Rapid spread of complex change: a case study in inpatient palliative care.

Background: Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC). Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program.

Preliminary validity of the barriers to treatment adherence questionnaire in fibromyalgia: combining quantitative and focus group data.

The goals of this study were to (1) provide preliminary reliability and validity of the Barriers to Treatment Adherence Questionnaire, developed for patients with fibromyalgia, and (2) examine barriers to adherence and general adherence to multimodal treatment during a 3-mo. period. A secondary goal was to explore in a focus discussion group format patients' perceptions of the adherence process and ways of managing the treatment program.

Identifying target areas of treatment for depressed early inflammatory arthritis patients.

Background: The goal of this study was to identify target areas for psychosocial intervention for depressed patients with early inflammatory arthritis.

Methods: One hundred and sixty-five patients with early inflammatory arthritis (> or =1 joint with synovitis for > or =6 weeks and <1 year with a diagnosis of either rheumatoid or undifferentiated inflammatory arthritis) were referred to the McGill Early Arthritis Registry (McEAR) by their rheumatologist. McEAR patients agree to periodic physical exams and to completing questionnaires.