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1
Hemphill, Jean Croce. "Homeless Health Care: A Nursing Initiative." Digital Commons @ East Tennessee State University, 1994. https://dc.etsu.edu/etsu-works/7569.
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Webb, Joseph. "Effect of a faith-based initiative on hospital readmissions." Thesis, The University of Alabama at Birmingham, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3591680.
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<p> The purpose of this study was to examine the relationship between a faith-based initiative and hospital readmissions. The main data source used was the inpatient data-base of Methodist LeBonheur Healthcare System (MLH) in Memphis, TN. Data were collected from admissions that occurred during years 2008 through 2012 at four of MLH's five adult acute-care hospitals. Data from the U.S. Census Bureau's American Community Survey were also used in the study.</p><p> This study uses theoretical tenets from the Social Justice and Equity Theory and the Chronic Care Model as its conceptual framework. The study consisted of an aggregated cross-section data analysis. Univariate, bivariate, and multivariate statistics were calculated using PASW/SPSS statistical software, version 20. The dependent variable was hospital readmission within 30 days of an index admission. The independent variable was CHN member or non-CHN member. Due to the dependent variable being dichotomous, logistic regression was determined to be the most appropriate analysis.</p><p> Key findings in the study indicated that among inpatients admitted for chronic conditions, the likelihood of readmission for CHN members was not significantly different than that of non-CHN members. Secondly, among inpatients admitted for chronic conditions and residing in low socioeconomic neighborhoods, the likelihood of readmis-sion was not significantly different between CHN and non-CHN members. Additional findings indicated that among patients with chronic illnesses, an increase in level of severity of illness contributes significantly to higher odds of readmission. Finally, the study indicated that among the four chronic illnesses identified in the study, CHF has significantly higher odds of being readmitted within 30 days.</p>
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Roberson, Kerrie L. "Patient and Family Engagement Initiative| A Quantitative Causal-Comparative Analysis." Thesis, University of Phoenix, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10615091.
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<p> Patients and families play an important role at the bedside, and that is making sure the transition of care among providers is safe and effective. Bedside shift report (BSR), a type of patient and family engagement, is a process where patients, families, and health care providers work together as partners to improve the quality and safety of hospital care. In 2010, TJC developed and revised the standards for patient-centered care, which were designed to improve the safety and quality of care for patient and family involvement. The purpose of this quantitative descriptive study with a causal-comparative design was to compare two dependent variables of patient and nurse satisfaction from the pre-and post-implementation of BSR as a patient and family engagement strategy and determine if BSR resulted in a positive return on investment for a health care organization. This quantitative descriptive study employed Donabedian’s structure-process-outcome (SPO) approach model. This model is a foundation for modern health care quality measurement, studying the structures of process and outcome, and the means to an end of a relationship. The data analysis utilized both descriptive and inferential statistics. The mean and standard deviation were calculated on two dependent variables, nurse satisfaction and patient satisfaction. Both research questions were measured using Chi-square to compare the difference in the yearly data for patient satisfaction and nurse satisfaction pre-and post-implementation of BSR as a patient and family engagement strategy on a surgical unit. The dependent variable patient satisfaction is statistically significant and the dependent variable nurse satisfaction is not statistically significant. Each year, post-implementation BSR for both dependent variables had a positive trend.</p><p>
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Scarlett, Marjorie V. "Evidence-Based Diabetic Discharge Guideline| A Standardized Initiative to Promote Nurses' Adherence." Thesis, Nova Southeastern University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10685982.
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<p> <b>Background:</b> 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. </p><p> <b>Purpose:</b> 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. </p><p> <b>Theoretical Framework:</b> The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. </p><p> <b>Methods:</b> Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired <i>t</i> 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 <i>t</i> tests. </p><p> <b>Results:</b> A statistically significant difference was found in the pre-posttest survey responses for question 5 (<i>p</i> = 0.046 Wilcoxon; <i>p</i> = 0.041<i>t</i> test), and question 13 (<i>p</i> = 0.022 Wilcoxon; <i>p</i> = 0.018 <i> t</i> 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. </p><p> <b>Conclusion:</b> 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. </p><p>
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Cherry, Jacqueline Helen. "The feasibility of the Uitenhage provincial hospital private initiative." Thesis, Nelson Mandela Metropolitan University, 2010. http://hdl.handle.net/10948/1508.
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The South African Health Care environment is in state of reform. Government strategy and change in legislation have been the catalyst for the development of new business models in South Africa. This report deals with the feasibility of a proposed model which is to be implemented by the Eastern Cape Department of Health at the Provincial Hospital in Uitenhage. The fundamental challenge in South Africa is the shortage of resources to support the health care industry from a public perspective. The point of departure for this research was to understand the complexity of this industry and investigate models that have evolved in South Africa and internationally. The literature research covers funding mechanisms from both a public and private perspective and takes into account the role the government plays in providing equitable health care for all. The literature provided the foundation to develop the model which is to be piloted at the hospital in Uitenhage. In terms of the research objective, a single case study methodology approach was conducted. Triangulation technique was used to gain insight from different perspectives and to test the model for validity. The core of this research focuses on the viability of the proposed model and the integration of this into the government health reform plan. The research revealed that in comparison to the existing PPP models in South Africa, this model is feasible. As a result of the analysis and the development of the proposed model, the research is concluded by offering suggestions for further research.
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Raza, Mattie V. "Trauma Informed Care Training Initiative: Implementation Study in Appalachia." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/honors/632.
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This study aims to evaluate the implementation of Trauma-Informed Care (TIC) trainings in Johnson City, Tennessee, and the surrounding Appalachian area. Previous TIC trainees were sent an email survey asking them if they had followed through with their plan to implement the training at their place of work or in other areas of their lives. The response rate for this study was 2%, possibly due to extraneous variables such as the Coronavirus Pandemic and the lag time between the initial training and survey follow-up. The responses that were analyzed indicated promise for the practical implementation of TIC concepts at the companies involved in the training initiative. Additional research is needed in order to further analyze TIC implementation.
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Whiteman, Jane. "Response of community pharmacists to a distance learning initiative on health screening." Thesis, Queen's University Belfast, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.333851.
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Chama-Chiliba, Chitalu Miriam. "An economic analysis of maternal health care in Zambia." Thesis, University of Pretoria, 2013. http://hdl.handle.net/2263/40259.
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This thesis investigates the utilisation of maternal health care in Zambia, where despite being a signatory to the Safe Motherhood Initiative and Millennium Development Goals, which are aimed at improving maternal health, indicators of maternal health continue to perform poorly. The need to understand crucial factors in improving maternal health motivated the current research, especially since there is a dearth of literature in this area in Zambia. The thesis focuses on two aspects of maternal health care: antenatal care (ANC) and facility-based deliveries, to answer two broad questions. Firstly, what factors determine the use of ANC in Zambia? Secondly, to what extent has the abolition of user fees affected facility-based deliveries?
An assessment of the factors, which explain the utilisation of ANC in Zambia, using three sets of comparable datasets reveals that, while there are differences in the factors explaining the decision to use ANC and the frequency of visits over time, the decision to seek ANC and the frequency of use is low among the poor and less educated, and there are marked regional differences in utilisation. The most appropriate econometric specification for antenatal visits, according to different performance indicators, was the two-part model, which differs from recent research favouring more complex methodologies.
The analysis is further extended through the inclusion of supply-side factors and the examination of individual and community level factors associated with inadequate and non-use of ANC, following the adoption of the focused ANC approach in Zambia. To incorporate the supply side factors, the 2007 Zambia Demographic and Health Survey was linked to administrative and health facility census data using geo-referenced data. To assess the factors associated with (1) the inadequate use of ANC (defined as three or less visits), and (2) the non-use of ANC in the first trimester of pregnancy, we specify two multilevel logistic models. At the individual level, the woman’s employment status, quality of ANC received and the husband’s educational attainment are negatively associated, while parity, the household childcare burden and wealth are positively associated with inadequate utilisation of ANC. Both individual and community level characteristics influence inadequate use and non-use of ANC in the first trimester; however, community level factors are relatively stronger in rural areas.
Although ANC is an important facet of maternal care, it occurs before delivery, but does not necessarily provide much information with respect to delivery decisions. Therefore, the thesis investigates delivery decisions, as well, in particular, the effect of user fee removal in rural areas of Zambia on facility-based deliveries. To account for regional differences, we employ a Seemingly Unrelated Regression model incorporating an Interrupted Time Series design. The analysis uses quarterly longitudinal data covering 2003q1-2008q4. When unobserved heterogeneity, spatial dependence and quantitative supply-side factors are controlled for, user fee removal is found to immediately increase aggregate facility-based deliveries, although the national trend was unaffected. Drug availability and the presence of traditional birth attendants also influence facility-based deliveries at the national level, such that, in the short-term, strengthening and improving community-based interventions could increase facility-based deliveries. However, there is significant variation and spatial dependence masked in the aggregate analysis. The results highlight the importance of service quality in promoting facility-based deliveries, and also suggest that social and cultural factors, especially in rural areas, influence the use of health facilities for delivery. These factors are not easily addressed, through an adjustment to the cost of delivery in health facilities.
Additionally, we analyse the effect of user fee abolition on the location of childbirth, focussing on deliveries that occur in public health facilities using household survey data. To elicit the causal relationship, we exploit the relative change in fees across health districts within a difference-in-differences framework. Surprisingly, although reductions in home deliveries were observed, as expected, reductions in public health facility-based deliveries were also uncovered, along with increases in deliveries at private health facilities. However, these findings were statistically insignificant; suggesting that the abolition of user fees had little, if any, impact on the choice of location for childbirth. The statistically insignificant, but unexpected, causal effects further suggest that the removal of user fees have unintended consequences, possibly the transference of facility costs to the client, which would deter the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in outcomes; instead, other efforts, such as improving service quality, could have a greater impact.<br>Thesis (PhD)--University of Pretoria, 2013.<br>gm2014<br>Economics<br>unrestricted
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Böttiger, B. W., A. Lockey, R. Aickin, et al. "Over 675,000 lay people trained in cardiopulmonary resuscitation worldwide - The "World Restart a Heart (WRAH)" initiative 2018." Elsevier Ireland Ltd, 2019. http://hdl.handle.net/10757/625698.
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Siazon, Maria Reina Ventura. "Evaluating the Discharge Process Improvement Initiative in Reducing the Length of Stay." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6949.
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Extended hospital length of stay (LOS) causes increased health care costs and incidence of never events, such as hospital-acquired infections, pressure ulcers, and falls, which are not reimbursed by Medicare. This study examined if there would be a statistically significant decrease in the LOS of patients after the implementation of a discharge process improvement initiative (DPII), The model for improvement and small tests of change concept were used to guide the DPII at a hospital in northern California. Sources of data included archival data obtained from the hospital's quality improvement department that showed LOS prior to and after the implementation of the DPII. The LOS for 2015 and 2017 were compared using the t test for independent samples. The LOS in 2015 was longer (M = 4.59, SD = 3.66) than in 2017 (M = 4.09, SD = 3.81), a statistically significant difference, M = 0.50, 95% CI [0.32, 0.67], t (77) = 5.574, p = .005, d = 1.3, showing that the implementation of the DPII led to a reduction in the LOS. This reduction cannot be attributed solely to the DPII because other projects were implemented at the same time, such as the Clinical Decisions Unit and multidisciplinary rounds. Future research could focus on the relationship between reduced LOS and readmission and the degree of collaboration among health care team members. The implications of this study for social change include the potential to lower health care costs and increase patients' awareness of their responsibility for their own health.
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Grubnic, Suzana. "The social construction of care pathways : a nursing management initiative towards operationalising continuous quality improvement in a children's hospital." Thesis, University of Derby, 2000. http://hdl.handle.net/10545/227118.
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The literature is dominated by prescriptive accounts of the application of Continuous Quality Improvement and care pathways in the acute hospital services sector. The authors assume that the organisation is a designed artefact (Scapens, Otley and Lister, 1984): goals can be achieved. This thesisr eports on the nature, processa nd consequenceso f a Nurse Manager introducing care pathways in a Children's Hospital It believes, in opposition to the conventional view, that the organisation is a culture. The actions and interactions of individuals and groups shape initiatives. This is within context and within time. The research investigation was conducted over a twenty-five month period, from February 1996 to April 1998. It was ethnographic in nature. Interviews were conducted with managers, nurses and doctors, formal meetings and activity in the Children's Emergency Department observed, and documentation collected. The findings are, however, presented from the nurses' perspective using their words. Files for newspaper clippings were created and maintained. The thesis contributes to the literature in three ways. In the main, it represents the first contextual and critical account of the implementation of care pathways than that believed to be contained in the literature. Further, it purposefully utilises for the first time two conceptualf rameworks in order to explicate the changep rocessesin the Children's Hospital. These are Watson's (1994) Strategic Exchange Perspective and Dawson's (1994) Processual Framework. It presents the descriptive part of the findings in the form of a narrative. The Nurse Manager established a project to multiskill experienced nurses in the diagnosis and treatment of minor conditions using care pathways as the vehicle. Her role changed during the process of implementation, but the project had little, if no, impact on power structures between and decision making of doctors and nurses
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O’Donnell, Barbara Ann. "Quality improvement, or quality care : an ethnographic study of frontline National Health Service staff engagement with a quality improvement initiative." Thesis, University of the West of Scotland, 2018. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.768251.
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Moritz, Dean. "The effects of an integrated behavioral health initiative on the behavior of providers in an Ob/Gyn primary care clinic." ScholarWorks, 2009. https://scholarworks.waldenu.edu/dissertations/681.
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The separation between behavioral services and traditional medicine is increasingly being seen as counterproductive on personal and societal levels. Despite this, there has been little research examining how integrated models blending mental and physical health services could be implemented. The literature revealed that behavioral interventions have been incorporated into traditional medical treatments, but this often has been piecemeal in nature and has yielded equivocal results. This study examined the assertion that effective integration between behavioral and medical services will increase the standard of care for the patient. Integration in this study was accomplished by colocating a psychologist on the primary care unit, implementing formal behavioral screening, and ongoing consultations between primary care and psychological/psychiatric providers. Data obtained from 15 medical providers pre and post implementation examined if there would be an increase in the number of behavioral discussions between patients and providers, and the number of behavioral referrals generated. Also, data was examined to determine if there would be a drop in the number of emergency room and psychiatric admissions related to these provider's patients. A repeated measures ANOVA showed a significant increase in mental health discussions and referrals by providers for their patients post intervention. With integrated services, positive social change for patients could be realized in decreased stigma associated with mental health issues, less personal distress, and the ability to better manage daily demands. There will be positive societal results with increased productivity in the workplace and relief from the burdens of increased healthcare utilization associated with comorbid behavioral and medical issues.
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Rice, Heather Marie. "Neighborhood Disorganization, Social Support, Substance Use and Functioning amongst Adolescents: An Analysis of the Ohio Behavioral Health Juvenile Justice Initiative." Case Western Reserve University School of Graduate Studies / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1499463442029744.
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Chiarelli, Donna Carleton University Dissertation International Affairs. "Dollars for drugs? An exploration of the Bamako initiative as an appropriate intervention for meeting women's health care needs in Kenya." Ottawa, 1996.
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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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Greenham, Felicity J. "How the New Labour Government Third Way policies (1998-2010) and the delivery of the New Deal for Communities (NDC) regeneration programme impacted on participation in health care in an area-based initiative. A longitudinal study using action-learning research methodology in a New Deal for Communities Area Based Initiative." Thesis, University of Bradford, 2018. http://hdl.handle.net/10454/16922.
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The research examines New Labour’s Third Way policies and the impact New Deal for Communities (NDC) regeneration programme had on participation in health care. This longitudinal study (1998-2007) explores participatory joint working, welfare state, social capacity, health inequalities, citizen involvement and community capacity. It captures the experiences of local community and front-line workers whilst delivering the Health Focus Group (HFG) in the NDC programme. Using action learning reflection techniques, the study analyses a purposeful sample of 15 from the local community, front-line workers, and strategic respondents involved in the NDC health programme. The research demonstrated the NDC did increase participation, joint working and involvement of local actors 1998–2003. The importance of communication, leadership and relationships was recognised as an important catalyst for developing community governance models. The new action learning spaces initiated, designed and delivered 19 new models of joint local clinical, community and complementary health and well-being projects.
In 2001, New Labour introduced public private finance initiatives with the Primary Care Trust (PCT) which conflicted with the local actors’ involvement in the participatory joint decision-making. The reconfiguration of health and social care services and the new public health models introduced complex governance and monitoring models, further distancing the local actors from the process. Strategic staff changes in key governance positions also adversely affected the communication and trust established with local actors. The research concluded operational, tactical, and strategic alignment is necessary to maximise joint participation in decision-making.
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Wasti, Syed Muhammad Taha. "Achieving Personalized Interoperable Patient Information Systems;benefits & challenges in Swedish context." Thesis, Blekinge Tekniska Högskola, Sektionen för datavetenskap och kommunikation, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-2340.
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Due to a rapid increase in aging population, demand for personalized health care increases proportionally. Personalized patient data can be a helpful way of catering the needs and requirements of elderly people staying at home. Indirectly, it can be a manner of providing better eHealth services according to their needs. Another interesting aspect of providing better personalized eHealth services is to make patient information systems interoperable. Interoperability of eHealth systems is an issue of great concern to current research and development but in this study, we focus on patient information systems. Like in some other European countries, introduction of open source platform to achieve interoperability and personalization of patient information system could save money for health care organizations and make the procedure easier in Sweden also. The purpose of this study is to identify what standards are available for interoperability and what are the benefits and challenges of introducing open source systems for achieving personalized interoperable patient information systems (PIPIS). In light of this investigation, author has identified the benefits and challenges of introducing OSS for achieving PIPIS. Author has also made several recommendations regarding the challenges identified.<br>In the name of ALLAH, the most gracious and merciful. I extend my gratitude to the beautiful creator of this beautiful universe that He made for us to conquer. Without the love of my parents this thesis report could never be possible for me to write. All my love and care is for them which no one else can share. I thank Mr. Hans Kyhlbäck whose supervision is a source of inspiration for doing this study. He is definitely the best supervisor to work with. In the end, I would like to thank my friends and colleagues whose help just kept me going despite of many hurdles that I faced.
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Trinidad, Kristy. "Strategies for Successful Implementation of Change Initiatives in Health Care." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3126.
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Changing regulations, increased competition, and evolving customers' expectations have necessitated significant organizational changes in the health care industry. This multiple case study investigated the strategies of senior managers from 3 California health care organizations to implement significant change initiatives. The participating organizations had a positive reputation for successfully implementing change. Data from interviews and a review of organizational documents were analyzed through the conceptual lens of Lewin's phases of change model and Kotter's 8-step process for implementing change. The analysis revealed 3 general themes: communications, training, and employee involvement. The managers of each participating organization emphasized the importance of keeping employees informed, and the importance of continuous bidirectional communication between all levels of the organization. They emphasized that communication facilitated a smooth and timely implementation of the planned change; they also noted the importance of training to assist employees in adapting to new job requirements and new technology. However, it was noted that the managers did not undergo any formal training in change implementation. Participants also emphasized the importance of employee involvement in the form of consultation concerning aspects of the implementation. Contrary to Lewin and Kotter's assumptions, the employees had no say in the initial decision to change, how to change or when to change. These findings have positive social change implications by assisting managers of health care organizations to improve their strategies for implementing change initiatives.
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Thompson, Jennifer W. "Insurance status, health care access, and adolescent smoking initiation." CONNECT TO ELECTRONIC THESIS, 2007. http://dspace.wrlc.org/handle/1961/4144.
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Sajnani, Calli. "Time Banks as Aging-in-Place Initiatives." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5521.
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There has been growing concern over how state and federal governments can support the increasing population of aging Americans and their need for long-term care. Current insurance funding models cover acute hospitalization and skilled care only, leaving unskilled care needs and homemaker services at the full expense of those in need. Time banking allows individuals to exchange or barter time for goods or services without monetary payment. There is insufficient evidence to determine if members believe time banks to be a viable alternative to support aging-in-place care needs. This phenomenological study explored time banking as a potential vehicle for nonskilled health care support to defray health care costs as one ages. Ostrom's co-production theory provided the theoretical foundation for the research questions, which examined the participants' lived experiences with the role time banks played in their decision to age in place. Face-to-face interviews were conducted with 10 Southern California time bank participants, age 50 years or older. Using a Moustakas-modified van Kaam method and a priori coding emergent themes were extracted. Study findings illustrated that time bank participation did support aspects of nonskilled health care needs and provided members with confident options for aging in place. Study findings also indicated a need for continued collaborations between professional and managerial staff in public agencies, including California's Health and Human Services Agency and time bank users in their communities. Reducing health care costs for taxpayers in any government-funded health insurance model benefits positive social change, and nonskilled health care provider time bank initiatives may be a sustainable alternative for those wishing to age in place.
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Morroni, Chelsea. "Randomized trial comparing bleeding patterns after immediate and conventional oral contraceptive initiation." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/9363.
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Bibliography: leaves 89-94.<br>Starting oral contraceptives immediately, under direct observation, increase OC initiation rates and may increase effective use and continuation However, if adverse bleeding pattern occur, then such an approach may paradoxically decrease continuation rates. The purpose of this study is comapare 90-day bleeding patterns following immediate ("Quickstart) versus conventional OC initiation.
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Roelofse, Maryke. "Investigating factors contributing to late initiation of antenatal care in a health facility in Cape Town." University of the Western Cape, 2018. http://hdl.handle.net/11394/6849.
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Magister Curationis - MCur<br>Despite the awareness of the importance of initiating antenatal care in the first trimester of a pregnancy (before 12 weeks gestation), late initiation of antenatal care (on or after 24 weeks of gestation) remains a common trend amongst pregnant women. The late initiation of antenatal care poses such a risk, to both the pregnant women and their unborn babies that it can contribute to maternal and foetal mortality and morbidity. The late initiation of antenatal care, an entirely avoidable occurrence, has an impact on targets set by the United Nations Millennium Development Goals (MDGs), now focusing on the Sustainable Development Goals (SDG‟s) set out by the United Nations. This study aim to investigate the factors which contribute to and cause the late initiation of antenatal care in pregnant women in a region in the Western Cape.
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The aim of this study was to investigate the factors that influence pregnant woman and contribute to late initiation of antenatal care (after 24 weeks gestational age) in one health facility/district in Cape Town. The findings of the study identified possible factors that may cause pregnant women to initiate antenatal care late in pregnancy and these findings could facilitate planning and possible interventions targeting the importance of early initiation in the community.
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Royce, Robert Gregory. "A study of the dynamics of the private health care market in the United Kingdom, with particular reference to the impact of British United Provident Association (Bupa) Provider and benefit initiatives." Thesis, Swansea University, 2011. https://cronfa.swan.ac.uk/Record/cronfa43128.
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The private health care market in the United Kingdom is a multi-billion pound industry whose dynamics remain largely unexamined. This is so even though the boundaries between the public and private sectors are becoming increasingly blurred, particularly in England. Given the growing importance of this sector, the policy community needs to know more about the nature of private health care in the UK, how well the private market operates and how successful have been the various attempts within it to improve value for money and health care quality, given that private health care has traditionally been seen by many citizens as unaffordable. In particular this thesis traces recent efforts by the British United Provident Association (Bupa) to reshape the UK private healthcare market. The account provided draws on the author's experience as a senior Bupa manager involved in planning and implementing such changes. The thesis describes a series of Bupa initiatives designed to change provider behaviour in pursuit of improved quality and value-for-money, and the difficulties and obstacles encountered. The latter often centred on tensions or confrontation between the insurer and professional providers that are discussed in relation to the wider literature on the social and economic organisation of health care markets. An attempt has been made to draw some general conclusions via an empirical study of the role and limitations of market-based changes within the UK private sector. The broad conclusion is that the private market in the UK exemplifies those features of health care seen throughout the developed world that create imperfect market conditions. As such the market is highly resistant to insurer initiatives that would reverse the longstanding trend for premiums to rise above the rate of inflation. It is considered unlikely given the current market structure that any insurer, including Bupa, can escape these constraints in the short term. However, Bupa has implemented some successful initiatives that suggest that longer-term incremental change is possible.
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Ueckermann, Julius. "Green initiatives in hospitals in Ontario : is there a business case." Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/80784.
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Thesis (MBA)--Stellenbosch University, 2011.<br>This study was conducted to investigate on what basis hospitals in Ontario could justify the capital and resource requirements needed to implement green initiatives. The study used two theoretical references as the basis for the literature review as well as for the interpretation of the results. The one reference used was a report released by the World Health Organization (WHO) and Health Care Without Harm (HCWH) in 2009, that addressed the responsibility of hospitals towards reducing greenhouse gas emissions. The second reference looked at a theoretical model that discussed four potential competitive environmental strategies that businesses can use to differentiate themselves based on green initiatives.
The literature review more specifically discussed the seven opportunities that were identified by the WHO and HCWH that hospitals can use to reduce their carbon footprint. These were: (1) energy efficiency; (2) built environment; (3) alternative energy; (4) transportation; (5) waste; (6) water; and (7) food. Each opportunity was discussed in detail and was evaluated in both a competitive and non-competitive environment. In addition, each opportunity was evaluated in light of its ability to be used in one of the competitive environmental sustainability strategies. In order to assess what the regulatory pressures are on Ontario hospitals, the Canadian Environmental Protection Act was evaluated. No major environmental legislative pressures on hospitals could be identified.
Another important part of the literature review was the evaluation of the funding model for Ontario hospitals. It was seen, that hospitals in Ontario received around 85 percent of their funding from the Ontario government and that hospitals and the ministry are both under financial pressure. This is an important indicator that funding to hospitals is very restricted.
The research data for this study was obtained through a survey that was conducted among hospital representatives who have already implemented some form of green initiatives. The results from 33 questionnaires indicated that hospitals primarily implemented green initiatives to obtain cost savings. In this regard, an eco-efficiency strategy would be a logical competitive strategy for Ontario hospitals to follow. This is a clear indication that green initiatives are seen more as a cost reduction tool than a direct attempt to reduce greenhouse gas emissions. Projects that are quick to implement, require low capital and have a quick payback, are favoured. The areas on which hospitals have focused, were energy efficiency, waste management and water savings. In general, it seems that most green initiative projects were still in an immature stage. Further results also showed that hospitals had no opportunity to increase revenue by making use of the benefits of green initiative projects. The research concluded that the only basis on which Ontario hospitals could justify the capital and resource required to implement green initiatives, were on a cost savings basis.
This report concludes with a discussion on the use of certain competitive strategies in a non-competitive environment before recommendations are made on how to improve the current situation. The study concludes with shortcomings of this study and recommendations on further research to be done.
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Sanderson, Christine. "Feeding the baby : new mothers' experiences of breastfeeding." Title page, table of contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09MPM/09mpms216.pdf.
Full textAbstract:
Funded by the Primary Health Care Initiatives Program. Bibliography: p. 161-170. This thesis examines the public health of breastfeeding from a feminist perspective, based on a qualitative longitudinal study. From reviewing the history of infant feeding, a number of discourses of breastfeeding are identified and their continuing influence on contemporary thinking is discussed.
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Diggs, Jessica Carmelita. "The imact of Medicaid expansion initiatives and county characteristics on the health and healthcare access of Ohio's children." Connect to text online, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1144677107.
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Thesis (Ph. D.)--Case Western Reserve University, 2006.<br>[School of Medicine] Department of Epidemiology and Biostatistics. Includes bibliographical references. Available online via OhioLINK's ETD Center.
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Chambers, David A. "An exploration of the influences on evidence-based change to clinical practice : a comparative study of US/UK health care initiatives." Thesis, University of Oxford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365600.
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Werner, Jennifer Eilleen. "Barriers to initiation and continuation of vision care among diabetics." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2259.
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Warri, Denis. "Perceptions of pregnant women on reasons for late initiation of antenatal care in Nkwen Baptist Health Center, North West Region, Cameroon." University of the Western Cape, 2018. http://hdl.handle.net/11394/6894.
Full textAbstract:
Magister Public Health - MPH<br>Background:
Antenatal care serves as a key entry point for a pregnant woman to receive a broad range of services and should be initiated at the onset of pregnancy (WHO, 2016). Cameroon has one of the highest maternal mortality ratios in the world (UNICEF, 2016). The majority of pregnant women in Cameroon initiate antenatal care after the first trimester (Njim, 2016). Most studies on initiation of antenatal care in Cameroon have not explored in greater depth the reasons why most of the pregnant women initiate antenatal care late.
Methodology:
The aim of the study is to understand the reasons why pregnant women initiate antenatal care late in Nkwen Baptist Health Center, North West Region, Cameroon. It is an exploratory study and applied purposive sampling to recruit eighteen pregnant women and three key informants for data collection through individual interviews. Pregnant women who initiated antenatal care after the first trimester were recruited during antenatal care clinics and interviewed in a room at the antenatal care unit. Key informants were midwives working at the antennal care unit. Participation in the study was voluntary. Participants were explained the purpose of the study and signed a consent form if they were willing to participate in the research. Participation in the research did not inhibit the respondent’s access to care. Data was collected using an audio tape and analyzed using Thematic Coding Analysis (TCA) to identify recurring themes that emerged from the data to adequately describe the perceptions of respondents on the reasons for late initiation of antenatal care.
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Thomas, Jennifer Lee. "How do knowledge and attitudes relate to the initiation of breastfeeding in Native American women in a North Dakota health care facility?" Thesis, Montana State University, 2012. http://etd.lib.montana.edu/etd/2012/thomas/ThomasJ0812.pdf.
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Despite research consistently demonstrating the benefits of breastfeeding, Native American women in North Central North Dakota have the lowest rate of breastfeeding in North Dakota with a rate of 8.24%. The reasons why these women are not breastfeeding are not known. There have been no studies regarding the attitudes and knowledge about breastfeeding of these women or their health care professionals. The purpose of this study was to assess the knowledge and attitudes about breastfeeding in this population. Thirteen pregnant women, ten women who have given birth, and twelve health care professionals who provide care to these women comprised the sample of this descriptive study. The results of the surveys demonstrated that these women knew the benefits of breastfeeding but the majority of them did not breastfeed their infants. Attitudes seem to be a more relevant factor than knowledge in influencing breastfeeding initiation in this sample of women. Health care providers should be aware that their own attitude toward breastfeeding may affect a woman's choice to breastfeed. Results also demonstrated the health care professionals had limited education about infant feeding, lactation, and breastfeeding. These health care providers may be providing conflicting and possibly incorrect knowledge about breastfeeding. Current evidence based breastfeeding recommendations and practices should be incorporated into continuing education so consistent and correct information is provided. Health systems should establish a baby friendly environment that supports and encourages breastfeeding. In addition, the unique characteristics of the Native American women in North Central North Dakota, or any community in which one lives or works, should be considered to better plan interventions that will be effective and sustainable. It is not one identifiable factor that the decision to breastfeed is dependent upon, but factors that may interact and overlap in ways to influence a women's decision to breastfeed. Understanding context is vital to designing and implementing successful interventions in breastfeeding promotion. Culturally relevant information gathered from this population may not be transferable to others in this particular tribe who may live somewhere else or to other Native American tribes, as their specific cultural attributes may be different from this particular tribe.
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Ariefdien, Shaakira. "Timely initiation of MDR-TB treatment: A descriptive qualitative study at primary health care facilities in a district of the Cape Metropole." University of the Western Cape, 2018. http://hdl.handle.net/11394/5822.
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Magister Public Health - MPH (Public Health)<br>Timely initiation of Drug Resistant Tuberculosis (DR-TB) treatment is essential for an
effective TB control programme. Delays in initiating DR-TB treatment increase the risk of
death and transmission of DR-TB within communities. DR-TB is diagnosed using GeneXpert
testing, results are available to the local clinics within twenty four hours and DR-TB services
have been decentralised to Primary Health Care Facilities to potentially reduce the length of
time taken to initiate DR-TB treatment. However, it has been reported that despite these
efforts, a large number of patients fail to initiate DR-TB treatment. Direct transmission is
becoming the main driver of new DR-TB infections in the Western Cape and late initiation of
treatment contributes to the spread of DR-TB within the community. The aim of the study is to explore the factors influencing whether newly diagnosed DR-TB
patients initiate treatment on time at Primary Health Care facilities within the Mitchell's Plain
sub-district. A descriptive qualitative research design was used. Semi-structured interviews were
conducted in English with 16 purposefully sampled patients from two facilities in the
Mitchell's Plain sub district were diagnosed with DR-TB. The patient sample consists of
some patients who initiated treatment within five days from the date of sputum collection and
some patients who initiated treatment more than five days from the date of sputum collection.
Interviews were also conducted with health care workers from the health facilities. Data was
collected using a digital recorder and field notes. The data was analysed using Thematic
Coding Analysis and emerging themes were obtained. Ethical approval was sought from the University of the Western Cape Senate Research
Committee and permission to conduct studies at the facilities was sought from the City of
Cape Town. Informed consent was sought from participants.
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Haque, Monirul. "Barriers to initiating insulin therapy for patients with poorly controlled type 2 diabetes mellitus on maximum dose of oral agents in public sector primary health care centres in Cape Town, South Africa." Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/9374.
Full textAbstract:
Includes bibliographical references.<br>Most patients with type 2 diabetes in Cape Town are attending at primary care community health centers (CHCS) and have unsatisfactory glycaemic control. Insulin therapy is indicated in patients with type 2 diabetes, with inadequate metabolic control on maximum oral therapy. Insulin can be initiated in these CHCs.
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McLaughlin, John Michael. "Human and Economic Costs Associated with Longer Times from Confirmed-diagnosis to Initiation of Treatment among Low-income Women with Breast Cancer." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1284604147.
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Al-Muhanna, Khawlah S. "Are There Differences in Nutrient Intake Following Initiation of A Low FODMAP Diet in Patients with Irritable Bowel Syndrome?" The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1492607846495982.
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Benjamin, Caroline Mary. "'Realisation of risk' : a central process involved in initiating referral from primary care to cancer services of women with a family history of breast cancer." Thesis, University of Liverpool, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272588.
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Kamkuemah, Monika. "Prevalence and incidence of renal dysfunction in patients initiating Antiretroviral Therapy at a Primary Health Care Centre in Gugulethu, Cape Town : a cohort study." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/11002.
Full textAbstract:
Includes bibliographical references.<br>Tenofovir disoproxil fumarate (TDF) is used worldwide for the treatment of HIV-1 infection. Tenofovir has been found to be associated with declines in renal function and chronic kidney disease in HIV-infected patients. There are limited data on how soon after antiretroviral therapy (ART) initiation any loss of renal function can be detected. We studied a cohort of HIV-infected adults initiating TDF-containing ART regimens at the Hannan Crusaid Antiretroviral Treatment Centre in Gugulethu. The centre provides ART to the residents of the Gugulethu and Nyanga districts situated on the outskirts of Cape Town. We described the prevalence and incidence of renal dysfunction in this cohort, the patterns of change in their renal function in the first 12 months on therapy and factors associated with renal dysfunction. We also examined the diagnostic value of early serum creatinine tests in identifying incident renal dysfunction after 12 months.
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Kerns, Elizabeth E. "A Study on the Efficacy of the Medicare Bundled Payments for Care Improvement Initiative at a Large Community Hospital in the Southeast United States." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/7044.
Full textAbstract:
In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) Initiative which linked payments for multiple services for a complete episode of patient care. With this innovative reimbursement model, hospitals accepted fixed target payments for certain types of clinical diagnoses that were intended to support better care coordination and better outcomes for patients at lower cost to Medicare. This was one of many programs aimed at addressing the serious challenges facing United States healthcare, including costs that are skyrocketing to unsustainable levels and lack of coordination of care across venues.
Preliminary Medicare results showed that bundled payments might lead to lower costs and higher quality of care, however, this idea comes from a relatively small sample size and limited run time of the program. This study examined one large community hospital in the southeast part of the United States participating in the BPCI Initiative. Patient level data was retrospectively analyzed using statistical techniques to determine if financial, operational and clinical outcomes improved as result of the BPCI program compared to similar patient data before the program.
The results were mixed. Financial outcomes did not change significantly, and remained higher than the CMS targets. Length of stay decreased significantly, as anticipated. The 30-day readmissions was statistically unchanged. This study illuminated both challenges and strategies in implementing bundled payments to achieve positive financial, operational, and clinical outcomes.
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Hajduk, Alexandra M. "Cognitive Status and Initiation of Lifestyle Changes Following Acute Coronary Heart Syndrome: A Dissertation." eScholarship@UMMS, 2003. http://escholarship.umassmed.edu/gsbs_diss/701.
Full textAbstract:
Background: Cognitive impairment is prevalent in survivors of acute coronary syndrome (ACS) and increases risk for poor outcomes. Lifestyle changes are recommended to patients after ACS to reduce their risk for recurrent events, but cognitively impaired patients may encounter difficulties initiating these changes. This dissertation had three aims: (1) to examine cognitive status as a predictor of lifestyle changes after ACS, (2) to examine whether caregiver support moderates the association of cognitive status and initiation of lifestyle changes, and (3) to assess the reliability of self-reported lifestyle changes in cognitively impaired patients through comparison of their reports of lifestyle change with those from their caregivers.
Methods: For aims 1 and 2, Poisson regression with robust error variance was used to examine the association of cognitive status and caregiver support with patient-reported initiation of five lifestyle changes (improving diet, increasing exercise, quitting smoking, reducing stress, and attending cardiac rehabilitation) in 881 patients from TRACE-CORE, a prospective longitudinal observational study of outcomes in ACS. For aim 3, pilot data from 78 patient-caregiver dyads from TRACE-CARE, an ancillary substudy, were used to examine whether patient-caregiver congruence on reports of lifestyle changes varied according to patients’ cognitive function.
Results: Patient-reported rates of lifestyle change did not vary according to cognitive status, except for participation in cardiac rehabilitation. Caregiver support improved patient-reported rates of lifestyle change among cognitively intact patients but not cognitively impaired patients. Patients’ cognitive function was positively associated with patient-caregiver congruence on reports of initiation of lifestyle changes and patients with decreased cognitive function tended to over-report initiation of lifestyle changes compared to reports by their caregivers.
Conclusion: Although cognitive status was not associated with initiation of most lifestyle changes and the influence of caregiver support on initiation of lifestyle changes was only beneficial to cognitively intact patients in this cohort of ACS patients, these null findings may be explained by the questionable validity of self-report in cognitively impaired patients. This dissertation yields new knowledge about secondary prevention in ACS patients and provides insight into the challenges of conducting patient-reported outcomes research in cognitively compromised populations.
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Hajduk, Alexandra M. "Cognitive Status and Initiation of Lifestyle Changes Following Acute Coronary Heart Syndrome: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/701.
Full textAbstract:
Background: Cognitive impairment is prevalent in survivors of acute coronary syndrome (ACS) and increases risk for poor outcomes. Lifestyle changes are recommended to patients after ACS to reduce their risk for recurrent events, but cognitively impaired patients may encounter difficulties initiating these changes. This dissertation had three aims: (1) to examine cognitive status as a predictor of lifestyle changes after ACS, (2) to examine whether caregiver support moderates the association of cognitive status and initiation of lifestyle changes, and (3) to assess the reliability of self-reported lifestyle changes in cognitively impaired patients through comparison of their reports of lifestyle change with those from their caregivers.
Methods: For aims 1 and 2, Poisson regression with robust error variance was used to examine the association of cognitive status and caregiver support with patient-reported initiation of five lifestyle changes (improving diet, increasing exercise, quitting smoking, reducing stress, and attending cardiac rehabilitation) in 881 patients from TRACE-CORE, a prospective longitudinal observational study of outcomes in ACS. For aim 3, pilot data from 78 patient-caregiver dyads from TRACE-CARE, an ancillary substudy, were used to examine whether patient-caregiver congruence on reports of lifestyle changes varied according to patients’ cognitive function.
Results: Patient-reported rates of lifestyle change did not vary according to cognitive status, except for participation in cardiac rehabilitation. Caregiver support improved patient-reported rates of lifestyle change among cognitively intact patients but not cognitively impaired patients. Patients’ cognitive function was positively associated with patient-caregiver congruence on reports of initiation of lifestyle changes and patients with decreased cognitive function tended to over-report initiation of lifestyle changes compared to reports by their caregivers.
Conclusion: Although cognitive status was not associated with initiation of most lifestyle changes and the influence of caregiver support on initiation of lifestyle changes was only beneficial to cognitively intact patients in this cohort of ACS patients, these null findings may be explained by the questionable validity of self-report in cognitively impaired patients. This dissertation yields new knowledge about secondary prevention in ACS patients and provides insight into the challenges of conducting patient-reported outcomes research in cognitively compromised populations.
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Ouendo, Edgard-Marius D. "Indigence et soins de santé primaires en République du Bénin: approche de solutions au problème d'identification des indigents dans les formations sanitaires publiques." Doctoral thesis, Universite Libre de Bruxelles, 2005. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/211005.
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Introduction: Du fait des faibles résultats enregistrés par différents systèmes de santé dans le monde, la conférence d'Alma Ata de 1978 avait préconisé l’approche des Soins de Santé Primaires. Pour renforcer cette approche et faciliter l’accessibilité universelle aux soins, l’Initiative de Bamako fut adoptée en 1987. Cette initiative se fonde sur la participation financière des patients aux soins. L'une des conséquences est le coût financier des soins pour les bénéficiaires avec un risque d'exclusion de certains patients. Mais l’Initiative de Bamako suggère les dispositions à prendre pour éviter l'exclusion des indigents. Au Bénin, les comités de gestion des centres de santé ont la responsabilité de veiller à l'accès aux soins des indigents. Mais malgré cela, la prise en charge des indigents n’est pas effective. Les professionnels de la santé se plaignent de ne pas disposer de critères d'identification des indigents. Sur cette base, l'identification des indigents constitue la pierre angulaire de leur prise en charge. En conséquence, la mise en place d'une stratégie opérationnelle fondée sur l'identification des indigents par les personnes ressources de la communauté et soutenue par un outil quantitatif d'identification, permet une identification fiable des indigents en vue de leur prise en charge sanitaire. <p>Méthode: Après un état des lieux de la situation des indigents dans le système de santé au Bénin, trois études ont été réalisées pour approfondir la question des indigents; <p>•\<br>Doctorat en Sciences de la santé publique<br>info:eu-repo/semantics/nonPublished
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Blomquist, Tomas, and Johann Packendorff. "Ekonomisk styrning för förändring : en studie av ekonomiska styrinitiativ i hälso- och sjukvården." Doctoral thesis, Umeå universitet, Företagsekonomi, 1998. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-93853.
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Since the end of the 1980’s Swedish county council managers has been preoccupied with planning and implementing organisational change in order to alleviate the financial problems and to create more efficient production systems. Many of these efforts to change have implied changing the systems for management accounting and control, changes that have been inspired both by market-oriented ideologies and by the governance principles of large corporations in the private sector. Literature on management accounting and control indicates however, that management is unintentionally contributing to the creation of organisational inertia and conservatism. This contradiction is formulated as a change dilemma; ”How can managerial principles that make organizations subject to bureaucratization and inertia be used as important strategies for organizational change?” The purpose of the study is thus to analyze the use of management control systems as organizational change strategies in health care, employing a change perspective on management control. When used as a change strategy, management accounting and control becomes manifest as management control initiatives. Actors handle these control inititatives by organising themselves around the issue at hand. This organising process ends or fades away when there are no need for further attention to the control initiative. Empirical studies were made in the councils of Västerbotten, Sörmland and Uppsala counties. Management control initiatives investigated were performance-related pay, quality improvement work, systematic planning procedures, provider/purchaser-models, downsizing projects and profit center systems. The systems for management accounting and control appeared to structure health care organisations in terms of spatial structuring temporal structuring and actor categorization. The management control initiatives introduced were structured as extraordinary organising processes delimited in terms of space, time and involved actors. Actors in the administrative norm system participated with the intention to change the organisation, while those in the medical norm system aimed at just handling the initiative. Management control initiatives can therefore be seen as passing opportunities to change, passing in the sense that the organising processes are temporary by nature, opportunities in the sense that temporary re-coupling can be used to achieve long-term change. One such opportunity is the formulation of control initiatives; the possibility of using simple and standardized change strategies can be useful, but only if they are also linked to the medical norm system. A second opportunity is the temporary organising processes; if the project form of organising change can also be conveyed to the medical norm system, management control initiatives could result in short, intense courses of events that actually change things. The third opportunity s the recurrent cyc ica pro perties of management accounting and control systems, enabling recurrent activities around the same themes, thereby keeping them alive.<br><p>Diss. av båda förf. Umeå : Umeå univ., 1998 ; Framlägges för vinnande av filosofie doktorsexamen respektive ekonomie doktorsexamen.</p><br>digitalisering@umu
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Senate, University of Arizona Faculty. "Faculty Senate Minutes December 2, 2013." University of Arizona Faculty Senate (Tucson, AZ), 2014. http://hdl.handle.net/10150/312042.
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Raynaud, Joy. "L'accès aux soins : des perceptions du territoire aux initiatives des acteurs : concepts, mesures et enquêtes pour une analyse géographique de l'organisation et du développement d'une offre de soins durable." Phd thesis, Université Paul Valéry - Montpellier III, 2013. http://tel.archives-ouvertes.fr/tel-00967067.
Full textAbstract:
L'accès aux soins est une préoccupation des pouvoirs publics, des patients et des médecins. Après avoir identifié le rôle et les différentes aspirations de ces acteurs de santé, une synthèse reposant sur la construction des concepts en sciences sociales est proposée afin de comparer les différentes approches de l'analyse et de la mesure de l'accès aux soins. En France, ce concept est principalement étudié à travers les difficultés financières ou la distance géographique, pourtant sa nature est multidimensionnelle. A partir de cette analyse, deux enquêtes ont été menées pour recueillir les perceptions de mille patients et cinq cents médecins libéraux afin de déterminer précisément la nature et la fréquence des difficultés d'accès aux soins. Les résultats montrent que les principaux obstacles sont le temps d'attente en cabinet chez les généralistes et le délai d'obtention d'un rendez-vous chez les spécialistes. Ces éléments sont également des facteurs de renoncement aux soins. L'enquête réalisée auprès des médecins identifie leurs perceptions concernant les difficultés d'accès aux consultations de leurs patients, leurs conditions de travail et les solutions privilégiées pour diminuer lesdélais de prise en charge des patients. Un vif intérêt pour le regroupement avec d'autres confrères est exprimé, en particulier pour les jeunes médecins. Ainsi, les deux principaux modes d'organisation émergents de l'offre de soins, les maisons de santé pluriprofessionnelles et la télémédecine, sont analysés et discutés à la suite de retours d'expériences et d'entretiens semi-directifs. A l'initiative des acteurs locaux, ces coopérations entre professionnels de santé favorisent la qualité et la durabilité des services de soins sur les territoires.
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Chen, Yi-Chien, and 陳怡蒨. "Impact of the "Family Doctors Integrated Care Initiative” of National Health Insurance on Patients' Continuity of Care." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/78317441291193640513.
Full textAbstract:
碩士<br>國立陽明大學<br>醫務管理研究所<br>95<br>Background:
Primary care played an important role in the medical care system. After National Health Insurance (NHI) implemented, hospitals became more large-sized and competitive, caused primary care to shrink gradually. On March 2003, a "Family Doctors Integrated Care Initiative” (FDICI) was implemented by NHI, to enhance the quality of primary health care in regard to comprehensiveness, coordination and continuity.
Objectives:
1.To evaluate the impact of the FDICI of NHI on patients' continuity of care.
2.To compare patients’ continuity of care among community medical care groups with different characteristics.
Materials and methods：
The study population was outpatient of primary care clinic. Regarding design, in patients’ level applied “pretest-post-test controlled group design” and “Difference-in- differences” approach to compare the change of the patients’ continuity of care and between the intervention and the control groups before and after FDICI. We used 6 indices to measure continuity of care, for each clinic and doctor separability, including modified modified continuity index (MMCI), usual provider of care (UPC), Herfindahl-Hirschman Index (HHI). In community medical care groups’ level we applied “one-group posttest-only design” to compare the changes in rate of patients who have fixedness of community “usual provider of care” after FDICI intervention. The major data was 2002-2005 NHI claim databases, provided by Bureau of National Health Insurance (BNHI), data in 2003 was excluded because of SARS. The dependent variables were continuity of care indices. The control variables were patients’ characteristics (gender, age, catastrophic illness or not, Charlson comorbidity index). After data were merged and cleaned, we use Generalized Estimating Equation (GEE) to assess the impacts of the FDICI of NHI on patients' continuity of care. In order to use Generalized Estimating Equation (GEE) analysis, we adapt stratified sampling experiment groups of 2001’s data with proportion 0.02, and then paired 1:1 with patients’ characteristics (gender, age, catastrophic illness or not, Charlson comorbidity index) with the control group.
The major findings of this study are summarized as follows：
The FDICI intervention improved MMCI significantly at individual and clinic level, it also improved UPC significantly at clinic level and HHI at clinic level, but it reduced UPC significantly at individual level and HHI at individual level. It means that patients inclined to seek care at a fixed clinic rather than from a fixed doctor. Finally, in community medical care groups’ level, after controlling patients’ characteristics, the percent of patients with usual source care varied by years, and branches of BNHI, had non-significant difference among community medical care groups with different organizations characteristics and payments methods.
Recommendations：
1.We suggested that government should raise the coverage rate of FDICI.
2.We suggested BNHI adopt the 6 indices in this study to evaluate the continuity of care of the clinic regularly, to improve the patients’ participating rate in FDICI at medical area with few resources. We recommend that financial incentive should provide to clinic which actually improve quality or continuity of care.
3.We suggested future researchers may link household family members’ data study to evaluate the continuity of care, and to probe the relationship between continuity of care and medical quality outcome.
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Hsu, Chieh, and 徐婕. "Impact of the “Family Doctors Integrated Care Initiative” on Patients’ Behavior to Seek Care at Higher Levels’ Health Care Institutions." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/79850911560275153498.
Full textAbstract:
碩士<br>國立陽明大學<br>衛生福利研究所<br>104<br>Background:
Seeking care at higher levels’ health care institutions is an important issue in Taiwan; hence, “Family Doctors Integrated Care Initiative (FDICI)” was implemented by National Health Insurance (NHI) to enhance quality and continuity of primary care and to improve functionality of the referral system. The aim of this study is to evaluate the effect of the FDICI on pacients’ behavior to seeking care at higher levels’ health care institutions.
Methods:
The study population is people who receive medical treatment because of A diseases, diseases which can be dealt with in primary care, every 6 months. Case group define as people who initially participated in FDICI between 2007 and 2010. Case group was pared 1:1 with patients’ gender, age, catastrophic illness or not, Charlson comorbidity index, income with control group. The study uses pretest-protest control group design and difference in difference method to invest the change of people’s behavior of seeking care at higher levels’ health care institutions.
Result:
The FDICI can reduce people’s higher levels’ health care institutions using rate; however, the effect decreases with time. Moreover, after people drop the FDICI, their higher levels’ health care institutions using rate increase. The FDICI shows no effect on people who initially joined in 2010.
Recommendation:
For policy maker, this study suggests Nation Health Insurance to encourage primary care physicians enhancing patients’ continue participation rate, to improve the plan coverage rate and to modify the condition of enrollment of patients. For furture researchers, this study suggests them to invest reasons of the policy effect decrease and conduct to economic evaluation for FDICI.
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Musse, Tsegahun Manyazewal. "An analysis of the implementation of business process reengineering health care reform initiative in Ethiopia." Thesis, 2015. http://hdl.handle.net/10500/19638.
Full textAbstract:
The purpose of this research was to explore and describe the effectiveness of the health care reform implemented in Ethiopia in the form of Business Process Reengineering (BPR) and develop strategies to strengthen its implementation.
The research was conducted in two phases. In phase I, the effectiveness of the BPR health care reform was explored and described through gathering quantitative information from health care providers (n=406) using a structured questionnaire. All public hospitals of Addis Ababa, Ethiopia which have been implementing the reform from its inception (n=5) were included. In Phase II, in-depth strategies aimed at strengthening implementation of the reform were developed. Two-rounds of Delphi study were conducted to seek the opinions of senior health policy experts (n=10) and arrive at consensus on the developed strategies. Cronbach's alpha, descriptive statistics, Chi-square, logistic regression analysis, principal component analysis, weighted median score, adjusted and standard satisfaction scores, Mann-Whitney U test, and Kruskal-Wallis test were conducted for data analysis.
The BPR health care reform was able to restructure the hospitals’ departments into case teams, with the goal of adopting a “one-stop shopping” approach. However, 50% of the health care providers reported that the reform was not effective to satisfy the perceived health service needs. Limited effects were reported in favour of health care quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%). While poor effects were reported in patient-provider (41%) and provider-management (32%) interactions.
The most important predictors that influenced implementation of the reform were financial resources (AOR=3.54, 95%CI: 1.97, 6.33), top management commitment and support (AOR=2.27, 95%CI: 1.15,
4.47), collaborative working environment (AOR=1.77, 95%CI: 1.00, 3.11), and information technology (AOR=3.15, 95%CI: 1.57, 6.32).
The overall job satisfaction in the public health sectors remained poor, with only 25% job-satisfied providers engaged. Moral satisfaction (AOR=177.654, 95%CI: 59.539, 530.08), management style (AOR=4.017, 95%CI: 1.490, 10.828), workload (AOR=2.422, 95%CI: 0.925, 6.342), and task (AOR=5.491, 95%CI: 2.307, 13.069) were the most significant factors. Job satisfaction results were significantly different among the study hospitals (2 = 30.557, p < 0.001).
The current health care delivery performance of the public hospitals was 60% when weighed against the World Health Organization’s health system framework which required a minimum of 80% score. However, there existed a significant difference in performance at least between two hospitals (2 = 571.902, p < 0.001).
Five strategies that could disrupt the status quo and strengthen the BPR health care reform are proposed based on their strategic priority, which were: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing; and maximize innovations and the use of health technologies. The strategies could be used to enrich the quality of health care interventions through continuous review, refinement and adjustment of the reform as required.
Key words: Health care reform; Business Process Reengineering; quality; access; equity; efficiency; sustainability; job satisfaction; health system; patient-centred care; workforce; leadership and governance; hospital financing; health technologies; Ethiopia.<br>Health Studies<br>D. Litt. et Phil. (Health Studies)
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Lawrence, Tamara. "The examination of an empowerment approach in a healthy living initiative of a non-profit organization." Thesis, 2006. http://www.oregonpdf.org.
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"The effects of an integrated behavioral health initiative on the behavior of providers in an Ob/Gyn primary care clinic." WALDEN UNIVERSITY, 2010. http://pqdtopen.proquest.com/#viewpdf?dispub=3366980.
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Xu, Kathleen. "A quality improvement initiative to streamline and standardize a process to optimize communication between providers and low English proficiency patients/families in the Pediatric Inpatient Unit of Boston Medical Center by incorporating interpreters on all morning rounds." Thesis, 2015. https://hdl.handle.net/2144/16341.
Full textAbstract:
INTRODUCTION: Language barriers between providers and low English proficiency (LEP) families in pediatric hospital care can reduce the quality of care provided to LEP patients/families. Boston Medical Center serves a population with a large LEP patient base. Currently, there is no existing model of care that efficiently and effectively incorporates interpreters on all morning rounds to optimize communication for all patients, especially LEP patients/families.
OBJECTIVE: To improve communication between providers and LEP families on morning rounds in the Pediatric Inpatient Unit of Boston Medical Center. The aim for the QI initiative was to increase the percentage of rounding episodes with LEP patients/families in which the care plan was discussed between providers and families through the use of an in-person interpreter during morning rounds by 50% by February 28, 2015.
METHODS: A quality improvement initiative utilizing residents, medical students, the unit coordinator and the ward assistant to introduce, streamline and standardize a process to incorporate interpreters on all morning rounds as needed for LEP families. The Model for Improvement was used for testing this initiative. Four Plan-Do-Study-Act (PDSA) cycles of testing were conducted between October 21, 2014 and February 20, 2015. The primary outcome was the proportion of rounding episodes for LEP patients/families in which the care plan was discussed between the provider and patients/families through an in-person interpreter. This data was collected through a newly created "Interpreter Rounding Form" (IRF) that served as a checklist for the process. The secondary outcome looked at patient satisfaction for both LEP and English proficient (EP) patients. This data was collected through survey questions from the CAHPS and AHRQ patient surveys. Process measures included if interpreter was requested, if interpreter was used and if any change in care management due to having in-person interpreter present. Balancing measures included duration of rounds, interpreter arrival time, and resident satisfaction. Language being included in resident verbal signouts and written signouts between teams was also tracked. Run charts were analyzed for all outcomes and measures to determine the effectiveness of changes tested.
RESULTS AND CONCLUSIONS: For the first three PDSAs, there was a significant amount of variation in data measurement, which required focused efforts on better operationalizing our measurement framework. Changes were made after each PDSA to streamline the process and enforce completion of IRF, with which data was collected. For the fourth PDSA, starting in January 2015, completion rates for the IRF slowly increased to a median of 40%. Primary outcome data for PDSA 1-4 showed a median of 52% based on the rounding episodes that were recorded on the IRF forms, which suggests that the aim for a 50% increase in using an in-person interpreter on all morning rounds was achieved by February 28, 2015. However, this data may not reflect all the requests and encounters in which an in-person interpreter was used due to the missing data from a low completion rate of forms before PDSA 4. Further analysis of PDSA 4 data showed that though an in-person interpreter was used at a median of 38% of all encounters with LEP patients/families, providers were communicating with patients/families in their preferred language at 100% of the time; if did not request interpreter, providers used a resident or medical student who spoke the family's language 43% of the time. Patient survey data suggested that out of all patients in the unit, 80% of patients/families reported having "Always" understood the doctors, with LEP patients/families at a slightly higher percent than EP patients (100% vs 88%). Patients reported "Good" or higher for the quality of the information that was provided by the doctors on morning rounds at a median of 84%, with LEP patients at 100% compared to 84% for English-speaking patients. Qualitative analysis of patient responses showed that LEP patients liked the explanations and information provided in the morning rounds while EP patients mostly liked the attitude and approach of the doctors. One major limitation to our process was the constantly rotating residents/medical students and the need to train new teams. The project is ongoing with a focus on further standardization until a goal of 90% completion rate for IRF and 80% for primary outcome can be reached. Future PDSAs will encourage using medical interpreters for all LEP patient encounters and family-centered rounding.