Predictors of Patient Activation Among Underserved Patients in a Nurse-managed Health Center: A Pilot Study

The concept of patient activation has gained traction as the term referring to patients who understand their role in the care process and have “the knowledge, skills and confidence” necessary to manage their illness over time (Hibbard & Mahoney, 2010). Improving health outcomes for vulnerable and underserved populations who bear a disproportionate burden of health disparities presents unique challenges for nurse practitioners who provide primary care in nurse-managed health centers. Evidence that activation improves patient self-management is prompting the search for theory-based self-management support interventions to activate patients for self-management, improve health outcomes, and sustain long-term gains. Yet, no previous studies investigated the relationship between Self-determination Theory (SDT; Deci & Ryan, 2000) and activation. The major purpose of this study, guided by the Triple Aim (Berwick, Nolan, & Whittington, 2008) and nested in the Chronic Care Model (Wagner et al., 2001), was to examine the degree to which two constructs– Autonomy Support and Autonomous Motivation– independently predicted Patient Activation, controlling for covariates. For this study, 130 nurse-managed health center patients completed an on-line 38-item survey onsite. The two independent measures were the 6-item Modified Health Care Climate Questionnaire (mHCCQ; Williams, McGregor, King, Nelson, & Glasgow, 2005; Cronbach’s alpha =0.89) and the 8-item adapted Treatment Self-Regulation Questionnaire (TSRQ; Williams, Freedman, & Deci, 1998; Cronbach’s alpha = 0.80). The Patient Activation Measure (PAM-13; Hibbard, Mahoney, Stock, & Tusler, 2005; Cronbach’s alpha = 0.89) was the dependent measure. Autonomy Support was the only significant predictor, explaining 19.1% of the variance in patient activation. Five of six autonomy support survey items regressed on activation were significant, illustrating autonomy supportive communication styles contributing to activation. These results suggest theory-based patient, provider, and system level interventions to enhance self-management in primary care and educational and professional development curricula. Future investigations should examine additional sources of autonomy support and different measurements of autonomous motivation to improve the predictive power of the model. Longitudinal analyses should be conducted to further understand the relationship between autonomy support and autonomous motivation with patient activation, based on the premise that patient activation will sustain behavior change.

THE FEASIBILITY OF USING WEB-BASED TECHNOLOGY FOR THE MANAGEMENT OF DREDGING PROJECTS

The research investigates the feasibility of using web-based project management systems for dredging. To achieve this objective the research assessed both the positive and negative aspects of using web-based technology for the management of dredging projects. Information gained from literature review and prior investigations of dredging projects revealed that project performance, social, political, technical, and business aspects of the organization were important factors in deciding to use web-based systems for the management of dredging projects. These factors were used to develop the research assumptions. An exploratory case study methodology was used to gather the empirical evidence and perform the analysis. An operational prototype of the system was developed to help evaluate developmental and functional requirements, as well as the influence on performance, and on the organization. The evidence gathered from three case study projects, and from a survey of 31 experts, were used to validate the assumptions. Baselines, representing the assumptions, were created as a reference to assess the responses and qualitative measures. The deviation of the responses was used to evaluate for the analysis. Finally, the conclusions were assessed by validating the assumptions with the evidence, derived from the analysis. The research findings are as follows: 1. The system would help improve project performance. 2. Resistance to implementation may be experienced if the system is implemented. Therefore, resistance to implementation needs to be investigated further and more R&D work is needed in order to advance to the final design and implementation. 3. System may be divided into standalone modules in order to simplify the system and facilitate incremental changes. 4. The QA/QC conceptual approach used by this research needs to be redefined during future R&D to satisfy both owners and contractors. Yin (2009) Case Study Research Design and Methods was used to develop the research approach, design, data collection, and analysis. Markus (1983) Resistance Theory was used during the assumptions definition to predict potential problems to the implementation of web-based project management systems for the dredging industry. Keen (1981) incremental changes and facilitative approach tactics were used as basis to classify solutions, and how to overcome resistance to implementation of the web-based project management system. Davis (1989) Technology Acceptance Model (TAM) was used to assess the solutions needed to overcome the resistances to the implementation of web-base management systems for dredging projects.

A Thermal Management Solution for Compact Power Converters

Regulated Transformer Rectifier Units contain several power electronic boards to facilitate AC to DC power conversion. As these units become smaller, the number of devices on each board increases while their distance from each other decreases, making active cooling essential to maintaining reliable operation. Although it is widely accepted that liquid is a far superior heat transfer medium to air, the latter is still capable of yielding low device operating temperatures with proper heat sink and airflow design. The purpose of this study is to describe the models and methods used to design and build the thermal management system for one of the power electronic boards in a compact, high power regulated transformer rectifier unit. Maximum device temperature, available pressure drop and manufacturability were assessed when selecting the final design for testing. Once constructed, the thermal management system’s performance was experimentally verified at three different power levels.