Home-based Prevention Program Research Articles

Implementing Home-based Prevention Physical Therapy: A Scoping Review and Path to Launch of HOP-UP-PT.

The purpose of this study was to conduct a scoping review of the available service delivery models related to home-based fall prevention programs led by rehabilitation professionals and to describe the path to launching one such program entitled Home-based Older Persons Upstreaming Prevention Physical Therapy (HOP-UP-PT). Topics of review included: Medicare and private billing structures available for current prevention programs and traditional rehabilitation, the Affordable Care Act and its application to reimbursement of preventive services and direct access care models, and a comparative review of CMS' Patient Driven Group Model (PDGM) home health benefit and Medicare Part B billing and reimbursement. Additionally, a path to launch one prevention-focused program, HOP-UP-PT, is described. There is emerging evidence that upstreaming fall prevention programs can help reduce falls and have money-saving downstream effects. A reimbursement model for this type of programming must be established in order ensure long-term sustainability. Although there is evidence that home-based prevention programs such as HOP-UP-PT can reduce falls and fall-risk metrics among an older adult population, there is not a clear and sustainable payment pathway, which limits proliferation of similar programs. Therefore, this preventative care model which has emerging evidence of cost savings will require reimbursement restructuring beyond what is available with existing payment models.

Mobile diagnostics and consultation for the prevention of the metabolic syndrome and its secondary diseases in Brandenburg\u2014study protocol of a regional prospective cohort study: the Mobile Brandenburg Cohort

BackgroundThe metabolic syndrome (MetS) is a risk cluster for a number of secondary diseases. The implementation of prevention programs requires early detection of individuals at risk. However, access to health care providers is limited in structurally weak regions. Brandenburg, a rural federal state in Germany, has an especially high MetS prevalence and disease burden. This study aims to validate and test the feasibility of a setup for mobile diagnostics of MetS and its secondary diseases, to evaluate the MetS prevalence and its association with moderating factors in Brandenburg and to identify new ways of early prevention, while establishing a “Mobile Brandenburg Cohort” to reveal new causes and risk factors for MetS.MethodsIn a pilot study, setups for mobile diagnostics of MetS and secondary diseases will be developed and validated. A van will be equipped as an examination room using point-of-care blood analyzers and by mobilizing standard methods. In study part A, these mobile diagnostic units will be placed at different locations in Brandenburg to locally recruit 5000 participants aged 40-70 years. They will be examined for MetS and advice on nutrition and physical activity will be provided. Questionnaires will be used to evaluate sociodemographics, stress perception, and physical activity. In study part B, participants with MetS, but without known secondary diseases, will receive a detailed mobile medical examination, including MetS diagnostics, medical history, clinical examinations, and instrumental diagnostics for internal, cardiovascular, musculoskeletal, and cognitive disorders. Participants will receive advice on nutrition and an exercise program will be demonstrated on site. People unable to participate in these mobile examinations will be interviewed by telephone. If necessary, participants will be referred to general practitioners for further diagnosis.DiscussionThe mobile diagnostics approach enables early detection of individuals at risk, and their targeted referral to local health care providers. Evaluation of the MetS prevalence, its relation to risk-increasing factors, and the “Mobile Brandenburg Cohort” create a unique database for further longitudinal studies on the implementation of home-based prevention programs to reduce mortality, especially in rural regions.Trial registrationGerman Clinical Trials Register, DRKS00022764; registered 07 October 2020—retrospectively registered.

Baseline Predictors of Singular Action Among Participants With Multiple Health Behavior Risks.

Previous studies found that treatment effects can change two behaviors, but not one. This study examined baseline transtheoretical model constructs as three alternative predictors (stage of change, effort, and severity) of singular action among participants with co-occurring health behavior risks. The study examined participants at risk for three pairs of behaviors (sun and smoking; smoking and diet; and diet and sun). Analyses were conducted with participants who changed only one behavior in a pair (singular action). School and home-based behavior change programs recruited participants via schools, worksites, and physician practices. School, worksite, medical, and home-based prevention programs were the study setting. The sample (N = 3213) was age 44.6 years (SD, 11.1 years), 94.6% white, and 63.7% female. Stages of change, effort, and severity variables were measured. Pooled data were analyzed using logistic regressions from three randomized controlled trials. Across all three behaviors, stage of change, effort, and severity effects were consistently related to behavior change at 24 months. Change efforts on one behavior were related to change on another behavior. Baseline sun severity (odds ratio, .97 [.94, 1.00]; p = .046) and smoking severity (odds ratio, .89 [.80, .98]; p = .019) were significant predictors of change on diet at final follow-up. Stage of change was the biggest predictor. Problem severity was the smallest predictor of change at 2-year follow-up. Four of six predictors were within behaviors, whereas two were between.

Effectiveness of the home-based alcohol prevention program "In control: no alcohol!": study protocol of a randomized controlled trial.

BackgroundIn the Netherlands, children start to drink at an early age; of the Dutch 12-year olds, 40% reports lifetime alcohol use, while 9.7% reports last-month drinking. Starting to drink at an early age puts youth at risk of developing several alcohol-related problems later in life. Recently, a home-based prevention program called "In control: No alcohol!" was developed to delay the age of alcohol onset in children. The main aim of this project is to conduct a Randomized Controlled Trial (RCT) to evaluate the effectiveness of the program.Methods/DesignThe prevention program will be tested with an RCT among mothers and their 6 grade primary school children (11-12 years old), randomly assigned to the prevention or control condition. The program consists of five printed magazines and an activity book designed to improve parental alcohol-specific socialization. Parent-child dyads in the control group receive a factsheet information brochure, which is the standard alcohol brochure of the Trimbos Institute (the Netherlands Institute for Mental Health and Addiction).Outcome measures are initiation of alcohol use (have been drinking at least one glass of alcohol), alcohol-specific parenting, susceptibility to drinking alcohol, alcohol expectancies, self-efficacy, and frequency and intensity of child alcohol use. Questionnaires will be administered online on secured Internet webpages, with personal login codes for both mothers and children. Mothers and children in both the experimental and control condition will be surveyed at baseline and after 6, 12, and 18 months (follow-ups).DiscussionThe present study protocol presents the design of an RCT evaluating the effectiveness of the home-based "In control: No alcohol!" program for 6 grade primary school children (11-12 years old). It is hypothesized that children in the prevention condition will be less likely to have their first glass of alcohol, compared to the control condition. When the prevention appears to be effective, it can easily and relatively quickly be implemented as a standard alcohol prevention program on a large scale.Trial registrationNederlands Trial Register NTR2564

Prevention for Preschoolers at High Risk for Conduct Problems: Immediate Outcomes on Parenting Practicesand Child Social Competence

This study investigated the immediate impact of an 8-month center- and home-based prevention program for preschoolers at high risk for conduct problems. We report immediate program effects on observed and self-rated parenting practices and observed child behavior with peers. Ninety-nine preschool-age siblings of adjudicated youths and their families were randomly assigned to an enhanced version of the Incredible Years Series (Webster-Stratton, 1989; n = 50) or to a no-intervention control condition (n = 49). In an intent-to-treat design, the intervention yielded significant effects on negative parenting, parental stimulation for learning, and child social competence with peers. Improvements in negative parenting, stimulation for learning, and child social competence support the potential of the intervention to prevent later conduct problems in high-risk children.

The Prevention of Child Abuse and Neglect: Pipe Dreams or Possibilities?

A new interest in the prevention of child abuse and neglect has resulted in the development of home-based prevention programs in the USA. Several randomized trials comparing home visitation with standard care have been conducted, and results from these studies suggest that such interventions can affect the occurrence of maltreatment, as well as other outcomes related to the child's and mother's functioning. This new evidence suggests that the prevention of abuse and neglect is a real possibility and not a pipedream.

A home-based prevention program for sixth-grade alcohol use: Results from project Northland

Project Northland is designed to prevent alcohol use among young adolescents. The project is ongoing in 24 school districts, randomly assigned to intervention or reference conditions. Multiple interventions begin with sixth graders and continue through eighth grade. The reference districts offer their standard health curricula. Evaluation consists of school surveys with the cohort (N = 2201) and telephone surveys of half their parents. This article describes the sixth-grade home-based intervention, the Slick Tracy Home Team. Findings of broad-based participation across sex, race, and risk status were documented, as well as some increases in knowledge and family communication about alcohol use.