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1
Woolcott, John Clifford. "A health care operations research analysis of elderly fallers' emergency department services utilization and cost." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/39804.
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Introduction: Falls in the elderly are a significant cause of morbidity. Prescription
medication use has been identified as an independent risk factor for falls. Among all Emergency Department (ED) presentations by elderly persons, 14-40% are due to
falls, placing considerable strain on ED resources. Aims: In my thesis I aimed to 1) Provide updated estimates of the association between the use of specific medications and falling, 2) Determine whether the care
provided to elderly fallers while patients in the ED follows published recommendations and was provided in a timely fashion, 3) Estimate the cost per fall
resulting in an ED presentation, 4) Design a discrete event simulation (DES) model
simulating care and then simulating other approaches to care including hypothetical
changes. Methods: 1) A Bayesian meta-analysis of studies assessing the association between specific classes of medication use and risk of a fall. 2) A cohort study of
elderly fallers presenting to the ED. 3) DES of the ED care received by elderly fallers. Results: Use of anti-hypertensives, diuretics, sedatives and hypnotics, neuroleptics and anti-psychotics, antidepressants, benzodiazepines, and non-steroidal antiinflammatory
drugs are associated with an increased risk of falling.
1) In a sample of 101 ED fall presentations, 38% of elderly fallers leave the ED without a geriatric assessment and 14% are assessed by a physiotherapist.
Less than 8% of fallers received care which met the wait time benchmarks. The estimated cost per fall causing an ED presentation is $11,408 with the cost per fall-related hospitalization estimated to be $29,363.
2) Providing care in a timely fashion could significantly reduce the time an elderly faller spends in the ED and the opportunity costs associated with waiting to be seen by physician or admission to hospital. Summary: Many commonly used medications are associated with falls. The care
provided by the elderly faller in the ED does not currently meet the
recommendations of published guidelines, nor is it provided in a timely fashion. The economic burden of falls is significant. By not providing ED care that meets
recommended wait time benchmarks significant opportunity costs are incurred by the ED.
2
Hagtvedt, Reidar. "Applications of Decision Analysis to Health Care." Diss., Georgia Institute of Technology, 2007. http://hdl.handle.net/1853/22535.
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This dissertation deals with three problems in health care. In the first, we consider the incentives to change prices and capital levels at hospitals, using optimal control under the assumption that private payers charge higher prices if patients consume more hospital services. The main results are that even with fixed technology, investment and prices exhibit explosive growth, and that prices and capital stock grow in proportion to one another.
In the second chapter, we study the flow of nosocomial infections in an intensive care unit. We use data from Cook County Hospital, along with numerous results from the literature, to construct a discrete event simulation. This model highlights emergent properties from treating the flow of patients and pathogens in one interconnected system, and sheds light on how nosocomial infections relate to hospital costs. We find that the system is not decomposable to individual systems, exhibiting behavior that would be difficult to explain in isolation.
In the third chapter, we analyze a proposed change in diversion policies at hospitals, in order to increase the number of patients served, without an increase in resources. Overcrowding in hospital emergency departments is caused in part by the inability to send patients to main hospital wards, due to limited capacity. When a hospital is completely full, the hospital often goes on ambulance diversion, until some spare capacity has opened up. Diversion is costly, and often leads to waves of diversions in systems of hospitals, a situation that is regarded as highly problematic in public health. We construct and analyze a continuous-time Markov chain model for one hospital. The intuition behind the model is that load-balancing between various hospitals in a metro area may hinder full congestion. We find that a more flexible contract may benefit all parties, through the partial diversion of federally insured patients, when a hospital is very close to full. Discrete event simulation models are run to assess the effect, using data from DeKalb Medical Center, and also to show that in a two-hospital system, more federally insured patients are served using this mechanism.
3
Beojone, Caio Vítor [UNESP]. "Avaliação do desempenho e cenários alternativos em um samu utilizando o modelo hipercubo estacionário e não-estacionário." Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/152022.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Vários Sistemas de Atendimento Emergenciais (SAE’s) sofrem com as variações diárias da demanda e da disponibilidade das ambulâncias. Nesses sistemas pode haver flutuação do desempenho ao longo do dia devido, por exemplo, a mudança no número de servidores e nas taxas de chegada, levando à necessidade de considerar explicitamente tais variações em uma extensão ao modelo hipercubo ainda não explorada na literatura. Como ocorre em alguns SAE’s, as ambulâncias melhor equipadas são reservadas para o atendimento exclusivo de chamados com risco de vida. Dessa maneira, a política de despacho pode ser diferenciada com a finalidade de reservar totalmente o atendimento de alguns servidores para certas gravidades de ocorrências. Além disso, somam-se à natureza aleatória desses sistemas, como por exemplo, as incertezas da disponibilidade das ambulâncias, a chegada de um novo chamado e sua localização. Nesse contexto, os objetivos do presente estudo são: (i) estender o modelo hipercubo de filas para reserva total de capacidade, dependendo do tipo do chamado; (ii) estender o modelo hipercubo de filas para torná-lo mais eficiente computacionalmente, sem haver perda de precisão durante a modelagem e resolução; e (iii) propor uma abordagem baseada no modelo hipercubo não-estacionário para organização do trabalho das ambulâncias em qualquer momento do dia. Para verificar a viabilidade e a aplicabilidade dessas abordagens, é realizado um estudo de caso no SAMU da cidade de Bauru (SAMU-Bauru) que, além de reservar suas ambulâncias avançadas para ocorrências mais graves, é afetado pelas variações diárias na demanda e disponibilidade das ambulâncias. Além da configuração original do SAMU-Bauru, estudada em duas etapas, foram analisados um total de quatro cenários alternativos que consideram questões importantes: o impacto do aumento na demanda do período mais congestionado; a mitigação desse impacto incluindo uma nova ambulância; a alteração do horário das pausas diárias; e o impacto de aumentos na demanda em horários específicos do dia. Foram calculadas importantes medidas de desempenho para cada cenário como a carga de trabalho, tempos médios de espera e tempos médios de resposta. Os resultados mostram que as extensões realizadas no modelo hipercubo são capazes de analisar satisfatoriamente sistemas como o SAMU-Bauru, além de possibilitar a criação e mensuração de propostas de melhorias nos níveis táticos e operacionais.
Many Emergency Service Systems face daily variations on demand and ambulance availability. These systems may suffer, for example, performance fluctuations throughout the day, changes on the number of servers and on arrival rates, leading to the need to explicitly consider such variations in a hypercube model extension not yet explored in the literature. As occurs in some SAMU’s, which reserve their best equipped ambulances to exclusively serve life-threating requests. Therefore, the dispatch policy can be differentiated in order to completely reserve the service of some ambulances to more severe requests. These problems add up to the random nature of these systems with uncertainties upon ambulance availability or the arrival of a new request and its location. Thus, this study aims to: (i) extend the hypercube queueing model to be able to capture the complete capacity reservation of advanced ambulances, depending on the request classification; (ii) extend the hypercube model in order to make it more computationally efficient, without losing any information during modeling and resolution. (iii) propose an approach based on nonstationary hypercube queueing model to organize the operation of ambulances at any time of the day. To verify the feasibility of these approaches, a case study is carried out on the SAMU from Bauru city (SAMU-Bauru), which, in addition to the advanced ambulance reservation for life-threating requests, is affected by daily variations in demand and ambulance availability. In addition to the original configuration of SAMU-Bauru, studied on a two-step approach, we studied a total of four alternative scenarios that exploited important matters as: the impact of average demand increase on the congestion peak; mitigation of this impact by including a new ambulance; changing the schedule of daily breaks; and the impact of increases in the demand at specific hours of the day. We calculated important performance measures for each scenario, such as workload, mean waiting times and mean response times. Results show that the proposed extensions to the hypercube model are capable of satisfactorily analyze systems such as SAMU-Bauru, besides making it possible to create and to measure improvements proposals in tactical and operational levels.
4
Hayes-Burrell, Ingrid Monique. "Financing School-Based Health Centers: Sustaining Business Operational Services." ScholarWorks, 2015. http://scholarworks.waldenu.edu/dissertations/1684.
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Walden University
College of Management and Technology
This is to certify that the doctoral study by
Ingrid Hayes-Burrell
has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.
Review Committee
Dr. Ify Diala, Committee Chairperson, Doctor of Business Administration Faculty
Dr. Anne Davis, Committee Member, Doctor of Business Administration Faculty
Dr. Yvette Ghormley, University Reviewer, Doctor of Business Administration Faculty
Chief Academic Officer
Eric Riedel, Ph.D.
Walden University
2015
â??
School-based health centers (SBHCs) have faced challenges in securing adequate funding for operations and developing sound business systems for billing and reimbursement. Specifically, administrators often lack strategies to develop and sustain funding levels to support appropriate resources for business operations. The focus of this descriptive study was to explore best practice strategies to develop and sustain funding through the experiences of SBHC administrators. The conceptual framework included Elkington's sustainability theory, which posits that corporate social responsibility, stakeholder involvement, and citizenship improve manager's effect on the business system. Twenty full-time SBHC administrators working in separate locations throughout the state of Maryland participated in semistructured telephone interviews. The van Kaam process was used to cluster descriptive experiences in data analysis that resulted in the development of thematic strategies for implementing best practices relevant to developing and sustaining funding for SBHC business operations. Major themes provided by the participants were interagency communications, creating marketing plans, and disparities in the allocation of funding for programs and professional staff. Findings indicated SBHC administrators continue to face challenges in developing and sustaining adequate funding for operations in the state of Maryland. Suggestions for future research include how administrators can develop marketing plans and explore long-range funding for SBHC services. The findings in this study may contribute to positive social change by demonstrating to officials in the Maryland State Department of Education the significance of SBHCs, and the need to increase mental health services.
5
Gage, Heather. "Papers in health services research." Thesis, University of Surrey, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417521.
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Lee, Seung Yup. "Proactive Coordination in Healthcare Service Systems through Near Real-Time Analytics." Thesis, Wayne State University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10839804.
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The United States (U.S.) healthcare system is the most expensive in the world. To improve the quality and safety of care, health information technology (HIT) is broadly adopted in hospitals. While EHR systems form a critical data backbone for the facility, we need improved 'work-flow' coordination tools and platforms that can enhance real-time situational awareness and facilitate effective management of resources for enhanced and efficient care. Especially, these IT systems are mostly applied for reactive management of care services and are lacking when they come to improving the real-time "operational intelligence" of service networks that promote efficiency and quality of operations in a proactive manner. In particular, we leverage operations research and predictive analytics techniques to develop proactive coordination mechanisms and decision methods to improve the operational efficiency of bed management service in the network spanning the emergency department (ED) to inpatient units (IUs) in a hospital, a key component of healthcare in most hospitals. The purpose of this study is to deepen our knowledge on proactive coordination empowered by predictive analytics in dynamic healthcare environments populated by clinically heterogeneous patients with individual information changing throughout ED caregiving processes. To enable proactive coordination for improved resource allocation and patient flow in the ED-IU network, we address two components of modeling/analysis tasks, i.e., the design of coordination mechanisms and the generation of future state information for ED patients.
First, we explore the benefits of early task initiation for the service network spanning the emergency department (ED) and inpatient units (IUs) within a hospital. In particular, we investigate the value of proactive inpatient bed request signals from the ED to reduce ED patient boarding. Using data from a major healthcare system, we show that the EDs suffer from severe crowding and boarding not necessarily due to high IU bed occupancy but due to poor coordination of IU bed management activity. The proposed proactive IU bed allocation scheme addresses this coordination requirement without requiring additional staff resources. While the modeling framework is designed based on the inclusion of two analytical requirements, i.e., ED disposition decision prediction and remaining ED length of stay (LoS) estimation, the framework also accounts for imperfect patient disposition predictions and multiple patient sources (besides ED) to IUs. The ED-IU network setting is modeled as a fork-join queueing system. Unlike typical fork-join queue structures that respond identically to a transition, the proposed system exhibits state-dependent transition behaviors as a function of the types of entities being processed in servers. We characterize the state sets and sequences to facilitate analytical tractability. The proposed proactive bed allocation strategy can lead to significant reductions in bed allocation delay for ED patients (up to ~50%), while not increasing delays for other IU admission sources. We also demonstrate that benefits of proactive coordination can be attained even in the absence of highly accurate models for predicting ED patient dispositions. The insights from our models should give confidence to hospital managers in embracing proactive coordination and adaptive work flow technologies enabled by modern health IT systems.
Second, we investigate the quantitative modeling that analyzes the patterns of decreasing uncertainty in ED patient disposition decision making throughout the course of ED caregiving processes. The classification task of ED disposition decision prediction can be evaluated as a hierarchical classification problem, while dealing with temporal evolution and buildup of clinical information throughout the ED caregiving processes. Four different time stages within the ED course (registration, triage, first lab/imaging orders, and first lab/imaging results) are identified as the main milestone care stages. The study took place at an academic urban level 1 trauma center with an annual census of 100,000. Data for the modeling was extracted from all ED visits between May 2014 and April 2016. Both a hierarchical disposition class structure and a progressive prediction modeling approach are introduced and combined to fully facilitate the operationalization of prediction results. Multinomial logistic regression models are built for carrying out the predictions under three different classification group structures: (1) discharge vs. admission, (2) discharge vs. observation unit vs. inpatient unit, and (3) discharge vs. observation unit vs. general practice unit vs. telemetry unit vs. intensive care unit. We characterize how the accumulation of clinical information for ED patients throughout the ED caregiving processes can help improve prediction results for the three-different class groups. Each class group can enable and contribute to unique proactive coordination strategies according to the obtained future state information and prediction quality, to enhance the quality of care and operational efficiency around the ED. We also reveal that for different disposition classes, the prediction quality evolution behaves in its own unique way according to the gain of relevant information. (Abstract shortened by ProQuest.)
7
Harper, Paul Robert. "Operational modelling for the planning and management of healthcare resources." Thesis, University of Southampton, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249668.
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Tiwari, Vikram. "Information sharing and coordinated capacity management in service delivery networks." [Bloomington, Ind.] : Indiana University, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3331249.
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Thesis (Ph.D.)--Indiana University, Kelley School of Business, 2008.Title from PDF t.p. (viewed on Jul 23, 2009). Source: Dissertation Abstracts International, Volume: 69-11, Section: A, page: 4414. Advisers: Kurt M. Bretthauer; Munirpallam A. Venkataramanan.
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Oliff, Monique. "Integration of STI services into reproductive health services in Tanzania : an operational analysis of oppertunities, barriers & achievements." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.396342.
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Fewell, Zoe. "Causal modelling in epidemiology and health services research." Thesis, University of Bristol, 2007. http://hdl.handle.net/1983/f12fb11d-0826-46d6-a5ed-7a87fa582b63.
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Revely, Shirley. "Introducing the nurse practitioner into a group general medical practice : operational and theoretical perspectives on the role." Thesis, Lancaster University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310358.
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Mykhalovskiy, Eric. "Knowing health care / governing health care exploring health services research as social practice /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0018/NQ56249.pdf.
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Cooper, Susanna R. "Mental health services in the Marine Corps : an exploratory study of stigma and potential benefits of desigmatization training within the operational Operational Stress Control and Readiness (OSCAR) program /." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2004. http://library.nps.navy.mil/uhtbin/hyperion/04Dec%5FCooper.pdf.
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Thesis (M.S. in Leadership and Human Resource Development)--Naval Postgraduate School, Dec. 2004.Thesis Advisor(s): Gail Thomas, Roderick Bacho. Includes bibliographical references (p. 77-80). Also available online.
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Wu, Ning. "Measurement issues in evaluating provider performance in health services research /." View online version; access limited to Brown University users, 2005. http://wwwlib.umi.com/dissertations/fullcit/3174695.
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Greenwood, Penelope Nan. "Marginalised groups and health services : provision, experiences and research issues." Thesis, Kingston University, 2010. http://eprints.kingston.ac.uk/20342/.
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This commentary is a reflective account of research published over the last eleven years. It highlights the themes underlying the publications and tracks the development of the author's research skills while simultaneously showing the impact of the publications on knowledge in the areas covered. Three themes from the research are highlighted. The first relates to the research participants in the publications who include detained and voluntary psychiatric patients, minority ethnic groups and carers. Members of these groups can all be described as marginalised or disadvantaged and are known to sometimes have poorer experiences of health and health services. Their experiences are the second theme. The commentary then highlights some issues in the research as the third theme, in particular the often unrecognised impact of the methods used and concepts employed on the research findings. Although some limitations of these are described, the commentary demonstrates the complexity of the concepts and issues and suggests that these should be acknowledged more widely. A possible way forward is by greater involvement of service users and altering the research perspectives. The next section discusses the impact of being a contract researcher during a period of greater recognition of the importance of listening to patients and their carers. This has had a bearing on both the research and the author's development as a researcher. The commentary then provides reflections on the individual publications submitted detailing the roles played by the author and recent research in the area. Some overarching ethical issues are also discussed. The ultimate aim of all the research presented here has been to improve the experiences of health service users and it is concluded that in each case it has contributed, even if only in a small way, to this aim whether to the academic literature or more directly to service improvement.
16
Sturt, Jacqueline Alys. "Implementation of self-efficacy theory into health promotion practice in primary health care : an action research approach." Thesis, Bucks New University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251328.
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Mollison, Jill. "Use of cluster randomised trials in implementation research." Thesis, University of Aberdeen, 2002. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU602063.
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Background. Implementation research is the scientific study of methods to promote the uptake of research findings in clinical practice. Cluster randomised trials are commonly adopted in implementation research, where interventions are generally targeted at health professionals or policymakers, in order to protect against contamination that would occur if individual patients were randomised. The application of cluster randomisation has important implications for design and analysis of trials evaluating implementation strategies. Case study: The Urological referral guidelines evaluation (URGE) has been used throughout this thesis, to explore the design and analysis issues of adopting a cluster randomised trial design in implementation research. URGE aimed to evaluate the effectiveness and efficiency of a guideline-based open access urological investigation service. This cluster randomised study adopted a 2X2 balanced incomplete block (BIB) design and collected data both prior to and following introduction of the intervention. The unit of randomisation was general practice and patients were recruited upon referral to secondary care. Aim: To investigate the implications of cluster randomisation for the design and analysis of trials evaluating implementation strategies. Objectives: This thesis has four distinct components. 1. A review of published cluster randomised trials in the field of implementation research. The methodological quality of these studies is assessed (Chapter 2). 2. An exploration of clustering within the URGE trial. Estimates of clustering and the imprecision in these estimates are considered for a number of endpoints, including process and outcome of care indicators and costs (Chapters 4 and 7). 3. The application of statistical methods in the analysis of cluster randomised trials. A number of approaches to the analysis of cluster randomised trials are described, applied and compared empirically. Incorporation of the BIB design and pre-intervention performance are also considered (Chapters 5 and 6). 4. Analysis of cost data collected from the economic evaluation conducted within the URGE trial. The analysis of skewed cost data collected within a cluster randomised trial design is considered (Chapter 7).
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Polaha, Jodi. "Telehealth Services for Rural Behavioral Health: Directions for Development and Research." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/6704.
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O'Cathain, Alicia. "Exploiting the potential of mixed methods studies in health services research." Thesis, University of Sheffield, 2006. http://etheses.whiterose.ac.uk/14493/.
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Mixed methods studies, where qualitative and quantitative methods are used together in a single study, are undertaken in health services research (HSR). The question addressed here is whether researchers in HSR are fully exploiting the potential of mixed methods studies, and if not, then how they might maximise the potential of this approach. Methods used to examine this question included a review of the literature on mixed methods research; a quantitative documentary analysis of the research proposals, reports and publications of 75 mixed methods studies funded by ten Department of Health programmes in the period 1994 - 2004; and a qualitative study involving semi-structured face-to-face interviews with 20 researchers. It was evident from the documentary analysis that researchers are mixing methods in a range of different ways, with quantitative methods dominating, thus reflecting the conventional hierarchy of evidence in HSR. However, researchers could further exploit this approach by being clear about the purpose and practice of mixing methods when planning their studies, exploiting the contribution of qualitative components of studies, engaging with a wider range of ways of integrating data and findings from different components of a study, and being explicit in peerreviewed journal articles about any unique contribution made by this approach. Findings from the interviews with researchers suggest that researchers can contribute to fully exploiting the potential of mixed methods research by learning more about the different ways of integrating data and findings, respecting and understanding the strengths of the different methodological approaches, communicating with team members, and valuing integration. In HSR a multidisciplinary approach to team working is the norm whereby study components are undertaken separately. An interdisciplinary approach to team working is less common but may be associated with exploiting more of the potential of mixed methods studies. The external research environment appears to be conducive to interdisciplinary endeavour but not to interdisciplinary outputs. Structural change, as well as change in researcher behaviour, will be necessary if health services researchers are to fully exploit the potential of using mixed methods research.
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Stanton, Jennifer Margaret. "Health policy and medical research : hepatitis B in the UK since the 1940s." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1995. http://researchonline.lshtm.ac.uk/682243/.
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This thesis explores the way changing constructions of hepatitis B have mediated between science and policy during the past fifty years. Research-based 'facts' were filtered in the policy arena according to social, political and economic pressures. Central policy processes depended heavily on expert advisers, who emerged from networks of researchers. This account draws on scientific, clinical and epidemiological research, central policy documents, and interviews with people working with or suffering from the disease. Though epidemiologically close to AIDS, hepatitis B has rarely attracted public attention: there are an estimated 100,000 carriers in the UK, but few deaths due to the acute form. The disease was a major problem in the blood supply, and featured as a hospital infection, with notable outbreaks from 1965 in renal dialysis units. It was seen as an occupational hazard for laboratory workers, doctors, nurses and dentists. The introduction of a test for hepatitis B around 1970 opened up opportunities for epidemiological research. Hepatitis B was increasingly recognized as a sexually transmitted disease, widespread among gay men; also, because of needle sharing, prevalent among drug users. Another outcome of research in the 1970s was the development of a vaccine. However, availability of a vaccine in the UK from 1982 afforded no immediate resolution of public health issues raised by hepatitis B. The legacy of a restricted screening policy from the 1970s, emphasizing prevention via hygiene precautions among health care workers, facilitated a limited vaccine policy throughout the 1980s. While discussing negotiations over hepatitis B in the past five decades, this thesis aims to contribute to a broader analysis of interactions between science and policy, between centre and regions, and between interest groups.
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Hull, James H. K. "Large artery haemodynamics in cystic fibrosis." Thesis, Kingston University, 2010. http://eprints.kingston.ac.uk/20343/.
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Cystic Fibrosis (CF) is the most common lethal autosomal recessive condition and affects approximately 1/2500 Caucasian newborns in the United Kingdom and 70,000 individuals worldwide. The gene defect classically leads to a phenotype comprising significant respiratory I and gastrointestinal manifestations, however is recognised to have multisystem consequences. Over the past 70 years there has been considerable progress in the understanding and treatment of CF such that it has moved from a poorly understood condition, almost universally fatal in infancy, to a complex multisystem disorder now affecting as many adults as children. This 'evolution' of the disease presents new challenges for clinicians and has increased focus on its extra-pulmonary components. In the general population cardiovascular disease is the leading cause of morbidity and mortality and it is now recognised that progressive changes in the structure and function of the large arterial system are a key determinant of this association. Furthermore these changes lead to alterations in large artery haemodynamics which have immediate physiological relevance for myocardial work and oxygen demand but also perfusion of the distal organs. Modern techniques permit large artery haemodynamics to be evaluated simply and effectively using the non-invasive technique of applanation tonometry with pulse wave analysis. The overall aim of this thesis was to use this technique to provide an evaluation of large artery haemodynamics in a cohort of adult patients with CF. The experimental work in this thesis includes a study assessing the validity of the haemodynamic techniques used in this thesis (study A) and three studies evaluating large artery haemodynamics in patients with CF; at rest (study I), in response to exercise (study II) and finally following a therapeutic intervention (study III).
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Luu, Shyuemeng. "The Determinants of Post-discharge Healthcare Utilization and Outcomes for Veterans with Posttraumatic Stress Disorder: A Social Ecological Perspective." VCU Scholars Compass, 2000. https://scholarscompass.vcu.edu/etd/5231.
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Posttraumatic stress disorder (PTSD) has a persistent nature: PTSD troubles patients
even decades after the occurrence of traumatic events. The “health behavioral model” is
adopted to examine the effects of external environmental, predisposing, enabling, and
need for care factors on the use of VA post-discharge ambulatory care and readmissions.
Data were obtained from the Patient Treatment File (PTF) and the Outpatient Care File
(OPT), the Area Resource File (ARF), American Hospital Association data sets (AHA), and the Uniform Crime Report (UCR).
The use of VA post-discharge ambulatory care is analyzed by using structural equation modeling (SEM). The readmission to VAMCs is evaluated by Cox regression with forward selection. A cross-sectional study is performed on 1,420 PTSD veterans admitted to Veterans Affairs Medical Centers (VAMCs) in 1994 and 1,517 veterans in 1998 in the Veterans Integrated Services Networks 6 (VISN 6).
In both years, the most important determinants of the use of VA post-discharge ambulatory care is “prior use of outpatient care services.” For the 1994 sample, prior use of inpatient services impeded the utilization of post-discharge ambulatory care. For the 1998 sample, barriers to access to care and the length of stay for other mental health encounters in the last year reduced the utilization of post-discharge ambulatory care.
For readmission in both years, higher numbers of medical or mental VA post-discharge visits reduce the likelihood of readmission to VAMCs.
The service lines program was found to increase the use of VA post-discharge ambulatory care and decrease readmission rates for PTSD veterans.
The application of the “health behavioral model” can be extended to outcome research to investigate the contributing factors. A risk adjustment system can also be developed based upon the findings.
Communities, VAMCs, and PTSD patients and their families should work to raise awareness of the factors that contributing to both use of care and outcomes, and should form a comprehensive network to improve the wellbeing of PTSD veterans.
23
Youn, Kyung II. "ORGANIZATIONAL SLACK, EFFICIENCY, AND QUALITY OF CARE IN ACUTE CARE HOSPITALS." VCU Scholars Compass, 1995. https://scholarscompass.vcu.edu/etd/5059.
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The relationship between technical efficiency and quality of care in hospitals is studied in the context of resource availability in hospital organizations. The resource availability of hospitals is conceptualized by organizational slack.
An integrated model is developed encompassing the source of organizational slack, its impact on technical efficiency and on quality of care, and its impact on the relationship between efficiency and quality. Organizational threat as an environmental factor affecting the level of slack is measured by the level of competition and regulation. Organizational slack is measured using financial and operational indicators of the hospitals. Technical efficiency is estimated by efficiency "scores generated using the Data Envelopment Analysis. Mortality rates of Medicare patients are used as the proxy for quality of care in individual hospitals.
The sample is composed of 832 urban, not-for-profit hospitals in the United States. The data are compiled from the Health Care Finance Administration data set and the American Hospitals Association annual survey data set. Hypotheses are tested using ordinary least squares regression and logistic regression.
The analysis reveals that the level of and change in organizational slack have a negative relationship with efficiency and a positive relationship with quality of care. The results also indicate that environmental threat has a negative effect on level of slack, and efficiency has a negative effect on quality of care.
The findings are discussed in terms of the theoretical implications for the concept of organizational slack and the implications for health policy and hospital management.
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Warner, Lora Hanson. "Control of Hospital Strategy in Small Multihospital Systems." VCU Scholars Compass, 1987. https://scholarscompass.vcu.edu/etd/5086.
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Hospitals are joining multihospital systems (MHSs) with growing frequency. About 80% of MHSs are small, composed of 2-7 hospitals. An important management issue in MHSs is the extent to which member hospitals retain control over their own strategic directions.
Using a contingency framework, this study uses both system and hospital—level determinants to explain the extent to which hospital members of MHSs control their own strategies. Survey and secondary data from 272 member hospitals of 62 small multi hospital systems (size 2-7 hospitals) are analyzed. System dispersion, size, ownership, strategic type, and age along with hospital occupancy, size, relationship to the MRS, and market factors are determinants of hospital control of strategy.
Two types of hospital strategic decisions were revealed by factor analysis: tactical and periodic. For tactical decisions, such as those relating to hospital budgets, service additions, and formulation of strategies, Catholic system ownership is a significant predictor of greater hospital control. Prospector system strategy and older system age are significant predictors of reduced hospital control. For periodic decisions, such as appointment of hospital board members, sale of hospital assets, and changes in bylaws, older system age is negatively associated with hospital control, and a hospital which is owned by the system has significantly less control.
The results are analyzed using the framework of the Hickson, Butler, Cray, Mallory, & Wilson (1986) typology of strategic decisions. Thus the results of this work can be useful to managers in identifying the nature of a decision and understanding its associated decision process.
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Lynch, Janet. "THE FINANCIAL PERFORMANCE OF SYSTEM ACQUIRED HOSPITALS." VCU Scholars Compass, 1988. https://scholarscompass.vcu.edu/etd/5224.
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This study investigated the financial performance of not-for-profit hospitals in 10 Southern states acquired by either the for-profit or not-for-profit multihospital systems between the years 1978 through 1982. The impact of system affiliation on acquired hospitals was investigated by looking at average financial performance from the two years before acquisition to 1984/1985. Differences between the performance of hospitals acquired by for-profit and not-for-profit multihospital systems were examined as well. with regard to the latter, major findings revealed both for-profit and not-for-profit multihospital systems increased debt in acquired hospitals and made improvements to plant and equipment. For-profit multihospital systems additionally increased profitability and appeared to operate their acquisitions in a more business-like fashion than the not-for-profit multihospital systems did. Comparing acquired hospitals with matched independents revealed that both for-profit and not-for-profit multihospital facilities used more debt and had newer plant and equipment than the not-for-profit independents did. Multihospital systems decreased liquidity in acquisitions as compared with independent not-for-profit hospitals. Only for-profit multihospital system facilities showed increased profitability, and this was largely due to higher prices. Little or no improvement in efficiency was observed in either for-profit or not-for-profit multi hospital system hospitals; however, the financial indicators used to measure efficiency proved to be problematic.
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Rowell, Patricia A. "Hospital Quality Assurance and Outcomes of Hospitalization." VCU Scholars Compass, 1990. https://scholarscompass.vcu.edu/etd/5281.
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This study was undertaken to address the need of professionals responsible for assuring the quality of hospital care for a framework for understanding and evaluating quality assurance mechanisms and their impact on hospital quality of care. Primary data were collected from 70 Virginia short term acute care general hospitals on the design and resources of their quality assurance programs in 1986. Adverse outcome data for 1986 were collected from the Medical Society of Virginia Review Organization. Hospital structural data were obtained from the American Hospital Association computer data base and the Federal Register. The intermediate outcome variables are: rate of unexpected return to the operating room, rate of treatment/medication problems, rate of in-hospital trauma, rate of medical instability at discharge, and rate of unexpected deaths.
Exploratory analyses of hospital size and specialization demonstrate that size positively affects the numbers of RNs in quality assurance, the number of quality assurance professionals with academic degrees above the associate level, and negatively affect the ratio of quality assurance personnel full-time equivalents (FTEs) — both total and professional — to total hospital FTEs. Hospital specialization negatively affects the ratio of quality assurance personnel FTEs — both total and professional — to total hospital FTEs.
Structural equation models, causally relating the adequacy of quality assurance design and resources to adverse outcomes of hospitalization, were used to test the causal relationships. The model supports the work of Donabedian and of Deming. The model demonstrates the effects of quality assurance constructs on perceived organizational commitment to quality assurance and commitments effect on process-related outcomes. Process-related outcomes are strongly and positively related to the terminal measure of unexpected deaths.
When size and specialization are controlled, some changes are noted in the model. The R2 increases, the Chi-square/df ratio increases and the adjusted goodness of fit ratio decreases. This change was not unexpected due to the statistical significance of the percent of board certified physicians (BRDCERT) on the outcome variable unexpected death (DEDPROBR).
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Driscoll, Ryan. "Opting Into Medicaid Expansion under the Patient Protection and Affordable Care Act and Hospital Performance." Scholarship @ Claremont, 2016. http://scholarship.claremont.edu/cmc_theses/1324.
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Healthcare has had a storied past in the United States, and to say that the two have had a complicated relationship would be an egregious understatement. Intertwined in the narrative of our healthcare system is the narrative of United States hospitals, both how they came to be and the nature of their structures. Over time, legislation at local, state, and federal levels has shaped hospital organization and cost-structure. Here, I aim to better understand the effect of the Patient Protection and Affordable Care Act (PPACA), and more specifically Medicaid expansion, on hospitals in a handful of Southern states.
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Robinson, Rachel Elizabeth. "Living knowledge : embodied health care research practice /." Thesis, Connect to this title online; UW restricted, 2007. http://hdl.handle.net/1773/11187.
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Bryant, Wendy. "An occupational perspective on user involvement in mental health day services." Thesis, Brunel University, 2008. http://bura.brunel.ac.uk/handle/2438/3365.
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This participatory action research project enabled service users to influence the modernisation of local mental health day services. The modernisation programme was based on principles of social inclusion, and there were limited understandings of how it could be applied locally. Interpretations of policy gave priority to the relocation of services and facilitating individual recovery. An occupational perspective informed the design, implementation and analysis, emphasising what people chose to do. Critical ethnography informed the role of the researcher. Service user involvement was understood as a democratic process, drawing on direct experience for service development. A forum, established for four years, worked on and supported three research strands, focused on social networking. Service users captured their use of a social lounge using photography in Strand A. In Strand B a checklist was used to investigate social activities. Userled social groups were explored in Strand C through individual interviews. All the findings were systematically analysed and service users were involved in this for Strands A and B. The findings of this research emphasised the importance of social networking within the day services. Strand A indicated the benefits of a safe space, before getting involved and moving on. The final report from this strand led to ongoing funding being allocated for a safe space. For Strand B many social and recreational activities were identified by service users. Stigma was recognised as an ongoing barrier to sustained inclusion. A poster was designed and displayed locally to share the findings. Themes from Strand C demonstrated that user-led groups required active collaboration with mental health services to survive and thrive. A final stage of analysis aimed to uncover the details of taking an occupational perspective. The findings indicated that varied occupational forms involved different service users in different ways, enabling more people to participate. Making the functions of the different events explicit was important for negotiating participation. Meanings were expressed in shared and individual reflection as the research unfolded. Understanding and attending to these aspects facilitated meaningful service user involvement in this research, enabling many people to influence the development of the services they received.
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Marshall, Carol. "Modelling the shift in the balance of care in the NHS." Thesis, University of Stirling, 2013. http://hdl.handle.net/1893/20350.
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The concept of Shifting the Balance of Care was first introduced to NHS Scotland in 2005 through the Kerr Report. The key messages from the report were to: ensure sustainable and safe local services, which are supported by the right skills, change the emphasis of care into the community, provide preventative reactive care, and fully integrate the system to tackle the changes, use technology more effectively, and involve the public in finding solutions to change. Following the report, a framework was developed which highlighted and prioritised eight areas of improvement. These areas for improvement are the focus by which this research examines if Operational Research (OR), specifically OR models, can have a positive impact in Shifting the Balance of Care. The research utilises underlying OR methodologies and methods and provides evidence from the literature of the ability of nine selected models to facilitate the Shift in the Balance of Care. A contributing factor to the research is the barriers to implementation of OR models into the NHS. With reference to the literature, the common barriers to implementation of OR models are categorised and used to provide direction to modellers where implementation barriers are more prevalent in some models than in others. The research also provides empirical evidence of three selected models’ (the Lean Methodology, Process Mapping and Simulation, developed over two Case Studies) ability to address and influence the prioritised Improvement Areas, with the addition of a newly developed model: SoApt. The development of SoApt follows the Principles of Model Development derived as a guide to modellers who wish to develop a new model. SoApt is also empirically explored in a Case Study and provides some evidence of the models ability to aid Decision-makers, faced with limited budgets, to choose between options which will Shift the Balance of Care. OR methods and methodologies are examined to ascertain the Roles of Models for each model explored in the Case Studies. Examination of the Roles of Models against the Improvement Areas provided evidence of a models’ ability to address more than one of the priority areas and that models can be used together or sequentially. In addition, with reference to OR methods and methodologies, a theoretical Evaluation Framework is proposed which suggests the User and User Satisfaction is key to the evaluation of a model’s success; positive experiences of the User and Use of the model may help to eliminate some of the barriers to implementation.
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Wykoff, Randy, and Kate E. Beatty. "Poverty & Health." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6859.
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Meyer, Julienne Elizabeth. "Lay participation in care in a hospital setting : an action research study." Thesis, King's College London (University of London), 1995. https://kclpure.kcl.ac.uk/portal/en/theses/lay-participation-in-care-in-a-hospital-setting--an-action-research-study(e6309043-5c3d-45df-8939-375351712445).html.
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Beatty, Kate, Michael Meit, Emily Phillips, and Megan Heffernan. "Rural Health Departments: Capacity to Improve Communities' Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6838.
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Local health departments (LHD) serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. LHDs serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. Results demonstrate that rural LHDs differed from their urban counterparts. Specifically, rural LHDs relied more heavily on state and federal resources and have less access to local resources making them more sensitive to budget cuts. Rural LHDs also rely more heavily on clinical services as a revenue source. Larger rural LHDs provide more clinical services while urban health departments work more closely with community partners to provide important safety net services. Small rural LHDs have less partners and are unable to provide as many direct services due to their lack of human and financial resources. LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs.
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Wilson, David. "Behavioural and public health research and practice to reduce STI/HIV transmission in southern Africa." Thesis, Staffordshire University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.311257.
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Asiimwe, Sarah. "Use of health information for operational and strategic decision-making by division level managers of Kampala City Council Health Department." Thesis, University of the Western Cape, 2002. http://etd.uwc.ac.za/index.php?module=etd&.
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McIntyre, Rosemary. "Nursing support for relatives of dying cancer patients in hospital : improving standards by research." Thesis, Glasgow Caledonian University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308329.
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Sproat, Louise Jane. "Implementing change in infection control practice : an action research study in two intensive care units." Thesis, University of Sheffield, 1999. http://etheses.whiterose.ac.uk/3481/.
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The increased emergence of bacterial resistance to antibiotics means that primary prevention of all hospital-acquired infections is essential, but ensuring that infection control practice is evidence-based requires reliable measurement of endemic hospital-acquired infections. The research sought to develop a comprehensive method for combining surveillance of infection with improved infection control by incorporating a problem solving approach within nursing process documentation. Prior to the research there was little evidence of nursing documentation of infection risk assessment, evaluation or outcomes monitoring. Development of the documentation matched the aspirations for a clear, objective complete system to support infection control care planning and audit. The documentation was designed to collect and collate only routine items of clinical information that the nurse at the bedside on an ICU would already know or be able to access in a very short time. The data items were successfully incorporated within the audit documentation for measuring incidence of each of the four site-specific infections. The system provided a framework for case-mix identification, case definitions, data collection and identification of indicators for measurement of ICU-acquired infection. It was shown to be feasible to incorporate the audit tool within routine documentation of clinical care. The method has potential application for surveillance of endemic hospital-acquired infections in a wide range of clinical specialities and could be adapted by others facing similar difficulties in determining priorities for monitoring and controlling endemic hospital-acquired infections within limited resources.
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Garris, Bill R., and Amy J. Weber. "Relationships Influence Health: Family Theory in Health-Care Research." Digital Commons @ East Tennessee State University, 2018. https://doi.org/10.1111/jftr.12294.
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This article reviews the presence of family theory in health-care research. First, we demonstrate some disconnect between models of the patient, which tend to focus on the individual, and a large body of research that finds that relationships influence health. We summarize the contributions of family science and medical family therapy and conclude that family science models and measures are generally underutilized. As a result, practitioners do not have access to the rich tool kit of lenses and interventions offered by systems thinking. We propose several possible ways that family scientists can contribute to health-care research, such as using the family as the unit of analysis, exploring theories of the family as they relate to health, and suggesting greater involvement of family scientists in health research.
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Hamilton, Sharon. "The management of change : an evaluation of the use of a multifaceted strategy to implement best practice in the multidisciplinary assessment of stroke patients." Thesis, Kingston University, 2004. http://eprints.kingston.ac.uk/20338/.
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Background: The drive to incorporate best evidence into clinical practice is supported by health policy. The implementation of best evidence requires professionals to change their practice. It is clear that in a health system where resources are finite, change should be prioritised towards an area of high burden on the NHS and where chnage would make a difference to patients. Stroke fulfils this criteria as it is a major cause of mortality and morbidity and therefore a major health issue. Furthermore, studies have shown that storke care is poor and assessment is often incomplete. Change is a complex process requiring a multifaceted implementation strategy as this is more likely to change practice, although specific combinations still need to be evaluated. Aim: To evaluate the use of a combined strategy (an opinion-leader; guideline; a staff education programme; and a new recording system) for implementing multidisciplonary stroke assessment in an acute hospital setting. Methods: A quasi-experimental study design with a pre-test/post-test group which incorporated an evaluation research approach and elements of action research was implemented. Conducted in five inter-related phases over 38 months this encompassed development, implementation and evaluation of the intervention. In Phase 1 (6 months) a diagnostic analysis was conducted using a multi-method approach to identify barriers and faciliatators to change. Phase 2 (9 months) comprised the development of evidence-based guidelines for the multidisciplinary assessment of stroke patients followed by a comparison of current recording practice with these guidelines. This phase also incorporated the collection of patient outcome data (length of stay, hospital mortality and satisfaction). Phase 3 (9 months) comprised the development and implementation of evidence-based guidelines for stroke assessment. Phase 4 repeated the measures of phase 2. Phase 5 comprised a diagnostic evaluation of the change management process and the modelling of 'context-mechanism-outcome' (CMO) configurations to bring together the resiluts of the phases of the study. Results: The major findings were that the combined strategy had a variable impact on the practice of all the professions. The greatest impact was seen with the nursing profession. Pre-test compliance ranged between 0% and 95% (median 60%); post-test 39% and 72% (median 86%) demonstrating a 26% improvement in compliance. Fourteen of the 20 nursing profession specific guidelines reached statistical significance. Least compliance occurred in the medical profession whre compliance in the pre-test period ranged between 2% and 91% (median 45%); post-test 25% and 27% (median 27%). No measurable impact on patient satisfaction or patient outcomes was recorded. Conclusion: The use of the multifaceted strategy had a variable affect on professional compliance with guidelines. Changing professional practice is a complex process requiring leadership with an opinion-leader and professional staff. Furthermore, a strong commitment is needed from professional staff to enable barriers such as professional power to be addressed. A diagnostic analysis is a useful tool for supporting the implementation of organisational change.
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Brennan, Arthur B. "A study of the Couvade syndrome in the male partners of pregnant women in the UK." Thesis, Kingston University, 2008. http://eprints.kingston.ac.uk/20340/.
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The Couvade syndrome or pregnancy-related symptoms in men occurs mainly in industrialised countries around the globe. However, a comprehensive review of available literature suggests that there is a notable dearth of research within the United Kingdom. To address this, a 2-phase study was conducted in the UK. Phase I comprised a qualitative phenomenological study of a purposive sample of fourteen .men, who were interviewed to explore the characteristics of the syndrome and explanations for it. The use of interview fieldnotes and summary sheets provided supplementary data. Three themes emerged from an inductive analytical approach: "emotional diversity in response to pregnancy", "nature, duration and management of symptoms" and "explanatory attempts for symptoms". Few, if any, previous study instruments of the Couvade syndrome have been informed by qualitative studies and evidence of their validation is lacking in the literature. Phase II sought to develop and pilot test a structured questionnaire based on the findings of the qualitative study to assess the physical and psychological symptoms of the syndrome in 23 purposively selected male partners of pregnant women. The questionnaire was completed repeatedly over two time periods. The Cronbach Alpha Coefficient of reliability test for the total scale was 0.89. Other tests of internal consistency showed high reliability and validity, except for nine items, which were subsequently removed from the final amended questionnaire. Few studies have investigated the type, severity, distress and duration of the syndrome's symptoms collectively. These were investigated using the newly developed questionnaire and the perceived stress coping scale in an experimental group of men with pregnant partners (n =182) over the 1st and 3rd trimesters of gestation and 4-weeks into the postpartum period. This was compared with a control group (n = 181) whose partners were not pregnant over a 3 and 6-month comparative time period. Results indicated a significantly higher incidence of 26 physical and 17 psychological symptoms associated with the syndrome for those in the experimental group. There were also statistically higher median severity and distress values for the majority of physical and psychological symptoms in the experimental. group. Symptom severity and distress for physical and psychological symptoms commenced in 1st trimester, dissipated in 2nd trimester, returned in the 3rd trimester and then decreased upon the birth or shortly in the postpartum period except for a minority of symptoms. For the control group the median severity and distress scores for physical and psychological symptoms between 3 and 6-month comparative time periods were all non-significant except for "sore gums" which revealed a statistically significant decrease between these periods. In the experimental group the physical symptoms of the longest duration in the 1st trimester were "stomach pain/cramps and "back pain", "weight gain" and, "stomach distension" in the 3rd trimester and, "tiredness" in the postpartum period, The psychological symptom of the longest duration during the 1 st and 3rd trimesters was "sleeping less than usual" and, "early morning waking" in the postpartum period. In the experimental group there no statistically significant associations between age and the severity and distress of physical and psychological symptoms. There was only one significant association between social class and the severity of the physical symptom of "poor appetite" and none for the distress of the remaining physical symptoms. There were statistically significant associations between social class and the severity scores of three psychological symptoms including "early morning waking", "feeling frustrated" and "feeling stressed". There were also statistically significant associations between social class and the distress scores of "sleeping less than usual" and "feeling frustrated". The largest number of associations were evident between the previous number of children and severity scores of "unable to keep food down", "cough"," sore throat", "pain while urinating", "toothache, "sore gums" and "mouth ulcers". Significant associations between previous number of children and the distress scores were also shown for "stomach pain/cramps" (P=O.018), "indigestion, "cough"," urinating more than usual" and "sore gums". There were also significant associations with the severity scores of 2 psychological symptoms namely, "sleeping less than usual" and "unable to cope with daily life" and the distress scores of the preceding symptom and "early morning waking". Binary logistic regression revealed five physical symptoms as strong predictors of the Couvade syndrome namely, "cough", "leg cramps", "headache" and "diarrhoea" and "pain while urinating" and four, which were weak or unreliable predictors with low R2 values. There were also three psychological symptoms, which were revealed as strong predictors of the syndrome including "loss of concentration", "sleeping less than usual" and "lack of motivation" and a further four, which were weak predictors. There was a higher incidence of all perceived stress coping (PSC) indicators as well as statistically higher median scores for the majority of indicators in the experimental compared to the control group. Between the 1st and 3rd trimesters of pregnancy the median scores of all PSC indicators increased, as did seven in the postpartum period where a further two decreased and one remained constant. For the control group the median PSC scores between 3 and 6-month comparative time periods were all non-significant. For the experimental group, the association between total perceived stress coping scores and the severity scores for physical and psychological symptoms showed no statistically significant relationships at all which was surprising. Binary logistic regression revealed 5 perceived stress coping indicators as weak or unreliable predictors of the Couvade syndrome with low R2 values. Thus, the results support the existence of the Couvade syndrome and its time course, and the male partner's of pregnant women in the study confirmed symptoms as severe and distressing. In view of such findings, men's health needs should be accorded a greater profile within the realms of antenatal care as their health can affect pregnancy outcome. In addition, past problems with the syndrome's diagnosis should now be resolved with regression analysis identifying clear symptom predictors for its presence.
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Maletras, Francois-Xavier. "Developments in fibre optic cardiac and respiratory plethysmography." Thesis, Kingston University, 2002. http://eprints.kingston.ac.uk/20700/.
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This work is the continuation of previous research by A. Raza and other contributors to the field of fibre optic plethysmography. Plethysmography is defined as the volume estimation of an object according to its external dimensions. fu particular, this technique can be used to produce an estimation of the respiratory volume of a human subject according to the dimension of his chest, measured at the thoracic and abdominal levels. A respiratory plethysmograph simply attempts to deliver a signal being the closest possible estimation of the true respiratory volume, as measured by a spirometer or a pneumotachometer. There are essentially two instrumental approaches to respiratory plethysmography: 1) The Respiratory Inductive Plethysmograph (RIP) estimates the cross section area of the chest by monitoring the variation of inductance in an electrical wire encircling the chest. 2) The Fibre Optic Respiratory Plethysmograph (FORP) sees the contribution of fibre optic sensors to measure the chest's circumference variations. The purposes of the present investigation were to improve the performance of previous FORP prototypes, and to extend its capabilities to cardiac monitoring. Both these targets have been reached, and the new prototype is now demonstrating the potential of plethysmography as a sound investigation technique for both cardiac and respiratory monitoring. Overall, the improved sensor and acquisition system permitted the resolution of details of the plethysmographic waveforms that were beyond the reach of the previous prototype. The new FORP prototype is generally more reliable and more precise, if not less compact. From a medical point of view, research carried out with the new FORP prototype has had two major outcomes: 1) The increased temporal resolution-of the new acquisition system has given us the possibility to precisely measure the phase shifts between the plethysmographic signals, and the spirometric signal. Such measurements have contributed. to producing a better estimation of the spirometric signal, therefore increasing the credibility of the FORP as a non-invasive, respiratory volume monitoring device. 2) The increased amplitude resolution of the new acquisition system, coupled with the better linearity, better precision and smaller hysteresis of the new sensor, has enabled the FORP to detect body circumference variations due to cardiac activity around head, neck, thorax and abdomen of a patient. Observations of heart movements at thoracic level had already been reported with the RIP, the direct analogue of the FORP. The signal processing required by the RIP for such monitoring only permitted offline, Electro-Cardio-Gram (ECG) assisted interrogation of cardiac displacements. However, thanks to better signal processing, the FORP has been made capable of real time cardiac position monitoring, without referencing to a simultaneous ECG signal. The combined impact of this research and previous research by A. Raza and A. Augousti on respiratory gating with the FORP, is potentially important in the field of cardiac imaging with Magnetic Resonance and Computed Tomography scanners. The FORP should permit better synchronisation with cardiac movements, while helping the patient to maintain stable chest position, subsequently increasing the image resolution by limiting motion blur.
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Beatty, Kate, Randy Wykoff, and M. White. "Poverty & Health in Tennessee." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/6858.
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Seicean, Andreea. "Risk, Outcomes, and Costs in Neurosurgery – The New Frontier in Health Services Research." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1365082448.
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Parslow, Roger Charles. "Children receiving intensive care in England and Wales epidemiology and health services research." Thesis, University of Leeds, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.485312.
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The epidemiology of children a'dmitted to paediatric intensive care units (I?tcUs) in England and Wales is described, focussing on the effect of deprivation and ethnicity on admission prevalence and mortality. The effects on mortality of size of the admitting unit, admission time, day of the week and season on mortality are investigated. The performance of the mortality risk-adjustment model is discussed in relation to other casemix factors including diagnosis, genetic ancestry and institutional characteristics. An analysis of the epidemiology of children admitted to intensive care with severe traumatic brain injury provides more detailed insight into this important subset of the paediatric intensive care population. In 2004-2005, there were 27859 admissions to paediatric intensive care in England and Wales involving over 20,000 children (under 16 years), 10% of whom ~ere classified as south Asian. Nearly half of all children admitted were under one year of age. Incidence for admission was 55% higher for south Asian children and was 71% higher in the most deprived fifth of the population compared with the least deprived. Deprivation is also associated 'Yith higher admission rat~s to paediatric intensive care for severe traumatic brain injury. Risk-adjusted mortality did not significantly increase with increasing deprivation but mortality in south Asian children was raised, especially in the least deprived fifth of the population. ~isk-adjusted mortality is higher in winter in I~Jrger PICUs and weekend admissions have higher mortality compared to weekdays in smaller PICUs. Mortality following admission to· PICU with a severe traumatic brain injury is highest in those injuries involved with motor vehicles but does not increase with deprivation. The data and analyses represent noveJ'information on the population characteristics of childre[l receiving paediatric intensive care in England and Wales, the effect of these on mortality, and the relationship between service provision and mortality.
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Gibson-White, Angela. "Using information from electronic patient records for clinical, epidemiological and health services research." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/41839.
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Background: Improving current and future healthcare is heavily reliant on continuous research and the secondary use of data from patients' medical records, particularly from electronic records. Considerable amounts of data are collected during the care and treatment of a patient, and this data can offer many opportunities, not only for supporting and improving individual patient care or making important contributions to research, but also for investigating causes of diseases, establishing the prevalence of risk factors, and identifying populations at risk of adverse outcomes. However, the management of such data poses challenges, which many believe can be mitigated by storing it electronically. The traditional method of storing medical information in a paper-based format has severe limitations, especially concerning the amount of effort needed to extract information. In contrast, data from electronic patient records (EPRs) is much easier to extract and allows healthcare professionals access to the information needed in a timely manner to provide appropriate care to patients and improve the public's health. The UK still faces the hurdle of balancing public interest with individual privacy. There is clearly a benefit regarding the use of EPRs but there is an increasing need for public education in order to be able to reap the maximum benefits they offer. This thesis examines the benefits and impact of EPRs in the contexts of clinical care and epidemiological and health services research. Methods: The methods used for this research project involved reviewing published materials available through electronic searching, grey literature and websites of bodies such as the Department of Health, and the Health and Social Care Information Centre. The use of the main national primary care databases and secondary care databases and their growth over time was also examined. Results: EPRs are extremely beneficial to research and have a significant potential to improve patient overall care. The use of EPRs is growing as technology advances and health systems move from paper to electronic records. Conclusions: The use of EPRs will only be successful when both the public, researchers and healthcare providers agree on their benefits. The use of EPRs will take healthcare to another level, where the accuracy of data entered is of very high quality and standardised, data security is well-controlled, and there is acceptance by the public concerning the use of their data both for providing clinical care and for other secondary uses.
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Meit, Michael, and Kate E. Beatty. "The Changing Role of Public Health. State Office of Rural Health Regional Partnership Meeting, Region B." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6842.
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Allen, Katherine Louise. "Hubble, bubble, toil and trouble : meddling in mental health services using participatory action research." Thesis, University of Central Lancashire, 2018. http://clok.uclan.ac.uk/25390/.
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This thesis explores whether participatory action research (PAR) can be a vehicle for knowledge democracy in mental health by telling the compelling tale of a team of mental health service users formed to conduct a PAR project in adult NHS mental health services. PAR is a methodology that seeks change through action and the collaborative efforts of participants, often people from marginalised groups. The team, self-named PAR Excellence, actively participated in every step of the research process, from the initial identification of the research topic (shared decision making in mental health), literature review, research design, data collection and analysis, to dissemination. The original contribution to knowledge is in two parts: findings on shared decision making and the use of recorded service user experiences in mental health, and findings on the PAR process itself. Through these intertwining efforts, an original analysis of knowledge democracy in the context of adult NHS mental health services in the UK has been reached. Having chosen shared decision making in mental health, PAR Excellence developed a multi-media library of service user experiences to be used as a shared decision making resource. They explored with NHS mental health staff whether this approach supported shared decision making through qualitative focus groups and interviews. It was concluded that whilst the use of recorded service user experiences as a shared decision making resource was generally welcomed in principle by staff, in practice there was limited utilisation of the resource. However, it was highly valued as an opportunity for staff reflective practice, and when used judiciously, showed the potential for having a profound effect for service users. It was also found that shared decision making is a complex concept that has many different meanings amongst staff, and they work in a system where true shared decision making cannot consistently occur. However, it was discovered that staff found the involvement of service users in the research process gave the project authenticity and credibility over research generated purely by traditional researchers, and were therefore more likely to engage with it. The shared decision making resource also provoked a particularly positive response in staff members who have used mental health services themselves. Throughout the project, qualitative focus groups were also held with PAR Excellence to explore the participatory process and its outcomes overall. These findings established that the motivations of the team (who were highly critical of mental health services) were rooted in a profound understanding of the power mental health services had over them, dissatisfaction with services, and a deep sense of injustice. This led the team to express a concept of subversive "meddling" in mental health services to address these issues. They found that whilst personal transformation through PAR was achievable, the potential for more general, external transformation was limited due to the enmeshment of the political and economic climate in which mental health services operate.
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Humphris, Debra. "The implementation of policy into clinical practice : the use of research evidence by doctors, nurses and therapists." Thesis, St George's, University of London, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301570.
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Hale, Nathan, Tamar Klaiman, Kate E. Beatty, and Michael Meit. "Rural Health Departments and Clinical Services: Transition to Whom?" Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6845.
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Bressington, D. "Medication management training for mental health professionals : a programme of research." Thesis, Canterbury Christ Church University, 2014. http://create.canterbury.ac.uk/12800/.
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Aim This research programme aimed to investigate issues relating to the management of patient non-adherence with antipsychotic medication. The findings from the patient-related studies and the systematic literature review informed the development of a medication management staff training programme; which was evaluated in terms of the effects on mental health professionals’ understanding and clinical practice in Hong Kong. Background Medication management interventions which are designed to maximise the potential benefits of antipsychotic medication for severe mental illness have shown promise in improving symptoms, reducing relapse rates and addressing non-adherence. Subsequent medication management studies which involve training mental health professionals in similar psychosocial interventions have also demonstrated that improvements in mental health professionals’ knowledge, attitudes and skills can result in improved patient outcomes; however, the studies have not been replicated outside western general psychiatry settings and therefore the effects of training mental health professionals in other clinical contexts have not been established. Methods This research programme consists of a series of five studies that utilised a variety of methodological approaches. Three cross-sectional surveys were used to identify and explore clinical problems central to medication management in order to refine the staff training programme; the first investigates the extent of, and associations with, antipsychotic medication non-adherence in prisons. Qualitative interview data from the prison study provides additional context to the requirements for medication management training interventions by exploring prisoners’ experiences of taking antipsychotic medication. The second survey ascertains and explores the problem of non-adherence with antipsychotics in an Asian population, and the third provides an estimate of potential treatment-related physical health problems. A systematic literature review investigates studies which measure the effects of medication management training on clinicians’ knowledge, attitudes and skills. Finally concept mapping and clinicians’ narratives are used in a longitudinal case series 2 study in order to establish the transferability of medication management training to an Asian setting and evaluate the effects of training on clinicians’ understanding and clinical practice. Results Patients’ positive attitudes towards antipsychotic medication, particularly awareness of the need for treatment predicted higher levels of adherence, and concerns about the adverse effects of these medications are closely related to the environmental context of treatment. Concerns associated with antipsychotic side effects appear to be less prominent when patients are not working or in prison but they may influence adherence when demands on functioning change. The modified medication management training was effective in improving clinicians’ understanding and was felt to be transferrable to an Asian setting, but patients’ and families’ traditional cultural beliefs about mental illness and concerns about the effects of western medication on physical health were found to be particular challenges when implementing adherence interventions. Patients with severe mental illness in Hong Kong are twice as likely compared to the general population to have developed metabolic syndrome, consequently medication management interventions could require greater focus on the identification and management of physical health problems; which may help to address patient and family concerns about long-term treatment. The staff training programme requires psychopharmacology teaching, provision of clinical supervision and side effects management content in order to improve clinicians’ confidence when implementing medication management interventions. Conclusions Concerns about the adverse effects of treatment that influence adherence are environmentally bound. As influences on medication adherence are different in different settings, staff training programmes should place more emphasis on the local context in order to improve efficacy and the feasibility of implementation. The results suggest that in Hong Kong medication management interventions should have an increased focus on families and that treatment satisfaction could be a suitable target for interventions. The findings also present a question about whether previous medication management studies have given due consideration to predicting and managing concerns about the impact of side effects on functioning over the longer term and the potential effects of medication on patients’ physical well-being. The outcomes of this programme also demonstrate that future medication management training studies need to use robust study designs in order to more certainly attribute clinicians’ improvements to the training intervention and could consider measuring treatment satisfaction as a primary patient outcome measure.