Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.

BACKGROUND: Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions. OBJECTIVE: To assess the effectiveness of nurse behavioral management of DM and HTN in community practices among patients with both diseases. DESIGN: The study was designed as a patient-level randomized controlled trial. PARTICIPANTS: Participants included adult patients with both type 2 DM and HTN who were receiving care at one of nine community fee-for-service practices. Subjects were required to have inadequately controlled DM (hemoglobin A1c [A1c] ≥ 7.5%) but could have well-controlled HTN. INTERVENTIONS: All patients received a call from a nurse experienced in DM and HTN management once every two months over a period of two years, for a total of 12 calls. Intervention patients received tailored DM- and HTN- focused behavioral content; control patients received non-tailored, non-interactive information regarding health issues unrelated to DM and HTN (e.g., skin cancer prevention). MAIN OUTCOMES AND MEASURES: Systolic blood pressure (SBP) and A1c were co-primary outcomes, measured at 6, 12, and 24 months; 24 months was the primary time point. RESULTS: Three hundred seventy-seven subjects were enrolled; 193 were randomized to intervention, 184 to control. Subjects were 55% female and 50% white; the mean baseline A1c was 9.1% (SD = 1%) and mean SBP was 142 mmHg (SD = 20). Eighty-two percent of scheduled interviews were conducted; 69% of intervention patients and 70% of control patients reached the 24-month time point. Expressing model estimated differences as (intervention--control), at 24 months, intervention patients had similar A1c [diff = 0.1 %, 95 % CI (-0.3, 0.5), p = 0.51] and SBP [diff = -0.9 mmHg, 95% CI (-5.4, 3.5), p = 0.68] values compared to control patients. Likewise, DBP (diff = 0.4 mmHg, p = 0.76), weight (diff = 0.3 kg, p = 0.80), and physical activity levels (diff = 153 MET-min/week, p = 0.41) were similar between control and intervention patients. Results were also similar at the 6- and 12-month time points. CONCLUSIONS: In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP. Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary care settings.

Sole agency vs multi-agency: An investigation of agency practice across England and Wales

Purpose: The purpose of this paper is to investigate the impact of different agency practice on agency fees, business efficiency, and housing market liquidity. Design/methodology/approach: The paper studies the effect of sole and multiple agency practices on estate agent efficiency, housing market liquidity, and commission fee levels. The analysis uses the survey data from 2000 to 2006 to investigate the different agency practices across England and Wales and their effect on estate agency business efficiency, housing market liquidity, selling price, and fee levels. Findings: The empirical analysis confirms that agency practice has a locality bias, that is, some regions are more likely to adopt sole agency practice than other regions. The estate agents with a sole agency practice charge a lower agency fee, help clients to achieve better selling price and are more efficient; whereas multiple agency practice facilitates liquidity in the housing market, but experiences higher fall-through rate. Research limitations/implications: The research focuses on estate agent rather than consumers due to the limitation of the data based on a research project concerning transaction costs designed prior to this analysis. Originality/value: There is little other research that investigates the residential estate agency practice and its impact on housing market in the past three decades in England and Wales. The findings are a useful guide for practitioners to better understand the issues associated with different agency practices and should enhance business efficiency and performance.

The determinants of business performance of estate agency in England and Wales

Purpose: This paper seeks to investigate the factors influencing the business performance of estate agency in England and Wales. Design/methodology/approach: The paper investigates the effect of housing market, company size and pricing policy on business performance in the estate agency sector in England and Wales. The analysis uses the survey data of Woolwich Cost of Moving Survey (a survey of transactions costs sponsored by the Woolwich/Barclays Bank) from 2003 to 2005 to test the hypothesis that the business performance of estate agency is affected by industry characteristics and firm factors. Findings: The empirical analysis indicates that the business performance of estate agency is subject to market environment volatility such as market uncertainty, housing market liquidity and house price changes. The firm factors such as firm size and the level of agency fee have no explanatory power in explaining business performance. The level of agency fee is positively associated with firm size, market environment and liquidity. Research limitations/implications: The research is limited to the data received and is based on a research project on transaction costs designed prior to this analysis. Originality/value: There is little other research that investigates the factors determining the business performance of estate agency, using consecutive data of three years across England and Wales. The findings are useful for practitioners and/or managers to allocate resources and adjust their business strategy to enhance business performance in the estate agency sector.

Hidden costs of control: four repetitions and an extension

We report four repetitions of Falk and Kosfeld's (Am. Econ. Rev. 96(5):1611-1630, 2006) low and medium control treatments with 476 subjects. Each repetition employs a sample drawn from a standard subject pool of students and demographics vary across samples. We largely confirm the existence of hidden costs of control but, contrary to the original study, hidden costs of control are usually not substantial enough to significantly undermine the effectiveness of economic incentives. Our subjects were asked, at the end of the experimental session, to complete a questionnaire in which they had to state their work motivation in hypothetical scenarios. Our questionnaires are identical to the ones administered in Falk and Kosfeld's (Am. Econ. Rev. 96(5):1611-1630, 2006) questionnaire study. In contrast to the game play data, our questionnaire data are similar to those of the original questionnaire study. In an attempt to solve this puzzle, we report an extension with 228 subjects where performance-contingent earnings are absent i.e. both principals and agents are paid according to a flat participation fee. We observe that hidden costs significantly outweigh benefits of control under hypothetical incentives.

Can grass biomethane be an economically viable biofuel for the farmer and the consumer?

Farm incomes in Ireland are in decline and many farmers would operate at a loss in the absence of subsidies. Agriculture is responsible for 27% of Ireland's greenhouse gas emissions and is the largest contributing sector. Penetration of renewable energy in the heat and transport sectors is falling short of targets, and there is no clear plan for achieving them. The anaerobic digestion of grass to produce biogas or biomethane is put forward as a multifaceted solution, which could help meet energy and emissions targets, reduce dependence on imported energy, and provide additional farm income. This paper addresses the economic viability of such a system. Grass biogas/biomethane fares poorly under the current combined heat and power tariff structure, which is geared toward feedstock that attracts a gate fee. Tariff structures similar to those used in other countries are necessary for the industry to develop. Equally, regulation should be implemented to allow injection of biomethane into the gas grid in Ireland. Blends of natural gas and biomethane can be sold, offering a cost-competitive green fuel. Sale as a renewable transport fuel could allow profitability for the farmer and savings for the consumer, but suffers due to the lack of a market. Under current conditions, the most economically viable outlet for grass biomethane is sale as a renewable heating fuel. The key to competitiveness is the existing natural gas infrastructure that enables distribution of grass biomethane, and the renewable energy targets that allow renewable fuels to compete against each other. © 2010 Society of Chemical Industry and John Wiley & Sons, Ltd.