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Wright DR, Chen T, Chalmers KD, Shah SK, Yi-Frazier JP, LeBlanc JL, Garvey K, Senturia KD, Pihoker C, Malik FS. Adolescent-Preferred financial incentives to promote type 1 diabetes Self-Care: A discrete choice experiment. Diabetes Res Clin Pract 2024; 215:111798. [PMID: 39096938 DOI: 10.1016/j.diabres.2024.111798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/12/2024] [Accepted: 07/28/2024] [Indexed: 08/05/2024]
Abstract
AIMS This study aimed to quantify preferences for the characteristics of a financial incentives program that would motivate adolescent engagement in type 1 diabetes (T1D) self-care. METHOD We performed a discrete choice experiment with 12-18 year-olds with T1D from two pediatric hospital endocrinology clinics (n = 317). We identified key attributes of incentives: (1) monthly value of the reward, (2) payment structure, and (3) difficulty of incentivized behaviors. In twelve choice questions, adolescents chose the incentive option from a pair of profiles that was more likely to motivate them to increase adherence to recommended self-care. Options presented were tailored to adolescents' T1D technology use and perceived difficulty of completing each behavior. We analyzed data using a conditional logit model. RESULTS The value of the reward accounted for 60.8% of preferences. Adolescents were willing to accept lower value rewards when incentive payments used positive vs. negative reinforcement (-$10.88 (95% CI: -$12.60, -9.24)) and preferred higher incentives for performing hard vs. easier behaviors (+$14.92 (95% CI: +$12.66, +$17.28)). CONCLUSIONS Stated preferences can inform intervention design. Future research will evaluate the external validity of the discrete choice experiment-informed intervention design by assessing adolescent health and behavioral outcomes in a randomized controlled trial.
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Affiliation(s)
- Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Tom Chen
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Seema K Shah
- Department of Pediatrics, Northwestern University School of Medicine, Chicago, IL, USA; Smith Child Health Outreach, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Lurie Children's Hospital, Chicago, IL, USA
| | - Joyce P Yi-Frazier
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA USA
| | - Jessica L LeBlanc
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Katharine Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Kirsten D Senturia
- Seattle Children's Research Institute, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Catherine Pihoker
- Seattle Children's Research Institute, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Faisal S Malik
- Seattle Children's Research Institute, Seattle, WA, USA; University of Washington, Seattle, WA, USA
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Krah NS, Zietzsch P, Salrach C, Toro CA, Ballester M, Orrego C, Groene O. Identifying Factors to Facilitate the Implementation of Decision-Making Tools to Promote Self-Management of Chronic Diseases into Routine Healthcare Practice: A Qualitative Study. Healthcare (Basel) 2023; 11:2397. [PMID: 37685431 PMCID: PMC10487156 DOI: 10.3390/healthcare11172397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
This study, as part of the COMPAR-EU project, utilized a mixed-methods approach involving 37 individual, semi-structured interviews and one focus group with 7 participants to investigate the factors influencing the implementation and use of self-management interventions (SMIs) decision tools in clinical practice. The interviews and focus group discussions were guided by a tailored interview and focus group guideline developed based on the Tailored Implementation for Chronic Diseases (TICD) framework. The data were analyzed using a directed qualitative content analysis, with a deductive coding system based on the TICD framework and an inductive coding process. A rapid analysis technique was employed to summarize and synthesize the findings. The study identified five main dimensions and facilitators for implementation: decision tool factors, individual health professional factors, interaction factors, organizational factors, and social, political, and legal factors. The findings highlight the importance of structured implementation through SMI decision support tools, emphasizing the need to understand their benefits, secure organizational resources, and gain political support for sustainable implementation. Overall, this study employed a systematic approach, combining qualitative methods and comprehensive analysis, to gain insights into the factors influencing the implementation of SMIs' decision-support tools in clinical practice.
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Affiliation(s)
| | - Paula Zietzsch
- OptiMedis, Research and Innovation, 20095 Hamburg, Germany
| | | | | | - Marta Ballester
- Avedis Donabedian Research Institute, 08037 Barcelona, Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute, 08037 Barcelona, Spain
| | - Oliver Groene
- OptiMedis, Research and Innovation, 20095 Hamburg, Germany
- Faculty of Management, Economics and Society, University of Witten/Herdecke, 58455 Witten, Germany
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Hodson N, Majid M, Vlaev I, Singh SP. Can incentives improve antipsychotic adherence in major mental illness? A mixed-methods systematic review. BMJ Open 2022; 12:e059526. [PMID: 35705342 PMCID: PMC9204416 DOI: 10.1136/bmjopen-2021-059526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Incentives have been effectively used in several healthcare contexts. This systematic review aimed to ascertain whether incentives can improve antipsychotic adherence, what ethical and practical issues arise and whether existing evidence resolves these issues. DESIGN Systematic review of MEDLINE, EMBASE and PsycINFO. Searches on 13 January 2021 (no start date) found papers on incentives for antipsychotics. Randomised controlled trials (RCTs), cohort studies, qualitative research and ethical analyses were included. Papers measuring impact on adherence were synthesised, then a typology of ethical and policy issues was compiled, finally the empirical literature was compared with this typology to describe current evidence and identify remaining research questions. RESULTS 26 papers were included. 2 RCTs used contingent financial incentives for long-acting injectable antipsychotic preparations. Over 12 months, there were significantly larger increases in adherence among the intervention groups versus control groups in both RCTs. There were no consistently positive secondary outcomes. 39 ethical and practical issues were identified. 12 of these are amenable to empirical study but have not been researched and for 7 the current evidence is mixed. CONCLUSIONS In keeping with other areas of healthcare, antipsychotic adherence can be increased with financial incentives. Payments of 2.5 times minimum wage changed behaviour. The typology of issues reported in this systematic review provides a template for future policy and ethical analysis. The persistence of the effect and the impact of incentives on intrinsic motivation require further research. PROSPERO REGISTRATION NUMBER CRD42020222702.
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Affiliation(s)
- Nathan Hodson
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
| | - Madiha Majid
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
| | - Ivo Vlaev
- Warwick Business School, Coventry, UK
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Stefanidis C, Bush A, Newby C, Nwokoro C, Liebeschuetz S, Skene IP, Griffiths CJ, Martineau AR. Vitamin D replacement in children with acute wheeze: a dose-escalation study. ERJ Open Res 2022; 8:00609-2021. [PMID: 35586451 PMCID: PMC9108968 DOI: 10.1183/23120541.00609-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/31/2022] [Indexed: 11/05/2022] Open
Abstract
Meta-analyses report protective effects of vitamin D supplementation against asthma exacerbations and acute respiratory infections in adults [1–3], but data relating to effects of vitamin D on risk of preschool wheeze and asthma attacks in childhood are more limited [4]. In preparation for a randomised controlled trial (RCT) of vitamin D in children with recurrent preschool wheeze or school-age asthma, we carried out a dose-escalation study to find the daily vitamin D3 supplementation regimen that is most effective in elevating circulating 25-hydroxyvitamin D (25(OH)D) concentrations in these children. We hypothesised that daily oral vitamin D3 supplementation of 1000 IU would be more effective than 400 IU (UK recommendation [5]) in elevating the circulating 25(OH)D concentration to ≥75 nmol·L−1 at 3 months in vitamin-D-insufficient children with recurrent preschool wheeze or school-age asthma. Vitamin D supplementation at the current UK recommended level (400 IU·day−1) or enhanced supplementation (1000 IU·day−1) failed to achieve adequate levels of vitamin D (>75 nmol·L−1) in vitamin-D-insufficient children with acute wheezehttps://bit.ly/3J43Ouo
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Howell D, Powis M, Kirkby R, Amernic H, Moody L, Bryant-Lukosius D, O'Brien MA, Rask S, Krzyzanowska M. Improving the quality of self-management support in ambulatory cancer care: a mixed-method study of organisational and clinician readiness, barriers and enablers for tailoring of implementation strategies to multisites. BMJ Qual Saf 2021; 31:12-22. [PMID: 33727415 DOI: 10.1136/bmjqs-2020-012051] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Improving the quality of self-management support (SMS) for treatment-related toxicities is a priority in cancer care. Successful implementation of SMS programmes depends on tailoring implementation strategies to organisational readiness factors and barriers/enablers, however, a systematic process for this is lacking. In this formative phase of our implementation-effectiveness trial, Self-Management and Activation to Reduce Treatment-Related Toxicities, we evaluated readiness based on constructs in the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT) and developed a process for mapping implementation strategies to local contexts. METHODS In this convergent mixed-method study, surveys and interviews were used to assess readiness and barriers/enablers for SMS among stakeholders in 3 disease site groups at 3 regional cancer centres (RCCs) in Ontario, Canada. Median survey responses were classified as a barrier, enabler or neutral based on a priori cut-off values. Barriers/enablers at each centre were mapped to CFIR and then inputted into the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC) to identify centre-specific implementation strategies. Qualitative data were separately analysed and themes mapped to CFIR constructs to provide a deeper understanding of barriers/enablers. RESULTS SMS in most of the RCCs was not systematically delivered, yet most stakeholders (n=78; respondent rate=50%) valued SMS. For centre 1, 7 barriers/12 enablers were identified, 14 barriers/9 enablers for centre 2 and 11 barriers/5 enablers for centre 3. Of the total 46 strategies identified, 30 (65%) were common across centres as core implementation strategies and 5 tailored implementation recommendations were identified for centres 1 and 3, and 4 for centre 2. CONCLUSIONS The CFIR and CFIR-ERIC were valuable tools for tailoring SMS implementation to readiness and barriers/enablers, whereas NPT helped to clarify the clinical work of implementation. Our approach to tailoring of implementation strategies may have relevance for other studies.
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Affiliation(s)
- Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Melanie Powis
- Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Ryan Kirkby
- Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Heidi Amernic
- Cancer Care Ontario Branch, Ontario Health, Toronto, Ontario, Canada
| | - Lesley Moody
- Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | | | - Mary Ann O'Brien
- Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Rask
- Medical Oncology, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada
| | - Monika Krzyzanowska
- Medical Oncology & Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
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Egede LE, Campbell JA, Walker RJ, Dawson AZ, Williams JS. Financial incentives to improve glycemic control in African American adults with type 2 diabetes: a pilot randomized controlled trial. BMC Health Serv Res 2021; 21:57. [PMID: 33435969 PMCID: PMC7803385 DOI: 10.1186/s12913-020-06029-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Financial incentives is emerging as a viable strategy for improving clinical outcomes for adults with type 2 diabetes. However, there is limited data on optimal structure for financial incentives and whether financial incentives are effective in African Americans with type 2 diabetes. This pilot study evaluated impact of three financial incentive structures on glycemic control in this population. Methods Sixty adults with type 2 diabetes were randomized to one of three financial incentive structures: 1) single incentive (Group 1) at 3 months for Hemoglobin A1c (HbA1c) reduction, 2) two-part equal incentive (Group 2) for home testing of glucose and HbA1c reduction at 3 months, and 3) three-part equal incentive (Group 3) for home testing, attendance of weekly telephone education classes and HbA1c reduction at 3 months. The primary outcome was HbA1c reduction within each group at 3 months post-randomization. Paired t-tests were used to test differences between baseline and 3-month HbA1c within each group. Results The mean age for the sample was 57.9 years and 71.9% were women. Each incentive structure led to significant reductions in HbA1c at 3 months with the greatest reduction from baseline in the group with incentives for multiple components: Group 1 mean reduction = 1.25, Group 2 mean reduction = 1.73, Group 3 mean reduction = 1.74. Conclusion Financial incentives led to significant reductions in HbA1c from baseline within each group. Incentives for multiple components led to the greatest reductions from baseline. Structured financial incentives that reward home monitoring, attendance of telephone education sessions, and lifestyle modification to lower HbA1c are viable options for glycemic control in African Americans with type 2 diabetes. Trial registration Trial registration: NCT02722499. Registered 23 March 2016, url.
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Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA. .,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joni S Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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Dietrich JJ, Hornschuh S, Khunwane M, Makhale LM, Otwombe K, Morgan C, Huang Y, Lemos M, Lazarus E, Kublin JG, Gray GE, Laher F, Andrasik M. A mixed methods investigation of implementation barriers and facilitators to a daily mobile phone sexual risk assessment for young women in Soweto, South Africa. PLoS One 2020; 15:e0231086. [PMID: 32324753 PMCID: PMC7179867 DOI: 10.1371/journal.pone.0231086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 03/17/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The HIV epidemiology in South Africa reveals stark age and gender disparities, with young women being the most vulnerable to HIV acquisition in 2017. Evaluation of HIV exposure is a challenge in HIV prevention research. Intermittent in-clinic interviewer-administered risk behaviour assessments are utilised but may be limited by social desirability and recall biases. We piloted a mobile phone application for daily self-report of sexual risk behaviour in fifty 18-25 year old women at risk of HIV infection enrolled in HIV Vaccine Trials Network 915 (HVTN 915) in Soweto, South Africa. Through a mixed-methods investigation, we explored barriers and facilitators to completing daily mobile phone surveys among HVTN 915 study participants and staff. METHODS We analysed quantitative data on barriers and facilitators to mobile phone study completion collected during the larger HVTN 915 study as well as two post-study focus group discussions (FGDs) with fifteen former participants with a median age of 24 years (IQR 23-25) and six individual in-depth interviews (IDIs) with HVTN 915 staff. FGDs and IDIs utilised semi-structured interview guides, were audio-recorded, transcribed verbatim and translated to English. After coding, thematic analysis was performed. RESULTS The main facilitator for daily mobile phone survey completion assessed across 336 follow-up visits for 49 participants was the daily short message system (SMS) reminders (93%, 312/336). Across 336 visits, 31/49 (63%) retained participants reported barriers to completion of daily mobile phone surveys: forgetting (20%, 12/49), being too busy (19%, 11/49) and the survey being an inconvenience (15%, 9/49). Five main themes were identified during the coding of IDIs and FGDs: (1) facilitators of mobile phone survey completion, such as daily SMS reminders and follow up calls for non-completers; (2) barriers to mobile phone survey completion, including partner, time-related and technical barriers; (3) power of incentives; (4) response bias in providing sensitive information, and (5) recommendations for future mobile phone based interventions. CONCLUSION Despite our enthusiasm to use innovation to optimise sexual risk assessments, technical and practical solutions are required to improve implementation. We recommend further engagement with participants to optimise this approach and to further understand social desirability bias and study incentives in sexual risk reporting.
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Affiliation(s)
- Janan J. Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Mamakiri Khunwane
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Lerato M. Makhale
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Cecilia Morgan
- Vaccine and Infectious Disease Division (VIDD), Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Yunda Huang
- Vaccine and Infectious Disease Division (VIDD), Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Maria Lemos
- Vaccine and Infectious Disease Division (VIDD), Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Erica Lazarus
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - James G. Kublin
- Vaccine and Infectious Disease Division (VIDD), Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Glenda E. Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Office of the President, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Fatima Laher
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Michele Andrasik
- Vaccine and Infectious Disease Division (VIDD), Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
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Zhang E, Tipirneni R, Beathard ER, Lee S, Kirch MA, Salman C, Solway E, Clark SJ, Haggins AN, Kieffer EC, Ayanian JZ, Goold SD. Health Risk Assessments in Michigan's Medicaid Expansion: Early Experiences in Primary Care. Am J Prev Med 2020; 58:e79-e86. [PMID: 31952944 PMCID: PMC7085853 DOI: 10.1016/j.amepre.2019.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Michigan is one of 3 states that have implemented health risk assessments for enrollees as a feature of its Medicaid expansion, the Healthy Michigan Plan. This study describes primary care providers' early experiences with completing health risk assessments with enrollees and examines provider- and practice-level factors that affect health risk assessment completion. METHODS All primary care providers caring for ≥12 Healthy Michigan Plan enrollees (n=4,322) were surveyed from June to November 2015, with 2,104 respondents (55.5%). Analyses in 2016-2017 described provider knowledge, attitudes, and experiences with the health risk assessment early in Healthy Michigan Plan implementation; multivariable analyses examined relationships of provider- and practice-level characteristics with health risk assessment completion, as recorded in state data. RESULTS Of the primary care provider respondents, 73% found health risk assessments very or somewhat useful for identifying and discussing health risks, although less than half (47.2%) found them very or somewhat useful for getting patients to change health behaviors. Most primary care provider respondents (65.3%) were unaware of financial incentives for their practices to complete health risk assessments. Nearly all primary care providers had completed at least 1 health risk assessment. The mean health risk assessment completion rate (completed health risk assessments/number of Healthy Michigan Plan enrollees assigned to that primary care provider) was 19.6%; those who lacked familiarity with the health risk assessment had lower completion rates. CONCLUSIONS Early in program implementation, health risk assessment completion rates by primary care providers were low and awareness of financial incentives limited. Most primary care provider respondents perceived health risk assessments to be very or somewhat useful in identifying health risks, and about half of primary care providers viewed health risk assessments as very or somewhat useful in helping patients to change health behaviors.
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Affiliation(s)
- Eunice Zhang
- Department of Preventive Medicine, University of Michigan, Ann Arbor, Michigan
| | - Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Erin R Beathard
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Sunghee Lee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Matthias A Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Cengiz Salman
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Sarah J Clark
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Pediatric and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | - Adrianne N Haggins
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Edith C Kieffer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - John Z Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Susan D Goold
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
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GP incentives to design hypertension and atrial fibrillation local quality-improvement schemes: a controlled before-after study in UK primary care. Br J Gen Pract 2019; 69:e689-e696. [PMID: 31455643 DOI: 10.3399/bjgp19x705521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/28/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Financial incentives in the UK such as the Quality and Outcomes Framework (QOF) reward GP surgeries for achievement of nationally defined targets. These have shown mixed results, with weak evidence for some measures, but also possible unintended negative effects. AIM To look at the effects of a local intervention for atrial fibrillation (AF) and hypertension, with surgeries rewarded financially for work, including appointing designated practice leads, attendance at peer review workshops, and producing their own protocols. DESIGN AND SETTING A controlled before-after study comparing surgery performance measures in UK primary care. METHOD This study used published QOF data to analyse changes from baseline in mean scores per surgery relating to AF and hypertension prevalence and management at T1 (12 months) and T2 (24 months) for the intervention group, which consisted of all 58 surgeries in East Lancashire Clinical Commissioning Group (CCG), compared to the control group, which consisted of all other surgeries in north-west England. RESULTS There was a small acceleration between T0 (baseline) and T2 in recorded prevalence of hypertension in the intervention group compared to the controls, difference 0.29% (95% confidence interval [CI] = 0.05 to 0.53), P = 0.017, but AF prevalence did not increase more in the intervention group. Improvement in quality of management of AF was significantly better in the intervention group, difference 3.24% (95% CI = 1.37 to 5.12), P = 0.001. CONCLUSION This intervention improved diagnosis rates of hypertension but not AF, though it did improve quality of AF management. It indicates that funded time to develop quality-improvement measures targeted at a local population and involving peer support can engage staff and have the potential to improve quality.
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Nhim K, Gruss SM, Porterfield DS, Jacobs S, Elkins W, Luman ET, Van Aacken S, Schumacher P, Albright A. Using a RE-AIM framework to identify promising practices in National Diabetes Prevention Program implementation. Implement Sci 2019; 14:81. [PMID: 31412894 PMCID: PMC6694543 DOI: 10.1186/s13012-019-0928-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/25/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The National Diabetes Prevention Program (National DPP) is rapidly expanding in an effort to help those at high risk of type 2 diabetes prevent or delay the disease. In 2012, the Centers for Disease Control and Prevention funded six national organizations to scale and sustain multistate delivery of the National DPP lifestyle change intervention (LCI). This study aims to describe reach, adoption, and maintenance during the 4-year funding period and to assess associations between site-level factors and program effectiveness regarding participant attendance and participation duration. METHODS The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation from October 2012 to September 2016. Multilevel linear regressions were used to examine associations between participant-level demographics and site-level strategies and number of sessions attended, attendance in months 7-12, and duration of participation. RESULTS The six funded national organizations increased the number of participating sites from 68 in 2012 to 164 by 2016 across 38 states and enrolled 14,876 eligible participants. By September 2016, coverage for the National DPP LCI was secured for 42 private insurers and 7 public payers. Nearly 200 employers were recruited to offer the LCI on site to their employees. Site-level strategies significantly associated with higher overall attendance, attendance in months 7-12, and longer participation duration included using self-referral or word of mouth as a recruitment strategy, providing non-monetary incentives for participation, and using cultural adaptations to address participants' needs. Sites receiving referrals from healthcare providers or health systems also had higher attendance in months 7-12 and longer participation duration. At the participant level, better outcomes were achieved among those aged 65+ (vs. 18-44 or 45-64), those who were overweight (vs. obesity), those who were non-Hispanic white (vs. non-Hispanic black or multiracial/other races), and those eligible based on a blood test or history of gestational diabetes mellitus (vs. screening positive on a risk test). CONCLUSIONS In a time of rapid dissemination of the National DPP LCI the findings of this evaluation can be used to enhance program implementation and translate lessons learned to similar organizations and settings.
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Affiliation(s)
- Kunthea Nhim
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA 30341 USA
| | - Stephanie M. Gruss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA 30341 USA
| | - Deborah S. Porterfield
- RTI International, RTP, NC, and the University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Sara Jacobs
- RTI International, P.O. Box 12194, 3040 E. Cornwallis Road, Rearch Triagle Park, NC 27709-2194 USA
| | - Wendi Elkins
- RTI International, P.O. Box 12194, 3040 E. Cornwallis Road, Rearch Triagle Park, NC 27709-2194 USA
| | - Elizabeth T. Luman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA 30341 USA
| | - Susan Van Aacken
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA 30341 USA
| | - Patricia Schumacher
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA 30341 USA
| | - Ann Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. Mailstop S107-3, Atlanta, GA 30341 USA
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Gardner K, Olney S, Dickinson H. Getting smarter with data: understanding tensions in the use of data in assurance and improvement-oriented performance management systems to improve their implementation. Health Res Policy Syst 2018; 16:125. [PMID: 30577854 PMCID: PMC6303867 DOI: 10.1186/s12961-018-0401-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background A better understanding of the conditions under which performance indicators can be used to improve accountability for outcomes and promote quality improvement could help policy-makers develop more effective performance management systems. One problem is the lack of conceptual models and empirical data that describe the processes through which different approaches use data together with other incentives to influence motivation. Discussion Drawing on the performance governance and quality improvement literature, we developed a framework that distinguishes between the practice of using information to verify levels of performance in market-oriented performance management approaches and using indicators to monitor and promote improvement through building capacity for using data in service and professional networks. The framework explores how performance indicators are deployed and used in the different approaches to enact accountability or stimulate motivation for improvement and articulates the types of system architecture and processes needed to advance implementation. Summary The framework encourages a critical appraisal of the motivations, reward systems and techniques that underpin different performance management approaches. Understanding how and for what purpose performance information is used in everyday practice will advance theory and help inform decision-makers in designing the conditions that effectively contribute to performance accountability and improvements.
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Affiliation(s)
- Karen Gardner
- Public Service Research Group, School of Business, UNSW Canberra, PO Box 7196, Canberra BC, 2610, Australia.
| | - Sue Olney
- Public Service Research Group, School of Business, UNSW Canberra, PO Box 7196, Canberra BC, 2610, Australia
| | - Helen Dickinson
- Public Service Research Group, School of Business, UNSW Canberra, PO Box 7196, Canberra BC, 2610, Australia
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