Achieving provider engagement: providers' perceptions of implementing and delivering integrated care

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda

'White knuckle care work' : violence, gender and new public management in the voluntary sector

Drawing on comparative data from Canada and Scotland, this article explores reasons why violence is tolerated in non-profit care settings. This article will provide insights into how workers' orientations to work, the desire to care and the intrinsic rewards from working in a non-profit context interact with the organization of work and managerially constructed workplace norms and cultures (Burawoy, 1979) to offset the tensions in an environment characterized by scarce resources and poor working conditions. This article will also outline how the same environment of scarce resources causes strains in management's efforts to establish such cultures. Working with highly excluded service users with problems that do not respond to easy interventions, workers find themselves working at the edge of their endurance, hanging on by their fingernails, and beginning to participate in various forms of resistance; suggesting that even among the most highly committed, 'white knuckle care' may be unsustainable

New Ohio and Indiana Records of Aquatic Insects (Ephemeroptera, Plecoptera, Trichoptera, Coleoptera: Elmidae, Diptera: Chironomidae)

New state records and additional locations for rarely collected species are reported for Ephemeroptera (mayflies), Plecoptera (stoneflies), Trichoptera (caddisflies), Coleoptera: Elmidae (riffle beetles), and Diptera: Chironomidae (chironomids, non-biting midges, midges). These specimen records result primarily from Ohio Environmental Protection Agency biomonitoring of Ohio streams and from records found in the Purdue University Entomological Research Collection and the Illinois Natural History Survey Insect Collection; a few records were derived from material housed in two other collections. New state records for Ohio consist of the mayflies Acentrella rallatoma Burian & Myers, Acerpenna pygmaea (Hagen), Anafroptilum album (McDunnough), Anafroptilum minor group species 1, Anafroptilum minor group species 2, Anafroptilum victoriae (McDunnough), Heterocloeon (Jubilatum) species B McCafferty et al., Heterocloeon (Jubilatum) species D McCafferty et al., Labiobaetis longipalpus (Morihara & McCafferty), Plauditus punctiventris (McDunnough), Ephemera guttulata Pictet, Habrophlebia vibrans Needham, and Anthopotamus verticis (Say); the stonefly Isoperla frisoni Illies; the caddisflies Brachycentrus nigrosoma (Banks), Homoplectra doringa (Milne), Ceraclea nepha (Ross), and Fabria inornata (Banks); the riffle beetle Oulimnius nitidulus (LeConte); and the chironomids Cricotopus (Isocladius) sp. “Ozarks” Epler, Cricotopus (Isocladius) sp. “Santa Fe” Epler, Fittkauimyia sp. [probably F. serta (Roback)], Parakiefferiella sp. F Epler, and Saetheria hirta Sæther. A previous report of the mayfly Macdunnoa persimplex (McDunnough) from the Ohio River, adjacent to Ohio, is substantiated with record data. The caddisfly Goerita betteni Ross is confirmed in Ohio. New state records for Indiana consist of the mayflies Heterocloeon (Jubilatum) species D McCafferty et al. and Leucrocuta walshi (McDunnough) and the chironomids Cricotopus (Isocladius) sp. “Ozarks” and Fittkauimyia sp. [probably F. serta (Roback)]. Recent Indiana records of the mayflies Homoeoneuria ammophila (Spieth) and Pentagenia vittigera (Walsh) are also included because these species are rarely collected and most existing records are old. These records represent significant range extensions north for Cricotopus (Isocladius) sp. “Santa Fe” Epler, Fittkauimyia sp. [probably F. serta (Roback)], Parakiefferiella sp. F Epler, and Saetheria hirta Sæther

Dialectic tensions in the financial markets: a longitudinal study of pre- and post-crisis regulatory technology

This article presents the findings from a longitudinal research study on regulatory technology in the UK financial services industry. The financial crisis with serious corporate and mutual fund scandals raised the profile of compliance as governmental bodies, institutional and private investors introduced a ‘tsunami’ of financial regulations. Adopting a multi-level analysis, this study examines how regulatory technology was used by financial firms to meet their compliance obligations, pre- and post-crisis. Empirical data collected over 12 years examine the deployment of an investment management system in eight financial firms. Interviews with public regulatory bodies, financial institutions and technology providers reveal a culture of compliance with increased transparency, surveillance and accountability. Findings show that dialectic tensions arise as the pursuit of transparency, surveillance and accountability in compliance mandates is simultaneously rationalized, facilitated and obscured by regulatory technology. Responding to these challenges, regulatory bodies continue to impose revised compliance mandates on financial firms to force them to adapt their financial technologies in an ever-changing multi-jurisdictional regulatory landscape

More Extensive Implementation of the Chronic Care Model is Associated with Better Lipid Control in Diabetes

Chronic disease collaboratives help practices redesign care delivery. The North Carolina Improving Performance in Practice program provides coaches to guide implementation of 4 key practice changes: registries, planned care templates, protocols, and self-management support. Coaches rate progress using the Key Drivers Implementation Scales (KDIS). This study examines whether higher KDIS scores are associated with improved diabetes outcomes

Supporting patients with low health literacy: what role do radiation therapists play?

Purpose: Health literacy plays a key role in a patient’s ability to use health information and services, and can affect health outcomes. This study aimed to explore radiation therapists’ perspectives on how they support people with lower health literacy who are undergoing radiotherapy. Methods: Semi-structured interviews were conducted with 25 radiation therapists working in radiation oncology departments in New South Wales, Australia. Results: The four key themes were (1) the process of identifying a patient with low health literacy, (2) the perceived consequences of low health literacy, (3) managing and responding to the needs of different health literacy groups and (4) recommendations to address low health literacy in radiotherapy. Radiation therapists appeared to make an informal, intuitive judgment about a patient’s health literacy, using a variety of verbal and non-verbal cues as well as impromptu conversations with the multi-disciplinary team. Patients perceived to have lower health literacy were described as having greater difficulties assimilating knowledge and engaging in self-care. Although participants reported communicating to patients at a basic level initially, they subsequently tailored their communication to match a patient’s health literacy. Strategies reported to communicate to low health literacy groups ranged from using lay language with minimal medical terminology, using visual aids (photos), using analogies, reiterating information and asking family members with higher literacy to attend consultations. Conclusion: A more structured approach to supporting patients with low health literacy and integrating health literacy training in radiation oncology departments may help to minimise the adverse outcomes typically experienced by this population

Addressing Literacy and Numeracy to Improve Diabetes Care: Two randomized controlled trials

OBJECTIVE - Diabetic patients with lower literacy or numeracy skills are at greater risk for poor diabetes outcomes. This study evaluated the impact of providing literacy- and numeracy-sensitive diabetes care within an enhanced diabetes care program on AlC and other diabetes outcomes. RESEARCH DESIGN AND METHODS - In two randomized controlled trials, we enrolled 198 adult diabetic patients with most recent A1C ≥7.0%, referred for participation in an enhanced diabetes care program. For 3 months, control patients received care from existing enhanced diabetes care programs, whereas intervention patients received enhanced programs that also addressed literacy and numeracy at each institution. Intervention pro- , viders received health communication training and used the interactive Diabetes Literacy and Numeracy Education Toolkit with patients. A1C was measured at 3 and 6 months follow-up. Secondary outcomes included self-efficacy, self-management behaviors, and treatment satisfaction. RESULTS - At 3 months, both intervention and control patients had significant improvements in A1C from baseline (intervention -1.50 [95% CI -1.80 to -1.02]; control -0.80 [-1.10 to -0.30]). In adjusted analysis, there was greater improvement in A1C in the intervention group than in the control group (P = 0.03). At 6 months, there were no , differences in A1C between intervention and control groups. Self-efficacy improved from , baseline for both groups. No significant differences were found for self-management behaviors or satisfaction. CONCLUSIONS - A literacy- and numeracy-focused diabetes care program modestly improved self-efficacy and glycemic control compared with standard enhanced diabetes care, but the difference attenuated after conclusion of the intervention

Materiality in information environments: Objects, spaces, and bodies in three outpatient hemodialysis facilities

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152032/1/asi24277.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152032/2/asi24277_am.pd

Exploring factors influencing asthma control and asthma-specific health-related quality of life among children

Abstract Background Little is known about factors contributing to children’s asthma control status and health-related quality of life (HRQoL). The study objectives were to assess the relationship between asthma control and asthma-specific HRQoL in asthmatic children, and to examine the extent to which parental health literacy, perceived self-efficacy with patient-physician interaction, and satisfaction with shared decision-making (SDM) contribute to children’s asthma control and asthma-specific HRQoL. Methods This cross-sectional study utilized data collected from a sample of asthmatic children (n = 160) aged 8–17 years and their parents (n = 160) who visited a university medical center. Asthma-specific HRQoL was self-reported by children using the National Institutes of Health’s Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Asthma Impact Scale. Satisfaction with SDM, perceived self-efficacy with patient-physician interaction, parental health literacy, and asthma control were reported by parents using standardized measures. Structural equation modeling (SEM) was performed to test the hypothesized pathways. Results Path analysis revealed that children with better asthma control reported higher asthma-specific HRQoL (β = 0.4, P < 0.001). Parents with higher health literacy and greater perceived self-efficacy with patient-physician interactions were associated with higher satisfaction with SDM (β = 0.38, P < 0.05; β = 0.58, P < 0.001, respectively). Greater satisfaction with SDM was in turn associated with better asthma control (β = −0.26, P < 0.01). Conclusion Children’s asthma control status influenced their asthma-specific HRQoL. However, parental factors such as perceived self-efficacy with patient-physician interaction and satisfaction with shared decision-making indirectly influenced children’s asthma control status and asthma-specific HRQoL

Exploring factors influencing asthma control and asthma-specific health-related quality of life among children

Abstract Background Little is known about factors contributing to children’s asthma control status and health-related quality of life (HRQoL). The study objectives were to assess the relationship between asthma control and asthma-specific HRQoL in asthmatic children, and to examine the extent to which parental health literacy, perceived self-efficacy with patient-physician interaction, and satisfaction with shared decision-making (SDM) contribute to children’s asthma control and asthma-specific HRQoL. Methods This cross-sectional study utilized data collected from a sample of asthmatic children (n = 160) aged 8–17 years and their parents (n = 160) who visited a university medical center. Asthma-specific HRQoL was self-reported by children using the National Institutes of Health’s Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Asthma Impact Scale. Satisfaction with SDM, perceived self-efficacy with patient-physician interaction, parental health literacy, and asthma control were reported by parents using standardized measures. Structural equation modeling (SEM) was performed to test the hypothesized pathways. Results Path analysis revealed that children with better asthma control reported higher asthma-specific HRQoL (β = 0.4, P < 0.001). Parents with higher health literacy and greater perceived self-efficacy with patient-physician interactions were associated with higher satisfaction with SDM (β = 0.38, P < 0.05; β = 0.58, P < 0.001, respectively). Greater satisfaction with SDM was in turn associated with better asthma control (β = −0.26, P < 0.01). Conclusion Children’s asthma control status influenced their asthma-specific HRQoL. However, parental factors such as perceived self-efficacy with patient-physician interaction and satisfaction with shared decision-making indirectly influenced children’s asthma control status and asthma-specific HRQoL