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  • 1.
    Bergman Bruhn, Åsa
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Olai, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Utvärdering av Hemsjukvården i Dalarna 2014: Slutrapport2019Rapport (Övrigt vetenskapligt)
  • 2.
    Eldh, Ann Catrine
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Uppsala universitet.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Fredriksson, Mio
    Uppsala universitet.
    Vengberg, Sofie
    Uppsala universitet.
    Winblad, Ulrika
    Uppsala universitet.
    Halford, Christina
    Uppsala universitet.
    Dahlström, Tobias
    Uppsala universitet.
    Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 11, artikel-id e011562Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement.

    Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression.

    Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with ‘Colleagues’ call for local results’ (p=<0.001), ‘Management Request of Registry data’ (p=<0.001), and it was said to be ‘Simple to explain the results to colleagues’ (p=0.02). Using stepwise regression, ‘Colleagues’ call for local results’ was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results.

    Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.

  • 3.
    Fjellfeldt, Maria
    et al.
    Umeå universitet, Institutionen för socialt arbete.
    Markström, Urban
    Umeå universitet, Institutionen för socialt arbete.
    Development of a Swedish community mental health service market2019Ingår i: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 9, nr 1, s. 72-84Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to examine changes in an organizational field over time when implementing a freedom of choice model. Main focus was on the range and characteristics of providers and services. Our findings suggest that the expected effects of the reform in terms of variety of providers and services within the organizational field did not materialise due to a lack of market competition. Providers complemented each other rather than competed with each other, and the logics of care, choice, and advocacy challenged each other within the quasi-market. All informants described financial conditions in the market as extremely strained. Strong personal commitment characterized providers entering and exiting the market. A gap was found between policy goals and experiences among stakeholders, and efficiency was found to be the policy goal achieved most often in practice. This raises the questions of how the Swedish community mental health service market will develop in the future and what the implications are for the participants.

  • 4. Grooten, Wilhelmus Johannes Andreas
    et al.
    Hansson, Amanda
    Forsman, Mikael
    Kjellberg, Katarina
    Toomingas, Allan
    Müller, Mira
    Svartengren, Magnus
    Äng, Björn
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Karolinska Institutet; Uppsala University.
    Non-participation in initial and repeated health risk appraisals: a drop-out analysis based on a health project2019Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, nr 1, artikel-id 130Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Health risk assessment (HRAs) are commonly used by occupational health services (OHS) to aid workplaces in keeping their employees healthy, but for unknown reasons, many employees choose not to participate in the HRAs. The aim of the study was to explore whether demographic, lifestyle and health-related factors in employees are associated with non-participation in initial and repeated HRAs.

    METHODS: In an OHS-based health project, 2022 municipal employees were asked to participate in three repeated HRAs. Multiple logistic regression analyses were used so as to determine associations between non-participating and demographic, lifestyle and health-related factors (e.g. biomarkers).

    RESULTS: Among the employees who were asked to participate in the health project, more than half did not participate in any HRA and among those who did, more than one third did not participate in repeated HRAs. Young age, male sex and being employed in the Technical department or Health and Social Care department in comparison with being employed in the department for Childcare and Education were factors significantly associated with non-participation in the initial HRA. These factors, together with being on sick leave and having unhealthy dietary habits, were factors associated with non-participation in repeated HRAs.

    CONCLUSIONS: Among the non-participators in initial HRAs and in repeated HRAs younger men and those already related to ill-health were overrepresented. This implicates that health care providers to a higher extent should focus on "those most needed" and that employers should be more engaged in results of repeated HRA's. Future studies should focus on modifiable variables that could make the HRAs more attractive and inclusive.

  • 5. Gunnarsson, Kristina
    et al.
    Andersson, Ing-Marie
    Högskolan Dalarna, Akademin Industri och samhälle, Industriell ekonomi och arbetsvetenskap.
    Rosén, Gunnar
    Högskolan Dalarna, Akademin Industri och samhälle, Arbetsvetenskap.
    Systematic work environment management: experiences from implementation in Swedish small-scale enterprises2010Ingår i: Industrial Health, ISSN 0019-8366, E-ISSN 1880-8026, Vol. 48, nr 2, s. 185-196Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Small-scale enterprises face difficulties in fulfilling the regulations for organising Systematic Work Environment Management. This study compared three groups of small-scale manufacturing enterprises with and without support for implementing the provision. Two implementation methods, supervised and network method, were used. The third group worked according to their own ideas. Twenty-three enterprises participated. The effects of the implementation were evaluated after one year by semi-structured dialogue with the manager and safety representative. Each enterprise was classified on compliance with ten demands concerning the provision. The work environment was estimated by the WEST-method. Impact of the implementation on daily work was also studied. At the follow-up, the enterprises in the supervised method reported slightly more improvements in the fulfilment of the demands in the provision than the enterprises in the network method and the enterprises working on their own did. The effect of the project reached the employees faster in the enterprises with the supervised method. In general, the work environment improved to some extent in all enterprises. Extensive support to small-scale enterprises in terms of advise and networking aimed to fulfil the regulations of Systematic Work Environment Management had limited effect especially considering the cost of applying these methods.

  • 6.
    Jess, Kari
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Bergman Bruhn, Åsa
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Patienten i centrum: Hemsjukvården i tre kommuner i Dalarna 20182019Rapport (Övrigt vetenskapligt)
  • 7. Kislov, R.
    et al.
    Wilson, P.
    Cummings, G.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gifford, W.
    Kelly, J.
    Kitson, A.
    Pettersson, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institute; Sahlgrenska Academy.
    Harvey, G.
    From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries2019Ingår i: PAR. Public Administration Review, ISSN 0033-3352, E-ISSN 1540-6210, Vol. 79, nr 5, s. 684-698Artikel i tidskrift (Refereegranskat)
  • 8.
    Kostela, Johan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle. Dalarnas forskningsråd.
    Tydén, Thomas
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle. Dalarnas forskningsråd.
    Varför sjukskrivs det så olika? Sjukskrivningsmönster vid Dalarnas vårdcentraler.2006Rapport (Övrigt vetenskapligt)
  • 9.
    Lindroos, Pontus
    et al.
    Capio S:t Görans sjukhus.
    Eldh, Ann Catrine
    Capio S:t Görans sjukhus.
    Förväxlingsrisker vid namn- och förpackningslika parenterala läkemedel. [Parenteral drugs with similar names and packaging a great risk of confusion.]2008Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 28-29, s. 2012-2017Artikel i tidskrift (Refereegranskat)
  • 10.
    Markström, Urban
    et al.
    Umeå universitet, Institutionen för socialt arbete.
    Fjellfeldt, Maria
    Umeå universitet, Institutionen för socialt arbete.
    Eklund, Mona
    Implementing Freedom of Choice System in Community Mental Health Services2017Ingår i: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 20, s. S22-S23Artikel i tidskrift (Refereegranskat)
  • 11. Nyberg, André
    et al.
    Wadell, Karin
    Lindgren, Helena
    Tistad, Malin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Umeå universitet, Institutionen för samhällsmedicin och rehabilitering, Fysioterapin.
    Internet-based support for self-management strategies for people with COPD-protocol for a controlled pragmatic pilot trial of effectiveness and a process evaluation in primary healthcare2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 7, artikel-id e016851Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: The use of adequate self-management strategies for people with chronic obstructive pulmonary disease (COPD) reduces healthcare use, improves health-related quality of life (HRQoL) and recovery after acute exacerbations. However, not many people with COPD receive support that promotes the use of such strategies and therefore new methods to facilitate and promote the use of self-management strategies are highly warranted. This pilot trial aims to evaluate the feasibility of the study design and study procedures considering effectiveness of the novel intervention, the COPD-web. METHODS AND ANALYSIS: The overall design is a pragmatic controlled pilot trial with preassessments and postassessments and a parallel process evaluation. Patients with the diagnosis of COPD will be eligible for the study. The intervention group will be recruited when visiting one of the six participating primary care units in Sweden. The control group will be identified from the unit's computerised registers. The intervention, the COPD-web, is an interactive web page with two sections; one directed at people with COPD and one at healthcare professionals. The sections aim to support patients' self-management skills-and to facilitate the provision of support for self-management strategies, respectively. Effectiveness with regard to patients' symptoms, HRQoL, knowledge of and readiness for COPD-related self-management, health literacy, self-efficacy for physical activity and time spent in physical activity and time being sedentary, and further, healthcare professionals' knowledge of and readiness to support COPD-related self-management strategies will be assessed using questionnaires at 3 and 12 months. The process evaluation will include observations and interviews.

    ETHICS AND DISSEMINATION: Ethical approval has been obtained. Findings will be presented at conferences, submitted for publication in peer-reviewed publications and presented to the involved healthcare professionals, patients and to patient organisations.

    TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02696187.

  • 12.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Karolinska institutet; Umeå universitet.
    Flink, Maria
    Ytterberg, Charlotte
    Eriksson, Gunilla
    Guidetti, Susanne
    Tham, Kerstin
    von Koch, Lena
    Resource use of healthcare services 1 year after stroke: a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 8, artikel-id e022222Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The objective of the study was to compare the total use of healthcare services in the course of the first year after a stroke between participants who, after the acute care, had received occupational therapy as a client-centred activities of daily living (ADL) intervention (CADL) and participants who had received usual ADL intervention (UADL).

    DESIGN: A secondary analysis of a multicentre cluster-randomised controlled trial (RCT).

    SETTING: Primary and secondary care in Sweden.

    PARTICIPANTS: Participants were included if they: (1) had received CADL or UADL in the RCT, either as inpatients in geriatric rehabilitation units or in their own homes, and (2) data could be retrieved about their use of healthcare services provided by the county council from computerised registers.

    INTERVENTIONS: CADL or UADL.

    OUTCOME MEASURES: Inpatient and outpatient healthcare in the course of the first year after stroke.

    RESULTS: Participants from 7 of the 16 units included in the RCT met the criteria. Participants in the CADL group (n=26) who received geriatric inpatient rehabilitation had a shorter length of hospital stay (p=0.03) than participants in the UADL group (n=46), and the CADL group with home rehabilitation (n=13) had fewer outpatient contacts (p=0.01) compared with the UADL group (n=25). Multiple regression analyses showed that in four of the models, a higher age was associated with a lower use of healthcare services. The use of healthcare services was also associated (some of the models) with dependence in ADL, stroke severity and type of rehabilitation received, CADL or UADL.

    CONCLUSIONS: The provision of client-centred occupational therapy after stroke did not appear to increase the use of healthcare services during the first year after stroke.rrrrr TRIAL REGISTRATION NUMBER: NCT01417585.

  • 13.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet; Umeå universitet.
    Palmcrantz, Susanne
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet; Göteborgs universitet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro universitet.
    Olsson, Christina B.
    Tomson, Göran
    Lotta, Widén Holmqvist
    Gifford, Wendy
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Developing leadership in managers to facilitate the implementation of national guideline recommendations: a process evaluation of feasibility and usefulness2016Ingår i: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, nr 8, s. 477-486Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation.

    Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention.

    Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation.

    Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

  • 14.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    von Koch, Lena
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle, Neurologkliniken Karolinska Universitetssjukhuset.
    Sjöstrand, Christina
    Institutionen för klinisk neurovetenskap, Karolinska Institutet, Neurologkliniken Karolinska Universitetssjukhuset.
    Tham, Kerstin
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle.
    Ytterberg, Charlotte
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle.
    What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke - amount, place, operator or timing?2013Ingår i: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 16, nr 3, s. e24-35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke.

    METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset.

    RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs.

    CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

1 - 14 av 14
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