The intention of college students to use electronic cigarettes: A study based on the theory of innovation diffusion

INTRODUCTION

The purpose of this study is to examine the use of electronic cigarettes (e-cigarettes) among college students in Hangzhou, and to analyze the influencing factors of their intention to use e-cigarettes.

METHODS

Using a stratified cluster sampling method, 775 students from two universities in Hangzhou were selected for an on-site questionnaire survey from March to April 2022. Adjusted logistic regression analysis was conducted on the influencing factors of use intention, based on innovation diffusion theory.

RESULTS

Within our sample of college students, 16.5% of students had tried e-cigarettes; 6.32% had used e-cigarettes in the past month, and 8.0% had the intention to use e-cigarettes. There were significant differences in willingness to use e-cigarettes among different genders, economic status, smoking status of close friends around them, and their own use of tobacco and alcohol (p<0.05). The logistic regression model showed that the observability of e-cigarettes (AOR=1.28; p<0.05), personal factors (AOR=1.39; p<0.05), and social systems (AOR=1.63; p<0.05), were all influencing factors of intention to use e-cigarettes.

CONCLUSIONS

College students in Hangzhou have a high intention to use e-cigarettes, and the impacts of the product itself, individual characteristics and the living environment are crucial. It is necessary to strengthen the promotion of tobacco knowledge at the social and family levels to reduce the occurrence of vaping.

Perinatal Telehealth: Meeting Patients Where They Are

INTRODUCTION

Prior to the coronavirus disease 2019 (COVID-19) pandemic, studies of innovative telehealth perinatal care models showed similar clinical outcomes and perceived quality of care between groups receiving a combination of virtual video and in-person visits. However, these studies included primarily White, English-speaking participants, excluding those who were economically disenfranchised or did not speak English. The purpose of this qualitative study was to describe perinatal patients' and providers' experiences with telehealth during and after the acute phase of the COVID-19 pandemic to inform future utilization of telehealth to drive the delivery of high-quality, accessible, and equitable perinatal care to diverse communities.

METHODS

This descriptive qualitative study included a purposive sample of 14 patients and 17 providers who received or provided perinatal care via telehealth in either a certified nurse-midwifery practice or the nurse-family partnership care model between March 2020 and April 2022. Maximum variation sampling offered a diverse population based on race, ethnicity, and rurality. Researchers conducted 2 rounds of semistructured interviews with a focus on understanding social and geographic context.

RESULTS

Six themes were identified through inductive analysis: (1) unexpected advantages of telehealth, (2) patient empowerment, (3) providers' fear of adverse outcomes, (4) concern for equitable care, (5) strategies to enhance the telehealth experience, and (6) strategies to address access to perinatal telehealth. Patients appreciated the increased ease and reduced cost of accessing visits, which led to fewer missed appointments. Health care providers saw great opportunity in telehealth but expressed concerns about accessibility for patients with language barriers or limited resources.

DISCUSSION

This study provides insight into priorities for continued telehealth utilization focused on providing equitable access to perinatal care. Rather than returning to practices from before the COVID-19 pandemic formed from longstanding routines and perceived limitations, providers are encouraged to capitalize on the rapid innovations in telehealth to build a more effective, equitable, and patient-centered approach to perinatal care.

Random Lasers as Social Processes Simulators

In this work, we suggest a quantum-like simulator concept to study social processes related to the solution of NP-hard problems. The simulator is based on the solaser model recently proposed by us in the framework of information cascade growth and echo chamber formation in social network communities. The simulator is connected with the random laser approach that we examine in the A and D-class (superradiant) laser limits. Novel network-enforced cooperativity parameters of decision-making agents, which may be measured as a result of the solaser simulation, are introduced and justified for social systems. The innovation diffusion in complex networks is discussed as one of the possible impacts of our proposal.

How to bridge the nurse innovation-diffusion gap? An in-depth case study of Create4Care

Introduction

Nurses frequently innovate in response to operational failures, regulations, procedures, and/or other workflow barriers that prevent them from delivering high-quality patient care. Unfortunately, most nurse innovations do not diffuse to a broader audience, depriving other nurses from taking advantage of solutions that have already been developed elsewhere. This under-diffusion is problematic from a societal and welfare point of view. The goal of this paper is to understand how diffusion shortage of nurse innovations can be reduced.

Methods

We develop a qualitative case study of a medical makerspace at the largest academic hospital in the Netherlands. This medical makerspace reported unusually high rates of nurse innovation diffusion. Our data collection includes on-site observations, archival data, secondary data, and fifteen in-depth interviews with key informants. Qualitative coding procedures and a combination of deductive and inductive reasoning are used to analyze the data.

Results

Our data show that personal, organizational, regulatory, and market barriers prevent nurses from further developing and diffusion their innovations in an anticipatory manner. That is, because nurses expect that transforming an initial solution into an innovation that can be shared with others will be too time consuming and difficult they do not proceed with the further development. The medical makerspace that we investigated adequately addresses this problem by developing an innovation ecosystem that largely takes over the innovation and diffusion process.

Discussion

We provide a concrete example of how a medical makerspace, and innovation support systems in a broader sense, can be designed to more adequately address the nurse innovation-diffusion gap. The two main elements of the practical solution that we identified are: (1) Support systems should facilitate that others may lead the development and diffusion of innovations and (2) The support system should promote that actors integrate their functional specializations within an innovation ecosystem. We make two theoretical contributions. First, we contribute to understanding barriers in the nurse innovation-diffusion process from a psychological point. Second, we identified that an ecosystem perspective is beneficial to develop innovation support systems in which diffusion occurs more often.

Responsibly shaping technology innovation for the energy transition: an RRI indicator system as a tool

Efforts to reduce global greenhouse gas emissions have had limited success. For many, the hopes rest on new energy innovations to advance the energy transition process. In this paper, we develop a Responsible Research and Innovation (RRI) base indicator system to steer the design of innovations in the field of energy transition innovations and, thus, improve social acceptance of these innovations. We propose a guideline for its application to assist R&D performing organizations and funding organizations in the design, selection, and communication of research proposals. The indicator system is intended to promote early integration of environmental and social aspects, support the formation of teams aware of the different responsibility aspects of innovation, and monitor progress in regard to relevant RRI dimensions.

Facilitating innovation diffusion in social networks using dynamic norms

Dynamic norms have recently emerged as a powerful method to encourage individuals to adopt an innovation by highlighting a growing trend in its uptake. However, there have been no concrete attempts to understand how this individual-level mechanism might shape the collective population behavior. Here, we develop a framework to examine this by encapsulating dynamic norms within a game-theoretic mathematical model for innovation diffusion. Specifically, we extend a network coordination game by incorporating a probabilistic mechanism where an individual adopts the action with growing popularity, instead of the standard best-response update rule; the probability of such an event captures the population's "sensitivity" to dynamic norms. Theoretical analysis reveals that sensitivity to dynamic norms is key to facilitating social diffusion. Small increases in sensitivity reduces the advantage of the innovation over status quo or the number of initial innovators required to unlock diffusion, while a sufficiently large sensitivity alone guarantees diffusion.

Grassroots innovation practices for social transformation of the health and well-being in a self-built settlement in Medellín-Colombia

Grassroots innovation generates possibilities for the informal and collective production of the territory that the city itself denies, from bottom-up solutions for sustainable development and consumption, which respond to the local situation, interests, and values of the communities involved. This paper aims to identify how grassroots innovation practices take place and are shaped in 'El Faro', a self-built settlement at the urban border of the city of Medellín; and how these have allowed the social transformation of health and well-being. This was done from a qualitative approach with an interpretative scope, under the case study methodology. 'El Faro' is a space built by its inhabitants, in a process that they have called "dignity and resistance", becoming the promoter of what we identify as four 'grassroots innovation practices' developed around three main issues: community water management, artistic training and the creation of community public spaces. This process has allowed them, from the capacity of agency, to understand their poverty situation and face it, modifying the conditions that reproduce it and responding to unsatisfied basic needs, based on innovative solutions that guarantee conditions of life with dignity and well-being. Likewise, it generates mechanisms that reduce inequality because the community becomes the main driving agent for the construction of the city and the transformation of the health-disease process, through its community assets.

Innovation Diffusion: The Influence of Social Media Affordances on Complexity Reduction for Decision Making

Social media is a prominent communication platform. Its active usage permeates all generations and it is imperative that the platform be fully optimized for knowledge transfer and innovation diffusion. However, there are several considerations regarding platform usage, including media affordances. Social media affordances enable users to interact with the world around them through features of modality, agency, interactivity, and navigation. Previous studies have indicated that social media affordances significantly influence user behavior and usage. However, research exploring the effect of social media affordances on knowledge acquisition and the reduction of decision-making complexities is limited. Therefore, focusing on 179 paddy farmers in Malaysia, this study examined the effect of social media affordances on information quality, knowledge acquisition, and complexity reduction regarding innovation adoption decisions using a quantitative approach. This study’s findings reveal that social media affordances have a significant effect on perceived information quality, knowledge acquisition, and complexity reduction.

Diffusion of innovations: a guiding framework for public health

Exploring the behavior change process has been of interest and importance to public health professionals, to translate research into practice. Diffusion of innovations (DOI) model has been extensively applied in public health to examine the process by which innovation is passively communicated to individuals and groups. It builds on a staged model of awareness, persuasion, decision, implementation, and confirmation; and categorizes communities into innovators (2.5%), early adopters (13.5%), early majority (34%), late majority (34%) and laggards (16%). It reflects on the diversity of strategies to be applied for different cadres of the society to bring about a wholistic change. Nonetheless, DOI suffers from 'pro-innovation' and 'individual blame' bias, as it fails to account for the influence of societal, cultural, and extraneous factors affecting individual behavior change. The social networks theory (SNT) in contrast, explains behavior change based on social networks and their influences. It builds on the constructs of homophily, centralization, reciprocity, transitivity, and density; and fills the void in the DOI model. We suggest public health professionals to combine the constructs of DOI and SNT in rolling out behavior change interventions, to yield a comprehensive approach.

Analyzing the Coevolution of Mobile Application Diffusion and Social Network: A Multi-Agent Model

The successful diffusion of mobile applications in user groups can establish a good image for enterprises, gain a good reputation, fight for market share, and create commercial profits. Thus, it is of great significance for the successful diffusion of mobile applications to study mobile application diffusion and social network coevolution. Firstly, combined with a social network’s dynamic change characteristics in real life, a mobile application users’ social network evolution mechanism was designed. Then, a multi-agent model of the coevolution of a social network and mobile application innovation diffusion was constructed. Finally, the impact of mobile applications’ value perception revenue, use cost, marketing promotion investment, and the number of seed users on the coevolution of social network and mobile application diffusion were analyzed. The results show that factors such as the network structure, the perceived value income, the cost of use, the marketing promotion investment, and the number of seed users have an important impact on mobile application diffusion.

The Cardiovascular Quality Improvement and Care Innovation Consortium: Inception of a Multicenter Collaborative to Improve Cardiovascular Care

Despite decades of improvement in the quality and outcomes of cardiovascular care, significant gaps remain. Existing quality improvement strategies are often limited in scope to specific clinical conditions and episodic care. Health services and outcomes research is essential to inform gaps in care but rarely results in the development and implementation of care delivery solutions. Although individual health systems are engaged in projects to improve the quality of care delivery, these efforts often lack a robust study design or implementation evaluation that can inform generalizability and further dissemination. Aligning the work of health care systems and health services and outcomes researchers could serve as a strategy to overcome persisting gaps in cardiovascular quality and outcomes. We describe the inception of the Cardiovascular Quality Improvement and Care Innovation Consortium that seeks to rapidly improve cardiovascular care by (1) developing, implementing, and evaluating multicenter quality improvement projects using innovative care designs; (2) serving as a resource for quality improvement and care innovation partners; and (3) establishing a presence within existing quality improvement and care innovation structures. Success of the collaborative will be defined by projects that result in changes to care delivery with demonstrable impacts on the quality and outcomes of care across multiple health systems. Furthermore, insights gained from implementation of these projects across sites in Cardiovascular Quality Improvement and Care Innovation Consortium will inform and promote broad dissemination for greater impact.

Barriers to Creating Scalable Business Models for Digital Health Innovation in Public Systems: Qualitative Case Study

Background

Health systems are increasingly looking toward the private sector to provide digital solutions to address health care demands. Innovation in digital health is largely driven by small- and medium-sized enterprises (SMEs), yet these companies experience significant barriers to entry, especially in public health systems. Complex and fragmented care models, alongside a myriad of relevant stakeholders (eg, purchasers, providers, and producers of health care products), make developing value propositions for digital solutions highly challenging.

Objective

This study aims to identify areas for health system improvement to promote the integration of innovative digital health technologies developed by SMEs.

Methods

This paper qualitatively analyzes a series of case studies to identify health system barriers faced by SMEs developing digital health technologies in Canada and proposed solutions to encourage a more innovative ecosystem. The Women’s College Hospital Institute for Health System Solutions and Virtual Care established a consultation program for SMEs to help them increase their innovation capacity and take their ideas to market. The consultation involved the SME filling out an onboarding form and review of this information by an expert advisory committee using guided considerations, leading to a recommendation report provided to the SME. This paper reports on the characteristics of 25 SMEs who completed the program and qualitatively analyzed their recommendation reports to identify common barriers to digital health innovation.

Results

A total of 2 central themes were identified, each with 3 subthemes. First, a common barrier to system integration was the lack of formal evaluation, with SMEs having limited resources and opportunities to conduct such an evaluation. Second, the health system’s current structure does not create incentives for clinicians to use digital technologies, which threatens the sustainability of SMEs’ business models. SMEs faced significant challenges in engaging users and payers from the public system due to perverse economic incentives. Physicians are compensated by in-person visits, which actively works against the goals of many digital health solutions of keeping patients out of clinics and hospitals.

Conclusions

There is a significant disconnect between the economic incentives that drive clinical behaviors and the use of digital technologies that would benefit patients’ well-being. To encourage the use of digital health technologies, publicly funded health systems need to dedicate funding for the evaluation of digital solutions and streamlined pathways for clinical integration.

Why Health Care Professionals Belong to an Intensive Care Virtual Community: Qualitative Study

Background

Clinical practice variation that results in poor patient outcomes remains a pressing problem for health care organizations. Some evidence suggests that a key factor may be ineffective internal and professional networks that limit knowledge exchange among health care professionals. Virtual communities have the potential to overcome professional and organizational barriers and facilitate knowledge flow.

Objective

This study aimed to explore why health care professionals belong to an exemplar virtual community, ICUConnect. The specific research objectives were to (1) understand why members join a virtual community and remain a member, (2) identify what purpose the virtual community serves in their professional lives, (3) identify how a member uses the virtual community, and (4) identify how members used the knowledge or resources shared on the virtual community.

Methods

A qualitative design, underpinned by pragmatism, was used to collect data from 3 asynchronous online focus groups and 4 key informant interviews, with participants allocated to a group based on their posting behaviors during the previous two years—between September 1, 2012, and August 31, 2014: (1) frequent (>5 times), (2) low (≤5 times), and (3) nonposters. A novel approach to focus group moderation, based on the principles of traditional focus groups, and e-moderating was developed. Thematic analysis was undertaken, applying the Diffusion of Innovation theory as the theoretical lens. NCapture (QRS International) was used to extract data from the focus groups, and NVivo was used to manage all data. A research diary and audit trail were maintained.

Results

There were 27 participants: 7 frequent posters, 13 low posters, and 7 nonposters. All participants displayed an external orientation, with the majority using other social media; however, listservs were perceived to be superior in terms of professional compatibility and complexity. The main theme was as follows: “Intensive care professionals are members of ICUConnect because by being a member of a broader community they have access to credible best-practice knowledge.” The virtual community facilitated access to all professionals caring for the critically ill and was characterized by a positive and collegial online culture. The knowledge found was credible because it was extensive and because the virtual community was moderated and sponsored by a government agency. This enabled members to benchmark and improve their unit practices and keep up to date.

Conclusions

This group of health care professionals made a strategic decision to be members of ICUConnect, as they understood that to provide up-to-date clinical practices, they needed to network with colleagues in other facilities. This demonstrated that a closed specialty-specific virtual community can create a broad heterogeneous professional network, overcoming current ineffective networks that may adversely impact knowledge exchange and creation in local practice settings. To address clinical practice variation, health care organizations can leverage low-cost social media technologies to improve interprofessional and interorganizational networks.

Digital innovation evaluation: user perceptions of innovation readiness, digital confidence, innovation adoption, user experience and behaviour change

Background

Innovation spread is a key policy objective for health systems world-wide, but adoption success varies enormously. We have developed a set of short generic user-reported measures to help understand how and why healthcare innovations spread. This work builds on the literature and on practical experience in developing and using patient-reported outcome measures.

Measures

The Innovation Readiness Score measures user perceptions of how much they are open to and up-to-date with new ideas, and whether their organisations are receptive to and capable of innovation. It is based on Rogers’ classification of innovativeness (innovator, early adopter, early majority, etc).

The Digital Confidence Score rates users’ digital literacy and confidence to use digital products, with dimensions of familiarity, social pressure, support and digital self-efficacy.

The Innovation Adoption Score rates the adoption process in terms of coherence and reflective thought before, during and after implementation. It is based on Normalisation Process Theory.

The User Satisfaction measure assesses a digital product in terms of usefulness, ease of use, support and satisfaction.

The Behaviour Change measure covers user perceptions of their capability, opportunity and motivation to change behaviour, based on the COM-B model.

These measures have been mapped onto Greenhalgh’s NASSS Framework (non-adoption, abandonment and challenges to scale-up, spread and sustainability of health and care technologies).

Conclusion

These tools measure different aspects of digital health innovations and may help predict the success of innovation dissemination, diffusion and spread programmes.

Acceptance and Resistance of New Digital Technologies in Medicine: Qualitative Study

BACKGROUND

This study discusses the acceptance of new medical technologies in health care settings and resistance to these technologies from hospitals, doctors' surgical centers, electronic health (eHealth) centers, and related institutions. We suggest a novel method of identifying factors that influence the acceptance of, and resistance to, new technologies by medical staff and patients.

OBJECTIVE

The objective of this study was to determine and evaluate the factors that influence acceptance and resistance to achieve a successful implementation of new technologies.

METHODS

The target group was patients residing in Brandenburg and major stakeholders in the local health care structure, for instance, medical institutions and medical professionals. The process relies on 3 models: the technology acceptance model, the unified technology acceptance and use of technology model, and the theory of technical innovation diffusion. Qualitative methodology was employed in this study, and an exploratory design was adopted to gain new insights into a poorly understood phenomenon in the German context. This enabled the researcher to take a flexible approach toward exploring a wide range of secondary data and to choose a different approach when unexpected information emerged. Content analysis was used to identify and interpret the data, and the researcher assured that the meaning associated with the information has concurred with that of the original source.

RESULTS

This study confirmed that adoption of new technologies in health care depended on individual opinions of the factors relating to them. Some medical professionals believed that technology would interfere with their ability to make independent diagnoses and their relationships with patients. Doctors also feared that technology was a means of management control. In contrast, other medical staff welcomed technology because it provided them with more opportunities to interact with patients and their carers. Generally, patients were more enthusiastic about technology than medical professionals and health care managers because it allowed them to have greater autonomy in selecting health care options. The need for all groups to be involved in the development of the new health care approach was an important outcome, otherwise resistance to it was likely to be greater. In other words, the strategy for change management was the indicator of success or failure. Therefore, following our analysis, a number of practical precepts emerged that could facilitate user acceptance of digital solutions and innovative medical technologies.

CONCLUSIONS

The acceptance of digital solutions and innovative medical technology by patients and professionals relies on understanding their anxieties and feelings of insecurity. The process will take time because individuals accept change at different rates. Hence, the development of an extensive user community to fully and successfully implement eHealth is less likely in the short term; however, this should not prevent the push for changes in health care technology.

Modelling the spread of innovation in wild birds

We apply three plausible algorithms in agent-based computer simulations to recent experiments on social learning in wild birds. Although some of the phenomena are simulated by all three learning algorithms, several manifestations of social conformity bias are simulated by only the approximate majority (AM) algorithm, which has roots in chemistry, molecular biology and theoretical computer science. The simulations generate testable predictions and provide several explanatory insights into the diffusion of innovation through a population. The AM algorithm's success raises the possibility of its usefulness in studying group dynamics more generally, in several different scientific domains. Our differential-equation model matches simulation results and provides mathematical insights into the dynamics of these algorithms.

Mental Health Mobile Apps: From Infusion to Diffusion in the Mental Health Social System

The roles of mental health educators and professionals in the diffusion of mental health mobile apps are addressed in this viewpoint article. Mental health mobile apps are emerging technologies that fit under the broad heading of mobile health (mHealth). mHealth, encompassed within electronic health (eHealth), reflects the use of mobile devices for the practice of public health. Well-designed mental health mobile apps that present content in interactive, engaging, and stimulating ways can promote cognitive learning, personal growth, and mental health enhancement. As key influencers in the mental health social system, counselor educators and professional associations may either help or hinder diffusion of beneficial mHealth technologies. As mental health mobile apps move towards ubiquity, research will continue to be conducted. The studies published thus far, combined with the potential of mental health mobile apps for learning and personal growth, offer enough evidence to compel mental health professionals to infuse these technologies into education and practice. Counselor educators and professional associations must use their influential leadership roles to train students and practitioners in how to research, evaluate, and integrate mental health mobile apps into practice. The objectives of this article are to (1) increase awareness of mHealth and mental health mobile apps, (2) demonstrate the potential for continued growth in mental health mobile apps based on technology use and acceptance theory, mHealth organizational initiatives, and evidence about how humans learn, (3) discuss evidence-based benefits of mental health mobile apps, (4) examine the current state of mHealth diffusion in the mental health profession, and (5) offer solutions for impelling innovation diffusion by infusing mental health mobile apps into education, training, and clinical settings. This discussion has implications for counselor educators, mental health practitioners, associations, continuing education providers, and app developers.

Pharmaceutical innovation: impact on expenditure and outcomes and subsequent challenges for pharmaceutical policy, with a special reference to Greece

Over the recent decades, advances in healthcare technology have led to significant improvements in the quality of healthcare and in population health. At the same time, technological change in healthcare, rising national income and expansion of insurance coverage have been acknowledged as the main determinants of the historical growth in health spending in industrialized countries. The pharmaceutical sector is of particular interest as it constitutes a market characterized by rapid technological change and high expenditure growth rates. The purpose of this article is to provide an overview of research findings on the impact of pharmaceutical innovation on pharmaceutical expenditure growth, total health expenditure and population health outcomes and to bring forward the challenges that arise for pharmaceutical policy in Greece.

Innovation spread: lessons from HIV

Efficient spreading of evidence-based innovations among complex health systems remains an elusive goal despite extensive study in the social sciences. Biology provides a model of successful spread in viruses, which have evolved to spread with maximum efficiency using minimal resources. Here we explore the molecular mechanisms of human immunodeficiency virus (HIV) spread and identify five steps that are also common to a recent example of spread in complex health systems: reduction in door-to-balloon times for patients with ST-segment elevation myocardial infarction (STEMI). We then describe a new model we have developed, called AIDED, which is based on mixed-methods research but informed by the conceptual framework of HIV spread among cells. The AIDED model contains five components: Assess, Innovate, Develop, Engage and Devolve, and can describe any one of the following: the spread of HIV among cells, the spread of practices to reduce door-to-balloon time for patients with STEMI and the spread of certain family health innovations in low- and middle-income countries. We suggest that by looking to the biological sciences for a model of spread that has been honed by evolution, we may have identified fundamental steps that are necessary and sufficient for efficient, low-cost spread of health innovations among complex health systems.

Trends and racial differences in the use of androgen deprivation therapy for metastatic prostate cancer

CONTEXT

Androgen deprivation therapy (ADT) is widely used to manage the symptoms of advanced prostate cancer and has been shown to slow the progression of the disease. Previous research investigating racial differences in the use of ADT has reported inconsistent findings.

OBJECTIVES

The purpose of this study was to assess use trends for ADT overall and by type (orchiectomy and luteinizing hormone-releasing hormone [LHRH] agonists) and the factors associated with time to receipt for metastatic prostate cancer.

METHODS

Data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry and Medicare claims database were obtained for 5,273 men, aged 65 years and older and diagnosed with Stage IV prostate cancer during 1991-1999 from seven SEER regions. An accelerated failure time regression model with log-normal distribution was used to examine factors associated with mean time to receipt of ADT.

RESULTS

African-American men were less likely than white men to receive any ADT after diagnosis (P<0.001). Differences were noted in the time to receipt of ADT, with African-American men having a longer mean time to receipt of orchiectomy (time ratio [TR]=1.50; 95% confidence interval [CI]=1.03, 2.17) or LHRH agonist (TR=1.42; 95% CI=1.06, 1.89) than white men.

CONCLUSION

African-American men with metastatic prostate cancer were significantly less likely to receive ADT and, when treated, had a slightly longer time to receipt than white men, which has implications for patients and physicians involved in the palliative management of metastatic prostate cancer.

Toward an agent-based patient-physician model for the adoption of continuous glucose monitoring technology

Health care is a major component of the U.S. economy, and tremendous research and development efforts are directed toward new technologies in this arena. Unfortunately few tools exist for predicting outcomes associated with new medical products, including whether new technologies will find widespread use within the target population. Questions of technology adoption are rife within the diabetes technology community, and we particularly consider the long-term prognosis for continuous glucose monitoring (CGM) technology. We present an approach to the design and analysis of an agent model that describes the process of CGM adoption among patients with type 1 diabetes mellitus (T1DM), their physicians, and related stakeholders. We particularly focus on patient-physician interactions, with patients discovering CGM technology through word-of-mouth communication and through advertising, applying pressure to their physicians in the context of CGM device adoption, and physicians, concerned about liability, looking to peers for a general level of acceptance of the technology before recommending CGM to their patients. Repeated simulation trials of the agent-based model show that the adoption process reflects the heterogeneity of the adopting community. We also find that the effect of the interaction between patients and physicians is agents. Each physician, say colored by the nature of the environment as defined by the model parameters. We find that, by being able to represent the diverse perspectives of different types of stakeholders, agent-based models can offer useful insights into the adoption process. Models of this sort may eventually prove to be useful in helping physicians, other health care providers, patient advocacy groups, third party payers, and device manufacturers understand the impact of their decisions about new technologies.

A retrospective review of significant events reported in one district in 2004-2005

BACKGROUND

Patient safety is a key issue in primary care. Significant event analysis (SEA) is a long established method of improving safety. In 2004, SEA was introduced as part of the Quality and Outcomes Framework (QOF) of the new general medical services (GMS) contract.

AIM

To review SEAs submitted for the QOF by general practices for a primary care trust (PCT) in 2004-2005.

DESIGN OF STUDY

A retrospective review of SEAs.

SETTING

St Helens PCT, Merseyside, North West England, UK (185 000 patients), now part of Halton and St Helens PCT.

METHOD

Three hundred and thirty-seven QOF-reported SEAs were reviewed from 32 (91%) of a total of 35 St Helens PCT practices (mean 10.5, range 4-17).

RESULTS

Practices identified learning points in 89% of SEAs. Twenty-two of 32 (69%) practices successfully performed SEA and required no further support. Four practices identified learning points but needed further facilitation in implementing change or actions arising from SEA. Six practices had significant difficulties with SEA processes and were referred for extra SEA training locally. Ninety (26.7%) of all significant events were classified as patient-safety incidents. Of these, 22 (6.5%) were 'serious or life threatening' and 67 (19.9%) were 'potentially serious'. Ninety-six (28.5%) of the significant events related to medicines management issues; and 63 (18.7%) had key learning points for partnership organisations. Main outcome measures were review of SEA process as a team learning event; QOF significant event criteria; National Patient Safety Agency classification of significant events, and category of patient-safety incidents.

CONCLUSION

SEA in general practice is a valuable clinical governance and educational tool with potential patient safety benefits. Most practices performed SEA successfully but there were performance concerns and patient-safety issues were highlighted. This review emphasises the need for primary care organisations to be able to analyse and share SEAs effectively.