Second Invitational Continuing Education Conference Community-Based Prevention and Management of Cardiovascular and Other Chronic Diseases among Caribbean Elderly: A Focus on Nursing Leadership WORKSHOP SESSION IV Cornerstones of Policy Development and Implementation Bougainvillea Room
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Second Invitational Continuing Education Conference Community-Based Prevention and Management of Cardiovascular and Other Chronic Diseases among Caribbean Elderly: A Focus on Nursing Leadership
WORKSHOP SESSION IVCornerstones of Policy
Development and Implementation
Bougainvillea Room
Cornerstones of Policy Development and Implementation
Pamela Duncan PhD, PT, FAPTADuke University
GenerateEvidence viaResearch
Synthesize the evidence
DevelopEvidenceBasedAlgorithm
Apply &EvaluateAlgorithm
Levels:Patient ProviderCommunity
Community: Support & sustain PA plans
Providers:Skill setTime
Patients:CapabilitiesCircumstances Preferences
Adapted from The Path from the Generation of Evidence to the Application of Evidence (Haynes and Haines, 1998, BMJ)
Translation to Practice
Guidelines
Research on falls prevention & exercise interventions
• Science is Complicated- Clinical Practice and Implementation More Complicated
Real-World Implementation:The influence of content, context, and process
Clinically relevant outcomesof substantial public health importancethat are cost effective
Reduce fractures, decrease health care utilization
Ecologically Valid Health Indicators
Patients Live LongerPatients Do Not Go to Nursing HomesReduced HospitalizationsReduced Rate of Bad Events ( eg balance
program reduces rates of injurious falls or hip fractures)
Ultimately Must Establish Performance Measures- Process
• Center for Medicare and Medicaid- Pay for Performance Measures
• Center for Medicare and Medicaid- Preventable conditions- Will NOT Pay
• Accessing Care for Vulnerable Elders – Quality Indicators
• JACHO – Certification
Develop Coalitions
Developing Integrated Programs from Department of Public Health
• Example from North Carolina Falls Coalition
• NC Department of Public Health- Multiple Stakeholders- Medical and Community Public Health
1. Infrastructure Development and Maintenance
• Establish and maintain coalitions of key stakeholders to systematically indentify needs, resources, and successes to build capacity
WHO ARE YOUR STAKEHOLDERES-
2. Community Awareness and Education
• Develop and apply effective social marketing and practices to engage and better inform the public and specific constituencies about falls risks and inactivity– FOCUS on HEALTH and FUNCTION
3. Provider Education
• Identify develop and implement training programs for clinical and community providers and enable them to plan, deliver, and evaluate the effective evidence-based programs and practices
4. Risk Assessment and Intervention
• Create and implement plans to identity and establish necessary complements of risk assessment and intervention strategies to address diverse needs of those of risk for falls and inactivity
• e.g. screening multiple entry points ( primary care providers, fitness centers, faith communities, senior centers, health fairs, parks and recreations)
5. Surveillance and Evaluation
• Monitor the growth and outcomes of programs and the processes,
• Use information for quality assessments andidentifying new goals and strategies.