Dissertations / Theses on the topic 'Medicare Assignment'

The Medicare Participating Physician Program was enacted in 1984 in an effort to increase physician assignment of Medicare claims, and thereby reduce beneficiary out of-pocket expenses. The program offers the physician the security of near-certain payment on all claims, although at rates that are in many cases, at levels substantially, less than actual physician fees. This paper examines the economic factors that influence the physician's decision on participation. Physicians of the Medical Society of Prince William County, Virginia, were surveyed for information relevant to making the participation decision and the responses tabulated and used as input to a ergre rgersessisioonn equation estimated using the logit technique. Physicians are more likely to participate the higher the relative price received for participating and the lower the probability of payment by Medicare-eligible patients. Additionally, salaried physicians are more likely to partiCipate than those who are self-employed.
Master of Arts

In the Department of Pathology and Laboratory Medicine, at the beginning of each month, the clinical managers use expert knowledge to assign pathologists to expected daily specimens based on the criteria of workload restrictions, clinical sub-specialties, and availability. Since the size of the pathologists’ assignment problem is large, finding a feasible assignment manually is a very time-consuming process that takes a number of iterations over a number of days to complete. Moreover, every time there is a need to make a revision, a new assignment needs to be developed taking into account all the above criteria. The goal of this research is to develop an optimization model and a decision support tool that will help with monthly staffing of pathologists based on the criteria outlined above. The developed model is rooted in the classical operations research assignment problem and it is extended to account for the following requirements: each pathologist should be assigned to a similar specimen type throughout a week; for a given pathologist, there should be a rotation of the specimen types between the weeks; and the clinical managers’ preferences in terms of assigning a particular specimen type to a particular pathologist on a specific day need to be considered. A monthly assignment model covering 36 pathologists and 26 specimen types was solved using IBM ILOG CPLEX Optimization Studio. It is embedded in a decision support tool that helps clinical managers to make staffing decisions. The decision support tool has been validated using data from The Ottawa Hospital (TOH).

BACKGROUND AND OBJECTIVES: Interprofessional education (IPE) is recommended by many as a means by which to prepare clinicians for collaborative practice and a mechanism by which to improve the overall quality of health care. The objective of this study was to determine the impact of an interprofessional medicine-pharmacy student home visit experience on students’ self-assessments of skills and abilities related to team-based care and identification of medication-related problems. METHODS: Third-year medical and fourth-year pharmacy students completed an interprofessional home visit centered on identification of medication-related problems. Students were surveyed before and after the IPE assignment to assess changes in self-assessed skills and abilities. Survey items consisted of Likert-type statements on a 5-point scale (1=strongly disagree, 5=strongly agree) and free-text responses. Students also completed reflection papers regarding their experiences. RESULTS: Twenty-two medical and 20 pharmacy students conducted medication-focused interviews of 22 patients at home as interprofessional teams. Medical and pharmacy student self-assessments of skills and abilities related to team-based care and identification of medication-related problems improved after completion of the assignment. Both groups of students perceived an improvement in confidence regarding communication skills, both with patients and with other health professions students. Changes were reported on 12 survey items. Student feedback on the IPE experience was positive. CONCLUSIONS: Students’ self-perception of skills and abilities related to interprofessional team-based care and identification of medication-related problems are improved after IPE medication-focused home visit assignment. Student feedback supports the value of interprofessional patient care clinical experiences.

Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Background: Medical male circumcision (MMC) has emerged as one of the Human Immunodeficiency Virus (HIV) prevention methods for HIV negative men engaged in heterosexual contact. Many studies have documented its efficiency in reducing the risk of contracting HIV infection in men. Because of that, Zimbabwe like other countries in the Southern Africa region, with generalised HIV infections is finding ways to scale-up MMC in non-circumcised communities. This study searched for knowledge, perceptions and attitudes of males in Bindura urban towards MMC. Bindura is the capital city of the Mashonaland Central Province of Zimbabwe. This town has diverse people with different social backgrounds who economically depend on the surrounding mines and commercial farms. Given the enormous differences in culture, religion, social and value systems among these people it was of particular importance to understand how they perceive medical male circumcision. Methodology: The study was conducted using quantitative data collection method. Random selection was done to choose respondents and age was used to determine eligibility to the study. The qualifying age was 18-49 and a sample size of 60 was considered to be appropriate taking into consideration financial and time associated with large samples. Structured questionnaire with open-ended and closed questions were used to gather data. Likert scale was used on some questions to determine perceptions and attitudes of respondents. The questionnaires used to solicit information did not require respondent to provide his name for purposes of maintain confidentiality but contained identification number. In some cases, Chi-square test for independence was conducted to test for associations between demographic characteristics and observed responses. Comparison of responses between the age groups 18-29 and 30-49 years were also done to determine if there were some differences in representations of respondents in observed responses. Results: The study aimed to assess knowledge, perceptions and attitudes of males in Bindura urban towards MMC and barriers they were confronting in accessing MMC. Respondents showed high level of awareness about HIV/AIDS intensity in Zimbabwe. Male circumcision (MC) was perceived by the majority of respondents as important in curbing HIV infections. A significant proposition of respondents regarded medical reasons as the most common reason why people undergo MC. However respondents demonstrated poor knowledge or understanding of other strategies that must be used in conjunction with MC. Risks associated with operation, its cost and protection of confidentiality and consideration of family concerns were considered by respondents as barriers to MMC. Availability of accurate information about MMC and easing of access to MMC services were considered to be very important facilitating factors. Religious and cultural reasons and stigma from peers and friends were considered non barriers. Statistically significant associations were only detected between MMC being motivated by medical reasons and demographic characteristics of age and marital status and also an association between education level and stigma as a barrier for MMC. The study failed to show a significant association between other observed responses and demographic characteristics.
AFRIKAANSE OPSOMMING: Agtergrond: Mediese manlike besnyding (MMB) het na vore gekom as een van die metodes vir die voorkoming van die oordrag van die menslike immuniteitsgebreksvirus (MIV) deur MIV-negatiewe mans betrokke by heteroseksuele kontak. Baie studies het reeds die doeltreffendheid daarvan ten opsigte van die vermindering van die risiko van MIV-infeksie by mans gedokumenteer. As gevolg daarvan is Zimbabwe, soos ander lande in die Suider-Afrika-streek met algemene MIV-infeksies, op soek na maniere om MMB by onbesnyde gemeenskappe uit te brei. Hierdie studie wou kennis, persepsies en gesindhede van manlike persone in die Bindura-stadsgebied ten opsigte MMB bepaal. Bindura is die hoofstad van die sentrale provinsie Masjonaland in Zimbabwe. Hierdie stad word bewoon deur diverse mense met verskillende maatskaplike agtergronde wat ekonomies van die omliggende myne en kommersiële plase afhanklik is. Gegewe die groot verskille in kultuur, godsdiens, maatskaplike en waardestelsels onder hierdie mense, was dit van besondere belang om te begryp hoe hulle mediese manlike besnyding verstaan. Metodologie: Die studie het van die kwantitatiewe data-insamelingsmetode gebruik gemaak. Ewekansige seleksie is gebruik om respondente te kies en ouderdom is gebruik om geskiktheid vir deelname aan die studie te bepaal. Die kwalifiserende ouderdom was 18-49 jaar en ʼn monstergrootte van 60 is geskik beskou in ag geneem finansiële beperkinge en tyd verbonde aan groot monsters. ʼn Gestruktureerde vraelys met oop en geslote vrae is gebruik om data in te samel. ʼn Likert-tipe skaal is by sommige vrae gebruik om persepsies en gesindhede van respondente te bepaal. Die vraelyste wat gebruik is om inligting te ontlok, het dit nie vir respondente nodig gemaak om hulle name te verskaf nie ten einde vertroulikheid te verseker, maar het ’n identifikasienommer bevat. In sommige gevalle is die chi-kwadraattoets vir onafhanklikheid gedoen om te toets vir verbande tussen demografiese eienskappe en response wat waargeneem is. Vergelyking van response tussen die ouderdomsgroepe 18-29 en 30-49 jaar is ook gedoen om te bepaal of daar enige verskille in verteenwoordigings van respondente in die waargenome response was. Resultate: Die studie wou kennis, persepsies en gesindhede ten opsigte van MMB by manlike persone in die Bindura-stadsgebied en hindernisse waarvoor hulle te staan kom ten einde toegang tot MMB te verkry, bepaal. Respondente het ʼn hoë vlak van bewustheid omtrent die intensiteit van MIV/VIGS in Zimbabwe getoon. Manlike besnyding (MB) is deur die meerderheid respondente as belangrik by die beperking van MIV-infeksies beskou. ʼn Beduidende aantal respondente het mediese redes gesien as die algemeensien rede waarom mense MB ondergaan. Respondente het egter swak kennis of begrip van ander strategieë wat tesame met MB gebruik moet word, getoon. Risiko’s geassosieer met die operasie, die koste daarvan en beskerming van vertroulikheid en agting vir die familie se bekommernisse is deur respondente as hindernisse met betrekking tot MMB beskou. Beskikbaarheid van akkurate inligting omtrent MMB en vergemakliking van toegang tot MMB-dienste is gesien as baie belangrike fasiliterende faktore. Godsdienstige en kulturele redes en stigmatisasie deur portuurs en vriende is nie as hindernisse beskou nie. Statisties beduidende verbande is slegs tussen MMB gemotiveer deur mediese redes en demografiese eienskappe van ouderdom en huwelikstatus bespeur en ook ʼn verband tussen opvoedingspeil en stigma as ʼn hindernis vir MMB. Die studie het nie daarin geslaag om ʼn beduidende verband tussen ander waargenome response en demografiese eienskappe aan te toon nie.

SMART designs tailor individual treatment by re-randomizing patients to subsequent therapies based on their response to initial treatment. However, the classification of patients being responders/non-responders could be inaccurate and thus lead to inappropriate treatment assignment. In a two-step SMART design, by assuming equal randomization, and equal variances of misclassified patients and correctly classified patients, we evaluated misclassification effects on mean, variance, and type I error/ power of single sequential treatment outcome (SST), dynamic treatment outcome (DTRs), and overall outcome. The results showed that misclassification could introduce bias to estimates of treatment effect in all types of outcome. Though the magnitude of bias could vary according to different templates, there were a few constant conclusions: 1) for any fixed sensitivity the bias of mean of SSTs responders always approached to 0 as specificity increased to 1, and for any fixed specificity the bias of mean of SSTs non-responders always approached to 0 as sensitivity increased to 1; 2) for any fixed specificity there was monotonic nonlinear relationship between the bias of mean of SSTs responders and sensitivity, and for any fixed sensitivity there was also monotonic nonlinear relationship between the bias of mean of SSTs non-responders and specificity; 3) the bias of variance of SSTs was always non-monotone nonlinear equation; 4) the variance of SSTs under misclassification was always over-estimated; 5) the maximized absolute relative bias of variance of SSTs was always ¼ of the squared mean difference between misclassified patients and correctly classified patients divided by true variance, but it might not be observed in the range of sensitivity and specificity (0,1); 6) regarding to sensitivity and specificity, the bias of mean of DTRs or overall outcomes was always linear equation and their bias of variance was always non-monotone nonlinear equation; 7) the relative bias of mean/ variance of DTRs or overall outcomes could approach to 0 where sensitivity or specificity wasn’t necessarily to be 1. Furthermore, the results showed that the misclassification could affect statistical inference. Power could be less or bigger than planned 80% under misclassification and showed either monotonic or non-monotonic pattern as sensitivity or specificity decreased. To mitigate these adverse effects, patient observations could be weighted by the likelihood that their response was correctly classified. We investigated both normal-mixture-model (NM) and k-nearest-neighbor (KNN) strategies to attempt to reduce bias of mean and variance and improve inference at final stage outcome. The NM estimated the early stage probabilities of being a responder for each patient through optimizing the likelihood function by EM algorithm, while KNN estimated these probabilities based upon classifications for the k nearest observations. Simulations were used to compare the performance of these approaches. The results showed that 1) KNN and NM produced modest reductions of bias of point estimates of SSTs; 2) both strategies reduced bias on point estimates of DTRs when the misclassified patients and correctly classified patients from same initial treatment had unequal means; 3) NM reduced the bias of point estimates of overall outcome more than KNN; 4) in general, there were little effect on power adjustment; 5) type I error should always be preserved at 0.05 regardless of misclassification when same response rate and same treatment effects among responders or among non-responders were assumed, but the observed type I error tended to be less than 0.05; 6) KNN preserved type I error at 0.05, but NM might increase type I error rate. Even though most of time both KNN and NM strategies improved point estimates in SMART designs while we knew misclassification might be involved, the tradeoff were increased type I error rate and little effect on power. Our work showed that misclassification should be considered in SMART design because it introduced bias, but KNN or NM strategies at the final stage couldn’t completely reduce bias of point estimates or improve power. However, in future by adjusting with covariates, these two strategies might be used to improve the classification accuracy in the early stage outcomes.

MPhil (Rehabilitation)
Thesis (MPhil (Interdisciplinary Health Sciences))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: A stroke comes suddenly and has a devastating effect on the lives of the patient and the caregiver. It is disabling and often leaves the patient dependent on care. Providing this care can put tremendous physical, emotional, social and financial demands on the caregiver. The purpose of the study is to determine the impact of caregiving on the primary caregivers of patients who suffered a stroke and were admitted to the Western Cape Rehabilitation Centre (WCRC), for intensive rehabilitation during 2006. This is a descriptive study that utilised both quantitative and qualitative methods of data collection. Quantitative data were collected through two data coding forms, one for caregivers and one for patients, the Bartel Index, the Caregiver Strain Index (CSI) and the Satisfaction With Life Scale (SWLS). Qualitative data were collected through indepth interviews with caregivers. Fifty-seven caregivers participated in the study. According to CSI findings 58% of caregivers were under levels of strain high enough to require support and intervention. The SWLS indicated that the life areas most adversely affected were employment and self and social life. Loss of employment by the caregiver (p = 0.04) and financial difficulties (p = 0.06), cognitive and perceptual problems (p = 0.01), personality changes (p = 0.01), level of physical dependency of patient (0.0012) and nervous strain experienced by the caregiver (0.01) were found to significantly impact on caregiver strain. Caregivers perceived their caregiving duties as overwhelming and a great strain. This was aggravated in some instances by poor health care service delivery at the time of the stroke, no or inadequate explanations on stroke, poor or no training of caregivers, no home visits and a lack of follow-up services in the community. They experienced the period just after discharge as especially challenging and required support, assistance and guidance at that time. Caregivers identified a need for community rehabilitation facilities, adult day care centres, outpatient rehabilitation services, home-based nursing care and caregiver support groups in the community.
AFRIKAANSE OPSOMMING: ’n Beroerte gebeur skielik en sonder enige waarskuwing met ’n vernietigende uitwerking op die lewens van die pasiënt asook die versorger. Dit veroorsaak gestremdheid en laat dikwels die pasiënt afhanklik van sorg. Die voorsiening van hierdie sorg kan erge fisiese, emosionele, sosiale en finansiele eise aan die versorger stel. Die doel van die navorsing is om die impak van versorging op die primêre versorger van beroerte pasiënte, wat gedurende 2006 intensiewe rehabilitasie by WKRS ontvang het, te ondersoek. Dit is ’n beskrywende studie wat gebruik gemaak het van beide kwantitatiewe en kwalitatiewe metodes om data in te samel. Kwantitatiewe data was verkry deur twee datakoderingsvorms, een vir pasiente en een vir versorgers, die Bartel Index, die Caregiver Strain Index (CSI) en die Satisfaction With Life Scale (SWLS). In diepte onderhoude was gevoer met versorgers om kwalitatiewe data te verkry. Sewe en vygtig versorgers het aan die studie deelgeneem. Bevindinge van die CSI dui daarop dat 58% van versorgers hoë vlakke van spanning ervaar en ondersteuning sowel as intervensie benodig. Volgens die SWLS was die areas wat die ernstigste be-invloed was werk en eie en sosiale lewe. Die volgende areas het volgens resulate ’n statisties beduidende impak op die spanning wat versorgers ervaar het gehad: finansiële spanning en verlies van werk (p = 0.04), in gevalle waar pasiente persoonlikheids veranderinge ondergaan het (p = 0.01) of kognitiewe en perseptuale skade oorgehou het (p = 0.01) na die beroerte en die emosionele impak van versorging (p = 0.01). Versorgers het hulle versorgings take as oorweldigend en as ’n bron van groot spanning gesien. Dit is in sommige gevalle vererger deur swak ondersteuning van gesondheidssorgdienste direk na die beroerte, geen of swak verduidelikings oor wat ’n beroerte is, geen of swak opleiding aan versorgers, geen tuisbesoeke en ’n tekort aan opvolg dienste in die gemeenskap. Die tydperk direk na ontslag uit die rehabilitasie sentrum was besonder uitdagend en hulle het ondersteuning, hulp en leiding nodig in daardie tyd. Swak ondersteuning en ’n tekort aan of afwesigheid van hulpbronne in die gemeenskap het die situasie vererger. Versorgers het ’n behoefte aan gemeensskapsrehabilitasie fasiliteite, volwasse dagsorg sentrums, buite patiënte rehabilitasie dienste, tuis verpleegsorg en ondersteuningsgroepe uitgespreek.

Human reproduction is increasingly commodified, which paves the way for reproductive enhancement rather than just assistance. Non-medical gender/sex selection is one of the reproductive enhancement services that is offered on the fertility market, and it is a practice that raises severe concerns regarding the social and political impact of biotechnologies. Through Critical Discourse Analysis and Biomedicalization theory, I analyse how non-medical gender/sex selection is legitimised in online forum discussions. I argue that gender/sex selection is legitimized through gender- and family-conservative and neoliberal ideologies, and that gender/sex selection can be understood as a tool to enhance the family, increase privilege, and attain hypernormativity.

Thesis (MPhil)--Stellenbosch University, 2012.
Background: Formative feedback is an important process in facilitating student learning as it helps students identify learning gaps early enough and devise means of covering those gaps. Most health professional educators spend most of the time designing summative assessment tools and pay little emphasis to giving qualitative feedback to students throughout the learning process. This problem has been identified at Makerere University College of Health Sciences (MaKCHS) and forms the basis of this study. Objectives: To investigate prior understanding of students and lecturers about formative feedback. The study also aimed at exploring experiences of students and lecturers regarding implementation of feedback in a resource-constrained context. Methods: This was an action research study using a participatory approach. Results: Initially, lecturers had some prior knowledge of feedback, however, students had misconceptions of what feedback could mean. After introducing a written feedback form, all participants expressed satisfaction with the feedback process. Key themes that emerged included: enhancing motivation, enhancing learning, promoting reflection and clarifying understanding. Conclusion: Students` motivation to learn can be greatly enhanced through formative qualitative feedback. A simple structured form is one way of providing qualitative formative feedback to students in resource-limited settings. Key words: formative feedback, structured form, action research.

Thesis (MOccTher (Interdisciplinary Health Sciences. Occupational Therapy))--University of Stellenbosch, 2007.
Objectives: The study aimed to identify the functions that occupational therapy leaders perform in clinical settings in the Metropole District of the Provincial Administration of the Western Cape (PAWC) and determine the influence of these functions on clinical practice. Methodology: The researcher used a descriptive design and a non-standardised questionnaire which was compiled to collect the data for the study. The questionnaire was piloted with a group of occupational therapy leaders from the Boland Overberg Region. Feedback was used to refine the final study questionnaire. Thirty-five study questionnaires were mailed or handed to the participants in the study and the researcher received 25 completed questionnaires; therefore, the response rate was 71.4%. The data were analysed using the Statistical Package for the Social Sciences (SPSS 10.0) for all the questions. Descriptive statistics were used to report the data. Inter-observer reliability was checked by using the split-half method. The results revealed that the study questionnaire was reliable as Cronbach's Alfa was calculated at 0.90, correlation coefficient Pearson’s r was calculated at 0.51, and Spearman-Brown was calculated at 0.67. Results: The results were presented in relation to the respondents’ number (N = 25). The participants identified 57 leadership functions, grouped as managerial, ethics-related, education, research, and consultation functions. The participants reported to have high performance in both direct and indirect occupational therapy services. Performance in the direct occupational therapy services functions was higher than the performance in the indirect occupational therapy services. Minimal performance in occupational therapy leadership functions was reported for consultation, ethics related, and research functions which need to be addressed by in-service training. The indirect occupational therapy services enabled the participants in the study to perform on a more optimum level regarding the direct occupational therapy services. The occupational therapy leaders had many empowering factors in their work place such as subordinates, supervisors, and top management. Conclusion: The 57 leadership functions identified in the study culminated in an occupational therapy leadership functions framework (OTLFF) which represents the managerial activities of the occupational therapy leaders in the PAWC. These study findings are useful guidelines for occupational therapy professionals and students as guidelines for leadership training, participant facilities to compile job descriptions, and educational facilities to set educational curricula. Recommendations: The study had many shortcomings; therefore, generalisation of results can't be done. The researcher recommends replication of the study using a larger and more representative sample.

This thesis considers three physician scheduling problems in health care systems. Specifically, we focus on improvements to current physician scheduling practices through the use of mathematical modeling. In the first part of the thesis, we present a physician shift scheduling problem focusing on maximizing continuity of care (i.e., ensuring that patients are familiar with their treating physicians, and vice versa). We develop an objective scoring method for measuring the continuity of a physician schedule and combine it with a mixed integer programming model. We apply our methods to the problem faced in the pediatric intensive care unit at Children's Healthcare of Atlanta at Egleston, and show that our schedule generation approach outperforms manual methods for schedule construction, both with regards to solution time and continuity. The next topic presented in this thesis focuses on two scheduling problems: (i) the assignment of residents to rotations over a one-year period, and given that assignment, (ii) the scheduling of residents' night and weekend shifts. We present an integer programming model for the assignment of residents to rotations such that residents of the same type receive similar educational experiences. We allow for flexible input of parameters and varying groups of residents and rotations without needing to alter the model constraints. We present a simple model for scheduling 1st-year residents to night and weekend shifts. We apply these approaches to problems faced in the Department of Surgery Residency Program at Emory University School of Medicine. Rotation assignment is made more efficient through automated schedule generation, and the shift scheduling model allows us to highlight infeasibilities that occur when shift lengths exceed a certain value, and we discuss the impact of duty hour restrictions under limitations of current scheduling practices. The final topic of this thesis focuses on the assignment of physicians to various tasks while promoting equity of assignments and maximizing space utilization. We present an integer programming model to solve this problem, and we apply this model to the physician scheduling problem faced in the Department of Gynecology and Obstetrics at Emory University Hospital and generate high quality solutions very quickly.

Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Based on the significant evidence from the three African randomized controlled trials, the WHO and UNAIDS recommended in 2007 that medical male circumcision should be a priority HIV prevention intervention. The three randomized trials in Africa demonstrated that adult male circumcision decreases the human immunodeficiency virus (HIV) acquisition in men between 51% to 60%, with long-term protective efficacy. This study intends to document and analyze the effectiveness of three communication interventions used in transferring knowledge about medical male circumcision as an HIV preventative strategy. Furthermore it also aims to determine which communication intervention will have the greatest effect in improving knowledge and understanding about medical male circumcision as an HIV preventative measure for implementation in future health promotion programmes. The research in this comparative study was conducted on a farm in the Overstrand sub-district of the Western Cape Province in South Africa, Haygrove Haven. A total of 30 male employees aged 18 to 45 was randomly selected to participate in the study. The data was collected using a self-administered pre-test questionnaire. In order to compare the pre- and post-test answers, the questions were repeated to determine the knowledge transfer after the respective information and training sessions. Analysis of the data was a simple process and limited to the necessary information to graph the required conclusions by using the computer programme Microsoft Excel 2010. The study looked at the statistical indicators of knowledge, perception and awareness of participants with regards to medical male circumcision as an HIV and AIDS prevention strategy. The findings exhibited that most people knew about MMC but very few had knowledge of the protective effect of the procedure against HIV acquisition and transmission. The study concluded that providing accurate information with fitting communication material at the right literacy levels, peoples’ knowledge of the benefits of medical male circumcision does increase. This will contribute to change the perception and therefore increase the acceptability of the procedure. This conforms to the subject of the WHO and UNAIDS 2007 study and can improve their findings.
AFRIKAANSE OPSOMMING: In 2007 het die WGO en UNAIDS aanbeveel dat mediese manlike besnydenis ‘n prioriteit MIV-voorkomings program moet raak, wat gebaseer is op die beduidende bewyse van drie Afrika gerandomiseerde gekontroleerde proewe. Die drie gerandomiseerde proewe in Afrika toon dat volwasse manlike besnydenis verminder die menslike immuniteitsgebreksvirus (MIV) in mans met 51% tot 60%, met 'n lang-termyn beskermende doeltreffendheid. Hierdie studie is van voorneme om die doeltreffendheid van drie kommunikasie-intervensies wat gebruik word in die oordrag van kennis oor mediese manlike besnydenis as 'n MIV-voorkomende strategie, te dokumenteer en te analiseer. Verder stel dit ook ten doel om te bepaal watter kommunikasie-intervensie die grootste invloed in die verbetering van kennis en begrip oor mediese manlike besnydenis as 'n MIV-voorkomende maatreël, vir implementering in toekomstige gesondheidsbevorderingsprogramme. Die navorsing in hierdie vergelykende studie is uitgevoer op 'n plaas in die Overstrand-sub-distrik van die Wes-Kaap in Suid-Afrika, Haygrove Haven. 'n Totaal van 30 manlike werknemers tussen die ouderdomme 18 tot 45 is lukraak gekies om deel te neem aan die studie. Die data is ingesamel met behulp van 'n self-geadministreerde vraelys waar die pre-toets vrae in die post-toets herhaal word, om die antwoorde met mekaar te vergelyk, om sodoende te bepaal watter opleidingsessie die grootste kennis oordrag laat plaasvind. Ontleding van die data is beperk en so eenvoudig as moontlik om die gevolgtrekkings te maak en grafies deur te gee deur gebruik te maak van die rekenaarprogram Microsoft Excel 2010. Die studie kyk na die statistiese aanwysers van kennis, persepsie en bewustheid van die deelnemers met betrekking tot mediese manlike besnydenis as 'n MIV-en VIGS-voorkoming strategie. Die bevindinge van die studie is dat die meeste mense bewus is van mediese manlike besnydenis, maar baie min kennis gehad het van die beskermende effek van die prosedure teen MIV verkryging en oordrag. Die studie het bevind dat die verskaffing van akkurate inligting met gepaste kommunikasie materiaal op die regte geletterdheidsvlakke, mense se kennis van die voordele van mediese manlike besnydenis kan laat toeneem. Dit is bydraend om ‘n individu se persepsie te verander en dus die aanvaarbaarheid van die prosedure te verhoog. Dit voldoen aan die onderwerp van die WHO en UNAIDS 2007 studie en kan sodoende hul bevindings verbeter.

Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Since the SPICES (S: student centred; P: problem-based learning; I: integration; C: community based/hospital based; E: electives; and S: systematic apprenticeship based) model of medical curriculum was proposed by Harden, most medical schools worldwide have introduced curriculum changes toward a paradigm shift in teaching and learning. Walter Sisulu University (WSU) introduced such changes in 1992 when problem-based learning (PBL) was implemented in the medical school. This research assignment examines the level of horizontal integration within the WSU Bachelor of Medicine and Bachelor of Surgery (MBChB III) programme. The purpose of the study was to determine the students’ and tutors’ perceptions of integration in the curriculum. A cross-sectional descriptive survey was designed and piloted in 2009 and the questionnaire was then administered to MBChB III students who agreed to form part of the study. The tutors’ opinions on integration were also explored. A questionnaire on integration using a five-point Likert scale, was administered to both the students (12 questions) and the tutors (six questions). Six open-ended questions on integration were added to the students’ instrument and one to the tutors’ instrument, for qualitative analysis and to assist in triangulation. In addition, semi-structured interviews were conducted with the tutors individually. As a result of the survey, it seemed that all the students were “satisfied” or “very satisfied” with the level of integration of content and learning. All the tutors were aware of the need for integration, but some were not familiar with how the learning environment could be modified to enhance students’ approach to integration. MBChB III students at WSU highly valued the integration of learning and teaching during tutorials. Thirty-three per cent of the tutors, though, believed that integration increased their workload. All the tutors thought that integration facilitated students’ learning skills and promoted student engagement, learning and interaction with faculty.
AFRIKAANSE OPSOMMING: Sedert Harden die SPICES-model as mediese kurrikulum voorgestel het, het die meeste mediese skole in die wêreld kurrikulumveranderings ingevoer as ʼn paradigmaskuif in onderrig en leer. (S – studentgesentreerde; P – problemgebaseerde leer; I – integrasie; C – gemeenskaps-/hospitaalgebaseer; E– keusevakke; en S – gebaseer op sistematiese vakleerlingskap.) Die Walter Sisulu-universiteit (WSU) het in 1992 sulke veranderings aangebring toe probleemgebaseerde leer (PBL) in die mediese skool geïmplementeer is. Hierdie navorsingswerkstuk ondersoek die mate van integrasie in die Baccalaureus in Geneeskunde-program en Baccalaureus in Chirurgie-program (MBChB III) aan die WSU verder as die PBL-tutoriale kan vorder. Die doel van die studie was om te bepaal wat studente en studieleiers se persepsies oor die integrasie van die kurrikulum is. ʼn Beskrywende deursnee-opname is in 2009 opgestel en ’n loodsstudie is gedoen. Die opname is weer gebruik met MBChB III-studente wat ingestem het om aan die studie deel te neem. Studieleiers se menings oor integrasie is ook ondersoek. ʼn Vraelys oor integrasie volgens 'n vyfpunt Likert-skaal, is aan die studente (12 vrae) sowel as die studieleiers (ses vrae) gestel. Ses oop vrae oor integrasie is by die studente se instrument gevoeg en een by die vraelys vir die studieleiers ter wille van kwalitatiewe ontleding en triangulasie. Daarbenewens is ʼn semigestruktureerde onderhoud met elke studieleier individueel gevoer. Na afloop van die toepassing en ontleding van die opname was al die studente “tevrede” of “baie tevrede” met die vlak van integrasie van leer, met begrip en met die vlak van integrasie van inhoud. Al die studieleiers was bewus van die behoefte aan integrasie, maar sommige was nie vertroud met hoe die leeromgewing aangepas kan word om die studente se benadering tot integrasie te bevorder nie. MBChB III-studente aan die WSU het 'n hoë waarde geheg aan die integrasie van leer en onderrig tydens tutoriale. Drie-en-dertig persent van die studieleiers het egter geglo dat integrasie hulle werkslading verhoog. Al die studieleiers was van mening dat integrasie die studente se leervaardighede fasiliteer en die studente se deelname, leer en interaksie met akademiese personeel bevorder.

Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Health statistics on adolescents in Namibia indaicate high incidences of teenage unwanted pregnancies, unsafe abortions, baby dumping, maternal ill health, early marriages and STIs including HIV. These are indicators of underutilisation of adolescent friendly health services (AFHS) by adolescents as education on these problems are covered in it. Although Government has made some strides to esure implementation starts, there is a recognisable lack of its adoption by health workers. The aim of this study was to establish the reasons for the slow adoption of AFHS practices by health workers at Katutura Health Centre. A quantitative non-experimental cross-sectional descriprive research approach was used in this study. Evidence using both primary data collected in the field through self-administered semi-structured questionnaires (with both open and closed questions) and secondary data collected in the literature review was employed . A census of the entire population of health workers was prefered over sampling. A total of 56 health workers accepted to participate in the study and the questionnaire, 46 of which returned it within a stipulated three weeks data collection period. Descriptive statistics was utilised together with frequencies, mean and basic collection. Eighty two percent of the sample participated in the study of which 67% respondents were female and 33% were male. The majority of the respondents (78.3%) had tertiary education. The results indicated: AFHS were not known to the majority of health workers; there is slow adoption of AFHS; and the programme introduction could have been done better. Factors significantly associated with adoption of AFHS are knowledge of such services, sex, level of education, job position, work experience and effective implementation of the programme. A probability value of p<0.05 was adopted. The programme is well appreciated despite concerns of lack of training and proper implementation. Key recommendations were on staff recruitment, retention and training of health workers; creation of space for implementing AFHS and marketing the programme. The system is in place, what is left is to tighten some loose ends and programme is up and running.
AFRIKAANSE OPSOMMING: Gesondheid statistieke oor die jeug in Namibië verwys na hoë voorkoms van ongewenste tiener swangerskappe en onveilige aborsies, weg gooi van babas, swak moederlike gesondheid, vroeë huwelike en seksueel oordraagbare siektes, insluitend MIV. Dit is aanwysers van die onderbenutting van jeug vriendelike gesondheidsdienste (AFHS) deur die jeug, as die onderwys op hierdie probleme gedek word. Hoewel die regering 'n paar implementerings begin het, is daar 'n beduidende gebrek van aanneming deur gesondheidswerkers. Die doel van hierdie studie was om die redes vas te stel vir die stadige aanvaarding van AFHS praktyke deur gesondheidswerkers by Katutura Gesondheids Sentrum. 'n Kwantitatiewe, nie-eksperimentele navorsingsbenadering is gebruik in hierdie studie. Bewyse uit beide primêre data wat ingesamel is in die veld deur middel van self-geadministreerde semi-gestruktureerde vraelyste (met beide oop en geslote vrae) en sekondêre data wat ingesamel is in die literatuuroorsig was gebruik. 'n Sensus van die hele bevolking van gesondheidswerkers is verkies in plaas van steekproefneming. 'n Totaal van 56 gesondheidswerkers het aanvaar om deel te neem aan die studie en die vraelys, waarvan 46 teruggedien is binne die vasgestelde tydperk van drie weke se data-invorderingstermyn. Beskrywende statistiek is gebruik saam met frekwensies, gemiddelde en basiese versameling. Tagtig en twee persent van die steekproef het deelgeneem aan die studie, waarvan 67% respondente vroulik en 33% manlik was. Die meerderheid van die respondente (78,3%) het tersiêre opleiding. Die resultate het aangedui: AFHS is nie bekend aan die meeste van gesondheidswerkers nie, en daar is stadige aanneming van AFHS; en die program inleiding kon beter gedoen gewees het. Faktore wat beduidend verband hou met die aanneming van AFHS is kennis van sodanige dienste, geslag, vlak van onderwys, werk posisie, werkervaring en doeltreffende implementering van die program. 'n Waarskynlikheid waarde van p <0,05 is aangeneem. Die program is goed waardeer ten spyte van kommer aan 'n gebrek van opleiding en behoorlike implementering. Belangrikste aanbevelings was op die personeel werwing, behoud en die opleiding van gesondheidswerkers; skepping van ruimte vir die implementering van AFHS en bemarking van die program. Die stelsel is in plek, wat oorbly om gedoen te word, is om 'n paar los punte te versterk en die program is aan die gang.

The aim of this thesis was to investigate the primary school principals' experiences and perceptions regarding the work to manage child poverty. Semi-structured qualitative interviews were conducted by meaningful selection of four principals at municipal primary schools. A conventional content analysis was performed to identify codes and categories in the data. Four main categories were identified. The results were presented on the basis of the main categories: The concept of child poverty and awareness of child poverty, Cooperation and engagement, School governance and responsibility, and The compensatory assignment. The work to manage child poverty perceived to be directly linked to the school's compensatory assignment, but there were differences in how the assignment was comprehended. At the schools where the compensatory assignment led to increased equality, rules and regulations had been introduced by the municipality and the principal. Which shows that child poverty has to be recognized, the term must be established and communal strategies and policies has to be adopted to prevent poverty from having a negative impact on children's and adolescent's schooling.

Thesis (MPhil)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: Worldwide the stigma attached to psychiatric patients, psychiatric disorders, psychiatrists and the field of Psychiatry is of great concern. The stigmatising perceptions of medical practitioners and medical students towards psychiatric patients have a negative impact on effective treatment, considering the increasing burden psychiatric disorders are placing on communities and health systems. Numerous efforts were attempted and recommendations made for destigmatising medical students' perceptions towards psychiatric patients. It was found that perception usually improved after a clinical rotation in Psychiatry, but the stigmatising perceptions mostly returned a year later. The first clinical exposure to Psychiatry for medical students at the Faculty of Medicine and Health Sciences, Stellenbosch University, is during the fourth or fifth year of study. This rotation was revised in 2010 and a service-learning component added. The research question which consequently developed, is: What is the influence of a service-learning approach on destigmatising students' perceptions towards psychiatric patients? The research followed a phenomenological school of thought in an interpretative paradigm with a qualitative-inductive approach. On the last day of a rotation students handed in their written reflections and an in-depth focus group interview was conducted. The focus group interviews were repeated a year later. Students' reflections and the transcribed texts were analysed. This served as the basis for conclusions from which recommendations were made. It was found that students had stigmatising perceptions towards psychiatric patients before their first clinical rotation in Psychiatry. Directly after that students' perceptions were destigmatised to a greater extend. A year later non-stigmatising perceptions of understanding, acceptance, comfortableness, compassion, respect and responsibility were still present, although a few students experienced the limited return of stigmatising perceptions. Students attributed the positive changes to their service-learning experience in combination with the clinical placement at a psychiatric hospital with a friendly atmosphere and where they were exposed to patients not suffering from complex and extreme psychiatric disorders. The non-stigmatising perceptions a year after a clinical rotation in Psychiatry demonstrates the transformative value of service-learning. Service-learning is where meaningful and relevant service is rendered with and in the community, social responsiveness is purposefully emphasised and structured reflections are done to enhance academic learning. As a result of this study medical schools worldwide can take cognisance that a service-learning approach made a significant contribution to the stained destigmatisation of medical students' perceptions towards psychiatric patients.
AFRIKAANSE OPSOMMING: Stigma teenoor psigiatriese pasiënte, psigiatriese steurings, psigiaters en Psigiatrie as vakgebied is wêreldwyd ʼn groot bron van kommer. Medici en mediese studente se stigmatiserende persep-sies teenoor psigiatriese pasiënte het ʼn negatiewe impak op effektiewe behandeling, veral gesien in die lig van die groterwordende las wat die toename in psigiatriese steurings op gemeenskappe en gesondheidsisteme plaas. Heelwat pogings is aangewend en aanbevelings gemaak om mediese studente se persepsies teenoor psigiatriese pasiënte te destigmatiseer. Daar is bevind dat persepsies gewoonlik verbeter direk na ʼn kliniese rotasie in Psigiatrie, maar dat stigmatiserende persepsies meestal binne ʼn jaar terugkeer. Mediese studente aan die Fakulteit Geneeskunde en Gesondheidswetenskappe, Universiteit Stellenbosch, se eerste kliniese blootstelling aan Psigiatrie is tydens die vierde of vyfde studiejaar. In 2010 is dié rotasie hersien en ʼn diensleerkomponent bygevoeg. Die navorsingsvraag wat hieruit ontwikkel is, is: Wat is die invloed van ʼn diensleerbenadering op die destigmatisering van mediese studente se persepsies teenoor psigiatriese pasiënte? Die navorsing het ʼn fenomenologiese denkrigting gevolg in ʼn interpretatiewe paradigma met ʼn kwalitatief-induktiewe benadering. Studente het skriftelike refleksies op die laaste dag van ʼn rotasie ingehandig en ʼn in-diepte fokusgroeponderhoud is gevoer. ʼn Jaar later is die fokus-groeponderhoude herhaal. ʼn Ontleding van studente se refleksies en die getranskribeerde tekste en gedoen. Dit het gedien het as basis vir die gevolgtrekkings waaruit aanbevelings gemaak is. Daar is gevind dat studente voor hulle eerste kliniese rotasie in Psigiatrie, stigmatiserende persepsies teenoor psigiatriese pasiënte gehad het. Direk daarna was studente se persepsies grotendeels gedestigmatiseer. Na ʼn jaar was nie-stigmatiserende persepsies van begrip, aanvaar-ding, gemaklikheid, deernis, respek en verantwoordelikheid steeds teenwoordig, alhoewel stigma-tiserende persepsies tot ʼn mate by sommige teruggekeer het. Studente het die positiewe verande-ring toegeskryf aan die diensleerervaring in kombinasie met 'n kliniese plasing in die psigiatriese hospitaal waar ʼn vriendelike atmosfeer geheers het en waar daar blootstelling was aan pasiënte wat nie aan komplekse en ekstreme psigiatriese steurings gely het nie. Die nie-stigmatiserende persepsies ʼn jaar na ʼn kliniese rotasie in Psigiatrie toon die transformatiewe waarde van diensleer. Met diensleer word sinvolle en relevante diens met en in die gemeenskap gelewer, doelbewuste klem word op sosiale verantwoordbaarheid gelê en ge-struktureerde refleksie word gedoen om beter akademiese leer te laat plaasvind. Na aanleiding van hierdie studie kan mediese skole wêreldwyd kennis neem dat ʼn diensleer-benadering ʼn betekenisvolle bydrae gelewer het tot die volhoubare destigmatisering van mediese studente se persepsies teenoor psigiatriese pasiënte.

Les établissements de santé sont confrontés à de nouveaux défis tels que le vieillissement de la population, la hausse des coûts des soins et les progrès rapides des technologies médicales. Les nouvelles politiques de contrôle du budget des soins ont été introduites pour augmenter l'efficacité, réduire les déchets et remodeler le système de santé.Ces établissements cibles présentent des réseaux complexes incluant de ressources humaines,financières, structurelles et technologiques visant à garantir les meilleurs soins. Ces enjeux concernent d’autant plus les services d’urgence engorgés par l’afflux massif des passages, qui doivent fournir des décisions rapides et assurer le dimensionnement de ses ressources afin de réduire les délais d’attente des patients sans compromettre la qualité de soin.L’objectif de cette thèse est de proposer des solutions appropriées aux services d’urgences permettant d’améliorer la prise en charge des patients en termes de temps d’attente. Nous avons commencé par analyser les problématiques de la filière des urgences afin d’engager une démarche d’amélioration. Par la suite, nous avons modélisé le processus de prise en charge des patients au service d’accueil des urgences à l’aide d’un système multi-agent ouvert et dynamique. Le système proposé permet de fournir une aide à la décision sur la planification de l’activité médicale et l’affectation des ressources humaines dans une unité où on se trouve souvent face à une situation d’urgence nécessitant une prise en charge rapide et efficace. Dans ce contexte, nous abordons le problème réactif d’optimisation de l’ordonnancement des opérations de soin et le problème de coordination du personnel médical. Nous nous intéressons au dimensionnement des ressources humaines au SU en adoptant une approche de prise en compte des compétences maîtrisées dans le but de trouver une adéquation avec celles requises par l’activité médicale afin avant tout d’accroitre la qualité, réduire les délais d’attente et permettre de dégager des gains de gestion
Health-care organizations are facing new challenges such as the aging population, the rise of health care costs and the rapid progress of medical technologies. New policies of health care budget control have been introduced to increase efficiency, reduce waste and reshape the entire health care system. Targeted organizations are complex networks of human,financial, structural and technological resources aiming at guarantying best public health care.These issues concern all the more Emergency Departments (ED) congested by the massive influx of passages and which must provide quick decisions and ensure the sizing of its resources to reduce waiting times for patients with out compromising quality of care.The objective of this thesis is to propose appropriate solutions to ED to improve carefor patients in terms of waiting time. We began by analyzing the problems of the emergency department in order to initiate a process of improvement. Subsequently, we modeled the process of care for patients at ED by using an open and dynamic multi-agent system. The proposed system can provide decision support on business planning and allocation of medical resources in a unit where one is often faced with an emergency situation requiring rapid and effective response. In this context, we study the reactive problem for optimizing scheduling of operations care and the coordination problem of medical staff. We take into account the skills mastered by human resources at ED in order to find a match with those required by the medical activity. This approach aims to increase quality, reduce time of expectation and provide pointers gains management

碩士
國立中央大學
工業管理研究所
105
The rapid development of science and technology have led to the improvement of medical technology. It also extends of human life. In recent years, both developed countries and developing countries are facing the phenomenon of aging population growth. And the demand of long-term care have become huger. Long-term care policies and care resource planning for the elder are important issues for these countries. There are many countries suffering from unfair distribution of medical and health resources. How to fairly distribute medical care resources have become an important issue within today's long-term care policy. This study focuses on the allocation of medical resources which follow the background of today’s long-term care policy. When the country allocates resources, most of the resources are easily distributed in areas which density population, easier accessibility and high economic development. On the contrary, there are lack of resource in the remote areas. Therefore, the scope of this study focuses on the lack of medical resources in the remote areas. The implementation of policies and specific hospital collaboration doctor-arrangements service the patients who suffer from the chronic diseases in remote areas at a fixed time. The core of research is focusing on how to allocate the demand of care and the supply of caregiver. According to known severity of the patient classification refers the frequency of referral. Also, we consider the physician who can travel to the district for weeks to plan the resource allocation. This study uses mathematical programming to calculate the minimum number of physicians that need to satisfy with the whole demand of patients. The results show that each physician’s service week and the frequency of assignment.

碩士
中原大學
資訊管理研究所
92
Because of natural disasters happen in Taiwan frequently, mainly aiming at the problem of how to distribute the limited medical resources and to plan emergency disaster measures, we design a Safety Transfer Medical Assignment Algorithm for Emergency Medical Services to let patients whose situation are better now transfer to the other hospital in the cause of accepting new patients. The research method we use is to transform our research problem into a mathematical programming. The objective function of this mathematical programming is to ensure the sum of all patients whose survival time is maximum, and we build some constraint to fit the limits of capacity of hospital, amount of ambulances, and safety transfer limits. Because our research problem is NP-complete problem, therefore we will apply the Lagrangean Relaxation method to solve this problem. We experimented with two scenarios, multi disaster area scenario and scenario of cooperating with air police service department. Base on the result of experiment, we prove our algorithm will improve the result of shortest path method for 60% to 90%. Therefore, our algorithm is much better then shortest path method in emergency disaster problem.

碩士
世新大學
行政管理學研究所(含博、碩專班)
95
This study discusses the enrollment test, training, selection, assessment, and appointment procedures of a forensic medical examiner. Also, this study tries to learn the background of the forensic medical examiner, doctor, forensic investigator, and pathologist and their opinions about the employment system and differences of their comments, and finally make some suggestions on the employment system of the forensic medical examiner. The research method is mainly based on the questionnaire survey and interviews. The reference material is the self-made “Complete Employment System of the Forensic Medical Examiner Survey Form” and the population is the forensic medical examiner and investigator of the legal system and the doctors and pathologists from National Taiwan University Hospital (NTUH), Mackay Memorial Hospital, Tri-Service General Hospital, and Taipei County Hospital. With random sampling and overall survey, the study selected 500 people as the samples and applied frequency distribution and chi square test to analyze them. After the survey, the study concludes the employment system of the forensic medical examiner: 1. Enrolling examination: Establishment the multiple subjects of enrolling examinations with confidential profilers is the crucial rule to evaluate the quality and to assure the performance of medico-legal examiners in the medico-legal system. 2. Training: Practical training can enrich the professional knowledge and promote each medico-legal examiner that will play a crucial role during the medico-legal investigation. 3. Selection (election): Establishment the selected committee with various professionals fulfilled with objective, judge and transparent to elect the qualified medico-legal examiners to perform their professional investigation. 4. Assessment: Importance of assessment can play a key role to measure the performance of medico-legal performance and to ensure the justice protection of human right. Appointment: Combined with confidential evaluation and professional profiling of each candidate can play a crucial role to promote the medico-legal examiners enrolling team work of the medico-legal investigation and meet the requirement of medico-legal examiners.

碩士
國立勤益科技大學
工業工程與管理系
105
With the evolution of times, the back-end storage warehouse of most enterprises have gradually transformed into "warehousing logistics center" through the clouds, 3C devices and the capture of digitized information to facilitate enterprises in the processes of purchasing → dismantling & packaging → Picking → shipping → distributing etc. So they can carry out their own warehousing operations, and achieve the most comprehensive "warehousing management". The items that each "warehousing logistics center" deals are different in storage type and characteristics. We look specifically at the medical logistics center in this study. In the past, storage management used on-site storage assessment model and relied mostly on the experience of warehouse managers. However, this type of management is very likely to waste storage space. In this study, we applied the Six Sigma DMAIC as the research methodology, and used the self-developed storage management APP in combination with the information management system of the medical logistics center to simulate the efficiency of the storage management. By applying the storage management APP on the improvement of the picking performance in 2014-2016, the result was 96.3%. Therefore, the effectiveness of storage management will improve.

碩士
東海大學
工業工程學系
89
Call upon to the quick change and diverse environment, Holonic Manufacturing System(HMS) has been proposed as a new framework to be the future manufacturing system. The basic idea in HMS is that each holon can organize, request, and response in an autonomous way and end up with the results in a highly cooperative notion. The nature of hospital management is similar to the highly distributed system in manufacture regime. And, due to the NHI design, each hospital dose face with the tough cost management issue. Starting with clinical pathway, the type of resource could be assigned preliminarily. However, the assignment of the particular resource has to be done along with the pathway. How to accurately log the utilization of each medical resource (e.g. medical doctors, operating room, patient beds and nurse)and rearrange the resource in order to achieve the better utilization and thus decreasing the operation cost is the main thesis of this research. In this research, we have developed a HMS based system analysis framework. And, a simulation model, based on the real data, is constructed to verify the application of this approach.

碩士
嘉南藥理科技大學
醫療資訊管理研究所
98
Objectives: The present study was conducted to illuminate the effects of medical record integrity on coding and Tw-DRGs assignment. Methods: Retrospective review of 396 medical records submitted DRGs for reimbursement differed from the database of disease coding during the fiscal year 2009 in a district hospital in Northern Taiwan. “Recodes” were carried out and then compared to the original codes. Furthermore, physicians’ and nursing specialists’ perspectives about medical record and Tw-DRGs payment system was gathered via self administered questionnaires. Statistical analysis was performed using descriptive analysis and paired t-test with SPSS. Results: The absence of complete documentation in patient medical records causing the DRG error, the main causes were incorrect principal diagnosis selection (197 records, 51%), missing secondary diagnosis (86 records, 21.8%), incorrect coding of principal diagnosis (34 records, 8.6%) and secondary diagnosis (34 records, 8.6%). The mean (+/- SD) DRG relative weight in the 34 incorrect coding of secondary diagnosis records and 86 missing secondary diagnosis records were 1.20+/-0.79 and 0.78+/-0.64, respectively. The DRG relative weight presented a significant difference resulting from complete and accurate documentation in the medical record, 0.86+/-0.64 (decrease) and 1.09+/- 0.77 (increase) with respect to incorrect coding of secondary diagnosis records and missing secondary diagnosis records (each p<0.001). Among 75 questionnaire respondents, 68 % of physicians and nursing specialists were aware that the principal diagnosis is defined as the condition to be chiefly responsible for occasioning the admission while 18.7 % recognized the principal diagnosis is defined as the most severe condition during the episode of care. Conclusions: The results showed that incorrect coding of secondary diagnosis relating to medical document insufficiency may lead to a decrease in DRG relative weight under the same clinical scenario. The healthcare organization should focus on ensuring accuracy and completeness in clinical documentation.

The research of my dissertation studies the methods of designing and analyzing sequential multiple assignment randomized trial (SMART) for comparing multiple adaptive interventions. As a SMART typically consists of numerous adaptive interventions, inferential procedures based on pairwise comparisons of all interventions may suffer substantial loss in power after accounting for multiplicity. I address this problem using two approaches. First, I propose a likelihood-based Wald test, study the asymptotic distribution of its test statistics, and apply it as a gate-keeping test for making an adaptive intervention selection. Second, I consider a multiple comparison with the best approach by constructing simultaneous confidence intervals that compare the interventions of interest with the truly best intervention, which is assumed to be unknown in inference; an adaptive intervention with the proposed interval excluding zero will be declared as inferior to the truly best with a pre-specified confidence level. Simulation studies show that both methods outperform the corresponding multiple comparison procedures based on Bonferroni's correction in terms of the power of test and the average width of confidence intervals for estimation. Simulations also suggest desirable properties of the proposed methods. I apply these methods to analyze two real data sets. As part of the dissertation, I also develop a user-friendly R software package that covers many statistical work related to SMART, including study design, data analysis and visualization. Both proposed methods can be implemented by using this R package. In the end of the dissertation, I show an application of designing a SMART to compare multiple patient care strategies for depression management based on one of the proposed methods.

碩士
東海大學
工業工程與經營資訊學系
95
ABSTRACT The pharmacy department in each hospital has been trying hard to improve its operation efficiency and to satisfy the patients’ demand. It is well known that the waiting time at outpatient pharmacy is an important indicator for patients’ satisfaction. Therefore, this study employs two methodologies so as to shorten the waiting time of the outpatient pharmacy in a medical center. We use our first methodology, namely, “Flow Analysis” to investigate the dispensing process to eliminate “non-value adding” activities. Our flow analysis assists us to bring up with a new facility-planning proposal in the outpatient pharmacy. We name the AS-IS scenario and the new proposal as Alternatives I and II, respectively. Also, we propose a new prescription type and order assignment rule to each delivery window for the operations in the new facility-planning proposal, which is called Alternative III in this study. Next, we utilize “System Simulation” as the second methodology to evaluate the performance of the three alternatives. In this study, we develop the simulation models corresponding to the three alternatives using the simulation software “eM-Plant” for the output analysis. Our numerical results show that the new facility-planning proposal in Alternative II gains a considerable annual cost saving of $1,333,467 over Alternative I. Also, it leads to a 26%-reduction (which is around 3 minutes and 14 seconds decrease) in the waiting time. On the other hand, the new dispensing order assignment rule in Alternative III does not show significant improvement over Alternative II. Our analysis concludes that Alternative II is the best one for the operations of the outpatient pharmacy in this study. We will keep working on deriving new dispensing order assignment rules as the extension of this study.

Thesis (M.Sc.)--University of Alberta, 2009.
Title from pdf file main screen (viewed on August 13, 2009). "A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science, Department of Mechanical Engineering , University of Alberta." Includes bibliographical references.