Months Of Program Participation Research Articles

Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study.

Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients' first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. Among all 95 patients, the average HbA1c decreased by -1.0 (from 8.2% to 7.2%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8%, the average HbA1c decreased by -2.1 (from 10.2% to 8.1%; P<.001), and in those with a baseline HbA1c >9%, the average HbA1c decreased by -2.8 (from 11% to 8.2%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by -1.2 (from 8.6% to 7.4%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg). A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible.

Relationships Between Blood Pressure Reduction, Weight Loss, and Engagement in a Digital App-Based Hypertension Care Program: Observational Study.

Home blood pressure (BP) monitoring is recommended for people with hypertension; however, meta-analyses have demonstrated that BP improvements are related to additional coaching support in combination with self-monitoring, with little or no effect of self-monitoring alone. High-contact coaching requires substantial resources and may be difficult to deliver via human coaching models. This observational study assessed changes in BP and body weight following participation in a fully digital program called Lark Hypertension Care with coaching powered by artificial intelligence (AI). Participants (N=864) had a baseline systolic BP (SBP) ≥120 mm Hg, provided their baseline body weight, and had reached at least their third month in the program. The primary outcome was the change in SBP at 3 and 6 months, with secondary outcomes of change in body weight and associations of changes in SBP and body weight with participant demographics, characteristics, and program engagement. By month 3, there was a significant drop of -5.4 mm Hg (95% CI -6.5 to -4.3; P<.001) in mean SBP from baseline. BP did not change significantly (ie, the SBP drop maintained) from 3 to 6 months for participants who provided readings at both time points (P=.49). Half of the participants achieved a clinically meaningful drop of ≥5 mm Hg by month 3 (178/349, 51.0%) and month 6 (98/199, 49.2%). The magnitude of the drop depended on starting SBP. Participants classified as hypertension stage 2 had the largest mean drop in SBP of -12.4 mm Hg (SE 1.2 mm Hg) by month 3 and -13.0 mm Hg (SE 1.6 mm Hg) by month 6; participants classified as hypertension stage 1 lowered by -5.2 mm Hg (SE 0.8) mm Hg by month 3 and -7.3 mm Hg (SE 1.3 mm Hg) by month 6; participants classified as elevated lowered by -1.1 mm Hg (SE 0.7 mm Hg) by month 3 but did not drop by month 6. Starting SBP (β=.11; P<.001), percent weight change (β=-.36; P=.02), and initial BMI (β=-.56; P<.001) were significantly associated with the likelihood of lowering SBP ≥5 mm Hg by month 3. Percent weight change acted as a mediator of the relationship between program engagement and drop in SBP. The bootstrapped unstandardized indirect effect was -0.0024 (95% CI -0.0052 to 0; P=.002). A hypertension care program with coaching powered by AI was associated with a clinically meaningful reduction in SBP following 3 and 6 months of program participation. Percent weight change was significantly associated with the likelihood of achieving a ≥5 mm Hg drop in SBP. An AI-powered solution may offer a scalable approach to helping individuals with hypertension achieve clinically meaningful reductions in their BP and associated risk of cardiovascular disease and other serious adverse outcomes via healthy lifestyle changes such as weight loss.

A COMPARISON OF FACE-TO-FACE AND DIGITAL DELIVERY OF FIRST-LINE INTERVENTION FOR PEOPLE WITH KNEE OR HIP OSTEOARTHRITIS

Purpose: To compare average pain reduction for two different modalities of first-line intervention delivery (face-to-face vs. digital delivery) for people with OA of the knee and/or hip after 3 months of program participation.

A Comparison of the Factor Analysis on Smoking Cessation Success between Inpatient Smoking Cessation Program and Residential Smoking Cessation Program

Background: Since 2015, Smoking cessation program have been provided by the local smoking cessation support center in Korea. This program consisted of a 5-days of residential smoking cessation program and an inpatient program. This article is to assist smokers to quit smoking by analyzing and comparing the success factor in smoking cessation from the two different programs.Methods: This study was conducted with a total of 996 participants from the residential smoking cessation program and the inpatient program, from January 2018 to December 2020 at the University Hospitals. Based on the registration card information, we did a retrospective research. Success defines that the smoking cessation continued after 6 months of program participation when it is confirmed by urine cotinine test or phone consultation. The outcome of this study was performed by cross-tabulation analysis and regression analysis.Results: The findings show that the expected value of success in smoking cessation is higher as the subject is older in their age (P&lt;0.05 in 60s or older), and more frequent consultations (P&lt;0.01) in both programs. The nicotine dependency (P&lt;0.01), social security system (P&lt;0.01), and drinking experience (P=0.01) showed a meaningful correlation to success in smoking cessation in the residential program.Conclusions: It is required to improve the smoking cessation program to active intervention with frequent consultations when providing these two programs.

467-P: Immediate and Sustained Trends in Glycemic Control during Remote Patient Monitoring in People with Type 2 Diabetes

Technologies that let patients share diabetes data with care teams can help care teams identify patients with deteriorating glycemic control and facilitate timely and remote-based interventions outside of routine clinic visits. In the current study, we investigated whether people with type 2 diabetes (PWT2D) demonstrate improved glycemia after enrolling in remote patient monitoring (RPM) pilot programs that incorporated remote data syncing and coaching. All program participants were instructed to sync their blood glucose meters with either a mobile app or a computer-based software regularly during program participation. Synced blood glucose data were available to the RPM teams via a web-based dashboard, and remote coaching was administered either regularly and/or as needed. Data from 384 PWT2D (42% female; median age: 50 years) were included in cross-sectional comparisons at baseline and at 3, 6, and 12 months of RPM program participation. Overall trends of immediate (i.e., at 3 months) and sustained (at 6 and 12 months) improvements were observed for mean blood glucose levels (baseline: 178 mg/dL to ~155 mg/dL at 3, 6, 12 months; all Ps &amp;lt;.05), and mean proportion of in-range (70-180 mg/dL; baseline: 60% to ~74% at 3, 6, 12 months; all Ps &amp;lt;.05) and high SMBG readings (&amp;gt;250 mg/dL; baseline: 14% to ~8% at 3, 6, 12 months; all Ps &amp;lt;.05), with no differences in the proportion of low (&amp;lt;70 mg/dL) readings. In summary, glycemic improvements are seen within 3 months of program participation and are sustained with continued engagement. These findings indicate that RPM programs that incorporate remote data sharing and coaching can make a substantial impact on glycemic control for people with type 2 diabetes. Disclosure T. Sheng: Employee; Self; Glooko, Inc. S. Babikian: Employee; Self; Glooko, Inc. V. Singh: Employee; Self; Glooko, Inc. M. A. Clements: Employee; Self; Glooko, Inc., Other Relationship; Self; Glooko, Inc.

Impact of Medical Cannabis on Patient-Reported Symptoms for Patients With Cancer Enrolled in Minnesota's Medical Cannabis Program.

Minnesota's medical cannabis program is unique, in that it routinely collects patient-reported scores on symptoms. This article focuses on changes in symptom severity reported by patients with cancer during their first 4 months of program participation. Patients with cancer in Minnesota's medical cannabis program reported symptoms (anxiety, lack of appetite, depression, disturbed sleep, fatigue, nausea, pain, and vomiting) at their worst over the last 24 hours before each medical cannabis purchase. Baseline scores on each of the eight symptoms were statistically compared with the average symptom scores reported in the first 4 months of program participation. Symptom scores were also calculated as percent change from baseline, with patients achieving and maintaining at least a 30% reduction in symptoms reported in this article. Patients also reported intensity of adverse effects. A significant reduction in scores was found across all symptoms when comparing baseline scores with the average score submitted within the first 4 months of program participation (all Ps < .001). The proportion of patients achieving 30% or greater symptom reduction within the first 4 months of program participation varied from 27% (fatigue) to 50% (vomiting), with a smaller proportion both achieving and maintaining those improvements. Adverse effects were reported in a small proportion of patients (10.5%). Patients with cancer enrolled in Minnesota's medical cannabis program showed significant reduction across all eight symptoms assessed within 4 months of program participation. Medical cannabis was well tolerated, and some patients attained clinically meaningful and lasting levels of improvement.

Family Involvement in the Clinical Care of Clients With First-Episode Psychosis in the RAISE Connection Program

This study described how families were involved in the RAISE Connection Program for clients with first-episode psychosis (FEP) and examined factors that predicted family involvement. Presence of family members at clinical visits for 65 clients with FEP was described. Multiple regressions were conducted to determine whether demographic characteristics, clinical factors, or client-provider discussions regarding family predicted family involvement during the first six months of the program. Most participants (95%) had at least one family member attend a clinical visit during program involvement. Age of the client with FEP, psychiatric symptoms, and substance use predicted the number of days family members attended visits during the first six months of program participation; client-provider discussions about family did not. Family involvement in the ongoing care of clients with FEP is common when efforts are made to engage clients with FEP and their families.

The Role of Controlled Substance Use in Diversion Outcomes Among Mentally Ill Offenders: A Pilot Study

Diversion programs offer opportunities to offenders with substance abuse or mental illness to attend treatment as an alternative to incarceration. The present study identified variables associated with drug relapse and recidivism and the moderating role of substance use on recidivism in a diversion sample. Data were collected from 80 clients with psychotic disorders from a diversion program in New York City. Outcomes were examined after 6 and 12 months of program participation. Individuals who used controlled substances other than alcohol or cannabis were more likely to have a positive toxicology result than those who used alcohol or cannabis only or those with no alcohol/drug history. Individuals with schizoaffective disorder were more likely to be rearrested than individuals with other diagnoses, as were those with a violent offense (e.g., assault, robbery). Positive toxicology results were unrelated to rearrest and did not moderate recidivism, suggesting substance abuse may be only indirectly related to rearrest among diverted offenders.

Outcomes of programs serving mothers with psychiatric disabilities and their young children: a multisite case file abstraction study.

This multisite study examined outcomes of mothers with mental illnesses receiving integrated clinical, rehabilitation, and parenting services for their preschool-age children. Mothers' outcomes included independent living and employment status, custody loss and reunification, psychiatric hospitalization, and substance abuse. Retrospective case file abstraction yielded data regarding 104 mothers served over 12-month periods during 1995-1999 at 4 programs located in 3 different states. Multivariable logistic regression (MLR) analysis explored associations between outcomes and predictors from prior research, controlling for study site. During their first 12 months of program participation, significant increases were found in the proportions of mothers employed and living independently. Significant decreases were noted in the proportion of mothers abusing substances. Although 10% of the women served lost formal custody during their first year of participation, 22% were reunited with 1 or more children. In MLR analysis, mothers who abused substances were more likely to have experienced childhood sexual abuse and custody loss; those who were psychiatrically hospitalized were more likely to have abused substances, lost custody of 1 or more children, and had more disabling forms of mental illness; and those who lost custody of 1 or more children were more likely to have experienced a psychiatric hospitalization and less likely to be residing with 3 or more children. Programs for mothers with mental illness and their preschool children address service needs in an integrated fashion that appears to improve clinical and rehabilitation outcomes, while preventing custody loss and supporting reunification.

Attachment and caregiving relationships in families affected by parental incarceration

This longitudinal, mixed method study focused on 57 families of children who participated in a mentoring program for children of incarcerated parents. Children ranged in age from 4 to 15 years. Monthly interviews were conducted with children, caregivers, and mentors during the first six months of program participation, and questionnaires were administered at intake and six months to assess caregiver–child and incarcerated parent–child relationships, contact with incarcerated parents, and children's behavior problems. Although some children viewed their incarcerated parents as positive attachment figures, other children reported negative feelings toward or no relationship with incarcerated parents. In addition, our assessments of children nine years old and older revealed that having no contact with the incarcerated parent was associated with children reporting more feelings of alienation toward that parent compared to children who had contact. Children's behavior problems were a primary concern, often occurring in a relational context or in reaction to social stigma associated with parental imprisonment.

Evaluation of a 6-month multi-disciplinary healthy weight management program targeting urban, overweight adolescents: Effects on physical fitness, physical activity, and blood lipid profiles

This study evaluated preliminary physical fitness, physical activity, and blood lipid profile data obtained from overweight adolescents upon enrolling in a healthy weight management program and following 6 months of program participation. One hundred and sixty-eight participants (13.4+/-1.8 years, 37.9+/-8.3 kg/m(2), 59.5% female and 76.2% African-American) enrolled in the program. The intervention addressed factors related to nutrition, physical activity, and other behaviors related to weight management. Sixty-four participants (38.1%) completed 6 months of program participation. While there was no significant reduction in body mass or body mass index (BMI), BMI z-score was reduced by 1.2% (p < 0.05), cardiorespiratory fitness was increased by 10.8% (p = 0.001), body fat percentage was reduced by 2.6% (p = 0.001), total cholesterol was reduced by 7.2% (p < 0.001), and low density lipoprotein (LDL-C) was reduced by 8.4% (p < 0.001) at 6 months. Continued development and evaluation of programs designed to prevent and treat child and adolescent overweight is warranted to address this major public health issue.

Psychological effects of prevention: do participants of a type 2 diabetes prevention program experience increased mental distress?

To evaluate the mental health outcome of a lifestyle intervention for the prevention of type 2 diabetes and to exclude possible harmful psychological effects. There is little empirical data on potential harmful effects of prevention programs. However, information, education, diagnostic procedures, phenotyping and risk assessment may cause or intensify psychological distress such as anxiety, depression or somatization in vulnerable individuals. The Tuebingen Lifestyle Intervention Program (TULIP) for the prevention of type 2 diabetes has assessed mental health outcome in the participants after 9 months of program participation using the Symptom Checklist-90-R (SCL-90-R). The 24-months lifestyle intervention TULIP comprises regular exercise and changes in nutrition and assesses both, a broad range of somatic parameters as well as psychometric variables. For an interim analysis of psychological outcome, complete data sets of the SCL-90-R assessed at baseline and after 9 months of intervention were available for 195 participants (125 females, 70 males; age: 46.1 +/- 10.6 years). Data on somatization, anxiety, depression and overall psychological distress were compared to baseline levels. SCL-90-R scores of the TULIP-participants did not significantly differ from the German healthy reference population. Compared to baseline, a significant decrease in SCL-90-R scores was found for anxiety, depression and overall psychological distress at re-assessment after 9 months. The interim analysis on mental health outcome of a type 2 diabetes prevention program comprising extensive phenotyping and risk assessment rules out adverse psychological effects, suggesting rather beneficial changes concerning symptoms of anxiety, depression and overall psychological distress.

Guaranteed minimum income and unemployment duration in France

In this article, we use data from the European Community Household Panel to evaluate the impact of a French guaranteed income program, the RMI, on the hazard out of unemployment. Self-selection into the program is corrected using a multivariate duration model developed by [Abbring, J.H., van den Berg, G.J., 2003. The non-parametric identification of treatment effects in duration models. Econometrica 71 (5), 1491–1517]. We find that RMI receipt has a strong negative impact during the first months of program participation, but that this disincentive effect quickly falls to insignificant levels after six months. Household structure also appears to be an important determinant of the importance of the adverse effect of program participation.

The PICTS Fear-of-Change Scale

The construct validity of the Psychological Inventory of Criminal Thinking Styles's Fear-of-Change scale (FOC) was evaluated by correlating it with scales from the Personality Assessment Inventory (PAI). As expected, the FOC displayed a positive association with the PAI Anxiety (ANX) scale and negative associations with the PAI Positive Impression Management and Treatment Rejection scales among 136 male inmates. The FOC also forged a stronger relationship with the ANX's Cognitive subscale than with the Affective or Physiological subscales. It was further surmised that a subgroup of 54 participants retested after 3 months of program participation witnessed significant FOC gains. An independent sample of 239 medium-security male inmates participated in a second study in which significant FOC accretions were found in offenders who discontinued programming but not in offenders who continued or graduated. A third study conducted on 46 nonprogram participants effectively ruled out the alternative hypothesis that FOC scores rise in nonprogram offenders.

Diabetes self-management training program in a community clinic improves patient outcomes at modest cost

Stringent glycemic control reduces complications and health care costs for people with diabetes. This study assessed the effectiveness of a diabetes self-management training (DSMT) program at a community clinic. Education and a glucometer were provided to 70 people with type 2 diabetes in a 4-hour class, followed by individual dietitian consults and monthly support meetings. Most participants were Hispanic or African American with mean age of 49±10 years and mean body mass index of 34±9. Body weight, glycosylated hemoglobin (A1C), medications, and follow-up attendance were monitored. After 2 to 12 months of program participation, mean A1C improved from 9.7±2.4% to 8.2±2.0% (P<.001); 61% experienced positive medication outcomes. The cost of community clinic DSMT was approximately $280 per person per year, $185 for each point reduction in A1C. This study indicated that community clinic DSMT can improve glycemic control at modest cost.

Welfare Program Reentry among Postreform Leavers

The dramatic welfare reforms of 1996 affected public assistance usage patterns, possibly leading to more cycling on and off welfare as opposed to long-term continuous participation. We examine 128,775 Tennessee families that left welfare between October 1996 and April 2001. Of these, about one-third returned to the program at least once during this period. We provide statistical portraits of these families and compare reentrants with those who remained off public assistance. We conclude with a multivariate analysis of the determinants of reentry. Results suggest that families with younger, female, or black caretakers and those with more children are more likely to return. Those less likely to return include families whose caretakers were married or who had more education or were not working as of case closure. Families who left because of a time limit or who accumulated more months of program participation were also more likely to return.

Welfare Program Reentry among Postreform Leavers

The dramatic welfare reforms of 1996 affected public assistance usage patterns, possibly leading to more cycling on and off welfare as opposed to long‐term continuous participation. We examine 128,775 Tennessee families that left welfare between October 1996 and April 2001. Of these, about one‐third returned to the program at least once during this period. We provide statistical portraits of these families and compare reentrants with those who remained off public assistance. We conclude with a multivariate analysis of the determinants of reentry, Results suggest that families with younger, female, or black caretakers and those with more children are more likely to return. Those less likely to return include families whose caretakers were married or who had more education or were not working as of case closure. Families who left because of a time limit or who accumulated more months of program participation were also more likely to return.

Groningen Active Living Model (GALM): stimulating physical activity in sedentary older adults; validation of the behavioral change model

Background A significant proportion of older adults in The Netherlands do not participate regularly in leisure-time physical activity. The Groningen Active Living Model (GALM) was developed to change this situation for the better. Longitudinal results of the validation of the GALM behavioral change model are presented. Methods We obtained data on potentially mediating variables of physical activity behavior change (self-efficacy, social support, perceived fitness, and enjoyment) from 96 participants in a prospective study during the 18 months the GALM strategy lasted. Results Prospective analyses revealed significant differences in several potentially mediating variables, although some of these differences were contrary to our hypothesis. Discriminant analysis resulted in canonical correlations of 0.50 after 6 months and 0.66 after 18 months of program participation between adherers and nonadherers, respectively; 73.8 and 80.0% of the subjects were classified correctly. Conclusions Based on the results, it can be concluded that we partially succeeded in manipulating the potentially mediating variables by means of our GALM strategy. Several mediating variables were identified that reliably discriminated long-term adherers from nonadherers, expanding the generalizability of social cognitive theory-driven variables to a Dutch population.

Impact of a family support program on mothers' social support and parenting stress.

The study examined two components of a family support program, a mothers' self-help discussion group and a parent education group, to determine their effects on social support and parenting stress. Findings suggest that, after three months of program participation, mothers in both groups felt less social isolation and parenting stress than did mothers in the control group.

A multimodal treatment approach for incarcerated alcoholics.

A multimodal milieu treatment approach for alcoholism was assessed in a prison setting by use of the MMPI. The participants had a mean age of 41, four prior incarcerations, and documented difficulty with alcohol abuse prior to their incarceration. Analysis of an A-B treatment design showed significant changes on the F, PT, ES (p less than .05), L, K, D, SI, and A (p less than .01) scales of the MMPI after 6 months of program participation. With the exception of the PD scale, all changes were seen as positive. It should be noted that the PD scale may not be the most appropriate indicator of positive behavioral changes in a prison setting.