A behavioral management system designed to reduce urinary incontinence was evaluated in two nursing homes with a pretest-posttest control group design with repeated measures.The primary components of the system were prompting and contingent social approval/ disapproval which required approximately 2.5 minutes per patient per hour to administer. The frequency of correct toileting for experimental subjects increased by approximately 45 %. The experimental groups were significantly different from the control groups on both incontinence and correct toileting measures. The results are discussed in view of the management issues inherent in nursing home settings.

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Background: While the transformation of a primary care practice into a patient-centered medical home (PCMH) has the potential to improve care, there is a dearth of data on patient perspectives. This study was conducted to assess patients' opinions related to current patient-centeredness, focusing on aspects of coordinated care, communication, accessibility, and management of care. Methods: A cross-sectional survey of English-speaking patients aged >18 years who had a scheduled appointment to see a primary care provider (PCP) at four Baylor Scott & White Health (BSWH) primary care clinics was conducted. The survey instrument included Likert-scale questions based on 5-item choices and data analysis focused on descriptive statistics. The study was approved by the BSWH Institutional Review Board. Results: Of 316 patients approached, 204 (64.6%) returned completed surveys. Their mean age was 47.4 years (SD=16.0; range 18-89) and they were predominantly white (84.4%), female (67.0%), employed (60.2%), and married (57.0%). More than half had at least some college education. Most of the positive responses pertained to patient-provider communication (e.g., provider and staff treating patient with courtesy and respect; provider and staff listening to patient's questions and answering them directly) and management of patient healthcare (e.g., patient thinking it is important to be proactive in their own healthcare; patient belief in playing an active role in their healthcare). Conclusions:A PCMH model appears to be an attainable goal that can better meet the needs of our patients in the ambulatory setting of our integrative healthcare system. Our patient sample endorsed survey items related to satisfactory patient-provider communication as well as those related to quality of participation in their treatment planning and self-management, concepts compatible with the tenants of the PCMH model. In addition, the study suggests that eliciting patient opinions can provide guidance for the initial planning and execution of PCMHs specific to a patient population.