ABSTRACT
IN BRIEF In 2017, 30 million Americans had diabetes, and 84 million had prediabetes. In this article, the authors focus on the journey people at risk for type 2 diabetes take when they become fully engaged in an evidence-based type 2 diabetes prevention program. They highlight potential drop-off points along the journey, using behavioral economics theory to provide possible reasons for most of the drop-off points, and propose solutions to move people toward making healthy decisions.
ABSTRACT
Issue: A deep understanding of human behavior is critical to designing effective health care delivery models, tools, and processes. Currently, however, few mechanisms exist to systematically apply insights about human behavior to improve health outcomes. Behavioral design teams (BDTs) are a successful model for applying behavioral insights within an organization. Already operational within government, this model can be adapted to function in a health care setting. Goal: To explore how BDTs could be applied to clinical care delivery and review models for integrating these teams within health care organizations. Methods: Interviews with experts in clinical delivery innovation and applied behavioral science, as well as leaders of existing government BDTs. Findings and Conclusions: BDTs are most effective when they enjoy top-level executive support, are co-led by a domain expert and behavioral scientist, collaborate closely with key staff and departments, have access to data and IT support, and operate a portfolio of projects. BDTs could be embedded in health care organizations in multiple ways, including in or just below the CEO's office, within a quality improvement unit, or within an internal innovation center. When running a portfolio, BDTs achieve a greater number and diversity of insights at lower costs. They also become a platform for strategic learning and scaling.
Subject(s)
Biobehavioral Sciences/methods , Delivery of Health Care, Integrated/methods , Patient Care Team/organization & administration , Practice Patterns, Physicians'/organization & administration , Behavior , Decision Support Techniques , Delivery of Health Care, Integrated/organization & administration , Diffusion of Innovation , HumansABSTRACT
Necrobacillosis due to Fusobacterium necrophorum is an uncommon anaerobic infection. It has a wide range of presentations and commonly presents as Lemierre's syndrome. We present a case of necrobacillosis defined by F. necrophorum bacteremia with epidural and pararectal fluid collection without evidence of internal jugular vein thrombophlebitis.
Subject(s)
Fusobacterium Infections/diagnosis , Fusobacterium necrophorum/isolation & purification , Sepsis/diagnosis , Adolescent , Epidural Abscess/diagnosis , Epidural Abscess/pathology , Fusobacterium Infections/microbiology , Head/diagnostic imaging , Humans , Male , Radiography , Sepsis/complications , Sepsis/microbiology , TomographyABSTRACT
Tinea versicolor is a common noninvasive cutaneous fungal disease. We recount a case of tinea versicolor that mimicked type I (classic adult) pityriasis rubra pilaris. A 54-year-old white man reported a 20-year history of a recurrent pruritic eruption that had marginally improved with use of selenium sulfide shampoo and treatment with oral antihistamines. Results of a skin examination revealed erythematous plaques; islands of spared skin; and follicular erythematous keratotic papules on the trunk, shoulders, and upper arms. A lesion was scraped to obtain skin scales for potassium hydroxide staining. Examination of the stained samples revealed the characteristic "spaghetti and meatballs," confirming the diagnosis.
Subject(s)
Pityriasis Rubra Pilaris/diagnosis , Tinea Versicolor/diagnosis , Antifungal Agents/therapeutic use , Diagnosis, Differential , Humans , Hydroxides , Itraconazole/therapeutic use , Male , Middle Aged , Potassium Compounds , Staining and Labeling , Tinea Versicolor/drug therapyABSTRACT
Classic porokeratosis is a rare skin disease occasionally involving the oral mucosa. It is characterized by the clinically and histologically distinctive comoid lamella. This case represents a variant of Mibelli's classic porokeratosis presenting as a solitary lesion on the mucosal surface of the lower lip.
Subject(s)
Mouth Diseases/pathology , Porokeratosis/pathology , Female , Humans , Lip/pathology , Middle Aged , Mouth Mucosa/pathologyABSTRACT
Localized heat induced urticaria is a rare clinical entity. Other physical urticarial subtypes include cholinergic, solar, cold, aquagenic, vibratory, and dermatographic. It is characterized by a well-demarcated urticarial lesion provoked by heat in direct contact with the skin. We describe a case of localized heat-induced urticaria in a 49-year-old woman after a heat-challenge test to her forearm.
