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1
Rolley, John Xavier. "Improving care for people undergoing percutaneous coronary interventions: elements of effective interventions." Thesis, Curtin University, 2009. http://hdl.handle.net/20.500.11937/810.
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Percutaneous coronary interventions (PCIs) are a frequent strategy for myocardial revascularisation in both the elective and emergency setting. In contrast to surgical techniques such as coronary artery bypass grafting (CABG), there is less procedural burden and a reduction in hospitalisation times. This rapid treatment means a reduced exposure of the individual to healthcare providers in the acute care setting limiting the time to prepare individuals and their families to cope and adjust to living with a chronic condition.In spite of the expansive research in respect of acute coronary syndromes (ACS), PCI and CABG, there is substantially less person centred research focussing on the needs of the individual undergoing PCI. Similarly, in spite of the number of evidence based practice guidelines for ACS and PCI, evidence supporting specific PCI nursing practice remains of a low level and minimally mentioned in practice guidelines. This thesis was undertaken to address these gaps in knowledge.The Chronic Care Model (CCM), promoting evidence based practice, communication and coordination of care for people with chronic conditions has informed the study design, implementation and interpretation of findings.Using the approach of the patient journey and the CCM, a sequential mixed method study was undertaken to describe the barriers and facilitators to improving the care outcomes of people undergoing PCI. Firstly, a study describing the clinical and demographic characteristics of individuals undergoing PCI and their perception of cardiovascular risk was completed. Secondly, a qualitative multi method study investigating patients’, carers’ and healthcare providers’ perceptions of the barriers, facilitators and opportunities for improving PCI care was conducted. Thirdly, an online survey of cardiovascular nurses’ beliefs, values, and practices. This survey was informed by a comprehensive literature review and issues identified through a consensus conference.Fourthly, clinical practice guidelines for PCI nursing care were developed to address limitations in providing coordinated and evidence based nursing care. A systematic method was adopted from the National Health and Medical Research Council’s recommended approach for developing guidelines. This project was conducted under the auspices of the Australasian Cardiovascular Nursing College and the Cardiovascular Nursing Council of the Cardiac Society of Australia and New Zealand; both peak cardiovascular nursing bodies in Australia and New Zealand.Finally, based upon study finding identifying challenges in communication and coordination across care settings, elements of effective interventions aimed at improving risk reduction and secondary prevention uptake have been identified.The series of studies presented in this thesis have contributed to ability of nurses to improve the health outcomes of individuals undergoing PCI across the care continuum. Information obtained from the series of studies in this thesis have provided useful information for further research in developing and implementing effective strategies to improve care for individuals undergoing PCI.
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Gervais, Mary Ellen. "Chronic Care Management to Improve Adherence: A Comparison of Approaches in the Care of Diabetes." VCU Scholars Compass, 2010. http://scholarscompass.vcu.edu/etd/2230.
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Managing chronic conditions is seen as the public health challenge of the 21st century. The number of Americans with chronic conditions is expected to rise to 157 million by 2020. Diabetes prevalence and costs contribute to the growing problem. Diabetes was the seventh leading cause of death in 2006. Nationally, the cost of diabetes is expected to be $138 billion in 2020. Diabetes leads to multiple and significant complications. The desired outcomes of management of chronic conditions are improvement in clinical status, avoidance of complications, prevention of co-morbid conditions and avoidance of the costs associated with complications. In the 1990s, disease management programs were implemented in an attempt to effectively manage chronic conditions. The primary approach in these programs focuses on individual-level interventions. Despite these efforts, poor outcomes exist. As a result, other approaches to diabetes management are being explored. This study examines a system-level approach to diabetes management versus an individual level one. The system level approach is based on full implementation of the Chronic Care Model, framed in Social Ecology Theory. This retrospective, non-experimental study explores changes in adherence to select diabetes screening guidelines based on the approach to adopted by two health plans. Analyses were conducted on adherence to LDL, A1c, retinopathy and nephropathy screening 2 ½ years after program implementation. In addition, logistic regression analyses were conducted on the predictive impact of approach to chronic care management in relation to changes in adherence. Other variables known to impact health behaviors were factored into the analysis. There were two main findings of the study. The first is that for each of the screenings, there was a statistically significant difference between participants in the two plans. Comparisons of changes in adherence by approach from before implementation to after implementation resulted in a small number of subjects in some cells which can lead to accepting the null hypothesis when it is false. The second is that approach to management was associated with changes in adherence to three of the four screenings. The logistic models, however, account for less than 23% of the variance in adherence, a moderate effect size.
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Williams, Margaret. "A chronic care coordination model for HIV-positive children requiring antiretroviral therapy." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1020346.
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The human immunodeficiency virus / acquired immune deficiency syndrome pandemic (HIV/AIDS) continues to increase in prevalence worldwide, particularly in South Africa. There is a concurrent and distinct increase in the prevalence of HIV/AIDS and HIV-related diseases in the paediatric population in South Africa, particularly those using public sector health services, with a corresponding increase in morbidity and mortality rates (Abdool Karim & Abdool Karim, 2010:363), which impacts greatly on paediatric healthcare services. Adding to this, the provision of paediatric antiretroviral care has numerous stumbling blocks, not least of which is lack of decentralisation of facilities to provide treatment. There is the additional shortage of staff, which includes staff that are comfortable dealing with children, lack of training programmes on the provision of antiretroviral therapy to children, and minimal on-site mentorship of staff regarding HIV/AIDS disease in children. This lack of capacity in the healthcare system means that not all of those who require treatment will be able to access it, and this is particularly pertinent to paediatric patients (Meyers et al., 2007:198). Therefore the purpose of this research was to develop a nursing model that would assist healthcare professionals, in particular professional nurses, to optimise the comprehensive treatment, care and support for HIV-positive children who require antiretroviral therapy at PHC clinics. To achieve the purpose of this study, a theory-generating design based on a qualitative, explorative, descriptive and contextual approach was implemented by the researcher to gain an understanding of how the healthcare professionals and parents/caregivers of HIV-positive children experienced the comprehensive treatment, care and support provided at primary healthcare clinics. The information obtained was used to develop a chronic care coordination model for the optimisation of comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy. The study design comprised the following four steps: Step One of the research design focused on the identification, classification and definition of the major concepts of the study. This involved describing and selecting the research population and the sampling process prior to conducting the field work which comprised in-depth interviews with two groups of participants, namely healthcare professionals and parents/caregivers who accompany their HIV-positive children to PHC clinics in order to receive antiretroviral therapy. Step Two of the research design focused on the development of relationship statements in order to bring clarity and direction to the understanding of the phenomenon of interest. Step Three of the design concentrated on the development and description of the chronic care coordination model for optimising comprehensive treatment, care and support for HIV-positive children who require antiretroviral therapy in order to ensure a well-managed child on ART. A visual representation of the structure of the model for chronic care coordination was given and described as well as a detailed description of the process of the model. Step Four was the last step of the research design and its focus was the development of guidelines for the operationalisation of the model for chronic care coordination for the optimisation of comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy at PHC clinics. Guidelines and operational implications for each of the five sequential steps of the model were developed. The evaluation criteria of Chinn & Kramer (2008:237‒248) were used to evaluate the model. It is therefore concluded that the researcher succeeded in achieving the purpose for this study because a chronic care coordination model that is understandable, clear, simple, applicable and significant to nursing practice has been developed for use by healthcare professionals, particularly professional nurses, in order to optimise the comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy at primary healthcare clinics.
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Addo, Emilia K. "Chronic Care Model Staff Education and Adherence with End-Stage Renal Disease Patients." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1813.
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The management and treatment of chronic diseases, such as end-stage renal disease, is often unproductive because of patients' poor adherence to treatment. The chronic care model toolkit is an Agency for Healthcare Research and Quality supported framework, associated with improved outcomes in patients living with chronic disease. The purpose of this project was to develop and plan an educational program using the chronic care model toolkit for the interdisciplinary clinical staff of a renal hemodialysis center. The goal of this project was to adapt team building between patients and their clinicians through the use of the chronic care model in order to improve patients' adherence to treatment. The educational program materials were developed, including a plan for future implementation over 6 weeks in 2-hour twice-weekly sessions. Program planning accounted for the mixed roles and responsibilities of the interdisciplinary clinical team members, who will share their knowledge among the team and act as patient advisors. The pretest and posttest materials were developed from the toolkit Team Health Audit Questionnaire, which can be used to evaluate staff learning after the program is delivered. Existing clinical metrics are tracked through a Quality Assessment Performance Improvement measure, which will be used to evaluate potential long term influences of the program on patient adherence and outcomes. The project may contribute to social change in practice by enhancing teamwork that has the potential to improve clinical outcomes. Future research should include longitudinal studies on team building using the chronic care model toolkit to determine if its adaption enhances team effort and contributes to a collaborative workforce that improves clinical outcomes.
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Stuckey, Sheila Delaine. "Impact of Transitional Care Model on Readmissions of Adults with Chronic Heart Failure." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7757.
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Chronic heart failure (CHF) is often associated with high morbidity, mortality, and increased health expenditures. The readmission rate of patients with CHF is approximately 30% within 30 to 60 days following discharge. This project examined the literature to identify best practices based on the use of the transitional care model (TCM) in the reduction of hospital readmissions among older patients with CHF. The review included articles that were published between 2015 and 2019, used a quantitative study methodology, were peer-reviewed, and written in English. Keywords used in the search were chronic heart failure, the transitional care model, and hospital readmissions. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to identify selected studies for review. After evaluation, 10 empirical articles were retained. Findings revealed that the use of the TCM framework resulted in the reduction of hospital readmission among patients with CHF, thereby improving patients’ quality of life. The implications of these findings for social change include encouraging healthcare institutions to develop policies aimed at increasing the use of the TCM framework. Such policies could support improved patient outcomes for elderly patients with CHF.
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Obot, Stella S. "Health Care Disparities and Chronic Disease Burden: Policy Implications for NGOs." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/iph_theses/88.
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The purpose of this capstone is to develop a program to address health literacy among African American adults. The social cognitive theory and the health belief model was used to create a model of an age appropriate, culturally sensitive program with a pre and post test to improve the health literacy in this population. The Community Health Literacy Improvement Program (CHIP) is a pilot program that will consist of a four week didactic intervention focused on combating prose, document, and quantitative health illiteracy. This program will be implemented through a community based nonprofit organization. Participants who complete the CHIP program will be able to identify risk factors for chronic diseases, assess their ability to avoid chronic diseases, and be able to locate community health resources. This proposed intervention will show that community based nonprofit organizations have an important role to play in building community buy in and establishing the agency necessary for community based, culturally sensitive programs such as CHIP to succeed.
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Kong, Hoi Mei. "A socio-ecological model for a community-based chronic heart disease management programme in Hong Kong." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/125532/1/Hoi_Kong_Thesis.pdf.
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A mixed methods design to evaluate the effectiveness of a community-based chronic ischemic heart disease (CIHD) programme. The programme was designed around the socio-ecological model with the intervention focusing on older adults with chronic heart disease. The intervention proposed to change health behaviours and subsequent health outcomes through influencing social support and community connection. In doing so, the study examined the effectiveness of medication adherence, chest pain, shortness of breath, cardiac physiological risk parameters, self-perceived adequacy of social support, quality of life, community connection and unplanned health service use.
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Mendes, David, M. J. Lopes, Artur Romão, and Irene Pimenta Rodrigues. "Healthcare Computer Reasoning Addressing Chronically Ill Societies Using IoT: Deep Learning AI to the Rescue of Home-Based Healthcare." Bachelor's thesis, IGI Global, 2016. http://hdl.handle.net/10174/19286.
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The authors present a proposal to develop intelligent assisted living environments for home based healthcare. These environments unite the chronical patient clinical history sematic representation with the ability of monitoring the living conditions and events recurring to a fully managed Semantic Web of Things (SWoT). Several levels of acquired knowledge and the case based reasoning that is possible by knowledge representation of the health-disease history and acquisition of the scientific evidence will deliver, through various voice based natural interfaces, the adequate support systems for disease auto management but prominently by activating the less differentiated caregiver for any specific need. With these capabilities at hand, home based healthcare providing becomes a viable possibility reducing the institutionalization needs. The resulting integrated healthcare framework will provide significant savings while improving the generality of health and satisfaction indicators.
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PAULO, Marilia Raquel Bettencourt Silva. "The chronic care model use in the emirate of Abu Dhabi helth system: is it enough to address the growing problem of chronic diseases?" Doctoral thesis, Instituto de Higiene e Medicina Tropical, 2019. http://hdl.handle.net/10362/66375.
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Abu Dhabi é a capital dos Emirados Árabes Unidos e o maior emirado em termos de área e população. Os emirados árabes unidos tem um elevado índice de morbilidade e mortalidade relacionados com as doenças crónicas. Para abordar o crescente problema das doenças não comunicáveis, o Modelo de Doença Crónica (CCM) tem a intenção de ter cuidados diários baseados na população, com intervenções de equipa estruturadas e planeadas; com o objectivo de converter a vida dos doentes crónicos de reactiva a proactiva. O modelo integra seis elementos para facilitar uma qualidade elevada dos cuidados.
Objectivos
Esta tese tem como objectivo explorar o sistema de saúde de Abu Dhabi usando a abordagem do CCM para melhorar e desenvolver a prestação de cuidados a pessoas com doenças crónicas.
Foram desenhados quatro objectivos específicos:
Caracterizar os serviços de saúde do emirado de Abu Dhabi;
Analisar o alinhamento dos serviços de saúde com o CCM, identificando as principais lacunas;
Explorer a percepcão dos profissionais de saúde sobre o nível de integração do CCM nos cuidados diários a doentes com diabetes, doenças cardiovasculares e cancro;
Priorizar os subcomponentes e as barreiras para o desenvolvimento do CCM no sistema de saúde do emirado de Abu Dhabi.
Métodos
Para operacionalizar os objectivos foi desenhado um estudo com três componentes distintas:
Revisão sistemática da literatura usando o CCM como uma framework para explorar a sua implementação e desenvolvimento nos cuidados de saúde primários; Estudo transversal misto para recolher informações sobre a percepção dos profissionais de saúde sobre os cuidados diários a doentes crónicos;
Painel Delphi utilizado para ordenar as prioridades e barreiras da implementação e desenvolvimento do CCM.
Resultados
As clinicas que prestam cuidados de saúde primários adotaram os princípios do modelo Patient-centered medical home, que está alinhado com o CCM. Parece que existe um esforço em seguir as últimas evidências científicas com a intenção de atingir ganhos em saúde. A implementação dos elementos do CCM está alinhada com os standards e é positivamente associada com o uso de intervenções dirigidas a comportamentos de alto risco. Os profissionais de saúde têm a percepção de que cinco elementos (sistemas de informação clínica, decisão suportada, comunidade, autogestão e sistema de saúde) foram considerados razoavelmente bons. Os participantes deram pontuações elevadas a alguns componentes, no entanto, os resultados qualitativos nem sempre suportaram os resultados quantitativos, indicando ainda a transição do modelo centrado no médico para o modelo centrado no doente. A ‘liderança organizacional para os cuidados da doença crónica’ foi considerada como a primeira prioridade (26.3%) e ‘participação do doente’ foi considerada como a primeira barreira (36.8%).
Conclusão
O sistema de saúde do emirado de Abu Dhabi está internacionalmente bem posicionado e competitivo face a outros países desenvolvidos, mesmo enfrentando o desafio da sua população única. Tem um razoavelmente bom suporte aos cuidados de doença crónica e o top cinco das prioridades e barreiras estão delineados. Este estudo representa um importante passo para compreender onde e mais relevante intervir de forma a maximizar o desenvolvimento do CCM no Sistema de saúde de Abu Dhabi.Abu Dhabi is the capital of the United Arab Emirates (UAE) and the largest emirate in terms of land mass and population. The UAE has a high population-burden of morbidity and mortality related to chronic diseases. To address the growing burden of non-communicable diseases, the Chronic Care Model (CCM) has the purpose of having population-based daily care for all with structured and planned team care interventions; aiming to convert the life of patients with chronic disease from reactive to proactive. The model integrates six elements to facilitate high-quality care. Aim and Objectives This thesis aims to explore the health system of the Abu Dhabi emirate, using the CCM approach to improve and develop the healthcare delivery to people with chronic diseases. Four specific objectives were outlined: Characterize the healthcare services in the emirate of Abu Dhabi; Analyze the alignment of the healthcare services with the CCM, identifying main gaps; Explore the perception of the healthcare workers about the level of integration of the CCM in the daily care of patients with chronic diseases: diabetes, cardiovascular diseases, and cancer; Prioritize the subcomponents and the barriers for the development of the CCM in the health system of the emirate of Abu Dhabi. Methods To operationalize the objectives, a study with three different components was designed: Systematic review used the CCM as a framework to further explore its implementation or development in primary health care; The cross-sectional mixed-methods study collected information about the perception of the healthcare workers about the stage of implementation and development of the CCM in the daily care of patients; Modified Delphi technique was used to rank the priorities and barriers of the implementation and development of the CCM. Results The primary health care clinics adopted the principles of the patient-centred medical home model, a model aligned with the CCM. It seems there is an effort in following the latest scientific evidence with the intention to achieve health gains. The implementation of the CCM elements aligns with those standards and is positively associated with the use of interventions targeting high-risk behaviours. The healthcare workers have the perception that five elements (i.e. clinical information system, decision support, community, self-management, health system) were rated as reasonably good. Participants awarded high scores for some components; however, the qualitative findings did not always support the quantitative data indicating that the transition from doctor-centred to patient-centred is still in process. The ‘overall organizational leadership in chronic illness care’ was considered as the priority to address (26.3%) and ‘patient compliance’ the top barrier (36.8%). Conclusion The Abu Dhabi emirate health system is internationally well positioned and competing with others from the high-income developed countries, even facing the challenge of the unique population. It has reasonably good support for chronic illnesses care and the top five priorities and barriers to further improve it was outlined. This study represents an important step to understanding where it is more relevant to intervene in order to maximize the development of the CCM in the Abu Dhabi health system.
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Brown, Connolly Nancy. "Application of receiver operating characteristic analysis to a remote monitoring model for chronic obstructive pulmonary disease to determine utility and predictive value." Thesis, Brunel University, 2013. http://bura.brunel.ac.uk/handle/2438/8057.
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This is a foundational study that applies Receiver Operating Characteristic (ROC) analysis to the evaluation of a chronic disease model that utilizes Remote Monitoring (RM) devices to identify clinical deterioration in a Chronic Obstructive Pulmonary Disease (COPD) population. Background: RM programmes in Disease Management (DM) are proliferating as one strategy to address management of chronic disease. The need to validate and quantify evidence-based value is acute. There is a need to apply new methods to better evaluate automated RM systems. ROC analysis is an engineering approach that has been widely applied to medical programmes but has not been applied to RM systems. Evaluation of classifiers, determination of thresholds and predictive accuracy for RM systems have not been evaluated using ROC analysis. Objectives: (1) apply ROC analysis to evaluation of a RM system; (2) analyse the performance of the model when applied to patient outcomes for a COPD population; (3) identify predictive classifier(s); (4) identify optimal threshold(s) and the predictive capacity of the classifiers. Methods: Parametric and non-parametric methods are utilized to determine accuracy, sensitivity, specificity and predictive capacity of classifiers Saturated Peripheral Oxygen (SpO2), Blood Pressure (BP), Pulse Rate (PR) based on event-based patient outcomes that include hospitalisation (IP), accident & emergency (A&E) and home visits (HH). Population: Patients identified with a primary diagnosis of COPD, monitored for a minimum of 183 days with at least one episode of in-patient (IP) hospitalisation for COPD in the 12 months preceding the monitoring period. Data Source: A subset of retrospective de-identified patient data from an NHS Direct evaluation of a COPD RM programme. Subsets utilized include classifiers, biometric readings, alerts generated by the system and resource utilisation. Contribution: Validates ROC methodology, identifies classifier performance and optimal threshold settings for the classifier, while making design recommendations and putting forth the next steps for research. The question answered by this research is that ROC analysis can provide additional information on the predictive capacity of RM systems. Justification of benefit: The results can be applied when evaluating health services and planning decisions on the costs and benefits. Methods can be applied to system design, protocol development, work flows and commissioning decisions based on value and benefit. Conclusion: Results validate the use of ROC analysis as a robust methodology for DM programmes that use RM devices to evaluate classifiers, thresholds and identification of the predictive capacity as well as identify areas where additional design may improve the predictive capacity of the model.
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Clough, Lynn. "Managing Diabetes Within the Context of Poverty." University of Akron / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=akron1225217621.
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Adeogun, Oluseun. "Informatics for devices within telehealth systems for monitoring chronic diseases." Thesis, Cranfield University, 2011. http://dspace.lib.cranfield.ac.uk/handle/1826/6493.
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Preliminary investigation at the beginning of this research showed that informatics on point-of-care (POC) devices was limited to basic data generation and processing. This thesis is based on publications of several studies during the course of the research. The aim of the research is to model and analyse information generation and exchange in telehealth systems and to identify and analyse the capabilities of these systems in managing chronic diseases which utilise point-of-care devices. The objectives to meet the aim are as follows: (i) to review the state-of-the-art in informatics and decision support on point-of-care devices. (ii) to assess the current level of servitization of POC devices used within the home environment. (iii) to identify current models of information generation and exchange for POC devices using a telehealth perspective. (iv) to identify the capabilities of telehealth systems. (v) to evaluate key components of telehealth systems (i.e. POC devices and intermediate devices). (vi) to analyse the capabilities of telehealth systems as enablers to a healthcare policy. The literature review showed that data transfer from devices is an important part of generating information. The implication of this is that future designs of devices should have efficient ways of transferring data to minimise the errors that may be introduced through manual data entry/transfer. The full impact of a servitized model for point-of-care devices is possible within a telehealth system, since capabilities of interpreting data for the patient will be offered as a service (c.f. NHS Direct). This research helped to deduce components of telehealth systems which are important in supporting informatics and decision making for actors of the system. These included actors and devices. Telehealth systems also help facilitate the exchange of data to help decision making to be faster for all actors concerned. This research has shown that a large number of capability categories existed for the patients and health professionals. There were no capabilities related to the caregiver that had a direct impact on the patient and health professional. This was not surprising since the numbers of caregivers in current telehealth systems was low. Two types of intermediate devices were identified in telehealth systems: generic and proprietary. Patients and caregivers used both types, while health professionals only used generic devices. However, there was a higher incidence of proprietary devices used by patients. Proprietary devices possess features to support patients better thus promoting their independence in managing their chronic condition. This research developed a six-step methodology for working from government objectives to appropriate telehealth capability categories. This helped to determine objectives for which a telehealth system is suitable.
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Stephens, Jacqueline G. "Relationships Between Interprofessional Teamwork and Clinical Management of." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4565.
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Diabetes mellitus (DM) is a highly prevalent chronic disease that affects 29 million people in the United States including over 2 million veterans who receive care through the Veterans Administration. Patient-aligned care teams (PACTs) are an interprofessional teamwork system designed to improve outcomes of chronic illness, but empirical explorations of the efficacy of the PACTs have been insufficient. Utilizing the chronic care model, the purpose of this retrospective study was to determine if PACTs have been efficient in the diabetic management of veterans receiving care through a Southeastern VA. Medical records for 114 veterans with type 2 DM were randomly selected. A 1-way ANOVA was used to analyze outcomes for 5 evidence-based standards (SBP, DBP, BGL, A1C, & LDL) among 6 outpatient clinics. A repeated measures ANOVA was used for the same 5 evidence-based standards for the clinics to assess if there were any changes from FY2014 to FY2016. Results revealed that blood pressure readings and LDL levels met evidence-based standards, while A1C and BGL levels did not. No significant differences over the 3-year period were noted nor were there significant differences in patterns of performance between the clinics. The findings provide an essential basis for initiating a discussion on the potential of PACTs for the delivery of quality healthcare to U.S. veterans with diabetes and other chronic diseases. Positive social change can result from improving the delivery of healthcare using the PACT model to decrease morbidity, improve clinical outcomes, and increase the quality of life of U.S. veterans with type 2 DM. Future research that examines perceptions of clinical team members, team stability, and the delivery of shared care is warranted.
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Sandström, Erik, and Isabell Ångman. "En systematisk litteraturstudieom metabola markörer och dess omvårdnadsorienterade implikationer : En jämförelse mellan lågkolhydratkostoch traditionell diabeteskost." Thesis, Umeå universitet, Institutionen för omvårdnad, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-102491.
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Bakgrund: I den systematiska litteratur studien Mat vid diabetes (SBU 2010) framgår det att lågkolhydratkost har likartade metabola effekter hos personer med diabetes i jämförelse med en traditionell lågfettskost. Trotts dessa råd visar en undersökning ifrån samma studie att endast 18 % av de tillfrågade sjuksköterskorna kliniskt tillämpade denna typ av kostintervention. Detta tycks vara problematiskt vilket nyligen uttryckts i en rad olika mediala sammanhang. Utöver denna debatt har vi idag också en epidemiskt stor utbredning av patienter med typ 2 diabetes mellitus vilket ställer krav på de allt mer begränsade resurser som finns inom vård och omsorg. Syfte: Syftet var att beskriva lågkolhydratkostens metabola påverkan hos patienter med Diabetes Mellitus typ 2. Metod: Den elektroniska sökningen av artiklar utfördes i PubMed, CINAHL, Academic Search Elite, Scopus, Web of Science, PsycINFO (2009-2014) samt PMC (2011-2014). 13 artiklar bedömdes utifrån studiedesign, metabola markörer, intervention/kontrollgrupp, inklusions och exklusionskriterer vara lämpliga för studien. Resultat: En övergripande majoritet studierna visade på att lågkolhydratkosten gav signifikant förbättrade metabola markörer och framförallt gällande HbA1c och HDL-kolesterol. Endast en studie visade på ett negativt icke-signifikant resultat. Konklusion: Lågkolhydratkost förefaller utifrån studiens syfte och resultat som ett fullgott alternativ till den traditionella diabeteskost som utgör stora delar av den kostbehandling som patienter med T2DM får idag. Men kan innebära ett stort ansvar i det arbetsätt som sjuksköterskan tillämpar för att stödja och hjälpa en patient med T2DM att nå en god egenvård, hälsa och metabolkontroll Nyckelord: Typ 2 diabetes mellitus. Lågkolhydratkost. Traditionell diabeteskost. Chronic Care Model. Egenvård. Empowerment.Background: The systematic literature review Mat vid diabetes (SBU 2010) indicates that a low carbohydrate diet possesses similar metabolic effects in people with diabetes compared to a traditional low-fat diet. Contrary to this advice, a review from the same study portrayed that only 18% of the surveyed nurses clinically applied this type of diet intervention. This seems to be problematic, as was recently expressed in a variety of media. In addition to this debate, health care now also face a widespread epidemic of patients with type 2 diabetes mellitus which in turn puts the increasingly diminished and limited resources in health care under additional pressure. Aim: The aim of this study was to describe a low-carbohydrate diet and its metabolic effects in patients with Diabetes Mellitus type 2. Method: Included articles in this review was found by searching PubMed, CINAHL, Academic Search Elite, Scopus, Web of Science, PsycINFO (2009-2014) and PMC (2011-2014). 13 articles were assessed to be eligible for this review by assessing study-design, metabolic markers, intervention / control group, inclusion and exclusions criteria. Results: An overall majority of studies proved that a low carbohydrate diet could result in significantly improved metabolic markers, and in particular the HbA1c and HDL cholesterol. Only one study showed a negative non-significant result. Conclusion: A low-carbohydrate diet seems based on our findings as a viable alternative to the traditional diabetic diet which constitute a large part of the diet treatment that patients with T2DM receives from current healthcare. But this in turn implies that a greater responsibility is taken by the nurse in order to support and help a patient with T2DM to achieve a good self-care, health and metabolic control. Keywords: Type 2 diabetes mellitus. Low carbohydrate diets. Traditional diabetic diet. Chronic Care Model. Self-care. Empowerment.
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Brissos, Maria Elisa Elias. "A gestão da doença crónica: o caso particular da insuficiência renal crónica na região Alentejo." Master's thesis, Universidade de Évora, 2007. http://hdl.handle.net/10174/17291.
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O objetivo da presente pesquisa é a avaliação do estado atual das práticas organizacionais relacionadas com a prestação de cuidados de saúde aos doentes com Insuficiência Renal Crónica. A metodologia da pesquisa foi baseada num estudo retrospetivo por questionário que investiga hospitais e centros de saúde que integram a rede de cuidados de saúde do Serviço Nacional de Saúde (SNS) da Região Alentejo e que abordam a doença crónica objeto desta investigação. Recorrendo a um modelo de análise baseado no Modelo de Cuidados Crónicos (MCC) (cf. Guerra, 2002), incorporando nele os princípios teóricos da Gestão da Doença, foi feita uma avaliação pluridimensional de dados relacionados com as categorias essenciais do continuum de cuidados crónicos que incidem sobre a estrutura e o processo subjacentes às práticas de cuidados de saúde. Este modelo, constitui o quadro de referência conceptual que orienta a investigação e evidência as seis áreas essenciais da intervenção e avaliação do continuum de cuidados crónicos preconizados neste modelo: Organização dos cuidados de saúde, Ligações aos recursos da comunidade, Suporte à Auto-Gestão, Desenho do Sistema de Prestação, Suporte à decisão, Sistemas de Informação (Bonomi et al., 2000). Baseado nestas referências teóricas, sem negligenciar a vivência no âmbito da minha atividade profissional, colocou-se como hipótese que “Os diferentes grupos profissionais (médicos e enfermeiros) tem perspetivas semelhantes sobre a gestão da doença crónica no caso particular da Insuficiência Renal Crónica”. Recorrendo à análise quantitativa dos dados, com técnicas estatísticas descritiva e inferencial para a análise dos mesmos, entre os quais testes paramétricos para a análise das diferenças de médias respeitantes às seis categorias do questionário, tendo em conta o grupo profissional e as sub-regiões incluídas no estudo. Em face dos resultados alcançados conclui-se a inexistência da GD, tornando-se necessária e urgente a revisão do atual modelo de cuidados, já que o estudo demonstrou que o mesmo é inadequado para responder às necessidades do IRC. /ABSTRACT - The purpose of this research is to evaluate the current state of organizational practises related with health care to patients with Chronic Kidney Failure. The research methodology was based on a retrospective survey by questionnaire that analyses hospitals and health centers included in the health care network of the Alentejo region SNS (National Health Service), which approach the chronic disease under present research. Taking a model of analysis based on the Chronic Care Model (MCC) (cf. Guerra, 2002), merging the theoretical principles of Disease Guidance, a multidimensional evaluation has been made for data related with the essential categories of the chronic care continuum, which influence the structure and process underlying health care practices. Such model establishes the conceptual reference view that guides the research and demonstrates the 6 essential areas of interference and evaluation of the chronic care continuum preconized in this model: Health Care organization, Connection to the community resources, Self-Guidance support, Assistance System Design, Support to the decision, Information Systems (Bonomi et al., 2000). Based on these theoretical references and on the experience of my professional activity, following assumption arose: “The several Professional groups (doctors and nurses) have similar views over the chronic disease guidance in the particular case of Chronic Kidney Failure”. Taking the descriptive method with quantitive data analysis, descriptive and inferential statistics methods have been used for the same analysis, as well as parametric tests for analysis of the differences of averages regarding the 6 categories in the questionnaire, considering the professional group and sub-regions included in the survey. Facing respective results, ones conclude the inexistence of GD (Disease Guidance) and the urgent need to review the current care model, as the survey demonstrated such model does not comply with the IRC (Chronic Kidney Failure Patients) needs.
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Giaco, Karen M. "Medical Nutrition Therapy in a Chronic Care Model for the Treatment of Diabetes—A Baseline Study as Precursor to a Pilot Study Collaborative." Akron, OH : University of Akron, 2007. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=akron1176300411.
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Thesis (M.S.)--University of Akron, School of Family and Consumer Science-Nutrition and Dietetics , 2007."May, 2007." Title from electronic thesis title page (viewed 4/26/2009) Advisor, Deborah Marino; Faculty readers, Richard Steiner, Evelyn Taylor, Cinda Chima; School Director, Richard Glotzer; Interim Dean of the College, James Lynn; Dean of the Graduate School, George R. Newkome. Includes bibliographical references.
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Tsolekile, Lungiswa Primrose. "Development of an integrated model of care for use by community health workers working with chronic non-communicable diseases in Khayelitsha, South Africa." University of the Western Cape, 2018. http://hdl.handle.net/11394/6903.
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Philosophiae Doctor - PhDNon-communicable diseases (NCD) continue to be a public health concern globally and contribute to the burden of disease. The formal health system in developing countries lacks the capacity to deal with these NCD as it is overburdened by communicable diseases. Thus, community health workers (CHWs) have been suggested as a solution for alleviating the burden for primary health facilities, by extending NCD care to the community. This thesis aims to develop an integrated model of care for CHWs working with patients with non-communicable diseases by describing and exploring current CHW roles, knowledge and practices in relation to community-based NCD care. The specific objectives for this study included 1) the exploration of the NCD roles of generalist CHWs in the context of a limited resource urban setting; 2) determining the NCD-related knowledge of CHWs, and factors influencing this in a limited resource urban setting and 3) a comparison of actual and envisaged roles in the management and prevention of NCD using the integrated chronic diseases management model (ICDM) as a benchmark, and propose key competencies and systems support for NCD functions of CHWs in South Africa Mixed methods were used to achieve the objectives of this study. First, a qualitative enquiry was conducted using observations to respond to the first objective. A quantitative cross-sectional design was then used to achieve the second objective, and a questionnaire was used to interview CHWs. A comparison of findings from both the quantitative and qualitative studies with policy guidelines was undertaken to address the third objective.
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Preece, Cecelia. "Developing a model of care to improve the health and well-being for Indigenous people receiving renal dialysis treatment." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/37644/1/Cecelia_Preece_Thesis.pdf.
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The high levels of end-stage renal disease among Indigenous Australians, particularly in remote areas of the country, are a serious public health concern. The magnitude of the problem is reflected in figures from the Australian and New Zealand Transplant and Dialysis Registry that show that Indigenous Australians experience end-stage renal disease at a rate almost 9–10 times higher than other non-Indigenous Australians. A majority of Indigenous Australians have to relocate to receive appropriate renal dialysis treatment. In some Australian states, renal treatment is based on self-care dialysis which allows those Indigenous Australians to be treated back in their community. Evidence clearly shows that reuniting renal patients with community and family improves overall health and well-being for those Indigenous Australians. With the appropriate resources, training, and support, self-care management of renal dialysis treatment is an effective way for Indigenous people with end-stage renal failure to be treated at home. In this context, the study was used to gain insight and further understanding of the impact that end-stage renal disease and renal dialysis treatment has had on the lives of Indigenous community members. The study findings are from 14 individually interviewed people from South East Queensland. Data from the interviews were analysed using a combination of thematic and content analysis. The study methodology was based on qualitative data principles where the Indigenous community members were able to share their experiences and journeys living with end-stage renal disease. Many of the experiences and understanding closely relate to the renal disease pattern and the treatment with other outside influences, such as social, cultural, and environmental influences, all having an equal impact. Each community member’s experience with end-stage renal disease is unique; some manage with family and medical support, while others try to manage independently. From the study, community members who managed their renal dialysis treatment independently were much more aware of their renal health status. The study provides recommendations towards a model of care to improve the health and well-being is based on self-care and self-determination principles.
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Liedström, Elisabeth. "Life situation of next of kin to persons in need of care-cronic sorrow, burden, quality of life." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-33839.
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Nursing research has been performed during the last 20-30 years, about the next of kin’s vulnerability. Despite this, the health care system has had difficulties to integrate the next of kin in a way that gives support. The overall aim of the thesis was to describe and further explore the life situation of the next of kin to persons who are long-term ill, disabled, and/or older, and in need of care. Method: Multiple methods were used. Study I had a descriptive design, 44 next of kin of patients with multiple sclerosis were interviewed, latent content analysis was used for the analysis. Study II had a mixed method approach; the descriptive core study was analyzed with directed content analysis. The supplementary study with descriptive, correlative design was analyzed with descriptive and correlative statistics. Forty-four next of kin of patients with multiple sclerosis were interviewed; thereafter 37 of them answered a questionnaire about Quality of Life. Study III had a descriptive, explorative design. Twelve next of kin of older persons were interviewed with repeated informal conversational interviews, analyzed with latent content analysis. Study IV was cross-sectional with a descriptive, correlative design. Eighty-four next of kin of persons who were long-term ill, disabled, and/or older answered two questionnaires about Burden and Quality of Life that were analyzed with descriptive and correlative statistics. Results and Conclusions: Next of kin described a balance/imbalance in their relations to others and a high burden, but in general a good Quality of Life. Some next of kin also experienced chronic sorrow. Significant correlations were found between interpersonal relations and Quality of Life as a whole. Love and obligations were two anchor points on a continuum, describing the next of kin’s relationship to the ill/disabled person. The relationship with the health care personnel was described through cooperation and obligations. Good communication was seen as the key to balance the relationship with others. One possibility to achieve symmetrical communications is to adapt the Partnership Model, as a tool for creating good relationships. Honest and specific communication between the health care personnel, the next of kin, and the care receiver are necessary.
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Garlington, Jennifer Erin, and Jennifer Erin Garlington. "Exploring Family Perceptions About Primary Care Management Following Diagnosis of Type 1 Diabetes in Preschool-Age Children." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/621004.
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Purpose: To describe family perceptions about pediatric primary care management following diagnosis of type 1 diabetes mellitus (T1DM) in preschool-aged children living in the Pacific Northwest region of the United States. Study Design and Method: Mothers of children diagnosed with T1DM before the fifth birthday and within the past two years were recruited anonymously through two regional support groups. Perceptions about pediatric primary care management following T1DM diagnosis were elicited through an anonymous 30-item online survey. Demographic characteristics of mother and child were obtained as well as information about five important domains of health care management for a young child with T1DM: (1) multidisciplinary, (2) holistic and compassionate, (3) accessible and communicative, (4) uses current standards and technology, and (5) actively promotes safe self-management. Results: Twenty-one biological mothers participated in this study, each on behalf of a child diagnosed with T1DM who fit inclusion criteria. Overall mothers held positive perceptions about care management by PCPs and endocrinologists within context of each of the five domains. Most mothers felt included in care planning, valued periodic well-child exams, and believed the child's providers were accessible, communicated effectively, and usually demonstrated consideration/compassion for the family. Although a majority of mothers at least somewhat agreed that the PCP used current standards and technology to care for the child, and functioned as the center of his/her health care coordination, these domains elicited a slightly greater number of responses indicating uncertainty or disagreement. Clinical Implications: Nurses and pediatric practitioners can use findings from this study to plan continued exploration into the perceptions and care management needs of families following diagnosis of a very young child with T1DM. The domains of care used to assess mothers' perceptions about care management-based on tenets of the Chronic Care Model (CCM) and Patient Centered Medical Home (PCMH)-can be used by pediatric PCPs and endocrinologists to dialogue with patients and staff about how care management may be improved for these families. Providing opportunities for feedback to the families of young children with T1DM should be encouraged so future research can examine relationships between care management variables and clinical outcomes.
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Barron-Kagan, Rene Norene. "An Evidence-Based Educational Intervention to Improve Nursing Staff's Critical Thinking and Decision-Making Skills." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2786.
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An Evidence-Based Educational Intervention to Improve Nursing Staff's Critical Thinking and Decision-Making Skills
by
Rene N. Kagan
MSN, University of New Mexico, 2009
BS, University of Phoenix, 2000
Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University
September 2016
Hospitalized patients in acute care settings are at a high risk of developing health complications that can eventually lead to failure to rescue (FTR) situations. The aim of this project was to deliver a structured comprehensive medical-surgical competency plan for acute care nurses to detect deterioration in a patient's condition through the triad of assessment model to promote clinical reasoning among acute care nurses. Data were collected using pretest surveys, a demographic sheet, and an evaluation survey. A convenient sample of between 22 and 29 nursing staff was recruited from three medical-surgical inpatient units at a VA Hospital. The pretest survey, administered simultaneously with the educational modules, assessed participants' baseline knowledge on components of the triad of assessment model and the processes involved in the prevention of FTR. The pretest scores for modules 1 to 6 were 2, 3, 3, 3, 2, and 3 respectively. The posttests scores for modules 1 to 6 were 4, 5, 5, 5, 4, and 5 respectively. The nurse's aides also recorded posttest scores of 4.6 for both Pulse Oximetry and orthostatic hypotension modules. The t-test (p<0.00) showed a significant difference between the pre and posttests scores, thus, indicating an improvement in nursing staff's knowledge regarding the triad of assessment model. Thus, it is important to adopt a comprehensive medical-surgical plan for acute care nurses institutional-wide. This project contributes to social change through identification of a medical-surgical intervention that improves nurses' critical thinking skills, thereby promoting patient satisfaction and safety. Because nurses play a significant role at the bedside, improved critical thinking skills will facilitate a significant reduction in FTR rates, heighten patient satisfaction, and enhance the nurse-patient relationship.
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Nwachuku, Ada Nwachuku. "Type 2 Diabetes Prevention and Management in a Primary Care Clinic Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3314.
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Approximately 8.3% of the U. S. population has type 2 diabetes. Preventing the onset and improving the management type 2 diabetes are crucial for health care professionals. The purpose of this project was to develop and evaluate a type 2 diabetes prevention and management education program in a primary care setting using group medical appointments (GMAs). The chronic care model provided the framework for the study. The education program consisted of information from the Centers for Disease Control on the management of type 2 diabetes to be delivered by clinic staff using a GMA approach, a timeline for implementing the education program, and evaluation strategies for assessing patient health outcomes. Staff participants included 9 females and 1 male. One week after the presentation, staff responded to open-ended questions addressing the plan for prevention and management of type 2 diabetes. Findings indicated that staff unanimously approved the content of the program, thought the program could realistically be implemented, thought the proposed evaluation methods were appropriate, and thought the program would have a positive influence on patient health outcomes. Prevention and management education programs using a GMA approach may be used to reduce incidence and improve management of type 2 diabetes.
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Cabrera, Tammy Elaine. "Increasing Referrals of Hospitalized Obese Patients." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5990.
Full textAbstract:
The rate of obesity continues to rise in the United States and globally, placing populations at
increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer,
and other disease states. Literature review shows that there have been many different methods
utilized to halt obesity's progression, however rates continue to increase. The United States
Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other
agencies recommend obesity screening and counseling at every patient encounter, but most
hospitals do not have a current obesity policy in place to accomplish this task. The purpose of
this project is to develop a program proposal for a hospital-based, obesity tool based on the 5 A's
framework to increase screening and referrals of obese, adult patients ages 18 and over. The
logic model was utilized to guide the program development, implementation, evaluation, and
dissemination. The program was accepted by the hospitalist group and nurse leaders for full
development and evaluation. Key stakeholders and content experts were convened to create a
proposal and algorithm to guide the project. The obesity program will increase screenings and
referrals upon full adoption. Increase in screenings and referrals will improve care, quality of
life, weight status, and decrease health care expenditure. The results of dissemination of the
program may stimulate other facilities to adopt the program to combat obesity and contribute to
social change
The rate of obesity continues to rise in the United States and globally, placing populations at
increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer,
and other disease states. Literature review shows that there have been many different methods
utilized to halt obesity's progression, however rates continue to increase. The United States
Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other
agencies recommend obesity screening and counseling at every patient encounter, but most
hospitals do not have a current obesity policy in place to accomplish this task. The purpose of
this project is to develop a program proposal for a hospital-based, obesity tool based on the 5 A's
framework to increase screening and referrals of obese, adult patients ages 18 and over. The
logic model was utilized to guide the program development, implementation, evaluation, and
dissemination. The program was accepted by the hospitalist group and nurse leaders for full
development and evaluation. Key stakeholders and content experts were convened to create a
proposal and algorithm to guide the project. The obesity program will increase screenings and
referrals upon full adoption. Increase in screenings and referrals will improve care, quality of
life, weight status, and decrease health care expenditure. The results of dissemination of the
program may stimulate other facilities to adopt the program to combat obesity and contribute to
social change
The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity-related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. A review of the literature showed that multiple methods have been used to address the rate of progression; however, obesity rates continue to increase. The U.S. Preventative Services Task Force, American Heart Association, and other agencies recommend obesity screening and counseling at every patient encounter; most hospitals do not have a policy to accomplish this task. The purpose of this project was to develop an obesity screening and referral tool for the hospital setting. The resulting tool was based on the 5 As framework to increase screening and referrals of obese patients. The logic model was used to guide program development, implementation, evaluation, and dissemination. Results of the obesity screening and referral program showed an increase in screenings and referrals upon a trial adoption, raising the number of identified referrals to 23, compared to 2 patients identified for referral prior to program implementation (p = 0.035). An increase in screenings and referrals can bring about positive change by improving care, quality of life, and weight status of patients and decreasing health care expenditure.
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Buckley, Tyra T. "Delivery of Asthma Management Services by a Federally Qualified Health Center in an Urban Setting." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/iph_theses/145.
Full textAbstract:
As a chronic disease, asthma presents a significant public health challenge nationally and in Georgia. In 2007, over 22 million people, including over 9 million children, had asthma in the United States. In Georgia, 230,000, or 10% of children have asthma, which is more prevalent among children less than 18 years of age than among adults. While asthma affects people of all ages and socioeconomic status, low income and minority populations have the highest asthma morbidity. This has proven to be the case with residents of Neighborhood Planning Unit V (NPU-V), a low-income minority community located in southeast Atlanta. Children comprise 35% of NPU-V's population, and over half of them live below the poverty line. Among other concerns, children with asthma have higher rates of hospitalization and absenteeism from school than their peers. The hospitalization rates for children with asthma in South Atlanta aged 0-17 years of age is almost five times the rate of North Fulton County. The Georgia State University Institute of Public Health received grant funding for the planning and implementation of the Accountable Communities: Healthy Together-Asthma (ACHT-A) program to help address the problems associated with asthma in NPU-V and among patients of Southside Medical Center (SMC). The capstone project involved development of an evaluation plan for future determinations about the program’s effectiveness in achieving desired outcomes. The evaluation process included development of a logic model and putting systems in place to track and measure specific indicators. The project culminated in a preliminary assessment of selected program activities to establish baseline information for the program, its participants, and SMC staff.
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Molist, Brunet Núria. "Adequació de la prescripció en pacients amb malalties i condicions cròniques avançades: model centrat en la persona." Doctoral thesis, Universitat de Vic - Universitat Central de Catalunya, 2016. http://hdl.handle.net/10803/399042.
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L’evidència científica actual suggereix que la prescripció dels pacients amb malalties cròniques avançades és sovint inadequada. Així, es pot generar morbiditat afegida, que representa una càrrega clínica i econòmica als pacients i a la societat en general, que requereix ser avaluada.
Donat aquest context, proposem el “model de prescripció centrat en la persona”, metodologia que aplica evidències científiques fent ús del judici clínic i d’acord amb el criteri del pacient. L’objectiu principal és millorar els resultats de salut dels pacients disminuint el risc d’efectes adversos. Per ser portat a terme requereix d’un treball multidisciplinari entre geriatres i farmacèutics clínics.
Per a validar l’aplicabilitat del Model de Prescripció centrat en la Persona en la pràctica clínica s’han portat a terme dos estudis a la Unitat Geriàtrica d’Aguts de l’Hospital Universitari de Vic, que ha identificat prescripció inadequada a més del 40% dels pacients i fa propostes per a millorar la prescripció.There is scientific evidence showing that current prescribing for patients with advanced chronic diseases is often inadequate. This results in added morbiditiy, which represents a clinical and economic burden to patients and to society in general that needs to be evaluated. In this context, we propose the "patient-centered prescription model". This is a systematic three step-process carried out by a geriatrician and a clinical pharmacist. It applies scientific evidence using clinical judgment and according to the criterion of the patient. It is performed by a multidisciplinary team of clinical pharmacists and geriatricians. The validation of the applicability of the model in clinical practice has been done throughtwo studies carried out in Acute Geriatric Unit of the Hospital Universitari de Vic, which identify more than 40% of patients with inappropriate prescribing and provide proposals to improve the prescription according to patient’s profile.
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Conic, Rosalynn Ruzica Zoran. "USING PSORIASIS AS A MODEL TO IDENTIFY UNIQUE BIOMARKERS." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1554485554569272.
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Callender, Marcia Callender. "Telehealth: Improving Quality of Life in Veterans with Congestive Heart Failure." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2524.
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Congestive heart failure (CHF) affects an estimated 5.1 million Americans over the age of 20. The purpose of this quantitative study was to determine whether there is a difference in the Quality of Life (QOL) for Congestive heart failure patients receiving care through telehealth compared to patients receiving face-to-face care (usual care). Guiding this project was the Self-Care Model of Chronic Illness because the primary outcome of the self-care model is illness stability, well-being, and quality of life. Seventy-seven veterans with Heart Failure (HF) from the Washington D.C. Veterans Affairs Medical Center (VAMC) participated in the project. Forty reported they were receiving telehealth and 37 reported that they were receiving face-to-face care. The average participant age was 67 years with a range of 44 to 93 years. Seventy-five of the participants were male and 2 were female. Sixty-four participants were Black and 12 were White. The Minnesota Living with Heart Failure (MLHF) questionnaire average score for the telehealth group was 49.4 (SD = 28.7) and the face-to-face care group was 37 (SD = 27.9). With equal variance assumed, there was no significant difference between MLHF scores in the telehealth group compared to the usual care group (t = -1.91, p > .05). Thus, opportunities for using telehealth without negatively affecting patient outcomes, such as QOL, are plausible. It can be concluded that providing services using home telehealth for HF patients may produce outcomes that are equivalent to those receiving traditional services.
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Costa, Loreta Marinho Queiroz. "Rede de atenção ao doente renal crônico: proposta de organização na lógica da linha de cuidado." Universidade Federal de Goiás, 2016. http://repositorio.bc.ufg.br/tede/handle/tede/6166.
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Considering the magnitude and incidence of chronic diseases in the current Brazilian epidemiological profile and the need to establish the Care Networks Health - RAS in the SUS as a response to chronic conditions, but that meet at the same time to acute conditions and acute exacerbation of chronic conditions this work is an intervention proposal within the service organization, which aims to develop Logic Model of Patient care Network with Chronic Kidney disease - DRC, seeking to ensure continuity and comprehensiveness of care.Logical Model is a methodological resource to explain program structure results-oriented, is Basically a systematic and visual way to present and share the understanding of the relationship between the resources available to the programmed actions and changes for results expected to achieve. Used - in the structure of the Logical Model guidelines and criteria defined in ministerial orders on the topic and the principles of Care Model to Chronic Conditions - MACC, designed to be applied in the SUS. The results presented contextualize the situation of Chronic Terminal Renal Disease (ESRD) in Goiás from December 2009 to 2013; describe the Nephrology Assistance Network of High Complexity available in Goiás / 2015 and bring the logical model of the Individual Care Network with Chronic Kidney Disease, CKD, to be operationalized in care line of logic, in order to maintain renal function, and when the inexorable progression is the slowness in speed loss of renal function. His final presentation consists of two parts: the first, the logical model of care to the population, and the second, the logical model of the operational structure of the RAS that despite being separated, constitute a single instrument in the network forming process. It is hoped that this work contribute to the process of planning and implementation of the Care Network Patient with Chronic Kidney Disease - DRC, the health system response to a chronic condition.
Considerando a magnitude e a relevância das doenças crônicas no atual perfil epidemiológico brasileiro e a necessidade de se estabelecer as Redes de Atenção à Saúde - RAS no SUS como resposta às condições crônicas, mas que atendam ao mesmo tempo às condições agudas e agudização das condições crônicas, este trabalho trata de uma proposta de intervenção no âmbito da organização dos serviços, que objetiva desenvolver Modelo Lógico da Rede de Atenção ao Paciente com Doença Renal Crônica - DRC, buscando a garantia da continuidade e integralidade da atenção. Modelo Lógico é um recurso metodológico para explicitar estrutura de programa orientado para resultados, basicamente é uma maneira sistemática e visual de apresentar e compartilhar a compreensão das relações entre os recursos disponíveis para as ações programadas e as mudanças por resultados que se espera alcançar.Utilizou-se, na estruturação do Modelo Lógico, as diretrizes e critérios definidos em portarias ministeriais referentes ao tema e os princípios do Modelo de Atenção às Condições Crônicas - MACC, idealizado para ser aplicado no SUS. Os resultados apresentados contextualizam a situação da Doença Renal Crônica Terminal (DRCT) em Goiás nos meses de dezembro de 2009 a 2013; descrevem a Rede de Assistência em Nefrologia de Alta Complexidade disponível em Goiás/2015 e trazem o Modelo Lógico da Rede de Atenção da Pessoa com Doença Renal Crônica - DRC, a ser operacionalizada na lógica da linha de cuidado, visando a manutenção da função renal, e quando a progressão é inexorável, a lentificação na velocidade de perda da função renal. Sua apresentação final é formada por duas partes: a primeira, o modelo lógico de atenção à população, e a segunda, o modelo lógico da estrutura operacional da RAS que, apesar de estarem separados, constituem-se num instrumento único no processo de conformação de rede. Espera-se com este trabalho contribuir no processo de planejamento e implantação da Rede de Atenção ao Paciente com Doença Renal Crônica - DRC, resposta do sistema de saúde a uma condição crônica.
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Scarlett, Marjorie V. "Evidence-Based Diabetic Discharge Guideline: A Standardized Initiative to Promote Nurses' Adherence." NSUWorks, 2017. https://nsuworks.nova.edu/hpd_con_stuetd/51.
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Background: Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care. Purpose: The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services’, Joint Commission on Accreditation of Healthcare Organization’s, and other professional healthcare organizations’ guidelines for nurses’ knowledge of evidence-based discharge practices; determine level of nurses’ knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida. Theoretical Framework: The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. Methods: Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired t test. An online demographic survey and pre- and posttest surveys were administered to determine nurses’ knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired t tests. Results: A statistically significant difference was found in the pre-posttest survey responses for question 5 (p=0.046 Wilcoxon; p=0.041t test), and question 13 (p= 0.022 Wilcoxon; p=0.018 t test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use. Conclusion: A standardized diabetic discharge guideline incorporated into the hospital’s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses’ adherence results in effective nursing practices and an informed patient population.
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Nwachuku, Goldie Okechi Nwaru. "The Relationship Between Sickle Cell Support Group Status and Barriers to Care as Perceived by Parents of Children with Sickle Cell Disease." ScholarWorks, 2016. http://scholarworks.waldenu.edu/dissertations/2369.
Full textAbstract:
By examining barriers to care, health professionals can better understand what disparities exist between groups and who may be at greater risk for poor primary care. Researchers have highlighted the need for additional research that focuses on the extent of unmet needs for U.S. children with sickle cell disease (SCD). The purpose of this quantitative study was to compare the differences between parents who are in a SCD support group and those who are not. The theoretical framework of this study is based on the chronic care model and social support theory. A total of 128 parents of children with SCD completed the study survey. The sampling occurred by e-mail, phone, and face-to-face conversations. Selection criteria for potential participants in both groups were based on their children being diagnosed with SCD. Seventy-four participants (57.8%) were members of a SCD support group, and 54 participants (42.4%) were not members of a SCD support group. In this study, the independent variables were parents attending or not a SCD support group. The t test and MANCOVA was used to assessed the association between perceptions of barriers to care and support group status. However, statistical analysis showed no significant results. The null hypothesis was not rejected. Therefore, the positive social change implication is to further explore potential factors that may shape perceptions of barriers to care for those with SCD so that perceived barriers to care can be overcome.
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Krucien, Nicolas. "Analyse de la qualité de l’offre de soins de médecine générale du point de vue des patients." Thesis, Paris 11, 2012. http://www.theses.fr/2012PA11T009/document.
Full textAbstract:
Les systèmes de santé accordent une attention croissante au point de vue des usagers dans l’organisation de l’offre de soins. L’instauration d’une offre de soins sensible aux besoins et préférences des patients constitue un enjeu majeur de qualité et d’efficacité des soins. Ce travail analyse le point de vue des patients pour l’offre de soins de médecine générale en utilisant différentes méthodes permettant d’obtenir des informations complémentaires en termes d’expérience de soins, de satisfaction, d’importance ou encore de préférences. Il s’agit des méthodes Delphi, de classement du meilleur au pire et de révélation des préférences par les choix discrets. Ces méthodes sont appliquées sur deux échantillons : en population générale pour la première et chez des patients poly-pathologiques pour les 2 autres afin d’identifier les principaux enjeux actuels et à venir de la réorganisation de l’offre de soins de médecine générale du point de vue des patients. Les résultats montrent le rôle central de la relation médecin-patient et plus particulièrement de l’échange d‘informations entre le médecin et le patient. Cependant une relation médecin-patient de qualité ne doit pas pour autant être réalisée au détriment de la qualité technique du soin et de la coordination de la prise en charge du patient. Ce travail montre également l’importance de prendre en compte l’expérience de soins des patients lors de l’analyse de leur point de vue, et plus particulièrement de leur disposition au changement. L’évaluation systématique et régulière des préférences des patients en pratique quotidienne peut permettre d’améliorer la communication médecin-patient ainsi que le contenu de l’offre de soins du point de vue des patientsThe healthcare systems are paying a great interest to the patients’ perspective for the organization of health care provision. Healthcare system which is accountable and responsive of patients’ needs and preferences is a major issue for the quality and efficiency of care. In this thesis, we analyze the views of patients for the supply of GP care in using different complementary methods about patients’ experience, satisfaction, importance or preferences. These methods are applied to a sample of patients in GP and to a sample of chronically ill patients in order to identify current and future major issues for the reorganization of GP care from the patients’ perspective. The results show the main role of the doctor-patient relationship and especially of the information exchange between doctor and patient and between patient and doctor. However the quality of the doctor-patient relationship is not enough. The technical quality of care (i.e. thoroughness) and the coordination are of high importance for patients. This work highlights that it is necessary to take into account the patients’ experiences in the analysis of their perspective (e.g. preferences) to fully and appropriately understand the results, especially in terms of willingness to change. The systematic and regular screening of patient preferences in daily GP practice can improve the doctor-patient communication and the content of the provision of care from the perspective of patients
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Guda, Dominic Robin. "A study to guide the design and implementation of a chronic disease management register in a regional health service." Phd thesis, 2012. http://hdl.handle.net/1885/11810.
Full textAbstract:
Background. The mounting burden of chronic disease associated with population ageing creates a challenge for health systems. Healthcare organisations are addressing this challenge by exploring new ways to improve patient health outcomes, including through the use of information technologies.
Aim. This research aimed to identify key design features of a chronic disease management (CDM) register for the public sector health services provided in the Australian Capital Territory.
Methods and setting. ACT Health, a government agency, is the largest health service provider in the ACT. An organisational analysis of ACT Health was conducted using qualitative, quantitative, and participant observation methods. Three index conditions- Chronic Heart Failure, Chronic Obstructive Pulmonary Disease, and Diabetes Mellitus Type 2 defined information according to the 'International Statistical Classification of Diseases and Health Related Problems: lOth Revision, Australian Modification' (ICD-10-AM) were chosen for data collection and analysis.
Results. ACT Health policies support evidence-based CDM interventions, but their implementation has been slow and disjointed. This research found that support for CDM in ACT Health is within the 'basic support' range as measured by the MacColl Institute's Assessment of Chronic Illness Care (ACIC) survey. The survey revealed continuity of care as a concern. On the positive side, factor analysis of the survey results identified a novel 'patient empowerment' factor that was strength within ACT Health. This patient empowerment factor is somewhat more than a concept; it is one of the powerful predictors of positive outcomes for CDM interventions, and has policy importance in this particular regional health system for working toward CDM goals.
In the participant observation aspect of this research, these findings were taken up to enrich the design features for an effective CDM register by incorporating the views of health professionals, patients and their carers. This research identified five data categories and associated variables required to support a CDM register. These five data categories are patient details, medical details, provider details, prevention details, and case coordination details. The prevention detail category is the centre of a CDM register intervention and consists of diagnostic, therapeutic and behavioural sub-categories. However, the research identified challenges regarding availability and completeness of these data in all five categories. Combining the survey and participant observation suggests that electronically incorporating standardised clinical information into a CDM register should enhance multidisciplinary communication, care planning and coordinated service delivery. A clinical data repository with data extraction and filtration systems compliant with the Health Level Seven International (HL7) metadata standard would enable the organisation to populate a CDM register's data fields from multiple sources.
Conclusion. A health service specific CDM register based on established data standards can actively support effective CDM interventions within the service. Further expansion toward a population-based CDM register would depend on implementation of local and national e-Health initiatives to standardise clinical information for automatic extraction into CDM registers. The research provides policy and design recommendations to further strengthen chronic care processes to benefit patients with chronic diseases, their carers and health service providers.
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Yang, Feng-Jung, and 楊豐榮. "Social Networking Services Enhanced Smart Care Model:New theory from Chronic Care Model for Chronic kidney disease stage V." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/b522w6.
Full textAbstract:
碩士國立臺灣大學
健康政策與管理研究所
107
Background: CKD stage V is a high risk for dialysis initiation and complication such as uremic encephalopathy, uremic symptoms, gastrointestinal bleeding and infection. IDEAL trial provides guidance on the safety of waiting for symptoms or lower levels of estimated glomerular filtration rate prior to beginning dialysis. There was a serious communication gap during CKD stage V care. Objective: Our aim was to establish a powerful care model with Social Networking Services (SMS) to improved care quality in health care and dialysis initiation. Methods: Our study is retrospective cohort from 2007 to 2017. The patient age is between 20-85 years. In 2014, Dr H started to use with SMS app to connect with CKD stage V patients and their family. In case of emergency, the patients and their family can report any condition to Dr H. Dr H help promote the “productive interactions” between CKD stage V patients and Healthcare system. End point is to delay initiation of dialysis therapy with safety. Patient divided to four group, Team during 2007 to 2014(Team), Dr H during 2007 to 2014( Dr H), Team without SMS(Team-mob) during 2014 to 2017 and Dr H with SMS(Dr H +mob). Results: In our study, 4 group patients have different time to dialysis. Before adjusting, Group “Dr H +mob” had longer time to dialysis (761.7 ±616.2 days) than another group (vs Team p=0.011*, vs Dr H p=0.039*, vs Team-mob p=0.049*) . After adjusting with baseline eGFR , “Dr H +mob” had prolonged more duration of each eGFR drop (84.8 ±65.1 days) than other group (vs Team p=0.005*, vs Dr H p=0.032*, vs Team-mob p=0.002**) . Conclusions: SMS in Chronic stage V patients and physician can resolve the gap of communication and create more benefits for Chronic kidney disease to delay initiation of dialysis. Therefore, the role of SMS and the associated care model should be further investigated in more large population. Trial Registration: The study has been approved by the ethical review board of National Taiwan University Hospital (NTUH 201901030RINB and 201903005RINA).
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Sharif, Shirin. "CHARACTERIZATION OF A LONGITUDINAL CARE PLAN MODEL FOR MANAGING CHRONIC DISEASES: A CARE PLAN ONTOLOGY TO COMPUTERIZE PAPER- BASED CARE PLANS." 2012. http://hdl.handle.net/10222/14797.
Full textAbstract:
Chronic diseases are the largest cause of morbidity and mortality. Due to long course there is a need to plan longitudinal care for chronic disease. In this thesis, we aim to standardize the longitudinal care process for chronic disease in the form of Generic Care Plan Model. We adapted knowledge management approach and our research is guided by Methontology for developing formal knowledge model. This knowledge model is represented as Care Plan Ontology to facilitate the computerization of care plans. We instantiated our Care Plan Ontology using paper based care plans of chronic diseases generated during the research process. We evaluated our Care Plan Ontology in 4 phases (a) Using Pellet reasoner to ensure consistency (b) Instantiation of 3 new care plans for chronic diseases (c) Instantiation of patient specific case to ensure that model is capable to handle personalised information (d) Evaluation on the basis of Ontological design principles.
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Gaudette, Étienne. "Waiting times, aging, chronic conditions and health care costs : teachings from the life-cycle model." Thèse, 2013. http://www.archipel.uqam.ca/5916/1/D2592.pdf.
Full textAbstract:
Cette thèse étudie plusieurs défis auxquels sont confrontés les systèmes de santé modernes avec des modèles calibrés inspirés des théories du capital-santé et du cycle de vie. Dans le premier chapitre, nous développons le premier modèle dynamique de demande de soins de santé dans un cadre public. Dans ce modèle, les agents choisissent d'utiliser les soins si la désutilité encourue en file d'attente est dominée par les gains dynamiques permis par l'impact des soins sur la santé. Nous intégrons ensuite cette modélisation de la demande dans un modèle macroéconomique, que nous calibrons à l'aide de données québécoises de 2005. À l'aide de simulations, nous questionnons la pertinence, du point de vue du bien-être social, de permettre à de longs temps d'attente d'émerger afin de réduire les coûts de santé. Nous trouvons que les temps d'attente constituent un mécanisme faible de rationnement de la demande et mènent à d'importants coûts sociaux. En contrepartie, toutes les politiques simulées menant à des réductions de temps d'attente génèrent des gains substantiels de bien-être. Dans le second chapitre, nous étendons notre méthodologie afin d'étudier les impacts du vieillissement de la génération du "baby-boom" sur les systèmes publics de santé. Nous faisons évoluer la distribution d'agents selon les prévisions des démographes de l'Institut de la statistique du Québec (ISQ) et anticipons l'évolution de l'utilisation des soins et des temps d'attente de 2005 à 2050. Nous trouvons que la politique actuelle d'augmentation de 5% par an du budget de la santé mènera à un allongement important des temps d'attente d'ici 2030, et ce malgré une augmentation marquée de la part des coûts de santé dans l'économie. D'ici à 2050, nous estimons qu'il sera nécessaire de doubler la part de l'économie allouée au système de santé afin de maintenir les temps d'attente à leurs niveaux de 2005. Dans le dernier chapitre, nous nous questionnons sur l'évolution à venir de la santé, de la longévité et des coûts des soins des États-Unis d'Amérique (É-U). Nous développons un modèle de demande de soins dont le point focal est l'incertitude pour les agents de contracter une maladie chronique. Nous calibrons ce modèle sur l'évolution des données américaines de 1985 à 2005. Selon nos simulations, les dépenses de santé atteindront 22% du PIB des É-U d'ici 2050 si les tendances récentes continuent au même rythme. Nous trouvons que la prévalence de maladies chronique continuera de croître durant cette période, mais n'entraînera pas d'augmentations importantes de coûts des soins. Ce sont plutôt les progrès technologiques en santé et l'augmentation des revenus qui entraîneront la hausse des dépenses.
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MOTS-CLÉS DE L’AUTEUR : Systèmes publics de santé, demande de soins de santé, coûts des soins de santé, temps d'attente, vieillissement, maladies chroniques.
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Chuang, Pei-Rong, and 莊佩蓉. "An Ontology-Based Knowledge Model of Nutrient Care─A Case Study for Chronic Kidney Disease." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/c25us7.
Full textAbstract:
碩士中原大學
資訊管理研究所
102
This study proposes a knowledge model of nutrient care especially for chronic kidney disease. According to national kidney foundation reports, most patients are incapable to adjust their proper dietary plan. This study will integrate the different structure of the source domain knowledge, and uses knowledge-based system development as a solution. With the knowledge model as the core of design, the system includes: First, a Domain Ontology for establishing common knowledge concepts and instances using is-a relations to express the knowledge categorization structure and to provide a standard terminology set for ontology communication; Second, a Task Ontology to establish an objective-oriented knowledge framework using has-a relations to express the combination of questions; and Third, Semantic Rules to develop the logical steps for problem solving and the computation rules for inference engine computation. Finally, this study obtaining basic information about chronic kidney disease patients as experimental subjects from medical institutions, the experiments results have been completed ten patients, and show that it is in line with pragmatic way to computing of nutrition care principles.
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Almojaibel, Abdullah. "Understanding intention to use telerehabilitation : applicability of the Technology Acceptance Model (TAM)." Diss., 2017. http://hdl.handle.net/1805/14970.
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Indiana University-Purdue University Indianapolis (IUPUI)Background: Pulmonary rehabilitation (PR) has the potential to reduce the symptoms and complications of respiratory diseases through an interdisciplinary approach. Providing PR services to the increasing number of patients with chronic respiratory diseases challenges the current health care systems because of the shortages in health care practitioners and PR programs. Using telerehabilitation may improve patients’ participation and compliance with PR programs. The purpose of this study was to examine the applicability of the technology acceptance model (TAM) to explain telerehabilitation acceptance and to determine the demographic variables that can influence acceptance. Methods: A cross-sectional survey-based design was utilized in the data collection. The survey scales were based on the TAM. The first group of participants consisted of health care practitioners working in PR programs. The second group of participants included patients attending traditional PR programs. The data collection process started in January 2017 and lasted until May 2017. Results: A total of 222 health care practitioners and 134 patients completed the survey. The results showed that 79% of the health care practitioners and 61.2% of the patients reported positive intention to use telerehabilitation. Regression analyses showed that the TAM was good at predicting telerehabilitation acceptance. Perceived usefulness was a significant predictor of the positive intentions to use telerehabilitation for health care providers (OR: 17.81, p < .01) and for the patients (OR: 6.46, p = .04). The logistic regression outcomes showed that age, experience in rehabilitation, and type of PR increased the power of the TAM to predict the intention to use telerehabilitation among health care practitioners. Age, duration of the disease, and distance from the PR center increased the power of the TAM to predict the intention to use telerehabilitation among patients. Conclusion: This is the first study to develop and validate a psychometric instrument to measure telerehabilitation acceptance among health care practitioners and patients in PR programs. The outcomes of this study will help in understanding the telerehabilitation acceptance. It will help not only to predict future adoption but also to develop appropriate solutions to address the barriers of using telerehabilitation.
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Chang, Mai-Fan, and 張梅芳. "The effectiveness of an integrated care model on patients with multiple chronic diseases: evaluation from a regional hospital in Southern Taiwan." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/36085446682087937961.
Full textAbstract:
碩士美和科技大學
健康照護研究所
101
Since the implementation of National Health Insurance, the domestic medical resources have been gradually popularized and the mortality rate has been decreased year by year, and the enhancement of access of care has made outpatient visits doubled; in the meantime, along with the aging of the population of the country, the prevalence rate of multiple chronic diseases has increased year by year, patients with multiple chronic diseases thus have become the most important resource users in health care system. The purpose of this study is mainly to understand the medical utilization situations and important factors of patients with multiple chronic diseases, and to explore and compare the differences of medical utilization effectiveness before and after the implementation of integrated care model. The data used in this study come from the Registry for Beneficiaries (ID) Claims Data Files of National Health Insurance Research Database from January 2008 to June 2009 (a total of 18 months), a list of total 4,054 loyal patients of the Hospital was provided, after screening the number of objects complying with integrated care plan is 1,935. This study adopted secondary data analysis, and took the same batch of patients divided into two stage (before implementation:2008/1~2009/6; after implementation: 2010/1~2011/6), to use paired-t, chi-square (χ2) test, independent samples t-test and one-way ANOVA and multiple regression analysis to explore the patients with multiple chronic diseases and their medical utilization situations as well as the important factors affecting changes in health care costs before and after the implementation of integrated care model. Study results: the medical utilization results before and after the implementation of integrated care model reveals that after the implementation the average number of medical visits per person per year is decreased by 4.83 visits, the average number of visited physicians per person per year is decreased by 0.09 physicians, the average number of visited medical divisions per person per year is decreased by 0.08 divisions, the average number of used medicine items per person per year is decreased by 0.83 items, and the average total medical expenses per person per year is decreased by NT$ 6,519.17. In the chronic disease category grouping, the one-way ANOVA analysis shows that, whether before or after the implementation of integrated care model, all of average numbers of chronic diseases, medical visits, visited physicians, visited medical divisions and used medicine items, as well as total amount of medical care expenses have reached a statistically significant difference (P <.001). In the age grouping, except that age has no significant influence on medical expenses after the implementation of integrated care model, for senior citizens above the age of 81 years, whether before or after the intervention of integrated care, all of health care utilization items including average number of chronic diseases, medical visits, visited physicians, visited medical divisions and used medicine items have had an obvious increasing trend along with the increase of age. From these results it can be inferred that, age is not a single principal factor which may affect the change in health care costs, the contents of effect not only cover the number of chronic diseases, but also cover the severity of different types of chronic diseases. Then this study further used multiple regression analysis, it was found that, in terms of age, before the implementation of integrated care model the total amount of health care expenses will be reduced by NT$ 85.63 for each additional 1 year of age, and after the implementation of integrated care model the total amount of health care expenses will be reduced by NT$ 177.33 for each additional 1 year of age; so, whether these results are associated with severity of diseases is worthy of further exploration in future studies. Conclusion: the concept of Holistic Health Care also can be achieved through integrating physicians’ prescriptions via medical visit process and information platform, regularly monitoring to proactively identify patients with high risk, enhancing coordinated care function of case managers, strengthening inter-profession communications and active involvement of team work, and reducing improper repeated utilization of medical resources by integrating medical professions to render patients with perfect medical care.
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Viviers, Linde Juana. "The different voices of chronic illness." Diss., 2005. http://hdl.handle.net/10500/1247.
Full textAbstract:
This study aimed at exploring chronic illness from both the perspectives of the patient, living with the illness and the professional, treating the illness.
The epistemological framework is social constructionism. Qualitative research was selected as the research approach. Three in-depth interviews with three patients, suffering with a chronic illness were conducted, as well as three interviews with professionals, who had experience with patients diagnosed with chronic illnesses. Thematic analysis was the method used for the analysis of data.
The stories of the participants were reconstructed in terms of themes. A comparative analysis for both participants groups was done, and linked to the relevant literature
This study created an understanding of the complexity of chronic illness. The themes identified, highlighted the importance of the patient-professional relationship, specifically in the context of chronic illness.Psychology
M.A. (Clinical Psychology)
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HUANG, TE-CHIH, and 黃得誌. "Impact of Tw-DRGs-based payments on health care providers with simulation Model: The Example of Chronic kidney disease, CKD(MDC5, MDC10, MDC11)." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/qn9raf.
Full textAbstract:
碩士嘉南藥理大學
醫務管理系
107
Objectives: In 2018, the National Health Insurance (NHI) Administration announced the Tw-DRGs (Taiwan Diagnosis-Related Groups) its full draft implementation. However, most of the Tw-DRGs implemented in the second stage were based on surgical divisions. Among the hospital specialties that have yet to implement Tw-DRGs, internal medicine is a specialty that deals with diseases that are often highly complex. In particular, the classification of CKD as a high-risk disease. In the past, CKD has become one of the 10 leading causes of death in Taiwan, as well as the costliest disease among the country’s top of medical resource utilization and expenses. Based on the aforementioned factors, CKD was selected as the subject matter of this study, while the impacts and effects of the Tw-DRGs 4.0 payment system on hospitals were examined through a model simulation of the system. Method: An experimental design approach was adopted in this study, collect a case hospital data (January 2017 to December 2017), and total 910 CKD data. Based on the relevant literature summarized and analyzed, with revised and verified by experts. A system simulation framework was developed in this study; subsequently, the relevant variables within the framework were used to collect and archive the data. A simulation based on the new Tw-DRGs 4.0 system was then performed and the results were compared with the actual medical expenses data. Results: (1) In terms of fixed benefits and medical resource utilization, a statistically significant difference with respect to case-mix groups was only observed between patients with only high blood pressure and patients with only diabetes. (2) In terms of the effects of CKD severity on fixed benefits and medical resource utilization, a statistically significant difference was only observed in the MDC11 group. (3) In terms of the predictive power of the overall system simulation framework, the explanatory power of the model was 56% while the explanatory power of the single MDC11 sample was 89%. Conclusion: The results of this study indicated that the simulated Tw-DRGs 4.0 system had statistically significant effects on medical facilities, including differences in fixed benefits due to arising complications. Regarding the effects of disease severity, it was shown that CKD severity was linked to the cost differences in the MDC11 group. In this study indicating that the selected variables were appropriate for the CKD samples. However, the selection of variables must be revised if one intends to apply the system simulation framework to the MDC5 and MDC10 groups, so as to enhance the predictive power of simulation results.
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Sheridan, Nicolette Fay. "Mapping a new future: Primary Health Care Nursing in New Zealand." 2005. http://hdl.handle.net/2292/507.
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The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.
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Makua, Mogalagadi Rachel. "Mixed method: exploration of caring practices related to the management of patients with chronic pain within the primary health care setting." Thesis, 2014. http://hdl.handle.net/10500/14565.
Full textAbstract:
Aim of the study is to explore the role caring practices within the nurse-patient relationship, in facilitating effective chronic pain management in the primary health care context.
Objectives are to analyse the current caring practices within the nurse-patient relationship during the management of patients with chronic pain within primary health care services; explore the challenges experienced by nurses in primary health care services when managing patients with chronic pain; observe the caring practices within the nurse patient interaction for the patients suffering from chronic pain within the Primary health care setting and explain the nurses‟ caring practices when managing their chronic pain in the primary health care setting.
Method The research design for this study is sequential, explanatory and mixed method, which is more appropriate due to the complexity of the phenomenon under study.
Findings: Although the survey measured the caring practices subjectively which other studies had done consistently, generally nurses associated caring as their core function within the health profession. Nurses do not actively involve the patients in the development of a treatment plan and as a result the caring behaviours that are intended to benefit the patients are not realised and, thus patients report nurses as not being caring. The results indicated that lack of an inclusive treatment plan, which can only be discovered through the development of the therapeutic NPR, is not given priority in the management of patients with chronic pain
Conclusions: Caring should not be seen as concrete execution of the set of activities towards the patient but rather as a joint venture between the nurse and the patient. The strength of the model developed in this study is the identification of the nurses‟ internal readiness to create a caring environment by experiencing the love, faith and hope before engaging with the patient.Health Studies
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Beauregard, Marie-Ève. "Effets des variations dans l’implantation d’un programme sur le risque cardiométabolique dans six CSSS de Montréal sur les résultats chez les patients." Thèse, 2016. http://hdl.handle.net/1866/16284.
Full textAbstract:
En 2011, l’Agence de la santé et des services sociaux de Montréal (ASSSM), en partenariat avec les Centres de santé et services sociaux (CSSS) de la région, a coordonné la mise en œuvre d’un programme de prévention et de prise en charge intégré sur le risque cardiométabolique. Ce programme, s’inspirant du Chronic Care Model et s’adressant aux patients atteints de diabète et d’hypertension artérielle, est d’une durée de deux ans et comporte une séquence de suivis individuels avec l’infirmière et la nutritionniste, de cours de groupe et de séances d’activité physique.
L’objectif de ce mémoire est d’évaluer, à l’aide d’un devis quasi-expérimental, l’impact de la variation dans l’implantation de certains aspects du programme dans les six CSSS participant à l’étude sur les résultats de santé des patients. Cinq aspects du programme ont été retenus : les ressources, la conformité au processus clinique prévu dans le programme régional, la maturité du programme, la coordination interne au sein de l’équipe de soins et la coordination externe avec les médecins de 1re ligne. Des analyses de différence de différences, incluant des scores de propension afin de rendre les groupes comparables, ont été effectuées dans le but d’évaluer l’influence de ces aspects sur quatre indicateurs de santé : l’hémoglobine glyquée, l’atteinte de la cible de tension artérielle et l’atteinte de deux cibles d’habitudes de vie concernant la répartition des glucides alimentaires et la pratique d’activité physique.
Les résultats indiquent que les indicateurs de santé sélectionnés se sont améliorés chez les patients participant au programme et ce, indépendamment des variations dans son implantation entre les CSSS participant à l’étude. Très peu d’analyses de différence de différences ont en effet relevé un impact significatif des variables d’implantation étudiées sur ces indicateurs. Les résultats suggèrent que les effets bénéfiques d’un tel programme sont davantage tributaires de la prestation des interventions auprès des patients que d’aspects organisationnels liés à son implantation.In 2011, the Agence de la santé et des services sociaux de Montréal (ASSSM), in partnership with the Health and social service centres (CSSS) of the region, coordinated implementation of an integrated and interdisciplinary program for prevention and management of cardiometabolic risk. The program, based on the Chronic Care Model and designed for patients with diabetes and hypertension, consists of a two-year sequence of individual follow-ups with a nurse and a nutritionist, group classes and physical activity sessions. The objective of this master’s thesis is to assess the impact of variations in implementation of some aspects of the program in the six CSSS participating in this study on patients’ health outcomes. Five aspects of implementation have been selected: resources, conformity to the clinical process proposed in the regional program, maturity of the program, internal coordination within the CSSS team and external coordination with primary care physicians. Analysis of difference in differences, including propensity scores that make the groups comparable, have been calculated to assess the impact of those aspects on four health outcomes: glycated hemoglobin, reaching the blood pressure level target and reaching two targets of lifestyle habits regarding the distribution of dietary carbohydrates and the practice of physical activity. The results show that the program yielded expected effects in regard to patients’ selected health outcomes, regardless of implementation variations among the studied CSSS. Indeed, few analysis revealed a significant impact of the implementation variables on those outcomes. Results suggest that beneficial effects of this program depend more on services provided to patients than on specific organisational aspects of its implementation.