Factors Affecting Customer Intention to Adopt a Mobile Chronic Disease Management Service

The Mobile Chronic Disease Management Service (MCDMS) is an emerging medical service for chronic disease prevention and treatment, but limited attention has been paid to the factors that affect users’ intention to adopt the service. Based on the unified theory of acceptance and use of technology 2 and the protection motivation theory, the authors built an MCDMS adoption model. The authors also verified the differentiating age effect on the service adoption intention from experiential distance perspective of the construal level theory. Empirical results showed that the young group focused more on the impact of effort expectancy, whereas the elderly group focused more on performance expectancy, imitating others, and perceived severity. Furthermore, the young group, however, focused more on the impact of perceived vulnerability, and offline medical habits showed no significant influence on either group’s intention to adopt, which were not consistent with the original hypotheses. The findings can aid MCDMS providers in selecting marketing strategies targeted toward different age groups.

Priority selection of agro-meteorological parameters for integrated plant diseases management through analytical hierarchy process

To understand the influence of agro-meteorological parameters to take decisions related to various factors in an integrated plant disease management, it becomes vital to carry out scientific studies on the factors affecting it. The different agro-meteorological parameters namely temperature, humidity, moisture, rain, phenological week, cropping season, soil type, location, precipitation, heat index, and cloud coverage have been considered for this study. Each parameter has been allocated the ranking by using a technique called analytical hierarchical process (AHP). The parameter priorities are determined by calculating the Eigenvalues. This helps to make decisions related to integrated plant disease management where the prediction of plant disease occurrence, yield prediction, irrigation requirements, and fertilization recommendations can be taken. To take these decisions which parameters are good indicators can be identified using this method. The parameters majorly contribute to plant diseases and pest management decision making while delivers minor contribution in irrigation and fertilizer management related decision making. The manual results are compared with software generated results which indicates that both the results correlate with each other. Therefore, AHP technique can be successfully implemented for prioritizing agro-meteorological parameters for integrated plant diseases management as the results for both levels are consistent (consistency ratio < 0.1).

Teaching a Man to Fish: An Evaluation of a Chronic Disease Management Men’s Cooking Class

There is limited data on the effects of cooking classes on male participants. The LiveWell Chronic Disease Management program’s Men’s Cooking Class (MCC) aims to help participants gain skills and confidence with food to manage chronic diseases more independently and improve their health. This paper evaluates whether, and how, the program is effective in achieving its goals. A qualitative process was used to collect data from past program participants. Data collection included telephone interviews conducted with a sample of 27 past MCC attendees and a focus group held with a subsample of seven participants. Thematic analysis was performed on collected data. Five major themes emerged, including (i) practical and applicable content, (ii) kinesthetic teaching and learning, (iii) catering to the interests of participants, (iv) tailoring to the demographic, and (v) enjoyment and engagement. Findings indicate the current LiveWell MCC program is effective in meeting its goals. The themes identified are aspects of the program that contribute to this effectiveness. The thematic findings indicate areas in which to continuously adapt and monitor the effectiveness of this program and serve as recommendations for other programming. Further research on the long-term impact of MCC for self-management of chronic disease is needed.

A Framework to Support the Progressive Implementation of Integrated Team-based Care for the Management of Copd: a Collective Case Study

Background: In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models; there is limited empirical evidence to support this process in chronic disease management. We studied the supporting, and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care.Methods: We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for chronic obstructive pulmonary disease (COPD) known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants included healthcare providers involved in the delivery of the BCC program. Results: We identified several mechanisms influencing the scale-up and spread of BCC and categorized them as Foundational (e.g., evidence-based program, readiness to implement, peer-led implementation team), Transformative (adaptive process, empowerment and collaboration, embedded evaluation), and Enabling Mechanisms (provider training, administrative support, role clarity, patient outcomes). Based on these results, we developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors. Conclusions: This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study’s focus on COPD, we believe the findings can be applied in other chronic disease contexts. We provide a framework to support the progressive implementation of integrated team-based care for chronic disease management.

Capitated versus fee-for-service reimbursement and quality of care for chronic disease: a US cross-sectional analysis

Background Upcoming alternative payment models Primary Care First (PCF) and Kidney Care Choices (KCC) incorporate capitated payments for chronic disease management. Prior research on the effect of capitated payments on chronic disease management has shown mixed results. We assessed the patient, physician, and practice characteristics of practices with capitation as the majority of revenue, and evaluated the association of capitated reimbursement with quality of chronic disease care. Methods We performed a cross-sectional analysis of visits in the United States’ National Ambulatory Medical Care Survey (NAMCS) for patients with hypertension, diabetes, or chronic kidney disease (CKD). Our predictor was practice reimbursement type, classified as 1) majority capitation, 2) majority FFS, or 3) other reimbursement mix. Outcomes were quality indicators of hypertension control, diabetes control, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) use, and statin use. Results About 9% of visits were to practices with majority capitation revenue. Capitated practices, compared with FFS and other practices, had lower visit frequency (3.7 vs. 5.2 vs. 5.2, p = 0.006), were more likely to be located in the West Census Region (55% vs. 18% vs. 17%, p < 0.001), less likely to be solo practice (21% vs. 37% vs. 35%, p = 0.005), more likely to be owned by an insurance company, health plan or HMO (24% vs. 13% vs. 13%, p = 0.033), and more likely to have private insurance (43% vs. 25% vs. 19%, p = 0.004) and managed care payments (69% vs. 23% vs. 26%, p < 0.001) as the majority of revenue. The prevalence of controlled hypertension, controlled diabetes, ACEi/ARB use, and statin use was suboptimal across practice reimbursement types. Capitated reimbursement was not associated with differences in hypertension, diabetes, or CKD quality indicators, in multivariable models adjusting for patient, physician, and practice characteristics. Conclusions Practices with majority capitation revenue differed substantially from FFS and other practices in patient, physician, and practice characteristics, but were not associated with consistent quality differences. Our findings establish baseline estimates of chronic disease quality of care performance by practice reimbursement composition, informing chronic disease care delivery within upcoming payment models.

Women's COPD

Chronic obstructive pulmonary disease (COPD) is no longer a respiratory disease that predominantly affects men, to the point where the prevalence among women has equaled that of men since 2008, partly due to their increasing exposure to tobacco and to biomass fuels. Indeed, COPD has become the leading cause of death in women in the USA. A higher susceptibility of female to smoking and pollutants could explain this phenomenon. Besides, the clinical presentation appears different among women with more frequent breathlessness, anxiety or depression, lung cancer (especially adenocarcinoma), undernutrition and osteoporosis. Quality of life is also more significantly impaired in women. The theories advanced to explain these differences involve the role of estrogens, smaller bronchi, impaired gas exchange in the lungs and smoking habits. Usual medications (bronchodilators, ICS) demonstrated similar trends for exacerbation prevention and lung function improvement in men and women. There is an urgent need to recognize the increasing burden of COPD in women and therefore to facilitate global improvements in disease management (smoking cessation, pulmonary rehabilitation…) in half of the population. Nevertheless, important limitations to the treatment of women with COPD include greater under-diagnosis than in men, fewer spirometry tests and medical consultations. In conclusion there is an urgent need to recognize the increasing burden of COPD in women and therefore to facilitate globally improvements in disease management in this specific population.