Motivation and attitudes toward changing health (MATCH): A new patient-reported measure to inform clinical conversations.

ObjectiveTo identify and assess patient motivation to initiate or maintain behavior changes.MethodsAttitudinal statements were developed from structured patient interviews and translated into 18 survey items. Items were analyzed with exploratory factor analysis (EFA).ResultsAn EFA with 340 type 2 diabetes patients identified three areas of patient attitudes toward changing health behaviors: (1) willingness to make changes (3 items; α = 0.69), (2) perceived ability to make or maintain changes (3 items; α = 0.74), and (3) and feeling changes are worthwhile (3 items; α = 0.61). Greater perceived ability and feelings of worthwhileness were associated with positive psychosocial and behavioral management indicators. All three areas were associated with confidence and attitudes toward making a specific behavioral change (e.g., improve diet).ConclusionsMATCH is an internally consistent and valid 9-item scale that provides a profile of factors influencing motivation that can be used in clinical and research settings

A New Leadership Development Model for Nursing Education

Background Leadership competency is required throughout nursing. Students have difficulty understanding leadership as integral to education and practice. A consistent framework for nursing leadership education, strong scholarship and an evidence base are limited. Purpose To establish an integrated leadership development model for prelicensure nursing students that recognizes leadership as a fundamental skill for nursing practice and promotes development of nursing leadership education scholarship. Method Summarizing definitions of nursing leadership, conceptualizing leadership development capacity through reviewing trends, and synthesizing existing leadership theories through directed content analysis. Discussion Nine leadership skills form the organizing structure for the Nursing Leadership Development Model. Leadership identity development is supported via dimensions of knowing, doing, being and context. Conclusion The Nursing Leadership Development Model is a conceptual map offering a structure to facilitate leadership development within prelicensure nursing students, promoting student ability to internalize leadership capacity and apply leadership skills upon entry to practic

Variations in amenable mortality--trends in 16 high-income nations.

BACKGROUND: There has been growing interest in the comparison of health system performance within and between countries, using a range of different indicators. This study examines trends in amenable mortality, as one measure of health system performance, in sixteen high-income countries. METHODS: Amenable mortality was defined as premature death from causes that should not occur in the presence of timely and effective health care. We analysed age-standardised rates of amenable mortality under age 75 in 16 countries for 1997/1998 and 2006/2007. RESULTS: Amenable mortality remains an important contributor to premature mortality in 16 high-income countries, accounting for 24% of deaths under age 75. Between 1997/1998 and 2006/2007, amenable mortality fell by between 20.5% in the US and 42.1% in Ireland (average decline: 31%). In 2007, amenable mortality in the US was almost twice that in France, which had the lowest levels. CONCLUSIONS: Amenable mortality continues to fall across high-income nations although the USA is lagging increasingly behind other high income countries. Despite its many limitations, amenable mortality remains a useful indicator to monitor progress of nations

Exploring patient empowerment : presenting an enhanced model for delivery in practice

Patient empowerment evolved as a strategy to address multi-faceted healthcare management issues. Studies over the past decades have provided different patient empowerment frameworks, but even with the emergent frameworks, there is no marked desired result. To date there has been no reliable patient empowerment. This thesis is driven by the ambition to enable greater patient empowerment in our global healthcare services.The methodological approach adopted was a mixed methodology approach based on taxonomical analysis, questionnaire study and focus group discussions. To better understand a patient empowered system, this work explored empowerment, patient empowerment and the role of technology. The thesis built through critical analysis on the knowledge of existing patient empowerment frameworks coupled with technology practice to develop an improved patient empowered system. Through review of existing frameworks and articulation of patients’ demands, weaknesses in current structures to support empowerment are determined.This thesis provides a platform for articulating an improved patient empowerment model, which considered systems theory ideas such as holism and iteration. Further research would propose implementing a trail of this model in practice and exploring with a wider range of stakeholders its potential for integration in the NHS or other health service organisations

Funding intensive care - approaches in systems using diagnosis-related groups.

This report reviews approaches to funding intensive care in health systems that use activitybased payment mechanisms based on diagnosis-related groups (DRGs) to reimburse hospital care. The report aims to inform the current debate about options for funding intensive care services for adults, children and newborns in England. Funding mechanisms reviewed here include those in Australia (Victoria), Denmark, France, Germany, Italy, Spain, Sweden and the United States (Medicare). Approaches to organising, providing and funding hospital care vary widely among these countries/states, largely reflecting structural differences in the organisation of healthcare systems. Mechanisms of funding intensive care services tend to fall into three broad categories: • those that fund intensive care through DRGs as part of one episode of hospital care only (US Medicare, Germany, selected regions in Sweden and Italy) • those that use DRGs in combination with co-payments (Victoria, France) • those that exclude intensive care from DRG funding and use an alternative form of payment, for example global budgets (Spain) or per diems (South Australia). Approaches to funding paediatric and neonatal intensive care largely reflect the overall funding mechanism for intensive care. Evidence reviewed here indicates a general concern of potential underfunding of intensive care. These problems may be particularly pertinent for those settings that provide neonatal and paediatric care because of the very high costs and the relatively smaller number of cases in these settings compared with adult intensive care. Similar issues apply to highly specialised services in adult intensive care, such as treatment of severe burns. Given the variety of approaches to funding intensive care services, this review suggests that there is no obvious example of “best practice” or dominant approach used by a majority of systems. Each approach has advantages and disadvantages, particularly in relation to the financial risk involved in providing intensive care. While the risk of underfunding intensive care may be highest in systems that apply DRGs to the entire episode of hospital care, including intensive care, concerns about potential underfunding were voiced in all systems reviewed here. Arrangements for additional funding in the form of co-payments or surcharges may reduce the risk of underfunding. However, these approaches also face the difficulty of determining the appropriate level of (additional) payment and balancing the incentive effect arising from higher payment

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The Role of NHS Leaders in Times of Austerity

This paper evaluates the role of leadership in the NHS in times of austerity, times that are characterised by budgetary cuts and privatisation. As state employees, the role of today’s NHS leaders is to enforce austerity measures by administering thought and praxis, socially reproducing, at micro-levels, ideologies and politics that are circumscribed by the government that employs them. The paper inspects the moral worth of NHS leaders and the mechanisms they utilise upon the workforce to enable them to take forward austerity, that is, to fulfill their role

Exploring entertainment medicine and professionalization of self-care : interview study among doctors on the potential effects of digital self-tracking

Background: Nowadays, digital self-tracking devices offer a plethora of possibilities to both healthy and chronically ill users who want to closely examine their body. This study suggests that self-tracking in a private setting will lead to shifting understandings in professional care. To provide more insight into these shifts, this paper seeks to lay bare the promises and challenges of self-tracking while staying close to the everyday professional experience of the physician. Objective: The aim of this study was to (1) offer an analysis of how medical doctors evaluate self-tracking methods in their practice and (2) explore the anticipated shifts that digital self-care will bring about in relation to our findings and those of other studies. Methods: A total of 12 in-depth semistructured interviews with general practitioners (GPs) and cardiologists were conducted in Flanders, Belgium, from November 2015 to November 2016. Thematic analysis was applied to examine the transcripts in an iterative process. Results: Four major themes arose in our body of data: (1) the patient as health manager, (2) health obsession and medicalization, (3) information management, and (4) shifting roles of the doctors and impact on the health care organization. Our research findings show a nuanced understanding of the potentials and pitfalls of different forms of self-tracking. The necessity of contextualization of self-tracking data and a professionalization of self-care through digital devices come to the fore as important overarching concepts. Conclusions: This interview study with Belgian doctors examines the potentials and challenges of self-monitoring while focusing on the everyday professional experience of the physician. The dialogue between our dataset and the existing literature affords a fine-grained image of digital self-care and its current meaning in a medical-professional landscape

From wealth to health: evaluating microfinance as a complex intervention

Innovative interventions that address the social determinants of health are required to help reduce persistent health inequalities. We argue that microcredit can act in this way and develop a conceptual framework from which to examine this. In seeking to evaluate microcredit this way we then examine how randomized controlled trials, currently considered as the ‘gold standard’ in impact evaluations of microcredit, compare with developments in thinking about study design in public health. This leads us to challenge the notion of trials as the apparent gold standard for microcredit evaluations and contend that the pursuit of trial-based evidence alone may be hampering the production of relevant evidence on microcredit’s public health (and other wider) impacts. In doing so, we introduce new insights into the global debate on microfinance impact evaluation, related to ethical issues in staging randomized controlled trials, and propose innovations on complementary methods for use in the evaluation of complex interventions. </jats:p