Kendall Kruszewski, Carolyn May, Evan Silverstein
Evaluation of a combined school-based vision screening and mobile clinic program
Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus
rates coronary angiograms ca related procedures percutaneous intervention pci significantly higher germany organisation economic coordination development oecd countries current guidelines recommend noninvasive diagnosis coronary heart disease chd ca limited role choosing appropriate revascularisation procedure aim present study explore whether improvements guideline adherence achieved implementation regional treatment pathways chose four regions germany high utilisation cas study report results concomitant qualitative study general practitioners specialist physicians cardiologists hospitalbased cardiologists emergency physicians radiologists nuclear medicine specialists caring patients suspected chd invited develop regional treatment pathways four academic departments provided support moderation provision materials etc study team observed session discussions took notes development treatment pathways 45 semistructured interviews conducted participating physicians interviews field notes transcribed verbatim underwent qualitative content analysis pathway development received little support among participants although consensus documents produced results unlikely improve practice participants expressed little commitment change although attempt clearly failed study regions experience provides relevant insights process evidence appraisal implementation lack organisational skills ignorance current evidence guidelines lack feedback regarding ones clinical behaviour proved insurmountable ca still seen diagnostic gold standard interviewees oversupply overutilisation assumed present study regions immediately perceived clinicians problem unlikely solved regional collaborative initiatives optimised resource planning within health care system combined appropriate economic incentives might best address issues