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The Journal of Mental Health Policy and... Dec 2023In the US, much of the research into new intervention and delivery models for behavioral health care is funded by research institutes and foundations, typically through... (Review)
Review
BACKGROUND
In the US, much of the research into new intervention and delivery models for behavioral health care is funded by research institutes and foundations, typically through grants to develop and test the new interventions. The original grant funding is typically time-limited. This implies that eventually communities, clinicians, and others must find resources to replace the grant funding -otherwise the innovation will not be adopted. Diffusion is challenged by the continued dominance in the US of fee-for-service reimbursement, especially for behavioral health care.
AIMS
To understand the financial challenges to disseminating innovative behavioral health delivery models posed by fee-for-service reimbursement, and to explore alternative payment models that promise to accelerate adoption by better addressing need for flexibility and sustainability.
METHODS
We review US experience with three specific novel delivery models that emerged in recent years. The models are: collaborative care model for depression (CoCM), outpatient based opioid treatment (OBOT), and the certified community behavioral health clinic (CCBHC) model. These examples were selected as illustrating some common themes and some different issues affecting diffusion. For each model, we discuss its core components; evidence on its effectiveness and cost-effectiveness; how its dissemination was funded; how providers are paid; and what has been the uptake so far.
RESULTS
The collaborative care model has existed for longest, but has been slow to disseminate, due in part to a lack of billing codes for key components until recently. The OBOT model faced that problem, and also (until recently) a regulatory requirement requiring physicians to obtain federal waivers in order to prescribe buprenorphine. Similarly, the CCBHC model includes previously nonbillable services, but it appears to be diffusing more successfully than some other innovations, due in part to the approach taken by funders.
DISCUSSION
A common challenge for all three models has been their inclusion of services that were not (initially) reimbursable in a fee-for-service system. However, even establishing new procedure codes may not be enough to give providers the flexibility needed to implement these models, unless payers also implement alternative payment models.
IMPLICATIONS FOR HEALTH CARE PROVISION AND USE
For providers who receive time-limited grant funding to implement these novel delivery models, one key lesson is the need to start early on planning how services will be sustained after the grant ends.
IMPLICATIONS FOR HEALTH POLICY
For research funders (e.g., federal agencies), it is clearly important to speed up the process of obtaining coverage for each novel delivery model, including the development of new billable service codes, and to plan for this as early as possible. Funders also need to collaborate with providers early in the grant period on sustainability planning for the post-grant environment. For payers, a key lesson is the need to fold novel models into stable existing funding streams such as Medicaid and commercial insurance coverage, rather than leaving them at the mercy of revolving time-limited grants, and to provide pathways for contracting for innovations under new payment models.
IMPLICATIONS FOR FURTHER RESEARCH
For researchers, a key recommendation would be to pay greater attention to the payment environment when designing new delivery models and interventions.
Topics: United States; Humans; Fee-for-Service Plans; Medicaid; Ambulatory Care Facilities
PubMed: 38113385
DOI: No ID Found -
Cureus Nov 2023Health dialogue plays a pivotal role in sustaining rural communities by enhancing help-seeking behaviors (HSBs). This article delves deep into how family physicians...
Health dialogue plays a pivotal role in sustaining rural communities by enhancing help-seeking behaviors (HSBs). This article delves deep into how family physicians accentuate the efficacy of rural health dialogues, prompting rural citizens to evaluate and adapt their current HSBs critically. Establishing a foundation of trust in rural family physicians significantly influences the motivation for refined HSBs. Additionally, such engagements optimize the application of limited healthcare resources. For these outcomes to be realized, family physicians must amplify their communication and leadership abilities, and confront the inherent challenges of disseminating contemporary medical evidence in rural domains.
PubMed: 38060724
DOI: 10.7759/cureus.48380 -
Breast Cancer Research and Treatment May 2018To review the empirical evidence to support the conventional (sequential) model of breast cancer progression, which is based on the paradigm that cancer passes through... (Review)
Review
PURPOSE
To review the empirical evidence to support the conventional (sequential) model of breast cancer progression, which is based on the paradigm that cancer passes through several stages, including an in situ stage prior to an invasive stage, and thereafter (in some cases) disseminates to the lymph nodes and distant organs.
METHODS
We review the cancer literature of the last 50 years which relates to the prevention of invasive breast cancer (through radiotherapy or surgery) and reductions in the mortality for breast cancer.
RESULTS
For both invasive cancers and DCIS, the literature indicates that prevention of in-breast invasive recurrences does not prevent death from breast cancer. Moreover, the presence of residual cancer cells in the breast after breast-conserving surgery does not compromise the cure rate.
CONCLUSION
We propose an alternate (parallel) model of breast cancer wherein there is a small pool of cancer stem cells which have metastatic potential from their inception and which disseminate synchronously through several routes-to the breast stroma, to the lymph nodes and to distant organs. Cancer cells which disseminate to the breast give rise to cells which make up the bulk of the tumour mass but these are not the source of the distant metastases.
Topics: Breast; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Neoplasm Invasiveness; Neoplasm Recurrence, Local
PubMed: 29353366
DOI: 10.1007/s10549-017-4644-3 -
Cancer Causes & Control : CCC Sep 2023Partnerships between researchers and community members and organizations can offer multiple benefits for research relevance and dissemination. The goal of this project...
PURPOSE
Partnerships between researchers and community members and organizations can offer multiple benefits for research relevance and dissemination. The goal of this project was to build infrastructure to create bidirectional relationships between University of Wisconsin Carbone Cancer Center (UWCCC) researchers and community educators in the Division of Extension, which connects the knowledge and resources of the university to communities across the state.
METHODS
This project had three aims: (1) create linkages with Extension; (2) establish an in-reach program to educate and train researchers on the science of Community Outreach and Engagement (COE); and (3) identify and facilitate collaborative projects between scientists and communities. Survey and focus group-based needs assessments were completed with both researchers and Extension educators and program activity evaluations were conducted.
RESULTS
Most Extension educators (71%) indicated a strong interest in partnering on COE projects. UWCCC faculty indicated interest in further disseminating their research, but also indicated barriers in connecting with communities. Outreach webinars were created and disseminated to community, a "COE in-reach toolkit" for faculty was created and a series of "speed networking" events were hosted to pair researchers and community. Evaluations indicated the acceptability and usefulness of these activities and supported continuation of collaborative efforts.
CONCLUSION
Continued relationship and skill building, along with a sustainability plan, is critical to support the translation of basic, clinical, and population research to action in the community outreach and engagement context. Further incentives for faculty should be explored for the recruitment of basic scientists into community engagement work.
Topics: Humans; Surveys and Questionnaires; Research Personnel; Neoplasms; Community-Institutional Relations; Program Evaluation
PubMed: 37247136
DOI: 10.1007/s10552-023-01725-8 -
Diagnosis (Berlin, Germany) Sep 2017In September of 2014, the American College of Radiology joined a number of other organizations in sponsoring the 2015 National Academy of Medicine report, Improving... (Review)
Review
In September of 2014, the American College of Radiology joined a number of other organizations in sponsoring the 2015 National Academy of Medicine report, Improving Diagnosis In Health Care. Our presentation to the Academy emphasized that although diagnostic errors in imaging are commonly considered to result only from failures in disease detection or misinterpretation of a perceived abnormality, most errors in diagnosis result from failures in information gathering, aggregation, dissemination and ultimately integration of that information into our patients' clinical problems. Diagnostic errors can occur at any point on the continuum of imaging care from when imaging is first considered until results and recommendations are fully understood by our referring physicians and patients. We used the concept of the Imaging Value Chain and the ACR's Imaging 3.0 initiative to illustrate how better information gathering and integration at each step in imaging care can mitigate many of the causes of diagnostic errors. Radiologists are in a unique position to be the aggregators, brokers and disseminators of information critical to making an informed diagnosis, and if radiologists were empowered to use our expertise and informatics tools to manage the entire imaging chain, diagnostic errors would be reduced and patient outcomes improved. Heath care teams should take advantage of radiologists' ability to fully manage information related to medical imaging, and simultaneously, radiologists must be ready to meet these new challenges as health care evolves. The radiology community stands ready work with all stakeholders to design and implement solutions that minimize diagnostic errors.
Topics: Delivery of Health Care; Diagnosis; Diagnostic Errors; Diagnostic Imaging; Humans; Patient Safety; Radiology; Societies, Medical
PubMed: 29536934
DOI: 10.1515/dx-2017-0020 -
Microbial Biotechnology Sep 2020Microbes and their activities have pervasive influence and deterministic roles in the functioning and health of the geosphere, atmosphere and biosphere, i.e. in nature....
Microbes and their activities have pervasive influence and deterministic roles in the functioning and health of the geosphere, atmosphere and biosphere, i.e. in nature. Microbiology can be considered a language of nature. We have argued that the relevance of microbes for everyday personal decisions and collective policies requires that society attains microbiology literacy, through the introduction of child-relevant microbiology topics into school curricula. That is: children should learn the microbiology language of nature. Children can be effective transmitters of new and/or rapidly evolving knowledge within families and beyond, where there is a substantive information asymmetry (witness digital technology, social media, and new languages in foreign countries). They can thus be key disseminators of microbiology knowledge, where there will be information asymmetry for the foreseeable future, and thereby contribute to the attainment of microbiology literacy in society. The education of family and friends can be encouraged/stimulated by home assignments, family leisure projects, and school-organised microbiology-centric social-education events. Children are key stakeholders in family decisions. Their microbiology knowledge, and their dissemination of it, can help inform and increase the objectivity of such decisions.
Topics: Child; Humans; Literacy
PubMed: 32649058
DOI: 10.1111/1751-7915.13619 -
JMIR Pediatrics and Parenting Jun 2023There is a need to disseminate evidence-based parenting interventions for adolescent externalizing concerns. Although family-based treatments have demonstrated efficacy...
BACKGROUND
There is a need to disseminate evidence-based parenting interventions for adolescent externalizing concerns. Although family-based treatments have demonstrated efficacy for such concerns, they have limitations and challenges when disseminated in the community. Behavioral-based parenting techniques form an integral part of well-established, family-based interventions for adolescent behavioral problems and are ideal for dissemination through coupling with smartphone technology. Despite the vast number of "parent" apps currently available in commercial markets, there is a dearth of reviews focused on evaluating mobile health apps through the lens of behavioral parenting training (BPT).
OBJECTIVE
This study aimed to conduct a systematic review of commercial mobile health apps for parents to increase effective parenting skills that include behavioral components.
METHODS
A search of the Google Play and Apple App Stores identified 57 apps that were included in the review and coded for availability, popularity, and infrastructure. In total, 89% (51/57) of them were sufficiently functional to be assessed for app design quality (engagement, functionality, esthetics, and information), and 53% (30/57) proceeded to the final evaluation of level of adherence to BPT principles.
RESULTS
In total, 57 apps met the initial inclusion criteria. Accessibility was high across these apps given that 44% (25/57) were available on both the Google Play and Apple App Stores and 68% (39/57) were free of charge. However, privacy concerns were addressed inconsistently among the apps. App design quality was average across the included apps, and apps with positive user star ratings or a high number of downloads received higher ratings on app design quality. In contrast, the identified apps largely fell short in providing BPT components adequately and with high interactivity, with low levels of adherence to BPT (mean 20.74%, SD 11%) across all commercial apps evaluated. Commercially popular apps did not show higher levels of adherence to BPT. Overall, a moderate relationship between app design quality and adherence to BPT was found. App features that have been found to increase user engagement, such as gamification and individualization, were only observed in a small minority of apps. Overall, there was a lack of focus on teenage development.
CONCLUSIONS
Future app developers hoping to increase the dissemination of BPT should aim for free and accessible apps that balance high-quality design features (eg, simple esthetics, interactivity, and individualization) with content consistent with BPT principles. They should also consider key issues that are inconsistently addressed in current apps, including privacy and teenage development. Future app developments will likely benefit from multisector (industry and academic) collaboration throughout the design process and involving end users (ie, parents) during different stages of app development.
PubMed: 37261886
DOI: 10.2196/43626 -
BMJ Open Oct 2023Internationally, healthcare improvement remains a clinical and educational priority. Consensus in Europe, Canada and the USA to implement quality improvement (QI)... (Review)
Review
How, and under what contexts, do academic-practice partnerships collaborate to implement healthcare improvement education into preregistration nursing curriculums: a realist review protocol.
INTRODUCTION
Internationally, healthcare improvement remains a clinical and educational priority. Consensus in Europe, Canada and the USA to implement quality improvement (QI) education into preregistration nursing curricula ensures students become equipped with the skills and knowledge required to improve practice. Now, New Zealand and Australia are beginning to implement QI education into their nursing curricula. However, QI education is complex; comprising multiple components, each influenced by the contexts under which they are developed and implemented. Evaluation studies of QI education unanimously acknowledge that academic and practice partnerships (APPs) are essential to optimally embed QI into preregistration curricula, yet it is not understood how, and under what contexts, APPs collaborate to achieve this.
METHODS AND ANALYSIS
A realist review to determine how, and under what contexts, APPs collaborate to implement QI education in pre-registration nursing will be conducted using the Realist and Meta-narrative Evidence Syntheses: Evolving Standards Guidelines. International stakeholders will be consulted at each stage which includes (1) clarifying the scope of the review through empirical literature and tacit expert knowledge, (2) searching for evidence in healthcare and social science databases/grey literature, (3) appraising studies using the Evidence for Policy and Practice Information and Co-ordinating Centre weight of evidence framework and extracting data using Standards for QUality Improvement Reporting Excellence in Education Publication Guidelines, (4) synthesising evidence and drawing conclusions through the creation of context, mechanism and outcome configurations and (5) disseminating findings through conferences and peer-reviewed publications.
ETHICS AND DISSEMINATION
Ethical approval was not required for this study. Findings will be disseminated to international nurse educators, leaders and front-line staff implementing QI education within their own academic and practice contexts through conferences and peer-reviewed publications.
PROSPERO REGISTRATION NUMBER
CRD42021282424.
Topics: Humans; Curriculum; Delivery of Health Care; Europe; Narration; Quality Improvement
PubMed: 37879689
DOI: 10.1136/bmjopen-2023-077784 -
Small GTPases Jul 2018How cancer disseminates and metastasizes remains an outstanding open question. Emerging evidence indicates that membrane trafficking is frequently harnessed by tumors of... (Review)
Review
How cancer disseminates and metastasizes remains an outstanding open question. Emerging evidence indicates that membrane trafficking is frequently harnessed by tumors of epithelial origin to acquire a mesenchymal program of invasiveness. However, the critical molecular hubs used by cancer cells this context have only began to be elucidated. Here, we discussed the results of a recent phenotypic screening that led to the identification of the small GTPase RAB2A, not previously involved in cancer dissemination, as pivotal for the acquisition of pericellular proteolysis, cell dissemination and distant metastatic spreading of human breast cancer. At the cellular levels, RAB2A controls both canonical polarized Golgi-to-Plasma membrane trafficking of the junctional protein E-cadherin, and post-endocytic trafficking of the membrane-bound metalloprotease, MT1-MMP. This finding reveals an unexpected plasticity in the control of diverse trafficking routes exerted by RAB2A through canonical (Golgi stacking) and non-canonical (late endosome recycling) functional interactions, contributing to break established membrane trafficking dogma on the rigorous molecular distinction between polarized Golgi and post endocytic routes. Finally, they suggest that epithelial cancers may specifically select for those molecules that enable them to control multiple trafficking routes, in turn essential for the regulation of activities necessary for acquisition of mesenchymal traits.
Topics: Animals; Cadherins; Cell Membrane; Humans; Neoplasm Invasiveness; Neoplasms; Protein Transport; rab GTP-Binding Proteins
PubMed: 28060560
DOI: 10.1080/21541248.2016.1223990 -
The Journal of the American Osteopathic... May 2015Dissemination is an important part of translational research. When the results of high-quality studies reach a wide audience of peers, they provide an evidence base that... (Review)
Review
Dissemination is an important part of translational research. When the results of high-quality studies reach a wide audience of peers, they provide an evidence base that can guide practice and improve patient care and safety. From proposal to publication, the authors provide the novice researcher with advice on ethics, tips on selecting a journal, a summary of manuscript requirements, and a brief outline of the submission process and outcomes. By demystifying these processes and outlining some of the basic requirements, the authors hope to encourage novice researchers to engage in quality research and prepare them for disseminating their results.
Topics: Biomedical Research; Guidelines as Topic; Humans; Osteopathic Medicine; Publishing; Research Personnel
PubMed: 25938527
DOI: 10.7556/jaoa.2015.063