Background The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers. Methods/design In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling. Discussion Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers. / <p>Funding Agencies|European Communitys Seventh Framework Program|259268|The Netherlands Organisation for Health Research and Development (ZonMW)|200310017|FP7 EC Grant||</p>

Clinical documentation is at the center of a patient's medical record; this record contains all the information applicable to the care a patient receives in the hospital. The practice problem addressed in this project was the lack of clear, consistent, accurate, and complete patient medical records in a pediatric hospital. Although the occurrence of incomplete medical records has been a known issue for the project hospital, the issue was further intensified following the implementation of the 10th revision of International Classification of Diseases (ICD-10) standard for documentation, which resulted in gaps in provider documentation that needed to be filled. Based on this, the researcher recommended a quality improvement project and worked with a multidisciplinary team from the hospital to develop an evidence-based documentation guideline that incorporated ICD-10 standard for documenting pediatric diagnoses. Using data generated from the guideline, an artificial intelligence (AI) was developed in the form of best practice advisory alerts to engage providers at the point of documentation as well as augment provider efforts. Rosswurm and Larrabee's conceptual framework and Kotter's 8-step change model was used to develop the guideline and design the project. A descriptive data analysis using sample T-test significance indicated that financial reimbursement decreased by 25%, while case denials increased by 28% after ICD-10 implementation. This project promotes positive social change by improving safety, quality, and accountability at the project hospital.