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Dissertations / Theses on the topic 'Quality of medical care'
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Fickel, Jacqueline Jean. "Quality of care assessment : state Medicaid administrators' use of quality information." Full text (PDF) from UMI/Dissertation Abstracts International Access restricted to users with UT Austin EID, 2002. http://wwwlib.umi.com/cr/utexas/fullcit?p3077639.
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Tabladillo, Mark Z. "Quality management climate assessment in healthcare." Diss., Georgia Institute of Technology, 1996. http://hdl.handle.net/1853/24162.
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Zaal, Ahmad. "Benchmarking the Quality of Medical Care of Childhood-Onset SLE." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1427962136.
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Nair, Dev J. "State Medicaid agencies approaches to quality improvement implications for policy, practice and health outcomes /." unrestricted, 2009. http://etd.gsu.edu/theses/available/etd-04222009-214921/.
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Thesis (M.P.H.)--Georgia State University, 2009.Title from file title page. Russ Toal, committee chair; Mark Trail, committee member. Description based on contents viewed Sept. 14, 2009. Includes bibliographical references (p. 77-81).
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Glover, Gloria. "Relationships Between Nursing Resources, Uncompensated Care, Hospital Profitability, and Quality of Care." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7142.
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The value-based purchase requirement of the Patient Protection and Affordable Care Act puts pressure on hospital leaders to control cost while improving quality of care. The resource dependency theory was the theoretical framework for this correlational study. Archival data from the Centers for Medicare and Medicaid Services collected from 166 acute care urban hospitals for the Fiscal Year 2016. Multiple linear regression analysis was used to determine the relationship between nursing salaries per patient day, cost of uncompensated care as a percentage of net patient revenue, percentage of net income from patient services, and overall patient satisfaction for quality of care received. The multiple regression analysis results indicated the model as a whole to significantly predict overall patient satisfaction for quality of care for the Fiscal Year 2016, F (3,162) = 13.788, p = .000, and R2 = .203. In the final model, all 3 independent variables significantly predicted overall patient satisfaction for quality of care. Nursing salaries per patient day and percentage of net income from patient services were significant positive predictors of overall patient satisfaction for quality of care. Nursing salaries per patient day (� = .366, t = 5.120, p = .000) accounted for a higher contribution to the model than percentage of net income from patient services (� = .169, t = 2.374, p = .019). The cost of uncompensated care as a percentage of net patient revenue displayed a significant negative relationship with overall patient satisfaction for quality of care (� = .176, t = 2.458, p = .015). The implications of this study for positive social change include the potential to enhance the quality of care for patients while maintaining local hospitals' financial viability.
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Swanson, Abby Jo. "Electronic Medical Records in Acute Care Hospitals: Correlates, Efficiency, and Quality." VCU Scholars Compass, 2006. https://scholarscompass.vcu.edu/etd/871.
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The purpose of this dissertation is to examine the organizational and environmental correlates of hospital EMR use and to examine the relationship between hospital EMR use and performance. Using a theoretical framework that combines resource dependence theory with Donabedian's structure, process, outcome model, a conceptual model is created. To test the hypotheses of this model, logistic regression and Data Envelopment Analysis (DEA) are used. The data included in this analysis come from the AHA, HIMSS, CMS, ARF, and HQA. In the analysis of hospitals correlates of EMR use, three hypotheses were supported, and one was partially supported. Hospital system affiliation, bed size, and environmental uncertainty were found to be positively associated with hospital EMR use. Hospital rurality was found to be associated with EMR use for all categories except one; at every other level of rurality, as the hospital moves on a continuum from least rural to most urban, the likelihood of hospital EMR use also increases. Hospital EMR use was not found to be associated with teaching status, environmental munificence, competition, operating margin, ownership, or public payer mix. In the hospital performance analyses, one hypothesis was supported, and one was partially supported. Regarding quality, hospitals with EMRs were found to provide higher quality than those without EMRs. In efficiency performance, only small hospitals with EMRs were found to be more efficient than hospitals without EMRs. No support was found that hospitals with EMRs improve their efficiency over time more than hospitals without EMRs. Hospital EMR use does vary by certain organizational and environmental characteristics. For this reason, hospitals and policy makers must take action that enables and encourages all hospitals to implement and use EMRs because some hospitals do not have the motivation or resources to begin using EMRs on their own. Hospital EMR use is positively associated with high quality care, thus justifying the practice. Hospital efficiency was not found to be associated with EMR use in medium or large hospitals, but it was found to be associated with EMR use in small hospitals. Interestingly, larger hospitals are more likely to use EMRs than small hospitals. It is possible that the efficiency gains of EMR use in hospitals will not be realized until a standardized, fully interoperable system is developed, allowing health care provides to quickly and easily share the medical charts of their patients.
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Orwelius, Lotti. "Health related quality of life in adult former intensive care unit patients." Doctoral thesis, Linköpings universitet, Institutionen för medicin och hälsa, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17829.
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Background: Patients treated in an intensive care unit (ICU) are seriously ill, have a high co‐morbidity, morbidity and mortality. ICUs are resource – demanding as they consume significant hospital resources for a minority of patients. The development of new medical procedures for critical care patients has over the years led to survival of larger numbers with more complex illnesses and extensive injuries. Improved survival rates lead to needs for outcome measures other than survival. The present study examines health‐related quality of life (HRQoL) and factors assumed to be important for the long term HRQoL for former ICU patients. Methods: This is a multicenter cohort study of 980 adult patients admitted to one of three mixed medical‐surgical ICUs in Southern Sweden, during 2000 to 2004. The patients were studied at four different occasions after their critical illness: 6, 12, 24, and 36 months after discharge from the ICU and hospital. HRQoL was assessed by the EuroQol 5‐Dimensions (EQ‐5D) and Medical Outcome Short Form (SF‐36), sleep disturbances by the Basic Nordic Sleep questionnaire (BNSQ), and pre‐existing diseases was collected by self‐reported disease diagnosis. Data from a large public health survey (n=6093) of the county population were used as reference group. Results: Compared with the age and sex adjusted general reference group the patients who had been in the ICU had significantly lower scores on EQ‐5D and in SF‐ 36 all eight dimensions. This was seen both for the general ICU patients as well as for the multiple trauma patients. Significant improvement over time was seen only in single and separate dimensions for the general ICU group, and for the multiple trauma group. Long term effects of ICU care on sleep patterns were found minor as 70 % reported an unchanged sleep pattern and only 9% reported worse sleep after the IC period. Pre‐existing diseases were found to be the factor that had the largest influence on HRQoL in both the short‐ and long term perspective for the general ICU patients as well as for the multiple trauma patients. It was also found to have negative impact on sleep. IC ‐related factors showed only a minor influence on HRQoL or sleep patterns after the ICU stay. Conclusions: This multicenter study shows that pre‐existing diseases influence the HRQoL short‐ and long‐term after IC, and it must be accounted for when HRQoL and outcome after IC are studied. Approximately, 50% of the decline in HRQoL for the ICU patients could be explained by pre‐existing diseases. Future research needs to focus on the remaining factors of importance for the total HRQoL impairment for these patients.
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Fredin, Rebecca Layton. "Perceptions of quality of medical care among consumers with schizophrenia who have a comorbid medical illness." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1330979750.
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Chu, Yim-kwong. "A study of the quality improvement of Hong Kong's health care system." Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B22050668.
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Case, Christina Vasquez. "Perceptions of healthcare quality : does culture matter? /." free to MU campus, to others for purchase, 2004. http://wwwlib.umi.com/cr/mo/fullcit?p3144404.
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Danquah, Augustina. "Exploration of the quality of health care delivery in rural Ghana." Thesis, University of Aberdeen, 2010. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=203831.
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This thesis explores the quality of health care delivery in rural Ghana. In Ghana, the Ministry of Health has been concerned about the quality of health care for sometime, but improvements in quality have been slow to develop and become noticeable: there continue to be complaints about the quality of care given by health workers and received by clients. For their part, health workers have reported the challenges to delivering quality services, while patients describe difficulties of accessibility and technical competence of health workers. It was envisaged that an exploration of the quality of care at the district level would reveal the range of constraints to provision and receipt of quality care, providing an evidence-based analysis incorporating the views of the important stakeholder groups, that could help to contribute to quality improvement in rural Ghanaian health care, especially in primary health care delivery at the local level. The study reported here was carried out in rural Amansie West district in the Ashanti region of Ghana. Using the administrative district as a case study allowed for “multiple sources of evidence gathering”, thus ensuring that the findings are more likely to reflect reality if based on several different sources of information and types of data. The study design was qualitative and involved qualitative data collection methods, including: semi-structured interviews with 66 patients, 25 health workers from seven primary health care facilities and six core members of the district health management team; and focus groups that involved discussions with members from seven communities. These data collection methods explored study participants‟ ideas about the definition of quality of health care, perceptions about the quality of actual health care delivery and feelings about the quality improvement strategy adopted in the primary care facilities studied. Interviews were tape recorded with consent, and translated into English as they were transcribed. Data were analysed manually, using iteration and thematic analysis. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of statements and their meaning to participants. Thematic qualitative analysis of the data suggested that the different provider, recipient and administrative level groups had similar views on what constituted quality of care. In their perceived definitions, all groups tended to emphasise the importance of interpersonal relations, accessibility, technical competence and effectiveness, but these dimensions variously „ranked‟ in importance by stakeholder groups. Perceptions of the quality of actual health care received and the quality improvement process being deployed in Amansie West revealed that many of the obstacles to high quality health care were described as residing within the structure of health care delivery. This study provides new knowledge about perceptions of quality, experience of quality and quality improvement in a rural area of a developing country. It has improved understanding of the differing views held by the different stakeholders. It shows the dimension of understanding about quality added when the views of patients and community members are considered in addition to providers and administrators. Findings suggest improvements could be made to structural aspects of health care provision that could improve quality: for example, appropriate equipment, trained health workers and sufficient numbers of trained workers.
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Javed, Sumbal. "Reconfiguration of vascular services to enhance quality of care." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206915.
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Hong Kong's aging population has, increased demand for vascular services. Currently, vascular surgery is subsumed under general surgery. The workload on both general surgery and vascular surgery is demanding and hence, not conductive to the development of vascular surgery. The volume of surgery, particularly emergency surgery provided by the Hospital Authority units varies significantly. The collaboration and differentiation of labor at present is not well defined in many centers. This may lead to unnecessary competition and duplication of resources in the long run.
This project examined if there is room for improvement in the present situation and provides evidence for relevant service reconfiguration and discusses how Hong Kong can learn from some overseas examples to enhance quality of services delivered to patients.published_or_final_version
Public Health
Master
Master of Public Health
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Thierry, Linda. "Does Implementing a Quality Improvement Practice Decrease Falls on the Medical Wards?" Thesis, Grand Canyon University, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13807507.
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Rationale/Background: Fall prevention is a paramount and lifesaving healthcare initiative. The investigation of interventions for the prevention of falls may lead to a decrease in injuries and promotion of superlative care for patients hospitalized in an acute healthcare environment.
Purpose: The purpose of this quantitative correlational direct practice improvement (DPI) project is to determine the relationship between the implementation of a fall prevention training program and changes in fall rates over a period over three months.
Theoretical Framework: The Neuman system model served as the theoretical foundation for this project. The model presents a holistic approach to patient at-risk for falling and guides bedside nursing care, assess stressors, safety needs, and environmental factors suggest potential indicators linked to fall-risk patients.
Project Method and Design: A quantitative method and correlational design was used to investigate the impact of the intervention. The intervention involved training for a total 28 nurses (N = 28) on two wards. The final data collection included fall rates for 56-patients (N = 56).
Data Results: The control ward had a fall rate of nearly twice as high than the ward who received the intervention. There is a statistically significant reduction in fall rates on the intervention ward (p = 0.04).
Implications: Based on the findings of this project, a fall education training program supported safety through a reduction of falls. The training program was adopted as a part of standard education for the site.
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Petersson, Håkan. "On information quality in primary health care registries /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/tek805s.pdf.
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Byrd, Linda W. Kavookjian Jan. "An examination of information technology and its perceived quality issues in single system hospitals in the United States." Auburn, Ala., 2009. http://hdl.handle.net/10415/1987.
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PonceVega, Jose A. "Leadership Strategies for Implementing Quality Improvement Initiatives in Primary Care Facilities." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6265.
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Health care spending accounts for 17.7% of the gross domestic product in the United States, and it is expected to continue rising at an annual rate of 5.3%. Despite high costs, health care quality lags behind other high-income countries; yet, over 70% of change initiatives fail. The purpose of this multiple case study was to explore strategies primary care leaders use for implementing quality improvement initiatives to improve patient outcomes and reduce waste in primary care facilities. The target population consisted of 3 health care leaders of 3 primary care facilities in southern California who successfully implemented quality improvement initiatives. The conceptual framework for this study was Kotter's 8-step of change management. Data were collected through face-to-face semistructured interviews with senior health care managers, document review, and quality reports. Member checking of interview transcripts strengthened the credibility of the findings. Data analysis included Yin's 5-phase process, which consisted of compiling, disassembling, reassembling, interpreting, and concluding the data. Themes emerged from the use of methodological triangulation of data. The themes included communication, leadership support, inclusive decision-making, and employee recognition. The implications of the findings of this study for positive social change include assisting primary care leaders in improving strategies for implementing quality improvement initiatives to increase efficiency, reduce health care cost, and improve patient and community health.
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Driesen, Kevin E. "Statistical process control as quantitative method to monitor and improve medical quality." Diss., The University of Arizona, 2004. http://hdl.handle.net/10150/280602.
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Statistical Process Control (SPC) methods, developed in industrial settings, are increasingly being generalized to medical service environments. Of special interest is the control chart, a graphic and statistical procedure used to monitor and control variation. This dissertation evaluates the validity of the control chart model to improve medical quality. The research design combines descriptive and causal comparative (ex-post facto) methods to address the principal research question, How is the control chart model related to medical quality? Hospital data were used for patients diagnosed with Community Acquired Pneumonia (CAP). During the initial research phase, five medical quality "events" assumed to affect CAP medical quality indicators were pre-specified by hospital staff. The impact of each event was then evaluated using control charts constructed for CAP quality indicators. Descriptive analysis was undertaken to determine whether data violated the statistical assumptions underlying the control chart model. Then, variable and attribute control charts were constructed to determine whether special cause signals occurred in association with the pre-specified events. Alternative methods were used to calibrate charts to different conditions. Sensitivity was computed as the proportion of event-sensitive signals. The descriptive analysis of CAP indicators uncovered "messy," and somewhat complex, data structure. The CAP indicators were marginally stable showing trend, seasonal cycles, skew, sampling variation and autocorrelation. Study results need to be interpreted with the knowledge that few events were evaluated, and that the effect sizes associated with events were small. The charts applied to the CAP indicators showed limited sensitivity; for three chart-types (i.e. XmR, Xbar, and P-charts), there were more false alarms than event-associated signals. Conforming to expectation, larger sample size increased chart sensitivity. The application of Jaehn Decision Rules led to increases in both sensitivity and false alarm. Increasing subgroup frequency from month, to week samples, increased chart sensitivity, but also increased data instability and autocorrelation. Contrary to expectation, the application of hybrid charting techniques (EWMA and CUSUM) did not increase chart sensitivity. Study findings support the conclusion that control charts provide valuable insight into medical variation. However, design issues, data character, and causal logic provide conditions to the interpretation of control charts.
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Long, Susannah. "Measuring and improving the safety and quality of care in older medical inpatients." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/9089.
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Older people, often frail with multiple co-morbidities, constitute the largest proportion of hospital inpatient populations. Yet existing ways of measuring the quality and safety of care that they receive are not usually designed with the unique problems encountered by this vulnerable population in mind. The aims of the work presented in this thesis were to investigate what is known about the types, incidence and causes of safety and quality issues in older medical inpatients, to develop and test novel tools to measure the safety and quality of care that they receive and finally to design and test interventions to improve care. In Section 1 of the thesis (Chapters 1 and 2), an introduction of patient safety and quality in older people is presented, with an overview of current strategies for measurement and improvement, and the rationale for undertaking this research. Section 2 (Chapters 3 - 5) contains three exploratory studies in which different approaches (a systematic review of the literature and re-analysis of the major adverse event studies, a qualitative study involving staff who are involved in the care of older people, and an exploratory retrospective case record review) were used to produce an overall picture of safety and quality issues in older medical inpatients. This information was used to develop two novel case record review tools (the “Long tool” and “COMPACT”) to measure the quality and safety of care in older medical inpatients, using a combination of outcome and process measures. Section 3 (Chapters 6 and 7) describes the development and testing of these tools. Next, Section 4 (Chapters 8 and 9) of the thesis consists of two studies which were designed to provide the basis for further safety and quality improvement work in older medical inpatients. In Chapter 8, an investigation of the importance and trainability of safety skills (attributes of the safe practitioner) that may form the basis of a template for future patient safety curricula is described. In Chapter 9, a different improvement approach is described - the development and use of a multidisciplinary goal sheet on a medicine for the elderly ward, its effect on quality of care as measured by COMPACT, on staff perceptions of the incidence of adverse events, teamwork and communication, and on goal understanding. Finally, the discussion (Section 5, Chapter 10) reflects on the overall findings, strengths and weaknesses of the studies, and implications for clinical practice and future research.
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Lo, Oi-sheung Anne. "A study of different perspectives on the quality of health care and its implication for medical social service /." [Hong Kong : University of Hong Kong], 1992. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13417496.
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Hess, Edward Alan. "The impact of diabetes nurse care managers in outlying medical offices on quality of care: An empirical investigation." CSUSB ScholarWorks, 2001. https://scholarworks.lib.csusb.edu/etd-project/1744.
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The objective of this study is to evaluate the impact of the Diabetes Nurse Care Manager on an at-risk diabetic population using a Primary Group Visit Model in Outlying Medical Offices within the Kaiser-Permanente Health Care System upon the process and outcome of care in this population.
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Patterson, Jan. "Consumers and complaints systems in health care /." Title page, contents and summary only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09php3174.pdf.
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Ho, Kenneth. "Improving the quality of the documentation system in a health care environment." [Denver, Colo.] : Regis University, 2006. http://165.236.235.140/lib/KHo2006.pdf.
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Noble, Marilynn. "Integrating Health Care Systems to Maintain Quality Care and to Manage Cost." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6851.
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The rising cost of health care in the Philippines is a concern for the Department of Defense and TRICARE beneficiaries. The purpose of this quantitative cross-sectional research study was to determine the efficacy and acceptability of a different method to deliver health care to increase access to health care and decrease out-of-pocket costs while maintaining quality of care for TOP Standard beneficiaries who receive health care under the Philippine Demonstration. Secondary data was used to determine the acceptability of an alternative reimbursement methodology to decrease cost but maintain access to quality care. The Andersen's behavioral health care model and the Donabedian quality health care model were used to interpret the study results. A data set of 180 participants was evaluated using a cross-sectional quantitative methodology. Two Spearman correlations were used to examine the relationship between financial burden and satisfaction (r = .41, p < .001) and financial burden and confidence (r = .44, p < .001). Linear and binary regressions assessed the effects of age and gender on satisfaction with health care finder functionality when requesting a waiver (F (2,26) = 1.22, p = .313, R2 = .09). A computation of one-sample t-tests to determine the impact of a closed network, beneficiary out-of-pocket cost, and quality health care in Demonstration areas found the beneficiaries were satisfied with the demonstration. An analysis of the claims data pre and post demonstration showed a difference in the patients' out-of-pocket expenses and the acceptability and preference for a closed network. Social change was demonstrated by a decrease in the cost for TRICARE standard beneficiaries in the Philippines.
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Walsh, Michael Paul. "Critical systems thinking, dialogue and quality management in the National Health Service." Thesis, University of Hull, 1995. http://hydra.hull.ac.uk/resources/hull:3900.
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This thesis considers quality in the National Health Service (NHS), the theories of dialogue, critical systems thinking, and quality - and how these domains can be related together to produce a new concept of quality called critical quality.A quality gap is identified between what the NHS produces and what the public requires of it. It is argued that this gap is unfair because of the generally unequal access of stakeholders to decisions about quality in the NHS. It is suggested that only through dialogue can the gap be reduced in size in a non-oppressive way.Principles of dialogue are derived from Habermas's (1991a,b) theory of communicative action and applied to interest group relationships using Grant's (1989) insider/outsider model. It is argued that critical systems thinking can be enhanced by embedding interventions within processes of dialogue, and that the analysis of insider/outsider relationships in situations can guide the use of critical systems thinking in creating dialogues.Three modes of quality management are identified (strategic, normative and critical). It is argued that the requirements and needs of the public cannot be met by an NHS that is dominated by strategic and normative quality. Instead critical quality, defined as the specification of services by mediation through dialogue between stakeholders, is advocated as a fairer mode of quality management for the NHS.An NHS quality dialogue (the Trent Quality Initiative) is evaluated. Dialogue is found to have occurred both within and between meetings. Two modes of peer group participation are identified (main dialogue vs meta-dialogue) and two general approaches to the implementation of critical quality in the NHS (incremental vs radical). Finally critical quality in public welfare services is discussed and a research agenda outlined for dialogue, quality and critical systems thinking.
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Selfe, Susan Anne. "Chronic pelvic pain in women : illness, disease and medical attitudes." Thesis, University of Southampton, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262875.
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Krasnopolskaya, N., and T. Zaitseva. "Improving the quality of medical care hypertension through the introduction of internal audit mechanism." Thesis, Sumy State University, 2015. http://essuir.sumdu.edu.ua/handle/123456789/41266.
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Clinical audit is the process of improving the quality of care provided by the systematic verification of care with clearly defined criteria and subject to subsequent changes. The purpose of the study is to show the possibility of the author's model of quality management of medical care on the basis of the mechanism of internal audit in hypertensive patients, introduced in the Sumy City Clinic Hospital number 5.
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Qin, Hong Prybutok Victor Ronald. "Links among perceived service quality, patient satisfaction and behavioral intentions in the urgent care industry empirical evidence from college students /." [Denton, Tex.] : University of North Texas, 2009. http://digital.library.unt.edu/permalink/meta-dc-11014.
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Cheung, Yuk-fai, and 張煜暉. "Clinical and health-related quality of life evaluation of acute strokeunit care versus conventional medical care for minor stroke patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48422800.
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The efficacy of stroke units has been extensively investigated in clinical trials. However, little information is available to the health care providers and policy makers on the benefits of stroke unit care in Hong Kong. The quality of life of our local stroke patients is largely unknown.
The objective of this study was to compare the 2-month outcomes after stroke admitted to either a stroke unit or a non-stroke unit. Outcomes included mortality, dependency, institutional care and quality of life. This was a prospective observational study conducted in a regional, tertiary hospital in Hong Kong. Baseline demographic and clinical data were collected from the subjects. The 36-Item Short-Form health survey (SF-36) questionnaire was administered to them. Follow up assessment at two months were made for mortality, dependency, institutionalisation, length of hospital stay and SF-36.
Eligible subjects were Cantonese-speaking Chinese aged 18 years or over. They should provide written informed consent, and verbally and cognitively competent in completing the SF-36 questionnaire
162 patients with acute stroke were included in the analysis. 106 patients were solely managed in the stroke unit. 41 patients were managed in other wards (as the control group). There were no statistically significant differences found between the two groups for death alone, death or dependency, and death or institutionalisation.
Multivariate logistic regression analyses showed similar findings. Mean lengths of acute and total hospital stay were similar between the two groups. Quality of life was impaired during the acute phase of stroke as reflected by low Physical Functioning (PF) and Social Functioning (SF) dimensions of the SF-36. At two months, significant improvement was observed in five out of eight dimensions of the SF-36 as well as its two summary scores, Physical Component Summary (PCS) and Mental Component Summary (MCS). There were several limitations in our study, namely small number of patients, minor stroke severity and tertiary hospital setting.
In conclusion, no significant differences in the clinical outcomes were found between the stroke unit group and the control group. These findings were inconclusive in view of limitations in this study. Stroke affected quality of life. Future researches with larger sample size are warranted.published_or_final_version
Public Health
Master
Master of Public Health
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Moutafis, Roxanne Alexis. "Symptomatology and life quality as predictors of emergent use." Thesis, The University of Arizona, 1989. http://hdl.handle.net/10150/277089.
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A nursing concern for patients with chronic obstructive airway disease (COAD) is to assist the patient/family in improving adaptation strategies and self-care abilities. Identification of emotional and behavioral characteristics impacting on symptoms and life quality may predict individuals at risk for greater utilization of health care resources. The purpose of this descriptive study was to apply Traver's Prediction Formula for Emergent Use to a more general COAD population to determine if the formula would accurately predict those subjects who have high versus low emergent use of institutional health care resources. Fifty subjects with a range of COAD severity were studied. Subjects completed instruments which measured symptoms and life quality: the Bronchitis-Emphysema Symptom Checklist and the Sickness-Impact Profile. Findings demonstrated Traver's Formula predicted low emergent subjects with 76 percent accuracy, high emergent subjects with 53 percent accuracy and predicted the overall emergent status of subjects with 67 percent accuracy.
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Glasson, Janet, University of Western Sydney, College of Social and Health Sciences, and of Nursing Family and Community Health School. "Improving aspects of quality of nursing care for older acutely ill hospitalised medical patients through an action research process." THESIS_CSHS_NFC_Glasson_J.xml, 2004. http://handle.uws.edu.au:8081/1959.7/481.
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The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge.Master of Health Science (Hons)
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Chu, Yim-kwong, and 朱琰光. "A study of the quality improvement of Hong Kong's health care system." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31966159.
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Lai, Tai-yee Barbara. "Pay for patient satisfaction what is the evidence for quality of improvement? /." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B4299486X.
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Rabih, Joyce. "TQM implementation in health care : a proposed framework." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ39974.pdf.
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Willis, Cameron David. "Measuring quality outcomes in patient care: the example of trauma services." Monash University. Faculty of Medicine, Nursing and Health Sciences. Department of Epidemiology and Preventive Medicine, 2008. http://arrow.monash.edu.au/hdl/1959.1/62206.
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As healthcare and health systems become increasingly complex, expectations of what constitutes high quality care continue to evolve. Stakeholders now require contemporary and meaningful measures of system performance. As such, valid healthcare quality metrics are rapidly becoming essential for those providing and receiving healthcare to assess performance and motivate change. This thesis investigates the utility of quality indicators in trauma care. Multiple in-hospital indicators have been promulgated by various bodies for assessing quality of trauma care. The properties of ideal indicators have been widely documented however few published data have reported these properties for many trauma measures. The emphasis on trauma process measures (eg. time to interventions) highlights the need for indicators with known links to patient outcomes. This process-outcome link may be viewed as a measure of an indicator’s construct validity. As this property is unknown for many trauma indicators, this thesis focuses on the construct validity of a number of routinely utilised trauma indicators. In this thesis, the available in-hospital indicators proposed by The American College of Surgeons Committee on Trauma and additional indicators used in the Victorian State Trauma System were investigated for their relationships with patient outcomes. A small number of indicators were found to have statistically significant relationships with patient outcomes, however many indicators demonstrated counter-intuitive relationships, whereby high quality care was linked with poorer patient outcomes. These results suggested that links between indicators and outcomes may not be best measured using individual indicators for individual patients. Rather, a strategy for measuring patient outcomes at the hospital level may be needed. To combine multiple indicators into a single measure of hospital level performance, a number of composite methods were explored using two trauma registries. Three composite weighting schemes were employed. As composite measures are often used for provider ranking or benchmarking, the stability of hospital ranks between providers and over time was investigated. The composites were found to have moderate to strong correlations (0.76-0.99) however variability in composite hospital rankings existed, particularly for middle ranking facilities. The construct validity of each available indicator and composite score was investigated through the relationship with hospital level risk-adjusted mortality using Poisson regression models, risk adjusting for expected deaths using the TRISS formulation. Each composite measure demonstrated a significant association with mortality, with the mortality decrease across the middle 50% of each composite score ranging from 12.06% – 16.13%. These findings suggest that complex measures such as trauma composite indices may be better able to measure the interactions between processes within complex systems that influence quality of care. This thesis adds valuable insight into the use of indicators for assessing quality of care in trauma systems. The combination of individual indicators into composite forms appears to strengthen the construct validity of these measures. By demonstrating the process-outcome link for trauma composite indices, this thesis has identified a means of utilising process measures to assess hospital level performance that may become important for future public reporting and hospital funding schemes.
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Lindström, Kjell. "Methods for quality development of the primary health care structure /." Linköping : Univ, 2002. http://www.bibl.liu.se/liupubl/disp/disp2002/med719s.pdf.
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Tomsons, Kira Anita. "Denying medical treatment, the right to health care and the quality-adjusted life-year (QALY)." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape15/PQDD_0012/MQ31261.pdf.
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Muñoz, Jorge A. "What is the quality of care in a developing country? measuring physician practice and health outcomes /." Santa Monica, CA : RAND, 2002. http://books.google.com/books?id=7fDaAAAAMAAJ.
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Chan, Adam Y., Elizabeth Farabee, Grace Wholley, Peter Blosser, Jordan L. Herring, and Richard L. Wallace. "Medical Student Burnout in a Small-Sized Medical School." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/72.
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Introduction: Burnout is an occupational condition characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. While medical students begin schooling with mental health profiles similar to or better than peers who pursue other careers, there is a downward trajectory throughout school suggesting this phenomenon often originates in medical school. For physicians and residents, burnout has been linked to poor outcomes such as patient safety, might contribute to suicidal ideation and substance abuse, and may undermine professional development. Furthermore, there is a lack of surveillance of the prevalence of medical student burnout in a small-sized school setting.
Methods: The Maslach Burnout Inventory (MBI), a 22-question survey, is largely accepted as the gold standard for assessment; however, we utilized the 7-question, Well-Being Index (WBI), which has been shown equal efficacy as the full MBI. Eligible participants were currently enrolled in their respective class at the East Tennessee State University Quillen College of Medicine. Each year, a participant was given a WBI survey during the winter season (overall response rate 83%, n = 239).
Results: Overall the self-reported burnout rate over the two-year study period was 65.2% and was significantly higher in those reporting as female (71%). There was also variation tracking the class from one year to the next. The second year at this institution showed the highest reported amount of burnout (75%, n=145) while the lowest amount of burnout reported was during the fourth year at 47%.
Conclusions: Burnout experienced at this institution was reportedly higher than national average. There are limitations to this study as the periods in which medical students were asked to answer the survey were consistently at the same time in the calendar year, but the host institution’s curriculum had been changed so that it might not match up accordingly. Furthermore, class sizes changed from year to year and might skew the data. This information suggests that burnout prevalence is higher at Quillen College of Medicine and intervention strategies to address burnout should be pursued.
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Iannacone, Stephen Mark. "Systemic and Racial Barriers to Palliative Care." Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/433062.
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Urban BioethicsM.A.
Those who have known an individual with a chronic medical condition or someone that has been diagnosed with a terminal illness have experienced the physical and emotional toll these diagnoses have on both patients and their loved ones. Medical providers encounter these situations daily and are often responsible for assisting the patient and their family in the decision-making process. The specialty of Hospice and Palliative Medicine was created specifically with these difficult, but very common, situations in mind. Even though the concept of palliative care has become mainstream and its practice is considered standard of care in many situations, it continues to be misunderstood, misrepresented, and underutilized, despite providing measurable benefits to patients, families and the healthcare system. This paper explores two systemic barriers to palliative care that contribute to this problem and highlights how race, cultural mistrust, and a long history of racial disparities in health care work together to undermine the effective delivery of palliative care.
Temple University--Theses
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Waterstraat, Frank Riegle Rodney P. "Adapting the quality function deployment model to health plan design." Normal, Ill. Illinois State University, 2001. http://wwwlib.umi.com/cr/ilstu/fullcit?p3064505.
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Thesis (Ph. D.)--Illinois State University, 2001.Title from title page screen, viewed March 10, 2006. Dissertation Committee: Rodney P. Riegle (chair), J. Christopher Eisele, George Padavil, John H. Bantham, Thomas J. Bierma. Includes bibliographical references (leaves 124-128) and abstract. Also available in print.
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He, Xinju. "Three essays on treatment quality : theory, measures and application in the hospital sector in China." HKBU Institutional Repository, 2019. https://repository.hkbu.edu.hk/etd_oa/698.
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This thesis investigates the treatment quality of medical services in the hospital sector from different angles: theory, measures and application in China. This thesis includes three essays. The first essay (Chapter 2) is a critical review about the quality assessment. It shows that the environmental performance index is suitable for measuring treatment quality. The second essay (Chapter 3) introduces alternative approaches to environmental performance indices to solve the infeasibility problem of current measures. Environmental performance indices are measures to evaluate the production of undesirable outputs relative to desirable outputs. My new measures are more accurate using the sequential frontier and various reference vectors. The last essay (Chapter 4) is an empirical case study in the Chinese hospital sector that examines how the degree of government involvement and the degree of market competition affect the performance of treatment quality. Using the environmental performance indices of Essay 2 to evaluate treatment quality, I find that the performance of treatment quality of Chinese hospitals improved during the 2009-2014 period. Therefore, the marketisation of hospitals and government subsidies contribute to this sustained improvement
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Gill, Peter John. "Developing paediatric quality indicators for UK general practice." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:1837f24f-e501-4e56-906d-6080191f09cb.
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The overall aim of this thesis is to define a candidate set of quality indicators that are evidence-based, feasible to implement, and have the potential to improve the quality of care provided for children in UK general practice. The indicators were developed using a three-stage process. First, the areas and aspects of care of highest priority for quality indicator development were identified. This was achieved by seeking the views of primary care clinicians and by undertaking a formal analysis of unplanned hospital admissions for ambulatory care sensitive conditions. Then, the evidence-base to underpin indicator development was identified through an overview of Cochrane systematic reviews of interventions relevant to the primary care of children. A search of SIGN and NICE national guidelines was also conducted to inform the evidence-base. Lastly, an expert panel determined the formulation and selection of indicators by applying the RAND appropriateness methodology. This process created a final set of 26 quality indicators in six priority areas: early recognition of potentially serious illness (n=7); child protection and safeguarding (n=4); mental health (n=4); health promotion (n=1); routinely managed conditions (n=6); and general practice management (n=4). The main strength of these indicators is that they reflect a strong professional consensus on their validity and feasibility. The main weakness is that the indicators are underpinned by evidence mainly derived from expert opinion rather than formal research; the requirement for professional consensus means that they do not challenge existing models of care delivery.
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Sist, Martha. "Implementing quality in the healthcare industry." Honors in the Major Thesis, University of Central Florida, 2001. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/302.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Engineering
Industrial Engineering and Management Systems
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Ueda, Kayo. "Applicability of care quality indicators for women with low-risk pregnancies planning hospital birth: a retrospective study of medical records." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/264665.
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京都大学新制・課程博士
博士(社会健康医学)
甲第23384号
社医博第117号
新制||社医||11(附属図書館)
京都大学大学院医学研究科社会健康医学系専攻
(主査)教授 佐藤 俊哉, 教授 滝田 順子, 教授 万代 昌紀
学位規則第4条第1項該当
Doctor of Public Health
Kyoto University
DFAM
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Kercado, Veronica. "Relationship Between Nurse Staffing and Quality of Care in Louisiana Nursing Homes." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2215.
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In 2014, Louisiana experienced substantive issues with quality of care in nursing homes. The state had the lowest nurse staffing level among all states, and 7,666 deficiencies for immediate jeopardy violations were recorded from 2011 to 2013. Despite ample research on nurse staffing and quality of care, there is no consensus on how higher nurse staffing relates to quality. The purpose of this quantitative, correlational research was to determine the relationship between nurse staffing levels and quality measures in Louisiana. Donabedian's category structure, process, and outcome was the conceptual framework used to develop the research questions. The data included the quality of care deficiency score and the quality measures found in the Centers for Medicare and Medicaid datasets. The quality measures were the deficiencies and the prevalence of nursing home residents with pressure ulcers, urinary tract infections, and physical restraints. Generalized linear models were used to analyze the relationship between nurse staffing levels and the quality measures. The findings suggested that RNs, nonprofits, chain-affiliated nursing homes, and smaller facilities are important to improve the quality of care in Louisiana nursing homes. These variables were associated with fewer quality of care deficiencies and fewer pressure ulcers. These findings have implications for social change. This information may help inform and direct policy makers in the development and implementation of Medicaid-managed long-term services and supports programs in order to improve the quality of care of a vulnerable population: the elderly and disabled.
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Qin, Hong. "Links among perceived service quality, patient satisfaction and behavioral intentions in the urgent care industry: Empirical evidence from college students." Thesis, University of North Texas, 2009. https://digital.library.unt.edu/ark:/67531/metadc11014/.
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Patient perceptions of health care quality are critical to a health care service provider's long-term success because of the significant influence perceptions have on customer satisfaction and consequently organization financial performance. Patient satisfaction affects not only the outcome of the health care process such as patient compliance with physician advice and treatment, but also patient retention and favorable word-of-mouth. Accordingly, it is a critical strategy for health care organizations to provide quality service and address patient satisfaction. The urgent care (UC) industry is an integral part of the health care system in the United States that has been experiencing a rapid growth. UC provides a wide range of medical services for a large group of patients and now serves an increasing population. UC is becoming popular because of the convenient locations, extended hours, walk-in policy, short waiting times, and accessibility. A closer examination of the current health care research, however, indicates that there is a paucity of research on urgent care providers. Confronted with the emergence of the urgent care industry and the increasing demand for urgent care, it is necessary to understand how patients perceive urgent care providers and what influences patient satisfaction and retention. This dissertation addresses four areas relevant to the above mentioned issues: (1) development of an instrument to measure perceived service quality in the urgent care industry; (2) identification of the determinants of patient satisfaction and behavioral intentions; (3) empirical examination of the relationships among perceived service quality, patient satisfaction and behavioral intentions; and (4) comparison of the perceived service quality across several primary urgent care providers, such as urgent care centers, hospital emergency departments, and primary care physicians' offices. To validate this new instrument and examine the hypothesized relationships proposed in this study, an electronic web based survey was designed and administered to college students. Both exploratory and confirmatory factor analysis were employed to assess the reliability and validity of the developed instrument. The contextualized relationships were evaluated using structural equation modeling. The results of this research could potentially contribute to urgent care management and quality improvement.
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English, Thomas MacAndrew. "Impact of an electronic medical record on adherence to current diabetes guidelines in a family medical center." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008p/english.pdf.
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Dempsey, Kyle Edward. "Joint Replacement Medical Mission Trips Can Provide High Quality Care in Developing Countries: Assessing Quality Using the Structure, Process, and Outcomes Paradigm." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27007732.
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Background: Medical mission trips that go to developing countries are becoming more popular worldwide and there is need for rigorous quality assessment of the care that these trips provide. Current scrutiny of these trips stems from the lack of established metrics to assess these programs’ quality and from the dearth of literature that attempts to evaluate these trips’ care quality. In developed countries, however, the structure, process, and outcomes paradigm is commonly used to comprehensively assess care quality and many tools exist to evaluate each of these respective quality categories. In this study, we apply these assessment tools to evaluate the structure, processes, and outcomes of Operation Walk (Op-Walk) Boston’s medical mission joint replacement trips to the Dominican Republic (D.R.).
Methods: For Op-Walk Boston’s medical mission trip to the D.R., the structure and process elements of care quality were assessed using the Blue Cross/Blue Shield’s (BCBS) Blue Distinction criteria. Full points were given for criteria that the program replicates entirely and zero points were given for criteria that are not replicated entirely. For non-replicated criteria, Op-Walk Boston’s clinical and administrative teams were asked if they compensate for failure to meet the criterion, and they were also asked to identify barriers that prevent them from meeting the criterion.
To assess the outcomes quality category, Op-Walk Boston’s patients completed Western Ontario and McMaster Universities’ Arthritis Indexes (WOMAC) and Short Form (36) Health Surveys (SF-36) preoperatively and at 12-month follow-up. Patients were stratified into low, medium, and high scoring preoperative groups based on their preoperative WOMAC function scores. We then examined the associations between these groups’ baseline functional status and two outcomes—improvement in functional status over 12 months and absolute functional status at 12 months—using ANOVA with multivariable linear regression.
Results: The structure and process assessment revealed that Op-Walk Boston’s program scored 71 out of 100 possible points, exceeding the 60-point threshold needed to qualify for Blue Distinction. The program met five out of eight “required” criteria and 11 out of 19 “informational” criteria. It scored 14/27 in the “general” category, 30/36 in the “structure” category, 17/20 in the “process” category, and 10/17 in the “outcomes and volume” category.
The outcomes assessment revealed that patients’ functional status and pain levels improved greatly after surgery and that those with the lowest WOMAC functional scores preoperatively made the greatest gains in function and pain relief following their joint replacement.
Conclusion: Our analysis shows that Op-Walk Boston’s medical mission trip provides high quality care across all care quality categories. An analysis of the program’s structure and processes reveals that Op-Walk Boston scores well on the Blue Distinction criteria’s structure and process categories. In addition to demonstrating high quality structure and processes, the Blue Distinction analysis identifies areas of programmatic improvement and identifies targets for future quality improvement initiatives. Furthermore, the analysis shows that many Blue Distinction criteria can only be met by hospitals operating in the United States (U.S.), so future work should focus on creating criteria that are applicable to total joint replacement (TJR) mission trips in the context of developing countries.
Our analysis of the program’s outcomes shows that all tertiles in the Dominican cohort exhibited substantial improvements and high absolute scores at one-year follow-up, demonstrating that the program achieves high quality outcomes. Similar to cohorts from developed countries, Op-Walk patients with poorer preoperative functional statuses improve more than patients who had a higher preoperative level of function. Contrasting developed country cohorts, however, all Dominican tertiles had similar one-year follow-up outcomes regardless of their baseline WOMAC function status, suggesting that poor preoperative function may not limit absolute scores at one-year follow-up. Additional research is needed to confirm these findings in other developing countries and to understand why these associations vary between patients in the D.R. and patients from developed countries.
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Adindu, Anthonia U. "The effect of incongruity on quality of health information systems : Bama, Nigeria PHC case study." Thesis, University of Hull, 1995. http://hydra.hull.ac.uk/resources/hull:3692.
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Generally, organisations mobilise information from varying sources on which policies, plans, objectives and organisational management are predicated. indeed, everyone within organisation needs information to perform tasks, it is thus indispensable and its use so pervasive that a methodical approach for collection and processing is imperative. In health care organisations, involved with people and life, this is even of greater significance, in many instances allowable margin of error is narrow and can be devastating.Accurate and reliable information in clinical care for example cannot be compromised.On the other hand, adequate assessment of health services quality,effectiveness and efficiency depends on quality of information generated by the system, that is, accurate, relevant, timely, understandable and complete information. To achieve this, appropriate system design and operation is essential. Adoption of primary health care (PHC), in many developing countries in response to the Global 2000, necessitated establishment of chanisms for monitoring and evaluating effectiveness of services and programmes.Accordingly, in 1986 PHC was adopted in Nigeria, concomitantly, system monitoring and evaluation or the PHC Management Information System was effexted.The information system was envisaged to ameliorate the lack of reliable health information that has persisted since nception of modern health services in Nigeria. Findings in this and other studies indicate that existing health information systems have failed to provide accurate and reliable information, systems of data generation and processing are ineffective.The aim of this was to identify and understand factors that have contributed to the seemingly intractable and insalubrious information problem within the Nigerian health care system. It would be a herculean task for a lone researcher to undertake study of the entire health system, within resource and time limitations, data collection was therefore narrowed to the PHC level. Quality of the PHC management information system was assessed, with Bama Local Government as a case study. Focus was on understanding the information system's structure from a broad perspective to include, policies, objectives,established procedures; physical, material and human resources, in terms of their quality and quantity.Data collection was carried out using both qualitative and quantitative techniques. The structure, process and outcome models provided a framework for in-depth data collection, through observation, interview, review of records and administration of questionnaire, as well as for organisation and analysis of research data. The PHC MIS was followed through, from the village, health facility, local government, state and national levels.Study results suggest general ineffectiveness due to pervasive incongruity in the information system. In the first instance design of the MIS did not reflect information needs of community health workers and the community in general,who to the most part limited appreciation of the MIS structure, objectives to be achieved. Local and regional information need was not delineated, data collected had little relevance to local information needs, resource for systems operation was abysmal, skilled personnel and training provided severely inadequate.Consequently, data collection and processing was hampered, information produced often inaccurate, untimely, immense, irrelevant and unreliable. Data collected were neither analysed nor utilised. The information system was short of being integrated since 60% of functional units within the PHC department as well as related health organisations in the community ran parallel information systems.Research data point to serious incongruity in the organisation and management of the information system. Incongruity that resulted from factors within the organisation as well derived from events within the wider social environment, which however culminated in an effective and dysfunctional information system.Chapters one to three of the thesis deal with conceptual issues related to management information systems, organisational design and quality respectively. In chapter four methodological issues surrounding data collection were discussed. Empirical data and analysis are presented are presented in chapters five to seven. In chapter eight, an attempt was made to develop a model of organisational incongruity, applied to explicate research findings.Chapter nine focuses on measures toward establishment of an effective PHC information system in Nigeria, contributions of this study and suggestions for future research.
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Lin, Yuh-feng, and 林裕峯. "Promotion of Medical Care Quality Through Internet Network and Medical Information." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/17355553007764631231.
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博士國立臺灣科技大學
管理研究所
102
In this dissertation, we address two health decision making projects, and both are implemented in TMU-SHH. In the first project, we implemented a drug refilling system, drive-through pharmacy service to the patients with a refilling prescription for chronic illnesses. The study is a hospital outpatient drug prescription level analysis that adopts a pretest-posttest control group experiment design. We analyze the changes in patient drug prescription behavior 6 months before and 6 months after the system was deployed to assess the efficacy of this new refilling system. An increase in the overall refilling prescription rate, with an increased use of online reservations (7.9% vs. 4.9%, p < 0.001), an increased proportion of medications picked up (93.0% vs. 88.1%, p < 0.001) were noted. Furthermore, an elevation in the percentage of patients using drive-through pharmacy services (45.4% vs. 28.9%, p < 0.001; second vs. first quarter, respectively) during the 6 months after the implementation period was found. After age-group analysis, we noticed that the middle-aged population group (40-65 years of age) utilizes the drive-through prescription service more than other age groups. Generally, the prescription refilling rate for all population categories at Shuang-Ho Hospital increased significantly after the drive-through service was provided (51.1% vs. 50.2%, p < 0.01). The drive-through pharmacy provides patients with convenient access to pick up refilling prescriptions within a shorter duration than ordinary pharmacy service. During a short-term follow-up, an overall increase in the prescription refilling rate was noted after the drive-through service was implemented. Our survey revealed that among the users, over 90% of the patients were satisfied with the drive-through service. In the second project, we use cloud-based manometers integrated to physician order entry systems to trace the patients’ blood pressure in assisting control renal function deterioration. Then, we investigated whether integrating cloud-based manometers and physician order entry systems benefit in our outpatient CKD patients compared with usual blood pressure tracing systems. A total of 36 participants with chronic kidney disease patients were randomly assigned to use cloud-based manometers integrate to physician order entry systems or usual blood pressure recording sheets to trace their blood pressure. The online blood pressure was seen weekly in the study group by physician and the antihypertensive medications will be adjusted in case of values higher than optimized level that is around 130/80mmHg. The composite outcome was patient’s blood pressure improvement and assessment of renal function deterioration. The patients were followed for 6 months. The systolic and diastolic blood pressure and renal function assessment were done during 0, 3 and 6 months after using,the integrated cloud-based manometers and usual blood pressure monitoring sheets are compared. Both the night time systolic and diastolic blood pressure were reduced significantly in the study group compared with control group. Serum creatinine level reduced significantly at 6th month in the study group. Glomerular filtration rate (eGFR) and proteinuria after using the integrated cloud-based manometers is also improved but did not reach significance statistically compared with the control group. Both systolic and diastolic blood pressures during night time significantly improve in the study group compared with baseline. Serum creatinine change from baseline is also found to be significantly reduced in the study group. In our knowledge, the above two projects were not implemented in Taiwan before. In conclusion, the first drive through prescription model improve the chronic prescription rate, first drive through rate and shorten the time to obtain regular medications. Cloud-based manometers integrated to physician order entry systems improve the blood pressure control and renal function preservation in chronic kidney disease patients. Two projects deserve future use and promote in the health care services, and may help physicians to improve patients’ therapeutic management and prognosis.