PubMed · 16472031
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Alan J Christensen. 2006. Looking back, looking forward.. https://doi.org/10.1207/s15324796abm3101_1
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OBJECTIVE: This paper considers the utility of actor-network theory as a basis for uncovering the mutual interdependencies between system design and system impact in an evolving project, and for exploring the implications that these interdependencies hold for the production of safety in behavioral health care. METHODS: Drawing on a field study of a systems project in a human-services firm, the paper applies key concepts from actor-network theory in the analysis of a design crisis that emerged during the course of the project. RESULTS: Actor-network theory provides a compelling framework in this situation for identifying the diverse interests involved, revealing their complex interactions, and illuminating the importance of the emerging system as an organizational actor in its own right. CONCLUSION: Actor-network theory shows promise for use in other analyses concerned with the role of information technology in the construction of safety in health care settings.
The evolution of behavioral health care financing and delivery has led to a wide variety of arrangements connecting consumers to behavioral health services. In this paper, we present a typology based on three distinguishing features of behavioral health arrangements along which there is a high degree of variability and this variability has been shown to affect the cost and quality of behavioral health care: (1) the extent to which sponsor oversight over care is outsourced by way of contracts rather than performed directly; (2) whether financing for behavioral health is partitioned from health care financing overall; and (3) the amount of financial risk shared by the sponsor with third parties.
A review of recent interactive behavioral technology (IBT) interventions applied to diabetes self-management identified 12 clinical trials, the majority being randomized controlled trials. Encouragingly, the studies used a wide range of technologies, were typically based in primary care settings, and mostly recruited disadvantaged or under-represented patients or those with little computer experience. However, only one third of the studies had incorporated behavioral theories or models into the interventions. Control conditions typically received some dose of the intervention or its components. Blood glucose control (A1c) was not significantly improved in 60% of studies, and where the intervention group was significantly improved over the control condition only modest improvements were found (-0.18% to 0.4%). Patient-reported outcomes were encouraging, but weak attention to psychometrics (eg, responsiveness) was evident. Health care utilization was reduced for several uncontrolled studies. Future research should target patient motivation to participate more intensely and consistently and integrate IBT interventions into routine medical care.