Disseminating Innovations in Health Care

Berwick, Donald M.

doi:10.1001/jama.289.15.1969

Cited by 1,550 publications

(1,264 citation statements)

References 26 publications

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“…Changing health care systems is known to be a challenge 12 . The stages of the change process, namely dissemination, adoption, implementation, continuation 13 can be applied specifically to the process of using PROs in clinical practice, recognizing local organizational and clinical issues.…”

Section: Methodsmentioning

confidence: 99%

Training clinicians in how to use patient-reported outcome measures in routine clinical practice

et al. 2015

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Patient-reported outcome measures (PROs) were originally developed for comparing groups of people in clinical trials and population studies, and the results were used to support treatment recommendations or inform health policy, but there was not direct benefit for the participants providing PROs data. However, as the experience in using those measures increased, it became obvious the clinical value in using individual patient PROs profiles in daily practice to identify/monitor symptoms, evaluate treatment outcomes and support shared decision-making. A effectively utilize PROs data in their clinical encounters.The implementation of PROs in patient care represents a significant change to clinical practice of individual clinicians and health organisations. Using a change-management theoretical framework, this paper describes the development and implementation of three programs for training clinicians to effectively use PRO data in routine practice. The training programs are in three diverse clinical areas (adult oncology, lung transplant and paediatrics), in three countries with different health care systems, thus providing a rare opportunity to pull out common approaches whilst recognizing specific settings. For each program we describe the clinical and organisational setting, the program planning and development, the content of the training session with supporting material, subsequent monitoring of PROs use and evidence of adoption. The common successful components and practical steps are identified, leading to discussion and future recommendations. The common successful components are identified, leading to discussion and future recommendations.

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Section: Methodsmentioning

confidence: 99%

Training clinicians in how to use patient-reported outcome measures in routine clinical practice

et al. 2015

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“…This intense interest has been prompted by a range of wellrehearsed arguments about the social and economic damage caused by failures to put research evidence to good use (Berwick 2003;Darzi 2008;World Health Organization 2004). In the wake of the current economic crisis arguments about wasted resources (in the form of funding for research whose outputs are not of practical use) and wasted opportunities (to implement cost-effective healthcare) are even more pertinent.…”

Section: Contextmentioning

confidence: 99%

Exploring knowledge exchange: A useful framework for practice and policy

Ward¹,

Smith²,

House³

et al. 2012

Social Science & Medicine

196

245

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“…Much of our time and effort, our slow rate of progress, and the limited scale of our project relate to this inertia. Traditional health care assumptions, priorities, politics, decision making, reimbursement mechanisms, and compensation plans do not support change (44). We were able to provide the additional patient care for our pilot project with existing resources by decreasing other unnecessary work through a rheumatology preappointment management program (45).…”

mentioning

confidence: 98%

“…Assigning patients to primary physicians and consultants based on disease severity has permitted us to provide this expanded care without adding providers. In a broader sense, strong leadership support and redesign of health system management and finances are required for sustaining and disseminating health care improvement (32,44,46). In fact, the relatively few health systems that have developed an improvement mindset and skills appear to be outperforming more traditional delivery environments (47,48).…”

mentioning

confidence: 99%

Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project

Harrington¹,

Barash²,

Day³

et al. 2005

Arthritis & Rheumatism

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Objective. To develop new processes that assure more reliable, population-based care of fragility fracture patients. Methods. A 4-year clinical improvement project was performed in a multispecialty, community practice health system using evidence-based guidelines and rapid cycle process improvement methods (plan-do-study-act cycles). Results. Prior to this project, appropriate osteoporosis care was provided to only 5% of our 1999 hip fracture patients. In 2001, primary physicians were provided prompts about appropriate care (cycle 1), which resulted in improved care for only 20% of patients. A process improvement pilot in 2002 (cycle 2) and full program implementation in 2003 (cycle 3) have assured osteoporosis care for all willing and able patients with any fragility fracture. Altogether, 58% of 2003 fragility fracture patients, including 46% of those with hip fracture, have had a bone measurement, have been assigned to osteoporosis care with their primary physician or a consultant, and are being monitored regularly. Only 19% refused osteoporosis care. Key process improvements have included using orthopedic billings to identify patients, referring patients directly from orthopedics to an osteoporosis care program, organizing care with a nurse manager and process management computer software, assigning patients to primary or consultative physician care based on disease severity, and monitoring adherence to therapy by telephone. Conclusion. Reliable osteoporosis care is achievable by redesigning clinical processes. Performance data motivate physicians to reconsider traditional approaches. Improving the care of osteoporosis and other chronic diseases requires coordinated care across specialty boundaries and health system support.

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Disseminating Innovations in Health Care

Cited by 1,550 publications

References 26 publications

Training clinicians in how to use patient-reported outcome measures in routine clinical practice

Training clinicians in how to use patient-reported outcome measures in routine clinical practice

Exploring knowledge exchange: A useful framework for practice and policy

Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project

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