scholarly journals Barriers and Facilitators to the Implementation of a Mobile Insulin Titration Intervention for Uncontrolled Diabetes Patients: A Qualitative Analysis (Preprint)

2019 ◽  
Author(s):  
Erin Rogers ◽  
Sneha R Aidasani ◽  
Rebecca Friedes ◽  
Lu Hu ◽  
Aisha T. Langford ◽  
...  
Keyword(s):  
Health Care ◽  
Text Messaging ◽  
Diabetes Management ◽  
Health Care Systems ◽  
Unmet Need ◽  
Future Research ◽  
Management Support ◽  
Implementation Climate ◽  
Time Saving ◽  
Care Systems

BACKGROUND In 2016, a text-messaging intervention to titrate insulin in patients with uncontrolled type 2 diabetes was implemented at two health care systems in New York City. OBJECTIVE This study conducted a qualitative evaluation assessing barriers to, and facilitators of, implementation of the mobile insulin titration intervention (called “MITI”) into usual care. METHODS We conducted in-depth interviews with patients enrolled in the MITI program (N=36) and staff involved in MITI (N=19) at the two health care systems. Interviews were transcribed and iteratively coded by two study investigators both inductively and deductively using a codebook guided by the Consolidated Framework for Implementation Research. RESULTS Multiple facilitator themes emerged: 1) MITI had strong relative advantages to in-person titration including its convenience and time-saving design; 2) the free cost of MITI was important to patients; 3) MITI was easy to use and patients were confident in their ability to use MITI; 4) MITI was compatible with patients’ home routines and clinic workflow; 5) patients and staff perceived MITI to have value beyond insulin titration by reminding and motivating patients to engage in healthy behaviors and providing a source of patient support; and 6) implementation in clinics was made easy by having a strong implementation climate, communication networks to spread information about MITI, and a strong program champion. Barriers identified included: 1) language limitations; 2) initial nurse concerns about scope of practice changes required to deliver MITI; 2) initial provider knowledge gaps about the program; and 3) provider perceptions that MITI may not be appropriate for some patients (e.g., older, not tech-savvy). There was also a theme that emerged during patient and staff interviewees of an unmet need for longer-term, additional diabetes management support among this population, specifically diet, nutrition and exercise support. CONCLUSIONS Patients and staff were overwhelmingly supportive of MITI, believed it had many benefits and believed it was compatible with the clinic workflow and patient’s lives. Initial implementation efforts should address staff training and nurse concerns. Future research should explore options for integrating additional diabetes support for patients.

scholarly journals Barriers and Facilitators to the Implementation of a Mobile Insulin Titration Intervention for Patients With Uncontrolled Diabetes: A Qualitative Analysis

10.2196/13906 ◽  
2019 ◽  
Vol 7 (7) ◽  
pp. e13906 ◽  
Author(s):  
Erin Rogers ◽  
Sneha R Aidasani ◽  
Rebecca Friedes ◽  
Lu Hu ◽  
Aisha T Langford ◽  
...  
Keyword(s):  
Health Care ◽  
Text Messaging ◽  
Diabetes Management ◽  
Unmet Need ◽  
Health Care Facilities ◽  
Future Research ◽  
Management Support ◽  
Implementation Climate ◽  
Time Saving ◽  
Provider Perceptions

Background In 2016, a short message service text messaging intervention to titrate insulin in patients with uncontrolled type 2 diabetes was implemented at two health care facilities in New York City. Objective This study aimed to conduct a qualitative evaluation assessing barriers to and the facilitators of the implementation of the Mobile Insulin Titration Intervention (MITI) program into usual care. Methods We conducted in-depth interviews with 36 patients enrolled in the MITI program and the staff involved in MITI (n=19) in the two health care systems. Interviews were transcribed and iteratively coded by two study investigators, both inductively and deductively using a codebook guided by the Consolidated Framework for Implementation Research. Results Multiple facilitator themes emerged: (1) MITI had strong relative advantages to in-person titration, including its convenience and time-saving design, (2) the free cost of MITI was important to the patients, (3) MITI was easy to use and the patients were confident in their ability to use it, (4) MITI was compatible with the patients’ home routines and clinic workflow, (5) the patients and staff perceived MITI to have value beyond insulin titration by reminding and motivating the patients to engage in healthy behaviors and providing a source of patient support, and (6) implementation in clinics was made easy by having a strong implementation climate, communication networks to spread information about MITI, and a strong program champion. The barriers identified included the following: (1) language limitations, (2) initial nurse concerns about the scope of practice changes required to deliver MITI, (3) initial provider knowledge gaps about the program, and (4) provider perceptions that MITI might not be appropriate for some patients (eg, older or not tech-savvy). There was also a theme that emerged during the patient and staff interviews of an unmet need for long-term additional diabetes management support among this population, specifically diet, nutrition, and exercise support. Conclusions The patients and staff were overwhelmingly supportive of MITI and believed that it had many benefits and that it was compatible with the clinic workflow and patients’ lives. Initial implementation efforts should address staff training and nurse concerns. Future research should explore options for integrating additional diabetes support for patients.

Institutionalization and Professionalization

2016 ◽  
Author(s):  
Trish Reay ◽  
Elizabeth Goodrick ◽  
Bob Hinings
Keyword(s):  
Health Care ◽  
Organizational Change ◽  
Health Care Systems ◽  
Future Research ◽  
Power Dynamics ◽  
Care Systems

Health care systems are both highly institutionalized and highly professionalized. We suggest that both characteristics should be considered to understand the underlying power dynamics and how organizational change can occur. Although these characteristics have mostly been considered separately, we identify three ways they are being brought together and show how each reveals different underlying power dynamics that in turn suggest different explanations of organizational change. To conclude, we set out three avenues for future research that will continue to advance our knowledge of change in health care.

Organizational Leadership and Health Care Reform

2016 ◽  
pp. 1043-1063
Author(s):  
T. Ray Ruffin ◽  
Joyce Marie Hawkins ◽  
D. Israel Lee
Keyword(s):  
Health Care ◽  
Organizational Leadership ◽  
Health Care Systems ◽  
Future Research ◽  
Health Care Reforms ◽  
Use Of Technology ◽  
Hitech Act ◽  
Care Systems ◽  
Future Research Directions ◽  
And Function

Policies, health, and government regulations affect various Health Care organizations and their members. One such policy, the Health Information Technology for Economic and Clinical Health (HITECH) Act, attempts to improve the performance of health care systems through the use of technology, such as Electronic Health Records (Bluementhal, 2010). The most critical task of leadership is to establish a mindset at the top of the organization and function to infuse a culture of excellence throughout the organization (Bentkover, 2012). Health organizations can only progress if their members share a set of values and are single-mindedly committed to achieving openly defined objectives (Bentkover, 2012). This chapter investigates organizational leadership in relation to health care reforms to include trends in health care leadership, Stratified Systems Theory (SST), Systems Thinking, and regulators perspectives. The chapter will consist of the following sections: background; issues controversies, and problems; solutions and recommendation; future research directions; and conclusion.

scholarly journals Involving citizens in disinvestment decisions: what do health professionals think? Findings from a multi-method study in the English NHS

2017 ◽  
Vol 13 (2) ◽  
pp. 162-188 ◽  
Author(s):  
Tom Daniels ◽  
Iestyn Williams ◽  
Stirling Bryan ◽  
Craig Mitton ◽  
Suzanne Robinson
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Public Involvement ◽  
Health Care Systems ◽  
Future Research ◽  
Local Health ◽  
The Public ◽  
Health Care Leaders ◽  
Local Health Care ◽  
Care Systems

AbstractPublic involvement in disinvestment decision making in health care is widely advocated, and in some cases legally mandated. However, attempts to involve the public in other areas of health policy have been accused of tokenism and manipulation. This paper presents research into the views of local health care leaders in the English National Health Service (NHS) with regards to the involvement of citizens and local communities in disinvestment decision making. The research includes a Q study and follow-up interviews with a sample of health care clinicians and managers in senior roles in the English NHS. It finds that whilst initial responses suggest high levels of support for public involvement, further probing of attitudes and experiences shows higher levels of ambivalence and risk aversion and a far more cautious overall stance. This study has implications for the future of disinvestment activities and public involvement in health care systems faced with increased resource constraint. Recommendations are made for future research and practice.

scholarly journals Access to Health Care and the Out‑of‑Pocket Burden of the European Elderly

2016 ◽  
Vol 64 (6) ◽  
pp. 1961-1970
Author(s):  
Veronika Krůtilová
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Health Care Systems ◽  
Unmet Need ◽  
Critical Issue ◽  
Factors Affecting ◽  
Care Burden ◽  
Access To Health ◽  
Health Care Burden ◽  
Care Systems

Provision of access to health care is a desirable feature of health care systems. Access to health care is caused to be restricted whether out‑of‑pocket burden is too high. The paper focuses on the European elderly with restricted access to health care and evaluates their health care burden and determines factors affecting the burden. The data from the Survey of Health, Ageing and Retirement in Europe from the fifth wave is used. The methods of descriptive and multivariate analysis are applied. A linear regression model with a bootstrapped method is used. The results showed that inequalities in access to health care exist. Unmet need is a critical issue in Estonia and Italy. The highest burden is found in Estonia, Italy and Belgium. Chronic diseases and limitation in activities significantly contributes to health care burden. Expenditure on drugs, outpatient and nursing care have a significant effect on the burden. The effect is found to be insignificant for inpatient care. Income and the employment status is a preventing factor.

scholarly journals Effect of Public Deliberation on Patient Attitudes Regarding Consent and Data Use in a Learning Health Care System for Oncology

2019 ◽  
Vol 37 (34) ◽  
pp. 3203-3211 ◽  
Author(s):  
Reshma Jagsi ◽  
Kent A. Griffith ◽  
Rochelle D. Jones ◽  
Chris Krenz ◽  
Michele Gornick ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Record ◽  
Medical Records ◽  
Health Care Systems ◽  
Insurance Companies ◽  
Future Research ◽  
Democratic Deliberation ◽  
Recommended Care ◽  
Care Systems

PURPOSE We sought to generate informed and considered opinions regarding acceptable secondary uses of deidentified health information and consent models for oncology learning health care systems. METHODS Day-long democratic deliberation sessions included 217 patients with cancer at four geographically and sociodemographically diverse sites. Patients completed three surveys (at baseline, immediately after deliberation, and 1-month follow-up). RESULTS Participants were 67.3% female, 21.7% black, and 6.0% Hispanic. The most notable changes in perceptions after deliberation related to use of deidentified medical-record data by insurance companies. After discussion, 72.3% of participants felt comfortable if the purpose was to make sure patients receive recommended care ( v 79.5% at baseline; P = .03); 24.9% felt comfortable if the purpose was to determine eligibility for coverage or reimbursement ( v 50.9% at baseline; P < .001). The most notable change about secondary research use related to believing it was important that doctors ask patients at least once whether researchers can use deidentified medical-records data for future research. The proportion endorsing high importance decreased from baseline (82.2%) to 68.7% immediately after discussion ( P < .001), and remained decreased at 73.1% ( P = .01) at follow-up. At follow-up, non-Hispanic whites were more likely to consider it highly important to be able to conduct medical research with deidentified electronic health records (96.8% v 87.7%; P = .01) and less likely to consider it highly important for doctors to get a patient’s permission each time deidentified medical record information is used for research (23.2% v 51.6%; P < .001). CONCLUSION This research confirms that most patients wish to be asked before deidentified medical records are used for research. Policies designed to realize the potential benefits of learning health care systems can, and should be, grounded in informed and considered public opinion.

Organizational Leadership and Health Care Reform

2016 ◽  
pp. 42-62
Author(s):  
T. Ray Ruffin ◽  
Joyce Marie Hawkins ◽  
D. Israel Lee
Keyword(s):  
Health Care ◽  
Organizational Leadership ◽  
Health Care Systems ◽  
Future Research ◽  
Health Care Reforms ◽  
Use Of Technology ◽  
Hitech Act ◽  
Care Systems ◽  
Future Research Directions ◽  
And Function

Policies, health, and government regulations affect various Health Care organizations and their members. One such policy, the Health Information Technology for Economic and Clinical Health (HITECH) Act, attempts to improve the performance of health care systems through the use of technology, such as Electronic Health Records (Bluementhal, 2010). The most critical task of leadership is to establish a mindset at the top of the organization and function to infuse a culture of excellence throughout the organization (Bentkover, 2012). Health organizations can only progress if their members share a set of values and are single-mindedly committed to achieving openly defined objectives (Bentkover, 2012). This chapter investigates organizational leadership in relation to health care reforms to include trends in health care leadership, Stratified Systems Theory (SST), Systems Thinking, and regulators perspectives. The chapter will consist of the following sections: background; issues controversies, and problems; solutions and recommendation; future research directions; and conclusion.

scholarly journals Pan-European Economic Analysis to Identify Cost Savings for the Health Care Systems as a Result of Integrating Glucose Monitoring Based Telemedical Approaches Into Diabetes Management

2019 ◽  
Vol 13 (6) ◽  
pp. 1112-1122 ◽  
Author(s):  
Katharina Fritzen ◽  
Kornelia Basinska ◽  
Matilde Rubio-Almanza ◽  
Antonio Nicolucci ◽  
Brian Kennon ◽  
...  
Keyword(s):  
Health Care ◽  
Diabetes Management ◽  
Health Care Systems ◽  
Controlled Trial ◽  
Glucose Monitoring ◽  
Cost Savings ◽  
Self Monitoring ◽  
The United Kingdom ◽  
Care Systems ◽  
European Health

Background: Self-monitoring of blood glucose supported by the diabetes-app OneTouch Reveal® has demonstrated to improve HbA1c. We aimed at analyzing costs savings related the integration of telemedical features into diabetes management. Methods: Data from a randomized controlled trial were used to assess the 10-year risk of patients for fatal myocardial infarction (MI). On the basis of this risk assessments—also related to a 5% or 10% reduction of hypoglycemic episodes—cost savings for the health care systems of five European countries—France, Germany, Italy, Spain, and the United Kingdom—were modeled. Results: HbA1c reduction of 0.92% in insulin-treated type 2 diabetes patients (T2DM) was associated with a 2.3% decreased 10-year risk for fatal MI. In combination with a 10% reduction of hypoglycemic events this risk reduction led to cost savings of €16.1 million (France), €57.8 million (Germany), €30.9 million (Italy), €23.8 million (Spain), and €5.8 million (UK), considering all insulin-treated T2DM patients in the respective countries. Conclusion: Improving metabolic control and thus risk for comorbidities like MI by combining the glucose meter with CRI with telemedical features has the potential to reduce costs for European health care systems.

Abstract 335: Population Well-being and Cardiovascular Disease

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Erica S Spatz ◽  
Jeph Herrin ◽  
Carley L Riley ◽  
Brita Roy ◽  
Dan Witters ◽  
...  
Keyword(s):  
Health Care ◽  
Heart Disease ◽  
Emotional Health ◽  
Health Care Systems ◽  
Well Being ◽  
Future Research ◽  
Behavioral Risk ◽  
Congressional District ◽  
Care Systems ◽  
Independent Effects

Background: Increasingly, policies and payment structures are holding health care systems accountable for the health of their population, refocusing attention on community attributes that influence health. However, the complex and contextual aspects of a community make it challenging to know which community attributes may affect the health risk of individuals. Methods: We investigated the relationship of CVD prevalence and risk factors with a novel index of well-being, the Gallup-Healthways Well-being Index (GHWBI, 2010), consisting of 55 survey responses organized into 6 domains: life evaluation ( LE ); emotional health (EH) ; work environment (WE) ; physical health (PH) ; healthy behaviors (HB) ; and basic access [to food, shelter, and health care] (BA) . Individuals >18y were randomly selected for telephone survey (n=348,846). Overall index and domain scores were made available to us aggregated to the Congressional District (CD) level. Prevalence of heart disease, stroke, hypertension, and diabetes, as well as CV health (absence of these factors), were determined using the 2011 Behavioral Risk Factor Surveillance System (BRFSS) sub-group study (224 counties). We linked datasets by assigning average BRFSS item responses at the county level to county zip codes; we then re-aggregated to CD and weighted by zip code. We used weighted linear regression to assess: (1) rates of CVD/CV health across GHWBI quintiles, and (2) independent effects of the 6 GHWBI domains on CVD/CV health, reported as t-scores. Because the PH domain included survey items related to CVD, we repeated this analysis excluding PH as an independent variable. Results: Higher CD well-being scores (n=316 CDs) were associated with lower prevalence of CVD and higher rates of CV health (Table). Independent effects of the GHWBI domains revealed inverse associations between CVD and HB , and heart disease and LE . CV health was positively associated with EH and BA, but negatively associated with HB . Excluding PH from this analysis did not meaningfully affect the results. Discussion: Population well-being is associated with reduced CVD and improved CV health, even at the CD level. Future research should investigate these relationships within smaller more homogeneous community populations, in order to identify targets for intervention.

Text Messages to Support Caregivers: Report of Implementation into a Health Care System (Preprint)

2021 ◽  
Author(s):  
Jennifer Lynn Martindale-Adams ◽  
Carolyn Davis Clark ◽  
Jessica Roxy Martin ◽  
Charles R Henderson ◽  
Linda Olivia Nichols
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Text Messaging ◽  
Low Cost ◽  
Health Care Systems ◽  
Text Messages ◽  
Loved One ◽  
Management Protocol ◽  
Care Systems ◽  
Care System

BACKGROUND While there are many interventions to support caregivers, text messaging has the capability to be an adjunct to clinical practice on a wide-spread basis. The Department of Veterans Affairs Annie text messaging system was developed to assist Veterans with self-care. OBJECTIVE This paper reports on the first system-wide implementation of a text messaging protocol for caregivers in a national health care system with an Annie stress management protocol for caregivers of Veterans. METHODS After pilot testing, in late 2019, a year-long protocol for caregivers with three messages a week focusing on education, motivation/inspiration, and activities to alleviate stress was begun. An online evaluation occurs at six months. RESULTS As of September 2021, 3807 caregivers had participated in the stress protocol. Caregivers report that the messages have been useful in increasing their confidence, managing their stress, and helping them take care of themselves and their loved one. This success has led to bereavement, taking care of you, COVID-19 precautions and symptoms, and dementia behaviors protocols, with a total of 5643 caregivers enrolled as of September 2021. CONCLUSIONS Caregivers frequently feel overlooked by the health care system but caregivers report that the messages make them feel cared for and less lonely. Text messaging, incorporated into clinical settings and health care systems, represents a seamless, low-cost way to provide useful and meaningful support to caregivers.

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