Program Implementation Approaches to Build and Sustain Health Care Coordination for Type 2 Diabetes.

Background: As more people enter the U.S. health care system under the Affordable Care Act (ACA), it is increasingly critical to deliver coordinated, high-quality health care.

Alliance system and policy change: necessary ingredients for improvement in diabetes care and reduction of disparities.

Reducing diabetes inequities requires system and policy changes based on real-life experiences of vulnerable individuals living with the condition. While introducing innovative interventions for African American, Native American, and Latino low-income people, the five community-based sites of the Alliance to Reduce Disparities in Diabetes recognized that policy changes were essential to sustain their efforts. Data regarding change efforts were collected from site leaders and examined against documents provided routinely to the National Program Office at the University of Michigan.

Heart disease management by women: does intervention format matter?

A randomized controlled trial of two formats of a program (Women Take PRIDE) to enhance management of heart disease by patients was conducted. Older women (N = 575) were randomly assigned to a group or self-directed format or to a control group. Data regarding symptoms, functional health status, and weight were collected at baseline and at 4, 12, and 18 months.

Exercise self-regulation among older women participating in a heart disease-management intervention.

Using behavioral self-regulation processes may facilitate exercise among older women with heart disease. Data from women in a heart disease-management program (n = 658, mean 73 years), was used to explore associations among exercise self-regulation components (i.e.

Asthma in 10- to 13-year-olds: challenges at a time of transition.

In 10- to 13-year-old children with asthma, we know less than is desirable about the nature of the disease management tasks they face as youngsters approaching adolescence. This article reviews aspects of asthma management in youngsters at a time of significant transition. They experience puberty and growth spurts.

An evaluation of asthma interventions for preteen students.

Background: Asthma is a serious problem for low-income preteens living in disadvantaged communities. Among the chronic diseases of childhood and adolescence, asthma has the highest prevalence and related health care use. School-based asthma interventions have proven successful for older and younger students, but results have not been demonstrated for those in middle school.

A current picture of asthma diagnosis, severity, and control in a low-income minority preteen population.

Background: Asthma severity, control, type of medical regimen provided, and compliance with it are not well understood in minority patients at the transition stage from childhood to adolescence.

Objective: Describe the level of asthma severity and control and the clinical regimens provided to a large population of low-income, African American children at this developmentally significant period.

Methods: Parents of 1292 children with asthma among 6827 preteens in 19 middle schools in predominantly African American (94%), low-income neighborhoods in Detroit, Michigan, were enrolled in the study.

Focusing on outcomes: making the most of COPD interventions.

A number of excellent intervention studies related to clinical and psychosocial aspects of chronic obstructive pulmonary disease (COPD) have been undertaken in the recent past. A range of outcomes have been examined including pulmonary function, health care use, quality of life, anxiety and depression, ambulation, exercise capacity, and self-efficacy. The purpose of this narrative review was to a) consider clinical, psychosocial, and educational interventions for people living with COPD in light of the health related outcomes that they have produced, b) identify the type of interventions most associated with outcomes, c) examine work related to COPD interventions as it has evolved regarding theory and models compared to work in asthma, and d) explore implications for future COPD research.

The effect of patient choice of intervention on health outcomes.

Background: Patient preference may influence intervention effects, but has not been extensively studied. Randomized controlled design (N=1075) assessed outcomes when women (60 years+) were given a choice of two formats of a program to enhance heart disease management.

Methods: Randomization to "no choice" or "choice" study arms.

Heart disease management by women: does intervention format matter?

A randomized controlled trial of two formats of a program (Women Take PRIDE) to enhance management of heart disease by patients was conducted. Older women (N = 575) were randomly assigned to a group or self-directed format or to a control group. Data regarding symptoms, functional health status, and weight were collected at baseline and at 4, 12, and 18 months.

Understanding and reducing stress and psychological distress in older women with heart disease.

Stress and psychological distress were assessed in 457 older women who were subsequently randomized to a six-week heart disease management program ("Women take PRIDE") or to a "usual care" control group. Baseline distress was significantly associated with age, symptoms, physical functioning, social support, optimism, and self-esteem (p < .05).

Longitudinal effects of social support on the health and functioning of older women with heart disease.

This study examined the effects of: 1) four dimensions of social support, 2) the number of close social ties, and 3) marital status on the physical and psychological health and functioning of 471 women aged 60 years and over with heart disease. Linear mixed models were used to assess the impact of each baseline social relations predictor on health outcomes at four-, 12-, and 18-month follow-up intervals. A second set of models examined the association between change in support variables over time with concomitant change in health outcomes.

Can a disease self-management program reduce health care costs? The case of older women with heart disease.

Background: There is increasing interest in the potential for chronic disease self-management interventions to provide health benefits while reducing health care costs.

Objectives: To assess the impact of a heart disease management program on use of hospital services; to estimate associated hospital cost savings; and to compare potential cost savings with the cost of delivering the program.

Research Design: Randomized, controlled study design.

The role of choice in health education intervention trials: a review and case study.

Although the randomized, controlled trial (RCT) is considered the gold standard in research for determining the efficacy of health education interventions, such trials may be vulnerable to "preference effects"; that is, differential outcomes depending on whether an individual is randomized to his or her preferred treatment. In this study, we review theoretical and empirical literature regarding designs that account for such effects in medical research, and consider the appropriateness of these designs to health education research. To illustrate the application of a preference design to health education research, we present analyses using process data from a mixed RCT/preference trial comparing two formats (Group or Self-Directed) of the "Women take PRIDE" heart disease management program.