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Animals : An Open Access Journal From... Aug 2023Domestic cats are euthanized at high rates in shelters, and appropriate matching between cats and adopters is believed to improve adoption success and reduce euthanasia...
Domestic cats are euthanized at high rates in shelters, and appropriate matching between cats and adopters is believed to improve adoption success and reduce euthanasia rates. The ASPCA's Meet Your Match Feline-ality™ program, designed to match cats with owners based on personality and lifestyle, has been implemented in various shelters. This study is the first systematic evaluation of its implementation process and efficacy. Using a controlled interrupted time series design (CITS), the outcome evaluation examined and compared records for five years (2015-2019) from the Seattle Animal Shelter (SAS) and the Multnomah County Animal Shelter located in Portland, Oregon (USA). The outcome evaluation demonstrated no changes in any outcomes (e.g., cat adoptions, euthanasias, returns, transfers, or length of stay) that could be reliably attributed to Feline-ality™. The process evaluation at SAS identified and quantified eight possible errors in implementation that could affect the success of Feline-ality™; the results indicated a 1.6% overall success rate. Whereas the lack of substantive effect may indicate that MYM Feline-ality™ does not perform as purported, it is equally as likely (if not more so) that this absence of evidence of any results reasonably attributable to Feline-ality™ has occurred because the error rate in implementation of the program was very high. The fact that a poorly implemented program necessarily impacts the results of an outcome evaluation underscores the need for process evaluation concurrent with implementation.
PubMed: 37685016
DOI: 10.3390/ani13172752 -
Federal Register Dec 2016The Social Security Act (the Act) requires that ACF regulate a national data collection system that provides comprehensive demographic and case-specific information on...
The Social Security Act (the Act) requires that ACF regulate a national data collection system that provides comprehensive demographic and case-specific information on children who are in foster care and adopted. This final rule replaces existing Adoption and Foster Care Analysis and Reporting System (AFCARS) regulations and the appendices to require title IV-E agencies to collect and report data to ACF on children in out-of-home care, and who exit out-of-home care to adoption or legal guardianship, children in out-of-home care who are covered by the Indian Child Welfare Act, and children who are covered by a title IV-E adoption or guardianship assistance agreement.
Topics: Adoption; Child; Foster Home Care; Humans; Mandatory Reporting; Records; United States
PubMed: 28029758
DOI: No ID Found -
BMC Oral Health May 2022Teledentistry has expanded access to oral health care by allowing patients and providers the option to receive care using technology and telecommunications. This study...
BACKGROUND
Teledentistry has expanded access to oral health care by allowing patients and providers the option to receive care using technology and telecommunications. This study used a cross-sectional, mixed-methods design to evaluate dentists' perceptions in the United States and understanding of the value and scope of teledentistry in their practices and to adopt virtual encounters as a care delivery methodology.
METHODS
This study used a cross-sectional, mixed-methods design. The DentaQuest Partnership for Oral Health Advancement (now CareQuest Institute for Oral Health) conducted an electronic survey of providers in the DentaQuest Network that assessed the impact of COVID-19 on dental practices' patient volume, staffing, dental insurance carriers, treatment protocols, and the office's pre-and post-COVID finances. A total of 2767 dental providers completed the survey with a response rate of 13%. Qualitative interviews were then conducted with ten providers to get more in-depth information on teledentistry. Descriptive statistics summarize the survey population. Thematic analysis, which allows both deductive and inductive approaches, were used to analyze the interviews.
RESULTS
About 23% of the dentists used teledentistry or virtual platforms. Findings illustrate that early adopter dentists were more likely to perceive the benefits of teledentistry as being more significant than its drawbacks. Late/resistant adopters to teledentistry were less aware of its benefits and were more focused on the drawbacks, such as upfront cost. Late adopters were also concerned about the level of care delivered through teledentistry.
CONCLUSIONS
This study explored dentists' perceptions of teledentistry. Expanding access to care was recognized as one of the greater values of teledentistry.
Topics: COVID-19; Cross-Sectional Studies; Dentists; Humans; Surveys and Questionnaires; Telemedicine; United States
PubMed: 35562798
DOI: 10.1186/s12903-022-02208-z -
International Journal of Environmental... Mar 2021In vitro fertilization (IVF) is a hallmark of reproductive medicine. However, the inconclusive outcome leads to marital disharmonies; thus, the choices of gamete...
In vitro fertilization (IVF) is a hallmark of reproductive medicine. However, the inconclusive outcome leads to marital disharmonies; thus, the choices of gamete donation and surrogacy (GD/S) are often offered. In restricted countries, the child-rearing choice through foster/adoption care is promising, but the uptake remains low. We explore the current reproductive services and adoption scenarios in Asian countries to delineate this issue. The web and literature search using PubMed and Ichushi was conducted in Japanese and English using the keywords "adoption", "foster care", "reproductive medicine", including the interview with the respective Asian clinicians. We found that an established adoption system was seen in China, Malaysia, and the Philippines, mainly due to the restriction of GD/S. Although GD/S were allowed in Thailand, Singapore, and India, the different local affordability of IVF cost led to various adoption system scenarios. Nevertheless, the country's economic aspect does influence the establishment of adoption care, mainly due to financial support from local government. Otherwise, the significant barrier was the cultural/religious background leading to low adoption rates. We concluded that the adoption option should always be highlighted as an alternative strategy as it synergistically contributes to children's and infertile couples' welfare.
Topics: Adoption; Child; China; Humans; India; Malaysia; Philippines; Reproductive Medicine; Singapore; Thailand
PubMed: 33810525
DOI: 10.3390/ijerph18073466 -
Scientific Reports Jan 2022Unsuccessful animal adoptions are stressful for many owners and may reduce their willingness to adopt again. The goal of this study was to determine the proportion of...
Unsuccessful animal adoptions are stressful for many owners and may reduce their willingness to adopt again. The goal of this study was to determine the proportion of return owners who adopted post-return and investigate return characteristics that affected the likelihood of post-return adoption. We analyzed adoption records from a South Carolina animal shelter between 2015 and 2019 (n = 1999) using a logistic regression model including post-return adoption (binary) and return reason, species, animal sex and age. We found one in 10 individuals adopted from the shelter within 12 months of return, and post-return adoption was associated with return reason and species. Returns due to owner-related reasons, such as the owner's health (OR 0.20, 95% CI 0.07, 0.57) or unrealistic expectations (OR 0.42, 95% CI 0.19, 0.94) were associated with significantly lower odds of post-return adoption. Owners who returned due to the animal's health exhibited four times greater odds of post-return adoption compared with behavioral returns (OR 4.20, 95% CI 2.37, 7.45). Our findings highlight the value of ensuring adopters' expectations are aligned with the reality of ownership and minimizing adopter-animal behavioral incompatibility as unsuccessful animal adoptions can reduce the owner's willingness to adopt again and may affect the adopter's relationship with the shelter.
PubMed: 35064179
DOI: 10.1038/s41598-022-05101-5 -
Journal of the American Medical... Feb 2021Our study estimates the prevalence and predictors of wearable device adoption and data sharing with healthcare providers in a nationally representative sample.
OBJECTIVE
Our study estimates the prevalence and predictors of wearable device adoption and data sharing with healthcare providers in a nationally representative sample.
MATERIALS AND METHODS
Data were obtained from the 2019 Health Information National Trend Survey. We conducted multivariable logistic regression to examine predictors of device adoption and data sharing.
RESULTS
The sample contained 4159 individuals, 29.9% of whom had adopted a wearable device in 2019. Among adopters, 46.3% had shared data with their provider. Individuals with diabetes (odds ratio [OR], 2.39; 95% CI, 1.66-3.45; P < .0001), hypertension (OR, 2.80; 95% CI, 2.12-3.70; P < .0001), and multiple chronic conditions (OR, 1.55; 95% CI, 1.03-2.32; P < .0001) had significantly higher odds of wearable device adoption. Individuals with a usual source of care (OR, 2.44; 95% CI, 1.95-3.04; P < .0001), diabetes (OR, 1.66; 95% CI, 1.32-2.08; P < .0001), and hypertension (OR, 1.78; 95% CI, 1.44-2.20; P < .0001) had significantly higher odds of sharing data with providers.
DISCUSSION
A third of individuals adopted a wearable medical device and nearly 50% of individuals who owned a device shared data with a provider in 2019. Patients with certain conditions, such as diabetes and hypertension, were more likely to adopt devices and share data with providers. Social determinants of health, such as income and usual source of care, negatively affected wearable device adoption and data sharing, similarly to other consumer health technologies.
CONCLUSIONS
Wearable device adoption and data sharing with providers may be more common than prior studies have reported; however, digital disparities were noted. Studies are needed that test implementation strategies to expand wearable device use and data sharing into care delivery.
Topics: Age Factors; Female; Health Care Surveys; Health Personnel; Humans; Information Dissemination; Logistic Models; Male; Middle Aged; Multivariate Analysis; Patient Generated Health Data; Wearable Electronic Devices
PubMed: 33180896
DOI: 10.1093/jamia/ocaa272 -
Frontiers in Psychology 2023Strategic cost management is vital to the Australian university sector's performance, and activity-based costing (ABC) is a widely accepted and used accounting...
Strategic cost management is vital to the Australian university sector's performance, and activity-based costing (ABC) is a widely accepted and used accounting technology assisting with this. We examine the status of ABC technology adoption in two categories-adopters and non-adopters of the technology-informed by Technology Diffusion Framework, Social Cognitive Theory and Dynamic Theory of Strategy. The study collected data by sending a pilot-tested survey questionnaire to senior executives for electronic completion. From the 39 universities that elected to participate, 24 usable responses were received, representing a 61% response rate. The data were analyzed using cognitive characteristics supported by Social Cognitive Theory, and organizational characteristics supported by the Dynamic Theory of Strategy of universities ABC technology adopter and non-adopter status. Cognitive characteristics provide a qualitative explanation, but selected determinants show no statistical significance. Organizational characteristics also provide a qualitative explanation and show organizational revenue is the most significant determinant; followed by universities located outside the cities, and in the southern part of Australia, have more propensity for ABC technology adoption.
PubMed: 37448710
DOI: 10.3389/fpsyg.2023.1168955 -
Journal of General Internal Medicine Dec 2022As part of the Centers for Medicare and Medicaid Innovation Practice Transformation Network, an integrated healthcare system implemented a multimodal, population...
INTRODUCTION
As part of the Centers for Medicare and Medicaid Innovation Practice Transformation Network, an integrated healthcare system implemented a multimodal, population health-based hypertension clinical pathway program (HCPP) focused on hypertension management.
AIM
To determine whether the HCPP was associated with changes in hypertension control or process-of-care measures and whether associations varied for sites serving higher versus lower proportions of historically underserved patients.
SETTING
An integrated academic health system encompassing 5 clinic networks and 85 primary and specialty care sites.
PROGRAM DESCRIPTION
The HCPP was implemented at some sites (adopters) but not others (non-adopters) and had four components: (1) stakeholder engagement; (2) clinical staff retraining; (3) electronic health record-based prompts; and (4) performance monitoring and feedback. Program goals were to encourage clinical teams to increase the frequency of follow up visits and adopt standardized approaches to blood pressure (BP) measurements and antihypertensive medication regimen advancement defined as adding or titrating existing medication.
PROGRAM EVALUATION
This quasi-experimental study used 2017-2019 data from 63,497 patients with hypertension and multivariable difference-in-differences analyses to evaluate changes in outcomes at 19 adopter versus 39 non-adopter sites before and after HCPP implementation. Adoption was associated with 3.5 times differentially greater odds of a BP reassessment (OR 3.5, 95% CI 3.3-3.8), 11% differentially greater odds of BP control (BP<140/90 mmHg) (OR 1.11, 95% CI 1.07-1.15), and 12% differentially greater odds of having non-severely elevated BP (systolic BP < 155 mmHg) (OR 1.12, 95% CI 1.05-1.19). HCPP adoption was not associated with differential changes in 90-day follow-up BP measurement. Adoption was associated with 23% differentially greater odds of appropriate medication advancement (OR 1.23, 95% CI 1.04-1.46). A similar pattern was observed when limiting comparisons to sites caring for a higher proportion of historically underserved populations.
DISCUSSION
A multimodal population health approach to transforming hypertension care was associated with improved BP outcomes.
Topics: Aged; Humans; United States; Medicare; Hypertension; Antihypertensive Agents; Blood Pressure; Population Health
PubMed: 35426007
DOI: 10.1007/s11606-022-07522-4 -
Frontiers in Medical Technology 2023Digital therapeutics (DTx) are innovative solutions that use meaningful data to provide evidence-based decisions for the prevention, treatment, and management of... (Review)
Review
OBJECTIVES
Digital therapeutics (DTx) are innovative solutions that use meaningful data to provide evidence-based decisions for the prevention, treatment, and management of diseases. Particular attention is paid to software-based diagnostics (IVDs). With this point of view, a strong connection between DTx and IVDs is observed.
METHODS
We investigated the current regulatory scenarios and reimbursement approaches adopted for DTx and IVDs. The initial assumption was that countries apply different regulations for the access to the market and adopt different reimbursement systems for both DTx and IVDs. The analysis was limited to the US, European countries (Germany, France, and UK), and Australia due to maturity in digital health product adoption and regulatory processes, and recent regulations related to IVDs. The final aim was to provide a general comparative overview and identify those aspects that should be better addressed to support the adoption and commercialization of DTx and IVDs.
RESULTS
Many countries regulate DTx as medical devices or software integrated with a medical device, and some have a more specific pathway than others. Australia has more specific regulations classifying software used in IVD. Some EU countries are adopting similar processes to the Digital Health Applications (DiGA) under Germany's Digitale-Versorgung Gesetz (DVG) law, which deems DTx eligible for reimbursement during the fast access pathway. France is working on a fast-track system to make DTx available to patients and reimbursable by the public system. The US retains some coverage through private insurance, federal and state programs like Medicaid and Veterans Affairs, and out-of-pocket spending. The updated Medical Devices Regulation (MDR) and Diagnostic Regulation (IVDR) in the EU includes a classification system specifying how software integrated with medical devices, and IVDs specifically must be regulated.
CONCLUSION
The outlook for DTx and IVDs is changing as they are becoming more technologically advanced, and some countries are adapting their device classifications depending on specific features. Our analysis showed the complexity of the issue demonstrating how fragmented are regulatory systems for DTx and IVDs. Differences emerged in terms of definitions, terminology, requested evidence, payment approaches and the overall reimbursement landscape. The complexity is expected to have a direct impact on the commercialization of and access to DTx and IVDs. In this scenario, willingness to pay of different stakeholders is a key theme.
PubMed: 36891483
DOI: 10.3389/fmedt.2023.1101476 -
JAMA Network Open Dec 2021The rapid transition to virtual health care has depended on physician and patient abilities to adopt new technology and workflows. Physicians transitioning more slowly...
IMPORTANCE
The rapid transition to virtual health care has depended on physician and patient abilities to adopt new technology and workflows. Physicians transitioning more slowly or not at all could result in access challenges for their patients.
OBJECTIVE
To identify physician characteristics associated with the transition to virtual health care in a large regional health care system.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cross-sectional study uses administrative health system databases to analyze data from all 3473 physicians providing ambulatory care through a large New England health care system, which includes 12 hospitals and their ambulatory practices, from October 1, 2019, through December 31, 2020.
EXPOSURES
Physicians characterized based on gender, popularized generational demographic cohort (Silent Generation, born 1928-1945; Baby Boomers, born 1946-1964; Generation X, born 1965-1980; and Millennials, born 1981-1996), specialty (behavioral health, primary care, medical, and surgical), and hospital affiliation as well as selected patient characteristics (number of visits and proportion of patients with self-pay or Medicaid insurance, aged 65 years or older, preference for speaking a language other than English, from a racial or ethnic minority group, and with an active patient portal).
MAIN OUTCOMES AND MEASURES
Early adoption of virtual health care. Bivariate comparisons were made, and regression modeling was used to examine characteristics associated with the likelihood of early adoption of virtual health care.
RESULTS
Of 3473 physicians conducting ambulatory visits during the study period, 1624 (46.8%) were women, 83 (2.4%) were in the Silent Generation, 994 (28.6%) were Baby Boomers, 1637 (47.1%) were in Generation X, and 759 (21.9%) were Millennials. There were 1649 physicians (47.5%) in medical specialties, 749 physicians (21.6%) in surgical specialties, and 248 physicians (7.1%) in behavioral health. After accounting for other characteristics, female (odds ratio [OR], 1.23; 95% CI, 1.06-1.44), behavioral health (OR, 2.92; 95% CI, 2.11-4.04), and primary care (OR, 1.69; 95% CI, 1.36-2.09) physicians had greater odds of being early adopters, and physicians in the Silent Generation (OR, 0.39, 95% CI, 0.24-0.65) and in surgical specialties (OR, 0.46; 95% CI, 0.38-0.57) were less likely to be early adopters. Patient characteristics were less strongly associated with physician adoption.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, there was physician-level variation in the adoption of virtual health care, with female, primary care, and behavioral health physicians in this system most likely to lead the transformation to virtual health care.
Topics: Cross-Sectional Studies; Ethnicity; Female; Humans; Male; Middle Aged; New England; Practice Patterns, Physicians'; Primary Health Care; Sex Factors; User-Computer Interface
PubMed: 34967876
DOI: 10.1001/jamanetworkopen.2021.41625