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Blakey, Heather. "Participation¿why bother?: The views of Black and Minority Ethnic mental health service users on participation in the NHS in Bradford. Report of a community research process undertaken by the International Centre for Participation Studies, University of Bradford and Sharing Voices (Bradford)." International Centre for Participation Studies, 2005. http://hdl.handle.net/10454/3798.
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YesThe International Centre for Participation Studies and Sharing Voices Bradford (for information on these organisations, see Appendices 3 and 4) maintain that participation is an important part of a healthy democracy, with benefits for all. However, participation can be anything from empowering to tokenistic, and must be critically examined if we are to understand how to use it effectively. This paper considers the contribution of participation to improved service delivery in the health service. For beneficiaries, participation can be about ownership and responsibility for the services we use, as well as rights and the chance to express what we want from them. For service providers, participation is widely recognised as an effective way of tailoring services to the needs of the different communities they serve. The NHS and other service providers have made great strides in developing mechanisms for participation by service users. However, these do not always reach all sections of the community. Many individuals feel sceptical about getting involved, unconvinced that their contribution could make a real difference. Through the Participation ¿ Why Bother? workshops, we set out to explore these feelings, to reflect on perceived barriers and identify changes that might help overcome them. The aim was not to look at the substance of service delivery issues, but to try and work out how the process of involving people in decision-making in the NHS could be improved, to make it easier for voices from Black and Minority Ethnic (BME) communities to be heard.
Bradford District Care Trust; South and West PCT; City tPCT
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Buckley, Tyra T. "Delivery of Asthma Management Services by a Federally Qualified Health Center in an Urban Setting." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/iph_theses/145.
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As a chronic disease, asthma presents a significant public health challenge nationally and in Georgia. In 2007, over 22 million people, including over 9 million children, had asthma in the United States. In Georgia, 230,000, or 10% of children have asthma, which is more prevalent among children less than 18 years of age than among adults. While asthma affects people of all ages and socioeconomic status, low income and minority populations have the highest asthma morbidity. This has proven to be the case with residents of Neighborhood Planning Unit V (NPU-V), a low-income minority community located in southeast Atlanta. Children comprise 35% of NPU-V's population, and over half of them live below the poverty line. Among other concerns, children with asthma have higher rates of hospitalization and absenteeism from school than their peers. The hospitalization rates for children with asthma in South Atlanta aged 0-17 years of age is almost five times the rate of North Fulton County. The Georgia State University Institute of Public Health received grant funding for the planning and implementation of the Accountable Communities: Healthy Together-Asthma (ACHT-A) program to help address the problems associated with asthma in NPU-V and among patients of Southside Medical Center (SMC). The capstone project involved development of an evaluation plan for future determinations about the program’s effectiveness in achieving desired outcomes. The evaluation process included development of a logic model and putting systems in place to track and measure specific indicators. The project culminated in a preliminary assessment of selected program activities to establish baseline information for the program, its participants, and SMC staff.
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Carpenter, Tyler, and Kate Beatty. "Demographic Fall Predictors in a Rural Level One Trauma Center." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6865.
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Falls are the number one mechanism of injury for The Trauma Center and Johnson City Medical Center (JCMC TC). JCMC TC is one of two level one trauma centers in the region and one of only six in the state. The main method for trauma prevention is outcome specific education and awareness. Injury prevention education is a critically needed area in the field of trauma and emergency care. Falls are the number one cause of injury in populations age >65. Socioeconomic status, age, gender, and race are all mitigating factors in the likelihood of greater length of stays, death in hospital, and death within one year of discharge for those who fall in a home setting. According to the CDC, people over the age of 75 are four to five times more likely than people under 75 to be admitted to a long-term care facility for more than a year. What is the relationship between patient characteristics and fall related outcomes in a level one trauma center? We looked at associations between patient demographics and associated outcomes for those admitted to the trauma center secondary to a ground level fall (GLF) in the home. Dataset: De-identified National Trauma Databank information was compiled by the JCMC Registrar for the past 8 years for the metrics: Injury Severity Score (ISS), length of stay, 48hr readmission, and disposition (home, nursing home, skilled nursing facility (SNF)).Demographic information, along with mechanism of fall, was collected for each patient. Patient age, gender, and date of injury was all used for statistical analysis and trend recognition. Statistical Analysis: Bivariate analyses included independent samples t-tests and Oneway ANOVA to find differences between groups. Results: T-test results show women are significantly more likely than men to be admit for a ground level fall (p<.001) and those with a higher ISS are more likely to have an extended stay in an inpatient setting (p<.001). One-Way ANOVA analysis of collected data shows an annual increase from 2006-2013 of trauma admissions for ground level falls (p<.01). Eight year analysis showed a two-fold increase in these admissions. Over 30% of patients admitted with a GLF are discharged to a SNF leading to higher societal costs due to Medicare reimbursement rates. Diagnosis related groups codes (DRG) dictate Medicare reimbursement rate of $14,091 per patient with an average facility cost of $14,196 per patient with no readmissions (Unplanned readmission within 180 days occurred at a rate of 8.3%). Conclusion: Fall education programs are necessary and needed in rural level one trauma centers to educate citizens on causes and methods of preventing falls in their homes. A decrease in these falls would lead to an increase in productive years of life and a reduction in strain on the hospital system.
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Van, Slingerland Krista. "Design, Implementation, and Evaluation of a Sport-Focused Mental Health Service Delivery Model Within a Canadian Centre for Mental Health and Sport." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42792.
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The overall aim of this Participatory Action Research (PAR; Chevalier & Buckles, 2013; Lewin, 1946) project was to design, implement, and evaluate a specialized sport-focused mental health service delivery model for competitive and high-performance athletes, integrated within a broader Canadian Centre for Mental Health and Sport (CCMHS). A transformative mixed methods research design (Cresswell, 2014) guided by the PAR approach was employed across three phases during which (a) a sport-specific mental health service delivery model for competitive and high-performance athletes was collaboratively designed by stakeholders (Design Phase [Study 1]), (b) the model was pilot-tested within the CCMHS (Implementation Phase [Study 2]), and (c) the model was evaluated to understand whether practitioners and service-users perceived the care delivered / received within the model to be acceptable and appropriate (Evaluation Phase [Study 3]). Design Phase (Study 1). The purpose of study 1 was to (a) perform an environmental scan of the Canadian mental health care and sport contexts, and (b) design a sport-focused mental health service delivery model for competitive and high-performance athletes within a broader CCMHS. To meet these objectives, 20 stakeholders from the sport and mental health sectors explored (a) the availability and effectiveness of mental health care for competitive and high-performance Canadian athletes, and (b) the strengths, weaknesses, opportunities and threats associated with creating a CCMHS, via two iterations of stakeholder-led focus groups (Rio-Roberts, 2011). The resulting data informed a subsequent Group Concept Mapping (GCM; Burke et al., 2005; Kane & Trochim, 2007; Rosas & Kane, 2012) activity undertaken by stakeholders, which produced an actionable framework (i.e., concept map) organized into six clusters that visually represented the elements (e.g., services, personnel, organizational structures) that stakeholders deemed important to include in the sport-focused mental health care model (e.g., bilingual services, a triage system, sport-specialized practitioners). In addition, the results revealed that misconceptions about the competitive and high-performance population’s mental health and experience of mental illness were widespread and required clarification before significant advances could be made. This led the group to develop six principles designed to establish a common language and understanding upon which to build effective models of mental health care, improved programming, and strategic education for Canada’s competitive and high-performance athletes, coaches, and organizations (Article 1). The framework that emerged from the GCM activity served to guide the remainder of the project, and supported actions (e.g., develop eligibility criteria to access services, hire a team of mental health practitioners with sport competencies [i.e., CCMHS Care Team]) to build the CCMHS and test the model during the Implementation Phase (Article 2). Implementation Phase (Study 2). The purpose of study 2 was to pilot test the mental health service delivery model designed during the first phase of the research project. To do so, an illustrative case study (Keegan et al., 2017; Stake, 1995, 2005) was carried out to demonstrate how (i.e., intake, referral, and service delivery processes) the CCMHS Care Team provided mental health care to a high-performance athlete, and what outcomes resulted from this process. Data to inform the case study was gathered through a review of the service-user’s clinical documents (e.g., intake summary, session notes), and qualitative interviews (n = 2) with the athlete’s Collaborative Care Team lead and the CCMHS Care Coordinator. Document analysis (Bowen, 2009) was used to organize the details of the case found within clinical documents under the categories of the case study framework (i.e., intake and referral process, service-user description, integrated care plan, and outcomes), while a conventional descriptive content analysis (Hsieh & Shannon, 2005) served to extract salient data from the interviews to further build out the case study. Results revealed that sport significantly influenced the onset and experience of mental illness for the athlete service-user. The lead practitioner’s sport-specific knowledge played a significant role in the diagnosis, treatment and recovery of this athlete given the nature of the athlete’s concerns and high athletic identity. Findings support the notion that specialized mental health care models and teams are necessary to address sport-related factors that can pose unique threats to the diagnosis and treatment of mental illness in athletes (Article 3). Implementation Phase (Study 3). The purpose of study 3 was to evaluate the acceptability and appropriateness of the mental health service delivery model designed during Phase 1 and implemented during Phase 2. Qualitative data from three sources (CCMHS practitioners, CCMHS service-users, and CCMHS stakeholders) were collected and analyzed using a multi-step, multi-method process, including16 one-on-one semi-structured interviews with CCMHS practitioners (n = 10) and service-users (n = 6), and a meeting with CCMHS stakeholders (captured via meeting minutes). In addition, 47 documents (e.g., clinical, procedural) created during the implementation phase of the project by CCMHS team members (i.e., practitioners, stakeholders, members of the board of directors) were used to triangulate the other data (Carter, Bryant-Lukosius, DiCenso, Blythe, and Neville, 2014). The Framework Method (Gale et al., 2013; Ritchie and Spencer, 1994) was used to analyze, synthesize, integrate, and interpret the dataset. The deductive data analysis approach taken was guided by the seven components of acceptability developed by Sekhon and colleagues (2017), and the Canadian Medical Association’s definition of appropriate care. Findings showed that the care provided and received within the CCMHS service delivery model was perceived to be acceptable and appropriate, and each component of the model uniquely contributed to practitioner and service-user experiences. For example, the collaborative interdisciplinary approach contributed to the ethicality of the model, promoted the professional development of team members, and enabled Pan-Canadian service provision. The sport-centered nature of care was perceived to enhance the ethicality of services delivered, effectiveness of care, and affective experience of service-users. Implications for further research and practice were discussed in light of areas of the model that emerged as needing improvement (e.g., prohibitive cost of care, practitioner burden from collaborative processes and procedures). Overall, the findings of the research project demonstrate that collaborative approaches to inquiry and practice can be successfully applied in sport to guide stakeholders in developing and testing novel models to improve the health outcomes of sport participants. The research also shows that an interdisciplinary team of practitioners can successfully deliver sport-focused mental health care that is acceptable and appropriate to service-users. Lastly, the project provides data on the first known empirical project to design, implement and evaluate a specialized mental health service delivery model applied nationwide in person and virtually with competitive and high-performance athletes experiencing mental health challenges and symptoms of mental illness.
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Bolton, Mychal. "Perceived Barriers to Obtaining Psychiatric Treatment at Johnson City Community Health Center." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/honors/223.
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The purpose of this study was to describe the perceived barriers to obtaining psychiatric treatment at the Johnson City Community Health Center. The context of the study was a rural area in Eastern Tennessee. Five patients with confirmed DSM-IV mental health diagnoses were recruited during treatment and interviewed at the Johnson City Community Health Center after their scheduled appointments with a Mental Health Nurse Practitioner (MHNP). The semi-structured interview focused on perceived barriers to obtaining treatment, perceptions of treatment received, and perceived availability of treatment. From those interviews, two themes were identified and each of which had two sub-themes identified: Realities of Treatment with the sub-themes of Therapy-Related Realities and Logistics Realities, The Way It Is with the sub-themes of Take Care of It Myself and Don’t Want People to Know. The findings indicate that there is a duality of positive and negative aspects of treatment at Johnson City Community Health Center. Understanding the needs and perceptions of those with psychiatric diagnoses will assist all staff and mental health providers in developing programs that are better suited for those with psychiatric diagnoses receiving treatment from Johnson City Community Health Center.
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Wenn, Janice. "Kaupapa hauora Māori : ngā whakaaro whakahirahira o ngā kaumātua : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Māori Studies at Te Pumanawa Hauora Research Centre for Māori Health and Development, Massey University, Wellington, Aotearoa/New Zealand." Massey University, 2006. http://hdl.handle.net/10179/995.
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There is a requirement for all services within the New Zealand health system to be accredited with an established quality organisation and to demonstrate an ability to provide a measurable quality service to consumers. For Māori these requirements must make sense in Māori terms. This thesis is based on the view that, for Māori, the concept of health is more effectively expressed as hauora - optimal health and wellbeing for Māori. This thesis makes five contributions to Māori health and Māori health research. First, it identifies a responsive approach to engaging kaumātua effectively in the process of qualitative research. Second, it identifies a fundamental underlying conceptual framework – kaupapa hauora Māori as a means of understanding hauora – expressed in terms derived from kaumātua in Taranaki and Kahungunu. Third, it adapts this conceptual framework into an analytical research framework and then applies it to allow kaupapa hauora Māori (described in terms of worldview, values and ethics) to be identified from a range of data. Fourth, it critically analyses popular models of Māori health – Te Whare Tapa Whā, Te Wheke and Ngā Pou Mana. Finally, it proposes and details post-doctoral research that will translate kaupapa hauora Māori into a quality services framework/tool. “Kaupapa Hauora Māori” is a conceptual framework articulated by kaumātua, and has its origins in te ao Māori, from which the aronga or worldview is developed. The aronga is composed of the kaupapa or values and tikanga or ethics that provide kaumātua with the values base of hauora. These components have been identified by kaumātua and not only inform the concept of KHM but also inform the analytical research framework that is applied to the data. The values have been identified as a core set of values comprising whakapapa, wairua, whenua, whānau, tikanga te reo Māori, tinana, and hinengaro, and the associated tikanga is expressed as behaviour or ethics. These, together, influence the perception and understanding individuals have of their world and of hauora.
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Quick, Cynthia L. "Measuring Change in University Counseling Center Students: Using Symptom Reduction and Satisfaction with Services to Propose a Model for Effective Outcome Research." Thesis, University of North Texas, 1999. https://digital.library.unt.edu/ark:/67531/metadc2268/.
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This study proposes a model for meeting increasingly mandated outcome research objectives in a university counseling center setting. It is proposed that counseling centers utilize their existing intake forms, along with an annual satisfaction survey to determine the effectiveness of counseling services. Effectiveness is defined as improvement and measured by the reduction of the symptoms or presenting concerns with which the client initially presented. It also introduces the Relative-Change Index (R-Chi) as an objective way to quantify intra-individual change occurring as a result of therapy. This new mathematical procedure allows for a more meaningful assessment of the client's degree of improvement, relative to their potential for improvement. By re-administering the problem checklist, routinely included as part of the initial paperwork for each client at intake, again post-therapy, it is possible to quantify improvement by measuring the difference in distressing concerns. Additionally, including a subjective, retrospective survey question asking the client to indicate their perceived rate if improvement at follow-up provides construct validity and allows for correlational comparisons with R-Chi. Results suggest that student/client ratings of the degree to which the services they received satisfactorily addressed their presenting concerns were significantly rated to their R-Chi score. This model suggests that the framework guiding client outcome research should include measures of the client's level of distress, improvement in reducing the distress, and satisfaction with services.
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Belcher, Michael D. "The Impact of a Rural School-Based Health Center on Students and Their Families in Sneedville, Tennessee: A Case Study." [Johnson City, Tenn. : East Tennessee State University], 2004. http://etd-submit.etsu.edu/etd/theses/available/etd-0331104-125143/unrestricted/BelcherM040804f.pdf.
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Thesis (Ed. D.)--East Tennessee State University, 2004.Title from electronic submission form. ETSU ETD database URN: etd-0331104-125143. Includes bibliographical references. Also available via Internet at the UMI web site.
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Hernández, Alison. "Enabling the performance of nurses in rural Guatemala : the role of relationships." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-95114.
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Background: Enhancing the performance of front-line health workers serving vulnerable populations is crucial for redressing inequities. Traditional approaches have focused on introducing technical solutions, such as guidelines and incentives, to modify performance outcomes. Recognition of the complex social nature of health system function draws attention to the intangible software elements that shape performance, including the values, ideas, interests, and norms that guide human behavior and interactions. Insight into the operation of software elements can provide a base for people-focused solutions to support health workers and enable them to confront constraints in low resource settings. This study examines the social environment of the practice of front-line auxiliary nurses (AN) in rural Guatemala, in order to understand the role of health system software elements in enabling their performance and to gain insight into how organizational support can be strengthened through locally-relevant actions. Methods: A mixed methods approach provided a multi-level view of the AN practice environment, situated in the regional health system of the rural department of Alta Verapaz. Interviews with ANs and observations of practice were conducted to understand the values orienting them and how these shaped their relationships with patients and communities. A theory-driven case study of AN supervision was conducted in selected health posts to understand the values orienting supervisors in their role and examine how these shaped their relationships with ANs. The participatory method of concept mapping was used to examine the views of health workers, district and regional managers on actions to strengthen organizational support for the performance of ANs. Results: The values of nursing vocation and community connectedness were prominent in ANs’ interpretations of their work. In relationships, nursing principles oriented them to be attentive to understanding patient needs, and a shared ethnic identity and personal experience of local needs served as a base for engaging with local leaders in community work. The dominant orientation of supervisors in their role was managerial control, and it provided limited support. It contributed to standard-centered relationships with ANs focused on fulfillment of ministry criteria. Supervision oriented by a holistic understanding of ANs’ needs and the goal of improving patient care was more successful in enabling AN motivation. This relationship was characterized as people-centered, based in a shared interpretation of the value of work with patients and the responsive support provided to ANs’ problems. “Organizational climate of support across levels”, where working relationships are characterized by respectful treatment, attention to psycho-social well-being and responsiveness to needs, was identified by health-system actors as a top priority for improving performance. Conclusions: To enable performance, there needs to be a balance between attention to standards and attention to the human dimensions of health worker practice. The dominant approach to supervision did not recognize or build on AN values. Supervision and management should be oriented by a more holistic view of the ANs’ work and their needs, in order to promote a people-centered approach to working relationships. Locally relevant action to strengthen district and regional management’s support for AN performance should focus on operationalizing performance goals that go beyond standards to encompass care that responds to patient and community needs.
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Iyengar, Reethi. "Factors Associated with Hospital Entry into Joint Venture Arrangements with Ambulatory Surgery Centers." VCU Scholars Compass, 2011. https://scholarscompass.vcu.edu/etd/2436.
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This study presented an empirical analysis of the key market, regulatory, organizational, operational and financial factors associated with hospital entry into joint venture (JV) arrangements with Ambulatory Surgery Centers (ASCs) as examined through the framework of resource dependency theory complimented with neo-institutional theory. This study used a cross sectional design to examine hospitals that entered into a joint venture arrangement with ASCs in 2006 and 2007. The data for this study were drawn from five main sources: the American Hospital Association Annual Survey (AHA), the Area Resource File (ARF), the CMS (Center for Medicare and Medicaid Services) minimum dataset, the National Legislative Assembly Website and the CM case-mix files. Descriptive analysis and multivariate logistic regression were performed to examine the association of various factors in this study. The study found that market factors such as unemployment rate and percentage of elderly were strongly associated with the hospitals decision to joint venture with ASCs. Also organizational size (measured by bed size) was a significant factor in these decisions. Other factors which showed a marginal significance were Herfindahl-Hirschman Index, number of ASCs, certificate of need laws, ownership status, and operating expense per adjusted discharge of the hospital. This research project sheds light on joint venture arrangements between hospitals and ASCs at a very opportune time. In light of the new Health Reform Legislation, studying hospital-ASC joint ventures is very important. For hospitals and ASCs, and their collaborative interests such as joint ventures, Accountable Care Organizations (ACO’s) could either provide incentives to help improve quality of care to patients or stint on needed care by making them focus narrowly on higher margin services (Fisher and Shortell 2010; Shortell and Casalino 2010). Since policy measures should encourage the first and not the second outcome, it is important to have a transparent performance measurement system that can win the confidence of the provider organizations such as hospitals and ASCs. Lacking which, it may discourage joint venture arrangements between hospitals and ASCs in future.
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Andrade, Marta Campagnoni. "Avaliação da organização assistencial de unidades básicas de saúde no Estado de São Paulo: uma análise a partir dos resultados e aplicação do QualiAB 2010." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-25102017-114401/.
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O movimento de reafirmação da importância da Atenção Primária à Saúde (APS) nas primeiras décadas deste século ressaltou a necessidade de qualificação dos serviços deste nível de atenção, impulsionando iniciativas de avaliação e monitoramento. No Brasil, correspondeu à implantação da Estratégia Saúde da Família (ESF). No Estado de São Paulo, implantou-se a ESF em uma rede de APS já organizada segundo Programas de saúde. A convivência entre esses dois modos de organizar e operar os serviços gerou grande diversidade de estruturação assistencial da APS.O objetivo desse estudo foi avaliar a capacidade de resposta de serviços do interior do Estado de São Paulo, a necessidades de saúde classicamente reconhecidas como próprias da APS. Os dados utilizados são provenientes do banco de respostas de 2.735 serviços ao questionário QualiAB - Avaliação da Qualidade e Monitoramento da Atenção Básica, composto por 85 questões de múltipla escolha. O quadro avaliativo Capacidade de resposta em APS resultou de determinadas questões do QualiAB, organizadas em 3 domínios: Disponibilidade de recursos (4 subdomínios: 59 indicadores), Operação direta da assistência (4 subdomínios: 50) e Gerenciamento Trabalho (3 subdomínios:25), cujo total resultou em 122 indicadores. Toda resposta positiva correspondeu ao valor 1. A média geral obtida foi 56,6%. Pelos testes de Friedman e Dunn, o domínio Disponibilidade de recursos teve maior contribuição no desempenho, seguido dos domínios Gerenciamento técnico do trabalho e Operação direta da assistência. Os três domínios mostraram correlação positiva (teste de Spearman). As k-médias dos subdomínios constituíram dois grupos de desempenho: Capacidade Satisfatória de resposta (CS), com 39% (1065) dos serviços estudados e o grupo Capacidade Insuficiente (CI), com 61% (1658). Para analisar a distribuição dos serviços nos grupos utilizou-se modelo de regressão logística que considerou como variáveis possivelmente associadas: população e índice de desenvolvimento humano (IDH) do município de localização do serviço, número de consultas do serviço, apoio técnico da gestão estadual, apoio financeiro da gestão estadual e arranjo organizativo, este último a partir daquelas formas de estruturação assistencial dos serviços. Os resultados mostraram que serviços de arranjo organizativo do tipo Mix Centro de Saúde - ESF, que realizam 800 ou mais consultas mensais, localizados em municípios com mais de 100 mil habitantes, que receberam apoio técnico adicional do Estado e de maior IDH mostraram maior chance de pertencer ao grupo de Capacidade Satisfatória de resposta. O apoio financeiro adicional do Estado não mostrou associação. Quando estas variáveis foram ajustadas apenas para serviços localizados em municípios com menos de 100 mil habitantes, o apoio financeiro contínuo desde 2000 mostrou associação, enquanto o IDH não mais se mostrou associado. Diante disto, conclui-se que a capacidade de resposta obtida foi baixa, comprometendo o papel esperado da APS. Arranjos organizativos que mesclem distintos modos de organizar e operar os serviços podem ser mais promissores. Medidas que busquem mitigar as desigualdades devem ser reafirmadas como políticas públicas, especialmente no caso de municípios de menor porte populacionalThe movement to reaffirm the importance of Primary Health Care (PHC) in the first decades of this century highlighted the need for qualification in the services of this level of care, fostering assessment and monitoring initiatives. In Brazil, this has corresponded to the implementation of Family Health Strategy (FHS). In the State of São Paulo, FHS was implemented within a PHC network already established according to heath Programs. The coexistence of these two ways of organizing and operating the services generated great diversity in care structuring within PHC. The objective of this study was to evaluate the response capacity of the services located on the countryside of the State of São Paulo to health needs classically regarded as being typical of PHC. The data utilized have come from a response bank to the QualiAB questionnaire - Primary Care Quality and Monitoring Evaluation comprising 85 multiple choice questions, from 2.735 services. The evaluative framework \'Response Capacity\' in PHC resulted from certain questions from QualiAB, organized in 3 dominions: Availability of resources (5 sub dominions: 51 indicators), direct assistance Operation (5 sub dominions: 50 indicators) and Work Management (4 sub dominions: 21 indicators), totaling 122 indicators. Every positive response corresponded to score 1. The overall average was 56,6%. According to Friedman e Dunn\'s tests, dominion Availability of resources had greater performance contribution, followed by dominions work\'s technical Management and direct assistance Operation. The three dominions showed positive correlations (Spearman\'s test). The sub dominions k-means comprised two performance groups: Satisfactory Capacity of response (SC), with 39% (1065) of services studied, and the Insufficient Capacity group (IC), with 61% (1658). In order to analyze the distribution of the services in the groups, a logistics regression model was utilized. This model considered the following variables as being possibly associated: population and human development index (HDI) of the service municipality, number of appointments in the services, technical support from the state government, financial support from state government, and an organizational arrangement based on models of care previously structured. Results showed that services whose organizational arrangements were Health Center-FHS mixed-type, with 800 or more monthly appointments, located in municipalities with more than 100 thousand inhabitants, receiving additional technical support from the state, and with a higher HDI showed higher probability of belonging to the Satisfactory Response group response. Additional financial support from the state did not show association. When those variables were adjusted only to the services located in municipalities with less than 100 thousand inhabitants, a continuous financial support since 2000 showed association, whereas HDI did not show association any longer. Therefore, it was concluded that the response capacity obtained was low, which compromised the expected role of PHC. Organizational arrangements combining different modes of organizing and operating the services might prove more promising. Measures seeking to mitigate inequalities must be reaffirmed as public policies, especially in the case of municipalities with smaller populations
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Walker, Lauryn. "Patient-Centered Medical Homes and Hospital Value-Based Purchasing: Investigating Provider Responses to Incentives." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/5796.
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Provider incentives are a commonly used policy tool to mold provider behaviors.1 However, while we frequently measure the change in patient outcomes, failure to consistently produce changes in outcomes does not mean that providers are not changing their behavior. This paper focuses on two programs with null or inconsistent quality outcomes to try to identify why such inconsistency occurs. The two programs, both ratified in the Affordable Care Act, are 1) patient-centered medical homes (PCMHs), and 2) the Medicare Hospital Value-Based Purchasing (HVBP) program.
Chapter 1: Using data from the Medical Expenditure Panel survey (MEPS), I match provider characteristic surveys to member experience with care in order to evaluate characteristics key to patient-centered medical homes. I find that patient-perceived patient-centeredness of a practice is not related to the number of PCMH attributes a practice reports. However, some characteristics do play specific and significant roles in patient perception and outcomes. For instance, case management is not only associated with increased patient perception of after-hours access to care, but overall costs were reduced. Interestingly, having after hours clinic hours was more common with practices highly consistent with PCMH criteria, but these hours did not result in decreased emergency department use or cost of care.
Chapter 2: The second provider incentive studied is the Medicare Hospital Value-Based Purchasing Program (HVBP). This program assigns payment adjustments based on performance on a series of rotating quality metrics. To date, changes in patient outcomes cannot be attributed to the program; however, it should not be concluded that hospitals are not responding at all. I identify changes in staffing by provider type as an early indicator of hospital response to payment incentives. Data come from the Virginia Health Information (VHI) Hospital Cost Report, 2010-2017. Using a generalized linear model, I find that when receiving a penalty, hospitals reduce staffing among the most and least expensive personnel (physicians and nursing aides). Hospitals increase nursing and administrative staff following a bonus. These findings are consistent with hospitals responding to incentives both by aiming to improve efficient use of resources and maintain or improve quality of care.
Chapter 3: Finally, I assess potential unintended consequences of the HVBP program, specifically the provision of charity care. Using the VHI cost reports for year 2013 to 2017 with a regression discontinuity model, I find that hospitals receiving a bonus decrease their charity care among the lowest income patients (under 100% federal poverty level (FPL)). Hospitals receiving a penalty tend to reduce charity care among higher income patients (100%-200% FPL). These findings are consistent with two separate responses to the incentives. Hospitals receiving bonuses appear to be cream-skimming healthier, wealthier individuals while hospitals receiving penalties appear to be shifting the focus of their charity care to the most needy, likely in an effort to reduce cost of care levels overall while maintaining their community benefit programs, potentially as a result of goal gradient cognitive bias.
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Al, Thunaian Saleh A. "Exploring the use of the Balanced Scorecard (BSC) in the healthcare sector of the Kingdom of Saudi Arabia: Rhetoric and reality. Evaluate understanding the five perspectives of the BSC. Evaluating the understanding of linkage between the BSC and strategy of the hospital. The reality of the implementation of BSC in KFSH." Thesis, University of Bradford, 2013. http://hdl.handle.net/10454/6290.
Full textAbstract:
This thesis aims to evaluate the implementation of the Balanced Scorecard (BSC) based on a case organization; the King Faisal Specialist Hospital and Research Centre (KFSH-RC). The study is an exploratory investigation. Understanding BSC perspectives is important for academic comprehension and is crucial for successful implementation. BSC at KFSH-RC includes five main perspectives: Quality of Care; Medical Care; Employees; Financial; and Education and Research (learning and growth). The thesis tackles two main anecdotal, practice-based arguments: BSC helps achieve business strategy, and the implementation of BSC has often fallen short of the assertions made about its potential for impact. A case study with a triangulation approach is justified and pursued. This study contributes to the literature in different ways. The application of the BSC has received limited attention in healthcare organisations in general, and in the Middle East and North Africa (MENA) in particular, and may be one of the first to explore such issues, across management and professional groups, to research BSC in the healthcare organisation in the KSA. It distinguishes between the understanding of financial and non-financial perspectives; and the researcher has developed a conceptual framework, which reflects the main elements of BSC implementation.
Quantitative data analysis from the case study indicates that staff members at the KFSH possess only a shallow understanding of various BSC perspectives. The study revealed a consistent lack of understanding of BSC by the department employees, due to their lack of interest. The results show that performance measures following the implementation of BSC created no significant improvement. It also confirms that even some senior managers face difficulties understanding BSC perspectives. The qualitative-based findings indicate that the level of understanding of BSC for clinical services is not significantly different from that for non-clinical services; staff members of the KFSH resist the implementation of BSC in the early stages; and there is ¿autocratic¿ leadership style at the KFSH inhibited the flow of information. The power distance and autocratic leadership style, in combination with an inadequate launch of BSC, fail to follow the implementation steps recommended by both Kaplan and Norton (2001a) and Kotter (1996). These organisational dynamics, it will be argued, are understated in the original BSC methodology, a view consistent with the findings of Woodley (2006) and may be especially so in environments with strong professional norms such as hospitals. The implications for the study and practice of non-profit organisations wishing to adopt methodology developed initially in a commercial context, is considered.Minister of Higher Education, Dr. Khalid Al-Angari (Saudi Arabia)
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McLaren, Stuart Joseph. "Noise in early childhood education centres: the effects on the children and their teachers : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Wellington, New Zealand." Massey University, 2008. http://hdl.handle.net/10179/977.
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Although the effects of noise on children’s learning in school classrooms is well documented, there is very little on the effects of noise on preschool children. There are strict legal requirements for the daily noise exposure an adult worker can received in the workplace but nothing to control the noise children can receive in school and early education. There is also little or no data on how sound affects a child, compared to an adult. The early years of life are critical for the development of speech, hearing and auditory processes, as well as being the most vulnerable time for middle ear infections. This work sets out to determine the typical noise levels in early childhood centres and the effects on a range of children and their teachers. Reverberation times in most centres were found to well exceed the 0.6 seconds prescribed by the Australasian standard for schools and learning spaces. Very high levels of noise were recorded in a number of centres with a significant number of children and staff members, exceeding the maximum daily sound exposure of 100% permitted for workers in industry. A range of special needs children were identified as being particularly at-risk to noise, with the most adverse outcomes reported for those experiencing sensory integration disorder. Yet, even though high levels of noise were recorded, the majority of respondents in a survey of teachers rated the lack of sufficient space for the number of children present as the main issue, and inclement weather as the greatest environmental condition contributing to noise (by confining children indoors, especially over long periods of time). Hearing tests on the children were not permitted under the strict human ethics criteria to which this study had to conform, but simple hearing tests on a small group of teachers, revealed that hearing loss could be a serious occupational health issue. The legal issues of noise control and management in early childhood education have been addressed in this thesis, current legal frameworks reviewed, and recommendations presented for future consideration.
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Nasi, Cíntia. "O cotidiano de usuários de um centro de atenção psicossocial na perspectiva da sociologia fenomenológica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2009. http://hdl.handle.net/10183/15602.
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Essa investigação está inserida no âmbito da cotidianidade dos usuários de um Centro de Atenção Psicossocial (CAPS), serviço substitutivo ao modo asilar. Os pressupostos dos CAPS destacam o atendimento aos sujeitos em sofrimento psíquico, visando a reabilitação psicossocial. Esta pesquisa tem como objetivo compreender o Cotidiano de usuários de um CAPS na perspectiva da Sociologia Fenomenológica. Trata-se de um estudo qualitativo, tendo como referencial teóricometodológico a sociologia fenomenológica de Alfred Schutz. O campo do estudo foi um CAPS no município de Porto Alegre e os sujeitos entrevistados constituíram-se em 13 usuários. A coleta de dados ocorreu nos meses de abril a junho de 2008, por meio de entrevista fenomenológica com a questão norteadora "Fale para mim o que o(a) senhor(a) faz nos seus dias". Na análise compreensiva dos depoimentos emergiram cinco categorias concretas, nas quais se pode compreender que o usuário vivencia o seu cotidiano: experienciando o sofrimento psíquico; desempenhando diversas atividades; considerando o CAPS como uma dimensão do seu cotidiano; destacando o trabalho como relevância intrínseca; estabelecendo relações sociais. Com essa pesquisa pôde-se compreender as concepções que os usuários têm acerca do seu cotidiano, demonstrando que estão (re)adquirindo o convívio social em diversos espaços da sociedade. Assim, os CAPS estão promovendo, além do atendimento, a reabilitação psicossocial dos seus usuários, na medida em que estes estabelecem diversas ações, relações sociais, ocupacionais e de lazer, propiciadas pelo modo psicossocial.This research is inserted in the ambit of the quotidianity of users of a Psychosocial Care Center (CAPS), which is a substitutive service to asylums. CAPS's suppositions highlight the care to the subjects who have psychological stress, aiming psychosocial rehabilitation. This research has the objective of understanding the CAPS users' quotidian, to the light of phenomenological sociology. It is a qualitative study, which follows the theoretical and methodological references from Alfred Schutz's phenomenological sociology. The field of study was a CAPS in Porto Alegre City, Rio Grande do Sul State, Brazil; and 13 users of it were interviewed, being the subjects of the study. Data collection occurred from April to June 2008, by phenomenological interview with the guiding question: "Tell me what you do in your days". In the comprehensive data analysis, it emerged five categories, from which it is possible to comprehend that the user lives his quotidian: experiencing psychological stress, developing several actions, considering CAPS as a dimension of his quotidian, highlighting work like an intrinsic relevance, establishing social relationships. Whit this research, it is possible to understand the conceptions the users have about quotidian, which shows they are (re) acquiring social relationships in various aspects of society. Thus, CAPS are promoting, in addition to care, the psychosocial rehabilitation of their users, in the way that they are establishing many kinds of actions, social, occupational and recreational relations, propitiated by the psychosocial way.
Esta investigación se inserta en el ámbito de la cotidianeidad de los usuarios de un Centro de Atención Psicosocial (CAPS), un servicio alternativo al del psiquiátrico. Los presupuestos de los CAPS destacan la atención de los sujetos con sufrimiento psíquico teniendo como fin la Rehabilitación Psicosocial. Esta investigación tiene como objetivo comprender la cotidianeidad de los usuarios de un CAPS en la perspectiva de la Sociología Fenomenológica. Se trata de un estudio cualitativo, cuyo referente teórico-metodológico es la sociología fenomenológica de Alfred Schutz. El campo de estudio fue un CAPS del municipio de Porto Alegre, en el que fueron entrevistados 13 usuarios del mismo. La recolección de datos tuvo lugar entre abril y junio del 2008, y fue realizada mediante una entrevista fenomenológica con una cuestión orientadora: "Hábleme de lo que el/la señor/a hace en sus días". Luego del análisis de las declaraciones, emergieron cinco categorías concretas, en que el usuario: presenta sufrimiento psíquico determinado en su cotidianeidad; desempeña acciones en su cotidianeidad; considera el CAPS como una dimensión de su cotidianeidad; destaca el trabajo como una relevancia intrínseca en su cotidianeidad; establece relaciones sociales en su cotidianidad. Con esta investigación se puede comprender las concepciones que los usuarios tienen de su cotidianeidad, demostrando que están (re)adquiriendo la convivencia social en diversos espacios de la sociedad. De esa manera, los CAPS están promoviendo además del atendimiento, la rehabilitación psicosocial de sus usuarios, en la medida en que estos establecen diversas acciones, relaciones sociales, ocupacionales y de placer, propiciadas por el modo psicosocial.
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Al, Thunaian Saleh Abdulrahman. "Exploring the use of the Balanced Scorecard (BSC) in the healthcare sector of the Kingdom of Saudi Arabia : rhetoric and reality : evaluate understanding the five perspectives of the BSC : evaluating the understanding of linkage between the BSC and strategy of the hospital : the reality of the implementation of BSC in KFSH." Thesis, University of Bradford, 2013. http://hdl.handle.net/10454/6290.
Full textAbstract:
This thesis aims to evaluate the implementation of the Balanced Scorecard (BSC) based on a case organization; the King Faisal Specialist Hospital and Research Centre (KFSH-RC). The study is an exploratory investigation. Understanding BSC perspectives is important for academic comprehension and is crucial for successful implementation. BSC at KFSH-RC includes five main perspectives: Quality of Care; Medical Care; Employees; Financial; and Education and Research (learning and growth). The thesis tackles two main anecdotal, practice-based arguments: BSC helps achieve business strategy, and the implementation of BSC has often fallen short of the assertions made about its potential for impact. A case study with a triangulation approach is justified and pursued. This study contributes to the literature in different ways. The application of the BSC has received limited attention in healthcare organisations in general, and in the Middle East and North Africa (MENA) in particular, and may be one of the first to explore such issues, across management and professional groups, to research BSC in the healthcare organisation in the KSA. It distinguishes between the understanding of financial and non-financial perspectives; and the researcher has developed a conceptual framework, which reflects the main elements of BSC implementation. Quantitative data analysis from the case study indicates that staff members at the KFSH possess only a shallow understanding of various BSC perspectives. The study revealed a consistent lack of understanding of BSC by the department employees, due to their lack of interest. The results show that performance measures following the implementation of BSC created no significant improvement. It also confirms that even some senior managers face difficulties understanding BSC perspectives. The qualitative-based findings indicate that the level of understanding of BSC for clinical services is not significantly different from that for non-clinical services; staff members of the KFSH resist the implementation of BSC in the early stages; and there is 'autocratic' leadership style at the KFSH inhibited the flow of information. The power distance and autocratic leadership style, in combination with an inadequate launch of BSC, fail to follow the implementation steps recommended by both Kaplan and Norton (2001a) and Kotter (1996). These organisational dynamics, it will be argued, are understated in the original BSC methodology, a view consistent with the findings of Woodley (2006) and may be especially so in environments with strong professional norms such as hospitals. The implications for the study and practice of non-profit organisations wishing to adopt methodology developed initially in a commercial context, is considered.
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Camatta, Marcio Wagner. "Vivências de familiares sobre o trabalho de uma equipe de saúde mental na perspectiva da sociologia fenomenológica de Alfred Schutz." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2008. http://hdl.handle.net/10183/13053.
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Desde o nascimento da psiquiatria, a participação da família no tratamento dos indivíduos em sofrimento psíquico tem sido pouco encorajada. Tendo em vista os recentes avanços alcançados pelo movimento da reforma psiquiátrica brasileira, dentre os quais, a implementação de serviços substitutivos ao hospital psiquiátrico como os Centros de Atenção Psicossocial (CAPS), torna-se relevante investigar o que nos apontam as famílias de usuários sobre o trabalho da equipe que atua nestes serviços. O objetivo deste estudo foi compreender as vivências de familiares de usuários de um CAPS sobre o trabalho da equipe, sob a perspectiva da Sociologia Fenomenológica de Alfred Schutz. Trata-se de um estudo de abordagem qualitativa, do tipo fenomenológico. Foram entrevistados 13 familiares em outubro e novembro de 2006, em um CAPS localizado em Porto Alegre. Para a coleta dos depoimentos, foi utilizada entrevista com a seguinte questão orientadora: “Fale sobre o trabalho da equipe do Centro de Atenção Psicossocial”. Da análise compreensiva, emergiram três categorias: o trabalho como projeto, ação e ato; fundamentado no interesse à mão; permeado por relações interativas. A análise realizada permitiu considerar que o trabalho da equipe do CAPS sofre interferência da gestão das políticas públicas municipais; tem resultados concretos na assistência em saúde mental; deveria integrar mais a família ao serviço. Estas considerações podem servir de subsídios para as equipes de saúde mental refletirem suas práticas quanto ao envolvimento da família no seu trabalho em um serviço substitutivo ao hospital psiquiátrico.Since psychiatry has arisen, family participation in the treatment of subjects undergoing psychiatric suffering has been little encouraged. Considering the recent progress reached by the movement of the Brazilian psychiatric reform, among which, the implementation of services in replacement of the psychiatric hospital like the Centers of Psychosocial Care (CAPS), it is relevant investigating what the users´ families point out to us about the work of the team that perform in these services. This study aimed at understanding the life experiences of family members of CAPS users about the team work, under the perspective of the Phenomenological Sociology of Alfred Schutz. It is a study of qualitative approach of the phenomenological type. Thirteen family members were interviewed in October and November 2006 at a CAPS unit, located in Porto Alegre. For the collection of the testimonies, interview was carried out with the following guiding issue: “Talk about the team work of the Center of Psychosocial Care”. From the comprehensive analysis, three categories have emerged: the work as project, action and act; founded in the interest at hand; featured by interactive relations. The performed analysis allowed considering that the CAPS team work suffers interference from the management of municipal public policies; it has concrete results in the mental health care; it should integrate more the family into the service. The considerations can provide inputs for the mental health teams to think over their practices regarding the involvement of the family in their work in a service that replaces the psychiatric hospital.
Desde el nacimiento de la psiquiatría, la participación de la familia en el tratamiento de los individuos en sufrimiento psíquico ha sido poco encorajada. Teniendo en cuenta los recientes avances alcanzados por el movimiento de la reforma psiquiátrica brasileña, de entre los cuales la implementación de servicios sustitutivos al hospital psiquiátrico como los Centros de Atención Psicosocial (CAPS), es relevante investigar lo que nos apuntan las familias de usuarios acerca del trabajo del equipo que actúa en estos servicios. El objetivo de este estudio fue comprender las experiencias de familiares de usuarios de un CAPS sobre el trabajo del equipo, bajo la perspectiva de la Sociología Fenomenológica de Alfred Schutz. Se trata de un estudio de abordaje cualitativo, de la clase fenomenológica. Fueron entrevistados 13 familiares en octubre y noviembre de 2006, en un CAPS localizado en Porto Alegre. Para la recolección de los testimonios, fue utilizada entrevista con la siguiente cuestión orientadora: “Hable acerca del trabajo del equipo del Centro de Atención Psicosocial”. Del análisis compreensivo emergieron tres categorías: el trabajo como proyecto, acción y acto; fundamentado en el interés a la mano; impregnado por relaciones interactivas. El análisis realizado permitió considerar que el trabajo del equipo del CAPS sufre interferencia de la gestión de las políticas públicas municipales; tiene resultados concretos en la asistencia en salud mental; debería integrar más la familia al servicio. Estas consideraciones pueden servir de subsidios para los equipos de salude mental reflexionar acerca de sus prácticas cuanto al envolvimiento de la familia en su trabajo en un servicio sustitutivo al hospital psiquiátrico.
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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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Fernandes, Rafaella Leite. "A palavra cantada nos espa?os intersubjetivos de um centro de aten??o psisossocial do munic?pio do Natal/RN." Universidade Federal do Rio Grande do Norte, 2010. http://repositorio.ufrn.br:8080/jspui/handle/123456789/14708.
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The psychiatric care and mental health are undergoing constant change over the History. The Brazilian Psychiatric Reform, which brings up the deinstitutionalization as a structuring in the restorative care process. The Reform has as one of the mainly substitutive services the Centers for Psychosocial Care (CAPS), which work from the Singular Therapeutic Project (PTS) in order to restore the autonomy and restore the dignity of users. The therapeutic workshop is some of the resources used and work several kinds of activities as: writing, handcraft, music, poetry, and so forth. This study set up to apprehend the social representations of helping of the music workshop carried out in the CAPS II east of Natal/RN, from the reports given by the participants of the workshop, using the focal group as technique. This is a descriptive exploratory study with a qualitative approach. A total of 16 users participated in four musical therapeutic workshops from April to May 2010. The study was approved by the Ethics and Research Committee of UFRN. The discursive material from the workshop was submitted to the informational resource of Analyse Lexicale par Contexte d um Ensemble de Segments de Texte, ALCESTE, and analyzed based on the Theory of Representations and the Central Core Theory. The majority of subjects were men (62.5%), single (62.5%), aged 40-49 years (37.6%) and elementary school level (56.2 %). The reports were transcribed and submitted to the classification system of ALCESTE, which elected the following categories: Category 1 - Experience in the Word Family Sung, Category 2 - Musical Experiences and Approaches, and Category 3 - Feelings and emotions evoked by music. The representation of these individuals is anchored in the experience they have with the CAPS, lived and socialized by common sense, through this particular social group workshop objectified in music therapy as a therapeutic modality enjoyable. The central core revealed the intrinsic relationship between users and the music, establishing a relationship of openness to use the same while its therapeutic use in workshops of substitute services for mental health. Peripherals elements issues are related to listen, share and experience music in the family. Intermediary Elements relate to the feelings and emotions evoked by music, given her close relationship with it. It was found in the study that music can be construed as an artifact of good therapeutic responsiveness to users, configuring it as an invigorating and enjoyable therapy, confirming the need for continuity of this activity, as well as its expansion into the service
O cuidado em psiquiatria e sa?de mental, ao longo da hist?ria, vem passando por constantes mudan?as. A Reforma Psiqui?trica Brasileira, que traz ? tona a desinstitucionaliza??o como eixo estruturante do processo de reestrutura??o da assist?ncia, tem como um dos principais servi?os substitutivos os Centros de Aten??o Psicossocial (CAPS). Estes trabalham a partir do Projeto Terap?utico Singular (PTS) a fim de restituir a autonomia e resgatar a dignidade dos usu?rios. As oficinas terap?uticas s?o alguns dos recursos utilizados e trabalham v?rios tipos de atividades como: escrita, artesanato, m?sica, poesia, dentre outros. Este estudo teve como objetivo apreender as representa??es sociais das contribui??es da oficina de m?sica desenvolvida no CAPS II Oeste do munic?pio de Natal/RN, a partir dos relatos dos participantes da oficina, utilizando a t?cnica do grupo focal. Trata-se de um trabalho descritivo explorat?rio com abordagem qualitativa. Participou de quatro oficinas terap?uticas de m?sica um total de 16 usu?rios, no per?odo de abril a maio de 2010. A pesquisa foi aprovada pelo Comit? de ?tica e Pesquisa da UFRN. O material discursivo proveniente das oficinas foi submetido ao recurso informacional do Analyse Lexicale par Contexte d um Ensemble de Segments de Texte, ALCESTE, e analisado com base na Teoria das Representa??es Sociais e na Teoria do N?cleo Central. Os sujeitos se caracterizaram em sua maioria como homens (62,5%), solteiros (62,5%), com idade entre 40-49 anos (37,6%) e grau de escolaridade prevalente no Ensino Fundamental Incompleto (56,2%). Os relatos foram transcritos e submetidos ao sistema de classifica??o do ALCESTE, que elegeu as seguintes categorias: Categoria 1 Experi?ncia da Palavra Cantada na Fam?lia; Categoria 2 Experi?ncias e Aproxima??es Musicais; e Categoria 3 Sentimentos e emo??es evocados pela m?sica. A representa??o desses indiv?duos encontra-se ancorada na experi?ncia que eles t?m com o CAPS, vivenciada e socializada pelo senso comum, por meio desse grupo social espec?fico objetivada na oficina terap?utica de m?sica, enquanto modalidade terap?utica prazerosa. O N?cleo Central evidenciou a rela??o intr?nseca existente entre os usu?rios e a m?sica, estabelecendo uma abertura ao v?nculo de aproveitamento da mesma enquanto seu uso terap?utico em oficinas de servi?os substitutivos de sa?de mental. Os Elementos Perif?ricos apontam quest?es relacionadas ao ouvir, partilhar e vivenciar a m?sica em fam?lia. Os Elementos Intermedi?rios relacionam-se aos sentimentos e emo??es evocados pela m?sica, diante de sua rela??o estreita com a mesma. Constatou-se no estudo que a m?sica se configura como um artefato terap?utico de boa receptividade pelos usu?rios, configurando-se como uma terapia revigorante e prazerosa, firmando a necessidade de continuidade dessa atividade, bem como sua expans?o, dentro do servi?o
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Heston, Jennifer L. "The Role of Direct Care Workers in Person-Centered Home Care." Miami University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=miami1491987309873559.
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Schiltz, Nicholas Kenneth. "Access to Care and Surgery Outcomes Among People with Epilepsy on Medicaid." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1372678525.
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Gottvall, Karin. "Birth centre care : reproduction and infant health /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-825-4/.
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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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Lewis, Richard. "Improving London's primary care : centre-local relations in the implementation of national policy objectives." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248237.
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Chow, Lily Lucia. "Criminalization of the mentally ill : a study of psychiatric services within the Lower Mainland Regional Correctional Centre, Health Care Centre." Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/29687.
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This paper examines the plight of the incarcerated mentally ill. After a consideration of the historical factors which have contributed to the current philosophy and pattern of services throughout North America, and specifically in British Columbia, the paper reports on a qualitative study using participant observation, informal and formal interviews, and Strauss' Constant Comparative Methods which was undertaken to identify the needs of the mentally ill individuals who are serving a term of imprisonment in the Health Care Centre of the Lower Mainland Regional Correctional Centre. Altogether there were eighteen formal participants. They included six mentally ill offenders, six correctional personnel, and six health care professionals. A critical analysis of the major findings -alienation, lack of organizational commitment, and the incongruencies between our social policies and practices - provided the basis for program recommendations. The challenge lies in the building of a vision that values humane treatment for the marginal members of our society.Arts, Faculty of
Social Work, School of
Graduate
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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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Moyle, Jodie L. "Centred voices : A study of the lived experience of women's health centre coordinators." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1999. https://ro.ecu.edu.au/theses/1221.
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The purpose of this phenomenological study is to explore and describe the lived experience of women's health centre coordinators. In addition to the intrinsic value of telling these women's stories, this research provides data which can he used to strengthen the economic, political, organisational and social position of women’s health centres and the women who work in them. Four women managers from regional urban women's health centres in Australia were interviewed about their subjective experiences with respect to their current working roles. Interviews were audio taped, transcribed and coded to produce themes and to preserve anonymity. Data was analysed using Colaizzi’s phenomenological method. Credibility and validity of data was enhanced by the use of multiple interviews, member checks, a pilot study and a clearly identifiable audit trail. The findings of the study reveal that the main themes relating to the experience of women's health centre coordinators are: the importance of shared principles, passions and rewards: their feminist leadership role as managers of a specialist health service; working with the wider system: and the demanding nature of their job. Theoretical sensitivity is demonstrated by re-analysing the emergent themes and descriptions obtained from the data- against the backdrop of the current social, economic and political climate of women's health in Australia. This second order analysis reveals the processes and strategies employed by women’s health centre coordinators in carrying out their work, and highlights the many factors that have influenced their development as feminist managers. Furthermore, the findings suggest that the experience of women's health centre coordinators in this study parallels those of feminist managers elsewhere, and as such, this thesis represents a significant contribution to the dearth of literature on women managers working in feminist, consumer-based organisations.
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Woreta, Fikadu. "Maternal and foetal outcomes of deliveries attended to at Emkhuzweni Health Centre in Swaziland." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/688.
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Thesis (M Med(Family Medicine)) -- University of Limpopo, 2010.Abstract AIM The aim of the study was to measure the maternal and foetal outcomes of the deliveries attended to at Emkhuzweni Health Centre, Swaziland. Objectives The objectives of the study were: .:. To determine maternal outcomes of the deliveries attended to at Emkhuzweni Health Centre. .:. To determine foetal outcomes of the deliveries attended to at Emkhuzweni Health Centre. .:. To identify risk factors that affect maternal and foetal outcomes at Emkhuzweni Health Centre Methods A retrospective chart review was performed for all 520 deliveries at Emkhuzweni Health Centre between January 1,2007 and December 31 2007. Labouring mothers were eligible for the study if they met the inclusion criteria. The study was conducted after ethical approvals from the relevant authorities were obtained. Data were obtained from records for the following variables: age, address, gravidity, parity, health service where ANC was attended, risk factor, mode of delivery, maternal condition after delivery and post-delivery maternal hospital stay. For each foetus, the APGAR score at the first and fifth minute, weight and sex of the neonate and condition after delivery were recorded. Results The results revealed that the maternal outcomes after delivery were normal for 89.85% of the mothers; 3.4% of those who delivered at EHC had PPH, 5.4% developed puerperal sepsis, 1 % PIH and 0.2% cases resulted in maternal death. The majority of mothers (61.7%) were discharged from the maternity ward in less than 24 hrs. As far as foetal outcomes were concerned, normal babies accounted for 68% of births, early onset neonatal sepsis for 1.9%, congenital malformation (0.6%), stillbirth (1.5%), low birth weight (9.2%), preterm babies (17.8 %) and neonatal death (0.4%0. Conclusion This study found that the maternal outcomes at Emkhuzweni Health Centre in 2007 were similar to those in Swaziland as a whole and in other developing countries, except that there was a higher rate of pre-term delivery among pregnant women assisted at Emkhuzweni Health Centre. The foetal outcomes of Emkhuzweni Health Centre in 2007 were similar to the data from developing countries. Additionally, however; significant numbers of pre-term babies were delivered and a high incidence of neonatal sepsis was observed at the Health Centre. Some of the risk factors for the observed maternal and foetal outcomes were poor antenatal care attendance, distance of the Health Centre from the home state of the pregnant woman, preterm labour, under age and teenage pregnancies.
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Barnsbee, Louise N. "The capacity of health services researchers to engage with research impact." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/180823/1/Louise_Barnsbee_Thesis.pdf.
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Demonstrating research impact in terms of social and economic benefits is a relatively new notion for many researchers but is of increasing importance in the research landscape. This thesis explored some of the relevant questions and practicalities which arise when considering the demonstration of research impact, such as researchers' perceived capability to understand research impact, to demonstrate research impact, and to engage with the end-users of research. This research builds the research impact literature in the Australian setting and provides insights into what practical training researchers may find of value.
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Irvine, Robert Lance. "Power and conflict in primary medical care : a case study of the micro-politics of health centre practice." Thesis, University of Edinburgh, 1985. http://hdl.handle.net/1842/24017.
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Young, Carolyn A. "An analysis of the need for a specialist neurological service in the management of disability from a regional neuroscience centre." Thesis, University of Bristol, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246295.
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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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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.
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Mfuko, Ncedo. "An assessment of primary health care services from the : perspective of the recipients in the Khayelitsha community health centre." Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_3124_1305890834.
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The general aim of this study is to undertake an assessment of the health care service provision in the Khayelitsha Community Health Centre taking into consideration the underlying principles of the Primary Health Care. More specific objectives include: an overview and discussion of the framework approach to primary health care and its use
the documentation of the practice of primary health care in the Khayelitsha Community Health Centre
an analysis of the results and findings which will highlight the obstacles in the pursuit of a better primary health care service. The perspective of the patients and nurses will be solicited and examined with a view to highlighting factors that facilitate and constrain the delivery of service
and finally to draw conclusions and make recommendations.
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Rammutla, Chuene William Thabisa. "The rights-based approach to development : access to health care services at ratshaatsha community health centre in blouberg municipality of Limpopo." Thesis, University of Limpopo, 2012. http://hdl.handle.net/10386/1294.
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Thesis (M.Dev. (Management and Law)) -- University of Limpopo, 2013Section 27 of the Constitution of the Republic of South Africa, 1996 provides that everyone has a right to have access to health care. South Africa embraces the concept of universal health care coverage. Access to health care has four dimensions: geographic accessibility, availability, financial accessibility and acceptability. If there were barriers to access to health care, the stake-holders would be duty-bound to design interventions requisite to address those barriers. The aim of the study was to establish whether health care users enjoy the right to have access to health services at Ratshaatsha Community Health Centre (RCHC). The study used a combination of quantitative and qualitative research designs. While a questionnaire was used to collect quantitative data, focused group discussions and participant observations were employed to collect qualitative data. The following are the main findings of the study. Human rights instruments clearly spell out the indivisible and mutually supportive rights that persons have. There are barriers that often affect the rights to have access to health services at RCHC. For instance, the RCHC is not within a 25 km radius of some of the consumers of health care. The roads that link up the health care users and RCHC are in poor condition. The community is generally poverty-stricken. Many cannot afford, among others, the costs of basic needs, transport fares and opportunity costs. Travelling distance and time, scarce skills and lack of medication and equipment rank among demand-side and supply-side barriers to access to health care. Health care users often choose to consult churches and traditional healers. It is recommended that government should, among others, co-ordinate primary health care services in collaboration with churches and traditional healers; commission research into traditional health medicine and healing procedures and protocols of other health care providers; develop policy on cross-referral of patients; improve community participation; set minimum norms and standards for the delivery of alternative health care services; establish health care management guidelines for churches and traditional healers; integrate health care provisioning into IDPs; and provide health care in an integrated intergovernmental manner.
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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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Bakar, Azman Abu. "Quality of life of end stage renal disease patients on centre haemodialysis and continuous ambulatory peritoneal dialysis : early experiences in the Malaysian setting." Thesis, University of Nottingham, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262780.
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Alexander, Kathy. "Promoting health at the local level : a management and planning model for primary health care services /." Title page, contents and introduction only, 1994. http://web4.library.adelaide.edu.au/theses/09PH/09pha376.pdf.
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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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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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Dwyer, Mary B. "Client satisfaction with services delivered in a mental health crisis centre during its first year of operation." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0009/MQ36114.pdf.
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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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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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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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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.
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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.