86 research outputs found
Implementation of national clinical guidelines and clinical quality registries to improve cardiac rehabilitation
No full textFormålet med denne afhandling var at øge vor forståelse af implementering af nationale kliniske retningslinjer og nationale kliniske databaser for at forbedre hjerterehabilitering.Dette formål stammede fra en erkendelse af de udfordringer med implementering som findes i sundhedsvæsenet generelt, hvor hjerterehabilitering er en case som illustrerer udfordringerne med at anvende evidensbaserede anbefalinger i praksis, hvilket resulterer i en kløft mellem viden og praksis. Danske myndigheder har, som en respons på suboptimal indhold og kvalitet af hjerterehabilitering i Danmark, lanceret to strategier for at forbedre tilbuddet: en national klinisk retningslinje og en national klinisk kvalitetsdatabase. Disse initiativer har til formål at føre til ændringer inden for praksis, men de kan være udfordrende at implementere. Med afsæt i disse forhold var målet for denne afhandling at studere implementeringen af de to strategier, hvilket blev gennemført i tre forskellige studier og ved brug af både kvantitative og kvalitative metoder. Målet med det første studie var at vurdere udfaldet af implementeringen af den nationale retningslinje, ved at fastlægge i hvilken udstrækning danske hjerterehabiliteringstilbud følger de nationale anbefalinger. Vi gennemførte en spørgeskemaundersøgelse lige før lanceringen af den nye retningslinje og med en opfølgning to år senere, med spørgsmål til indhold og kvalitet af indsatser. Både hospitaler og kommuner deltog i undersøgelsen, da de deler ansvaret for hjerterehabilitering i Danmark. Resultaterne viste, at der ikke var nogle forbedringer i kommunerne i den pågældende periode, medens nogle forbedringer blev rapporteret på sygehusniveau. Der var betragtelig variation i hjerterehabiliteringstilbuddene, og overordnet set var der plads til forbedring. Det andet studie satte fokus på implementering af kvalitetsdatabasen, herunder især dataindsamling og dataindtastning. Vi gennemførte interviews med klinisk og administrativt personale, der var involverede i disse opgaver, for at afdække hvordan de oplevede implementeringsprocessen. Ud over det danske register var yderligere en database, den Britiske, inkluderet i dette studie, for at give et bredere perspektiv og mulighed for øget forståelse for hvordan personale oplever det at arbejde med hjerterehabiliteringsregistre. Ved hjælp af indholdsanalyse fandt vi både ligheder og forskelle mellem de to registre. Generelt havde implementeringen kun fået begrænset opmærksomhed. Personalet oplevede en mangel på støtte fra ledelsen og mange fandt det udfordrende at få brugen af registret indpasset i en travl og kompleks dagligdag. Målet med det tredje studie var at måle i hvilken grad feedback-data fra den danske database bliver brugt i forbindelse med lokalt kvalitetsudviklingsarbejde, samt hvad der understøtter sådan brug af data. Et svensk spørgeskema omhandlende brug af database-data blev oversat til dansk og sendt til både klinisk personale og ledere i alle hospitalsafdelinger, som bidrager med data til det danske register. Resultaterne indikerede en begrænset brug af data, dog var der forskel mellem ledernes og personalets opfattelser af databrug. Blandt de understøttende faktorer for at bruge data var høj datakvalitet og brugbarhed, at ledelsen var involveret, samt personlig motivation.Overordnet set peger denne afhandling på, at implementeringen af både retningslinjen og databasen for hjerterehabilitering har fået sparsom opmærksomhed. Når implementering ikke er vel gennemført kan sundhedsvæsenet ikke forvente at kunne høste udbyttet fra at have lanceret disse strategier. The aim of this thesis was to improve our understanding of implementation of national clinical guidelines and national clinical registries to improve cardiac rehabilitation (CR).This aim originated from an acknowledgement of the challenges of implementing new research based knowledge in healthcare in general and CR is a case that clearly illustrates the difficulties of moving recommendations into evidence-based practice, resulting in knowing-doing gaps. In response to the insufficient provision and quality of CR in Denmark, Danish authorities have launched two strategies to improve services: a national clinical guideline and a national clinical quality registry. While intended to improve the implementation of CR, these strategies may, however, in themselves be difficult to implement. Hence, this health services research PhD project investigated the implementation of these strategies in three studies, using both quantitative and qualitative methods. The objective of the first study was to assess the service level outcomes of guideline implementation by determining the extent to which Danish CR services adhere to national recommendations. By means of a follow-up questionnaire survey, we studied the content and quality of services according to guideline-based recommendations immediately before launch of the new national clinical guideline and two years later. The study included both hospitals and municipalities, as these two settings share responsibility for the provision of CR in Denmark. We found considerable variation in CR services between units and, overall, we found there was room for improvement. No changes were found in the CR services offered at the municipality level, following the launch of the guideline, while some improvements were reported at the hospital level. The second study focused on registry implementation, in particular the processes of data collection and data entry. Interviews were conducted amongst staff involved in both these tasks, in order to explore how they experienced the process of registry implementation. To broaden perspectives, two registries were included: the Danish Cardiac Rehabilitation Database and the British National Audit of Cardiac Rehabilitation. Content analysis identified both similarities and differences within and between the studied registries. In general, implementation received little focused planning at a department level. Staff experienced a lack of active support from management, and seemed to experience challenges in fitting registry use into their busy and complex daily practice.The objective of the third study was to measure the extent of registry feedback used in local quality implementation work and to identify the factors facilitating such use of data. A questionnaire regarding perceptions of the registry and departmental use of registry data was sent to frontline staff and managers in all hospital departments taking part in the Danish CR registry. Results suggested a relatively low use of data, although managers and frontline staffs´ perceptions of use of data differed. Factors that facilitated data use were identified to include perceived quality of high level and usefulness of data, involvement of managers and personal motivation. Overall, the thesis suggests that implementation of the CR guideline and registry, in general, was relatively modest. Without a thorough implementation, healthcare cannot expect to harvest the benefits from launching these strategies.
Implementation of national clinical guidelines and clinical quality registries to improve cardiac rehabilitation
No full textFormålet med denne afhandling var at øge vor forståelse af implementering af nationale kliniske retningslinjer og nationale kliniske databaser for at forbedre hjerterehabilitering.Dette formål stammede fra en erkendelse af de udfordringer med implementering som findes i sundhedsvæsenet generelt, hvor hjerterehabilitering er en case som illustrerer udfordringerne med at anvende evidensbaserede anbefalinger i praksis, hvilket resulterer i en kløft mellem viden og praksis. Danske myndigheder har, som en respons på suboptimal indhold og kvalitet af hjerterehabilitering i Danmark, lanceret to strategier for at forbedre tilbuddet: en national klinisk retningslinje og en national klinisk kvalitetsdatabase. Disse initiativer har til formål at føre til ændringer inden for praksis, men de kan være udfordrende at implementere. Med afsæt i disse forhold var målet for denne afhandling at studere implementeringen af de to strategier, hvilket blev gennemført i tre forskellige studier og ved brug af både kvantitative og kvalitative metoder. Målet med det første studie var at vurdere udfaldet af implementeringen af den nationale retningslinje, ved at fastlægge i hvilken udstrækning danske hjerterehabiliteringstilbud følger de nationale anbefalinger. Vi gennemførte en spørgeskemaundersøgelse lige før lanceringen af den nye retningslinje og med en opfølgning to år senere, med spørgsmål til indhold og kvalitet af indsatser. Både hospitaler og kommuner deltog i undersøgelsen, da de deler ansvaret for hjerterehabilitering i Danmark. Resultaterne viste, at der ikke var nogle forbedringer i kommunerne i den pågældende periode, medens nogle forbedringer blev rapporteret på sygehusniveau. Der var betragtelig variation i hjerterehabiliteringstilbuddene, og overordnet set var der plads til forbedring. Det andet studie satte fokus på implementering af kvalitetsdatabasen, herunder især dataindsamling og dataindtastning. Vi gennemførte interviews med klinisk og administrativt personale, der var involverede i disse opgaver, for at afdække hvordan de oplevede implementeringsprocessen. Ud over det danske register var yderligere en database, den Britiske, inkluderet i dette studie, for at give et bredere perspektiv og mulighed for øget forståelse for hvordan personale oplever det at arbejde med hjerterehabiliteringsregistre. Ved hjælp af indholdsanalyse fandt vi både ligheder og forskelle mellem de to registre. Generelt havde implementeringen kun fået begrænset opmærksomhed. Personalet oplevede en mangel på støtte fra ledelsen og mange fandt det udfordrende at få brugen af registret indpasset i en travl og kompleks dagligdag. Målet med det tredje studie var at måle i hvilken grad feedback-data fra den danske database bliver brugt i forbindelse med lokalt kvalitetsudviklingsarbejde, samt hvad der understøtter sådan brug af data. Et svensk spørgeskema omhandlende brug af database-data blev oversat til dansk og sendt til både klinisk personale og ledere i alle hospitalsafdelinger, som bidrager med data til det danske register. Resultaterne indikerede en begrænset brug af data, dog var der forskel mellem ledernes og personalets opfattelser af databrug. Blandt de understøttende faktorer for at bruge data var høj datakvalitet og brugbarhed, at ledelsen var involveret, samt personlig motivation.Overordnet set peger denne afhandling på, at implementeringen af både retningslinjen og databasen for hjerterehabilitering har fået sparsom opmærksomhed. Når implementering ikke er vel gennemført kan sundhedsvæsenet ikke forvente at kunne høste udbyttet fra at have lanceret disse strategier. The aim of this thesis was to improve our understanding of implementation of national clinical guidelines and national clinical registries to improve cardiac rehabilitation (CR).This aim originated from an acknowledgement of the challenges of implementing new research based knowledge in healthcare in general and CR is a case that clearly illustrates the difficulties of moving recommendations into evidence-based practice, resulting in knowing-doing gaps. In response to the insufficient provision and quality of CR in Denmark, Danish authorities have launched two strategies to improve services: a national clinical guideline and a national clinical quality registry. While intended to improve the implementation of CR, these strategies may, however, in themselves be difficult to implement. Hence, this health services research PhD project investigated the implementation of these strategies in three studies, using both quantitative and qualitative methods. The objective of the first study was to assess the service level outcomes of guideline implementation by determining the extent to which Danish CR services adhere to national recommendations. By means of a follow-up questionnaire survey, we studied the content and quality of services according to guideline-based recommendations immediately before launch of the new national clinical guideline and two years later. The study included both hospitals and municipalities, as these two settings share responsibility for the provision of CR in Denmark. We found considerable variation in CR services between units and, overall, we found there was room for improvement. No changes were found in the CR services offered at the municipality level, following the launch of the guideline, while some improvements were reported at the hospital level. The second study focused on registry implementation, in particular the processes of data collection and data entry. Interviews were conducted amongst staff involved in both these tasks, in order to explore how they experienced the process of registry implementation. To broaden perspectives, two registries were included: the Danish Cardiac Rehabilitation Database and the British National Audit of Cardiac Rehabilitation. Content analysis identified both similarities and differences within and between the studied registries. In general, implementation received little focused planning at a department level. Staff experienced a lack of active support from management, and seemed to experience challenges in fitting registry use into their busy and complex daily practice.The objective of the third study was to measure the extent of registry feedback used in local quality implementation work and to identify the factors facilitating such use of data. A questionnaire regarding perceptions of the registry and departmental use of registry data was sent to frontline staff and managers in all hospital departments taking part in the Danish CR registry. Results suggested a relatively low use of data, although managers and frontline staffs´ perceptions of use of data differed. Factors that facilitated data use were identified to include perceived quality of high level and usefulness of data, involvement of managers and personal motivation. Overall, the thesis suggests that implementation of the CR guideline and registry, in general, was relatively modest. Without a thorough implementation, healthcare cannot expect to harvest the benefits from launching these strategies.
Implementation of national clinical guidelines and clinical quality registries to improve cardiac rehabilitation
No full textFormålet med denne afhandling var at øge vor forståelse af implementering af nationale kliniske retningslinjer og nationale kliniske databaser for at forbedre hjerterehabilitering.Dette formål stammede fra en erkendelse af de udfordringer med implementering som findes i sundhedsvæsenet generelt, hvor hjerterehabilitering er en case som illustrerer udfordringerne med at anvende evidensbaserede anbefalinger i praksis, hvilket resulterer i en kløft mellem viden og praksis. Danske myndigheder har, som en respons på suboptimal indhold og kvalitet af hjerterehabilitering i Danmark, lanceret to strategier for at forbedre tilbuddet: en national klinisk retningslinje og en national klinisk kvalitetsdatabase. Disse initiativer har til formål at føre til ændringer inden for praksis, men de kan være udfordrende at implementere. Med afsæt i disse forhold var målet for denne afhandling at studere implementeringen af de to strategier, hvilket blev gennemført i tre forskellige studier og ved brug af både kvantitative og kvalitative metoder. Målet med det første studie var at vurdere udfaldet af implementeringen af den nationale retningslinje, ved at fastlægge i hvilken udstrækning danske hjerterehabiliteringstilbud følger de nationale anbefalinger. Vi gennemførte en spørgeskemaundersøgelse lige før lanceringen af den nye retningslinje og med en opfølgning to år senere, med spørgsmål til indhold og kvalitet af indsatser. Både hospitaler og kommuner deltog i undersøgelsen, da de deler ansvaret for hjerterehabilitering i Danmark. Resultaterne viste, at der ikke var nogle forbedringer i kommunerne i den pågældende periode, medens nogle forbedringer blev rapporteret på sygehusniveau. Der var betragtelig variation i hjerterehabiliteringstilbuddene, og overordnet set var der plads til forbedring. Det andet studie satte fokus på implementering af kvalitetsdatabasen, herunder især dataindsamling og dataindtastning. Vi gennemførte interviews med klinisk og administrativt personale, der var involverede i disse opgaver, for at afdække hvordan de oplevede implementeringsprocessen. Ud over det danske register var yderligere en database, den Britiske, inkluderet i dette studie, for at give et bredere perspektiv og mulighed for øget forståelse for hvordan personale oplever det at arbejde med hjerterehabiliteringsregistre. Ved hjælp af indholdsanalyse fandt vi både ligheder og forskelle mellem de to registre. Generelt havde implementeringen kun fået begrænset opmærksomhed. Personalet oplevede en mangel på støtte fra ledelsen og mange fandt det udfordrende at få brugen af registret indpasset i en travl og kompleks dagligdag. Målet med det tredje studie var at måle i hvilken grad feedback-data fra den danske database bliver brugt i forbindelse med lokalt kvalitetsudviklingsarbejde, samt hvad der understøtter sådan brug af data. Et svensk spørgeskema omhandlende brug af database-data blev oversat til dansk og sendt til både klinisk personale og ledere i alle hospitalsafdelinger, som bidrager med data til det danske register. Resultaterne indikerede en begrænset brug af data, dog var der forskel mellem ledernes og personalets opfattelser af databrug. Blandt de understøttende faktorer for at bruge data var høj datakvalitet og brugbarhed, at ledelsen var involveret, samt personlig motivation.Overordnet set peger denne afhandling på, at implementeringen af både retningslinjen og databasen for hjerterehabilitering har fået sparsom opmærksomhed. Når implementering ikke er vel gennemført kan sundhedsvæsenet ikke forvente at kunne høste udbyttet fra at have lanceret disse strategier. The aim of this thesis was to improve our understanding of implementation of national clinical guidelines and national clinical registries to improve cardiac rehabilitation (CR).This aim originated from an acknowledgement of the challenges of implementing new research based knowledge in healthcare in general and CR is a case that clearly illustrates the difficulties of moving recommendations into evidence-based practice, resulting in knowing-doing gaps. In response to the insufficient provision and quality of CR in Denmark, Danish authorities have launched two strategies to improve services: a national clinical guideline and a national clinical quality registry. While intended to improve the implementation of CR, these strategies may, however, in themselves be difficult to implement. Hence, this health services research PhD project investigated the implementation of these strategies in three studies, using both quantitative and qualitative methods. The objective of the first study was to assess the service level outcomes of guideline implementation by determining the extent to which Danish CR services adhere to national recommendations. By means of a follow-up questionnaire survey, we studied the content and quality of services according to guideline-based recommendations immediately before launch of the new national clinical guideline and two years later. The study included both hospitals and municipalities, as these two settings share responsibility for the provision of CR in Denmark. We found considerable variation in CR services between units and, overall, we found there was room for improvement. No changes were found in the CR services offered at the municipality level, following the launch of the guideline, while some improvements were reported at the hospital level. The second study focused on registry implementation, in particular the processes of data collection and data entry. Interviews were conducted amongst staff involved in both these tasks, in order to explore how they experienced the process of registry implementation. To broaden perspectives, two registries were included: the Danish Cardiac Rehabilitation Database and the British National Audit of Cardiac Rehabilitation. Content analysis identified both similarities and differences within and between the studied registries. In general, implementation received little focused planning at a department level. Staff experienced a lack of active support from management, and seemed to experience challenges in fitting registry use into their busy and complex daily practice.The objective of the third study was to measure the extent of registry feedback used in local quality implementation work and to identify the factors facilitating such use of data. A questionnaire regarding perceptions of the registry and departmental use of registry data was sent to frontline staff and managers in all hospital departments taking part in the Danish CR registry. Results suggested a relatively low use of data, although managers and frontline staffs´ perceptions of use of data differed. Factors that facilitated data use were identified to include perceived quality of high level and usefulness of data, involvement of managers and personal motivation. Overall, the thesis suggests that implementation of the CR guideline and registry, in general, was relatively modest. Without a thorough implementation, healthcare cannot expect to harvest the benefits from launching these strategies.
Rehabilitering og palliation i Danmark– bud på næste skridt?:Hovedpointer fra REHPAs Strategi- og Ledelsesdag, 7. september 2020
No full text
Rehabilitering og palliation i tværsektorielle aftaler
Full text linkISBN 978-87-93356-18-4 (online). Marts 2017. Nyborg: REHPA
Rehabilitering og palliation i Danmark– bud på næste skridt?:Hovedpointer fra REHPAs Strategi- og Ledelsesdag, 7. september 2020
No full text- …
