Association of intervention outcomes with practice capacity for change: Subgroup analysis from a group randomized trial

<p>Abstract</p> <p>Background</p> <p>The relationship between health care practices' capacity for change and the results and sustainability of interventions to improve health care delivery is unclear.</p> <p>Methods</p> <p>In the setting of an intervention to increase preventive service delivery (PSD), we assessed practice capacity for change by rating motivation to change and instrumental ability to change on a one to four scale. After combining these ratings into a single score, random effects models tested its association with change in PSD rates from baseline to immediately after intervention completion and 12 months later.</p> <p>Results</p> <p>Our measure of practices' capacity for change varied widely at baseline (range 2–8; mean 4.8 ± 1.6). Practices with greater capacity for change delivered preventive services to eligible patients at higher rates after completion of the intervention (2.7% per unit increase in the combined effort score, p < 0.001). This relationship persisted for 12 months after the intervention ended (3.1%, p < 0.001).</p> <p>Conclusion</p> <p>Greater capacity for change is associated with a higher probability that a practice will attain and sustain desired outcomes. Future work to refine measures of this practice characteristic may be useful in planning and implementing interventions that result in sustained, evidence-based improvements in health care delivery.</p

Human Factors in Human-Systems Integration

Any large organization whose mission is to design and develop systems for humans, and train humans needs a well-developed integration and process plan to deal with the challenges that arise from managing multiple subsystems. Human capabilities, skills, and needs must be considered early in the design and development process, and must be continuously considered throughout the development lifecycle. This integration of human needs within system design is typically formalized through a Human-Systems Integration (HSI) program. By having an HSI program, an institution or organization can reduce lifecycle costs and increase the efficiency, usability, and quality of its products because human needs have been considered from the beginning

Classification and Identification of Pfiesteria and Pfiesteria-Like Species

Dinoflagellates can be classified both botanically and zoologically; however, they are typically put in the botanical division Pyrrhophyta. As a group they appear most related to the protistan ciliates and apicomplexans at the ultrastructure level. Within the Pyrrhophyta are both unarmored and armored forms of the dominant, motile flagellated stage. Unarmored dinoflagellates do not have thecal or wall plates arranged in specific series, whereas armored species have plates that vary in thickness but are specific in number and arrangement. In armored dinoflagellates, the plate pattern and tabulation is a diagnostic character at the family, subfamily, and even genus levels. In most cases, the molecular characterization of dinoflagellates confirms the taxonomy on the basis of external morphology; this has been demonstrated for several groups. Together, both genetic and morphological criteria are becoming increasingly important for the characterization, separation, and identification of dinoflagellates species. Pfiesteria and Pfiesteria-like species are thinly armored forms with motile dinospore stages characterized by their distinct plate formulae. Pfiesteria piscicida is the best-known member of the genus; however, there is at least one other species. Other genetically and morphologically related genera, now grouped under the common names of Lucy, Shepherd\u27s crook, and cryptoperidiniopsoid, are being studied and described in separate works. All these other heterotrophic dinoflagellate groups, many of which are thought to be benign, co-occur in estuarine waters where Pfiesteria has been found

Identification of larval sea basses (Centropristis spp.) using ribosomal DNA-specific molecular assays

This paper is not subject to U.S. copyright. The definitive version was published in Fishery Bulletin 106 (2008): 183-193.The identification of sea bass (Centropristis) larvae to species is difficult because of similar morphological characters, spawning times, and overlapping species ranges. Black sea bass (Centropristis striata) is an important fishery species and is currently considered to be overfished south of Cape Hatteras, North Carolina. We describe methods for identifying three species of sea bass larvae using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) assays based on species-specific amplification of rDNA internal transcribed spacer reg ions. The assays were tested against DNA of ten other cooccurring reef fish species to ensure the assay’s specificity. Centropristis larvae were collected on three cruises during cross-shelf transects and were used to validate the assays. Seventysix Centropristis larvae were assayed and 69 (91%) were identified successfully. DNA was not amplified from 5% of the larvae and identification was inconclusive for 3% of the larvae. These assays can be used to identify sea bass eggs and larvae and will help to assess spawning locations, spawning times, and larval dispersal.Collection of larvae at sea was supported by funding from the National Science Foundation through OCE 9876565 to C. Jones, S. Thorrold, A. Valle-Levinson, and J. Hare. Additional funding for this project was provided by Office of National Marine Sanctuaries and by Grays Reef National Marine Sanctuary

Outcomes associated with matching patients' treatment preferences to physicians' recommendations: study methodology

<p>Abstract</p> <p>Background</p> <p>Patients often express strong preferences for the forms of treatment available for their disease. Incorporating these preferences into the process of treatment decision-making might improve patients' adherence to treatment, contributing to better outcomes. We describe the methodology used in a study aiming to assess treatment outcomes when patients' preferences for treatment are closely matched to recommended treatments.</p> <p>Method</p> <p>Participants included patients with moderate and severe psoriasis attending outpatient dermatology clinics at the University Medical Centre Mannheim, University of Heidelberg, Germany. A self-administered online survey used conjoint analysis to measure participants' preferences for psoriasis treatment options at the initial study visit. Physicians' treatment recommendations were abstracted from each participant's medical records. The Preference Matching Index (PMI), a measure of concordance between the participant's preferences for treatment and the physician's recommended treatment, was determined for each participant at t₁(initial study visit). A clinical outcome measure, the Psoriasis Area and Severity Index, and two participant-derived outcomes assessing treatment satisfaction and health related quality of life were employed at t₁, t₂(twelve weeks post-t₁) and t₃(twelve weeks post-t₂). Change in outcomes was assessed using repeated measures analysis of variance. The association between participants' PMI scores at t₁and outcomes at t₂and t₃was evaluated using multivariate regressions analysis.</p> <p>Discussion</p> <p>We describe methods for capturing concordance between patients' treatment preferences and recommended treatment and for assessing its association with specific treatment outcomes. The methods are intended to promote the incorporation of patients' preferences in treatment decision-making, enhance treatment satisfaction, and improve treatment effectiveness through greater adherence.</p

Physician Practice Patterns and Variation in the Delivery of Preventive Services

BACKGROUND: Strategies to improve preventive services delivery (PSD) have yielded modest effects. A multidimensional approach that examines distinctive configurations of physician attributes, practice processes, and contextual factors may be informative in understanding delivery of this important form of care. OBJECTIVE: We identified naturally occurring configurations of physician practice characteristics (PPCs) and assessed their association with PSD, including variation within configurations. DESIGN: Cross-sectional study. PARTICIPANTS: One hundred thirty-eight family physicians in 84 community practices and 4,046 outpatient visits. MEASUREMENTS: Physician knowledge, attitudes, use of tools and staff, and practice patterns were assessed by ethnographic and survey methods. PSD was assessed using direct observation of the visit and medical record review. Cluster analysis identified unique configurations of PPCs. A priori hypotheses of the configurations likely to perform the best on PSD were tested using a multilevel random effects model. RESULTS: Six distinct PPC configurations were identified. Although PSD significantly differed across configurations, mean differences between configurations with the lowest and highest PSD were small (i.e., 3.4, 7.7, and 10.8 points for health behavior counseling, screening, and immunizations, respectively, on a 100-point scale). Hypotheses were not confirmed. Considerable variation of PSD rates within configurations was observed. CONCLUSIONS: Similar rates of PSD can be attained through diverse physician practice configurations. Significant within-configuration variation may reflect dynamic interactions between PPCs as well as between these characteristics and the contexts in which physicians function. Striving for a single ideal configuration may be less valuable for improving PSD than understanding and leveraging existing characteristics within primary care practices

Expanding the role of non-physician medical staff in primary care in Germany: protocol for a mixed-methods study exploring the perspectives of physicians in rural practices

Introduction Primary care faces substantial challenges worldwide through an increasing mismatch in supply and demand, particularly in rural areas. One option to address this mismatch might be increasing efficiency by delegation of tasks to non-physician medical staff. Possible influencing factors, motives and beliefs regarding delegation to non-physician medical staff and the potential of an expanded role, as perceived by primary care physicians, however, remain unclear. The aim of this study is to assess these factors to guide development of potential interventions for expanding the role of non-physician medical staff in delivering primary care services in rural Germany.Methods and analysis This mixed-methods study based on the theoretical domains framework (TDF) consists of survey and interviews conducted sequentially. The survey, to be sent to all primary care physicians active in rural Baden-Wuerttemberg (estimated n=1250), includes 37 items: 15 assessing personal and practice characteristics, 15 matching TDF domains and 7 assessing opportunities for delegation. The interview, to be performed in a subsample (estimated n=12–20), will be informed by results of the survey. The initial interview guide consists of 11 questions covering additional TDF domains. Perspectives towards delegation will be maximised by comparing data emerging in either part of the study, seeking confirmation, disagreement or further details.Ethics and dissemination The Ethics Committee of Heidelberg University approved this study (approval number: 2021–530). Written informed consent will be obtained before each interview; consent for participation in the survey will be assumed when the survey has been returned. Results will be disseminated via publications in peer-reviewed journals and talks at conferences. By combining quantitative and qualitative methods, our results will support future research for crafting potential interventions to expand the role of non-physician medical staff in rural primary care