BACKGROUND: Implementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect. CHP focuses on potentially modifiable lifestyle risks such as smoking, alcohol, diet, and physical inactivity. An operational program was created to improve implementation. It included patients, staff, and the organization, and it combined existing standards, indicators, documentation models, a performance recognition process, and a fast-track implementation model. The aim of this study was to evaluate if the operational program improved implementation of CHP in clinical hospital departments, as measured by health status of patients and staff, frequency of CHP service delivery, and standards compliance. METHODS: Forty-eight hospital departments were recruited via open call and stratified by country. Departments were assigned to the operational program (intervention) or usual routine (control group). Data for analyses included 36 of these departments and their 5285 patients (median 147 per department; range 29-201), 2529 staff members (70; 10-393), 1750 medical records (50; 50-50), and standards compliance assessments. Follow-up was measured after 1 year. The outcomes were health status, service delivery, and standards compliance. RESULTS: No health differences between groups were found, but the intervention group had higher identification of lifestyle risk (81% versus 60%, p < 0.01), related information/short intervention and intensive intervention (54% versus 39%, p < 0.01 and 43% versus 25%, p < 0.01, respectively), and standards compliance (95% versus 80%, p = 0.02). CONCLUSIONS: The operational program improved implementation by way of lifestyle risk identification, CHP service delivery, and standards compliance. The unknown health effects, the bias, and the limitations should be considered in implementation efforts and further studies. TRIAL REGISTRATION: ClinicalTrials.gov : NCT01563575. Registered 27 March 2012. https://clinicaltrials.gov/ct2/show/NCT01563575.

Cheng Hsin General Hospital Taipei Taiwan

Clinical Health Promotion Centre WHO CC Bispebjerg and Frederiksberg Hospital Copenhagen University Hospitals Nordre Fasanvej 57 Build 14 Entr 5 2nd fl 2000 Frederiksberg Denmark

Clinical Health Promotion Centre WHO CC Health Sciences Lund University Lund Sweden

Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London UK

General hospital Dr Tomislav Bardek Koprivnica Županija Koprivničko križevačka Croatia

Health Services Quality Department Ministry of Health Prague Czech Republic

National Institute for Health Development; Tallin Estonia

National Institute of Public Health Ljubljana Slovenia

OptiMedis AG Hamburg Germany

Penang Adventist Hospital Penang Malaysia

Saitama Cooperative Hospital Kawaguchi Saitama Japan

School of Medicine National Yang Ming University Taipei Taiwan

Sector for Spine Surgery and Research Lillebaelt Hospital Middelfart Denmark

Zobrazit více v PubMed

Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510–520. doi: 10.1258/jrsm.2011.110180. PubMed DOI PMC

Balas EA, Boren SA. Yearbook of medical informatics: managing clinical knowledge for health care improvement. Stuttgart: Schattauer Verlagsgesellschaft mbH; 2000. PubMed

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50. PubMed PMC

Glasgow RE, Klesges LM, Dzewaltowski DA, Bull SS, Estabrooks P. The future of health behavior change research: what is needed to improve translation of research into health promotion practice? Ann Behav Med. 2004;27(1):3–12. doi: 10.1207/s15324796abm2701_2. PubMed DOI

World health organization. Ottawa charter for health promotion. Health Promot Int. 1986;1(4):405.

World Health Organization (WHO). Health promotion glossary www.who.int/healthpromotion/about/HPR%20Glossary%201998.pdf [cited 2018 April 24].

Smith BJ, Tank KC, Nutbeam DWHO. Health promotion glossary: new terms. Oxford University Press, Oxford UK; 2006. www.who.int/healthpromotion/about/HP%20Glossay%20in%20HPI.pdf. PubMed

Tønnesen H. Clinical health promotion - what does it mean? Clin Health Promotion. 2011;1(2):39–40.

The working group concerning prevention, health promotion and population health under the Danish National Terminologi Counsel for Healthcare [Arbejdsgruppen vedrørende forebyggelse, sundhedsfremme og folkesundhed under Det Nationale Begrebsråd for Sundhedsvæsenet]. Terminology: Prevention, health promotion and population health [Terminologi: Forebyggelse, sundhedsfremme og folkesundhed]: Danish National Board of Health; 2005.

Golechha M. Health promotion methods for smoking prevention and cessation: a comprehensive review of effectiveness and the way forward. Int J Prev Med. 2016;7:7. doi: 10.4103/2008-7802.173797. PubMed DOI PMC

Pell JP, Haw S, Cobbe S, Newby DE, Pell AC, Fischbacher C, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med. 2008;359(5):482–491. doi: 10.1056/NEJMsa0706740. PubMed DOI

Mackay DF, Irfan MO, Haw S, Pell JP. Meta-analysis of the effect of comprehensive smoke-free legislation on acute coronary events. Heart. 2010;96(19):1525–1530. doi: 10.1136/hrt.2010.199026. PubMed DOI

National Board of Health and Social Affairs [Socialstyrelsen]. Swedish national guidelines for prevention and treatment of unhealthy lifestyle habits [Nationella riktlinjer för prevention och behandling vid ohälsosamma levnadsvanor] 2017.

World Health Organization (WHO). Health impact assessment (HIA). The determinants of health www.who.int/hia/evidence/doh/en [cited 2018 April 24].

Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67(12):2072–2078. doi: 10.1016/j.socscimed.2008.09.050. PubMed DOI

Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014;(3):CD002294. PubMed PMC

Egholm JWM, Pedersen B, Adami J, Møller A, Tønnesen H. Perioperative alcohol cessation intervention for postoperative complications. Cochrane Database Syst Rev. 2018;(11):CD008343. PubMed PMC

Beier-Holgersen R, Boesby S. Influence of postoperative enteral nutrition on postsurgical infections. Gut. 1996;39(6):833–835. doi: 10.1136/gut.39.6.833. PubMed DOI PMC

Nielsen PR, Andreasen J, Asmussen M, Tønnesen H. Costs and quality of life for prehabilitation and early rehabilitation after surgery of the lumbar spine. BMC Health Serv Res. 2008;8(1):209. doi: 10.1186/1472-6963-8-209. PubMed DOI PMC

Cnattingius S. The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics and pregnancy outcomes. Nicotine Tob Res. 2004;6(Suppl 2):S125–S140. doi: 10.1080/14622200410001669187. PubMed DOI

Rasmussen M, Heitmann BL, Tønnesen H. Effectiveness of the gold standard programmes (GSP) for smoking cessation in pregnant and non-pregnant women. Int J Environ Res Public Health. 2013;10(8):3653–3666. doi: 10.3390/ijerph10083653. PubMed DOI PMC

Ota E, Hori H, Mori R, Tobe-Gai R, Farrar D. Antenatal dietary education and supplementation to increase energy and protein intake. Cochrane Database Syst Rev. 2015;(6):CD000032. PubMed

Heiwe S, Jacobson SH. Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev. 2011;(10):CD0032362011. PubMed PMC

Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2014;(12):CD011273. PubMed PMC

Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006;3:CD002968. PubMed PMC

McKeough ZJ, Velloso M, Lima VP, Alison JA. Upper limb exercise training for COPD. Cochrane Database Syst Rev. 2016;11:CD011434. PubMed PMC

Oellgaard J, Gaede P, Rossing P, Rorth R, Kober L, Parving HH, et al. Reduced risk of heart failure with intensified multifactorial intervention in individuals with type 2 diabetes and microalbuminuria: 21 years of follow-up in the randomised Steno-2 study. Diabetologia. 2018;61(8):1724–1733. doi: 10.1007/s00125-018-4642-y. PubMed DOI PMC

Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014;348:g1151. doi: 10.1136/bmj.g1151. PubMed DOI PMC

Pedersen B, Hansen PE, Tønnesen H. Scand-ankle: cost-effectiveness of alcohol cessation intervention in acute fracture surgery. Clin Health Promot. 2014;2 suppl:1–68.

Møller AM, Villebro NM. Preoperative smoking intervention: what do patients think? A qualitative study. Ugeskr Laeger. 2004;166:3714–3718. PubMed

Lindström D, Sundberg-Petersson I, Adami J, Tønnesen H. Disappointment and drop-out rate after being allocated to control group in a smoking cessation trial. Contemp Clin Trials. 2010;31(1):22–26. doi: 10.1016/j.cct.2009.09.003. PubMed DOI

Lauridsen SV, Thomsen T, Kaldan G, Lydom LN, Tønnesen H. Smoking and alcohol cessation intervention in relation to radical cystectomy: a qualitative study of heavy smokers and risky drinkers’ experiences. BMC Cancer. 2017;17:793 PubMed PMC

Nolan MB, Warner DO. Perioperative tobacco use treatments: putting them into practice. BMJ. 2017;358:j3340 PubMed

WHO. Implementing health promotion in hospitals: manual and self-assessment forms: WHO Regional Office for Europe; 2010.

International Network of Health Promoting Hospitals & Health Services (HPH). www.hphnet.org [cited 2018 April 24].

Groene O, Jorgensen SJ, Fugleholm AM, Møller L, Garcia-Barbero M. Standards for health promotion in hospitals: development and pilot test in nine European countries. Int J Health Care Qual Assur. 2005;18(4):300–307. doi: 10.1108/09526860510602569. PubMed DOI

Groene O, Alonso J, Klazinga N. Development and validation of the WHO self-assessment tool for health promotion in hospitals: results of a study in 38 hospitals in eight countries. Health Promot Int. 2010;25(2):221–229. doi: 10.1093/heapro/daq013. PubMed DOI

ISQua. Guidelines and principles for the development of health and social care standards. www.isqua.org; 2015.

Tønnesen H, Svane JK, Lenzi L, et al. Handling clinical health promotion in the HPH DATA model: basic documentation of health determinants in medical records of tobacco, malnutrition, overweight, physical inactivity & alcohol. Clin Health Promot. 2012;2:5–11.

Tønnesen H, Christensen ME, Groene O, O'Riordan A, Simonelli F, Suurorg L, et al. An evaluation of a model for the systematic documentation of hospital based health promotion activities: results from a multicentre study. BMC Health Serv Res. 2007;7:145 PubMed PMC

Tønnesen H, Svane JK, Groene O, Chiou ST. The WHO-HPH recognition project: fast-track implementation of clinical health promotion - a protocol for a multi-center RCT. Clin Health Promot. 2016;6(1):13–20.

Birken SA, Powell BJ, Presseau J, Kirk MA, Lorencatto F, Gould NJ, et al. Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review. Implement Sci. 2017;12(1):2. doi: 10.1186/s13012-016-0534-z. PubMed DOI PMC

Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3(1):32. PubMed PMC

Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–1327. doi: 10.2105/AJPH.89.9.1322. PubMed DOI PMC

Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM. Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Educ Res. 2006;21(5):688–694. doi: 10.1093/her/cyl081. PubMed DOI

Gaglio B, Shoup JA, Glasgow RE. The RE-AIM framework: a systematic review of use over time. Am J Public Health. 2013;103(6):e38–e46. doi: 10.2105/AJPH.2013.301299. PubMed DOI PMC

Pantoja T, Opiyo N, Lewin S, Paulsen E, Ciapponi A, Wiysonge CS, et al. Implementation strategies for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev. 2017;(9):CD011086. PubMed PMC

Rubenstein LV, Pugh J. Strategies for promoting organizational and practice change by advancing implementation research. J Gen Intern Med. 2006;21(S2):S58–S64. doi: 10.1007/s11606-006-0276-8. PubMed DOI PMC

Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10(1):53. PubMed PMC

Moen R, Norman C. Evolution of the PDCA cycle. Tokyo: Asian Network for Quality Conference; 2009.

Svane JK, Egerod I, Tønnesen H. Staff experiences with strategic implementation of clinical health promotion: a nested qualitative study in the WHO-HPH Recognition Process RCT. Sage Open Medicine. 2018;6:1–12. doi: 10.1177/2050312118792394. PubMed DOI PMC

McHorney CA, Johne W, Anastasiae R. The MOS 36-item short-form health survey (SF-36) Med Care. 1993;31(3):247–263. doi: 10.1097/00005650-199303000-00006. PubMed DOI

Jenkinson C, Stewart-Brown S, Petersen S, Paice C. Assessment of the SF-36 version 2 in the United Kingdom. J Epidemiol Community Health. 1999;53(1):46–50. doi: 10.1136/jech.53.1.46. PubMed DOI PMC

Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med. 2008;35(2):158–176. doi: 10.1016/j.amepre.2008.04.009. PubMed DOI PMC

Rasmussen M. Efficacy of intensive face-to-face interventions for smoking cessation (prospective registry of a systematic review). Prospero. 2018.

Svane JK, Raisova B, Stanecka Z, Dolezel Z, Richter M, Cahlikova J, et al. Clinical health promotion in the Czech Republic: standards compliance and service provision. Clin Health Promot. 2014;4(1):15–21.

Svane JK, Chiou ST, Chang YL, Shen SH, Huang CH, Pan CY, et al. Integration of health promotion in clinical hospital departments: standards fulfilment, documentation of needs and service delivery. Clin Health Promot. 2015;5(1):11–17.

Ferketich AK, Khan Y, Wewers ME. Are physicians asking about tobacco use and assisting with cessation? Results from the 2001-2004 national ambulatory medical care survey (NAMCS) Prev Med. 2006;43(6):472–476. doi: 10.1016/j.ypmed.2006.07.009. PubMed DOI

Jamal A, Dube SR, King BA. Tobacco use screening and counseling during hospital outpatient visits among US adults, 2005-2010. Prev Chronic Dis. 2015;12:E132. doi: 10.5888/pcd12.140529. PubMed DOI PMC

Kemppainen V, Tossavainen K, Turunen H. Nurses’ roles in health promotion practice: an integrative review. Health Promot Int. 2013;28(4):490–501. doi: 10.1093/heapro/das034. PubMed DOI

Burke LE, Fair J. Promoting prevention: skill sets and attributes of health care providers who deliver behavioral interventions. J Cardiovasc Nurs. 2003;18(4):256–266. doi: 10.1097/00005082-200309000-00004. PubMed DOI

Joint Commision International (JCI) 2010. Screening and treating tobacco and alcohol use. https://manual.jointcommission.org/releases/archive/TJC2010B/ScreeningandTreatingTobaccoandAlcoholUse.html

Fiore MC, Goplerud E, Schroeder SA. The joint commission’s new tobacco-cessation measures — will hospitals do the right thing? N Engl J Med. 2012;366:1172–1174. doi: 10.1056/NEJMp1115176. PubMed DOI PMC

Makdissi R, Stewart SH. Care for hospitalized patients with unhealthy alcohol use: a narrative review. Addict Sci Clin Pract. 2013;8:11. doi: 10.1186/1940-0640-8-11. PubMed DOI PMC

American College of Surgeons. Business case for the National Surgical Quality Improvement Program. https://www.facs.org/quality-programs/acs-nsqip/joinnow/businesscase

Greenfield D, Pawsey M, Hinchcliff R, Moldovan M, Braithwaite J. The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact. BMC Health Serv Res. 2012;12(1):329. doi: 10.1186/1472-6963-12-329. PubMed DOI PMC

Flodgren G, Gonçalves-Bradley DC, Pomey M-P. External inspection of compliance with standards for improved healthcare outcomes. Cochrane Database Syst Rev. 2016;(12):CD008992. PubMed PMC

Nicklin W, Dickson S. The value and impact of health care accreditation: a literature review. https://aventa.org/pdfs/valueimpactaccreditation.pdf: Accreditation Canada; 2011.

Brubakk K, Vist GE, Bukholm G, Barach P, Tjomsland O. A systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health Serv Res. 2015;15(1):280. PubMed PMC

Greenfield D, Braithwaite J. Health sector accreditation research: a systematic review. Int J Qual Health Care. 2008;20(3):172–183. doi: 10.1093/intqhc/mzn005. PubMed DOI

Hinchcliff R, Greenfield D, Moldovan M, Westbrook JI, Pawsey M, Mumford V, et al. Narrative synthesis of health service accreditation literature. BMJ Qual Saf. 2012;21(12):979–991. doi: 10.1136/bmjqs-2012-000852. PubMed DOI

Vist GE, Nøstberg AM, Brubakk K, Munkeby BH. Effects of certification and accreditation of hospitals. Oslo: Norwegian knowledge Center for the Health Services [Nasjonalt Kunnskapssenter for helsetjenester]; 2009. PubMed

Scales DC. A multifaceted intervention for quality improvement in a network of intensive care units. JAMA. 2011;305(4):363. doi: 10.1001/jama.2010.2000. PubMed DOI

Cavalcanti AB, Bozza FA, Machado FR, Salluh JIF, Campagnucci VP, Vendramim P, et al. Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients. JAMA. 2016;315(14):1480. doi: 10.1001/jama.2016.0154. PubMed DOI

Du X, Gao R, Turnbull F, Wu Y, Rong Y, Lo S, et al. Hospital quality improvement initiative for patients with acute coronary syndromes in China: a cluster randomized, controlled trial. Circ Cardiovasc Qual Outcomes. 2014;7(2):217–226. doi: 10.1161/CIRCOUTCOMES.113.000526. PubMed DOI

Salmon JW, Heavens J, Lombard C, Tavrow P. The impact of accreditation on the quality of hospital care: KwaZulu-Natal Province, Republic of South Africa. Operations Research Results US Agency for International Development (USAID), Quality Assurance Project, University Research Co. LLC Bethesda. 2003;2(17):1–49.

Falstie-Jensen AM, Larsson H, Hollnagel E, Norgaard M, Svendsen MLO, Johnsen SP. Compliance with hospital accreditation and patient mortality: a Danish nationwide population-based study. Int J Qual Health Care. 2015;27(3):165–174. doi: 10.1093/intqhc/mzv023. PubMed DOI

OPM evaluation team. Evaluation of the healthcare commission’s healthcare associated infections inspection programme. OPM Report. 2009:1–23.

Rigotti NA, Tindle HA, Regan S, Levy DE, Chang Y, Carpenter KM, et al. A post-discharge smoking-cessation intervention for hospital patients: helping hand 2 randomized clinical trial. Am J Prev Med. 2016;51(4):597–608. doi: 10.1016/j.amepre.2016.04.005. PubMed DOI PMC

US Department of Labor OSaHA. Worker safety in hospitals 2017. https://www.osha.gov/dsg/hospitals/understanding_problem.html

Sejr HS, Osler M. Do smoking and health education influence student nurses’ knowledge, attitudes, and professional behavior? Prev Med. 2002;34(2):260–265. doi: 10.1006/pmed.2001.0981. PubMed DOI

Zabeen S, Tsourtos G, Campion J, Lawn S. Type of unit and population served matters when implementing a smoke-free policy in mental health settings: perceptions of unit managers across England. Int J Soc Psychiatry. 2015;61(7):700–710. doi: 10.1177/0020764015575799. PubMed DOI

Willaing I, Iversen L, Jørgensen T. What are the effects of healthcare staffs’ individual smoking habits on knowledge, attitudes and councelling practices related to smoking? [Hvad betyder sygehuspersonalets individuelle rygevaner for viden, holdning og rådgivningspraksis relateret til rygning?] Ugeskr Laeger. 2001;163(32):4180–4181. PubMed

Sarna L, Bialous SA, Wells M, Kotlerman J, Wewers ME, Froelicher ES. Frequency of nurses’ smoking cessation interventions: report from a national survey. J Clin Nurs. 2009;18(14):2066–2077. doi: 10.1111/j.1365-2702.2009.02796.x. PubMed DOI

Roelen C, Rhenen W, Schaufeli W, Klink J, Magerøy N, Moen B, et al. Mental and physical health-related functioning mediates between psychological job demands and sickness absence among nurses 2013. PubMed

Wilson PM, Sales A, Wensing M, Aarons GA, Flottorp S, Glidewell L, et al. Enhancing the reporting of implementation research. Implement Sci. 2017;12(1):13. doi: 10.1186/s13012-017-0546-3. PubMed DOI PMC

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