scholarly journals Evaluation of current practice: compliance with osteoporosis clinical guidelines in an outpatient fracture clinic

2008 ◽  
Vol 32 (1) ◽  
pp. 34 ◽  
Author(s):  
Cheryl M Kimber ◽  
Karen A Grimmer-Somers
Keyword(s):  
Best Practice ◽  
Guideline Implementation ◽  
Cost Savings ◽  
Fracture Prevention ◽  
Wrist Fracture ◽  
Fracture Clinic ◽  
Quality Guidelines ◽  
Sustainable Implementation ◽  
Metropolitan Hospital ◽  
Future Fracture

Better detection and management of osteoporosis will reduce unnecessary health expenditure. A number of high quality guidelines are available to support early detection and best practice management of osteoporosis in hospital settings. However, sustainable implementation of guidelines poses practical issues in terms of structure and processes in hospitals. This paper describes an investigation into guideline compliance in one large tertiary metropolitan hospital and discusses practical elements of guideline implementation. Given the evidence of poor practice across the two audit periods, we recommend that a coordinated clinical pathway be implemented in the fracture clinic, supported by a targeted and disciplinespecific training program. Small steps towards improving awareness and management of osteoporosis in patients presenting for the first time with non-trauma wrist fracture may well produce large cost savings by future fracture prevention.

scholarly journals Multifaceted guideline implementation strategies improve early identification and management of osteoporosis

2009 ◽  
Vol 33 (3) ◽  
pp. 423 ◽  
Author(s):  
Cheryl M Kimber ◽  
Karen A Grimmer-Somers
Keyword(s):  
Early Identification ◽  
Best Practice ◽  
Guideline Implementation ◽  
Implementation Strategies ◽  
Fragility Fractures ◽  
Management Approach ◽  
Routine Practice ◽  
Patient Records ◽  
Fracture Management ◽  
Metropolitan Hospital

Background: Osteoporosis contributes significantly to fractures, subsequent disability and premature mortality in Australia. Better detection and management of osteoporosis will reduce unnecessary health expenditure. Objective: To evaluate, in one large tertiary metropolitan hospital, the orthopaedic health care team?s approach to osteoporosis guideline implementation to improve early identification and management of osteoporosis. Methods: This paper describes the implementation of multifaceted strategies to improve healthpromoting behaviours and the uptake of osteoporosis guidelines by staff in the orthopaedic outpatient clinic at one metropolitan hospital, reflecting organisational and individual commitment to embedding guideline recommendations into routine practice. Implementation strategies were aimed at the requirements and perspectives of different stakeholder groups. Five audit datasets were compared: 62 patient records in two baseline audits, and three post-implementation audits of 31 patient records, collected over the following 3-month periods (August 2006 to April 2007). All audits used the same criteria to assess compliance with clinical guidelines, and outcomes of implementation strategies. Results: There was consistent improvement in compliance with osteoporosis guidelines over the audit periods. Comparing baseline and immediate post-implementation data, there was a significant improvement (P < 0.05) in the percentage of patients with likely fragility fractures who were identified with an osteoporotic fracture. The percentage of patients who had a likely fragility fracture, with whom staff communicated about their problems and how to deal with them, increased consistently over all post-implementation audit periods. For patients with established osteoporosis who presented with fragility fractures, there was sustained improvement over the audit periods in the percentage provided with guideline-based care. Conclusion: This study highlights that appropriate and targeted intervention strategies can be effective if modelled on best practice guideline implementation approaches with the use of a coordinated post-fracture management approach to osteoporosis.

Systematic approaches to fragility fracture prevention

2014 ◽  
Vol 23 (01) ◽  
pp. 39-44
Author(s):  
D. B. Lee ◽  
P. J. Mitchell
Keyword(s):  
Fragility Fracture ◽  
National Policy ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
The United States ◽  
Fracture Liaison Service ◽  
Reimbursement Mechanisms ◽  
Future Fracture ◽  
National Coalition ◽  
Fracture Liaison

SummaryIndividuals who have suffered fractures caused by osteoporosis – also known as fragility fractures – are the most readily identifiable group at high risk of suffering future fractures. Globally, the majority of these individuals do not receive the secondary preventive care that they need. The Fracture Liaison Service model (FLS) has been developed to ensure that fragility fracture patients are reliably identified, investigated for future fracture and falls risk, and initiated on treatment in accordance with national clinical guidelines. FLS have been successfully established in Asia, Europe, Latin America, North America and Oceania, and their widespread implementation is endorsed by leading national and international osteoporosis organisations. Multi-sector coalitions have expedited inclusion of FLS into national policy and reimbursement mechanisms. The largest national coalition, the National Bone Health Alliance (NBHA) in the United States, provides an exemplar of achieving participation and consensus across sectors. Initiatives developed by NBHA could serve to inform activities of new and emerging coalitions in other countries.

scholarly journals Making your geriatric and palliative programs a strength: TQIP guideline implementation and the VRC perspective

2021 ◽  
Vol 6 (1) ◽  
pp. e000677
Author(s):  
Vanessa P Ho ◽  
Sasha D Adams ◽  
Kathleen M O'Connell ◽  
Christine S Cocanour ◽  
Saman Arbabi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Best Practice ◽  
Guideline Implementation ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Best Practice Guidelines ◽  
American College Of Surgeons ◽  
Specialized Care ◽  
The Usa

BackgroundOlder patients compose approximately 30% of trauma patients treated in the USA but make up nearly 50% of deaths from trauma. To help standardize and elevate care of these patients, the American College of Surgeons (ACS) Trauma Quality Improvement Program’s best practice guidelines for geriatric trauma management was published in 2013 and that for palliative care was published in 2017. Here, we discuss how palliative care and geriatrics quality metrics can be tracked and used for performance improvement and leveraged as a strength for trauma verification.MethodsWe discuss the viewpoint of the ACS Verification, Review, and Consultation and three case studies, with practical tips and takeaways, of how these measures have been implemented at different institutions.ResultsWe describe the use of (1) targeted educational initiatives, (2) development of a consultation tool based on institutional resources, and (3) application of a nurse-led frailty screen.DiscussionSpecialized care and attention to these vulnerable populations is recommended, but the implementation of these programs can take many shapes.Level of evidence V

Proposed guidance on cost-avoidance studies in pharmacy practice

2021 ◽  
Author(s):  
Asad E Patanwala ◽  
Sujita W Narayan ◽  
Curtis E Haas ◽  
Ivo Abraham ◽  
Arthur Sanders ◽  
...  
Keyword(s):  
Clinical Pharmacy ◽  
Best Practice ◽  
Pharmacoeconomic Analysis ◽  
Pharmacy Practice ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Cost Assessment ◽  
Potential Consequence ◽  
Cost Avoidance ◽  
Pharmacist Interventions

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Cost-avoidance studies of pharmacist interventions are common and often the first type of study conducted by investigators to quantify the economic impact of clinical pharmacy services. The purpose of this primer is to provide guidance for conducting cost-avoidance studies pertaining to clinical pharmacy practice. Summary Cost-avoidance studies represent a paradigm conceptually different from traditional pharmacoeconomic analysis. A cost-avoidance study reports on cost savings from a given intervention, where the savings is estimated based on a counterfactual scenario. Investigators need to determine what specifically would have happened to the patient if the intervention did not occur. This assessment can be fundamentally flawed, depending on underlying assumptions regarding the pharmacists’ action and the patient trajectory. It requires careful identification of the potential consequence of nonaction, as well as probability and cost assessment. Given the uncertainty of assumptions, sensitivity analyses should be performed. A step-by-step methodology, formula for calculations, and best practice guidance is provided. Conclusions Cost-avoidance studies focused on pharmacist interventions should be considered low-level evidence. These studies are acceptable to provide pilot data for the planning of future clinical trials. The guidance provided in this article should be followed to improve the quality and validity of such investigations.

Why we still prescribe so many opioids: A qualitative study on barriers and facilitators to prescribing guideline implementation

2021 ◽  
Vol 17 (2) ◽  
pp. 115-124
Author(s):  
Kathryn W. Zavaleta, MHSA ◽  
Lindsey M. Philpot, PhD, MPH ◽  
Julie L. Cunningham, PharmD, RPh ◽  
Halena M. Gazelka, MD ◽  
Holly L. Geyer, MD ◽  
...  
Keyword(s):  
Best Practice ◽  
Guideline Implementation ◽  
Healthcare Setting ◽  
Medical Specialty ◽  
Critical Systems ◽  
Healthcare Organizations ◽  
Opioid Prescribing ◽  
Daunting Challenge ◽  
Additional Education ◽  
Safe Opioid Prescribing

Introduction: Opioid prescribing occurs within almost every healthcare setting. Implementation of safe, effective opioid stewardship programs represents a critical but daunting challenge for medical leaders. This study sought to understand the barriers and aids to the routine use of clinical guidelines for opioid prescribing among healthcare professionals and to identify areas in need of additional education for prescribing providers, pharmacists, and nurses.Methods: Data collection and analysis in 2018-2019 employed a team of two trained facilitators who conducted 20 focus groups using a structured facilitation guide to explore operational, interpersonal, and patient care-related barriers to best practice adherence. Each professional group was interviewed separately, with similar care settings assigned together. Invitation to participate was based on a sampling methodology representing emergency, medical specialty, primary care, and surgical practice settings.Results: Key concerns among all groups reflected the inadequacy of available tools for staff to appropriately assess and treat patients’ pain. Tools and technology to support safe opioid prescribing were also cited as a barrier by all three professional groups. All groups noted that prescribers tend to rely upon default settings within the electronic medical record when issuing prescriptions. Both pharmacists and prescribers cited time and scheduling as a barrier to adherence.Conclusions: In spite of significant regulatory and public policy efforts to address the opioid crisis, healthcare organizations face significant challenges to improve adherence to best practice prescribing guidelines. These findings highlight several facilitators for change which could boost opioid stewardship initiatives to focus on critical systems’ factors for improvement.

Prediction of a new fracture after a wrist fracture – a five year follow up

2020 ◽  
Author(s):  
Eva Ekvall Hansson ◽  
Leif E Dahlberg ◽  
Måns Magnusson ◽  
Anders Beckman
Keyword(s):  
Fracture Risk ◽  
Assessment Tool ◽  
Postural Sway ◽  
Force Plate ◽  
Wrist Fracture ◽  
Local Health ◽  
Ageing Population ◽  
Self Rated Health ◽  
Future Fracture

Abstract Background Falls and ensuing fractures are major challenges in our ageing population. The aim of this study was to study if clinical balance measures, function of the inner ear, self-rated health or fracture risk assessed by FRAX ® could predict future admission to hospital because of a fracture among a group of older persons with previous wrist fracture. Methods This was a longitudinal study with a 5-year follow-up. Searches in the local health authority’s patient administrative system (PAS) were performed 5 years after inclusion and baseline measurements were taken. Information was extracted about whether participants had been treated for a fracture or hospitalized other reasons during the 5-year period. Persons, 50 years and above, with previous wrist fracture (n=83). Five different clinical balance measures was assessed, postural sway was assessed by means of a force plate, vestibular asymmetry was assessed with the head- shake test, self-rated health by EuroQol 5 Dimension visual analogue scale and risk of future fracture by the Fracture Risk Assessment Tool (FRAX ® ). Age and body mass index was also used in the risk analysis. Results Age was associated with risk of future fracture, OR 1,06 (95% CI 1,01-1,12). The ability to stand on one leg with eyes open correlated significantly with future fracture (p=0.011) and so did FRAXosteo, however on the limits of significance (p=0.052). Conclusion This follow-up study showed that the one-leg standing time-test was a stronger predictor for future facture within five-years after a wrist fracture than FRAX not including a measure of balance.

Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing

2019 ◽  
Vol 40 (6) ◽  
pp. 668-673 ◽  
Author(s):  
Jasmine R. Marcelin ◽  
Charlotte Brewer ◽  
Micah Beachy ◽  
Elizabeth Lyden ◽  
Tammy Winterboer ◽  
...  
Keyword(s):  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Poisson Model ◽  
Panel Testing ◽  
Period 2 ◽  
Gastrointestinal Pathogen ◽  
Pathogen Testing ◽  
The Impact

AbstractObjective:To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP).Design:We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering.Setting:Midwest academic medical center.Participants:Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2).Intervention:A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours.Results:During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63–0.78; P < .001). The rate of inappropriate tests ordered decreased from 21.5% to 4.9% between the 2 periods (P < .001). The total savings calculated factoring only GIPP orders that triggered the hard stop was ∼$67,000, with potential savings of $168,000 when factoring silent best-practice alert data.Conclusions:A simple hard stop alert in the EHR resulted in significant reduction of inappropriate GIPP testing, which was associated with significant cost savings. Clinicians can practice diagnostic stewardship by avoiding ordering this test more than once per admission or in patients hospitalized >72 hours.

scholarly journals A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kelly Rushton ◽  
Claire Fraser ◽  
Judith Gellatly ◽  
Helen Brooks ◽  
Peter Bower ◽  
...  
Keyword(s):  
Focus Group ◽  
Best Practice ◽  
Psychological Treatment ◽  
Cost Savings ◽  
Clinical Effectiveness ◽  
Service Level ◽  
Patient Choice ◽  
Decision Makers ◽  
Normalisation Process Theory ◽  
Access To Treatment

Abstract Background Psychological treatment delivered by telephone is recommended by the National Institute for Health and Care Excellence (NICE) for mild to moderate depression and anxiety, and forms a key part of the Improving Access to Psychological Therapy (IAPT) programme in the UK. Despite evidence of clinical effectiveness, patient engagement is often not maintained and psychological wellbeing practitioners (PWPs) report lacking confidence and training to deliver treatment by telephone. This study aimed to explore the perspectives of professional decision makers (both local and national) on the barriers and facilitators to the implementation of telephone treatment in IAPT. Methods Sixteen semi-structured qualitative telephone interviews and one focus group were carried out with decision makers (n = 21) who were involved locally and nationally in policy, practice and research. The interviews and focus group were coded thematically, and then mapped onto the four core constructs of Normalisation Process Theory (NPT). Results The use of telephone for psychological treatment was universally recognised amongst participants as beneficial for improving patient choice and access to treatment. However, at service level, motives for the implementation of telephone treatments are often misaligned with national objectives. Pressure to meet performance targets has become a key driver for the use of telephone treatment, with promises of increased efficiency and cost savings. These service-focussed objectives challenge the integration of telephone treatments, and PWP acceptance of telephone treatments as non-inferior to face-to-face. Ambivalence among a workforce often lacking the confidence to deliver telephone treatments leads to reluctance among PWPs to ‘sell’ treatments to a patient population who are not generally expecting treatment in this form. Conclusions Perceptions of a need to ‘sell’ telephone treatment in IAPT persist from top-level decision makers down to frontline practitioners, despite their conflicting motives for the use of telephone. The need for advocacy to highlight the clinical benefit of telephone treatment, along with adequate workforce support and guidance on best practice for implementation is critical to the ongoing success and sustainability of telephone treatment in primary care mental health programmes.

scholarly journals 2346. Cost Savings Associated with Implementation of Clinical Decision Support for Clostridiodes difficile Testing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S806-S807
Author(s):  
Cindy L Hoegg ◽  
Katie L Williams ◽  
Eric Shelov ◽  
Talene A Metjian ◽  
Ana Maria Cardenas ◽  
...  
Keyword(s):  
Decision Support ◽  
Literature Review ◽  
Clinical Decision Support ◽  
Best Practice ◽  
Cost Savings ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
False Positives ◽  
Exclusion Criteria ◽  
Laboratory Staff

Abstract Background Clinical decision support for Clostridioides difficile infection (CDI) diagnostics reduces inappropriate testing, leading to decreased need for isolation and antibiotic use. Our institution utilized manual discontinuation by laboratory staff of CDI testing for inappropriate specimens, including formed stool and age < 1 year. We aimed to assess the financial impact of instituting a CDI best practice alert at a quaternary care children’s hospital. Methods A multidisciplinary team mapped inappropriate testing criteria identified from literature review with discrete fields in our electronic health record (EHR, EpicCare) to design an alert. The exclusion criteria identified included: (1) age < 1 year; (2) positive C. difficile test within past 14 days; (3) less than or equal to 3 unformed stools in past 24 hours; (4) current receipt of CDI-directed therapy; or (5) laxative use or barium exposure in prior 48 hours. 6 months of data prior to implementation were reviewed to estimate impact of the alert. At implementation, any exclusion criteria detected in the EHR at the time of order entry triggered an alert to deter CDI testing. Cost estimates for averted tests (Quick Check Complete Assay/Illumigene) included cost of test ($50), cost of isolation/personal protective equipment ($159/day), and cost of treatment with oral vancomycin in false-positives ($2250/treatment course). Results In a 6-month pre-implementation period, 586 tests for CDI were ordered; of which, 23% were identified by our criteria as inappropriate. During the first 3 months of alert implementation, 256 tests were ordered, of which 105 (41%) caused the alert to fire. Of those, 56 tests were not ordered, for a 22% reduction in testing. Laboratory staff continued to manually stop tests not meeting criteria, such as patient age <1 year when possible. Based on avoidance of testing, use of PPE, and 10 day antibiotic treatment for false-positives (assumed 25% by literature review), this translated to cost savings of $69,916, and an annual cost savings of $279,664. Conclusion Implementation of an alert for select patients using a bioinformatics algorithm reduced inappropriate CDI testing. Clinical decision support for CDI can lead to substantial cost savings for both antibiotic use and isolation precautions. Disclosures All authors: No reported disclosures.

35 Enhanced Service Through An Integrated New Model of Care in A Buckinghamshire Care Home

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i9-i10
Author(s):  
U Okoli ◽  
S Chimhau ◽  
B Nagyova ◽  
A Sahni ◽  
S Amin ◽  
...  
Keyword(s):  
Best Practice ◽  
Adverse Drug Events ◽  
Hospital Admissions ◽  
Care Home ◽  
Cost Savings ◽  
Care Homes ◽  
Multiple Chronic Conditions ◽  
Model Of Care ◽  
Nice Guideline ◽  
Care Plans

Abstract Introduction Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes. Polypharmacy and medication errors are common. The frequency and quality of medication reviews is variable with limited general practice (GP) capacity to carry out comprehensive reviews. The initiative used a care home pharmacist, technician, geriatrician and GPs to tackle these issues on an individual and care home level. The objective being to ensure the safe and effective use of medicines for all care home residents. NICE guideline [NG56] recommends reducing pharmacological treatment burden for adults with multimorbidity at risk of adverse drug events such as unplanned hospital admissions. A study by Dilles et al1 found adverse drug reactions in 60% of residents. Methods A new interdisciplinary model of care was delivered in a 120 bedded Buckinghamshire care home. Clinical Commissioning Group pharmacist, general practitioners and pharmacy technician reviewed medication for all residents. The most complex individuals were reviewed by the geriatrician and if needed by other multidisciplinary team members specialist. Results Overall 115 medications were stopped for 109 residents, with 31 interventions to reduce falls risk and 19 interventions on medication at high risk2 of causing admission. Total cost savings on medicines optimisation, medicines waste and non-elective admission prevented was £35,211. Residents’ care plans were updated to reflect best practice standards. Conclusions Future direction of this project focuses on system wide improvements to promote interdisciplinary healthcare professionals work in care homes. The success of this integrated model of care has enabled recurrent funding of pharmacist by the local county council and an additional 42 geriatrician sessions into Buckinghamshire care homes. References 1. Dilles T, Vander Stichele R, Van Bortel L, Elseviers M. Journal of American Medical Directors Association 2013; 14: 371–6. 2. Pirmohamed M, et al. Br Med J 2004; 329: 15–9 61.

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