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Background and aims Although a growing number of older people are suffering from multimorbidity, most of the health problems related to multimorbidity can be improved by self-management. The aim of this study was to examine the effectiveness of a healthcoaching self-management program for older adults with multimorbidity in nursing homes. Methods Older adults with multimorbidity from one nursing home in Korea were randomly allocated to either an intervention group (n=22) or conventional group (n=21). Participants in the intervention group met face to face with the researchers twice a week for 8 weeks, during which time the researchers engaged them in goal setting and goal performance using the strategies in the healthcoaching self-management program. Regular care was provided to the other participants in the conventional group. Results Participants in the intervention group had significantly better outcomes in exercise behaviors (P=0.015), cognitive symptom management (P=0.004), mental stress management/relaxation (P=0.023), self-rated health (P=0.002), reduced illness intrusiveness (P<0.001), depression (P<0.001), and social/role activities limitations (P<0.001). In addition, there was a significant time-by-group interaction in self-efficacy (P=0.036). According to the goal attainment scales, their individual goals of oral health and stress reduction were achieved. Conclusion The healthcoaching self-management program was successfully implemented in older adults with multimorbidity in a nursing home. Further research is needed to develop and evaluate the long-term effects of an intervention to enhance adherence to self-management and quality of life for older adults with multimorbidity.
Previous studies have shown that social ties enhance both physical and mental health, and that social isolation has been linked to increased cognitive decline. As part of our cognitive training platform, we created a socialization intervention to address these issues. The intervention is designed to improve social contact time of older adults with remote family members and friends using a variety of technologies, including Web cameras, Skype software, email and phone. We used usability testing, surveys, interviews and system usage monitoring to develop design guidance for socialization protocols that were appropriate for older adults living independently in their homes. Our early results with this intervention show increased number of social contacts, total communication time (we measure email, phone, and Skype usage) and significant participant satisfaction with the intervention. PMID:24111362
Jimison, Holly B; Klein, Krystal A; Marcoe, Jennifer L
Twelve individuals (four homeless, two formerly homeless, and six low-income) received 12 weeks of free healthcoaching, an intervention normally undertaken by clients who pay $40 to $200 out of pocket for coaching services. The healthcoaching relationships were conducted with protocols developed for managing executive health at a Fortune 100 firm. This experimental model was constructed to explore what happens when coaching conversations for change and possibility are delivered to marginalized and underserved communities that typically undergo vastly different interactions with authorities in law, healthcare, and social services. Phase 1 of the project recruited the homeless individuals from street sites throughout San Francisco, California, and a temporary shelter. Phase 2 of the project worked with low-income and formerly homeless individuals who occupied a subsidized housing complex. Of the coaching recipients, three were black, five were Hispanic, three were of mixed race, and one declined to disclose his ethnicity. Half were Spanish speaking; immigrant status was recent for five of the 12. None had ever talked with a healthcoach before; only three knew how to utilize low-cost public health clinics. This case report illustrates how the motivational power of coaching conversations was a modestly useful methodology in breaking through the social isolation and loneliness of street-dwelling adults with chronic health problems. It also was a useful methodology for developing capacity for accomplishing short-term goals that were self-identified. Additionally, healthcoaching presented an opportunity for transitioning poverty-level individuals from passive recipients using public health sector services to more empowered actors with first-stage awareness who initiated preventive health actions.
It's no secret that the rate and magnitude of stress in daily life, both at work and at home, are drastically affecting the health and well-being of people in our communities and around the world. People are desperate to find ways to improve their lives and feel happier, healthier, and more vibrant. Likewise, industry is clamoring to find resources to improve the health and well-being of their staff and their teams.1,2 With the aging population and rapidly growing demands of modern life, this need is expanding exponentially. Billions of dollars are spent annually on complementary and integrative care resources. Many people seek to combine allopathic medical care with proactive self-initiated choices and behaviors to prevent or manage illness and to increase their overall health and well-being.
Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN healthcoach role described in this paper addresses the complexities and ambiguities for persons living with chronic illness in order to provide person-centered care and support that are unique and responsive to the context of persons' lives. Informed by complexity thinking and relational inquiry, the RN healthcoach is an emergent innovation of creative action with community and groups that support persons as they shape their health and patterns of living.
There is great need for cost effective approaches to increase patient engagement and improve health and well-being. Health and wellness coaching has recently demonstrated great promise, but the majority of studies to date have focused on individual coaching (ie, one coach with one client). Newer initiatives are bringing a group coaching model from corporate leadership development and educational settings into the healthcare arena. A group approach potentially increases cost-effective access to a larger number of clients and brings the possible additional benefit of group support. This article highlights some of the group coaching approaches currently being conducted across the United States. The group coaching interventions included in this overview are offered by a variety of academic and private sector institutions, use both telephonic and in-person coaching, and are facilitated by professionally trained health and wellness coaches as well as trained peer coaches. Strengths and challenges experienced in these efforts are summarized, as are recommendations to address those challenges. A working definition of “Group Health and Wellness Coaching” is proposed, and important next steps for research and for the training of group coaches are presented.
Purpose:?This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer.?Methods:?In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff received step-by-step instructions for implementing an evidence-based nutritional management program. After each session, participants were asked to implement the care step they had just learned. Coaching calls helped facilitate implementation. Staff in 18 NHs in 12 states completed the course. Evaluation data were collected using a resident data form, pre- and post-training quizzes, a participant course evaluation survey, and a supervisor’s report.?Results:?NH staff attended an average of 4.8 teleconferences, with 5 staff members typically attending each teleconference. Average quiz scores increased 30% (p < .0001) from pre- to post-training. A majority of course participants (N = 35) said they would participate in a similar course (82.9%) and would recommend the course (80%). Just under half preferred the coaching course to a more traditional 1- to 2-day conference. Nine of 12 reporting supervisors said their facility planned to continue the new nutritional care program. The 10 NHs that submitted resident data assessed an average of 5 residents using the recommended protocols.?Implications:?We recommend the coaching course format. Dissemination outcomes may improve if resources currently used for short-duration training activities are used instead on coaching activities that support NHs over extended periods.
Rahman, Anna N.; Simmons, Sandra F.; Applebaum, Robert; Lindabury, Kate; Schnelle, John F.
Asthma is a widespread disease that affects more than 20 million Americans and up to 150 million people around the world. The cost of treating asthma is $14 billion annually. Particularly hard hit are children in inner city areas; researchers have found that 14 percent of inner city adolescent children are diagnosed with asthma. Sentara Home Care Services in Chesapeake, Virginia, has developed an innovative program to improve the management of asthma among children, particularly inner city children, by implementing a system of "Life Coaches" to counsel proper medication use and lifestyle behaviors for these patients and their families. PMID:14603862
Coaching is a dynamic field in which many forms of health promotion occur directly and indirectly on a daily basis. It would therefore be of interest to determine the extent to which research-based data has been collected pertaining to health promotion and its influence throughout coaching. Thus, the purpose of this study was to inductively…
... Medicare doesn't pay for: 24-hour-a-day care at home Meals delivered to your home Homemaker ... get homehealth care if you attend adult day care. Note: Homehealth services may also include medical ...
Healthcoaching (HC) is a process holding tremendous potential as a complementary medical intervention to shape healthy behavior change and affect rates of chronic lifestyle diseases. Empirical knowledge of effectiveness for the HC process, however, is lacking. The purposes of this paper are to present the study protocol for the Ithaca Coaching Project while also addressing research design, methodological issues, and directions for HC research. This is one of the first large-scale, randomized control trials of HC for primary prevention examining impact on physical and emotional health status in an employee population. An additional intent for the project is to investigate self-determination theory as a theoretical framework for the coaching process. Participants (n=300) are recruited as part of a campus-wide wellness initiative and randomly assigned to one of three levels of client-centered HC or a control with standard wellness program care. Repeated measures analyses of covariance will be used to examine coaching effectiveness while path analyses will be used to examine relationships between coaching processes, self-determination variables, and health outcomes. There is a great need for well-designed HC studies that define coaching best practices, examine intervention effectiveness, provide cost:benefit analysis, and address scope of practice. This information will allow a clearer definition of HC to emerge and determination of if, and how, HC fits in modern-day healthcare. This is an exciting but critical time for HC research and for the practice of HC.
Objective: This study aimed to investigate how patients with chronic conditions evaluate telephone healthcoaching provided by their health insurance company. Methods: A retrospective survey was conducted among coaching participants ("n" = 834). Outcomes included the general evaluation of the coaching, the evaluation of process and…
The effectiveness of coach turnover on team performance is widely discussed in the literature due to the indirect impact of a team's performance on a club's revenues. This study examines the effect of coach turnover within a competition season by focusing on the change in team quality and the change in home team advantage under the new coach. The change
The effectiveness of coach turnover on team performance is widely discussed in the literature due to the indirect impact of a team’s performance on a club’s revenues. This study examines the effect of coach turnover within a competition season by focusing on the change in team quality and the change in home team advantage under the new coach. The change
In February 2013, Global Advances in Health and Medicine (GAHMJ) interviewed eight pioneers in the field of healthcoaching education: Michael Arloski, PhD, PCC; Linda Bark, PhD, RN, MCC, NC-BC; Georgianna Donadio, PhD; Meg Jordan, PhD, RN; Sam Magill, MBA, MCC; Margaret Moore, MBA; Linda Smith, PA-C, MA; and Cheryl Walker, ML, MCC. This article features biographies of the participants and their perspectives on the evolution and value of healthcoaching education and the keys to its success.
The Federal HomeHealth Grant Program was initiated in 1976 and is intended to increase the provision of homehealth services by means of grants for the expansion of existing homehealth agencies and the development of new ones. The evalualion of the grant program is summarized in this article, emphasizing the visit increases generated by grantees and the factors
Coaching has attracted much attention from health professionals interested in collaborative, person-centred approaches to motivating behaviour change. Whilst initial research supports the efficacy of coaching in health contexts, more theoretical and empirical work is needed. Based on recent work demonstrating the important role that mindfulness plays in self-regulation, it was hypothesised that the efficacy of healthcoaching could be enhanced
Gordon B. Spence; Michael J. Cavanagh; Anthony M. Grant
Objectives To determine whether a distance coaching course on improving nursing home incontinence care could be replicated and brought to scale with a larger group of nursing homes without sacrificing outcomes. Design The study collected descriptive and comparative data. Setting The setting was comprised of 14 nursing homes in the original course and 34 homes in the replication course. Participants Participants in the study were supervisors and staff from enrolled nursing homes who completed the distance coaching courses on incontinence management. Measures Data for both courses were collected using a resident assessment form to evaluate implementation of new practices, pre- and post-training quizzes, a course evaluation survey, and a supervisor’s report. Results There were few significant differences between the course groups with respect to course participation, knowledge transfer, and training program preferences. Although course 1 nursing homes reported assessing more residents on average than course 2 homes (22 residents vs. 12 residents, respectively), this difference is likely an artifact of differences in the reporting methodologies for the two courses. Conclusion This study found qualified support for using a distance coaching course to facilitate adoption of evidence-based incontinence care practices in nursing homes. The findings also underscore the challenges associated with designing dissemination/implementation programs that are both effective and feasible to implement with nursing homes. We recommend that nursing home educators consider this study’s findings when designing new training programs. Outcomes may improve if some dissemination resources are diverted to distance coaching activities that support nursing home improvement efforts over extended periods.
Rahman, Anna N.; Schnelle, John F.; Applebaum, Robert; Lindabury, Kate; Simmons, Sandra
Despite pharmacologic advances, medication non-adherence continues to challenge primary care providers in blood pressure (BP) management. Medical, nursing and pharmacy students (n = 11) were recruited and trained as healthcoaches for uninsured, hypertensive patients (n = 25) of a free clinic in an uncontrolled open trial. Pre–post analysis was conducted on BP, medication adherence, frequency of home BP monitoring,
Lucinda B. Leung; Andrew M. Busch; Sarah L. Nottage; Naira Arellano; Eva Glieberman; Nicholas J. Busch; Stephen R. Smith
Despite pharmacologic advances, medication non-adherence continues to challenge primary care providers in blood pressure (BP) management. Medical, nursing and pharmacy students (n=11) were recruited and trained as healthcoaches for uninsured, hypertensive patients (n=25) of a free clinic in an uncontrolled open trial. Pre-post analysis was conducted on BP, medication adherence, frequency of home BP monitoring, and health behavior (eg, diet, exercise). Patient satisfaction and feasibility of a student coach model was qualitatively evaluated. In the 12 patients who completed the intervention, an increase in medication adherence as measured by the Brief Medication Questionnaire was observed (P<.01), with a 11 mmHg reduction in systolic BP (P=.03). Qualitative data showed patient satisfaction with the intervention and other health behavior change. This feasibility study shows use of student healthcoaches to combat medication non-adherence in uninsured, hypertensive adults is promising. PMID:22356599
Leung, Lucinda B; Busch, Andrew M; Nottage, Sarah L; Arellano, Naira; Glieberman, Eva; Busch, Nicholas J; Smith, Stephen R
The homehealth service segment of the Comprehensive Health Plan for Arizona is presented, including a background statement, description of needs and problems, assessment of current resources available, identification of needs, and recommendations. It is ...
Motivational Interviewing (MI) based healthcoaching is a relatively new behavioral intervention that has gained popularity in public health because of its ability to address multiple behaviors, health risks, and illness self-management. In this study, 276 employees at a medical center self-selected to participate in either a 3-month healthcoaching intervention or control group. The treatment group showed significant improvement
Susan Butterworth; Ariel Linden; Wende McClay; Michael C. Leo
It is a challenge for rural health professionals to promote medication safety among older adults taking multiple medications. A volunteer coaching program to promote medication safety among rural elders with chronic illnesses was designed and evaluated. A community-based interventional study randomly assigned 62 rural elders with at least two chronic illnesses to routine care plus volunteer coaching or routine care alone. The volunteer coaching group received a medication safety program, including a coach and reminders by well-trained volunteers, as well as three home visits and five telephone calls over a two-month period. All the subjects received routine medication safety instructions for their chronic illnesses. The program was evaluated using pre- and post-tests of knowledge, attitude and behaviors with regard to medication safety. Results show the volunteer coaching group improved their knowledge of medication safety, but there was no change in attitude after the two-month study period. Moreover, the group demonstrated three improved medication safety behaviors compared to the routine care group. The volunteer coaching program and instructions with pictorial aids can provide a reference for community health professionals who wish to improve the medication safety of chronically ill elders. PMID:23414637
Wang, Chi-Jane; Fetzer, Susan J; Yang, Yi-Ching; Wang, Jing-Jy
Purpose. The purpose of this study was to discover how coach training experts define coaching and what they would identify to be the essential components of a coach training program for mental health professionals. Methods. A panel of nine experts, through an iterative Delphi process of responding to three rounds of questionnaires, provided…
Despite its high media profile and growing popularity there have been no empirical investi- gations of the impact of life coaching on goal attainment, metacognition or mental health. This exploratory study used life coaching as a means of exploring key metacognitive factors involved as individuals move towards goal attainment. In a within-subjects design, twenty adults completed a life coaching program.
... of homehealth aides. Occupation Job Duties ENTRY-LEVEL EDUCATION 2012 MEDIAN PAY Childcare Workers Childcare workers care for children when parents and other family members are unavailable. They care ...
Background Healthcoaching is a new intervention offering a one-on-one focused self-management support program. This study implemented a healthcoaching pilot in primary care clinics in Eastern Ontario, Canada to evaluate the feasibility and acceptability of integrating healthcoaching into primary care for patients who were either at risk for or diagnosed with diabetes. Methods We implemented healthcoaching in three primary care practices. Patients with diabetes were offered six months of support from their healthcoach, including an initial face-to-face meeting and follow-up by email, telephone, or face-to-face according to patient preference. Feasibility was assessed through provider focus groups and qualitative data analysis methods. Results All three sites were able to implement the program. A number of themes emerged from the focus groups, including the importance of physician buy-in, wide variation in understanding and implementing of the healthcoach role, the significant impact of different systems of team communication, and the significant effect of organizational structure and patient readiness on Healthcoaches’ capacity to perform their role. Conclusions It is feasible to implement healthcoaching as an integrated program within small primary care clinics in Canada without adding additional resources into the daily practice. Practices should review their organizational and communication processes to ensure optimal support for healthcoaches if considering implementing this intervention.
During the last decade, debate about the nation's ailing healthcare system has moved to the forefront. In 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law. This groundbreaking piece of legislation impacts every aspect of the health industry, affecting everyone from doctors and health-care facilities to insurers and benefits consultants to business owners and patients. The ultimate goal of PPACA is to decrease the number of uninsured Americans and reduce the overall costs of healthcare.
Background Mental ill health, especially depression, is recognised as an important health concern, potentially with greater impact in rural communities. This paper reports on a project, Coach the Coach, in which Australian rural football clubs were the setting and football coaches the leaders in providing greater mental health awareness and capacity to support early help seeking behaviour among young males experiencing mental health difficulties, especially depression. Coaches and other football club leaders were provided with Mental Health First Aid (MHFA) training. Method Pre-post measures of the ability of those club leaders undertaking mental health training to recognise depression and schizophrenia and of their knowledge of evidence supported treatment options, and confidence in responding to mental health difficulties were obtained using a questionnaire. This was supplemented by focus group interviews. Pre-post questionnaire data from players in participating football clubs was used to investigate attitudes to depression, treatment options and ability to recognise depression from a clinical scenario. Key project stakeholders were also interviewed. Results Club leaders (n = 36) who were trained in MHFA and club players (n = 275) who were not trained, participated in this evaluation. More than 50% of club leaders who undertook the training showed increased capacity to recognise mental illness and 66% reported increased confidence to respond to mental health difficulties in others. They reported that this training built upon their existing skills, fulfilled their perceived social responsibilities and empowered them. Indirect benefit to club players from this approach seemed limited as minimal changes in attitudes were reported by players. Key stakeholders regarded the project as valuable. Conclusions Rural football clubs appear to be appropriate social structures to promote rural mental health awareness. Club leaders, including many coaches, benefit from MHFA training, reporting increased skills and confidence. Benefit to club players from this approach was less obvious. However, the generally positive findings of this study suggest further research in this area is desirable.
As part of an evaluation of the Medicare certification program for homehealth agencies (HHAs), we examined the extent to which certification findings were related to patient outcomes. In a previous study, we collected longitudinal patient data for a national sample of 42 HHAs and developed precise patient outcome measures. In this study, the outcome measures were compared to certification
Using OASIS data collected by all Medicare-certified homehealth agencies, this article first presents descriptive statistics on patient outcomes for a national agency sample in 2001, soon after Medicare prospective payment implementation. Ratios of actual to predicted outcome rates, aggregated for groups of outcomes, are considered as potential summary indicators of agency outcome performance. The aggregate ratios show promise, but
Robert E. Schlenker; Martha C. Powell; Glenn K. Goodrich
Objectives: To examine homehealth nurses' attitudes towards physician capabilities in homehealth care, and whether nurses' attitudes are associated with their experience, practice setting, degree of physician interaction, or use of homehealth guidelines.Design: A multiple regression analysis of a 90 item survey on agency characteristics, degree of interaction with physicians, and ratings of physicians' capabilities across multiple dimensions
Homebound older adults constitute a "hardly reached" population with respect to health communication. Older adults also typically suffer from health literacy challenges, which put them at increased risk of adverse health outcomes. Suboptimal interactions with providers are one such challenge. Interventions to improve interactive health literacy focus on training consumers/patients in question preparation and asking. Meals on Wheels volunteers are uniquely suited to coach their clients in such interaction strategies. Seventy-three Meals on Wheels volunteers participated in workshops to train as health literacy coaches. The 3- to 4-hour workshops included units on communicating with older adults, on the nature of health literacy, and on the process of interactive health literacy coaching. Participants viewed and discussed videos that modeled the targeted communication behaviors for older adult patients interacting with physicians. They role-played the coaching process. After 9 months, coaches participated in a "booster" session that included videos of ideal coaching practices. Evaluation questionnaires revealed that participants had favorable reactions to the workshops with respect to utility and interest. They especially appreciated learning communication skills and seeing realistic videos. A measure of knowledge about the workshop material revealed a significant increment at posttest. Fidelity of coaching practices with respect to workshop curriculum was confirmed. This training in interactive health literacy for community-based lay volunteers constitutes one way to implement the National Action Plan to Improve Health Literacy for one "hardly reached" population. An online tool kit containing all workshop materials is available. PMID:23877229
Rubin, Donald L; Freimuth, Vicki S; Johnson, Sharon D; Kaley, Terry; Parmer, John
Emerging healthcare delivery models suggest that patients benefit from being engaged in their care. Integrative healthcoaching (IHC) is designed to be a systematic, collaborative, and solution-focused process that facilitates the enhancement of life experience and goal attainment regarding health, but little research is available to describe the mechanisms through which empowerment occurs in the healthcoaching process. The purpose of this qualitative study is to describe apparent key components of the empowerment process as it actually occurs in IHC. A sample of 69 recorded healthcoaching sessions was drawn from 12 participants enrolled in a randomized controlled study comparing two different methods of weight-loss maintenance. Two researchers coded the word-for-word transcripts of sessions focusing on the structure of the sessions and communication strategies used by the coaches. Three basic sections of a coaching session were identified, and two main themes emerged from the communication strategies used: Exploring Participant's Experience and Active Interventions. In IHC, healthcoaches do not direct with prefabricated education based on the patient's presenting problem; rather, they use a concordant style of communication. The major tenets of the healthcoaching process are patient-centeredness and patient control focused around patient-originated health goals that guide the work within a supportive coaching partnership. As the field of healthcoaching continues to define itself, an important ongoing question involves how the structure of the provider-patient interaction is informed by the role of the healthcare provider (eg, nurse, therapist, coach) and in turn shapes the empowerment process.
Emerging healthcare delivery models suggest that patients benefit from being engaged in their care. Integrative healthcoaching (IHC) is designed to be a systematic, collaborative, and solution-focused process that facilitates the enhancement of life experience and goal attainment regarding health, but little research is available to describe the mechanisms through which empowerment occurs in the healthcoaching process. The purpose of this qualitative study is to describe apparent key components of the empowerment process as it actually occurs in IHC. A sample of 69 recorded healthcoaching sessions was drawn from 12 participants enrolled in a randomized controlled study comparing two different methods of weight-loss maintenance. Two researchers coded the word-for-word transcripts of sessions focusing on the structure of the sessions and communication strategies used by the coaches. Three basic sections of a coaching session were identified, and two main themes emerged from the communication strategies used: Exploring Participant's Experience and Active Interventions. In IHC, healthcoaches do not direct with prefabricated education based on the patient's presenting problem; rather, they use a concordant style of communication. The major tenets of the healthcoaching process are patient-centeredness and patient control focused around patient-originated health goals that guide the work within a supportive coaching partnership. As the field of healthcoaching continues to define itself, an important ongoing question involves how the structure of the provider-patient interaction is informed by the role of the healthcare provider (eg, nurse, therapist, coach) and in turn shapes the empowerment process. PMID:24416672
The study examined the homehealth and the nursing home markets for Medicare and Medicaid services in fifty states, using secondary financial data on state policies and supply for the 1978-88 period. Descriptive data showed the growth in licensed nursing ...
Background In recent years, coaching has received special attention as a method to improve healthy lifestyle behaviours. The fact that coaching has found its way into healthcare and may provide new ways of engaging the patients and making them accountable for their health, justifies the need for an overview of the evidence regarding coaching interventions used in patient care, the effect of the interventions, and the quality of the studies published. However, in order to provide a clear definition of the coaching interventions selected for this review, we have found it necessary to distinguish between healthcoaching and life coaching. In this review, we will only focus on the latter method and on that basis assess the health related outcomes of life coaching. Methods Intervention studies using quantitative or qualitative methods to evaluate the outcome of the life coach interventions were identified through systematic literature searches in PubMed, Embase, Psycinfo, and CINAHL. The quality of the methodology was independently assessed by three of the authors using a criteria list. Results A total of 4359 citations were identified in the electronic search and five studies were included; two of them were randomized controlled trials and met all quality criteria. The two studies investigating objective health outcomes (HbA1c) showed mixed but promising results, especially concerning the patient group that usually does not benefit from intensified interventions. Conclusion Because of the very limited number of solid studies, this review can only present tendencies for patient outcomes and a preliminary description of an effective life coaching intervention. The coaching method used in these studies aims to improve self-efficacy and self-empowerment. This may explain why the studies including disadvantaged patients showed the most convincing results. The findings also indicate that some patients benefit from being met with an alternative approach and a different type of communication than they are used to from health care personnel. In order to get a closer look at what is in the ‘black box’, we suggest that the description and categorisation of the coaching methods are described more comprehensively, and that research into this area is supplemented by a more qualitative approach.
SUMMARY The purpose of this article is to examine the current health promotion orientation of youth sports clubs in Finland in view of the standards created previously for the health promoting sports club (HPSC). Ninety-seven youth sports clubs participated, and 273 sports club offi- cials and 240 coaches answered the questionnaires. To describe clubs health promotion orientations, an HPSC index
A homehealth-care bibliography is presented. The bibliography includes a selection of references to descriptive reports, research papers, editorials, letters, and commentaries on homehealth-care (HHC) services. This bibliography represents important literature from the past 12 years on program planning, marketing, trends, and reimbursement for HHC services as well as specific types of home therapy. The bibliography can be helpful to pharmacy administrators and clinicians who are interested in designing HHC programs or becoming involved in the provision of home therapy. PMID:3085486
Healthcoaches and psychotherapists both work with the art and science of facilitating change in their patients and clients. While the evolving field of healthcoaching and the established disciplines of clinical or counseling psychology share major areas of overlap, there are also significant distinctions between the two fields. This article outlines those similarities and dissimilarities with the intention of fostering a cooperative and mutually enriching stance between the two helping professions for the benefit of the respective professionals and the countless clients and patients they serve.
Objective To examine effects of a teacher consultation and coaching program delivered by school and community mental health professionals on change in observed classroom interactions and child functioning across one school year. Method Thirty-six classrooms within five urban elementary schools (87% Latino, 11% Black) were randomly assigned to intervention (training + consultation/coaching) and control (training only) conditions. Classroom and child outcomes (n = 364; 43% girls) were assessed in the fall and spring. Results Random effects regression models showed main effects of intervention on teacher-student relationship closeness, academic self-concept, and peer victimization. Results of multiple regression models showed levels of observed teacher emotional support in the fall moderated intervention impact on emotional support at the end of the school year. Conclusions Results suggest teacher consultation and coaching can be integrated within existing mental health activities in urban schools and impact classroom effectiveness and child adaptation across multiple domains.
Cappella, Elise; Hamre, Bridget K.; Kim, Ha Yeon; Henry, David B.; Frazier, Stacy L.; Atkins, Marc S.; Schoenwald, Sonja K.
Despite their popularity, empirical support for healthcoaches is limited. This study examined the feasibility and preliminary efficacy of 3 types of coaching models for obesity treatment. Participants (N=44) were randomized to 6 months of reduced intensity group behavioral weight loss (rBWL) plus 1 of 3 types of healthcoaches: a) Professional (rBWL interventionist); b) Peer (group members randomly paired and coached one another); or c) Mentor (successful weight loser). Groups met weekly for the first 6-weeks, biweekly for the next 6-weeks, and monthly thereafter, for a total of 12 meetings. During weeks that group did not meet, participants emailed their weight loss information to their coach and received feedback. Coaches were trained on appropriate coaching strategies and feedback delivery. Retention was 95%. Participants emailed their progress to their coach 10.8±1.9 out of the 12 weeks that there were no group meetings. Coaches responded with feedback 94% of the time. Percent weight losses at 6-months were 9.6±8.1, 9.1±5.0, and 5.7±5.6 for the Professional, Peer, and Mentor conditions, respectively. More participants in the Professional and Peer conditions lost 10% of their initial body weight (Professional: 56%; Peer: 50%; Mentor: 17%), with a statistically significant difference between the Professional and Mentor conditions (p=0.03). These preliminary data suggest that combining a reduced intensity BWL program with healthcoaching may hold significant promise as a cost-effective obesity treatment paradigm. Larger trials are needed to conclusively determine whether adding coaches improves weight loss outcomes in reduced intensity treatments and to examine which type of coach is most effective.
Background Depression and diabetes cause significant burden for patients and the healthcare system and, when co-occurring, result in poorer self-care behaviors and worse glycemic control than for either condition alone. However, the clinical management of these comorbid conditions is complicated by a host of patient, provider, and system-level barriers that are especially problematic for patients in rural locations. Patient-centered medical homes provide an opportunity to integrate mental and physical health care to address the multifaceted needs of complex comorbid conditions. Presently, there is a need to not only develop robust clinical interventions for complex medically ill patients but also to find feasible ways to embed these interventions into the frontlines of existing primary care practices. Methods/design This randomized controlled trial uses a hybrid effectiveness-implementation design to evaluate the Healthy Outcomes through Patient Empowerment (HOPE) intervention, which seeks to simultaneously address diabetes and depression for rural veterans in Southeast Texas. A total of 242 Veterans with uncontrolled diabetes and comorbid symptoms of depression will be recruited and randomized to either the HOPE intervention or to a usual-care arm. Participants will be evaluated on a host of diabetes and depression-related measures at baseline and 6- and 12-month follow-up. The trial has two primary goals: 1) to examine the effectiveness of the intervention on both physical (diabetes) and emotional health (depression) outcomes and 2) to simultaneously pilot test a multifaceted implementation strategy designed to increase fidelity and utilization of the intervention by coaches interfacing within the primary care setting. Discussion This ongoing blended effectiveness-implementation design holds the potential to advance the science and practice of caring for complex medically ill patients within the constraints of a busy patient-centered medical home. Trial registration Behavioral Activation Therapy for Rural Veterans with Diabetes and Depression: NCT01572389.
Primary Objective: Review the operational definitions of health and wellness coaching as published in the peer-reviewed medical literature. Background: As global rates of preventable chronic diseases have reached epidemic proportions, there has been an increased focus on strategies to improve health behaviors and associated outcomes. One such strategy, health and wellness coaching, has been inconsistently defined and shown mixed results. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)—guided systematic review of the medical literature on health and wellness coaching allowed for compilation of data on specific features of the coaching interventions and background and training of coaches. Results: Eight hundred abstracts were initially identified through PubMed, with 284 full-text articles ultimately included. The majority (76%) were empirical articles. The literature operationalized health and wellness coaching as a process that is fully or partially patient-centered (86% of articles), included patient-determined goals (71%), incorporated self-discovery and active learning processes (63%) (vs more passive receipt of advice), encouraged accountability for behaviors (86%), and provided some type of education to patients along with using coaching processes (91%). Additionally, 78% of articles indicated that the coaching occurs in the context of a consistent, ongoing relationship with a human coach who is trained in specific behavior change, communication, and motivational skills. Conclusions: Despite disparities in how health and wellness coaching have been operationalized previously, this systematic review observes an emerging consensus in what is referred to as health and wellness coaching; namely, a patient-centered process that is based upon behavior change theory and is delivered by health professionals with diverse backgrounds. The actual coaching process entails goal-setting determined by the patient, encourages self-discovery in addition to content education, and incorporates mechanisms for developing accountability in health behaviors. With a clear definition for health and wellness coaching, robust research can more accurately assess the effectiveness of the approach in bringing about changes in health behaviors, health outcomes and associated costs that are targeted to reduce the global burden of chronic disease.
Simmons, Leigh Ann; Sforzo, Gary A.; Dill, Diana; Kaye, Miranda; Bechard, Elizabeth M.; Southard, Mary Elaine; Kennedy, Mary; Vosloo, Justine; Yang, Nancy
Objective: To examine effects of a teacher consultation and coaching program delivered by school and community mental health professionals on change in observed classroom interactions and child functioning across one school year. Method: Thirty-six classrooms within 5 urban elementary schools (87% Latino, 11% Black) were randomly assigned to…
Cappella, Elise; Hamre, Bridget K.; Kim, Ha Yeon; Henry, David B.; Frazier, Stacy L.; Atkins, Marc S.; Schoenwald, Sonja K.
All teachers, coaches, and guidance counselors should be concerned about eating disorders as a health and life threatening illness. While no reliable research studies or statistics exist on the incidence of eating disorders among athletes and aerobic exercisers, estimates suggest that 10-20% of the female high school population and a much higher…
The HealthCoaching Program facilitates health behavior counseling in all areas of primary medical care: prevention, therapy and rehabilitation, i.e. wherever the patient is the decisive agent of change. HealthCoaching gives the patient the main role. The physician becomes his coach. HealthCoaching offers skills training and simple algorithms with a colour-coded visual tool to assist patient and physician through the 4 steps of developing awareness, building motivation, preparing a personal health project and implementing it. HealthCoaching was tested successfully by 20 family doctors during 12 months: of 1045 patients invited 91% enrolled; 37% completed all four steps; one half achieved a positive behavior change. Acceptance and feasibility were high in physicians and patients. Nationwide dissemination is now in preparation. PMID:24930151
Healthcoaching is an emerging behavioral intervention to improve outcomes in chronic disease management and prevention; however, no studies have investigated its utility in postpartum women who have gained excess weight during pregnancy. A 32-year-old primigravida woman who was overweight at conception and gained 23 lbs more than Institute of Medicine recommendations for her pre-pregnancy body mass index participated in a 6-month personalized health planning with integrative healthcoaching (PHPIHC) intervention. The intervention included a baseline health risk assessment review with a healthcare provider and eight biweekly, 30-minute telephonic healthcoaching sessions. The participant demonstrated improvement in physical activity, energy expenditure, knowledge, and confidence to engage in healthpromoting behaviors. Although the participant did not reach the target weight by completion of the healthcoaching sessions, follow up 8 months later indicated she achieved the target goal (within 5% of prepregnancy weight). This case report suggests that PHP-IHC can support postpartum women in returning to pre-pregnancy weight after gaining excess gestational weight. Future research and clinical trials are needed to determine the best timing, length, and medium (online, in-person, telephonic) of PHP-IHC for postpartum women. PMID:24278848
Healthcoaching is an emerging behavioral intervention to improve outcomes in chronic disease management and prevention; however, no studies have investigated its utility in postpartum women who have gained excess weight during pregnancy. A 32-year-old primigravida woman who was overweight at conception and gained 23 lbs more than Institute of Medicine recommendations for her pre-pregnancy body mass index participated in a 6-month personalized health planning with integrative healthcoaching (PHPIHC) intervention. The intervention included a baseline health risk assessment review with a healthcare provider and eight biweekly, 30-minute telephonic healthcoaching sessions. The participant demonstrated improvement in physical activity, energy expenditure, knowledge, and confidence to engage in healthpromoting behaviors. Although the participant did not reach the target weight by completion of the healthcoaching sessions, follow up 8 months later indicated she achieved the target goal (within 5% of prepregnancy weight). This case report suggests that PHP-IHC can support postpartum women in returning to pre-pregnancy weight after gaining excess gestational weight. Future research and clinical trials are needed to determine the best timing, length, and medium (online, in-person, telephonic) of PHP-IHC for postpartum women.
This curriculum guide is intended to assist vocational instructors in preparing students for entry-level employment as homemakers/homehealth aides and getting them ready for advanced training in the workplace. The package contains a competency/skill and task list, an instructor's guide, and an annotated bibliography. The following competencies…
The Mississippi State Department of Health surveyed 1412 physicians, response rate being 51.1%. Most had practiced in Mississippi over 10 years. Over 93% were aware of homehealth in their area. Open-ended responses revealed: (a) A need for better communication and on-going public information/relations concerning referral and available services, (b) Physicians' wish to manage their cases, (c) Complaints about burdensome paperwork and lack of compensation for time/liability, (d) Declines in some areas due to the number of competing agencies, and (e) The suggestion that nurses be assigned to specific physicians, clinics, and hospitals for referral generation. PMID:10110888
The rise of health and wellness coaching holds significant promise for facilitating sustainable behavior change to help legions of individuals prevent and manage chronic disease. We all know the threats associated with the staggering epidemic of chronic disease and associated unhealthy lifestyles. But did we get here through a failure of personal responsibility? A failure of family units to support appropriate health behaviors? A failure of educational systems to teach healthy behaviors? A failure of medicine to cultivate health behaviors in patients? A failure of municipalities from an urban planning perspective? A failure of the social sciences to apply the latest in adult learning theory, psychology, and behavioral economics to health behaviors? A failure of government to incentivize or reinforce health behaviors? A failure of industry to prioritize health over capital? A failure of society to integrate all of the above? Or is this just the perfect time to synergize all that we know from numerous disciplines to conquer the challenge of unhealthy behavior that creates chronic disease? From my perspective as a health psychologist, understanding the origins of the problems will help us draft the solution. But from my perspective as a coach, how we got here is much less important than how we get out of here.
This paper describes a study designed to assess the impacts of passive health status monitoring technology in homehealth. Monitoring systems were installed in the homes of 13 homehealth clients to track physiological parameters (heart rate, breathing rate, and gait), the activities of daily living (ADLs) and key alert conditions of residents, such as falls. Activity reports and alert
Majd Alwan; David C. Mack; Siddharth Dalal; Steve Kell; Beverely Turner; Robin A. Felder
Advanced practice nurses play an important role in the delivery of homehealth care. They possess the advanced knowledge and skills to improve the quality of care given to clients. The increasingly complex needs of those receiving homehealth services today make access to these providers imperative. Many clients may not have this clinical expertise readily available to them because
The report was written by the CDRH Ad Hoc HomeHealth Care Committee in order to begin to address specific concerns associated with medical devices used in homehealth care. The report includes summaries of the following eight device-related issues: accre...
Objectives To test the effect of a telephone healthcoaching service (Birmingham OwnHealth) on hospital use and associated costs. Design Analysis of person level administrative data. Difference-in-difference analysis was done relative to matched controls. Setting Community based intervention operating in a large English city with industry. Participants 2698 patients recruited from local general practices before 2009 with heart failure, coronary heart disease, diabetes, or chronic obstructive pulmonary disease; and a history of inpatient or outpatient hospital use. These individuals were matched on a 1:1 basis to control patients from similar areas of England with respect to demographics, diagnoses of health conditions, previous hospital use, and a predictive risk score. Intervention Telephone healthcoaching involved a personalised care plan and a series of outbound calls usually scheduled monthly. Median length of time enrolled on the service was 25.5 months. Control participants received usual healthcare in their areas, which did not include telephone healthcoaching. Main outcome measures Number of emergency hospital admissions per head over 12 months after enrolment. Secondary metrics calculated over 12 months were: hospital bed days, elective hospital admissions, outpatient attendances, and secondary care costs. Results In relation to diagnoses of health conditions and other baseline variables, matched controls and intervention patients were similar before the date of enrolment. After this point, emergency admissions increased more quickly among intervention participants than matched controls (difference 0.05 admissions per head, 95% confidence interval 0.00 to 0.09, P=0.046). Outpatient attendances also increased more quickly in the intervention group (difference 0.37 attendances per head, 0.16 to 0.58, P<0.001), as did secondary care costs (difference £175 per head, £22 to £328, P=0.025). Checks showed that we were unlikely to have missed reductions in emergency admissions because of unobserved differences between intervention and matched control groups. Conclusions The Birmingham OwnHealth telephone healthcoaching intervention did not lead to the expected reductions in hospital admissions or secondary care costs over 12 months, and could have led to increases.
Community health centers (CHCs) seek effective strategies to address obesity. MidWest Clinicians’ Network partnered with [an academic medical center] to test feasibility of a weight management quality improvement (QI) collaborative. MidWest Clinicians’ Network members expressed interest in an obesity QI program. This pilot study aimed to determine whether the QI model can be feasibly implemented with limited resources at CHCs to improve weight management programs. Five health centers with weight management programs enrolled with CHC staff as primary study participants; this study did not attempt to measure patient outcomes. Participants attended learning sessions and monthly conference calls to build QI skills and share best practices. Tailored coaching addressed local needs. Topics rated most valuable were patient recruitment/retention strategies, QI techniques, evidence-based weight management, motivational interviewing. Challenges included garnering provider support, high staff turnover, and difficulty tracking patient-level data. This paper reports practical lessons about implementing a weight management QI collaborative in CHCs.
Wilkes, Abigail E.; John, Priya M.; Vable, Anusha M.; Campbell, Amanda; Heuer, Loretta; Schaefer, Cynthia; Vinci, Lisa; Drum, Melinda L.; Chin, Marshall H.; Quinn, Michael T.; Burnet, Deborah L.
Obesity (and its related comorbidities) is one of the fastest-growing health concerns facing the United States and shows no sign of abating.(1) The Centers for Disease Control and Prevention calculated that nearly 36% of American adults were obese in 2010 and estimates that this number will reach 44% by 2018. The current standard of care for the management of patients with obesity in primary care is often a general recommendation by the physician to lose weight through improved nutrition and increased physical activity. Educational materials may be provided along with a referral to a dietician, nutritionist, or weight management program. Healthcoaching as an obesity intervention has yet to be fully integrated into primary care practice but has proven to be effective in corporate wellness and behavioral weight loss programs.(2) (-) (5.) PMID:24278845
Sherman, Ryan; Crocker, Ben; Dill, Diana; Judge, David
... and maintenance, personal care, or hobbies Diisocyanates in polyurethane products applied or manufactured in a home, including polyurethane floor finishes and spray polyurethane foam (SPF) insulation ...
The Essential Vitality Program blends holistic nursing, functional medicine, and healthcoaching to promote lifestyle changes that modify risk factors of costly chronic disease. Karl is a client who experienced enhanced vitality, decreased chronic pain and medications use, and improved meaningful functioning, by partnering with a holistic nurse coach. PMID:20706092
Inflation, increasing costs of health care delivery in institutions, and the increasing need to be more cost efficient in matching needs with services, indicate that homehealth care may have a critical role in the '80s. Emphasis on providing homehealth ...
Nursing homes are considered lagging behind in adopting health information technology (HIT). Many studies have highlighted the use of HIT as a means of improving health care quality. However, these studies overwhelmingly do not provide empirical information proving that HIT can actually achieve these improvements. The main research goal of this…
The HomeHealth Aide (HHA) industry is challenged with low wages, little possibility of career advancement, and high turnover rates. Jewish Home Lifecare, Home Assistance Personnel Inc. (HAPI) is a home care aide agency that has developed a Peer Mentor HHA program. Peer Mentor HHAs mentor newly hired/trained HHAs within our agency. This career path leads to higher paying work that allows for growth of our workforce for the identified growing care need and positively impacts HHA retention. PMID:20811183
Community health centers (CHCs) seek effective strategies to address obesity. MidWest Clinicians' Network partnered with [an academic medical center] to test feasibility of a weight management quality improvement (QI) collaborative. MidWest Clinicians' Network members expressed interest in an obesity QI program. This pilot study aimed to determine whether the QI model can be feasibly implemented with limited resources at CHCs to improve weight management programs. Five health centers with weight management programs enrolled with CHC staff as primary study participants; this study did not attempt to measure patient outcomes. Participants attended learning sessions and monthly conference calls to build QI skills and share best practices. Tailored coaching addressed local needs. Topics rated most valuable were patient recruitment/retention strategies, QI techniques, evidence-based weight management, motivational interviewing. Challenges included garnering provider support, high staff turnover, and difficulty tracking patient-level data. This paper reports practical lessons about implementing a weight management QI collaborative in CHCs. PMID:23727964
Wilkes, Abigail E; John, Priya M; Vable, Anusha M; Campbell, Amanda; Heuer, Loretta; Schaefer, Cynthia; Vinci, Lisa; Drum, Melinda L; Chin, Marshall H; Quinn, Michael T; Burnet, Deborah L
Communication and health monitoring technology and devices will enhance the potential for improved homehealth care services over the next decade. The technology exists to improve patients' access to specialized care, to monitor in-home risks for patients who have dementia or limitations in activities of daily living, and to minimize annoyances such as delays and long waiting times. Certain barriers must be addressed, however, such as third-party reimbursement restrictions, regulatory issues, and technologic limitations. Innovative clinicians will find ways to use these technologies to improve care while lowering costs and increasing value. PMID:23420799
For the Certified Nursing Assistant, this 20-hour supplemental HomeHealth Aide course is required to work as a HomeHealth Aide. The course includes the role of the aide in the home, differences in families, food and household management and other related topics pertinent to homehealth services. Instructor: Joe Steed, RN
This paper presents a conceptual analysis of access, quality, and cost containment incentives created bv several current and potential Medicare reimbursement methodologies. The alternatives examined are methods used by health-maintenance organizations (HMOs) and three options receiving national policy consideration: prospective per-visit and per-episode payment, and \\
Few studies have analyzed for-profit and nonprofit differences in the homehealth care sector. Using data from the National Home and Hospice Care Survey, we found that patients in nonprofit agencies were more likely to be discharged within 30 days under Medicare cost-based payment compared to patients in for-profit agencies. However, this difference in length of enrollment did not translate into meaningful differences in discharge outcomes between nonprofit and for-profit patients, suggesting that – under a cost-based payment system – nonprofits may behave more efficiently relative to for-profits. These results highlight the importance of organizational and payment factors in the delivery of homehealth care services.
Grabowski, David C.; Huskamp, Haiden A.; Stevenson, David G.; Keating, Nancy L.
Objectives: The purpose of this study was to identify core journals in homehealth nursing and to determine how well these journals were covered by indexing and abstracting services. The study was part of the project for mapping the nursing literature of the Medical Library Association's Nursing and Allied Health Resource Section. Methods: A citation analysis of two core journals was done to determine distribution of references by format types and age of citations and dispersion of the literature, according to Bradford's Law of Scattering. The analysis of indexing coverage for Zone 1 and 2 was also provided. Results: The study showed that 64.2% of citations came from journals, versus 22.9% from books and 12.9% from other publications. PubMed/ MEDLINE rated highest in average indexing coverage of Zone 1 and 2 journals, followed by CINAHL. PsycINFO, SocioAbstracts, and EBSCO Health Business FullTEXT showed practically no coverage for the homehealth nursing literature. Conclusion: As expected, journal articles were found to be the primary source for referencing and books, the secondary source. In regard to bibliographic control, no databases provided full coverage of the journals in the field of homehealth nursing. PubMed/MEDLINE and CINAHL gave better results in combination, because CINAHL tended to cover more nursing journals, while PubMed/MEDLINE did better with medical titles.
Objective: To describe the evolution, training, and results of an emerging allied health profession skilled in eliciting sustainable health-related behavior change and charged with improving patient engagement. Methods: Through techniques sourced from humanistic and positive psychology, solution-focused and mindfulness-based therapies, and leadership coaching, Integrative HealthCoaching (IHC) provides a mechanism to empower patients through various stages of learning and change. IHC also provides a method for the creation and implementation of forward-focused personalized health plans. Results: Clinical studies employing Duke University Integrative Medicine's model of IHC have demonstrated improvements in measures of diabetes and diabetes risk, weight management, and risk for cardiovascular disease and stroke. By supporting and enabling individuals in making major lifestyle changes for the improvement of their health, IHC carries the potential to reduce rates and morbidity of chronic disease and impact myriad aspects of healthcare. Conclusion: As a model of educational and clinical innovation aimed at patient empowerment and lifestyle modification, IHC is aligned well with the tenets and goals of recently sanctioned federal healthcare reform, specifically the creation of the first National Prevention and Health Promotion Strategy. Practice Implications: IHC may allow greater patient-centricity while targeting the lifestyle-related chronic disease that lies at the heart of the current healthcare crisis.
Smith, Linda L.; Lake, Noelle H.; Simmons, Leigh Ann; Perlman, Adam; Wroth, Shelley
This plan for homehealth care in the Kentucky Bluegrass Region provides for medical care and supportive services to sick or disabled persons according to Kentucky State health care regulations and policies. Currently there are six home agencies operating...
Homehealth agencies are increasingly being challenged to cope with economic, financial and clinical pressures. This study examines the extent to which homehealth agencies have cultivated their information systems as an aid for managing performance and external forces. Colorado and New Mexico homehealth agencies participated in the research project. The findings indicate that only modest investments have been
Because homehealth differs from community health nursing, using homehealth agencies as clinical sites to teach community health nursing may be inappropriate. This retrospective descriptive study compared the perceptions of students who took community health before it included a homehealth placement with those whose course included homehealth. Mailed surveys were returned from 28(63.6%) of the 44 students enrolled prior to the homehealth placements and from 30(60%) of the 50 students enrolled afterwards. Students whose experience included homehealth rated the home visit experience significantly better in terms of providing them an opportunity to perform health promotion and to care for family as client. They found the course more relevant, felt safer in making home visits, and were more likely to consider working in community health nursing. This study supports using homehealth agencies as clinical placements for community health nursing if they are supplemented with aggregate-level experiences. PMID:8950713
Accordant Health Services specializes in Crohn's disease management for health plans and employer groups across the United States. The claims database was used to ascertain patterns of care that might reveal opportunities to improve clinical interventions. One component of the research involved identifying primary drivers for homehealth utilization. Many Crohn's patients require complex and costly homehealth services for
Lakevia Hall; Catherlene Hamlin; Amy Stephens Bregman; Andrew Krueger; Jason Cooper
In November 2010, the American Public Health Association endorsed the health care home model as an important way that primary care may contribute to meeting the public health goals of increasing access to care, reducing health disparities, and better integrating health care with public health systems. Here we summarize the elements of the health care home (also called the medical home) model, evidence for its clinical and public health efficacy, and its place within the context of health care reform legislation. The model also has limitations, especially with regard to its degree of involvement with the communities in which care is delivered. Several actions could be undertaken to further develop, implement, and sustain the health care home.
...2013-10-01 false Homehealth services. 441.15 Section 441.15 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: REQUIREMENTS AND...
Rochester's Healthy Home was a hands-on home environmental health museum that educated over 3500 visitors between June 2006 and December 2009. The Healthy Home provided visitors with the tools, resources, and motivation to make their homes healthier by reducing environmental hazards. The Healthy Home focused on empowering low-income renters to protect their families from homehealth risks, but served a broad audience. Based on the Healthy Home's initial successes with diverse visitors, in 2009 the county health department provided funding for a six-month project to educate 200 recently arrived refugees. This report summarizes the project's innovative approach to homehealth education, presents evaluation data on impacts on refugees and other visitors, suggests implications for resettlement agencies, and provides guidelines for those interested in replicating this approach in their own community.
Introduction: Homehealth care is the fastest growing sector in the health care industry, with an anticipated growth of 66 percent over the next 10 years and with over 7 million patients served each year. With the increasing acuteness of care provided in homehealth care and the increasing number of frail elderly that make up this patient population, it
Robyn R. M. Gershon; Monika Pogorzelska; Kristine A. Qureshi; Patricia W. Stone; Allison N. Canton; Stephanie M. Samar; Leah J. Westra; Marc R. Damsky; Martin Sherman
In the United States, over 600,000 homehealth aides (HHAs) provide supportive services and personal assistance to patients receiving homehealth care. Although aide services are essential to the health and well being of patients who receive them, the nur...
G. Maduro M. Ryvicker P. Feldman R. Rosati T. Schwartz
Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the HealthHome initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools – accountability measures and payment designs – to improve access to and quality of care for patients with behavioral health needs.
Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan
Objectives: Substance exposed infants present a major challenge to child welfare and public health systems. Prenatal substance exposure and continued substance abuse in the home are associated with a wide range of adverse social, emotional, and developmental outcomes. The objective of the current study is to evaluate the use of recovery coaches in…
Ryan, Joseph P.; Choi, Sam; Hong, Jun Sung; Hernandez, Pedro; Larrison, Christopher R.
Background The aim was to evaluate the effect of a 12-month individualized healthcoaching intervention by telephony on clinical outcomes. Methods An open-label cluster-randomized parallel groups trial. Pre- and post-intervention anthropometric and blood pressure measurements by trained nurses, laboratory measures from electronic medical records (EMR). A total of 2594 patients filling inclusion criteria (age 45?years or older, with type 2 diabetes, coronary artery disease or congestive heart failure, and unmet treatment goals) were identified from EMRs, and 1535 patients (59%) gave consent and were randomized into intervention or control arm. Final analysis included 1221 (80%) participants with data on primary end-points both at entry and at end. Primary outcomes were systolic and diastolic blood pressure, serum total and LDL cholesterol concentration, waist circumference for all patients, glycated hemoglobin (HbA1c) for diabetics and NYHA class in patients with congestive heart failure. The target effect was defined as a 10-percentage point increase in the proportion of patients reaching the treatment goal in the intervention arm. Results The proportion of patients with diastolic blood pressure initially above the target level decreasing to 85?mmHg or lower was 48% in the intervention arm and 37% in the control arm (difference 10.8%, 95% confidence interval 1.5–19.7%). No significant differences emerged between the arms in the other primary end-points. However, the target levels of systolic blood pressure and waist circumference were reached non-significantly more frequently in the intervention arm. Conclusions Individualized healthcoaching by telephony, as implemented in the trial was unable to achieve majority of the disease management clinical measures. To provide substantial benefits, interventions may need to be more intensive, target specific sub-groups, and/or to be fully integrated into local health care. Trial registration ClinicalTrials.gov Identifier: NCT00552903
The Patient-Centered Medical Home (PCMH) is an approach to providing comprehensive care for children, youth, and adults in the primary care setting. PCMH emphasizes planned care, care coordination, family-centered approaches, and quality of care while also improving access to care and modernizing the care experience. Although health educators as a group have not traditionally focused their efforts on the primary care setting, the PCMH model increases the potential for their inclusion. Health educators, given their training and expertise, are likely to be well positioned to contribute to primary care oriented with a PCMH model. Health educator roles within PCMH that are especially relevant include participating in a team approach to care, attention to coordination and integration of care, and preventive and end-of-life care. Such roles may be realized in direct delivery of patient education such as healthcoaching, serving as a facilitator or connector to community resources, or involvement in practice or practice organization quality improvement and population-based assessment efforts. If implemented properly, the involvement of health educators in this new model of care has the potential to enhance how primary care is delivered, improve the health of Americans with regard to chronic conditions, and reduce related health care costs. PMID:20817632
Home telemonitoring can augment homehealth care services during a patient's transition from hospital to home. Homehealth care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to homehealth care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from homehealth care services. Results showed no difference in the time to rehospitalizations or emergency visits between those who received a telemonitoring vs. usual care. Older heart failure patients who received telemonitoring had better health status by homehealth care discharge than those who received usual care. Therefore for older adults with heart failure telemonitoring may be important adjunct to homehealth care services to improve health status.
Madigan, Elizabeth; Schmotzer, Brian J.; Struk, Cynthia J.; DiCarlo, Christina M.; Kikano, George; Pina, Ileana L.; Boxer, Rebecca S.
A prospective telephone-administered questionnaire study in new home occupants compared general and respiratory health at occupancy and 1 year later in two groups. The test group or cases, was 52 R-2000 TM homes (128 occupants) built to preset and certified criteria for energy efficient ventilation and construction practices. The control group were 53 new homes (149 occupants) built in the
Medicare homehealth care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, homehealth care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…
Background Many patients with chronic disease do not reach goals for management of their conditions. Self-management support provided by medical assistant healthcoaches within the clinical setting may help to improve clinical outcomes, but most studies to date lack statistical power or methodological rigor. Barriers to large scale implementation of the medical assistant coach model include lack of clinician buy-in and the absence of a business model that will make medical assistant healthcoaching sustainable. This study will add to the evidence base by determining the effectiveness of healthcoaching by medical assistants on clinical outcomes and patient self-management, by assessing the impact of healthcoaching on the clinician experience, and by examining the costs and potential savings of healthcoaching. Methods/Design This randomized controlled trial will evaluate the effectiveness of clinic-based medical assistant healthcoaches to improve clinical outcomes and self-management skills among low-income patients with uncontrolled type 2 diabetes, hypertension, or hyperlipidemia. A total of 441 patients from two San Francisco primary care clinics have been enrolled and randomized to receive a healthcoach (n?=?224) or usual care (n?=?217). Patients participating in the healthcoaching group will receive coaching for 12 months from medical assistants trained as healthcoaches. The primary outcome is a change in hemoglobin A1c, systolic blood pressure, or LDL cholesterol among patients with uncontrolled diabetes, hypertension and hyperlipidemia, respectively. Self-management behaviors, perceptions of the health care team and clinician, BMI, and chronic disease self-efficacy will be measured at baseline and after 12 months. Clinician experience is being assessed through surveys and qualitative interviews. Cost and utilization data will be analyzed through cost-predictive models. Discussion Medical assistants are an untapped resource to provide self-management support for patients with uncontrolled chronic disease. Having successfully completed recruitment, this study is uniquely poised to assess the effectiveness of the medical assistant healthcoaching model, to describe barriers and facilitators to implementation, and to develop a business case for sustainability. Trial registration ClinicalTrials.gov identifier NCT-01220336
In the ever changing arena of homehealth care, there always remains the need to provide quality care and services in a cost-efficient and acceptable manner. Occupational therapy, physical therapy, and speech-language pathology services have experienced similar workforce fluctuations to that of the nursing field. In an effort to remain a comprehensive homehealth provider, agencies may find themselves utilizing
A collection of articles provides current instructional information to softball players and coaches. Topics discussed in the series include practice, basic skills, defense, pitching, catching, offense, and warm-up exercises to be used in conjunction with other conditioning drills. (JN)
The need for homehealth care has been increasing in Japan and the application of various techniques such as medical informatics are desired to support homehealth care services. Therefore, we developed an information system for health evaluation of the elderly including patients at home by applying a multifunctional telephone set and an IC memory card, by which complaints, symptoms,
H. Inada; H. Horio; K. Nakazawa; Y. Sekita; T. Yamanaka; E. Harasawa; H. Hosaka; K. Ishikawa
Wide variation in Medicare home care utilization became apparent in the 1990s. This study examined the impact of patient, provider, agency, and market factors on five measures of home care practice. Data were collected at 44 agencies in eight states. The final analysis sample included 732 home care episodes for which longitudinal patient data were available. Results indicated that patient
Angela G. Brega; Anne K. Jordan; Robert E. Schlenker
This study reports on the design and testing of an integrated suite of vocabulary training games for Nintendo[TM] collectively designated "My Word Coach" (Ubisoft, 2008). The games' design is based on a wide range of learning research, from classic studies on recycling patterns to frequency studies of modern corpora. Its general usage and learning…
The U.K. government has committed to an 80% reduction in carbon emissions by 2050, with housing accounting for 27% of total current emissions. There are several drivers both to reduce emissions from homes and to reduce fuel poverty, promoting a range of building and behavioural measures in homes. The health benefits of warmer homes in winter have been described, but there has been less consideration of the potential negative impacts of some of these measures. We examine the changes in U.K. homes, and the possible consequences for health. The main concerns for health surround the potential for poor indoor air quality if ventilation is insufficient and the possible risks of overheating in heatwave conditions. This paper notes a limited evidence base and the need for further research on the health effects of energy-efficient homes, particularly with regard to ventilation. PMID:21086820
This study describes nursing homes' use of Minimum Data Set (MDS) software and identifies features that are available in the most commonly used software packages. Data came from the On-line Survey, Certification and Reporting system and a national survey of nursing home administrators (N = 2,899) conducted in 2005. Results show that 2,397 (82.7%) of nursing homes used third-party MDS
Purpose: Mental health problems are pervasive in nursing homes (NHs), but little is known regarding the delivery of mental health services in these settings. To fill this gap in knowledge, we conducted a survey of NH administrative personnel views on mental health services use.Design and methods: We analyzed 146 surveys from NH administrative personnel, reflecting 70% of the NHs that
Victor Molinari; Deborah Hedgecock; Larry Branch; Lisa M. Brown; Kathy Hyer
The demand for homehealth aides is expected to rise, despite concerns about the sustainability of this workforce. Homehealth workers receive low wages and little training and have high turnover. It is difficult to recruit and retain workers to improve clinical outcomes. This study presents national estimates to examine how homehealth workers and the subgroup of workers differ in terms of sociodemographic characteristics, compensation, benefits, satisfaction, and retention. Hospice aides fare better than other categories of workers and are less likely to leave their job. Policymakers should consider strategies to increase the quality and stability of this workforce. PMID:24372475
The ageing of the population, the growth of chronic diseases, and the explosion of healthcare costs jeopardise the sustainability of healthcare systems in many European countries. This opens opportunities for innovative prevention and healthcare services supported by information and communication technologies (ICT). The natural focus for providing such services is the home. However, the e-health services provided in the home so far are limited in scope and fragmented. This paper suggests a comprehensive service model for home-based e-health services in Europe, which aims to overcome the current service fragmentation. The Health@Home model integrates disease prevention and healthcare for different groups of citizens at different stages on the health scale. The technical challenge of this model is the national and Europe-wide integration of heterogeneous systems and services in a way that makes them reliable and easy to use for all citizens, particularly those with low technical abilities and severe impairments.
BackgroundCommunication is problematic in healthcare. The Veterans Health Administration is implementing Medical Team Training. The authors describe results of the first 32 of 130 sites to undergo the programme. This report is unique; it provides aggregate results of a crew resource-management programme for numerous facilities.MethodsFacilities were taught medical team training and implemented briefings, debriefings and other projects. The authors coached
Julia Neily; Peter D Mills; Pamela Lee; Brian Carney; Priscilla West; Katherine Percarpio; Lisa Mazzia; Douglas E Paull; James P Bagian
The survey of homehealth care agencies was designed to provide much-needed information on the magnitude of home care services in Illinois and the types of services provided. The IDPH and the Illinois Council on HomeHealth Services hope that the survey w...
Relationship-based infant mental healthhome visiting services for infants, toddlers, and their families intensify the connection between the personal and professional. To promote the therapeutic relationship and maximize the effectiveness of the intervention, home visitors must exercise good judgment, in the field and in the moment, to set and…
The responsibilities of home care nurse executives were investigated. A 51 item survey developed by an expert panel was completed by 54 home care nurse executives in Pennsylvania and New Jersey. Respondents evaluated the importance and time spent on each activity. A second expert panel identified where each activity is usually taught in an interdisciplinary curriculum. Based on the survey results, recommendations for graduate education for home care nurse executives were developed, emphasizing course content in the areas of law and policy, financial management, marketing, quality assurance, and organizational behavior. PMID:10110882
Quality improvement is as central to homehealth care as to any other field of health care. With the mandated addition in 2000 of Outcome Assessment and Information Set (OASIS) and outcome-based quality improvement (OBQI), Medicare homehealth agencies entered a new era of documenting, tracking, and systematically improving quality. OBQI is augmented by the Medicare Quality Improvement Organization (QIO) program, which is now entering the ninth in a series of work assignments, with the tenth scope in the planning stages. Evidence has shown that applied quality improvement methods can drive better outcomes using important metrics, such as acute care hospitalization. This article reviews key findings from the past 2 decades of home care quality improvement research and public policy advances, describes specific examples of local and regional programmatic approaches to quality improvement, and forecasts near-future trends in this vital arena of homehealth care. PMID:19217497
In an effort to better understand the current use and adoption rates of electronic health records and other health information technology (HIT) applications within nursing homes, the Division of Health Care Policy and Research at the University of Colorad...
The demand for homehealth care services is rising tremendously. It is important to maintain these services especially in\\u000a times of natural disasters. Therefore, powerful algorithms are required to assist decision making. This paper presents a model\\u000a formulation and solution approach for the daily planning of homehealth care services. In cooperation with the Austrian Red\\u000a Cross, one of the
Andrea Trautsamwieser; Manfred Gronalt; Patrick Hirsch
Over the last decade, cost-containment pressures, health care reform debates, movement to case-managed health care, and reductions\\u000a in health care benefits have required most families to be responsible for selecting specific health care services that keep\\u000a costs to a minimum. As Eddy [17-20] discussed in a series of articles on making decisions in health care, the consensus among\\u000a health care
Carol E. Smith; Susan V. M. Kleinbeck; Karen Fernengel; Linda S. Mayer
...Rate Update for CY 2014, HomeHealth Quality Reporting Requirements, and Cost Allocation of HomeHealth Survey Expenses...Rate Update for CY 2014, HomeHealth Quality Reporting Requirements, and Cost Allocation of HomeHealth Survey...
...NHTSA-2008-0210; Notice 2] Newell Coach Corporation, Grant of Petition...SUMMARY: Newell Coach Corporation (Newell) has determined that certain motor homes that it manufactured...paragraph S5.3 of Federal Motor Vehicle Safety...
Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many homehealth agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare homehealth benefit that impede access
Despite limited scientific study on ADHD coaching as an intervention for adults with ADHD, the field of ADHD coaching has grown significantly and gained popularity in recent years. ADHD coaching is becoming a bona fide profession where one must advance through a rigorous training process, in order to be certified as a professional ADHD coach.…
Murphy, Kevin; Ratey, Nancy; Maynard, Sandy; Sussman, Susan; Wright, Sarah D.
Unobtrusive and easy-to-use sensor devices are used for monitoring the health condition of people interested in adopting a healthier lifestyle. The collected data from body sensors and input from questionnaires are analyzed allowing to derive improvement plans and recommendations. With the help of feedback, coaching and motivation a closed-loop system approach is realized optimally supporting people to reach their goals
Harald Reiter; Elke Naujokat; Robert Pinter; Sandrine Devot
Background Despite well-publicized guidelines on the appropriate management of cardiovascular disease (CVD) and type 2 diabetes, implementation of risk-reducing practices remains poor. This paper describes the rationale and design of a randomized controlled clinical trial evaluating the effectiveness of a comprehensive program of CVD risk reduction delivered by nurse practitioner (NP)/community health worker (CHW) teams versus enhanced usual care in improving the proportion of patients in urban community health centers who achieve goal levels recommended by national guidelines for lipids, blood pressure, HbA1c and prescription of appropriate medications. Methods The COACH (Community Outreach and Cardiovascular Health) trial is a randomized controlled trial in which patients at federally-qualified community health centers were randomly assigned to one of two groups: comprehensive intensive management of CVD risk factors for one year by a NP/CHW team or an enhanced usual care control group. Results A total of 3899 patients were assessed for eligibility and 525 were randomized. Groups were comparable at baseline on sociodemographic and clinical characteristics with the exception of statistically significant differences in total cholesterol and hemoglobin A1c. Conclusions This study is a novel amalgam of multilevel interdisciplinary strategies to translate highly efficacious therapies to low-income federally-funded health centers that care for patients who carry a disproportionate burden of CVD, type 2 diabetes and uncontrolled CVD risk factors. The impact of such a community clinic-based intervention is potentially enormous.
Allen, Jerilyn K; Himmelfarb, Cheryl R Dennison; Szanton, Sarah L; Bone, Lee; Hill, Martha N; Levine, David M
The potential for health information technology to improve the efficiency and effectiveness of health care has resulted in several U.S. policy initiatives aimed at integrating health information technology into health care systems. However, homehealth care agencies have been excluded from incentive programs established through policies, raising concerns on the extent to which health information technology may be used to improve the quality of care for older adults with chronic illness and disabilities. This analysis examines the potential issues stemming from this exclusion and explores potential opportunities of integrating homehealth care into larger initiatives aimed at establishing health information technology systems for meaningful use. PMID:23937673
Ruggiano, Nicole; Brown, Ellen L; Hristidis, Vagelis; Page, Timothy F
Background Lower socioeconomic strata (SES) populations have higher chronic disease risks. Smartphone-based interventions can support adoption of health behaviors that may, in turn, reduce the risks of type 2 diabetes-related complications, overcoming the obstacles that some patients may have with regular clinical contact (eg, shiftwork, travel difficulties, miscommunication). Objective The intent of the study was to develop and test a smartphone-assisted intervention that improves behavioral management of type 2 diabetes in an ethnically diverse, lower SES population within an urban community health setting. Methods This single-arm pilot study assessed a smartphone application developed with investigator assistance and delivered by healthcoaches. Participants were recruited from the Black Creek Community Health Centre in Toronto and had minimal prior experience with smartphones. Results A total of 21 subjects consented and 19 participants completed the 6-month trial; 12 had baseline glycosylated hemoglobin (HbA1c) levels >7.0% and these subjects demonstrated a mean reduction of 0.43% (SD 0.63) (P<.05) with minimal changes in medication. Conclusions This project supported the feasibility of smartphone-based healthcoaching for individuals from lower SES with minimal prior smartphone experience.
We explored health literacy in parents as an underlying construct that develops through social interaction and reflection and involves an array of skills that enable a parent to manage personal and child health and healthcare. We hypothesized that depression impairs health literacy and impedes efforts to promote health literacy through home visitation. We analyzed an AHRQ/NIH database of 2,572 parent/child dyads compiled in a 2006-2008 quasi-experimental six-site nationwide study using multiple waves of measurement and a matched comparison group. Cohort families participated in home visitation programs augmented to develop parents' reflective skills. Visitors monitored depression, health- and healthcare-related practices, and surrounding family conditions at baseline and 6-month intervals for up to 36 months using the Life Skills Progression instrument. We examined differences in initial depression ratings for demographic subgroups and explored patterns of change in health literacy among depressed versus not-depressed parents. Correlation analysis showed that at each of four assessments better depression scores were consistently and positively correlated with use of information and services (r = 21-22, P < .001) and with self-management of personal and child health (r = 42-49, P < .001). Overall, parents made significant improvements in health literacy (P < .001). As expected, depressed parents demonstrated lower baseline health literacy scores than not-depressed parents; however, they achieved greater gains (P < .001). While depression is linked with lower parental health literacy, after 1 year of enhanced home visitation, vulnerable parents were better able to manage personal and family health and healthcare, especially if depressed. Enhanced home visitation could be an effective channel to develop health literacy as a life skill, and to improve depression. PMID:22120425
Running is an enjoyable exercise for many people today. Trainers help people to reach running goals. However, today’s busy and nomadic people are not always able to attend running classes. A combination of a virtual and physical coach should be useful. A virtual coach (MyCoach) was designed to provide this support. MyCoach consists of a mobile phone (real time) and a web application, with a focus on improving health and well-being. A randomised controlled trial was performed to evaluate MyCoach. The results indicate that the runners value the tangible aspects on monitoring and capturing their exercise and analysing progress. The system could be improved by incorporating running schedules provided by the physical trainer and by improving its usability. Extensions of the system should focus on the real-time aspects of information sharing and “physical” coaching at a distance.
...Administration Noncompetitive Supplements to Nursing Assistant and HomeHealth Aide Program...expansion supplements of $100,000 to 10 Nursing Assistant and HomeHealth Aide (NAHHA...Health Sciences Center (TTUHSC) School of Nursing, 302 Pine Street, Abilene, TX...
The Long Term HomeHealth Care Program was created in 1979 with the intent of providing another alternative to institutional care. The LTHHCP may be provided by a homehealth agency certified under Article 36 of the Public Health Law; a public, voluntary ...
A questionnaire concerning health and living conditions was sent to the parents of 1387 children aged 0-15 years to answer the question if children living in homes built with large amounts of particle board had more headaches and respiratory and skin symptoms than other children. There were 1376 possible respondents, and of those 1036 (75.3)% returned the questionnaire. Of the questionnaires returned, 972 (70.6%) were analyzable. The children lived in homes with much particle board (group A); little particle board, or homes as group A but treated in a special way (group B); and homes with no particle board (group C). For the 0- to 5-year-old children, living in homes with much particle board was a risk factor for developing wheezy bronchitis, eye and nose irritation, and coughing. For the 6- to 15-year-old children, living in a home with much particle board was not a risk factor. Risk factors for headache, irritation of the throat, and need for daily antiasthmatic medication were analyzed for all the children collectively. Living in a home with much particle board was a risk factor for all three conditions.
Daugbjerg, P. (Univ. of Copenhagen, Glostrup (Denmark))
Efforts to improve the quality and efficiency of primary care have recently focused on the concept of the Patient Centered Medical Home (PCMH). Given that primary care serves as a main venue for providing mental health treatment, it is important to consid...
Examines the policies and procedures that homehealth care agencies have developed to handle incapacitated patients and life-sustaining treatment decisions. Although most directors, staff, and patients agree that patients know their legal rights, only 67% of agencies reported having existing policies on advance directives, and only 41.5% had…
The great majority of children receiving intervention from child welfare and protection services (CWS) in Norway live at home. The purpose of this study was to assess mental health problems among these children. Data stem from a population-based study, the Bergen child study, conducted in 2006. Of a sample consisting of 4,162 children in the fifth…
This book offers insights into the coaching profession and examines the many facets involved in the world of the coach. It provides a description of the nature of coaching, points out problem areas, offers advice, and creates discussion and debate for individuals entering the profession. Chapter topics include: (1) Nature of the Profession; (2)…
This study describes the effects of a program designed to train Dutch primary school teachers in skills needed to coach and act as mentors for beginning teachers. The study investigated whether mentors who participated in the training program would implement the target coaching skills and whether the beginning teachers coached by the mentors would…
National surveys have shown that mental health problems are prevalent in long-term care and suggest that these settings are largely underserved by mental health services. Nursing home administrators are gatekeepers for mental health services in nursing homes. Administrators of Kentucky nursing homes were surveyed regarding their perceptions of mental health problems, current and future services use, satisfaction with services, and
Suzanne Meeks; Martin W. Jones; Vladimir Tikhtman; Tammi R. La Tourette
The relationships between selected child health outcomes and programmatic interventions using home visitors are analyzed. The following features of seven programs are systematically reported: program characteristics; description of the home visitors; program objectives, sample size, and research design; outcome measures and reported data. A number of issues such as funding and long-term viability, use of professional or paraprofessional visitors, visitor selection and supervision, and evaluation of home visitor programs require clarification and are discussed. It is concluded that home visitor programs can contribute to child health outcomes such as increased birth weight, improved prenatal care, improved maternal-infant interaction, and improved use of community resources. Pediatricians can be supportive of such programs at many levels: becoming aware of the existence and range of services of home visitor programs in their area that serve families with children and referring families to those programs; being available to advise programs that are in the planning stages; providing advocacy at the local, state, and national level for the funding and development of such programs; and taking the initiative to join multidisciplinary efforts to develop new programs. PMID:2339030
From Harvard@Home, this website presents more than seven hours of video clips from the Radcliffe Institute for Advanced Study's third-annual conference on women, gender, and society held in October of 2004. Titled _Reproductive Health in the 21st Century_, the "conference examines a broad array of issues surrounding reproductive health and features panels of distinguished physicians, scholars, and health policy advocates discussing the scientific, ethical, and social dimensions of medical and technological advances in the field and their global implications." Conference topics include The Politics and Ethics of Bodily Integrity; In Vitro Fertilization in the Muslim Middle East; Women Workers as Reproducers; and The Moral Issue of Sex Selection, to name a few. In addition to the video clips, the website contains topic summaries, short biographies of the numerous panelists, a feedback survey form, and links to related Harvard@Home programs. This site is also reviewed in the February 4, 2005_NSDL Life Sciences Report_.
This article presents coaching, which facilitates the highest form of learning, as a potential strategy for promoting professional development in nursing. In doing so, it sets out what coaching is and highlights its benefits in terms of team building, adaptation to changes, career planning and professional development. Having established the rudiments of coaching and identifying its qualities, the article then sets out strategies of coaching using three models: the 3-D Technique Model, The Practice Spiral Model and The Grow Model. Three case histories are presented to explain how these models could be used to implement coaching and personal learning plans (PLP). Directions are provided where training for coaching is available. It is concluded that coaching can be a powerful tool in enhancing nurses' and other health professionals' ability to contribute to the success of healthcare organisations. PMID:24933546
The aim of the study was to compare two coaching channels—a combination of telephone and face-to-face coaching (combined phone and face-to-face) versus telephone coaching only (phone)—on exercise performances in a home-based low-intensity program. Multiple regression models were used to examine if the two coaching channels were associated with different 3-month posttest exercise performances. Individuals with the combined phone and face-to-face
Designed for use in a self-paced, open-entry/open-exit vocational training program for homehealth aides, this program guide is one of six for teachers of adult women offenders from a correctional institution. Module topic outlines are presented on eight topics: your career as a health aide; maintaining health; recognizing illness; positioning and…
...false Services of residents in skilled nursing facilities and homehealth agencies...204 Services of residents in skilled nursing facilities and homehealth agencies...specified requirements: (1) Skilled nursing facility. Payment to a...
Background As more people reach older age, there is a growing interest in improving old person’s health, activity, independence and social participation, thereby adding quality to the extended years. Preventive home visits (PHV) programs for old people have received much attention in recent decades. A large body of research shows mixed effects, and argues that a home visit is a complex social process influenced by numerous factors. To evaluate the impact of PHV, as well as making decisions on whether, how, and to whom the service should be provided, requires a deeper understanding of PHV than we have now. Consequently, the aim of the study was to describe the variations in older people’s (80+) experiences of a single preventive home visit and its consequences for health. Methods Seventeen participants between 80 and 92 years of age who had all received a structured PHV were interviewed in their own homes. The interviews were analyzed using the phenomenographic method, looking at the variations in the participants’ experiences. Results The interviews revealed four categories: “The PHV made me visible and proved my human value”; “The PHV brought a feeling of security”; “The PHV gave an incentive to action”; and “The PHV was not for me”. Conclusions The experiences of a PHV were twofold. On one hand, the positive experiences indicate that one structured PHV was able to empower the participants and strengthen their self-esteem, making them feel in control over their situation and more aware of the importance of keeping several steps ahead. Together this could motivate them to take measures and engage in health-promoting activities. On the other hand, the PHV was experienced as being of no value by a few. These findings may partly explain the positive results from PHV interventions and emphasize that one challenge for health care professionals is to motivate older people who are healthy and independent to engage in health-promoting and disease-preventive activities.
Five agencies providing homehealth care to indigent populations in New Orleans, Louisiana were evaluated in terms of emergency planning and implementation. This was to help improve response to community disasters for indigent populations. Preparation for Hurricane Katrina was examined looking at interaction with local and state departments of health. It was found that the state dept of health provided leadership in making the emergency plans, but not in implementation. Local departments of health appeared to have very little responsibility in emergency planning. Although every agency had a plan, when it came to implementation there was lack of coordination and breakdown in communication at all government levels. Recommendations for future policy include: 1) early evacuation of special needs patients; 2) improved training of staff to include practice drills; 3) improve communication systems; and, 4) increased funding of state and local departments of health to provide training. PMID:17483559
Homehealth agencies are increasingly being challenged to cope with economic, financial and clinical pressures. This study examines the extent to which homehealth agencies have cultivated their information systems as an aid for managing performance and external forces. Colorado and New Mexico homehealth agencies participated in the research project. The findings indicate that only modest investments have been
Private-duty, homehealth care agencies have struggled in assuring compliance with accurate and complete nursing documentation. In this descriptive study, the author reports on an improvement and innovation project in a private-duty, homehealth care agency aimed at improving nursing documentation, as measured in chart review audits. Initial strategies were directed toward revising the documentation system, with implementation of a flow record, and conducting group nurse education. These efforts had a minimal effect on improving documentation compliance. A major, multifocus strategy was then implemented. The educational component stressed pre- and posttest. The chart audit tool was revised to track individual nurse behaviors. Nurses were mentored when documentation did not meet standards. Lastly, the nurse job description and corresponding performance appraisal document were revised to clarify nurse responsibility and strengthen nurse accountability; progressive discipline was initiated when warranted. Significant and sustained improvement was subsequently realized. PMID:10343478
A prospective randomized trial was conducted to examine the effectiveness, feasibility, and degree of implementation of homehealth care quality improvement interventions when implemented under usual conditions by usual care providers. A total of 311 older adults were randomized to enhanced usual care (EUC) that included routine depression screening and staff training in depression care management for older adults or to the intervention group (INT) that included antidepressants and/or psychotherapy treatment plus EUC. Implementing a routine screening protocol using the PHQ-9 and depression care management quality improvements is feasible in diverse homehealth care organizations and results in consistently better (but not statistically significant) depression outcomes in the INT group. PMID:17804354
Institutionalised elderly often report oral and dental problems which reduce nutrition ability and compromise significantly quality of life. The main objective of this study was to assess the prevalence of oral diseases in a group of residential homes elderly and to evaluate the association between degree of edentulism and some individual characteristics. From November 2004 to April 2005 448 subjects living in 10 residential homes of the city of Rome were enrolled in a special dental health programme in Lazio (Central Italy). The median age was 83.2 yrs, 47.3% of the subjects were edentulous, while 24.8% had 1 to 9 teeth, 63.1% of whom didn't have denture. 57.1% of subjects reported one or more oral disorders. Multivariate analysis showed a significant association between edentulism and the following factors: age > or = 75 yrs (Odds Ratio [OR] = 3.16 CI 95% 2.11-4.74) permanence of stay in the residential home > or = 3 yrs (OR = 1.96 CI 95% 1.13-3.40), lack of routine dental visits (OR = 1.71 CI 95% 1.14-2.58). The study findings confirmed that institutionalised elderly subjects, together with several chronic diseases, also show a poor oral health. Consequently greater attention should be paid to improve actively oral health services in this care setting. PMID:18210776
This paper provides an analysis of the structure of the health care delivery system, emphasizing physician group practices. The authors argue for comprehensive integrated delivery systems (IDSs). The jumping-off point for their analysis is the recently published Redefining Health Care: Creating Value-Based Competition on Results, by Michael Porter and Elizabeth Teisberg. The authors focus on the book's core idea that competitors should be freestanding integrated practice units (or "islands in archipelagos") versus IDSs (or "medical homes"). In any case, the authors contend that this issue should be resolved by competition to attract and serve informed, cost-conscious, responsible consumers on a level playing field. PMID:17848447
Enthoven, Alain C; Crosson, Francis J; Shortell, Stephen M
Mental health problems are highly prevalent among individuals with HIV and are consistently associated with negative health outcomes. However, mental illness often remains untreated due to significant psychosocial and physical barriers to treatment participation. The Collaborative HIV/AIDS Mental Health Program (CHAMP) assessed the outcomes associated with providing 9 months of in-home mental health counseling for 40 individuals with HIV and a Major Axis I mental disorder. The evidence-based Illness Management and Recovery Model was adapted for use with HIV-positive individuals for the study using a community-based participatory research approach. Study participants were surveyed at baseline, 5 and 9 months to assess for changes in health outcomes. Thirty-five percent of study participants were female, 80% African American, 33% self-identified as MSM and the average participant age was 43. Forty percent of participants were on psychotropic medication at baseline. Participants had an average of 8 counseling visits (median 9). Statistically significant decreases in the global Brief Symptom Inventory (BSI) score and a number of BSI symptoms dimensions including anxiety, depression, obsessive compulsive, phobic anxiety and hostility were detected, indicating a reduction of psychiatric symptoms. Statistically significant improvement was also identified for the SF-12 mental health scale, adaptive coping, overall social support and emotional support. No differences in psychiatric outcomes were identified by gender, race/ethnicity, or sexual preference. Findings from the CHAMP Study suggest that the use of in-home mental health treatment may be beneficial in engaging and treating HIV-positive individuals with comorbid mental health disorders. PMID:23050767
Reif, Susan S; Pence, Brian W; LeGrand, Sara; Wilson, Elena S; Swartz, Marvin; Ellington, Terry; Whetten, Kathryn
Background: UK care home residents are often poorly served by existing healthcare arrangements. Published descriptions of residents’ health status have been limited by lack of detail and use of data derived from surveys drawn from social, rather than health, care records. Aim: to describe in detail the health status and healthcare resource use of UK care home residents Design and setting: a 180-day longitudinal cohort study of 227 residents across 11 UK care homes, 5 nursing and 6 residential, selected to be representative for nursing/residential status and dementia registration. Method: Barthel index (BI), Mini-mental state examination (MMSE), Neuropsychiatric index (NPI), Mini-nutritional index (MNA), EuroQoL-5D (EQ-5D), 12-item General Health Questionnaire (GHQ-12), diagnoses and medications were recorded at baseline and BI, NPI, GHQ-12 and EQ-5D at follow-up after 180 days. National Health Service (NHS) resource use data were collected from databases of local healthcare providers. Results: out of a total of 323, 227 residents were recruited. The median BI was 9 (IQR: 2.5–15.5), MMSE 13 (4–22) and number of medications 8 (5.5–10.5). The mean number of diagnoses per resident was 6.2 (SD: 4). Thirty per cent were malnourished, 66% had evidence of behavioural disturbance. Residents had contact with the NHS on average once per month. Conclusion: residents from both residential and nursing settings are dependent, cognitively impaired, have mild frequent behavioural symptoms, multimorbidity, polypharmacy and frequently use NHS resources. Effective care for such a cohort requires broad expertise from multiple disciplines delivered in a co-ordinated and managed way.
Gordon, Adam Lee; Franklin, Matthew; Bradshaw, Lucy; Logan, Pip; Elliott, Rachel; Gladman, John R.F.
The University of Oregon has developed a coaching specialization program that allows students to train for prospective coaching assignments without obtaining a teaching certification. Background information on the status of coaching certification is offered. (DF)
Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding homehealth care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…
Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.
Purpose of study: The direct care workforce continues to rank as one of the most frequently injured employee groups in North America. Occupational health and safety studies have shown that workplace injuries translate into negative outcomes for workers and their employers. The National Institute for Occupational Safety and Health (NIOSH)…
The U Special Kids (USK) programme at the University of Minnesota provides intensive care coordination and case management services to children with complex special health-care needs. We conducted a one-year pilot study to evaluate the feasibility of videoconferencing between the USK office and family homes. To ensure easy installation, families were provided with prepackaged equipment and software. However, the families had different Internet providers, different modems and/or routers and different firewall software, which required case-by-case resolution during home visits by the project coordinator. Five families participated in 3-5 videoconferencing sessions with a USK nurse. All connections with urban families had clear audio and video, whereas connections with rural families had clear audio, but unclear video. All of the scheduled virtual visits were rated by nurses as providing information that was similar to a telephone call. However, the unscheduled virtual visits were rated by the nurses as providing more information than a telephone call, suggesting that home-based videoconferencing may be useful in the management of children with complex special health-care needs. PMID:18534949
On July 31, 1996, new regulations took effect that were promulgated under the Safe Medical Devices Act (SMDA). These regulations squarely address the homehealth care provider, creating new reporting and communication challenges for homehealth care agencies (HHAs). As the months have elapsed, questions have begun to emerge regarding the SMDA regulations that reflect the unique nature of home
The author reviewed the literature to identify the variables associated with homehealth care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Homehealth care was defined as in-home skilled nursing,…
This report presents information from the Home Care Supplement to the National Health Interview Survey (NHIS) on the types of help needed by adults with chronic health problems who live outside of institutions. Home care items discussed include: (1) assistance in basic physical activities; (2) assistance in home management activities; (3) adults…
Professional health and wellness coaches are passionate about helping people learn, change, and grow. We are lifelong students of what enables humans to perform at our best. The phrase coaching the whole person is common coaching parlance; full engagement in self-care often requires that clients shift a spectrum of beliefs, motives, and perspectives in order to make changes that are sustainable. Just as important is the need for coaches to fully engage in their own self-care in order to best serve their clients.
...furnished as a homehealth service. 409.50 Section 409.50 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS HomeHealth Services...
The report discusses Medicare's homehealth care benefit and the administration's forth coming legislative proposals related to it. After relatively modest growth during the 1980s, Medicare's expenditures for homehealth care have grown rapidly in the 199...
Health visitors in Scotland gift 'play@home', a book-based early intervention programme, to parents as part of the universal health visiting service. The provision of health improvement information to parents is recognised as a core function of health visiting and yet evidence shows that not every family receives the play@home resources. This paper discusses the perceived facilitators and barriers to implementing this programme through exploring the views of ten health visitors and four health visiting managers in two health board areas in Scotland. The findings conclude that increasingly vulnerable families, supported by fewer qualified health visitors, present challenges to the health visiting service. The play@home programme is valued by health visitors as a flexible tool with which to engage with families. Collaborative working with other services enhances provision and play@home does become embedded in practice over time. Strategic policy links to raise the profile of play@home are improving. PMID:23914476
This handbook is based on experience with courses in which writing coaches participated, as part of the Program in Humanities at the University of Southern Mississippi. The courses were in the areas of humanities, philosophy, fine arts, and history. The handbook first defines a writing coach as a person who is attached to a class for the purpose…
The ability to coach staff and learners is a critical skill for current staff development educators. Coaching includes setting your intention, creating a safe space, staying present, staying curious, withholding judgment, mirroring and modeling, avoiding a set agenda, and requiring accountability. PMID:24702052
The basic principles and techniques of soccer are explained and illustrated with photographs and diagrams to aid teachers who are introducing soccer into the physical education curriculum. In addition, it is designed to guide youth soccer coaches who wish to improve their presentations. The book discusses: (1) coaching methods; (2) passing and…
In this study, the implementation effects of a program for the training in coaching skills with Dutch school counselors are described. These school counselors are expected to provide help and support to primary school teachers. Coaching is a form of in-class support intended to provide teachers with feedback on their own functioning, thereby…
Change in today's health care landscape is a daily, if not hourly, reality. The nurse manager must have strong leadership skills to navigate through change with a focus on the patient and the provision of safe and reliable care. The historical term for those leading change is "change agent." In this article, the authors introduce the idea of a change coach, building on the nurse manager foundational skill of coaching and weaving this concept into the manager's role in change. A change coach uses the coaching behaviors including guidance, facilitation, and inspiration to inspire others toward change, altering human capabilities, and supporting and influencing others toward change. An exemplar of the nurse manager's role as a change coach in practice is provided using American Organization of Nurse Executives' Care Innovation and Transformation initiative. It is the agile manager that is able to successfully move between the roles of change agent and change coach to continuously transform the environment and how care is delivered. PMID:23222749
Stefancyk, Amanda; Hancock, Beverly; Meadows, Mary T
...Payment for homehealth agency services. 413.125 Section 413.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT...
... and essential hypertension was more common among women. Keywords : homehealth care • home and community-based services • ... C.)(11) and SUDAAN version 9.0 (RTI, Research Triangle Park, N.C.)(12). Results Rate of ...
Youth sport is a social institution designed to help improve the health and wellness of the athletes and provide an opportunity for positive youth development. Coaches have a strong influence upon the benefits experienced by youth athletes. Given the importance of the coaching role, the purpose of this article is to outline several positive steps that coaches can take to
Introduction There is a critical need for public health interventions to support the independence of older adults as the world’s population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions. Methods We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology. Results One thousand, six hundred and thirty nine candidate articles were identified. Thirty-one studies from the years 1998–2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier). Conclusion The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of these used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults, social support and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries.
Objective: To examine the added benefit of homehealth services for elderly patients with hip fracture discharged home after inpatient rehabilitation.Data: Medicare claims from 1% of 1986 beneficiaries followed until 1992.Study Population: Persons hospitalized with hip fracture at 70 years or older who had no major Medicare claims during the year before hospitalization and who were discharged home after inpatient
...DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare...Face-to-Face Requirements for HomeHealth Services; Policy Changes and Clarifications Related to HomeHealth AGENCY: Centers for Medicare &...
...purpose of religious nonmedical health care institutions providing home service...PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...purpose of religious nonmedical health care institutions providing home...
Evidence from randomised trials indicates that out-of-home day care has important effects in domains that are integral to the health of mothers and children. The evidence that day care results in cognitive gains is compelling. These effects and the long term effects in reducing crime and violence should suffice to put the question of day care provision high on the paediatric agenda. However, some important questions remain to be answered. Evidence from a randomised trial suggests that the effect of infant day care on infectious disease morbidity is not as great as would be expected on the basis of results from observational studies. However, the trial in question had some important methodological weaknesses. No trials to date have examined the effect of day care on otitis media. Data from observational studies on the effect of day care on injury occurrence are confliciting. Finally, studies in the US point to an important effect of out-of-home day care on maternal employment. The effect of day care on maternal employment and income inequality in Britain has yet to be examined. PMID:8660056
The basic results of the study of the general disease incidence and the pathological affectedness of the inmates of children's homes of Omsk oblast during 2000-2005. The respiratory diseases, the diseases of digestive system, the ophthalmic and accessory apparatus diseases, the infectious and parasitogenic diseases, the diseases of nervous system predominate in the structure of morbidity of the children-orphans. According the medical examination data, the percent of the healthy children does not exceed 9% and the percent of the children with chronic diseases makes up to more than 40%. The assessment of the subjective status of the school-age orphans revealed the discrepancy of their appraisal of state of health, physical activity and emotional conditions which is caused by the social immaturity and the fatigue. PMID:17674531
BACKGROUND: Home visiting programs have been developed aimed at improving the health and independent functioning of older people. Also, they intend to reduce hospital and nursing home admission and associated cost. A substantial number of studies have examined the effects of preventive home visiting programs on older people living in the community; the findings have been inconsistent. The objective of
Ans Bouman; Erik van Rossum; Patricia Nelemans; Gertrudis IJM Kempen; Paul Knipschild
IntroductionHaving a health care home has been shown to be associated with positive health outcomes for children with special health care needs (CSHCN), but its relationship to parental coping has not been established. The purpose of this study was to explore the health care home as a process of care related to parental coping with day-to-day demands of raising a
Though rates of foreclosure are at a historic high, relatively little is known about the link between foreclosure and health. We performed a case-control study to examine health conditions and health care utilization in the time period prior to foreclosure. Homeowners who received a home foreclosure notice from 2005 to 2008 were matched (by name and address) to a university hospital system in Philadelphia and compared with controls who received care from the hospital system and who lived in the same zip code as cases. Outcome measures included prevalent health conditions and visit history in the 2 years prior to foreclosure. We found that people undergoing foreclosure were similar to controls with regard to age, gender, and insurance status but significantly more likely to be African American. Rates of hypertension and renal disease were significantly higher among cases after adjustment for sociodemographic characteristics. In the 2 years prior to foreclosure, cases were more likely to visit the emergency department, have an outpatient visit, and have a no-show appointment. Cases were less likely to have a primary care physicians (PCP) visit in the 6 months immediately prior to the receipt of a foreclosure notice. The results suggest changes in health care utilization in the time period prior to foreclosure. Policies designed to decrease the incidence of home foreclosure and support people during the process should consider its association with poor health and changes in health care utilization. PMID:21491152
Organizations, health systems, and interested individuals globally are assessing and investigating issues related to community health care services, homehealth management, and advanced nursing practice. Scarcity of financial and human resources has motivated health care policy makers to rise to the challenge to explore skill mix in the health care workforce in the hope of improving multidisciplinary collaboration in the
Background: Type 2 diabetes (T2D) and coronary heart disease (CHD) are prevalent chronic diseases from which military personnel are not exempt. While many genetic markers for these diseases have been identified, the clinical utility of genetic risk testing for multifactorial diseases such as these has not been established. The need for a behavioral intervention such as healthcoaching following a risk counseling intervention for T2D or CHD also has not been explored. Here we present the rationale, design, and protocol for evaluating the clinical utility of genetic risk testing and healthcoaching for active duty US Air Force (AF) retirees and beneficiaries. Primary Study Objectives: Determine the direct and interactive effects of healthcoaching and providing genetic risk information when added to standard risk counseling for CHD and T2D on health behaviors and clinical risk markers. Design: Four-group (2 X 2 factorial) randomized controlled trial. Setting: Two AF primary care clinical settings on the west coast of the United States. Participants: Adult AF primary care patients. Intervention: All participants will have a risk counseling visit with a clinic provider to discuss personal risk factors for T2D and CHD. Half of the participants (two groups) will also learn of their genetic risk testing results for T2D and CHD in this risk counseling session. Participants randomized to the two groups receiving healthcoaching will then receive telephonic healthcoaching over 6 months. Main Outcome Measures: Behavioral measures (self-reported dietary intake, physical activity, smoking cessation, medication adherence); clinical outcomes (AF composite fitness scores, weight, waist circumference, blood pressure, fasting glucose, lipids, T2D/CHD risk scores) and psychosocial measures (self-efficacy, worry, perceived risk) will be collected at baseline and 6 weeks, and 3, 6, and 12 months. Conclusion: This study tests novel strategies deployed within existing AF primary care to increase adherence to evidence-based diet, physical activity, smoking cessation, and medication recommendations for CHD and T2D risk reduction through methods of patient engagement and self-management support.
Vorderstrasse, Allison A.; Ginsburg, Geoffrey S.; Kraus, William E.; Maldonado, Maj Carlos J.
NIOSH received a confidential employee request for an HHE at the Huntington Coach Corporation bus repair and body shops, Huntington Station, New York, in November 2006. Employees were concerned that exposures to cleaning solvents, paint vapors, diesel exh...
Career counselors and job search coaches must be prepared to assist disabled clients as this sector of the labor market increases. As the work force ages, there are greater numbers of workers dealing with disabilities and serious health problems. Sadly, individuals with disabilities often approach the job search process with misconceptions,…
Working with chronic illness may present challenges for individuals-for instance, managing symptoms at work, attaining accommodations, and career planning while considering health limitations. These challenges may be stressful and lead to strains. We tested a 12-week, 6-session, phone-based coaching intervention designed to help workers manage these challenges and reduce strains. Using theories of stress and resources, we proposed that coaching would help boost workers' internal resources and would lead to improved work ability perceptions, exhaustion and disengagement burnout, job self-efficacy, core self-evaluations, resilience, mental resources, and job satisfaction, and that these beneficial effects would be stable 12 weeks after coaching ended. Fifty-nine full-time workers with chronic illnesses were randomly assigned to either a coaching group or a waitlisted control group. Participants completed online surveys at enrollment, at the start of coaching, after coaching ended, and 12 weeks postcoaching. Compared with the control group, the coaching group showed significantly improved work ability perceptions, exhaustion burnout, core self-evaluations, and resilience-yet no significant improvements were found for job self-efficacy, disengagement burnout, or job satisfaction. Indirect effects of coaching on work ability, exhaustion and disengagement burnout, and job satisfaction were observed through job self-efficacy, core self-evaluations, resilience, and mental resources. Results indicated that the positive effects of coaching were stable 12 weeks after coaching ended. Results suggest that this coaching intervention was helpful in improving the personal well-being of individuals navigating challenges associated with working and managing chronic illness. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24796227
McGonagle, Alyssa K; Beatty, Joy E; Joffe, Rosalind
Over the last decade, new hospitals are integrating Information and Communication Technologies (ICTs) in their facilities. Although e-health is a relatively recent term for healthcare practice supported by electronic processes, ubiquitous healthcare monitoring, also known as m-health, is already an emerging research area. Patient monitoring in diverse environments, such as nursing homes or assisted living, are gaining importance. Traditional methods present some problems, as they don't allow enough patient mobility. In this situation, real time transmission of multiple medical data, wearable computing, wireless access in ubiquitous systems and wearable devices for pervasive healthcare can meet the needs of these environments. However, the software and infrastructure deployed in hospitals is not easy to migrate to wireless systems. In some cases, the migration to new technologies can be costly. This paper focuses on the design of a modular, scalable and economical framework to improve the monitoring and checking of patients in different contexts. The challenge is to produce a system to transmit the patient's biomedical data directly to a hospital for monitoring or diagnosis using new communication modules. The modular designed adopted is intended to provide a future-proofed system, whose functionality may be upgraded by modifying the hardware or software. The modules have been validated in different contexts to prove their versatility. PMID:23367314
Torrado-Carvajal, Angel; Rodriguez-Sanchez, Maria Cristina; Rodriguez-Moreno, Alberto; Borromeo, Susana; Garro-Gomez, Cesar; Hernandez-Tamames, Juan Antonio; Luaces, Maria
Training and satisfaction with training were examined using data from nationally representative samples of 2,897 certified nursing assistants (CNAs) from the National Nursing Assistant Survey and 3,377 homehealth aides (HHAs) from the National HomeHealth Aide Survey conducted in 2004 and 2007 respectively. This paper focuses on the commonalities and differences in the perceptions of CNAs and HHAs regarding
Manisha Sengupta; Farida K. Ejaz; Lauren D. Harris-Kojetin
An exploratory study focused on how, when, and under what conditions clients with long term illness and their families view the Public Health Nurse Home Visit Service (PHNHVS) as assisting them in family health care. Data were obtained from home interviews and nurse records of 68 families served by 13 nurses in one San Francisco Bay Area locality.…
Rapid growth in homehealth care has led to heightened attention by third-party payers and regulators. Increasingly homehealth agencies (HHAs) must demonstrate the value of their serv ices. A major concurrent trend within the industry and at the federal level is toward incorporat ing standardized outcome measures in the continuous quality improvement (CQI) programs in HHAs. We suggest that
Robert E. Schlenker; Peter W. Shaughnessy; Kathryn S. Crisler
Demographic trends towards an aging society motivate the search for alternative health care paradigms. Information technology driven home-care and telecare are popular concepts, and a lot of projects resulted in corresponding systems. Thus the question arises what implications for health information system (HIS) architectures emerge and how sensor technology as a core technolog yf or home and telecare can systematically
Oliver J. Bott; Michael Marschollek; Joachim Bergmann; Uw Wolf; Reinhold Haux
The Boarding Home Support Program for adults with mental health problems uses health promotion mechanisms of self-care, mutual aid, and healthy environments. The program is challenged by increased numbers of persons served, substandard homes, and conflicts between tenant and operator needs and between individual and group tenant needs. (SK)
Training and satisfaction with training were examined using data from nationally representative samples of 2,897 certified nursing assistants (CNAs) from the National Nursing Assistant Survey and 3,377 homehealth aides (HHAs) from the National HomeHealth Aide Survey conducted in 2004 and 2007, respectively. This article focuses on the…
Sengupta, Manisha; Ejaz, Farida K.; Harris-Kojetin, Lauren D.
Environmental hazards in the home can contribute significantly to disease. These hazards disproportionately affect low income, urban, and minority children. Childhood lead poisoning and asthma are prime examples of health concerns to which poor housing conditions may contribute significantly. A community-academic partnership in Rochester, New York created a model Healthy Home, an interactive museum in a typical city home, to help residents, property owners, contractors, and community groups reduce environmental hazards. The Healthy Home project educates visitors about home environmental health hazards, demonstrates low-cost methods for reducing home hazards, and helps visitors develop individualized strategies for action. In its first year of operation, over 700 people visited the Healthy Home. Evaluation surveys indicate that the Healthy Home experience motivated visitors to take action to reduce environmental hazards in their homes. Follow-up phone interviews indicate that most visitors took some action to reduce home environmental hazards. The Healthy Home has established a diverse Advisory Council to share its messages more broadly, invite input into future directions, and recruit visitors. This paper presents experiences from the Healthy Home’s first year, highlighting the partnership principles that guided its development and lessons learned from the process.
Information and communication technologies may be used to provide health care services to people living at home. The term "home telecare" has been coined for this service. The elderly and patients with chronic pulmonary conditions, heart disease and diabetes have been thought to be obvious beneficiaries. The evidence base supporting home telecare is growing; however, there is a need for studies of long-term deployment and integration with existing health system processes. We discuss the experiences gained from one such pilot conducted in the Sydney West Area Health Service, which examines the integration of home telecare within the framework of an existing respiratory ambulatory care service. Interim results demonstrate high levels of reliability and positive patient attitude towards use of home monitoring. Clinical staff acceptance levels appeared lower. Effects on health burden, such as hospital admissions and nurse workload, were not significantly altered. The study results have been essential in developing local telecare knowledge within the health care community. PMID:21191167
The homehealth care sector is a critical element in a pandemic influenza emergency response. Roughly 85% of the 1.5 million workers delivering in-home care to 7.6 million clients are low-wage paraprofessionals, mostly women, and disproportionately members of racial and ethnic minorities. Homehealth care workers' ability and willingness to respond during a pandemic depends on appropriate communication, training, and adequate protections, including influenza vaccination and respiratory protection. Preparedness planning should also include support for child care and transportation and help homehealth care workers protect their income and access to health care. We summarize findings from a national stakeholder meeting, which highlighted the need to integrate homehealth care employers, workers, community advocates, and labor unions into the planning process. PMID:19461108
Baron, Sherry; McPhaul, Kathleen; Phillips, Sally; Gershon, Robyn; Lipscomb, Jane
ObjectiveThis report provides updated estimates on use of electronic medical records (EMRs) in US homehealth and hospice (HHH) agencies, describes utilization of EMR functionalities, and presents novel data on telemedicine and point of care documentation (PoCD) in this setting.DesignNationally representative, cross-sectional survey of US HHH agencies conducted in 2007.MeasurementsData on agency characteristics, current use of EMR systems as well
A growing array of biomedical goods and services has become central to the North American experience of navigating illness and pursuing good health. Yet despite the utility of consumption as an analytical framework within the social sciences, the selection, purchase, and use of biomedical goods and services has been understudied. By using the home pregnancy test as a case study, we suggest new approaches to thinking about the consumption of these goods and services. We chose the home pregnancy test because it is the best-known example of a mass-produced diagnostic tool used by consumers. We draw on two sources of data for this qualitative analysis: a set of stories submitted between 2003 and 2005 by women and men to an online exhibit mounted by the National Institutes of Health called "A Thin Blue Line: The History of the Pregnancy Test Kit," which we analysed between 2006 and 2007; and web sampling conducted in 2009 and 2010 of personal web and video logs of women and men who have posted stories and opinions about their experiences with contemporary home pregnancy testing products. We adapt the term "domestication" from Science and Technology Studies scholarship to describe the movement of diagnostic devices into homes for use by consumers. Specifically, we propose that the consumption of domesticated biomedical devices, goods, and services should be theorized as work performed by consumers, in two senses: as a form of tool use that allows non-experts to produce diagnostic knowledge about their own bodies and health; and as the ongoing biopolitical work that is expected of citizens to produce healthy bodies. Our paper draws attention to these understudied phenomena, while suggesting new approaches to theorizing the social and cultural elements of goods and services for health. PMID:23608088
The paper explores design considerations for a Foundation Degree in Community Sports Coaching with a focus on cricket. We view coaching as social practice and explore the potential for seeing Community Sports Coaches as 'agents of Citizenship Education'. Cricket's position is historically ironic in post-colonial Britain, being both the game of the colonial elite yet also woven into the habitus
The health status of 206 female caregivers supporting adults with intellectual and developmental disabilities at home was investigated using objective (i.e., presence of chronic health conditions and activity limitations) and subjective (i.e., self-perceived health status) health measures compared with those of women in the general population in 2…
Objective This report provides updated estimates on use of electronic medical records (EMRs) in US homehealth and hospice (HHH) agencies, describes utilization of EMR functionalities, and presents novel data on telemedicine and point of care documentation (PoCD) in this setting. Design Nationally representative, cross-sectional survey of US HHH agencies conducted in 2007. Measurements Data on agency characteristics, current use of EMR systems as well as use of telemedicine and PoCD were collected. Results In 2007, 43% of US HHH agencies reported use of an EMR system. Patient demographics (40%) and clinical notes (34%) were the most commonly used EMR functions among US HHH agencies. Only 20% of agencies with EMR systems had health information sharing functionality and about half of them used it. Telemedicine was used by 21% of all HHH agencies, with most (87%) of these offering homehealth services. Among homehealth agencies using telemedicine, greater than 90% used telephone monitoring and about two-thirds used non-video monitoring. Nearly 29% of HHH agencies reported using electronic PoCD systems, most often for Outcome and Assessment Information Set (OASIS) data capture (79%). Relative to for-profit HHH agencies, non-profit agencies used considerably more EMR (70% vs 28%, p<0.001) and PoCD (63% vs 9%, p<0.001). Conclusions Between 2000 and 2007, there was a 33% increase in use of EMR among HHH agencies in the US. In 2007, use of EMR and PoCD technologies in non-profit agencies was significantly higher than for-profit ones. Finally, HHH agencies generally tended to use available EMR functionalities, including health information sharing.
This study explores the use of occupational performance coaching (OPC) with three parent-child dyads using descriptive case study methodology. OPC is a parent-directed intervention in which parents are coached to improve their own or their children's performance in home and community contexts. In this study, parent and child performance was…
Background: Little is known about whether racial\\/ ethnic differences exist in household family activities, safety practices, and educational opportunities known to impact young children's healthy development and school success. Objective: To examine whether racial\\/ethnic dispari- ties exist in early childhood home routines, safety mea- sures, and educational practices\\/resources. Methods: The 2000 National Survey of Early Child- hood Health is a
Purpose: This study examines population-based trends in home care service utilization, alone and in conjunction with hospitalizations, during a period of health reform in Canada. It focuses on the extent to which observed trends suggest enhanced community-based care relative to three competing hypotheses: cost-cutting, medicalization, and…
Penning, Margaret J.; Brackley, Moyra E.; Allan, Diane E.
Amid budget cuts in U.S. public schools, the spotlight is on how to make less effective teachers more effective--fast. The authors describe virtual coaching--in which a coach interacts electronically with a teacher as a lesson unfolds--as a promising way to help teachers with weak teaching skills. Virtual coaching uses online and mobile technology…
Rock, Marcia L.; Zigmond, Naomi P.; Gregg, Madeleine; Gable, Robert A.
This article discusses the dramatic injury incidence in high school athletics, the lack of medical support for these injuries, and coaches' lack of knowledge and preparation regarding these injuries. It then considers implications of this situation for the coaching profession and for physical education programs that prepare coaches. (IAH)
This paper describes the preliminary findings of a training program to develop skills of Dutch primary school principals in coaching teachers for improved teaching. The major research questions addressed whether the 28 school principals who participated in the training program implemented the target coaching skills whether teachers coached by the…
In this article, the authors explore which conditions support the success of literacy coaches. Because the literacy coach position is a relatively new one, this article examines some of the questions related to designing and implementing the position of the literacy coach, and the potential influence of the position on student achievement. The…
Home Care Basic Facts & Information Role of Health Care Professionals in Home Care Your physician is the leader of an interdisciplinary ... travel to see the healthcare team. Is Home Care Right for You? Home care is especially useful ...
The purpose of this study was to provide an assessment tool to judge coaching performance that was appropriate for completion by athletes. The questionnaire underwent a variety of developmental stages. In its final form, it contained 36 items. The tool was shown to be a valid, reliable, and standardized questionnaire. It demonstrated discriminability and provoked honest, accurate responding in subjects. The test was capable of providing immediate feedback to coaches seeking information about athletes' perceptions of their coaching performance. Responses on the developed scale were weighted to reflect the desirability of the coaching characteristics of a good coach. The questionnaire provides a total score which can be interpreted by the coach as a measure of how much of an "ideal" coach exists in him/her. PMID:4053263
The Affordable Care Act directed Medicare to update its homehealth prospective payment system to reflect more recent data on costs and use of services-an exercise known as rebasing. As a result, the Centers for Medicare and Medicaid Services will reduce homehealth payments 3.5 percent per year in the period 2014-17. To determine the impact that these reductions could have on beneficiaries using homehealth care, we examined the Medicare reimbursement margins and the use of services in a national sample of 96,621 episodes of care provided by twenty-six not-for-profit homehealth agencies in 2011. We found that patients with clinically complex conditions and social vulnerability factors, such as living alone, had substantially higher service delivery costs than other homehealth patients. Thus, the socially vulnerable patients with complex conditions represent less profit-lower-to-negative Medicare margins-for homehealth agencies. This financial disincentive could reduce such patients' access to care as Medicare payments decline. Policy makers should consider the unique characteristics of these patients and ensure their continued access to Medicare's homehealth services when planning rebasing and future adjustments to the prospective payment system. PMID:24889943
Rosati, Robert J; Russell, David; Peng, Timothy; Brickner, Carlin; Kurowski, Daniel; Christopher, Mary Ann; Sheehan, Kathleen M
Secondary prevention programmes can be effective in reducing morbidity and mortality from coronary heart disease (CHD). In particular, UK guidelines, including those from the Department of Health, emphasize physical activity. However, the effects of secondary prevention programmes with an exercise component are moderate and uptake is highly…
Shaw, R.; Gillies, M.; Barber, J.; MacIntyre, K.; Harkins, C.; Findlay, I. N.; McCloy, K.; Gillie, A.; Scoular, A.; MacIntyre, P. D.
Functioning as a Coach is a key role for a manager and, in fact, distinguishes the manager as a leader. Coaching focuses on two distinct areas: 1) coaching to orient employees to new situations, and 2) coaching for performance with employees who are showing marginal performance, who are meeting expectations, or who are showing high performance. This article describes coaching for orientation and for performance, identifies coaching skills, and provides a coaching self-assessment. PMID:10165559
Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors.
Grabowski, David C.; Aschbrenner, Kelly A.; Rome, Vincent F.; Bartels, Stephen J.
Medicare continues to implement payment reforms that shift reimbursement from fee-for-service toward episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for homehealth agencies. The homehealth interim payment system in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The homehealth prospective payment system in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. PMID:24395018
Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P
This research aims to increase transparency and simplify consumer decision-making regarding the selection of a homehealth care provider. Currently, quality information on homehealth care providers is fragmented and difficult to interpret. In this study, a quality-ranking model is developed by selecting multidimensional quality indicators across multiple sources and respective weights using expert judgment. Given the weights and providers' performance on each quality indicator, a composite score is calculated that summarizes a homehealth care provider's overall quality level. This quality information empowers consumers to narrow their search and select the best-performing, most efficient providers. PMID:23924223
An ever-increasing number of people are affected by lifestyle-related health risks, such as overweight, physical inactivity and stress. An ongoing Nuadu trial studies the user acceptance and effectiveness of technologies in supporting the wellness management of working-age citizens. The technologies consist of different Web, mobile and wearable solutions. In this paper, we present the user experience results of three mobile
Aino Ahtinen; Elina Mattila; A. Vaatanen; Lotta Hynninen; Jukka Salminen; Esa Koskinen; Klaus Laine
This report presents national estimates on homehealth care patients and discharged hospice care patients. Information on characteristics, length of service, medical diagnoses, functional limitations, service use, advance care planning, and emergent and h...
A. Moss C. Caffrey L. Harris-Kojetin M. Sengupta R. Valverde
Coaching adolescent athletes can be challenging because of their varying degrees of physical, emotional, and social development and/or maturity. How much and how well each athlete develops tactically, psychologically, emotionally, and physically is directly influenced by these factors. This article discusses that the main reasons athletes…
Good nutrition is important for optimal athletic performance. Adolescent athletes often depend on their coaches for nutritional information on weight management, dietary supplements, and dietary practices. Some dietary practices, such as vegetarianism, have the potential to be harmful to the adolescent athlete if not followed with careful…
In the course of transitioning from classroom teacher to math instructional coach, Tara Zuspan identified critical themes and lessons she had learned. She focused her efforts on building relationships, partnering with the principal, understanding the process of change, and providing teachers with opportunities to collaborate. These intentional…
The purpose of this paper is to create a guide for beginning coaches of the "communication analysis" event in forensics and to attempt to arouse interest in the activity. According to the paper, the American Forensic Association defines communication analysis as an original speech designed to offer an explanation and/or evaluation of a…
This volume is based on the premise that professional preparation for coaching should include viable experiences in drug education, with particular reference to coping with drug-related problems. The first section provides general information on the purposes and effects of drugs, controls, and concepts of doping. The second section deals with four…
COACH, a computer assisted wheelchair for handicapped people, is designed to assist its user to move in an every day environment, equipped with an embedded computer and data sensors. We tried to avoid the solutions that were too `high-tech' in order to produce a representative prototype. For this reason the regular POIRIER electric wheelchair is used. The computer used is
R. Gelin; J. M. Detriche; J. P. Lambert; P. Malblanc
Medicare Parts A and B cover homehealth services furnished by HHAs to Medicare beneficiaries. In 2010, Medicare paid $19.5 billion to 11,203 HHAs for homehealth services provided to 3.4 million beneficiaries. Homehealth services include part-time or in...
CONTEXT.The receipt of health care in a medical home is increasingly touted as a fundamental basis for improved care for persons with chronic conditions, yet the evidence for this claim has not been systematically assessed. OBJECTIVE.Our goal was to determine the evidence for the federal Maternal and Child Health Bureau recommendation that children with special health care needs receive ongoing
Charles J. Homer; Kirsten Klatka; Diane Romm; Karen Kuhlthau; Sheila Bloom; Paul Newacheck; James M. Perrin
The Veterans Health Affairs is in the process of implementing a new model for the delivery of primary care: The Patient-Centered Medical Home (PCMH). One critical challenge of any PCMH model will be the integration of basic mental health treatment into primary care. Such a mental health integration program must be flexible enough to incorporate new evidence-based treatments as patient
Health delivery practices are shifting towards home care. The reasons are the better possibilities for managing chronic care, controlling health delivery costs, increasing quality of life and quality of health services and the distinct possibility of predicting and thus avoiding serious complications. For the above goals to become routine, new telemedicine and information technology (IT) solutions need to be implemented
Nikolaos Maglaveras; Vassilis Koutkias; Ioanna Chouvarda; Dimitrios Goulis; A. Avramides; D. Adamidis; George Louridas; E. Andrew Balas
As the number of chronically ill elderly increases and the costs of hospital and nursing home care rises, consideration is being given to alternatives for long-term care. One alternative being explored in California is the Alameda County Homemaker Program which provides homehealth care to the frail elderly. Interviews were conducted with all 30…
The objective of this study was to evaluate the efficacy of a home-based intervention targeted to parents with intellectual disability to promote child health and home safety in the preschool years. A total of 63 parents were recruited for the study with 45 parents (40 mothers and 5 fathers) from 40 families completing the project. The research design permitted comparison
Gwynnyth Llewellyn; David McConnell; Anne Honey; Rachel Mayes; Domenica Russo
Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were…
Frahm, Kathryn; Gammonley, Denise; Zhang, Ning Jackie; Paek, Seung Chun
Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were found to be in regular contact
Kathryn Frahm; Denise Gammonley; Ning Jackie Zhang; Seung Chun Paek
Modern sensor and communication technology, coupled with advances in data analysis and artificial intelligence techniques, is causing a paradigm shift in remote management and monitoring of chronic disease. In-home monitoring technology brings the added benefit of measuring individualized health status and reporting it to the care provider and caregivers alike, allowing timely and targeted preventive interventions, even in home and
This article explores the essential relationship needs and capacities of infants, parents, practitioners, and supervisors in a story about reflective practice. The author shares her experience supervising a home visitor who is a trainee in an infant mental health intervention program. The home visitor's relationship with her supervisor was a…
Nurse coaches are responding to the mandate of Florence Nightingale (1820-1910)—the foundational philosopher of modern nursing—to advocate, identify, and focus on factors that promote health, healthy people, and healthy communities that are recognized today as environmental and social determinants of health.1,2 The Institute of Medicine report3 and other health initiatives suggest the need for increased education and leadership from nurses to address the healthcare needs of our nation and world. Nurse coaches are strategically pos-i tioned and equipped to implement health-promoting and evidence-based strategies with clients and support behavioral and lifestyle changes to enhance growth, overall health, and well-being. With possibilities not yet imagined, employment opportunities for nurses who incorporate coaching into professional practice are developing across the entire spectrum of health, well-ness, and healing.
This article examines the rationale and strategies for surveillance of health-care-associated infections in home-care settings, the challenges of nonhospital-based surveillance, and the feasibility of developing a national surveillance system.
Background: The understanding of the complex relationship between the home environment, well-being and daily functioning in the third age is currently weak. The aim of this paper is to present the methodological background of the Home and Health in the Third Age Study, and describe a sample of men and women in relation to their home and health situation. Methods and Design: The study sample included 371 people aged 67–70, living in ordinary housing in the south of Sweden. Structured interviews and observations were conducted to collect data about objective and perceived aspects of home and health. Results: The majority of the participants were in good health and had few functional limitations. Women had more functional limitations and reported more symptoms than men. Environmental barriers were found in every home investigated; the most were found in the kitchen and hygiene area. Environmental barriers were more common in multi-family than in one-family dwellings. Discussion: This study will increase our knowledge on home and health dynamics among people in the third age. The results have potential to contribute to societal planning related to housing provision, home care and social services for senior citizens.
Background: The understanding of the complex relationship between the home environment, well-being and daily functioning in the third age is currently weak. The aim of this paper is to present the methodological background of the Home and Health in the Third Age Study, and describe a sample of men and women in relation to their home and health situation. Methods and Design: The study sample included 371 people aged 67-70, living in ordinary housing in the south of Sweden. Structured interviews and observations were conducted to collect data about objective and perceived aspects of home and health. Results: The majority of the participants were in good health and had few functional limitations. Women had more functional limitations and reported more symptoms than men. Environmental barriers were found in every home investigated; the most were found in the kitchen and hygiene area. Environmental barriers were more common in multi-family than in one-family dwellings. Discussion: This study will increase our knowledge on home and health dynamics among people in the third age. The results have potential to contribute to societal planning related to housing provision, home care and social services for senior citizens. PMID:25019267
The Canadian Professional Coaching Association (CPCA) recently developed a code of ethics for coaches that was based on the Canadian Psychological Association's ethical code. Because the CPCA did not use coaches' actual experiences to develop their code, we solicited sport-related ethical concerns from coaches to determine the comprehensiveness of the code. Twelve male and seven female coaches from both individual
Colleen J. Haney; Bonita C. Long; Gail Howell-jones
There are challenges in caring for patients with diabetes. Homehealth should utilize nurse practitioners who have specialty diabetes programs for homebound individuals within their practice. Agencies benefit from designing specific disease management program models that provide standardized delivery of care with defined outcomes that can be evaluated for program effectiveness. Collaboration between programs like DOS and chronic disease management programs within homehealth agencies can achieve optimal patient outcomes and potential cost savings. PMID:19266749
The Department of Veterans Affairs (VA) amends its regulations concerning the billing methodology for non-VA providers of homehealth services and hospice care. Because the newly applicable methodology cannot supersede rates for which VA has specifically contracted, this rulemaking will only affect homehealth and hospice care providers who do not have existing negotiated contracts with VA. This rule also rescinds internal guidance documents that could be interpreted as conflicting with this final rule. PMID:23646376
This article examines the rationale and strategies for surveillance of health-care-associated infections in home- care settings, the challenges of nonhospital-based surveillance, and the feasibility of developing a national sur- veillance system. ver the past 2 decades, the delivery of health care in the United States has shifted increasingly from hospitals to patients' homes (1-3). Nearly eight million people in the
Lilia P. Manangan; Michele L. Pearson; Jerome I. Tokars; Elaine Miller; William R. Jarvis
This study examined Florida Medicaid mental health expenditures for children in out-of-home care. Child welfare and Medicaid\\u000a administrative databases were analyzed using two-part models to identify characteristics associated with expenditures. Mental\\u000a health expenditures were higher for older children, boys, children who were abused or lost their caregivers, or with a longer\\u000a length of stay in out-of-home care. In contrast, African
Athletes obtain nutritional information from their coaches, yet their competency in this area is lacking. Currently, no research exists in the UK which has a different coach education system to many other countries. Therefore, the aim of this study was to evaluate the sports nutrition knowledge of UK coaching certificate (UKCC) level 2 and 3, hockey and netball qualified coaches. All coaches (n = 163) completed a sports nutrition questionnaire to identify: (a) if they provided nutritional advice; (b) their level of sport nutrition knowledge; and (c) factors that may have contributed to their level of knowledge. Over half the coaches provided advice to their athletes (n = 93, 57.1%), even though they were not competent to do so. Coaches responded correctly to 60.3 ± 10.5% of all knowledge questions with no differences between those providing advice and those who did not (p > 0.05). Those coaches who had undertaken formal nutrition training achieved higher scores than those who had not (p < 0.05). In conclusion, UK sports coaches would benefit from continued professional development in sports nutrition to enhance their coaching practice.
Athletes obtain nutritional information from their coaches, yet their competency in this area is lacking. Currently, no research exists in the UK which has a different coach education system to many other countries. Therefore, the aim of this study was to evaluate the sports nutrition knowledge of UK coaching certificate (UKCC) level 2 and 3, hockey and netball qualified coaches. All coaches (n = 163) completed a sports nutrition questionnaire to identify: (a) if they provided nutritional advice; (b) their level of sport nutrition knowledge; and (c) factors that may have contributed to their level of knowledge. Over half the coaches provided advice to their athletes (n = 93, 57.1%), even though they were not competent to do so. Coaches responded correctly to 60.3 ± 10.5% of all knowledge questions with no differences between those providing advice and those who did not (p > 0.05). Those coaches who had undertaken formal nutrition training achieved higher scores than those who had not (p < 0.05). In conclusion, UK sports coaches would benefit from continued professional development in sports nutrition to enhance their coaching practice. PMID:24727434
This final rule will update the HomeHealth Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, the low-utilization payment adjustment (LUPA) add-on, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for homehealth agencies (HHAs), effective January 1, 2014. As required by the Affordable Care Act, this rule establishes rebasing adjustments, with a 4-year phase-in, to the national, standardized 60-day episode payment rates; the national per-visit rates; and the NRS conversion factor. In addition, this final rule will remove 170 diagnosis codes from assignment to diagnosis groups within the HH PPS Grouper, effective January 1, 2014. Finally, this rule will establish homehealth quality reporting requirements for CY 2014 payment and subsequent years and will clarify that a state Medicaid program must provide that, in certifying HHAs, the state's designated survey agency carry out certain other responsibilities that already apply to surveys of nursing facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID), including sharing in the cost of HHA surveys. For that portion of costs attributable to Medicare and Medicaid, we will assign 50 percent to Medicare and 50 percent to Medicaid, the standard method that CMS and states use in the allocation of expenses related to surveys of nursing homes. PMID:24294635
To enhance mother-infant interaction, paraprofessional home visitors provided parents with emotional support, information, and help in using community resources during pregnancy and throughout the infants' first 14 months. This study reports effects on child health. Both home-visited women and controls made good use of well-child care. Home-visited women made greater use of sick-child care (p = 0.002), most of which was appropriate. The greater use of sick-child care was concentrated among mothers with moderate or high family stress, with whom home visitors had closer relationships. Case histories showed a variety of individual effects on parents. PMID:2708538
The burgeoning costs of healthcare and growth in consumer use of the Internet to attain health-related information to better manage their health-care, coupled with demographic changes in the industrialized countries, strongly argues for the use of tele-health applications that can lower costs and improve the quality of healthcare delivery. Despite its potential, telehealth and digital home-health, has not progressed as
The objective of this study was to investigate the possible modifying effect of medical home on the association between low birthweight and children's health outcomes. The analytic sample included children 5 years and under from the 2007 National Survey of Children's Health whose mothers were the primary respondents and who had non-missing covariate information (n = 19,356). Controlling for sociodemographic factors, logistic and ordinal regression models estimated the presence of developmental, mental/behavioral or physical health outcomes, condition severity, and health status by birthweight, medical home, and their interaction. Prevalence estimates of physical, developmental, mental/behavioral and severe conditions among those with any conditions as well as fair/poor overall health were 8.9, 6.8, 2.4, 41.6, and 2.5 %, respectively. Overall, low compared to normal birthweight children had a higher prevalence of physical and developmental conditions and fair/poor health (15.2 vs. 8.3 %, 11.1 vs. 6.4 %, 4.5 vs. 2.3 %, respectively). Medical home did not significantly modify the effect of birthweight on health outcomes; however, prevalence of all outcomes was higher for children without a medical home. Adjusted models indicated that low birthweight children were almost twice as likely as normal birthweight children to have a physical or developmental condition and poorer overall health, regardless of having a medical home. Having a medical home was associated with equally improved health outcomes among normal and low birthweight children. Adequacy and frequency of medical home care should be investigated further, especially among low birthweight children. PMID:22447500
BACKGROUND: Despite the many antihypertensive medications available, two-thirds of patients with hypertension do not achieve blood pressure control. This is thought to be due to a combination of poor patient education, poor medication adherence, and \\
Heather Bennett; Kelsey Laird; David Margolius; Victoria Ngo; David H Thom; Thomas Bodenheimer
Introduction: This editorial is part of the Focus Theme of Methods of Information in Medicine on "Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records". Background: To increase efficiency in the health care of the future, data from innovative technology like it is used for ambient assisted living (AAL) or smart homes should be available for individual health decisions. Integrating and aggregating data from different medical devices and health records enables a comprehensive view on health data. Objectives: The objective of this paper is to present examples of the state of the art in research on information management that leads to a sustainable use and long-term storage of health data provided by innovative assistive technologies in daily living. Results: Current research deals with the perceived usefulness of sensor data, the participatory design of visual displays for presenting monitoring data, and communication architectures for integrating sensor data from homehealth care environments with health care providers either via a regional health record bank or via a telemedical center. Conclusions: Integrating data from AAL systems and smart homes with data from electronic patient or health records is still in an early stage. Several projects are in an advanced conceptual phase, some of them exploring feasibility with the help of prototypes. General comprehensive solutions are hardly available and should become a major issue of medical informatics research in the near future. PMID:24828122
In his work as an executive coach, psychotherapist Kets de Vries sometimes comes across bosses with mental demons. The four kinds he encounters most frequently are pathological narcissists, who are selfish and entitled, have grandiose fantasies, and pursue power at all costs; manic-depressives, who can leave a trail of emotional blazes behind them; passive-aggressives, who shy away from confrontation but are obstructive and under-handed; and the emotionally disconnected--literal-minded people who cannot describe or even recognize their feelings. Left unchecked, these personalities can warp the interactions, plans, and systems of entire organizations. But with appropriate coaching, toxic bosses can learn to manage their conditions and become effective mentors and leaders. This article describes how to recognize each pathology and, step by step, guide people who suffer from it toward healthier and more-productive interactions. PMID:24830286
Find out how Caroline Horner, director of i-coach academy and Sam Humphrey, head of global coaching at Unilever are using a unique assessment and selection process to produce more effective executive coaches.
Practice coaching, also called practice facilitation, assists physician practices with the desire to improve in such areas as patient access, chronic and preventive care, electronic medical record use, patient-centeredness, cultural competence, and team-building. This issue brief clarifies the essential features of practice coaching and offers guidance for health system leaders, public and private insurers, and federal and state policymakers on how best to structure and design these programs in primary care settings. Good-quality evidence demonstrates that practice coaching is effective. The authors argue that primary care delivery in the United States would benefit from a more systematic approach to the training and deployment of primary care practice coaches. PMID:22712103
Grumbach, Kevin; Bainbridge, Emma; Bodenheimer, Thomas
Objective: Contemporary health care places enormous health information management demands on laypeople. Insights into their skills and habits complements current developments in consumer health innovations, including personal health records. Using a five-element human factors model of work, health information management in the household (HIMH) is characterized by the tasks completed by individuals within household organizations, using certain tools and technologies in a given physical environment. Design: We conducted a descriptive-exploratory study of the work of HIMH, involving 49 community-dwelling volunteers from a rural Midwestern community. Measurements: During in-person interviews, we collected data using semistructured questionnaires and photographs of artifacts used for HIMH. Results: The work of HIMH is largely the responsibility of a single individual, primarily engaged in the tasks of acquiring, managing, and organizing a diverse set of health information. Paper-based tools are most common, and residents develop strategies for storing information in the household environment aligned with anticipated use. Affiliative relationships, e.g., parent-child or spousal, within the household serve as the organization that gives rise to health information management practices. Synthesis of these findings led to identification of several storage strategies employed in HIMH. These strategies are labeled “just-in-time,” “just-because,” “just-in-case,” and “just-at-hand,” reflecting location of the artifacts of health information and anticipated urgency in the need to retrieve it. Conclusion: Laypeople develop and employ robust, complex strategies for managing health information in the home. Capitalizing on these strategies will complement and extend current consumer health innovations to provide functional support to people who face increasing demands to manage personal health information.
Two home telehealth technologies (the Intel Health Guide and the Apple iPad) were trialled by four clinical services of the Hunter New England Local Health District. The iPad was selected by the Paediatric Palliative Care Service, the Stroke Service and the Brain Injury Rehabilitation Service. The Intel Health Guide was selected by the Cardiac Coaching Service. The telehealth devices were loaned to a total of 102 patients for different lengths of time, depending on clinical needs, but typically for about 3 months. A total of 42 clinicians were involved. During the trial, 16 technical problems were recorded and resolved, most concerning problems with connectivity. Nonetheless, the use of home telehealth technologies was positively received by clinicians, management and patients alike. Telehealth is now being integrated into the standard practices of the health district. PMID:24218357
Objective: Although the medical home is promoted by the American Academy of Pediatrics and the Affordable Care Act, its impact on children without special health care needs is unknown. We examined whether the medical home is associated with beneficial health care utilization and health-promoting behaviors in this population. Methods: This study was a secondary data analysis of the 2003 National Survey of Children’s Health. Data were available for 70?007 children without special health care needs. We operationalized the medical home according to the National Survey of Children’s Health design. Logistic regression for complex sample surveys was used to model each outcome with the medical home, controlling for sociodemographic characteristics. Results: Overall, 58.1% of children without special health care needs had a medical home. The medical home was significantly associated with increased preventive care visits (adjusted odds ratio [aOR]: 1.32 [95% confidence interval (CI): 1.22–1.43]), decreased outpatient sick visits (aOR: 0.71 [95% CI: 0.66–0.76), and decreased emergency department sick visits (aOR: 0.70 [95% CI: 0.65–0.76]). It was associated with increased odds of “excellent/very good” child health according to parental assessment (aOR: 1.29 [95% CI: 1.15–1.45) and health-promoting behaviors such as being read to daily (aOR: 1.46 [95% CI: 1.13–1.89]), reported helmet use (aOR: 1.18 [95% CI: 1.03–1.34]), and decreased screen time (aOR: 1.12 [95% CI: 1.02–1.22]). Conclusions: For children without special health care needs, the medical home is associated with improved health care utilization patterns, better parental assessment of child health, and increased adherence with health-promoting behaviors. These findings support the recommendations of the American Academy of Pediatrics and the Affordable Care Act to extend the medical home to all children.
Bauchner, Howard; Sege, Robert D.; Cabral, Howard J.; Garg, Arvin
People around the world come together on Dec. 1 each year for World AIDS Day, a time to commemorate those lost to the deadly disease and to celebrate progress made to stop its spread. One way of preventing the spread of the disease is early detection of the HIV virus, which some say could be more easily done at home.
Background Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. Methods The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. Results There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. Conclusion In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients’ own needs, but also on the needs of all the other residents.
This curriculum guide for students in grades K-4 is part of the My Health My World series which explores environmental health issues. It includes (1) an activities guide for teachers, which focuses on physical science, life science, and environment and health, presenting activity based lessons that entice students to discover concepts in science,…
Context Level of acuity and number of referrals for homehealth care have been escalating exponentially. As referrals continue to increase, health care organizations are encouraged to find more effective methods for providing 0high-quality patient care with cost savings.
Barbara Johnston; Linda Wheeler; Jill Deuser; Karen H. Sousa
Inappropriate efforts to manage uncertainty may account for difficulties associated with communication about serious illness. This study tested a series of predictions concerning the relationship between the amount of uncertainty associated with a communicative task and health care providers’ comfort levels when engaging in that task. A mailed survey of 540 homehealth care nurses confirmed expectations that discussions of
Stephen C. Hines; Nan Leslie; Laurie Badzek; Jackie Glover
A new concept is revolutionizing the way companies and consumers communicate in the digital age. That concept is social media—online communication that is interactive, collaborative, and democratic. Things that you will learn from this article are the following: What is social media and what does it have to offer the health care community? More important, how can homehealth care
The patient-centered medical home (PCMH) is an innovative care delivery model designed to provide comprehensive primary care services to people of all ages by fostering partnerships between patients, families, health care providers and the community. National Assembly on School-Based Health Care (NASBHC) recommends practices and policies that…
National Assembly on School-Based Health Care, 2010
The author interviewed parents who had participated in infant mental health (IMH) home visiting programs in community mental health agencies in Detroit, Michigan, as part of a larger qualitative study exploring parents' and practitioners' perceptions of IMH practice. Parents were asked to describe what they remembered about the practitioner and…
The Patient Protection and Affordable Care Act (PPACA) was passed into legislation in March 2010, making health care reform a reality. Perhaps the most well-developed model of primary care that aligns with the PPACA's agenda is the patient-centered medical home (PCMH). Integrated care, as defined by collaborative care between mental health and primary care providers and systems, will undoubtedly play
This book contains various aids for Peace Corps home extension volunteers. Section I, "Culture Resource Material," contains four articles by Paul Benjamin: (1) "Values in American Culture"; (2) "The Cultural Context of Health Education"; (3) "Problems of Introducing Public Health Programs in 'Underdeveloped Areas'"; and (4) "The Role of Beliefs…
Peace Corps, Washington, DC. Information Collection and Exchange Div.
Medicare Part B payments for mental health services during non-Part A nursing home stays continue to be an area of concern. Our results are consistent with prior OIG reports that have identified inappropriately paid mental health services. Thirty-nine per...
Health literacy promotion techniques are important for the school nurse's tool kit. Forty-three percent of the adult population have difficulty understanding basic health information, yet written materials sent home from schools are often at a level well above the average reader. Learning and applying techniques to improve the appearance and comprehension of your written materials will help to get the school nurse's message home. This article is the second and final in a series of articles focusing on health literacy. The first article, focusing on verbal communication, was published in the September 2013 issue of NASN School Nurse. PMID:24624755
Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011). The American Association for Marriage and Family Therapy (AAMFT) represents a mental health profession with a long track record in integrated primary care, particularly with family medicine. The authors begin by affirming several core themes in the joint principles-behavioral health (JP-BH) statement. They then offer a systemic/relational perspective on the patient-centered medical home that goes beyond the focus of the JP-HP. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24955682
Doherty, William J; Hodgson, Jennifer L; Lamson, Angela L; Mendenhall, Tai J; Todd, Tracy
To conduct a systematic review of the evidence associating the medical home with beneficial health outcomes in healthy children. The English-language pediatric literature 1975-2011 was searched via PubMed, Embase and CINAHL. Inclusion criteria (the medical home as an independent variable, individual-level quantitative analysis, outpatient setting in the US, healthy children) and exclusion criteria (age >18, medical home operationalized with only one American Academy of Pediatrics component) were determined a priori. Presence of a medical home was examined in relation to three outcome measures: primary care services, health care utilization, and child well-being. Of 4,856 unique citations, 9 studies were included in the final systematic review, amassing 290,180 children from 6 data sources. Two drew on prospective cohort data; the remainder, on cross-sectional design. Children with a medical home were more likely to receive preventive medical care (2 studies), anticipatory guidance (1 study), and developmental screening (1 study); to have higher health-related quality of life (1 study); and were less likely to seek care in the emergency department (2 studies). The medical home was associated with full immunization status in only 1 of 4 studies examining this outcome. No protective effect of the medical home was found with regard to preventable hospitalization (1 study). The medical home is associated with beneficial health outcomes among healthy children. However, the evidence is limited in comparison with that for children with special health care needs. As healthy children represent the majority of the pediatric population, this lack of evidence represents a significant knowledge gap. PMID:23784614
According to recent academic reviews, formal coach education courses are rarely considered important or useful events in a broader coach learning process. At present, there is insufficient research to define the nature and extent of this problem which is likely to become more important under the prevailing governing rationalities of modernisation…
Why do some athletic coaches succeed every season while others suffer loss after loss? This book describes the beliefs, behaviors, and attitudes of great athletic coaches. Where do they focus their attention? How do they spend their time and energy? And how can others gain the same advantages? Here, Rob Haworth and Todd Whitaker describe the…
This article describes the Women in Coaching Workshop which provided opportunities for 43 women to acquire skills and experience needed to assume secondary school coaching positions. Included are descriptions of the format and operational mechanisms for the workshop. Participants included preservice and inservice teachers, college athletes, and…
This article presents five specific components of the certified nursing assistant's (CNA's) role in the clinical setting that are essential to patient care quality. These are hands-on skill level, communication, reliability and integrity, documentation and technology, and clinical knowledge base. The importance of education and communication by the caregiver staff for patients within long-term- and home-care settings is discussed relative
Despite the negative nomenclature used to describe interinstitutional relocation of elders—such as relocation stress—research\\u000a on the detrimental effects of these relocations has so far provided equivocal results. In our analyses we use six years of\\u000a data from the Minimum Data Set and 301 nursing home residents. We determine some detrimental effects of interinstitutional\\u000a relocation on changes in cognitive performance, depression,
Dysphagia has devastating effects on millions of adults and children in the United States and contributes to the increasing cost of healthcare because of the aspiration that results. A new treatment, Vital-Stim, is a form of electrical stimulation that speech therapists can administer in the home care setting. This article reflects one agency's success in changing people's lives by helping them swallow again. PMID:15486509
In addition to its clinical efficacy as a communication style for strengthening motivation and commitment to change, motivational interviewing (MI) has been hypothesized to be a potential tool for facilitating evidence-based practice adoption decisions. This paper reports on the rationale and content of MI-based implementation coaching Webinars that, as part of a larger active dissemination strategy, were found to be more effective than passive dissemination strategies at promoting adoption decisions among behavioral health and health providers and administrators. The Motivational Interviewing Treatment Integrity scale (MITI 3.1.1) was used to rate coaching Webinars from 17 community behavioral health organizations and 17 community health centers. The MITI coding system was found to be applicable to the coaching Webinars, and raters achieved high levels of agreement on global and behavior count measurements of fidelity to MI. Results revealed that implementation coaches maintained fidelity to the MI model, exceeding competency benchmarks for almost all measures. Findings suggest that it is feasible to implement MI as a coaching tool. PMID:24347225
Objective To explore multiple family members’ perceptions of risk and protective factors for healthy eating and physical activity in the home. Design Ten multi-family focus groups were conducted with 26 families. Setting Community setting. Participants Primarily Black and White families. Family members (n = 103) were between the ages of 8–61 years. Analysis A grounded hermeneutic approach. Phenomenon of Interest Risk and protective factors for healthy eating and physical activity in the home environment. Results Ten major themes were identified by family members related to health behaviors in the home environment, including: (a) accessibility to healthy foods and activity, (b) time constraints, (c) stage of youth development, (d) individual investment in health behaviors, (e) family investment in health behaviors, (f) family meals and shared activities, (g) parent modeling, (h) making health behaviors fun, (i) making health behaviors part of the family lifestyle, and (j) community investment in family health behaviors. Conclusions and Implications This study identified the importance of the family system and the reciprocal influences within the home environment on health behaviors. In addition, individual and community-level suggestions were identified. Insights from the families provide leads for future research and ideas for the prevention of youth obesity.
Berge, Jerica M.; Arikian, Aimee; Doherty, William J.; Neumark-Sztainer, Dianne
Children and youth with complex medical issues, especially those with technology dependencies, experience frequent and often lengthy hospitalizations. Hospital discharges for these children can be a complicated process that requires a deliberate, multistep approach. In addition to successful discharges to home, it is essential that pediatric providers develop and implement an interdisciplinary and coordinated plan of care that addresses the child's ongoing health care needs. The goal is to ensure that each child remains healthy, thrives, and obtains optimal medical home and developmental supports that promote ongoing care at home and minimize recurrent hospitalizations. This clinical report presents an approach to discharging the child with complex medical needs with technology dependencies from hospital to home and then continually addressing the needs of the child and family in the home environment. PMID:22547780
This article examines issues related to paraprofessionals in job coach roles for students with disabilities. It describes issues related to recruitment, retention, orientation, and training of paraprofessionals in job coach roles. In addition, roles and responsibilities, supervision, evaluation, and compensation issues are discussed.…
Suggests many students dislike school science. Outlines strategies science teachers ("coaches") can use to ensure that all students are in the winner's circle. Discusses the object of the game (purposes and goals in the classroom), creating a winning classroom learning climate, what winning students are doing in the classroom, coach's role, and…
In this study, the implementation effects of a program for teaching coaching skills to Dutch primary school teachers acting as supervising or cooperating teachers for teachers-in-training are described. Coaching is a form of in-class support intended to provide teachers-in-training with feedback on their functioning and, thereby, stimulate…
Sexual harassment in sport has become an active research field within the past decade yet we know relatively little about the characteristics of the harassing coach. How are harassing coaches characterised by their victims, that is, the athletes themselves? Do they demonstrate specific kinds of behaviours? One purpose of this article is to address…
This editorial paper presents a vision for intelligent health care in the home of the future, focusing on technologies with the highest potential payoff given targeted government funding over the next ten years. A secure, plug-and-play information framework provides the starting point for identifying technologies that must be developed before home-based devices can know their context and assimilate information to support care decisions.
Nursing home residents have a high prevalence of remediable visual impairment and blindness. Future research on the effectiveness of providing eye care to nursing home residents will need to include a vision-targeted health-related quality of life (HRQOL) instrument appropriate for this population. The purpose of this study was to identify the core content areas for such an instrument. In-depth interviews
Drawing on two waves of survey data conducted six months apart in 2006, this study examined the impacts of a team-level flexibility initiative (ROWE – Results Only Work Environment) on changes in the work-home spillover and health behavior of employees at the Midwest headquarters of a large US corporation. Using cluster analysis, we identified three distinct baseline spillover constellations: employees with high negative spillover, high positive spillover, and low overall spillover. Within-team spillover measures were highly intercorrelated, suggesting that work teams as well as individuals have identifiable patterns of spillover. Multilevel analyses showed ROWE reduced individual- and team-level negative work-home spillover but not positive work-home spillover or spillover from home-to-work. ROWE also promoted employees’ health behaviors: increasing the odds of quitting smoking, decreasing smoking frequency, and promoting perceptions of adequate time for healthy meals. Trends suggest that ROWE also decreased the odds of excessive drinking and improved sleep adequacy and exercise frequency. Some health behavior effects were mediated via reduced individual-level negative work-home spillover (exercise frequency, adequate time for sleep) and reduced team-level negative work-home spillover (smoking frequency, exercise frequency, and adequate time for sleep). While we found no moderating effects of gender, ROWE especially improved the exercise frequency of singles and reduced the smoking frequency of employees with low overall spillover at baseline.
The purpose of the present study was to gather information from coaches regarding their monitoring\\/management of athlete eating and weight, knowledge of nutritional health issues, availability of prevention\\/intervention services for athletes at their school, expience with athletes exhibiting symptoms of eating and body image disturbances, and their attitudes toward eating and weight in the sport. A total of 303 coaches
Jaimee L. Heffner; Benjamin M. Ogles; Ellsa Gold; Kimberlyann Marsden; Michael Johnson
Background: Coach education has been identified as a key vehicle for raising the standard of coaching practice. However, the existing body of literature suggests that coach education has had a limited impact on the learning and development of coaching practitioners. In this respect, it has been contended that coach educations ills might be…
Background: There are approximately 52,000 teacher-coachescoaching 750,000 high school student-athletes in Canada. Despite this large population, Canadian high school teacher-coaches remain relatively unstudied. High school coaches in Canada are often asked to coach sports with which they are unfamiliar, and because they are not required to…
The interactions of professional football coaches and teams in the National Football League (NFL) form a complex social network. This network provides a great opportunity to ana- lyze the influence that coaching mentors have on their pro- teges. In this paper, we use this social network to identify notable coaches and characterize championship coaches. We also utilize the coaching network
This article is based on the invited presentation by the author at the American Psychological Association's Annual Convention, August 4-7, 2011, upon his receipt of the Joseph D. Matarazzo Award for Distinguished Contributions to Psychology in Academic Health Centers presented by the Association of Psychologists in Academic Health Centers. This article relates the history, roles, and responsibilities of psychologists in academic health centers to the ultimate survival and success of professional psychology. It describes implications of the Patient Protection and Affordable Care Act (ACA) on the institutional practice of psychology including how psychology's place in academic health centers positions the field well for the future of healthcare reform. The article provides several recommendations to help professional psychology prepare for that future of integrated, interprofessional healthcare. PMID:22592297
The US health care industry is experiencing a substantial paradigm shift with regard to home care due to the convergence of several technology areas. Increasingly-capable telehealth systems and the internet are not only moving the point of care closer to the patient, but the patient can now assume a more active role in his or her own care. These technologies, coupled with (1) the migration of the health care industry to electronic patient records and (2) the emergence of a growing number of enabling health care technologies (e.g., novel biosensors, wearable devices, and intelligent software agents), demonstrate unprecedented potential for delivering highly automated, intelligent health care in the home. This editorial paper presents a vision for the implementation of intelligent health care technology in the home of the future, focusing on areas of research that have the highest potential payoff given targeted government funding over the next ten years. Here, intelligent health care technology means smart devices and systems that are aware of their context and can therefore assimilate information to support care decisions. A systems perspective is used to describe a framework under which devices can interact with one another in a plug-and-play manner. Within this infrastructure, traditionally passive sensors and devices will have read/write access to appropriate portions of an individual's electronic medical record. Through intelligent software agents, plug-and-play mechanisms, messaging standards, and user authentication tools, these smart home-based medical devices will be aware of their own capabilities, their relationship to the other devices in the home system, and the identity of the individual(s) from whom they acquire data. Information surety technology will be essential to maintain the confidentiality of patient-identifiable medical information and to protect the integrity of geographically dispersed electronic medical records with which each home-based system will interact.
Examines the role that mentoring could have in helping female athletes become leaders in their sports through coaching, focusing on: women in coaching; the importance of mentoring potential female coaches; successful mentoring relationships for female coaches; and strategies for mentors. This type of collaboration may help reverse the ongoing…
To investigate whether coaches encourage their athletes to use imagery, two studies were undertaken. In the first, 317 athletes completed the Coaches' Encouragement of Athletes' Imagery Use Questionnaire. In the second, 215 coaches completed a slightly modified version of this questionnaire. It was found that coaches and athletes generally agreed…
Leadership for literacy coaching is evolving in both the skills of the literacy coaches and the skills of those they coach. Issues of role clarification, communication with administration, and hesitancy to provide authentic feedback are consistently identified. Trends associated with literacy coaching indicate that they continue on their…
Coaching is a means of instruction that combines elements of mentoring and tutoring in natural community environments. Coach and student characteristics, processes of coaching, and outcomes of coaching in varied community settings and across different developmental levels are examined. Programs utilizing adults and peers from the community in…
The National Cancer Institute (NCI), part of the National Institutes of Health, announced the launch of a Clinical Proteomic Tumor Analysis Consortium (CPTAC) in August 2011. CPTAC is a comprehensive and coordinated effort to accelerate the understanding of the molecular basis of cancer through the application of robust, quantitative, proteomic technologies and workflows. Read more.
Patient satisfaction is an important issue for homehealth providers. This study tested the influence of organizational factors, particularly human resource management practices, on quality of care, as measured by patient satisfaction. Six hundred ninety-six patients of thirteen homehealth agencies were surveyed to test the influence of organizational factors on five dimensions of patient satisfaction. Organizational variables included size of the agency, staffing characteristics, educational preparation of RNs, continuing education, and compensation. We found that full-time staffing, the number of BSN-prepared RNs, and percent of budget allocated to benefits all predicted high patient satisfaction scores. PMID:10139289
Objective: To estimate the effect of telephonic wellness coaching on weight loss in a commercially insured population. Study Design: Pre-post evaluation design. Methods: Self-reported weight was obtained from 2 annual health assessment questionnaires administered during 2008 and 2010. Baseline (T1) information from these questionnaires was used to identify overweight/obese individuals and to determine targets for a 4-call wellness coaching program. Overweight/obese individuals identified at T1 were classified into following groups: (1) targeted for wellness coaching (N = 1448, including 1050 participants and 398 nonparticipants); (2) not targeted for wellness coaching, but targeted for other telephonic wellness care management (WCM) programs (N = 1270); (3) not targeted for any WCM programs (N = 7586). Weight reported on questionnaires a year later (T2) was used to calculate weight change between T1 and T2. Paired t-tests were used to detect significant weight changes over time. Multivariable linear regressions were used to compare weight changes between the groups. Stratified analysis was conducted to determine the effectiveness of telephonic wellness coaching for subgroups based on participants' selected health goals, intensity of the intervention received and initial stage of change. Results: The group targeted for wellness coaching reported an average weight change of -0.44 kg (95% confidence interval [CI], -0.76 to -0.16) at T2, significantly more weight loss than reported by the group not targeted for any WCM programs. Participants who started in preparation stage and completed the program reported weight change of -1.43 kg (95% CI, -2.17 to -0.68), highest among program participants. Conclusions: Small weight loss was observed for obese/individuals targeted for telephonic wellness coaching. PMID:24738553
Tao, Min; Rangarajan, Krishna; Paustian, Michael L; Wasilevich, Elizabeth A; El Reda, Darline K
Purpose To test an evidence-implementation intervention to improve the quality of care in the homehealth care setting for patients at high risk for fractures. Methods We conducted a cluster randomized trial of a multimodal intervention targeted at home care for high-risk patients (prior fracture or physician-diagnosed osteoporosis) receiving care in a statewide homehealth agency in Alabama. Offices throughout the state were randomized to receive the intervention or to usual care. The primary outcome was the proportion of high-risk homehealth patients treated with osteoporosis medications. A t-test of difference in proportions was conducted between intervention and control arms and constituted the primary analysis. Secondary analyses included logistic regression estimating the effect of individual patients being treated in an intervention arm office on the likelihood of a patient receiving osteoporosis medications. A follow-on analysis examined the effect of an automated alert built into the electronic medical record that prompted the homehealth care nurses to deploy the intervention for high risk patients using a pre-post design. Results Among the offices in the intervention arm the average proportion of eligible patients receiving osteoporosis medications post-intervention was 19.1%, compared with 15.7% in the usual care arm (difference in proportions 3.4%, 95% CI: ?2.6 ?9.5%). The overall rates of osteoporosis medication use increased from 14.8% prior to activation of the automated alert to 17.6% afterward, a non-significant difference. Conclusions The homehealth intervention did not result in a significant improvement in use of osteoporosis medications in high risk patients.
Home visiting services are cost-effective and improve the health of children and families among those at increased risk. From 1985-2008, home visiting services in Hawai'i were provided primarily through state funding of the Hawai'i Healthy Start Program, but the program was severely reduced due to the economy and state budget changes over the past decade. The Maternal and Child Health Branch (MCHB) in the Family Health Services Division responded to these changes by seeking out competitive grant opportunities and collaborations in order to continue to promote home visiting services to those children and families in need. In 2010, the MCHB was awarded a federally funded Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant for home visiting services to promote maternal, infant, and early childhood health, safety and development, strong parent-child relationships, and responsible parenting. In 2011, the MCHB was also awarded a competitive MIECHV development grant that funded the re-establishment of the hospital Early Identification program. Families in need of additional support identified through this program are referred for family strengthening services to a network of existing home visiting programs called the Hawai'i Home Visiting Network (HHVN). The HHVN is supported by MIECHV and a small amount of state funds to assist programs with capacity building, training, professional development, quality assurance, and accreditation/certification support. The MIECHV grant requires that programs are evidence-based and address specific outcome measures and benchmarks. The HHVN provides home visiting services to families prenatally through 5 years of age that reside in specific at-risk communities, and is aimed at fostering positive parenting and reducing child maltreatment using a strength-based approach by targeting six protective factors: (1) social connections, (2) nurturing and attachment, (3) knowledge of parenting and child development, (4) parental resilience, (5) social and emotional competence of children, and (6) concrete supports for parents. This article provides an introduction to the HHVN as a diverse network of evidence-based home visiting programs with services currently available on all islands, and highlights aspects of home visiting programs that support the Family-Centered Medical Home (FCMH) model. The HHVN provides important services to families at risk and uses evidence-based practices to yield positive results. Health care professionals can support this network to promote the health of children and families by being aware that these home visiting services exist and encouraging families at-risk to participate. Continued collaboration and expanded partnerships with health providers can help strengthen the home visiting network and improve outcomes for children and families in Hawai'i. PMID:24843840
Yoshimoto, D Kaulana; Robertson, N Tod; Hayes, Donald K
Staff training is one of the interventions that managers can embed in their organizations to help staff improve their professional competences related to challenging behaviour of clients with intellectual disabilities. Individual coaching adds learning opportunities that are feasible but difficult to achieve in an in-service setting. In the present study, we have followed the coaching process of three staff members. Based on differences in the Linell balance of power across sessions, we explored the question: do different coaching processes have similar patterns in the development of dominance and coherence in interactions between coach and staff? Additionally, a qualitative approach was conducted to illustrate and enrich the meaning of quantitative outcomes. Processes were different regarding the balance of power at the start of the coaching, probably due to differences in resistance and insecurity. As a consequence of different starting points and differences in learning styles, each coaching process had its unique development over time. At the end, all dyads were comparable in the sense that all dyads were highly satisfied about the outcomes and process of coaching. This is in line with similar levels of power at the end of the coaching sessions suggesting equal contributions and leadership. The present findings suggest some relevant competencies of coaches within health-care services. Due to the small number of participants, the results have to be interpreted with caution. The present study provides suggestions for future research and clinical practice. PMID:23474998
van Oorsouw, Wietske M W J; Embregts, Petri J C M; Bosman, Anna M T
The purpose of the present study was to gather information from coaches regarding their monitoring/management of athlete eating and weight, knowledge of nutritional health issues, availability of prevention/intervention services for athletes at their school, experience with athletes exhibiting symptoms of eating and body image disturbances, and their attitudes toward eating and weight in the sport. A total of 303 coaches (51% response rate) involved in six sports (i.e., gymnastics, swimming, basketball, softball, track, and volleyball) at all levels of collegiate competition (NCAA Divisions I, II, III, and NAIA) completed a 40-item survey. Gender was found to be related to differential responding on only one of the 40 items, while sport and level of competition were related to responses on multiple items. Gymnastics coaches and NCAA Division I coaches differed significantly from coaches of other sports and divisions in that they reported more monitoring/management behaviors, had more experience with athletes exhibiting eating disturbances, and had more resources available for preventing and treating athletes with eating disorders. Gymnastics coaches also differed from other coaches on a number of items related to their attitudes toward eating and weight in the sport. Many coaches have encountered disturbed eating among their athletes, and some of their coaching attitudes and behaviors may inadvertently increase the risk for such disturbances. Implications for clinical and sport psychologists providing prevention or intervention services to intercollegiate athletes are discussed. PMID:16801252
Heffner, Jaimee L; Ogles, Benjamin M; Gold, Ellsa; Marsden, Kimberlyann; Johnson, Michael
The objective of this study was to evaluate the use of NHS money to improve health by improving housing conditions. A pilot study assessing health outcomes before and after improving housing conditions was conducted, studying 72 children with previously diagnosed asthma living in 59 damp houses in Cornwall. The intervention was the installation of central heating. This improved the energy efficiency of the housing. The children's health was a symptom-based outcome measure for asthma and time lost from school. Improvements comprised installation of gas central heating in 28/59 (47%) houses, electric storage heaters in 22/59 (37%), solid fuel central heating in 7/59 (12%) and oil-fired central heating in 2/59 (4%) houses. Energy efficiency improved by a mean of 2.1 on the National Home Energy Rating scale (95% CI 1.68-2.47, P<0.001) in the 37/59 (62%) houses for which two readings were available. Initially, 69/72 (92%) children's bedrooms were unheated and 44/72 (61%) were damp; following improvements, the proportions were 10/72 (14%) and 15/72 (21%) respectively. All respiratory symptoms were significantly reduced after intervention; the greatest reduction was seen in nocturnal cough from a median score of 3 (most nights) to 1 (on one or several nights) (P<0.001) in the previous month. School-age children lost significantly less time from school for asthma in the previous 3 months (9.3 days per 100 school days before intervention and 2.1 days afterwards, P<0.01) but not for other reasons (1.4 days per 100 school days before and 3.2 after, P>0.05). In conclusion, this study provides the first evaluation of health outcomes following housing improvements. Lack of a comparison group means that effects of age, season and biased reporting cannot be eliminated. More work is needed to substantiate these results. PMID:11114752
Since 2003 about 14 percent of U.S. Army soldiers have been reporting symptoms of post traumatic stress disorder (PTSD) following deployments. The objective of this study is to examine how symptoms of PTSD or of other mental health symptoms are correlated...
Executive coaching, as an emerging practice for leadership development in organizations, has grown over the past few years. Increasing numbers of consultants are practicing as coaches, and more and more organizations are requesting their services. Coaches...
Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention.
Or, Calvin K.L.; Valdez, Rupa S.; Casper, Gail R.; Carayon, Pascale; Burke, Laura J.; Brennan, Patricia Flatley; Karsh, Ben-Tzion
This paper explores the dose-response relation between formaldehyde (HCHO) concentration and reported health complaints (eye irritation, nose/throat irritation, headaches and skin rash) of nearly 2,000 residents living in 397 mobile and 494 conventional homes. The study analyzes the effects of HCHO concentration, age and sex of respondent, and smoking behavior on each of the four health effects. The results demonstrate a positive dose-response relation between HCHO concentration and reported health complaints, with reported health complaints demonstrated at HCHO concentrations of 0.1 ppm and above. Concentrations of 0.4 ppm in manufactured homes as targeted by the Department of Housing and Urban Development (HUD), may not be adequate to protect occupants from discomfort and from acute effects of HCHO exposure.
...relate to separate administration of hospice care and homehealth services by the Veterans Health Administration's Office of Geriatrics and Extended Care, which uses separate methods for forming agreements with non-VA providers for the provision of...
With homehealth care patients and their care givers using an increasing number of medical devices of varying complexity, the Center for Devices and Radiological Health, Food and Drug Administration (FDA), has concerns about the safe and effective use of ...
The objective of this paper is to explore the perceptions of health visitors working in frontline child protection concerning the role of clinical supervision. Fifteen health visitors ('home visitors') providing an intensive home visiting service to high-risk families in the south east of England were interviewed about their experience of receiving supervision. The model of clinical supervision used was based on the Family Partnership Programme and delivered by two trained psychotherapists. The data were analysed using thematic analysis. Home visitors believed that clinical supervision enabled them to maintain boundaries, regulate and reflect on their practice, and develop a better understanding of the issues clients were facing. The model of supervision used and the organisational context were believed to be important factors in the delivery of clinical supervision and to have contributed to its success. PMID:24597137
Accountingfor a patient's emotional state is integ ral in medical care. Tele-health research attests to the challenge clinicians must overcome in assessing patient emotional state when modalities are limited (J. Adv. Nurs. 36(5) 668). The extra effort involved in addressingthis challenge requires attention, skill, and time. Large caseloads may not afford tele-homehealth- care (tele-HHC) clinicians the time and focus
Traumatic injuries in children account for a large percentage of physician and emergency de partment visits, as well as inpatient hospital admissions. Changes in the health care environ ment, as well as the special needs of children and families, are the incentives for the develop ment of a comprehensive home care program. This article describes the program components and educational
The Outcome and Assessment Information Set (OASIS) is used for outcome reporting, quality improvement, and case mix adjustment of per-episode payment for homehealth care. The research described here addresses interrater reliability of OASIS items and compares clinician time required to complete patient assessment with and without OASIS. Interrater reliability for OASIS data items was estimated using independent assessments by
David F. Hittle; Peter W. Shaughnessy; Kathryn S. Crisler; Martha C. Powell; Angela A. Richard; Karin S. Conway; Paula M. Stearns; Karen Engle
The purpose of this paper is to identify the information that nurses in hospitals exchange with nurses in homehealth care (HHC), and what nurses perceive to be the most significant information to exchange. Method: Nurses have an obligation to support and ensure continuity of patient care and to prevent an information gap when patients are transferred from one organizational
Ragnhild Hellesø; Margarethe Lorensen; Lena Sorensen
A health hazard evaluation of the Palatine Nursing Home, Palatine, New York was conducted to determine if the nursing staff had contracted scabies from a patient at the facility which provides constant care for the acute and chronically ill. Scabies, caus...
The document maintains that the world is filled with health hazards and the best a person can do is to assess the danger of individual products, learn the risks, weigh the risks against the benefits, and decide whether or not to personally take these risks or to subject family members to them. This perspective begins in the home. This book…
Objectives: To assess the impact of a voluntary, paraprofessional home visiting program on promoting child health and development and maternal parenting knowledge, attitudes, and behaviors. Methods: This collaborative, experimental study of 6 Healthy Families Alaska (HFAK) programs enrolled 325 families from 1/00 to 7/01, randomly assigned them to…
Caldera, Debra; Burrell, Lori; Rodriguez, Kira; Crowne, Sarah Shea; Rohde, Charles; Duggan, Anne
The purpose of this model curriculum and teaching guide is to assist agencies, educational institutions, and other groups to plan, organize, and provide the initial training needed by homemaker-homehealth aides. Persons aged 35-60 are considered most desirable as trainees, but indication of maturity is more appropriate as a criterion. Based on…
National Council for Homemaker-Home Health Aide Services, New York, NY.
Among older adults, the challenges of maintaining mobility and cognitive function make it increasingly difficult to remain living alone independently. As a result, many older adults are forced to seek residence in costly clinical institutions where they can receive constant medical supervision. A home-based automated system that monitors their health and well- being while remaining unobtrusive would provide them with
Amaya Arcelus; Megan Howell Jones; Rafik Goubran; Frank Knoefel
Base on the ZigBee technology, a wireless sensor networks for remote home environment monitoring and health care monitoring was built in this paper, and the applications of data fusion algorithms in system of front & back end data processing were deeply discussed. The experiment is proved that the applications of data fusion algorithm, which is a combination of Bayesian estimation
The concept of the pediatric patient-centered medical home (PCMH) as a theory has been evolving since it was initially conceived more than 40 years ago. When the American Academy of Pediatrics' (AAP) Council on Pediatric Practice first wrote about this model, "medical home" was defined solely as the central location of a pediatric patient's medical records. Approximately two decades later, the AAP published its inaugural policy statement on this topic. Through this policy statement, the medical home was defined as a place where care for pediatric patients would be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. Although the lack of access to providers, especially in rural communities, may inhibit the adoption of the PCMH or chronic care models, technology has evolved to the point where many of the gaps in care can be bridged. mHealth, defined by the National Institutes of Health (NIH) as the use of mobile and wireless devices to improve health outcomes, health care services, and health research, can be one specific example of how technology can address these issues. One early study has shown that patients who use mHealth tools are more likely to adhere to self-monitoring requirements and, in turn, have significantly improved outcomes. A rapidly evolving and scalable mHealth technology that has the ability to address these issues are self-management mobile applications, or apps. It has been estimated that there are currently more than 40,000 health care-related apps available. Furthermore, use of these apps is growing, as more than 50% of smartphone users surveyed responded that they have used their device to gather health information, and almost 20% of this population has at least one health care app on their device. PMID:24512160
Background Despite well-publicized guidelines on the appropriate management of cardiovascular disease (CVD) and type 2 diabetes, the implementation of risk-reducing practices remains poor. This paper describes the results of a randomized controlled clinical trial evaluating the effectiveness of a comprehensive program of cardiovascular disease risk reduction delivered by nurse practitioner/community health worker (NP/CHW) teams versus enhanced usual care (EUC) to improve lipids, blood pressure, glycated hemoglobin (HbA1c), and patients’ perceptions of the quality of their chronic illness care in patients in urban community health centers. Methods and Results A total of 525 patients with documented cardiovascular disease, type 2 diabetes, hypercholesterolemia, or hypertension and levels of LDL-cholesterol, blood pressure or HbA1c that exceeded goals established by national guidelines were randomized to NP/CHW (n=261) or EUC (n=264) groups. The NP/CHW intervention included aggressive pharmacologic management and tailored educational and behavioral counseling for lifestyle modification and problem solving to address barriers to adherence and control. As compared to EUC, patients in the NP/CHW group had significantly greater 12 month improvement in total cholesterol (difference, 19.7mg/dL), LDL cholesterol (difference,15.9 mg/dL), triglycerides (difference, 16.3 mg/dL), systolic blood pressure (difference, 6.2 mm Hg), diastolic blood pressure (difference, 3.1 mm Hg), HbA1c (difference, 0.5%), and perceptions of the quality of their chronic illness care (difference, 1.2 points). Conclusions An intervention delivered by a NP/CHW team using individualized treatment regimens based on treat-to-target algorithms can be an effective approach to improve risk factor status and perceptions of chronic illnes care in high risk patients.
Allen, Jerilyn K.; Dennison Himmelfarb, Cheryl R.; Szanton, Sarah L.; Bone, Lee; Hill, Martha N.; Levine, David M.; West, Murray; Barlow, Amy; Lewis-Boyer, LaPricia; Donnelly-Strozzo, Mary; Curtis, Carol; Anderson, Katherine
Purpose We developed and tested a multi-modal intervention, delivered in the homehealth care setting, aimed at increasing osteoporosis treatment rates to prevent fractures. Material and Methods The intervention focused on homehealth nurses. Key components included: nursing education; development of a nursing care plan; patient teaching materials and creation of physician materials. Nursing education consisted of a lecture covering osteoporosis, fracture risks and prevention, and the effectiveness of anti-osteoporosis treatment options. Patients received education materials concerning osteoporosis and anti-osteoporosis medications. A pocket-sized treatment algorithm card and standardized order sets were prepared for physicians. Focus groups of physicians and nurses were conducted to obtain feedback on the materials and methods to facilitate effective nurse-physician communication. Successful application required nurses to identify patients with a fracture history, initiate the care plan, prompt physicians on risk status, and provide patient education. The intervention was piloted in one field office. Results In the year prior to the intervention, homehealth patients (n=92) with a fracture history were identified in the pilot field office and only 20 (22%) received osteoporosis prescription therapy. In the three months following the intervention, 21 newly enrolled patients were identified and 9 (43%) had received osteoporosis prescription medications. Conclusions Homehealth care provides a venue where patients and physicians can be informed by nurses about osteoporosis and fracture risks and, consequently, initiate appropriate therapy. This multi-modal intervention is easily transportable to other homehealth agencies and adaptable to other medical conditions and settings.
Outman, Ryan C.; Curtis, Jeffrey R.; Locher, Julie L.; Allison, Jeroan J.; Saag, Kenneth G.; Kilgore, Meredith L.
Since 2003, about 14 % of U.S. Army soldiers have reported symptoms of posttraumatic stress disorder (PTSD) following deployments. In this article, we examine how post-deployment symptoms of PTSD and of other mental health conditions are related to the probability of divorce among married active-duty U.S. Army soldiers. For this purpose, we combine Army administrative individual-level longitudinal data on soldiers' deployments, marital history, and sociodemographic characteristics with their self-reported post-deployment health information. Our estimates indicate that time spent in deployment increases the divorce risk among Army enlisted personnel and that PTSD symptoms are associated with further increases in the odds of divorce. Although officers are generally less likely to screen positive for PTSD than enlisted personnel, we find a stronger relationship between PTSD symptoms and divorces among Army officers who are PTSD-symptomatic than among enlisted personnel. We estimate a larger impact of deployments on the divorce risk among female soldiers, but we do not find a differential impact of PTSD symptoms by gender. Also, we find that most of the effect of PTSD symptoms occurs early in the career of soldiers who deploy multiple times. PMID:24781649
In 1996, "Lifespan" was born when four home care agencies in Battle Creek, Michigan, merged to create a wholly owned subsidiary of the Battle Creek Health System (BCHS), a community health care delivery organization that provides acute care, long-term care, psychological services, outpatient care, homehealth care, and occupational and business services. By banding together to effect savings through joint contract purchasing and shared services, Lifespan and BCHS have formed a communal relationship that allows the two to offer a seamless continuum of care without establishing wholly discrete organizations. Lifespan has thus been free to independently make mutually beneficial partnerships with an information technology company to enhance patient care services to their clients. PMID:15875424
D.S. presented to a medical and surgical weight-loss program to initiate bariatric surgery. He had made numerous attempts at weight loss to no avail and was taking steps toward bariatric surgery as a last viable option. D.S.'s health insurance provider required 3 months of supervised weight loss prior to approval for surgery, and this was initiated with a board-certified bariatrician (MD) and a registered dietitian nutritionist (RDN)/wellness coach. D.S. presented with a body mass index (BMI) >40 and was classified as morbidly obese with comorbidities of high cholesterol and hyperglycemia and degenerative joint disease (DJD) of the knees. D.S. began the process outlined by his insurance company, meeting with the MD and RDN/wellness coach monthly. A plan was developed by D.S. and his RDN/wellness coach that alligned with his wellness vision, values, and lifestyle. D.S. ate meals and snacks at regular intervals throughout the day, consumed little to no red meat, increased his consumption of fruits and vegetables, and spent 1 hour daily in a swimming pool—walking, swimming, or both. By the end of the 3-month period required by the insurance provider, D.S. had lost more than 30 lbs, improved his exercise capacity, no longer used a cane, and chose to continue with coaching rather than undergo bariatric surgery. D.S. continued to meet with the MD and RDN monthly for 1 year and averaged a 10-lb weight loss per month for a total of 120 lbs, normalizing his blood panels and improving his joint mobility. D.S. continued to meet with the RDN/wellness coach for a total of 10 visits during year 2 and quarterly visits through year 3. D.S. lost a total of 240 lbs, maintained the weight loss over the 3-year period, and achieved these results solely through lifestyle interventions. Although bariatric surgery is a viable treatment option for class 2 and 3 obesity, many patients pursue this treatment option without the help of medical and commercial weight loss personnel to improve the likelihood of weight loss sustainability. The investment of lifestyle intervention in this circumstance was less than $5000 (exculsive of blood panels) compared with the $20 000 cost of bariatric surgery at the time of intervention.
D.S. presented to a medical and surgical weight-loss program to initiate bariatric surgery. He had made numerous attempts at weight loss to no avail and was taking steps toward bariatric surgery as a last viable option. D.S.'s health insurance provider required 3 months of supervised weight loss prior to approval for surgery, and this was initiated with a board-certified bariatrician (MD) and a registered dietitian nutritionist (RDN)/wellness coach. D.S. presented with a body mass index (BMI) >40 and was classified as morbidly obese with comorbidities of high cholesterol and hyperglycemia and degenerative joint disease (DJD) of the knees. D.S. began the process outlined by his insurance company, meeting with the MD and RDN/wellness coach monthly. A plan was developed by D.S. and his RDN/wellness coach that alligned with his wellness vision, values, and lifestyle. D.S. ate meals and snacks at regular intervals throughout the day, consumed little to no red meat, increased his consumption of fruits and vegetables, and spent 1 hour daily in a swimming pool-walking, swimming, or both. By the end of the 3-month period required by the insurance provider, D.S. had lost more than 30 lbs, improved his exercise capacity, no longer used a cane, and chose to continue with coaching rather than undergo bariatric surgery. D.S. continued to meet with the MD and RDN monthly for 1 year and averaged a 10-lb weight loss per month for a total of 120 lbs, normalizing his blood panels and improving his joint mobility. D.S. continued to meet with the RDN/wellness coach for a total of 10 visits during year 2 and quarterly visits through year 3. D.S. lost a total of 240 lbs, maintained the weight loss over the 3-year period, and achieved these results solely through lifestyle interventions. Although bariatric surgery is a viable treatment option for class 2 and 3 obesity, many patients pursue this treatment option without the help of medical and commercial weight loss personnel to improve the likelihood of weight loss sustainability. The investment of lifestyle intervention in this circumstance was less than $5000 (exculsive of blood panels) compared with the $20 000 cost of bariatric surgery at the time of intervention. PMID:24278847
Objective To assess whether a model of care with augmented services within an existing medical home could improve immunization rates\\u000a for Children with Special Health Care Needs (CSHCN) and to evaluate the influence of family and practice characteristics on\\u000a these children’s immunization rates.\\u000a \\u000a \\u000a \\u000a Method Participants were six general pediatric practices, CSHCN, and their families. Enhancements were added to the medical home\\u000a for
Ronald C. Samuels; Jihong Liu; Lisa A. Sofis; Judith S. Palfrey
This paper describes the design and evaluation of a wearable personal wellness coach system that supports a range of activities including health data collection, interpretation, feedback and self-monitoring. We implemented a wearable computing platform consisting of an array of sensors and application software to motivate users to reach fitness goals and prevent harm in a real-time environment. Evaluation and testing
Ramy Asselin; Guillermo Ortiz; Jonathan Pui; Asim Smailagic; Christian Kissling
BACKGROUND: Food and drink are important determinants of physical and social health in care home residents. This study explored whether a pragmatic methodology including routinely collected data was feasible in UK care homes, to describe the health, wellbeing and nutritional status of care home residents and assess effects of changed provision of food and drink at three care homes on
Andrea Kenkmann; Gill M Price; Joanne Bolton; Lee Hooper
This paper describes the process of undertaking a dental health needs assessment of older people resident in care homes in the North East of England and the challenges involved. It illustrates many competency areas of interest to dental public health practitioners: oral health surveillance, dental public health intelligence and collaborative working. PMID:23550499
Background The Internet can facilitate diary monitoring (experience sampling, ecological momentary assessment) and behavioral coaching. Online digital assistance (ODA) is a generic tool for mobile Web-based use, intended as an adjuvant to face-to-face or Internet-based cognitive behavioral treatment. A current ODA application was designed to support home-based training of behavioral attack prevention in chronic migraine, focusing on the identification of attack precursors and the support of preventive health behaviour. Objective The aim was to establish feasibility of the ODA approach in terms of technical problems and participant compliance, and ODA acceptability on the basis of ratings of user-friendliness, potential burden, and perceived support of the training for behavioral attack prevention in migraine. Methods ODA combines mobile electronic diary monitoring with direct human online coaching of health behavior according to the information from the diary. The diary contains three parts covering the following: (1) migraine headache and medication use, (2) attack precursors, and (3) self-relaxation and other preventive behavior; in addition, menstruation (assessed in the evening diary) and disturbed sleep (assessed in the morning diary) is monitored. The pilot study consisted of two runs conducted with a total of five women with chronic migraine without aura. ODA was tested for 8.5 days (range 4-12 days) per participant. The first test run with three participants tested 4-5 diary prompts per day. The second run with another three participants (including one subject who participated in both runs) tested a reduced prompting scheme (2-3 prompts per day) and minor adaptations to the diary. Online coaching was executed twice daily on workdays. Results ODA feasibility was established on the basis of acceptable data loss (1.2% due to the personal digital assistant; 5.6% due to failing Internet transmission) and good participant compliance (86.8% in the second run). Run 1 revealed some annoyance with the number of prompts per day. Overall ODA acceptability was evident by the positive participant responses concerning user-friendliness, absence of burden, and perceived support of migraine attack prevention. The software was adapted to further increase the flexibility of the application. Conclusions ODA is feasible and well accepted. Tolerability is a sensitive issue, and the balance between benefit and burden must be considered with care. ODA offers a generic tool to combine mobile coaching with diary monitoring,independently of time and space. ODA effects on improvement of migraine remain to be established.
Mak, Sander B; Houtveen, Jan H; Kleiboer, Annet M; van Doornen, Lorenz JP
Coaching occurs when one professional works closely with another professional to increase productivity or to meet a common outcome. For a coach or mentor to be successful, the teacher must believe in the expertise the coach espouses, and the coach must believe in the teacher's abilities. Through "reflective coaching," teachers and coaches…
The shortcomings of behavioral modificaion methods for dealing with unmanageable residents in nursing homes are examined in the second of three reports concerned with the reasons for and consequences of inappropriate reliance on nursing homes to care for ...
Background This paper explores the nature of food and plants and their meanings in a British Bengali urban context. It focuses on the nature of plants and food in terms of their role in home making, transnational connections, generational change and concepts of health. Methods An ethnographic approach to the research was taken, specific methods included participant observation, focus group discussions and semi-structured interviews. Thirty women of Bengali origin were mostly composed of “mother” and “daughter” pairs. The mothers were over 45 years old and had migrated from Bangladesh as adults and their grown-up daughters grew up in the UK. Results Food and plants play an important role in the construction of home “here” (London) while continuing to connect people to home “there” (Sylhet). This role, however, changes and is re-defined across generations. Looking at perceptions of “healthy” and “unhealthy” food, particularly in the context of Bengali food, multiple views of what constitutes “healthy” food exist. However, there appeared to be little two-way dialogue about this concept between the research participants and health professionals. This seems to be based on “cultural” and power differences that need to be addressed for a meaningful dialogue to occur. Conclusion In summary, this paper argues that while food is critical to the familial spaces of home (both locally and globally), it is defined by a complex interplay of actors and wider meanings as illustrated by concepts of health and what constitutes Bengali food. Therefore, we call for greater dialogue between health professionals and those they interact with, to allow for an enhanced appreciation of the dynamic nature of food and plants and the diverse perceptions of the role that they play in promoting health.
A new trend of admitting more and more senior citizens hailing from the Indian middle class background to old age homes is being observed in recent times. The objectives of this study were to study sociodemographic dimensions and common health problems of inmates of old age homes and to know various reasons for their admissions and their leisure time activities in old age homes. The present cross-sectional study was conducted during March and April 2010 in 4 different old age homes in and around Belgaum city, North Karnataka, by interviewing the inmates of old age homes using predesigned, pretested, structured questionnaire followed by thorough clinical examination and haemoglobin estimation by Sahli's method. The collected data was compiled and analysed using SPSS software version 14. Out of 73 elderly, 54 were females (74.0%). Majority were in the age group of 61-70 years (50.7%) and 56 were belonging to nuclear family (76.7%). Thirty-nine inmates were widow/widower (53.4%) and 42 were having no children (57.5%). Forty-seven inmates were admitted as there was nobody to take care of them (64.4%). Common health problems observed were locomotive/joint and muscle disorders (35.6%), hypertension (34.2%), diabetes mellitus (26.0%), respiratory disorders (23.3%), hearing loss (21.9%) etc. Forty-nine were having normal body mass index (67.1%) while 19.2% were underweight. Majority were having haemoglobin levels between 10-12 g/dl (58.9%). Old age homes definitely will enable the elderly to remain sociopsychologically healthy and lead active lives if effective medical and emotional support is given. PMID:24968497
Viveki, R G; Halappanavar, A B; Joshi, A V; Pujar, Kirankumar; Patil, Sandhya
Objective Determine the factors that impact HIT use and MU readiness for community health centers (CHCs). Background The HITECH Act allocates funds to Medicaid and Medicare providers to encourage the adoption of electronic health records (EHR), in an effort to improve health care quality and patient outcomes, and to reduce health care costs. Methods We surveyed CHCs on their Readiness for Meaningful Use (MU) of Health Information Technology (HIT) and Patient Centered Medical Home (PCMH) Recognition, then we combined responses with 2009 Uniform Data System data to determine which factors impact use of HIT and MU readiness. Results Nearly 70% of CHCs had full or partial EHR adoption at the time of survey. Results are presented for centers with EHR adoption, by the length of time that their EHR systems have been in operation.
Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on "Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records". Objectives: In this paper, we present a prototype of a Home-Centered Health-Enabling Technology (HET-HC), which is able to capture, store, merge and process data from various sensor systems at people's home. In addition, we present an architecture designed to integrate HET-HC into an exemplary regional Health Information System (rHIS). Methods: rHIS are traditionally document-based to fit to the needs in a clinical context. However, HET-HC are producing continuous data streams for which documents might be an inappropriate representation. Therefore, the HET-HC could register placeholder-documents at rHIS. These placeholder-documents are assembled upon user-authenticated request by the HET-HC and are always up-to-date. Moreover, it is not trivial to find a clinical coding system for continuous sensor data and to make the data machine-readable in order to enhance the interoperability of such systems. Therefore, we propose the use of SNOCAP-HET, which is a nomenclature to describe the context of sensor-based measurements in health-enabling technologies. Results: We present an architectural approach to integrate HET-HC into rHIS. Our solution is the centralized registration of placeholder-documents with rHIS and the decentralized data storage at people's home. Conclusions: We concluded that the presented architecture of integrating HET-HC into rHIS might fit well to the traditional approach of document-based data storage. Data security and privacy issues are also duly considered. PMID:24477851
Gietzelt, M; von Bargen, T; Kohlmann, M; Marschollek, M; Schwartze, J; Song, B; Wagner, M; Wolf, K-H; Haux, R
Background Staff who provide support services to older adults are in a unique position to detect depression and offer a referral for mental health treatment. Yet integrating mental health screening and recommendations into aging services requires staff learn new skills to integrate mental health and overcome client barriers to accepting mental health referrals. This paper describes client rates of depression and a novel engagement intervention (Open Door) for homebound older adults who are eligible for home delivered meals and screened for depression by in-home aging service programs. Methods Homebound older adults receiving meal service who endorsed depressive symptoms were interviewed to assess depression severity and rates of suicidal ideation. Open Door is a brief psychosocial intervention to improve engagement in mental health treatment by collaboratively addressing the individual level barriers to care. The intervention targets stigma, misconceptions about depression, and fears about treatment, and is designed to fit within the roles and responsibilities of aging service staff. Results Among 137 meal recipients who had symptoms when screened for depression as part of routine home meal service assessments, half (51%) had Major Depressive Disorder and 13% met criteria for minor depression on the SCID. Suicidal ideation was reported by 29% of the sample, with the highest rates of suicidal ideation (47%) among the subgroup of individuals with Major Depressive Disorder. Conclusion Individuals who endorse depressive symptoms during screening are likely to have clinically significant depression and need mental health treatment. The Open Door intervention offers a strategy to overcome barriers to mental health treatment engagement and to improve the odds of quality care for depression.
Sirey, Jo Anne; Greenfield, Alexandra; DePasquale, Alyssa; Weiss, Nathalie; Marino, Patricia; Alexopoulos, George S; Bruce, Martha L
Examined how model youth sport coaches learned to coach through experience. Data collected via interviews, observations, and documents indicated that all the coaches developed and refined coaching strategies through a process of reflection. Components characterizing reflection included strategy generation, experimentation, and evaluation. Three…
This study explored coaches' and athletes' perceptions of coaching staff cohesion (CSC) and their relationships with team cohesion and performance. Eighteen NCAA Division I, II, and III teams participated. Coaches completed the Coaching Staff Cohesion Scale (CSCS; Martin, 2002). Athletes completed a modified CSCS, the Group Environment Questionnaire (GEQ; Carron, 1985), and an item of perceived team performance. Significant differences
Rebecca A. Zakrajsek; Christiaan G. Abildsoa; Jennifer R. Hurst; Jack C. Watson
We present a multi-phase coaching model that was implemented to help principals improve their instructional leadership practices. We then discuss a rubric based on this coaching model that we used to evaluate coaches' implementation of key model phases and to identify principals' responses to the coaching. After presenting the leadership…
Coaches are influential in creating positive and achievement-oriented sport environments and the development of a sound philosophy is the key to successful coaching (Martens, 2004). Yet, few coaches spend significant time early in their careers developing and modifying their philosophical beliefs (Wilcox & Trudel, 1998). While coaching educators…
This study examined how outstanding high school football coaches developed life skills in their players. In-depth phone interviews were conducted with 10 outstanding coaches ranging in age from 47 to 68 years (M = 54). Coaches averaged 31 years of coaching experience, and were highly successful (76.6% winning percentage). Hierarchical content analysis of the data revealed that two general dimensions
Daniel Gould; Karen Collins; Larry Lauer; Yongchul Chung
Background: Winning and losing have consistently been used as one criterion upon which to evaluate coaches. Since winning coaches have long been thought of as knowledgeable and effective at providing instruction, researchers have often studied coaches who have obtained a high winning percentage. While researchers know some about the behaviors and thought processes of winning and losing coaches, this research
Background: Winning and losing have consistently been used as one criterion upon which to evaluate coaches. Since winning coaches have long been thought of as knowledgeable and effective at providing instruction, researchers have often studied coaches who have obtained a high winning percentage. While researchers know some about the behaviors and thought processes of winning and losing coaches, this research
A survey questionnaire sought information on the background of paid coaches in Oregon high schools during 1984-85. Specific questions addressed coaches' teacher certification status, preparation for coaching, and training for athletic injury management. Additionally, the gender of the coach was identified. A secondary purpose of the study was to…
There is increased recognition that more mental health concerns are seen in primary care than any other healthcare setting. The Patient-Centered Medical Home (PCMH) is a significant redesign of primary care, and many of the principles of the PCMH appeal to the usage of a whole person mind-and-body treatment approach that is responsive to all the patient's needs. This study examined the level of collaboration between National Committee for Quality Assurance (NCQA)-recognized PCMH primary care practices and outpatient specialty behavioral health services (when compared to other medically oriented specialties). In 2010, a 20-item survey was sent to 238 NCQA PCMHs to learn what they were doing to address behavioral health needs in primary care. A sub-dataset from the survey was analyzed in order to look specifically at referrals, communication, and scheduling-support processes. These data were compared with how the practice responded to similar questions about endocrinology and cardiology. Results from the participating 123 practices revealed that very few practices address behavioral health conditions as they would other medical conditions. This is evidenced by the lack of routinized processes to assist with referrals, communication, and scheduling to outpatient behavioral health services. There appears to be significant opportunity to improve how behavioral health is addressed in the patient-centered medical home. PMID:24073132
Massa, Idalia; Miller, Benjamin F; Kessler, Rodger
This study describes a qualitative inquiry–informing program development in a maternal and child home visiting program. Low-income women's perceptions of the meaning and experiences of depression were ascertained through focus groups and interviews. Simultaneously, the study examines staff member perceptions and roles related to depression. Specific findings from clients and staff reveal culturally situated beliefs about depression and stressful life events; comparing and contrasting these beliefs offers a novel perspective on identification and intervention for maternal depression. This study offers a foundation for a translational research agenda that will be used for program and policy development to enhance mental health services situated within maternal and child healthhome visiting programs.
Although nursing personnel have used personal digital assistants (PDAs) to support homehealth care services for the past ten years, little is known about their experiences. This study was conducted to examine experiences of nursing personnel using a specialized homehealth care computer software application called Gerica. In addition, this research analyzed how well this application aligned with the workflow of the nursing personnel in their daily care of patients. The evaluation methods included user observations and learnability testing. Nursing personnel from two different municipalities were observed while performing real tasks in natural settings. This study shows that the nursing personnel were satisfied with the PDA user interface and the Gerica software; however, they identified areas for improvement. For example, the nursing personnel were concerned about trusting the reliability of the PDA in order to eliminate the need for handwritten documentation. Solutions to meet these shortcomings for nursing managers and vendors are discussed.
Hansen, Linda M.; Fossum, Mariann; Soderhamn, Olle; Fruhling, Ann
The authors have developed the Genetics Home Reference, a consumer resource that addresses the health implications of the Human Genome Project. The research results made possible by the Human Genome Project are being made available increasingly in scientific databases on the Internet, but, because of the often highly technical nature of these databases, they are not readily accessible to the lay public. The authors' goal is to provide a bridge between the clinical questions of the public and the richness of the data emanating from the Human Genome Project. The Genetics Home Reference currently focuses on single gene or polygenic conditions that are also topics on MEDLINEplus, the National Library of Medicine's primary consumer health site. As knowledge of genetics expands, the interrelationships between genes and diseases will continue to unfold, and the site will reflect these developments.
Few decisions are as determinative of a child’s well-being and long-term success as the decision to remove a child from his or her own home following an allegation of abuse by a parent. Using the public health lens Professor Marsha Garrison develops elsewhere in this Issue, this Comment examines one of the most critical questions Child Protective Services agencies face
Abstract: A Survey of Home-Based Workers in Japan: Emerging Health Issues: Wendy A. SPINKS. Department of Management Science, Science University of Tokyo—Changes such as the greater diversification of work arrangements, either the result of or enabled by the rise of information communication technology, are testing many long-standing practices and assumptions in the workplace. The emergence,of the virtual organization and telework
E-health delivers healthcare services and education, via a Web portal, to older persons with chronic conditions and their caregivers and enables the patient's home to be the point of care. This growing industry is ripe for exploration by nurses who can empower the patient and caregiver to gain self-care and coping skills. Advances in information technology now make this dream a reality. PMID:16006829
There is increasing evidence of a direct association between unaffordable housing and poor mental health, over and above the effects of general financial hardship. Type of housing tenure may be an important factor in determining how individuals experience and respond to housing affordability problems. This study investigated whether a relationship exists between unaffordable housing and mental health that differs for home purchasers and private renters among low-income households. Data from 2001 to 2010 of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) survey were analysed using fixed-effects linear regression to examine change in the SF-36 Mental Component Summary (MCS) score of individuals aged 25-64 years, associated with changes in housing affordability, testing for an interaction with housing tenure type. After adjusting for age, survey year and household income, among individuals living in households in the lower 40% of the national income distribution, private renters in unaffordable housing experienced somewhat poorer in mental health than when their housing was affordable (difference in MCS = -1.18 or about 20% of one S.D. of the MCS score; 95% CI: -1.95,-0.41; p = 0.003) while home purchasers experienced no difference on average. The statistical evidence for housing tenure modifying the association between unaffordable housing and mental health was moderate (p = 0.058). When alternatives to 40% were considered as income cut-offs for inclusion in the sample, evidence of a difference between renters and home purchasers was stronger amongst households in the lowest 50% of the income distribution (p = 0.020), and between the 30th and 50th percentile (p = 0.045), with renters consistently experiencing a decline in mental health while mean MCS scores of home purchasers did not change. In this study, private renters appeared to be more vulnerable than home purchasers to mental health effects of unaffordable housing. Such a modified effect suggests that tenure-differentiated policy responses to poor housing affordability may be appropriate. PMID:23931950
Mason, Kate E; Baker, Emma; Blakely, Tony; Bentley, Rebecca J
Purpose To examine the cost structure of homehealth agencies by estimating an empirical cost function for those that are Medicare-certified, ten years following the implementation of prospective payment. Design and Methods 2010 national Medicare cost report data for certified homehealth agencies were merged with case-mix information from the Outcome and Assessment Information Set (OASIS). We estimated a fully interacted (by tax status) hybrid cost function for 7,064 agencies and calculated marginal costs as percent of total costs for all variables. Results The homehealth industry is dominated by for-profit agencies, which tend to be newer than the non-profit agencies and to have higher average costs per patient but lower costs per visit. For-profit agencies tend to have smaller scale operations and different cost structures, and are less likely to be affiliated with chains. Our estimates suggest diseconomies of scale, zero marginal cost for contracting with therapy workers, and a positive marginal cost for contracting with nurses, when controlling for quality. Implications Our findings suggest that efficiencies may be achieved by promoting non-profit, smaller agencies, with fewer contract nursing staff. This conclusion should be tested further in future studies that address some of the limitations of our study.
Mukamel, Dana B; Fortinsky, Richard H; White, Alan; Harrington, Charlene; White, Laura M; Ngo-Metzger, Quyen
Objective To examine whether homehealth agencies selectively discontinue services to areas with socio-economically disadvantaged people after the introduction of HomeHealth Compare (HHC), a public reporting program initiated by Medicare in 2003. Study Design /Methods We focused on agencies' initial responses to HHC and examined selective market-area exits by agencies between 2002 and 2004. We measured HHC effects by the percentage of quality indicators reported in public HHC data in 2003. Socio-economic status was measured by per capita income and percent college-educated at the market-area level. Data Source(s) 2002 and 2004 Outcome and Assessment Information Set (OASIS); 2000 US Census file; 2004 Area Resource File; and 2002 Provider of Service File. Principal Findings We found a small and weak effect of public reporting on selective exits: a 10-percent increase in reporting (reporting one more indicator) increased the probability of leaving an area with less-educated people by 0.3 percentage points, compared with leaving an area with high education. Conclusion The small level of market-area exits under public reporting is unlikely to be practically meaningful, suggesting that HHC did not lead to a disruption in access to homehealth care through selective exits during the initial year of the program.
There are few studies about school-environment in relation to pupils' respiratory health, and Korean school-environment has not been characterized. All pupils in 4th grade in 12 selected schools in three urban cities in Korea received a questionnaire (n = 2,453), 96% participated. Gaseous pollutants and ultrafine particles (UFPs) were measured indoors (n = 34) and outdoors (n = 12) during winter, 2004. Indoor dampness at home was investigated by the questionnaire. To evaluate associations between respiratory health and environment, multiple logistic- and multi-level regression models were applied adjusting for potential confounders. The mean age of pupils was 10 yr and 49% were boys. No school had mechanical ventilation and CO2-levels exceeded 1,000 ppm in all except one of the classrooms. The indoor mean concentrations of SO2, NO2, O3 and formaldehyde were 0.6 µg/m3, 19 µg/m3, 8 µg/m3 and 28 µg/m3, respectively. The average level of UFPs was 18,230 pt/cm3 in the classrooms and 16,480 pt/cm3 outdoors. There were positive associations between wheeze and outdoor NO2, and between current asthma and outdoor UFPs. With dampness at home, pupils had more wheeze. In conclusion, outdoor UFPs and even low levels of NO2 may adversely contribute to respiratory health in children. High CO2-levels in classrooms and indoor dampness/mold at home should be reduced.
Elfman, Lena; Wieslander, Gunilla; Ferm, Martin; Toren, Kjell; Norback, Dan
Background: There are approximately 52,000 teacher-coachescoaching 750,000 high school student-athletes in Canada. Despite this large population, Canadian high school teacher-coaches remain relatively unstudied. High school coaches in Canada are often asked to coach sports with which they are unfamiliar, and because they are not required to obtain formal training, they acquire knowledge from various situations in order to meet
Evidence-based approaches to coach training and education are vital if the coaching industry is to continue to mature. Drawing on past research on mandatory personal therapy for therapists-in-training, this paper reports a qualitative and quantitative within-subject exploration of the impact of compulsory participation in a personal life coaching program for coaches-in-training. Twenty-nine coaches-in-training set personal goals and completed a 10
Some educators think of literacy coaches as teachers who help students refine the strategies they use to comprehend text, but "literacy coach" is more commonly used to describe an educator whose clients are teachers. In this capacity, literacy coaches provide job-embedded professional development that helps teachers build their capacity to make…
Today's school principals face unprecedented challenges. This article proposes a school-based outline framework in which the principal is the primary agent of change aided by an external coach. In this framework, the principal receives coaching and guides the change process at the school through a variety of coaching practices involving the…
Coach education is important, but expensive--both in cost and time to public and private athletic programs. To provide basic coach education to coaches, new, innovative, inexpensive approaches must be developed. Joint efforts between state high school associations and colleges and universities can meet those needs. The "Montana approach" is one…
Following a brief introduction, in which the chosen format is discussed, this article comprises a dialogue between present-day coaching science (CS) and a critic, educational relationship (ER). ER disparages current conceptualisations of coaching as irrelevant and implores CS to redefine itself as an educational relationship between coach and…
Coaches have always needed to respond to differences in sport and have always been concerned with finding hard-working kids who mesh well as a team. While coaches still try to build team cohesiveness, today's coaches must respond to complex issues related to diversity and are expected to be politically correct. The purpose of this article is to…
Many major urban districts have committed large investments to school-based professional development anchored in the work of literacy coaches. At base is a shared belief that instructional coaches are key levers for improvement. Yet, clinical accounts of the role of an instructional coach suggest that this is a complex practice to implement well.…
Explains that semantic coaching is a system of conversational analysis and communication design developed by Fernando Flores, and was based on the earlier research of John Austin and John Searle. Describes how to establish the coaching relationship, and how to coach for improved performance. (PA)
Literacy coaches inspire teacher reflection and promote a culture of ongoing professional learning. This article illustrates the role of literacy coaches, describes how coaches differentiate support for a diverse group of teachers, and explains how teacher reflection can be a catalyst for change and professional growth. The authors, current and…
The Québec health sector is facing profound macroeconomic and macro-organizational changes. This article addresses the impact of these changes on the work of homehealth aides (HHAs) and their occupational health and safety (OHS). The study was carried out in the home care services of four local community service centers (CLSCs) with different organizational characteristics. It is based on an analysis by triangulation of 66 individual and group interviews, 11 work days, and 35 multidisciplinary or professional meetings observed, as well as administrative documents. HHAs are experiencing an erosion of their job because the relational and emotional components of their work are disappearing. This results in an increase in musculoskeletal and psychological health problems. This study also shows that managers' decisions can reduce or increase the HHAs' work constraints. Stability in the clientele served and the possibility of organizing their routes are good examples of positive impacts. PMID:17434861
Objective Older adults receiving Medicare homehealth services who experience under-nutrition may be at increased risk of experiencing adverse outcomes. We sought to identify the association between baseline nutritional status and subsequent health service utilization and mortality over a one-year period in older adults receiving Medicare homehealth services. Design This was a longitudinal study using questionnaires and anthropometric measures designed to assess nutritional status (Mini-Nutritional Assessment [MNA]) at baseline and health services utilization and mortality status at six-month and one-year follow-ups. Setting Participants were evaluated in their homes. Participants 198 older adults who were receiving Medicare homehealth services. Results Based upon MNA, 12.0% of patients were Malnourished, 51.0% were At Risk for Malnourishment, and 36.9% had Normal Nutrition Status. Based upon body mass index (BMI), 8.1% of participants were underweight, 37.9% were normal weight, 25.3% were overweight, and 28.8% were obese. Using multivariate binary logistic regression analyses, participants who were Malnourished or At Risk for Malnourishment were more likely to experience subsequent hospitalization, emergency room visit, homehealth aide use, and mortality for the entire sample and hospitalization and nursing home stay for overweight and obese participants. Conclusions Experiencing under-nutrition at the time of receipt of Medicare homehealth services was associated with increased health services utilization and mortality for the entire sample, and with increased health services utilization only for the overweight and obese subsample. Opportunities exist to address risk of under-nutrition in patients receiving homehealth services, including those who are overweight or obese, to prevent subsequent adverse health outcomes.
The surge of information generated by the Human Genome Project has left many health professionals and their patients struggling to understand the role of genetics in health and disease. To aid the lay public and health professionals, the US National Library of Medicine developed an online resource called 'Genetics Home Reference' (GHR), located at http://ghr.nlm.nih.gov/. Launched in April 2003, GHR's goal is to help the public interpret the health implications of the Human Genome Project. It bridges the clinical questions of consumers and the rich technical data emerging from the sequenced human genome. The GHR web site is designed for easy navigation among summaries for genetic conditions and the related gene(s) and chromosome(s). This design strategy enhances the user's appreciation of how genes, chromosomes, and conditions are interrelated. PMID:17003538
We deal in this paper with the concept of health smart home (HSH) designed to follow dependent people at home in order to avoid the hospitalisation, limiting hospital sojourns to short acute care or fast specific diagnostic investigations. For elderly people the project of such a HSH has been called AISLE (Apartment with Intelligent Sensors for Longevity Effectiveness). For this
Jacques Demongeot; Gilles Virone; Florence Duchêne; Gila Benchetrit; Thierry Hervé; Norbert Noury; Vincent Rialle
This research was conducted to understand paraprofessional home visitors' perceptions of their training in addressing poor mental health, substance abuse, and domestic violence, and their actions in working with families in addressing these issues. Five focus groups were conducted with a total of 28 paraprofessional home visitors. Three main…
Tandon, S. Darius; Mercer, Constance D.; Saylor, Elizabeth L.; Duggan, Anne K.
This paper considers the role of smart home technology in relation to current housing design principles within the field of health and well being. The concepts of barrier free 'lifetime homes' and universal design1 are considered and UK community care and Building Regulations are investigated in relation to the design process. It is contended that the current role of assistive
Background: Concussions remain a serious public health concern. It is important that persons involved in youth sports, particularly coaches, be made aware and educated on the signs and symptoms of concussion. This study assessed the perceptions of youth sport coaches who have received the Centers for Disease Control and Prevention's…
As an alternative method of coaching education, with a focus on situated learning, mentoring has the potential to encourage "communities of practice," which are groups of people who share a common interest and engage in a process of collective learning that creates bonds between them. In addition, mentoring has the potential to overcome the…
To identify geographic areas that exhibited aberrant Medicare homehealth outlier payment patterns in 2008. In December 2008, the Centers for Medicare & Medicaid Services (CMS) announced its continuing efforts to fight Medicare fraud, waste, and abuse by ...
While much research focuses on adoption of electronic health-care records and other information technology among health-care providers, less research explores patient attitudes. This qualitative study examines barriers to adoption of home-based health information technology, particularly personal electronic health records, among older adults. We conducted in-depth interviews (30-90 min duration) with 35 American adults, aged 46-72 years, to determine their perceptions of and attitudes toward home-based health information technology. Analysis of interview data revealed that most barriers to adoption fell under four themes: technological discomfort, privacy or security concerns, lack of relative advantage, and perceived distance from the user representation. Based on our findings, systems to promote home-based health information technology should incorporate familiar computer applications, alleviate privacy and security concerns, and align with older adults' active and engaged self-image. PMID:24056750
In the current healthcare system, family caregiving usually is at the core of end-of-life care. The homehealth clinician can play an important role in easing the burdens often experienced by the caregiver. This relationship may provide some challenges and some opportunities. This article describes some potentially helpful interventions that homehealth clinicians can use to improve the experiences of patients and caregivers. PMID:18301118
Background Home mechanical ventilation probably represents the most advanced and complicated type of medical treatment provisioned outside\\u000a a hospital setting. The aim of this study was both to explore the challenges experienced by health care professionals in community\\u000a health care services when caring for patients dependent on home mechanical ventilation, continual care and highly advanced\\u000a technology, and their proposed solutions to
Pregnant mothers in South African townships face multiple health risks for themselves and their babies. Existing clinic-based\\u000a services face barriers to access, utilization, and human resource capacities. Home visiting by community health workers (CHW)\\u000a can mitigate such barriers. The Philani Plus (+) Intervention Program builds upon the original Philani CHW home-visiting intervention\\u000a program for maternal and child nutrition by integrating
Mary Jane Rotheram-Borus; Ingrid M. le Roux; Mark Tomlinson; Nokwanele Mbewu; W. Scott Comulada; Karl le Roux; Jacqueline Stewart; Mary J. O’Connor; Mary Hartley; Kate Desmond; Erin Greco; Carol M. Worthman; Faith Idemundia; Dallas Swendeman
Although studies show the relation between influenza immunization of health care workers and the benefits for residents\\u000ain nursing homes, compliance to vaccination is still low. In this article we explore and discuss two specific moral\\u000areasons for nursing home professionals to accept vaccination. These special reasons derive from two sources: the\\u000aresponsibilities they have as health professionals, and the
This report presents national estimates on differences in the use of homehealth care between men and women aged 65 years and over. Estimates are based on data from the 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Contr...
The health status of 206 female caregivers supporting adults with intellectual and developmental disabilities at home was investigated using objective (i.e., presence of chronic health conditions and activity limitations) and subjective (i.e., self-perceived health status) health measures compared with those of women in the general population in 2 age groups: middle age (Ages 40-59 years) and older ages (> or =60 years). Prevalence of arthritis, high blood pressure, obesity, and activity limitations for the caregivers in both age groups was significantly higher than that for women in the general population. Middle-age caregivers reported a higher prevalence of diabetes and high blood cholesterol than their age peers from the general population. Despite the potential health challenges, the caregivers generally perceived their health better than that of women in the general population. Older caregivers' perceptions on their psychological well being, however, appeared to an exception. Implications regarding potential health risks for caregivers and residential services for persons with intellectual and developmental disabilities are discussed. PMID:20020798
In this article, the authors describe how coaches can apply principles of athlete growth and development to the learning and performance of motor skills. They present 7 habits that lead to well-rounded athletes who experience increased enjoyment, self-motivation, skill improvement, and ultimately more success on the playing field. (Contains 1…
At schools that align with the Common Principles, there's often a palpable sense of high expectations, personalization, and the purpose of school as a place for students to use their minds well. As the co-director and longtime school coach at the Michigan Coalition of Essential Schools, the author has witnessed what it takes for schools to develop…
Through critical readings of several images and texts, including photographs and artifacts in this collected montage, my aim here is to use multiple interactional analyses (visual culture techniques and deconstructive techniques) to assist in the critique of these presented visual images that represent current coaching policies in the USA.
This book is intended for beginning basketball coaches at either the school or agency level. The chapters contain information on simple team administration to the detailed planning and development of team strategy. In addition, the book contains chapters concerning the principles relating to basketball mechanics, conditioning the team, setting up…
The pressure to improve the quality of instruction in schools may be higher today than at any other time in the history of U.S. education. To respond to this urgent demand, schools across the nation are hiring instructional coaches (ICs), even though there is little published research that shows what works and what does not work when it comes to…
Context Little is known about the cost associated with a health center’s rating as a patient-centered medical home (PCMH). Objective To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Design, Setting, and Participants Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Main Outcome Measures Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Results Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD,12; range, 21–90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86–$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27 300; 95% CI,$3047–$57 804) and higher operating cost per patient per month ($1.06;95%CI,$0.29–$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32 731; 95% CI, $1571–$73 670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54–$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39 809; 95% CI, $1893–$63 169). Conclusions According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost.
Nocon, Robert S.; Sharma, Ravi; Birnberg, Jonathan M.; Ngo-Metzger, Quyen; Lee, Sang Mee; Chin, Marshall H.
There is the potential for homehealth nurses and other home care clinicians to be subjected to intrusive and possibly stalking behavior by current and former clients. Most healthcare clinicians do not receive training on the risk of intrusive interactions or stalking, nor on strategies to manage this objectionable client behavior. This article informs nurses and other homehealth clinicians about the potential risk of stalking. Included is a true case vignette, the legal definition of stalking, incidence occurrence among clinicians, the basic profile and behaviors of a stalker, the victimology and psychological consequences, and implications for policy and procedures and prevention techniques. PMID:19609143
Background Maternal mortality among poor rural women in the Lao People’s Democratic Republic (Lao PDR) is among the highest in Southeast Asia, in part because only 15% give birth at health facilities. This study explored why women and their families prefer home deliveries to deliveries at health facilities. Methods A qualitative study was conducted from December 2008 to February 2009 in two provinces of Lao PDR. Data was collected through eight focus group discussions (FGD) as well as through in-depth interviews with 12 mothers who delivered at home during the last year, eight husbands and eight grandmothers, involving a total of 71 respondents. Content analysis was used to analyze the FGD and interview transcripts. Results Obstacles to giving birth at health facilities included: (1) Distance to the health facilities and difficulties and costs of getting there; (2) Attitudes, quality of care, and care practices at the health facilities, including a horizontal birth position, episiotomies, lack of privacy, and the presence of male staff; (3) The wish to have family members nearby and the need for women to be close to their other children and the housework; and (4) The wish to follow traditional birth practices such as giving birth in a squatting position and lying on a “hot bed” after delivery. The decision about where to give birth was commonly made by the woman’s husband, mother, mother-in-law or other relatives in consultation with the woman herself. Conclusion This study suggests that the preference in rural Laos for giving birth at home is due to convenience, cost, comfort and tradition. In order to assure safer births and reduce rural Lao PDR’s high maternal mortality rate, health centers could consider accommodating the wishes and traditional practices of many rural Laotians: allowing family in the birthing rooms; allowing traditional practices; and improving attitudes among staff. Traditional birth attendants, women, and their families could be taught and encouraged to recognize the signs of at-risk pregnancies so as to be able to reach health facilities on time.
In many sports, it is common for top coaching positions to be held by former players; however, despite the natural progression in many sports for skilled players to become high level coaches, we have little understanding of how playing may develop useful skills for coaching. In this study we considered perceptual-cognitive skill across groups of high and low-skilled soccer players and soccer coaches. A range of perceptual-cognitive variables was measured in an attempt to capture the diverse skills related to expertise in sport and coaching. Generally, results highlighted similarities between coaches and players on some tasks and differences on others. PMID:23518523
Gründel, Anna; Schorer, Jörg; Strauss, Bernd; Baker, Joseph
Krouse, RZ, Ransdell, LB, Lucas, SM, and Pritchard, ME. Motivation, goal orientation, coaching, and training habits of women ultrarunners. J Strength Cond Res 25(X): 000-000, 2011-Ultrarunners participate in running events that exceed the 26.2-mile marathon distance (e.g., 50k, 50-100 miles). Very little research exists on ultrarunners, especially women. This study is a descriptive study detailing the motivation, goal orientation, demographic characteristics (e.g., age, job demands, family structure), training habits (e.g., hours per week of training), and coach utilization of women ultrarunners. Participants (N = 344) were recruited via the Ultra List serve and 4 popular ultrarunning websites, and they completed a questionnaire on motivation, goal orientation, training, and coaching using Survey Monkey. General health orientation (mean ± SD) (4.71 ± 1.06) and psychological coping (4.71 ± 1.03) were the 2 strongest motivational factors. Participants were higher in task orientation (1.38 ± 0.68) (e.g., finishing the race or accomplishing various goals) than ego orientation (3.38 ± 1.01) (e.g., placing in the top 3 overall or beating an opponent). Women trained an average of 12.49 h·wk and spent 64% of their time training alone. Training information came from their own experience, blogs, websites, and the Ultra List Serve. Over three-fourths of the participants (80%) did not use a coach because of cost and a perceived lack of necessity. Women ultrarunners in this study were task oriented, internally motivated, health, and financially conscious individuals. With additional information about women ultrarunners, coaches will be better prepared to work with this population and ultrarunners can improve their performance by learning about current participants' practices. PMID:21873905
Krouse, Rhonna Z; Ransdell, Lynda B; Lucas, Shelley M; Pritchard, Mary E
Abstract This study evaluated the financial impact of integrating a systemic care management intervention program (Community Care of North Carolina) with person-centered medical homes throughout North Carolina for non-elderly Medicaid recipients with disabilities during almost 5 years of program history. It examined Medicaid claims for 169,676 non-elderly Medicaid recipients with disabilities from January 2007 through third quarter 2011. Two models were used to estimate the program's impact on cost, within each year. The first employed a mixed model comparing member experiences in enrolled versus unenrolled months, accounting for regional differences as fixed effects and within physician group experience as random effects. The second was a pre-post, intervention/comparison group, difference-in-differences mixed model, which directly matched cohort samples of enrolled and unenrolled members on strata of preenrollment pharmacy use, race, age, year, months in pre-post periods, health status, and behavioral health history. The study team found significant cost avoidance associated with program enrollment for the non-elderly disabled population after the first years, savings that increased with length of time in the program. The impact of the program was greater in persons with multiple chronic disease conditions. By providing targeted care management interventions, aligned with person-centered medical homes, the Community Care of North Carolina program achieved significant savings for a high-risk population in the North Carolina Medicaid program. (Population Health Management 2013;17:141–148)
DuBard, C. Annette; Ritter, Grant A.; Jackson, Carlos T.
Abstract This study evaluated the financial impact of integrating a systemic care management intervention program (Community Care of North Carolina) with person-centered medical homes throughout North Carolina for non-elderly Medicaid recipients with disabilities during almost 5 years of program history. It examined Medicaid claims for 169,676 non-elderly Medicaid recipients with disabilities from January 2007 through third quarter 2011. Two models were used to estimate the program's impact on cost, within each year. The first employed a mixed model comparing member experiences in enrolled versus unenrolled months, accounting for regional differences as fixed effects and within physician group experience as random effects. The second was a pre-post, intervention/comparison group, difference-in-differences mixed model, which directly matched cohort samples of enrolled and unenrolled members on strata of preenrollment pharmacy use, race, age, year, months in pre-post periods, health status, and behavioral health history. The study team found significant cost avoidance associated with program enrollment for the non-elderly disabled population after the first years, savings that increased with length of time in the program. The impact of the program was greater in persons with multiple chronic disease conditions. By providing targeted care management interventions, aligned with person-centered medical homes, the Community Care of North Carolina program achieved significant savings for a high-risk population in the North Carolina Medicaid program. (Population Health Management 2013;17:141-148). PMID:24053757
Fillmore, Herbert; DuBard, C Annette; Ritter, Grant A; Jackson, Carlos T
With emerging technology, patients are able to access the health care system from settings such as their homes, long-term care facilities, and schools. Telemonitoring allows care teams to oversee patients' clinical data captured and transmitted by specialized devices, with minimal involvement or manual effort, on a near real-time basis. This review was undertaken to provide insight into the capacity of telemonitoring technology to improve population health. Despite the potential of telemonitoring, evidence for its clinical, economic, and patient-reported benefits is inconclusive. Much of the outcome variation seen in the literature may be due to the heterogeneity of the interventions' characteristics, with some telemonitoring programs more effectively integrating into standard practice, targeting patients, and utilizing technology. A particular challenge is the ability to comprehensively leverage data to improve health outcomes. To accomplish this, the mass data collected by the devices must be aggregated with data from other clinical systems and used to develop predictive algorithms that can be embedded across the continuum of care. Innovations such as the Healthe Intent cloud-based platform can support a population health strategy by integrating telemonitoring and electronic health record data. PMID:24569764
Aguilar, Kathleen M; Campbell, Rebecca S; Fiester, Angela; Simpson, Roy L; Hertel, Cheryl
Moving to recovery-oriented service provision in mental health may entail retraining existing staff, as well as training new staff. This represents a substantial burden on organisations, particularly since transfer of training into practice is often poor. Follow-up supervision and/or coaching have been found to improve the implementation and sustainment of new approaches. We compared the effect of two coaching conditions, skills-based and transformational coaching, on the implementation of a recovery-oriented model following training. Training followed by coaching led to significant sustained improvements in the quality of care planning in accordance with the new model over the 12-month study period. No interaction effect was observed between the two conditions. However, post hoc analyses suggest that transformational coaching warrants further exploration. The results support the provision of supervision in the form of coaching in the implementation of a recovery-oriented service model, and suggest the need to better elucidate the mechanisms within different coaching approaches that might contribute to improved care. PMID:23982458
Deane, Frank P; Andresen, Retta; Crowe, Trevor P; Oades, Lindsay G; Ciarrochi, Joseph; Williams, Virginia
Background Knee osteoarthritis (OA) is one of the most common and costly chronic musculoskeletal conditions world-wide and is associated with substantial pain and disability. Many people with knee OA also experience co-morbidities that further add to the OA burden. Uptake of and adherence to physical activity recommendations is suboptimal in this patient population, leading to poorer OA outcomes and greater impact of associated co-morbidities. This pragmatic randomised controlled trial will investigate the clinical- and cost-effectiveness of adding telephone coaching to a physiotherapist-delivered physical activity intervention for people with knee OA. Methods/Design 168 people with clinically diagnosed knee OA will be recruited from the community in metropolitan and regional areas and randomly allocated to physiotherapy only, or physiotherapy plus nurse-delivered telephone coaching. Physiotherapy involves five treatment sessions over 6 months, incorporating a home exercise program of 4–6 exercises (targeting knee extensor and hip abductor strength) and advice to increase daily physical activity. Telephone coaching comprises 6–12 telephone calls over 6 months by health practitioners trained in applying the Health Change Australia (HCA) Model of Health Change to provide behaviour change support. The telephone coaching intervention aims to maximise adherence to the physiotherapy program, as well as facilitate increased levels of participation in general physical activity. The primary outcomes are pain measured by an 11-point numeric rating scale and self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale after 6 months. Secondary outcomes include physical activity levels, quality-of-life, and potential moderators and mediators of outcomes including self-efficacy, pain coping and depression. Relative cost-effectiveness will be determined from health service usage and outcome data. Follow-up assessments will also occur at 12 and 18 months. Discussion The findings will help determine whether the addition of telephone coaching sessions can improve sustainability of outcomes from a physiotherapist-delivered physical activity intervention in people with knee OA. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12612000308897
The purpose of this validity study was to improve measurement of coaching efficacy, an important variable in models of coaching effectiveness. A revised version of the coaching efficacy scale (CES) was developed for head coaches of high school teams (CES II-HST). Data were collected from head coaches of 14 relevant high school sports (N = 799).…
Myers, Nicholas D.; Feltz, Deborah L.; Chase, Melissa A.; Reckase, Mark D.; Hancock, Gregory R.
Technologies continue to evolve to provide more compelling and interactive learning opportunities. Coaching has traditionally been face-to-face or by email. By combining the new technologies with coaching, learning developers now have the opportunity to develop an asynchronous, online, nonhuman coaching system, or e-coaching system. An e-coaching…
Developing a sound coaching philosophy and displaying ethical behavior is the backbone of effective coaching at any level. Coaches cannot communicate the standards of behavior they expect from their athletes or coaching staff if they have not identified the priorities and values associated with their coaching philosophy. When reflecting on Domain…
Victorian and Edwardian coaches and athletes often referred to their training regimes as ‘scientific.’ However, the impact of experimental science on coaching programmes was minimal, and coaching was considered an art as much as a science. Coaching operated as a trade or a craft with the typical coach relying on traditional practices, experience, intuition, and the ability to innovate. In
Effective coaching is a mixture of pedagogy and principles of sciences, e.g., motor skill acquisition, sociology, and physiology, often referred to as the science of coaching. Instinctive or intuitive coaching has often been incorrectly viewed as the art of coaching. More important should be how coaches develop knowledge, how they access that knowledge at the appropriate times and how this
Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.
The main aim of this article is to explore the association between mental health problems in children placed out-of-home and family risk factors reported as reasons for placement. The sample consisted of 109 Norwegian children aged 6-12 years. Mental health problems were assessed by the Revised Rutter scales reported by the parents and the…
Objective: This longitudinal, prospective study examines the role of specialty mental health care as provided by community-based, usual-care practice settings in predicting out-of-home placements among children served by a child welfare and juvenile justice system. Method: The mental health needs of 1,249 children from 22 counties in Tennessee…
At the Little Farm mobile home park, the Florida Department of Health's (DOH) and the US Agency for Toxic Substances and Disease Registry's (ATSDR) top priority is to ensure nearby residents have the best information to safeguard their health. The Little ...
Because a high percentage of primary care patients have behavioral problems, patient-centered medical homes (PCMHs) that wish to attain true comprehensive whole-person care will find ways to integrate behavioral health services into their structure. Yet in today's health care environment, the incorporation of behavioral services into primary care is exceptional rather than usual practice. In this article, we discuss the components considered necessary to provide sustainable, value-added integrated behavioral health care in the PCMH. These components are to: (1) combine medical and behavioral benefits into one payment pool; (2) target complex patients for priority behavioral health care; (3) use proactive onsite behavioral "teams;" (4) match behavioral professional expertise to the need for treatment escalation inherent in stepped care; (5) define, measure, and systematically pursue desired outcomes; (6) apply evidence-based behavioral treatments; and (7) use cross-disciplinary care managers in assisting the most complicated and vulnerable. By adopting these 7 components, PCHMs will augment their ability to achieve improved health in their patients at lower cost in a setting that enhances ease of access to commonly needed services. PMID:24615314
The Preventive Health Education and Medical Home Project (PHEMHP) is a predictive and contextual model intended to reduce low levels of health services utilization and improve preventive health techniques and disease self-management for low-income families in South Central Los Angeles, with the ultimate goal of attaching each child to a medical home. The model is designed to be implemented through educational and case management strategies. This paper presents the conceptual framework, critical intervention activities, and the different implementation variations the PHEMHP has already assumed. Implications for research, policy, and practice are discussed. PMID:19821189
Tataw, David B; James, Frederick; Bazargan, Shahrzad
A major objective of sports scientists and elite coaches is the enhancement of athletic performance. Despite this common goal, there is a general perception that research in sports science does not meet the needs of coaches. A study using survey and interview examined the perceptions of elite coaches and sports science researchers in Australia regarding the research needs of elite coaching. Congruence was found between coaches and researchers regarding research practice at the elite level. Both groups held common perceptions on the importance and application of research, the methods by which research questions are determined, and the qualities valued in elite coaches and sports science researchers. However, elite coaches perceived a need for more research in the area of sports psychology, dissemination of research findings via coaching clinics and sports-specific magazines, and the use of more appropriate "lay" language in information dissemination. PMID:17852663
A survey was made during 1986-87 of three agencies in each state to gain information on required coach certification programs, voluntary programs, and minimum requirements for coaches. Results are discussed, and state requirements are presented. (MT)
Background This study examines whether bed days are alternative methods to medical care use for treating a particular illness. If bed days at home are considered as an alternative to medical treatment, then medical care use and bed days at home should be influenced by an individual’s health insurance status. Method This study uses data from the 2003 Medical Expenditure Panel Survey (MEPS) on medical care use and bed days at home for each contracted illness of non-working married women. Results The results suggest that the health insurance status of non-working married women has considerable influence on their choice between medical care use and bed days at home. In addition, those with health insurance are more likely to use medical care and less likely to use bed days at home, but they tend to avoid the simultaneous use of medical care and bed days at home. Conclusions In contrast to previous studies’ findings indicating that absences from work and medical care use among working males may be complements, this study’s results for non-working married women without health insurance suggest that they use rest and medical treatment as substitutes, not complements.
Healthcare spending varies widely across markets, and previous empirical studies find little evidence that higher spending translates into better health outcomes. The main innovation in this paper exploits this cross-sectional variation in hospital spending in a new way by considering patients who are exposed to healthcare systems not designed for them: patients far from home when a health emergency strikes. Visitors to Florida who become ill in high-spending areas have significantly lower mortality rates compared to visitors in lower-spending areas. The results are robust within groups of similar visitors and within groups of destinations that appear to be close demand substitutes—areas that likely attract similar visitors.
This research reviews the factors affecting the pricing or rate schedules of homehealth care agencies. A large number of factors affect costs and thus rate structures. The major factors include reimbursement structures with accompanying discount structures, administrative burdens, and risks. Channel issues include bargaining power, competition, and size. Staffing issues affect pricing and product through the provider level, productivity, and quality outcomes. Physician and patient issues include quality concerns and choices. These factors are discussed in light of overall marketing strategy and the interaction of pricing with other marketing controllables such as product, place/distribution, and promotion. Economic and accounting principles are also reviewed with consideration to understanding direct and indirect costs in order to enable negotiators to effectively price health care services. PMID:10623194
\\u000a Running is an enjoyable exercise for many people today. Trainers help people to reach running goals. However, today’s busy\\u000a and nomadic people are not always able to attend running classes. A combination of a virtual and physical coach should be\\u000a useful. A virtual coach (MyCoach) was designed to provide this support. MyCoach consists of a mobile phone (real time) and
STUDY OBJECTIVE: To identify the main determinants of self assessed health among community dwelling elderly. PARTICIPANTS AND SETTING: A representative sample of 677 people aged 65 and over of the city of Madrid, Spain. DESIGN: Cross sectional study. Information was collected through personal interviews at the homes of the selected subjects. The five category dependent variable was grouped into two categories: good and poor self assessed health. Age, sex, social class, use of physician services, number of chronic conditions, and functional capacity, were included as main explanatory factors. Adjusted odds ratios were estimated through multiple logistic regression models. MAIN RESULTS: A total of 49.5% of subjects rated their health as good or very good. Those aged 85 and over rated their health higher than those aged 65-74 (adjusted odds ratio (OR): 0.37; 95% confidence intervals (CI): 0.18, 0.77). The adjusted OR for an increase of three chronic conditions was 3.48 (95% CI: 2.49, 4.85). Functional capacity also showed a strong independent effect (OR: 3.64; 95% CI: 1.89, 7.02). Social class was one of the main determinants for the youngest group, with those in the upper class reporting a better health perception (OR: 3.28 95% CI: 1.70, 6.35), but showed no effect in the oldest old (OR: 1.05; 95% CI: 0.57, 1.96). CONCLUSIONS: Age, chronic conditions, and functional status were the main determinants of perceived health among Spanish elderly. The effect of social class on perceived health markedly decreases with age. This study may contribute to a better utilisation and interpretation of self ratings in research and in general practice.
Damian, J.; Ruigomez, A.; Pastor, V.; Martin-Moreno, J. M.
\\u000a The workplace represents a large and significant arena for employee learning to occur. The scholarly literature has recognized\\u000a that coaching and mentoring are often activities that can be used to facilitate such learning and that managers are increasingly\\u000a being encouraged to serve as coaches for their employees. This chapter integrates conceptual and empirical research on managerial\\u000a coaching to develop a
Andrea D. Ellinger; Robert G. Hamlin; Rona S. Beattie; Yu-Lin Wang; Orla McVicar
A major objective of sports scientists and elite coaches is the enhancement of athletic performance. Despite this common goal, there is a general perception that research in sports science does not meet the needs of coaches. A study using survey and interview examined the perceptions of elite coaches and sports science researchers in Australia regarding the research needs of elite
The vast majority of youth sport programs in the United States relies primarily on parent volunteers to serve as coaches. Unfortunately, most of these volunteer coaches have not received formal training to prepare them adequately for the role of youth sport coach. To exacerbate the issue, according to the popular media, parents and other adults…
The question ‘what is coaching?’ continues to provoke debate, with many writers attempting to distinguish coaching from other forms of ‘helping by talking’, particularly therapy and counselling. Despite this level of discussion, confusion and lack of clarity continues to exist. This situation is compounded by vested interests and lack of relevant empirical research. Practicing coaches must therefore decide on the
Leadership coaching has become vitally important to today's most successful businesses. This book is a landmark resource that presents a variety of perspectives and best practices from today's top executive coaches. It provides valuable guidance on exactly what the best coaches are now doing to get the most out of leaders, for now and into the…
This article focuses on an evaluation of the Microsoft Peer Coaching (MPC) program in Florida, USA. First, the design of the MPC materials was analyzed using characteristics of exemplary peer coaching and technology integration models. Second, facilitators (n = 14) and coaches (n = 46) who attended the MPC workshops in Florida were surveyed…
Barron, Ann E.; Dawson, Kara; Yendol-Hoppey, Diane
This handbook presents practical advice for the soccer coach. The first section contains an explanation of soccer and how to teach individual offensive and defensive skills. The coaching points, teaching progressions, illustrations, and practice activities are designed to help the coach understand and plan how to teach and develop those skills.…
Background: Winning and losing have consistently been used as one criterion upon which to evaluate coaches. Since winning coaches have long been thought of as knowledgeable and effective at providing instruction, researchers have often studied coaches who have obtained a high winning percentage. While researchers know some about the behaviors and…
San Diego State University (California) has developed a coach-of-coaches model of providing support, assistance, and supervision to intern-teachers in its rural special education alternative credential program. Coaches, who are fully credentialed teachers with supervisory skills, make a minimum of nine direct and indirect (video analysis)…
Cegelka, Patricia Thomas; Fitch, Suzanne; Alvarado, Jose Luis
Using the 2001 California Health Interview Survey, this study compared health status, medical insurance, and having a usual source of care for 2,230 ethnic minority adolescents based on language use at home: Group 1, English only; Group 2, both English and another language; and Group 3, exclusively another language. Adjusting for demographic…
Hahm, Hyeouk Chris; Lahiff, Maureen; Barreto, Rose M.; Shin, Sunny; Chen, Wan-Yi
This study examines the impact of professional development on teacher knowledge and quality early language and literacy practices in center- and home-based care settings. Participants from 291 sites (177 centers; 114 home-based) in four cities were randomly selected to: Group 1, 3-credit course in early language and literacy; Group 2, course plus ongoing coaching; Group 3, control group. Analysis of
Background The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. Objective The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. Methods A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. Results The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. Conclusions This paper describes the health care professionals’ competencies and requirements needed for the use of eHealth technologies to support elderly adults to age in place. In addition, this paper underscores the need for further discussion of the changing role of health care professionals working in home care within the context of emerging eHealth care technologies. The findings are of value to local and central government, health care professionals, service delivery organizations, and commissioners of care to use this paper as a framework to conduct and develop competencies for health care professionals working with eHealth technologies.
Barakat, Ansam; Woolrych, Ryan D; Sixsmith, Andrew; Kearns, William D
Patients receiving home care are becoming increasingly dependent upon competent caregivers’ 24-h availability due to their substantial care needs, often with advanced care and home care technology included. In Sweden, care is often carried out by municipality-employed paraprofessionals such as health care assistants (HC assistants) with limited or no health care training, performing advanced care without formal training or support. The aim of this study was to investigate the work experience of the HC assistants and to explore how they manage when delivering 24-h home care to patients with substantial care needs. Grounded theory methodology involving multiple data sources comprising interviews with HC assistants (n=19) and field observations in patients’ homes was used to collect data and constant comparative analysis was used for analysis. The initial analysis revealed a number of barriers, competence gap; trapped in the home setting; poor supervision and unconnected to the patient care system, describing the risks associated with the situations of HC assistants working in home care, thus affecting their working conditions as well as the patient care. The core process identified was the HC assistants’ strivings to combine safe home care with good working conditions by using compensatory processes. The four identified compensatory processes were: day-by-day learning; balancing relations with the patient; self-managing; and navigating the patient care system. By actively employing the compensatory processes, the HC assistants could be said to adopt an inclusive approach, by compensating for their own barriers as well as those of their colleagues’ and taking overall responsibility for their workplace. In conclusion, the importance of supporting HC assistants in relation to their needs for training, supervision,and support from health care professionals must be addressed when organising 24-h home care to patients with substantial care needs in the future.
Swedberg, Lena; Chiriac, Eva Hammar; Tornkvist, Lena; Hylander, Ingrid
The purpose of this study was to better understand the experiences of former female coaches and their decision to terminate their careers. A feminist perspective and mixed-methods (surveys and interviews) were used to allow for a richer understanding of their experiences. The survey findings, which included 121 former female coaches, suggest that time and family commitments were the main reasons they left coaching. Also, a small number (18%) left coaching for reasons such as opportunity for promotion. Six women from the survey sample were individually interviewed. Through a descriptive analytic strategy and indexing process (Creswell, 1998), three general themes emerged: (a) gender disparities in women's work, (b) technical demands of coaching, and (c) college coaching and normalized sexualities. Overall, the interview findings confirmed the open-ended responses on the survey and described gender discrimination, the centrality of male coaches, and rampant homophobia in U.S. collegiate coaching. In addition, some female coaches discussed perceptions of conflict between working as a coach and motherhood, or women with children as being "distracted" by motherhood. Collectively, the survey and interview results revealed that women have multiple, complex, and overlapping reasons for leaving collegiate coaching. PMID:20949856
Indoor fungal contamination has been associated with a wide range of adverse health effects, including infectious diseases, toxic effects and allergies. The diversity of fungi contributes to the complex role that they play in indoor environments and human diseases. Molds have a major impact on public health, and can cause different consequences in hospitals, homes and workplaces. This review presents the methods used to assess fungal contamination in these various environments, and discusses advantages and disadvantages for each method in consideration with different health risks. Air, dust and surface sampling strategies are compared, as well as the limits of various methods are used to detect and quantify fungal particles and fungal compounds. In addition to conventional microscopic and culture approaches, more recent chemical, immunoassay and polymerase chain reaction (PCR)-based methods are described. This article also identifies common needs for future multidisciplinary research and development projects in this field, with specific interests on viable fungi and fungal fragment detections. The determination of fungal load and the detection of species in environmental samples greatly depend on the strategy of sampling and analysis. Quantitative PCR was found useful to identify associations between specific fungi and common diseases. The next-generation sequencing methods may afford new perspectives in this area. PMID:23586944
We endeavor to provide a novel tool to evaluate environmental comfort level in Health Smart Home (HSH). HSH is regarded a good alternative for the independent life of elders and people with disability. Numerous intelligent devices, installed within a home environment, can provide the resident with continuous monitoring and comfortable environment. In this paper, a novel method of evaluating environmental comfort level is provided. An intelligent sensor is a fuzzy comfort sensor that can measure and fusion the environmental parameters. Based upon the results, it will further give a linguistic description about the environmental comfort level, in the manner of an expert system. The core of the sensor is multi-parameter information fusion. Similar to human behavior, the sensor makes all the evaluation about the surrounding environment's comfort level based on the symbolic measurement theory. We applied chart representation theory in multivariate analysis in the biomedical engineering field to complete the human comfortable sensor's linguistic concept creation. We achieved better performance when using this method to complete multi-parameter fusion and fuzziness. It is our belief that this method can be used in both biology intelligent sensing and many other areas, where the quantitative and qualitative information transform is needed. PMID:17281642
Xin, Li; Wenxue, Hong; Jialin, Song; Jiannan, Kang
A project was developed for the creation of an Internet-based network aimed at improved management of home care activities in brain-injured children. At the patient's side, a home care unit was provided, made of a portable medical device, and a tablet PC. Measured clinical data were blood oxygen saturation, heart rate, breath rate and quantity of movement. Thanks to device portability, the patient was free to move while measurements were taken. At prescribed time intervals, measured data were automatically transmitted to the tablet PC via Bluetooth. From the tablet PC, data were transmitted remotely to a Service Centre (via ADSL or GPRS) and made available for consultation by health care professionals through the project Web portal. At the portal, other functionalities were also available, both for patients and families, and for professionals (such as weekly planning agenda, access to relevant information resources, communication tools). Information was delivered for the right participant through a workflow engine. A first trial involving nine patients was performed for two months. At the end, although some improvements were suggested, good acceptance was detected, and 78% of patients and families claimed to be interested in further use of the platform. PMID:16531352
Tura, Andrea; Quareni, Luca; Longo, David; Condoluci, Claudia; van Rijn, Astrid; Albertini, Giorgio
A substantial reduction in hospitalization rates has been associated with the implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement intervention using the accompanying paper-based clinical practice tools (INTERACT II). There is significant potential to further increase the impact of INTERACT by integrating INTERACT II tools into nursing home (NH) health information technology (HIT) via standalone or integrated clinical decision support (CDS) systems. This article highlights the process of translating INTERACT II tools from paper to NH HIT. The authors believe that widespread dissemination and integration of INTERACT II CDS tools into various NH HIT products could lead to sustainable improvement in resident and clinician process and outcome measures, including enhanced interclinician communication and a reduction in potentially avoidable hospitalizations. PMID:22267955
Handler, Steven M; Sharkey, Siobhan S; Hudak, Sandra; Ouslander, Joseph G
Acute care hospitalization during or immediately following a Medicare homehealth care (HHC) episode is a major adverse outcome, but little has been published about HHC patient-level risk factors for hospitalization. The authors determined risk factors at HHC admission associated with subsequent acute care hospitalization in a nationally representative Medicare patient sample (N = 374,123). Hospitalization was measured using Medicare claims data; risk factors were measured using Outcome Assessment and Information Set data. Seventeen percent of sample members were hospitalized. Multivariate logistic regression analysis found that the most influential risk factors (all p < .001) were skin wound as primary HHC diagnosis, clinician-judged guarded rehabilitation prognosis, congestive heart failure as primary HHC diagnosis, presence of depressive symptoms, dyspnea severity, and Black, compared to White. HHC initiatives that minimize chronic condition exacerbations and actively treat depressive symptoms might help reduce Medicare patient hospitalizations. Unmeasured reasons for higher hospitalization rates among Black HHC patients deserve further investigation. PMID:24781967
Fortinsky, Richard H; Madigan, Elizabeth A; Sheehan, T Joseph; Tullai-McGuinness, Susan; Kleppinger, Alison
This paper reports the findings of a qualitative study investigating the impacts of renting a home on the psychosocial health of tenants in the Accra Metropolitan Area (AMA) in Ghana. In-depth interviews (n = 33) were conducted with private renters in Adabraka, Accra. The findings show that private renters in the AMA face serious problems in finding appropriate and affordable rental units, as well as a persistent threat of eviction by homeowners. These challenges tend to predispose renters to psychosocial distress and diminishing ontological security. Findings are relevant to a range of pluralistic policy options that emphasize both formal and informal housing provision, together with the reorganization and decentralization of the Rent Control Board to the district level to facilitate easy access by the citizenry.
Acute care hospitalization during or immediately following a Medicare homehealth care (HHC) episode is a major adverse outcome, but little has been published about HHC patient-level risk factors for hospitalization. We determined risk factors at HHC admission associated with subsequent acute care hospitalization in a nationally representative Medicare patient sample (n=374,123). Hospitalization was measured using Medicare claims data; risk factors were measured using Outcome Assessment and Information Set data. Seventeen percent of sample members were hospitalized. Multivariate logistic regression analysis found that the most influential risk factors (all p<.001) were: skin wound as primary HHC diagnosis; clinician-judged guarded rehabilitation prognosis; congestive heart failure as primary HHC diagnosis; presence of depressive symptoms; dyspnea severity; and Black, compared to White. HHC initiatives that minimize chronic condition exacerbations, and that actively treat depressive symptoms, might help reduce Medicare patient hospitalizations. Unmeasured reasons for higher hospitalization rates among Black HHC patients deserve further investigation.
Fortinsky, Richard H.; Madigan, Elizabeth A.; Sheehan, T. Joseph; Tullai-McGuinness, Susan; Kleppinger, Alison
In the patient-centered medical home, PCMH, patient care is overseen by a primary care physician leading a team of health care providers, who collaborate to optimize treatment. To facilitate interactions in PCMH, secure collaboration will be needed to: control access to information; dictate who can do what when; and promote sharing and concurrent access. This contrasts approaches such as the National Institute of Standard and Technology (NIST) role-based access control (RBAC), where the emphasis is on controlling access and separating responsibilities. This paper investigates secure collaboration within an application such as PCMH, through: a futuristic scenario for patient care; proposed collaboration extensions to the NIST RBAC standard with a fine-grained obligated mechanism and workflow; and a prototype of PCMH via the Google Wave real-time collaboration platform.
The purpose of this book is to help athletic coaches improve the way they teach sport skills. Section I covers the athletic coach's instructional responsibilities for a single season, and ways of adjusting teaching styles to the learning needs of athletes. Section II offers guidance in presenting sport skills and how to introduce, explain, and…
Although the idea of educational coaching is not new, the way teachers-in-training across six west Alabama counties are receiving job-embedded support is far from routine. Educational consultants 764 miles away are pioneering the use of virtual coaching for professional development. From their offices at the Pennsylvania Training and Technical…
Rock, Marcia L.; Gregg, Madeleine; Howard, Pamela W.; Ploessl, Donna M.; Maughn, Sharron; Gable, Robert A.; Zigmond, Naomi P.
The purpose of this study was to investigate the effectiveness of the peer coaching model as a professional development tool for pre-service ESL/EFL teachers, and its possible applicability to the Binational Centres in Brazil, as well as to teacher development programmes in general. Peer coaching, a reflective approach to teacher development,…
A leader doesn't have to solve every problem personally to be effective. In fact, helping others learn to resolve issues and implement their own solutions is the key to sustainable leadership and an empowered staff. This companion and follow-up book to "Coaching Conversations" brings the coaching style of leadership to life with stories from the…
This paper offers a genealogical account of safeguarding in sport. Drawing specifically on Foucault's work, it examines the "politics of touch" in relation to the social and historical formation of child protection policy in sports coaching. While the analysis has some resonance with the context of coaching as a whole, for…
To discover whether peer coaching is altering the teacher-supervisor relationship, teachers, supervisors, and staff developers in several states were surveyed concerning principals' attitudes and motivations concerning this innovative approach. For some teachers, peer coaching seems to stimulate transformations in self-perception and relations…
Qualified and skilled sport coaches are vital to the development of sport in general and of elite sport in particular. Research suggests that the development of coaching expertise in elite sport is a complex matter involving mediated, unmediated and internal learning situations. However, it is less clear to what extent and in which ways these…
This booklet helps coaches educate student athletes in middle, junior high, and high school about the dangers of drugs. Athletic coaches have a special relationship with athletes and other students but often underestimate their influence on them. When they talk to their players and students about the dangers of drugs, the message is more effective…
Department of Justice, Washington, DC. Office of Juvenile Justice and Delinquency Prevention.
Billy Gillispie, like many college basketball coaches, was hired--and fired--in a hurry. But the contract negotiations that dragged on for nearly two years while he coached the University of Kentucky's men's basketball team showed little of the same urgency that defined his entrance and exit. Mr. Gillispie worked for Kentucky under a memorandum of…
A number of factors have led to the dearth of qualified high school athletic coaches: an aging faculty, the gender equity promoted in Title IX, a shrinking pool of new teachers willing to coach, meager budgets, the explosive growth of sports such as soccer, and a hyper-competitive attitude among many students and parents. (MLF)
Reports a study that ascertained high school coaches' perceptions regarding students' motivation to participate in or withdraw from high school athletics. The study also noted differences between coaches' and students' perceptions. Some items were rated identically by both groups, whereas others showed vast differences in opinion. (SM)
This paper describes part of research conducted with fifteen Numeracy Coaches as they carried out their work supporting teachers in Victorian government schools. There was great variation in the mathematical background of coaches, and this area of the research investigated the changing perception of professional learning priorities to support…
The escalating success of personal coaching and the significant potential it holds as a vehicle for effective learning, appear to have had little impact within educational contexts to date. In response, this paper therefore presents an introduction to personal coaching practice and its outcomes and examines its processes through a discussion of learning theory. In doing so, it demonstrates the
There are increasing demands and requirements in the coaching profession, and as a result, coaching education programs worldwide have seen an increase in overall participation. In addition, many schools and sport programs in the United States have begun to require a minimum standard of certification. This, in turn, has created sport-specific…
During the 2003 football season, African Americans were employed as head coaches at five of the 117 NCAA Division I-A colleges and universities. At the conclusion of the 2003 season, there were 13 head coaching vacancies at Division I-A football programs; one African American was hired. Today, five African Americans have the responsibility of…
Students' literacy achievement tends to lessen as they progress from elementary to middle level to high school as measured by state and national assessments. To ensure that secondary school students retain their literacy skills, many states and districts have created the position of literacy coach for middle and high schools. Literacy coaches are…
Taylor, Rosemarye T.; Moxley, Dale E.; Chanter, Carol; Boulware, Don
Simplicity, as espoused by American philosopher Henry David Thoreau, is a method of removing unnecessary obstacles, a tangible means to attain a higher life, one of crystallization and transcendence. A complex profession such as coaching stands to greatly benefit from this concept. The purpose of this paper is to apply simplicity to coaching. A…
Badminton is a growing sport with a limited amount of expertise both in players and coaches so attempts are being made to extend the expertise internationally. The purpose of this study is to gain an understanding of coaching expertise in badminton because such an understanding might have implications for a more general understanding of expertise,…
Teacher-coaches are particularly susceptible to stress and burnout because of role conflict, role ambiguity, and role overload. Administrators need to be more aware of the special problems teacher-coaches have, develop alternative staffing patterns, and try to relieve some of the stress and pressure. (CB)
Ultrarunners participate in running events that exceed the 26.2-mile marathon distance (e.g., 50k, 50-100 miles). Very little research exists on ultrarunners, especially women. This study is a descriptive study detailing the motivation, goal orientation, demographic characteristics (e.g., age, job demands, family structure), training habits (e.g., hours per week of training), and coach utilization of women ultrarunners. Participants (N = 344) were recruited via the Ultra List serve and 4 popular ultrarunning websites, and they completed a questionnaire on motivation, goal orientation, training, and coaching using Survey Monkey. General health orientation (mean ± SD) (4.71 ± 1.06) and psychological coping (4.71 ± 1.03) were the 2 strongest motivational factors. Participants were higher in task orientation (1.38 ± 0.68) (e.g., finishing the race or accomplishing various goals) than ego orientation (3.38 ± 1.01) (e.g., placing in the top 3 overall or beating an opponent). Women trained an average of 12.49 h·wk(-1) and spent 64% of their time training alone. Training information came from their own experience, blogs, websites, and the Ultra List Serve. Over three-fourths of the participants (80%) did not use a coach because of cost and a perceived lack of necessity. Women ultrarunners in this study were task oriented, internally motivated, health, and financially conscious individuals. With additional information about women ultrarunners, coaches will be better prepared to work with this population and ultrarunners can improve their performance by learning about current participants' practices. PMID:21946910
Krouse, Rhonna Z; Ransdell, Lynda B; Lucas, Shelley M; Pritchard, Mary E
Background Providing safety education to parents of young children is important in the prevention of unintentional injuries in or around the home. We developed a Web-based, tailored safety advice module to support face-to-face counseling in the setting of preventive youth health care (E-health4Uth home safety) in order to improve the provision of safety information for parents of young children. Objective This pilot study evaluated a Web-based, tailored safety advice module (E-health4Uth home safety) and evaluated the use of E-health4Uth home safety to support counseling in routine well-child care visits. Methods From a preventive youth health care center, 312 parents with a child aged 10-31 months were assigned to the E-health4Uth home safety condition or to the care-as-usual condition (provision of a generic safety information leaflet). All parents completed a questionnaire either via the Internet or paper-and-pencil, and parents in the E-health4Uth condition received tailored home safety advice either online or by a print that was mailed to their home. This tailored home safety advice was used to discuss the safety of their home during the next scheduled well-child visit. Parents in the care-as-usual condition received a generic safety information leaflet during the well-child visit. Results Mean age of the parents was 32.5 years (SD 5.4), 87.8% (274/312) of participants were mothers; mean age of the children was 16.9 months (SD 5.1). In the E-health4Uth condition, 38.4% (61/159) completed the online version of the questionnaire (allowing Web-based tailored safety advice), 61.6% (98/159) preferred to complete the questionnaire via paper (allowing only a hardcopy of the advice to be sent by regular mail). Parents in the E-health4Uth condition evaluated the Web-based, tailored safety advice (n=61) as easy to use (mean 4.5, SD 0.7), pleasant (mean 4.0, SD 0.9), reliable (mean 4.6, SD 0.6), understandable (mean 4.6, SD 0.5), relevant (mean 4.2, SD 0.9), and useful (mean 4.3, SD 0.8). After the well-child visit, no significant differences were found between the E-health4Uth condition and care-as-usual condition with regard to the satisfaction with the information received (n=61, P=.51). Health care professionals (n=43) rated the tailored safety advice as adequate (mean 4.0, SD 0.4) and useful (mean 3.9, SD 0.4). Conclusions Less than half of the parents accepted the invitation to complete a Web-based questionnaire to receive online tailored safety advice prior to a face-to-face consultation. Despite wide access to the Internet, most parents preferred to complete questionnaires using paper-and-pencil. In the subgroup that completed E-health4Uth home safety online, evaluations of E-health4Uth home safety were positive. However, satisfaction scores with regard to tailored safety advice were not different from those with regard to generic safety information leaflets.
Vogel, Ineke; Beirens, Tinneke Monique Jozef; Kloek, Gitte Caroline; den Hertog, Paul; van der Veen, Monique Desiree; Raat, Hein
Background This study described the differences between elderly men and women living in Lebanese long-term care nursing homes on socio-economic, health and nutritional status. Methods This study used a cross-sectional design. Field researchers obtained data from 221 residents; 148 (67%) women and 73 (33%) men, living in 36 nursing homes. Data on health conditions; nutritional, psychological, and functional status; socio-demographic characteristics, as well as social relations were collected. The analysis used both chi-square and t-test tests. Results The majority of elderly had low socio-economic and poor health status. In comparison to men, women were significantly less educated, had lower occupational status, had no partner, relied financially on their children and relatives, and enjoyed better social relations and health behaviours. Furthermore, the prevalence of both; malnutrition, and at risk of malnutrition, were at 3.2% and 27.6% respectively. There was no statistically significant difference between women and men on Mini Nutritional Assessment, Activities of Daily Living, Geriatric Depression Scale, Body Mass Index, and chronic diseases. While women reported “good” health status compared to men, they continued to have higher prevalence of diseases and chronic pain. Conclusions This study explored the socio-demographic, health, and nutritional status of elderly residing in Lebanese nursing homes and compared these characteristics across gender. The results indicated the need of health support and institutional interventions for elderly women residents.
A variety of legislation, initiatives and organizations exist to support, encourage and even oblige schools to collaborate more effectively with parents or guardians. However, there is minimal understanding of the experiences and opinions of parents and school staff about their roles, especially in relation to children's health education. This study examined how parents of 10-11-year-old children perceive the roles of both home and school in educating children about health. A questionnaire, based partly on the Finnish national core curriculum for basic education, was administered to 348 parents; the response rate was 53%. Factor analysis was used to define sum variables, which were then used as dependent variables in an analysis of variance examining the effects of children's gender and health; parents' education, gender, work status and year of birth; and school location (urban/rural). The results suggested that parents considered that either health education was mainly their responsibility, or it was a mutual responsibility with the school. Parents living in rural areas and the youngest group of parents were more likely to consider that health education should be shared with schools than were parents living in cities, or older parents. To expand awareness about the role of home and school in children's health education and to develop further health promotion within the whole school community, it is important to gather parents' views regarding health issues. This study was conducted as part of a broader program in the health promotion network of the Schools for Health in Europe (SHE). PMID:22373543
Week-long integrated nitrogen dioxide (NO/sub 2/) measurements were made by using diffusion tube samplers inside and outside 137 homes in Portage, WI, over a 1-year period. The annual mean ambient NO/sub 2/ concentrations in this rural community were 10-15 ..mu..g/m/sup 3/. NO/sub 2/ levels inside the kitchens of 112 homes with gas stoves averaged about 50 ..mu..g/m/sup 3/ higher, and bedroom levels were about 30 ..mu..g/m/sup 3/ higher, than outdoor levels. Ten percent of the gas-cooking homes had annual average kitchen NO/sub 2/ levels higher than the National Ambient Air Quality Standard of 100 ..mu..g/m/sup 3/. NO/sub 2/ levels inside kitchens of 25 homes with electric stoves were about two-thirds outdoor levels, while corresponding bedroom levels were one-half outdoor levels. Distinct seasonal patterns (higher indoor levels in winter, lower in summer) consistent with changes in normal air-exchange rates were evident in gas-cooking homes. The large variation of NO/sub 2/ concentrations among homes, likely due to differences in stove use, emission rates, and air-exchange rates, limits the development of prediction models. In addition, this variation would reduce the power of epidemiological studies of respiratory health, which use ambient NO/sub 2/ concentration levels, a simple dichotomous description of stove type and two categories of home cooking fuel to describe exposure.
Spengler, J.D. (Harvard School of Public Health, Boston, MA); Duffy, C.P.; Letz, R.; Tibbitts, T.W.; Ferris, B.G. Jr.
To address increasing rates of overweight and obesity, a population-based telephone intervention was introduced in New South Wales, Australia. The Get Healthy Information and Coaching Service[R] (GHS) offered participants a 6-month coaching program or detailed self-help information. Determining the population reach of GHS is of public health…
O'Hara, Blythe J.; Phongsavan, Philayrath; Venugopal, Kamalesh; Bauman, Adrian E.
Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011). The American Psychiatric Association Workgroup on Integrated Care supports the recommendations made in these Joint Principles and recognizes the significant benefit of treating behavioral and general medical conditions concurrently. The workgroup offers comments on this effort as it pertains to health care in general and psychiatric practice. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24955687
Raney, Lori; Pollack, David; Parks, Joe; Katon, Wayne
The methodology of a study in which a comparison is made of the health and house characteristics of the occupants of 231 control homes and 571 houses containing urea formaldehyde foam insulation (UFFI) is described. All homes and occupants were examined on two occasions separated by an interval of 12 months, during which two-thirds of the UFFI houses performed remedial work. The occupants were examined using a health questionnaire and a series of objective tests including pulmonary function, nasal airway resistance, sense of smell, nasal surface cytology, and patch tests. The houses were assessed using a questionnaire and measurements of indoor formaldehyde and carbon dioxide levels. No obvious bias has been identified in this survey with respect to the representativeness of the population studied, the classification of the UFFI and control groups, and the input from both the respondents and observers. The symptom responses made by individuals within the same households were not correlated. Quality control assessment of the objective health tests and formaldehyde sampling and assays demonstrated that these procedures remained stable over the two phases of the study, with the exception of the expected decrease in the pulmonary flow rates over 1 year and a small unexpected increase in the forced vital capacity and the forced expiratory volume in 1 s. PMID:3349973
Broder, I; Corey, P; Cole, P; Lipa, M; Mintz, S; Nethercott, J R
The aims of this study were firstly to determine the players' perceptions of their respective coaches' coaching effectiveness and secondly, determine the difference between big and small schools of the players' perceptions of their respective coaches' coaching effectiveness. Four hundred and seventy six players from 22 schools were asked to fill…
This article discusses the various sources of athlete stress and the strategies that coaches can use to help young athletes cope with it. The information is based on a study with a competitive adolescent soccer team and its two coaches, and a review of the coaching and sport psychology literature. The suggested coaching strategies can help to…
In recent years, literacy coaches have emerged as an integral part of a school's literacy team. Although current research on literacy coaching examines the work of coaches at the elementary and middle\\/secondary school levels, little research exists on the roles and perspectives of early childhood literacy coaches. This study sought to fill that gap by examining the current priorities of
Brian Kissel; Maryann Mraz; Bob Algozzine; Katie Stover
Executive coaching is a rapidly growing form of organisation development intervention, and one which is receiving increasing attention in the management and psychology literature. This study reports on the state of the practice of executive coaching in New Zealand, about which little is currently known. Fifty-nine executive coaches responded to a survey that gathered data on the demographics of coaches;
Analyzed the perceptions of college athletic coaches regarding the recruitment of international student athletes, focusing on coach gender, athletic association, division, institutional type, gender of sports team, and sport coached. Results indicated that these factors influences coaches