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Chronic rewards programme

Utz J Pape, Kit Huckvale, Josip Car, Azeem Majeed, Christopher Millett
Pay-for-performance programs are often aimed to improve the management of chronic diseases. We evaluate the impact of a local pay for performance programme (QOF+), which rewarded financially more ambitious quality targets ('stretch targets') than those used nationally in the Quality and Outcomes Framework (QOF). We focus on targets for intermediate outcomes in patients with cardiovascular disease and diabetes. A difference-in-difference approach is used to compare practice level achievements before and after the introduction of the local pay for performance program...
2015: PloS One
Kingshuk Pal, Sophie V Eastwood, Susan Michie, Andrew J Farmer, Maria L Barnard, Richard Peacock, Bindie Wood, Joni D Inniss, Elizabeth Murray
BACKGROUND: Diabetes is one of the commonest chronic medical conditions, affecting around 347 million adults worldwide. Structured patient education programmes reduce the risk of diabetes-related complications four-fold. Internet-based self-management programmes have been shown to be effective for a number of long-term conditions, but it is unclear what are the essential or effective components of such programmes. If computer-based self-management interventions improve outcomes in type 2 diabetes, they could potentially provide a cost-effective option for reducing the burdens placed on patients and healthcare systems by this long-term condition...
March 28, 2013: Cochrane Database of Systematic Reviews
Przemysław Biliński, Andrzej Wojtyła, Lucyna Kapka-Skrzypczak, Roman Chwedorowicz, Małgorzata Cyranka, Tadeusz Studziński
The interaction between environmental signals and genes has now taken on a clear molecular form as demonstrated by stable changes in chromatin structure. These changes occur through activation or repression of specific gene programmes by a combination of chromatin remodelling, activation and enzymatic modification of DNA and histones as well as nucleosomal subunit exchange. Recent research investigating the molecular mechanisms controlling drug-induced transcriptional, behavioural and synaptic activity has shown a direct role for chromatin remodelling--termed as epigenetic regulation--of neuronal gene programmes and subsequent addictive behaviour arising from it...
2012: Annals of Agricultural and Environmental Medicine: AAEM
Stephen J Gillam, A Niroshan Siriwardena, Nicholas Steel
PURPOSE: Primary care practices in the United Kingdom have received substantial financial rewards for achieving standards set out in the Quality and Outcomes Framework since April 2004. This article reviews the growing evidence for the impact of the framework on the quality of primary medical care. METHODS: Five hundred seventy-five articles were identified by searching the MEDLINE, EMBASE, and PsycINFO databases, and from the reference lists of published reviews and articles...
September 2012: Annals of Family Medicine
Robert Fleetcroft, Nicholas Steel, Richard Cookson, Simon Walker, Amanda Howe
BACKGROUND: The General Medical Services primary care contract for the United Kingdom financially rewards performance in 19 clinical areas, through the Quality and Outcomes Framework. Little is known about how best to determine the size of financial incentives in pay for performance schemes. Our aim was to test the hypothesis that performance indicators with larger population health benefits receive larger financial incentives. METHODS: We performed cross sectional analyses to quantify associations between the size of financial incentives and expected health gain in the 2004 and 2006 versions of the Quality and Outcomes Framework...
April 16, 2012: BMC Health Services Research
Margaret M Skutsch, Arturo Balderas Torres, Tuyeni H Mwampamba, Adrian Ghilardi, Martin Herold
The paper reviews a number of challenges associated with reducing degradation and its related emissions through national approaches to REDD+ under UNFCCC policy. It proposes that in many countries, it may in the short run be easier to deal with the kinds of degradation that result from locally driven community over-exploitation of forest for livelihoods, than from selective logging or fire control. Such degradation is low-level, but chronic, and is experienced over very large forest areas. Community forest management programmes tend to result not only in reduced degradation, but also in forest enhancement; moreover they are often popular, and do not require major political shifts...
2011: Carbon Balance and Management
Catherine Sermet, Veronique Andrieu, Brian Godman, Eric Van Ganse, Alan Haycox, Jean-Pierre Reynier
The rapid rise in pharmaceutical costs in France has been driven by new technologies and the growing prevalence of chronic diseases as well as considerable prescribing freedom and choice of physician among patients. This has led to the introduction of a number of reforms and initiatives in an attempt to moderate expenditure whilst ensuring universal coverage and rewarding innovation. These reforms include accelerating access to and granting average European prices for new innovative drugs, delisting drugs where there are concerns over their value and instigating rebates for excessive prescribing...
2010: Applied Health Economics and Health Policy
Fan Zhou, Jun Liu, Yi Yu, Xiang Tian, Hui Liu, Yaoyao Hao, Shaomin Zhang, Weidong Chen, Jianhua Dai, Xiaoxiang Zheng
A practical brain-machine interface (BMI) requires real-time decoding algorithms to be realised in a portable device rather than a personal computer. In this article, a field-programmable gate array (FPGA) implementation of a probabilistic neural network (PNN) is proposed and developed to decode motor cortical ensemble recordings in rats performing a lever-pressing task for water rewards. A chronic 16-channel microelectrode array was implanted into the primary motor cortex of the rat to record neural activity, and the pressure signal of the lever were recorded simultaneously...
January 15, 2010: Journal of Neuroscience Methods
Paolo Rossi, Rigmor Jensen, Giuseppe Nappi, Marta Allena
The management of medication overuse headache (MOH) is based essentially on the withdrawal of the overused drug(s). Drug withdrawal is performed according to widely differing protocols, both within and across countries; therefore, therapeutic recommendations for the acute phase of detoxification vary considerably among studies. Basically, the aims of MOH management are: (a) to withdraw the overused drug(s); (b) to alleviate withdrawal symptoms by means of a bridge therapy, which includes pharmacological and non-pharmacological support, designed to help the patient to tolerate the withdrawal process; (c) to prevent relapse...
December 2009: Journal of Headache and Pain
Gérard Reach
OBJECTIVE: The aim of this article is to discuss the background and the consequences of preference on short-term rewards by individuals, which represents an obstacle to any educational programme aimed to prevent long-term complications of chronic diseases such as diabetes, hypertension or obesity. METHODS: We used a trans-theoretical analysis referring to three theories: (1) Construal Level Theory (Trope and Liberman) suggests that the human mind tends to assign remote events as "high-level" criteria, abstraction, in particular, and to proximal events as "low-level" criteria, a concrete description, in particular...
November 2009: Patient Education and Counseling
Dave Sells, William H Sledge, Melissa Wieland, David Walden, Elizabeth Flanagan, Rebecca Miller, Larry Davidson
OBJECTIVE: To describe and better understand adults' responses to the onset, accrual and influence of multiple chronic conditions and to social support in adapting to consequent difficulties. METHODS: Qualitative study of 33 adults with multiple chronic illnesses randomly sampled from an urban primary care clinic. Semi-structured interviews targeted retrospective accounts of illness onset, consequent loss, as well as current accounts of social support and adaptation...
June 2009: Chronic Illness
P McEvoy, P Barnes
Effective psychological and pharmacological treatments are available, but for depressed older adults with long-term physical conditions, the outcome of routine care is generally poor. This paper introduces the chronic care model, a systemic approach to quality improvement and service redesign, which was developed by Ed Wagner and colleagues. The model highlights six key areas that need to be addressed, if depression is to be tackled more effectively in this neglected patient group: delivery system design, patient-provider relationships, decision support, clinical information systems, community resources and healthcare organization...
May 2007: Journal of Psychiatric and Mental Health Nursing
Y Adi, A Juarez-Garcia, D Wang, S Jowett, E Frew, E Day, S Bayliss, T Roberts, A Burls
OBJECTIVES: To investigate the clinical effectiveness and cost-effectiveness of naltrexone for relapse prevention in detoxified formerly opioid-dependent individuals compared with any strategy that does not use naltrexone, including treatment with placebo, other pharmacological treatments, psychosocial interventions or no treatment. DATA SOURCES: Major electronic databases were searched from inception to September 2005. REVIEW METHODS: Selected studies were screened and quality assessed...
February 2007: Health Technology Assessment: HTA
John Wm Agar, Richard J Knight, Rosemary E Simmonds, Janeane M Boddington, Claire M Waldron, Christine A Somerville
Dialysis is an expensive therapy, particularly considering its recurrent, protracted nature while patient numbers are also increasing. To afford dialysis for those in need, smarter, more efficient use of limited funds is mandatory. Newer techniques and improved equipment now permit safe, highly effective haemodialysis (HD) at home, alone and while asleep. Indeed, the increase in treatment hours and frequency achieved through nocturnal HD both increase HD efficiency and reduce cardiovascular stress when comparing nocturnal HD (6 nights/week for 8 h/treatment) to conventional daytime HD (4 h/treatment, three times/week)...
December 2005: Nephrology
Mark Thomas
Rates of end-stage renal disease in the Aboriginal community have been increasing over the past two decades, particularly in the northern and more remote areas of Australia, and especially in disadvantaged communities. Proteinuria predicts the rate of loss of renal function and is common in young adults and virtually universal in those over 50 years old. Cumulative independent risk factors include low birthweight, recurrent skin infections, adult obesity, diabetes or its precursors, smoking, excessive alcohol intake and a family history of renal disease...
December 2004: Nephrology
Susan J Fairweather-Tait
Sequencing of the human genome has opened the door to the most exciting new era for nutritional science. It is now possible to study the underlying mechanisms for diet-health relationships, and in the near future dietary advice (and possibly tailored food products) for promoting optimal health could be provided on an individual basis, in relation to genotype and lifestyle. The role of food in human evolution is briefly reviewed, from palaeolithic times to modern-day hunter-gatherer societies. The aetiology of 'diseases of modern civilization', such as diabetes, heart disease and cancer, and the effect of changes in dietary patterns are discussed...
October 29, 2003: Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences
Jo Anne B Gorski, Alana C Westbrook
Leukocyte Adhesion Deficiency (LAD) is a rare immuno-deficiency disorder which results in chronic infections, such as gingivitis, necrotic skin infections and gastrointestinal ulcers. This case describes an 18-year-old male who was non-compliant during an inpatient hospitalization with several aspects of his complex medical regimen, particularly his wound care, physical therapy and use of his crutches. The patient's dressing change protocol was task analysed in order to create a structured, predictable routine by having the subject complete small, discrete steps...
January 2002: Pediatric Rehabilitation
P Van Damme
In the eight years since the Global Advisory Group of the Expanded Program on Immunisation set 1997 as the target for integrating hepatitis B (HB) vaccination into national immunisation programs world-wide, more than 116 countries have included HB vaccine as part of their routine infant or adolescent immunisation programs. Meanwhile, many countries have performed economic evaluation studies, while others have initiated sero-epidemiological studies to generate input data for burden of disease calculation. These studies have indicated that epidemiological and economic arguments cannot be used to delay the implementation of universal hepatitis B vaccination...
March 21, 2001: Vaccine
P Khajehdehi
BACKGROUND: Persistent differences between social classes and genders exist in the quality of medical care due to disparities in need and access. METHODS: 149 haemodialysis (HD) patients including 114 renal transplant candidates, and their proposed live donors were interviewed and followed for 4 years. Differences in need and access were analysed among the living non-related compared to related renal transplant according to social status, age and gender of recipients and donors...
November 1999: Nephrology, Dialysis, Transplantation
K L Armstrong, A R Van Haeringen, M R Dadds, R Cash
OBJECTIVES: To explore the association between maternal distress and depression in the first years of a newborn's life and the child's sleeping behaviour and problems associated with this behaviour. To asses the effectiveness of an outpatient-based individualised behaviour modification programme to modify children's sleep behaviour and to decrease levels of maternal distress and depression. METHOD: Families were referred to an outpatient childhood sleep problems clinic...
June 1998: Journal of Paediatrics and Child Health
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