursing measures can be put in place to promote nurse-patient communication and improve patient satisfaction significantly. Key words: Basic nursing; High quality care; Nursing quality; Satisfaction degree

Prioritization of Ecosystem Services Research: Tampa Bay Demonstration Project

The Tampa Bay Ecosystem Services Demonstration Project (TBESDP) is part of the U.S. Environmental Protection Agency’s Ecosystem Services Research Program. The principal objectives of TBESDP are to (1) quantify the ecosystem services of the Tampa Bay watershed, (2) determine the value of ecosystem services to society, (3) predict the supply of ecosystem services under future scenarios of population growth and climate change, and (4) apply this knowledge through models and tools that will support the best informed environmental decisions possible. The scope and complexity of this project required intensive effort to establish which services can be quantified by applying existing models, data, and scientific literature and which services will require supporting research. Research priorities were assessed by: (1) developing and refining conceptual models of major ecosystems in the Tampa Bay region, (2) gathering input from stakeholders about the relative importance and values of various ecosystem services, (3) preparing and reviewing a bibliometric analysis of the volume of scientific literature relevant to the ecosystems and services of interest, and (4) evaluating an integrated analysis of importance, value, and availability of scientific information. This analysis led us to focus on two research priorities, seagrass-habitat functions as support for fishery production, and wetlands as regulators of water quality.