To standardize and improve the reporting quality of digital health implementation research, the Geneva Digital Health Hub has developed the guidelines and checklist for reporting digital health implementations (iCHECK-DH). This paper introduces the background of iCHECK-DH and based on practical application experiences, emphasizes the importance of interdisciplinary collaboration. It focuses on economic cost-effectiveness and local policy guidance in the clinical implementation of digital health technologies. This will provide valuable insights for Chinese scholars when writing implementation reports on digital health technologies.
With the encouragement of national policy on drug and medical device innovation, multi-center clinical trials and multi-regional clinical trials are facing an unprecedented opportunity in China. Trials with a multi-center design are far more common at present than before. However, it should be recognized there still exists shortcomings in current multi-center trials. In this paper, we summarize the problems and challenges and provide corresponding resolutions with the aim to reduce heterogeneity between study centers and avoid excessive center effects in treatment. It is urgent to develop design, implementation and reporting guidelines to improve the overall quality of multi-center clinical trials.
Objective To evaluate the implementation effects and problems about quota payment of specific diseases for hyperplasia prostate and ureteral calculi in Chengdu. Methods Payments, man-time of operation, and the lengths of hospitalization of hyperplasia prostate and ureteral calculi as quota payment of specific diseases in Chengdu from 2013 to 2015 were analyzed by using SPSS 16.0 software. Results Based on the standards of medical expense limitation in Chengdu unchanged, tertiary and secondary hospitals remained surplus with quota standards of single diseases unchanged. The average lengths of hospitalization of hyperplasia prostate and ureteral calculi in tertiary and secondary hospitals were significantly decreased (P<0.05). Conclusion The application of quota payment policy for single disease in Chengdu city of Sichuan province has been proved to work on controlling the medical expense of treating hyperplasia prostate and ureteral calculi. Our results indicate the continuous implementation of quota payment policy. However, the exploration of proper payment standardization, enhance of hospital supervision and establishment of efficient system are still needed to define.
Implementation science is a relatively emergent and growing research area. Implementation research can assist to transform what is possible in theory to reality in practice and address the challenge of implementing proven interventions in the real world. Implementation research has a wide range of usages and complex research problems, so appropriate research methods, designs, and outcomes variables are required to address different research objectives. To better conduct implementation research, this paper systematically introduces the research designs, outcome variables, and reporting guideline of the implementation research in health care, based on the purposes and research questions of implementation research.
ObjectiveTo evaluate the reliability and validity of Guideline Implementation Success Assessment Tool (A-GIST). MethodsWith the guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition) as the target guideline, health care providers and patients from different hospitals across the country were investigated by questionnaire using A-GIST. Spearman-Brown coefficient and Cronbach's α coefficient were used to evaluate the split-half reliability and internal consistency reliability, while the structural validity, convergent validity and discriminant validity were investigated by confirmatory factor analysis based on structural equation. ResultsThe internal consistency reliability and split half reliability coefficients of the whole tool and each dimension ranged from 0.650 to 0.986. The scale-level content validity index (S-CVI/Ave) of content validity was 0.846. Confirmatory factor analysis showed that, the χ2/df of two sections of the tool were 8.695 and 6.123, respectively. The root mean square residual (RMR), the standard root mean square residual (SRMR) and the root mean square error of approximation (RMSEA) were under or almost under the threshold. Besides, the goodness-of-fit index (GFI) of them were 0.901 and 0.822, the adjusted goodness-of-fit index (AGFI) were 0.836 and 0.787, and the parsimonious normed fit index (PNFI) were 0.545 and 0.788, respectively. ConclusionGuideline Implementation Success Assessment Tool (A-GIST) was proved to be valid and reliable, and it shows that it is necessary to optimize the items under the dimensions of maintenance and evaluation of diagnosis and treatment effect in the future.
Implementation science is a systematic research approach that promotes the integration of research findings and evidence-based practices into routine clinical practice. It has been a crucial topic in scientific inquiry. As the notion of ‘implementation science’ has evolved and associated theoretical and practical methodologies have been refined, researchers in this field have devised implementation strategies to address the determinants of implementation (barriers and facilitators) for clinical interventions, evidence-based practices, or novel technologies in clinical practice. The development of implementation strategies aims to foster the adoption and dissemination of innovations. This article offers a comprehensive introduction to the definition of implementation strategies, the process of selecting appropriate implementation strategies, the associated documentation and reporting procedures, with the aim of providing valuable references for enhancing future implementation research efforts.
This article elaborates the concept, meaning and role of clinical pathway, discusses development stages and implementation effects of clinical pathway at home and abroad, and proposes that clinical pathway has been developed very well abroad, but it still has many problems in domestic gtowth which needs to be put into effect with Single-DRGs system in combination.
N-of-1 trial design offers a methodologically sound approach to determining optimum treatment for an individual patient and solves some limitations of randomized controlled trials. This design could offer an efficient method of reaching a personal treatment regime tailored to suit individual needs and preferences. The paper introduces practical application, objects and the implementation process of N-of-1 trial, to explore its design points and implementation.
ObjectiveTo summarize the evaluation tools for the implementation effect of clinical practice guidelines (CPGs), to inform and support the evidence-based development of a general tool for the evaluation of implementation effect of CPGs. MethodsSeven biomedical literature databases, including PubMed, Embase and CNKI, and two academic websites, were searched from establishment to June 2022. Theoretical and empirical research on the evaluation tools of the implementation effect of CPGs were included. Two researchers independently screened literature and extracted data according to the inclusion and exclusion criteria. Based on the Implementation Science RE-AIM theoretical framework, an evaluation framework and a list of alternative items of the implementation effect of the CPGs were initially drawn up by thematic synthesis methods. ResultsA total of 208 articles were included, and 8 mature evaluation tools related to the implementation effect of guidelines were selected. Current research on the evaluation of the implementation effect of CPGs mainly focused on single diseases, with concern of the cognition, attitude and compliance of users to CPGs, and the process of the implementation of CPGs and factors affecting the implementation effect of CPGs. There were limitations such as a lack of evaluation on the terminal effect of the implementation of CPGs, the rare use of mature theoretical frameworks, the use of single evaluation perspectives, and inclusion of limited evaluation dimensions. The initial proposed evaluation framework contains a list of alternative items with 6 primary indicators, 12 secondary indicators and 41 tertiary indicators. ConclusionCurrently, there is a lack of a comprehensive, multi-perspective, mature theory based, general tool for the evaluation of implementation effect of CPGs. The framework and the list of alternative items for the evaluation of implementation effect of CPGs based on the implementation science RE-AIM theory can inform and support the development of a tool for the evaluation of implementation effect of CPGs.
Objective To summarize the role and implementation effect of risk management in Ophthalmic Day Surgery Center. Methods Since the establishment of Ophthalmic Day Surgery Center on October 8th, 2012, risk management was implemented in the aspects of hardware management, post setting, file management, operating process, service, etc., and the adverse events occurred in the period were analyzed to find out the defectiveness and hidden dangers in the working process, and then refined intervention measures were put forward and carried out. The surgical amount, occurrence of nosocomial infections and nursing adverse events, and patients satisfaction from October 8th, 2012 to June 30th, 2015 were analyzed. Results During this period, 52 073 ambulatory operations were completed, with no nosocomial infection and 2 cases of nursing adverse events. The patients satisfaction in 2013, 2014, and 2015 was 98.09%, 98.22%, and 99.85%, respectively. Conclusion The implementation of risk management in Ophthalmic Day Surgery Center can effectively reduce the occurrence of adverse events in nursing work, improve work efficiency, help to establish and improve the nursing security environment, improve the nurse-patient relationship, and improve patients satisfaction.