Dissertations / Theses on the topic 'Healthcare program'
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Armenta, Angela. "Program Evaluation of a Motivational Interviewing Program for Rural Healthcare Providers." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/556494.
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This Doctorate of Nursing Practice (DNP) Project is a program evaluation of a Motivational Interviewing (MI) Training Program provided by Southeast Arizona Health Education Center (SEAHEC). MI is a counseling style that focuses on exploring and resolving ambivalence to elicit behavior change. The purpose of this DNP Project was to: 1) describe the Motivational Interviewing Training Program provided by SEAHEC for ¡Vivir Mejor! healthcare providers; and 2) evaluate the long-term effectiveness of the MI training program by assessing: a) if program participants have retained the MI skills they learned in the training program, and b) if program participants apply these learned MI skills one-year post intervention in their encounters with patients diagnosed with T2DM. The Centers for Disease Control (CDC) Framework for Program Evaluation was used to guide this program evaluation. An online survey was administered to the ¡Vivir Mejor! healthcare providers to evaluate the MI program. Overall, based on the survey results, there was a positive response to the SEAHEC MI Training Program. The results of this program evaluation are limited due to a low response rate. However, these results will be shared with key stakeholders to inform the development of future MI training programs for rural healthcare providers.
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Zhang, Qi M. Eng Massachusetts Institute of Technology, and Muching Zhang. "Unlocking value in healthcare delivery channels." Thesis, Massachusetts Institute of Technology, 2017. http://hdl.handle.net/1721.1/112857.
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Thesis: M. Eng. in Supply Chain Management, Massachusetts Institute of Technology, Supply Chain Management Program, 2017.Cataloged from PDF version of thesis.
Pharmaceutical supply chains are strictly regulated and work within unique constraints. Traditionally, innovator companies that are manufacturing the product have no direct interaction with the end users (treatment sites or individual patients); rather, over 90% of the orders go through intermediary wholesalers and distributors. However, with the introduction of new technologies for patients to manage their own health, federal regulations coming into effect on supplier responsibility for tracking drugs down to the user, and ever more pressure to cut costs and justify the high cost of medicine, manufacturers are actively reshaping their role in the pharmaceutical supply chain. Our objective in this thesis project was to support our Sponsor Company, a "Big Pharma" company with a wide range of medicines, to understand the key cost drivers of their current distribution channel and to explore the impact that a shift to an alternative distribution channel would have from a financial and operational standpoint. We first conducted a literature review to examine the existing research on costing methodologies, the impact of home delivery for clinical care and the drug distribution landscape. The literature shows some evidence that home delivery improves patient adherence and reduces inventory costs for suppliers. We then analyzed a targeted product's distribution network within the US by building a cost-to-serve model, which maps out the end-to-end service components conducted by the Sponsor Company. With this model we were able to test the supply chain impacts of volume change and a gradual shift to alternative distribution channels. The results of the model showed that for this particular product, working capital was a key cost driver, shifting volume to incorporate alternative distribution channels is highly beneficial; even some significant increases in operating costs are effectively neutralized by reductions in working capital for the entire channel. Aside from the model results, we recommend validating the assumptions and suggest that this 'bottom-up' costing model be extended for other products and geographies and used to inform the company's overall corporate strategic planning exercise. The cost-to-serve model framework can also be extended beyond the pharmaceutical industry to benefit consumer facing industries considering an omni-channel strategy.
by Qi Zhang and Muching Zhang.
M. Eng. in Supply Chain Management
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Danielson, Danielle Marie. "Designing a Hypertension Management Program for Family Healthcare." Diss., North Dakota State University, 2014. https://hdl.handle.net/10365/27363.
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The purpose of the practice improvement project was to determine the hypertension management needs of the Family HealthCare (FHC) clinic in Fargo, ND by staff interviews, observation, and data review as well as to develop a hypertension management program to meet those needs. The clinic?s needs and barriers regarding hypertension patients were identified and addressed in the newly proposed hypertension management program. FHC did not have a structured hypertension management program. The main barriers identified included poor patient follow-up, limited patient educational materials on hypertension, and ineffective patient flow. The program was developed based on the U.S. Department of Health and Human Services Health Resources and Services Administration?s hypertension control program. Items addressed in the program were correct blood-pressure taking techniques, evidence-based guidelines regarding patients with hypertension, hypertension tools for providers, education for providers and patients, and follow-up recommendations. The hypertension management program is to be managed by a quality improvement (QI) team that consists of providers, nurses, pharmacists, dietitians, health coaches, receptionists, and schedulers. The QI team will be responsible for evaluating the progress of the program using FHC?s Uniform Data Set report. The goal is to increase hypertension control (patients with a blood pressure of less than 140/90) to 70%. The hypertension program and recommendations were presented to the clinic director Dr. Espejo. The goal was for FHC staff members to recognize the benefits of the hypertension management program and for them to decide to try to implement the program at their facility.
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Cochran, Emily D. "Hospital Characteristics Associated with Hospital Acquired Condition (HAC) Reduction Program Payment Penalties across Program Years." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/5962.
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Objective: The primary objective of this study was to examine the relationship between hospital structural characteristics and penalization status (penalized or not penalized) in any given hospital acquired condition (HAC) Reduction Program year, FY 2015 through 2018. Structural characteristics included hospital type, case mix index, average daily census, bed size, ownership, disproportionate share percentage, location, and American Nurses Credentialing Center Magnet status. The secondary objective of the study was to determine whether a hospital's penalization status across one or more HAC Reduction Program years is related to quality performance (Total HAC Score) in subsequent years. These objectives were achieved through retrospective, longitudinal, multivariate regression analysis using 4 publicly available data sources. Background: The intention of pay-for-performance programs, including the Centers for Medicare and Medicaid HAC Reduction Program, is to improve the quality of care delivered; however, the theoretical and conceptual basis of pay-for-performance programs and their efficacy in improving care are widely debated. This study was designed to address the gap in knowledge related to the efficacy of value-based reimbursement as a means of motivating providers and organizations to improve healthcare quality. Results: Higher average daily census, disproportionate share percentage, and case mix index were associated with increased likelihood of receiving a penalty in the HAC Reduction Program. Approximately half (49%) of who did not experience a penalty at all improved their Total HAC Score. 51% of hospitals with 1 year of penalty improved their Total HAC Score; 54% of hospitals with 2 years of penalty improved their Total HAC Score; 73% of hospitals with 3 years of penalty improved their Total HAC Score. Conclusions: Despite the inability of some hospitals to meet the benchmark to avoid penalty, the vast majority of hospitals improved their performance over time. This finding holds promise for value-based reimbursement as a means for improving HAC incidence.
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Yaghmaee, Sarah. "Does the H-1B Visa Program Impact Quality of Healthcare?" Scholarship @ Claremont, 2018. http://scholarship.claremont.edu/scripps_theses/1116.
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Recently, the H-1B visa program has been a target of reform under the Trump administration. This study explores whether the employment of H-1B physicians in U.S. hospitals has any effect on the quality of healthcare provided. As indicators of quality, I use patient survey scores as well as mortality and readmission rates. This new econometric evidence suggests that patient perception of quality is not influenced by prejudice toward nonimmigrant physicians, but provides inconclusive results for the rate-based measures of healthcare quality.
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Chung, Kristie (Kristie J. ). "Applying systems thinking to healthcare data cybersecurity." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/105307.
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Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, Engineering Systems Division, 2015.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 85-90).
Since the HITECH Act of 2009, adoption of Electronic Health Record (EHR) systems in US healthcare organizations has increased significantly. Along with the rapid increase in usage of EHR, cybercrimes are on the rise as well. Two recent cybercrime cases from early 2015, the Anthem and Premera breaches, are examples of the alarming increase of cybercrimes in this domain. Although modem Information Technology (IT) systems have evolved to become very complex and dynamic, cybersecurity strategies have remained static. Cyber attackers are now adopting more adaptive, sophisticated tactics, yet the cybersecurity counter tactics have proven to be inadequate and ineffective. The objective of this thesis is to analyze the recent Anthem security breach to assess the vulnerabilities of Anthem's data systems using current cybersecurity frameworks and guidelines and the Systems-Theoretic Accident Model and Process (STAMP) method. The STAMP analysis revealed Anthem's cybersecurity strategy needs to be reassessed and redesigned from a systems perspective using a holistic approach. Unless our society and government understand cybersecurity from a sociotechnical perspective, we will never be equipped to protect valuable information and will always lose this battle.
by Kristie Chung.
S.M. in Engineering and Management
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Etges, Ana Paula Beck da Silva. "The economic enterprise risk management innovation program for healthcare organizations : E2RMhealthcare." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2018. http://hdl.handle.net/10183/185804.
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A Gestão de Riscos Corporativos (ERM), a partir das publicações da ISO 31000 em 2009 e do guia do COSO em 2007, vem sendo aplicada e adaptada às especificidades de múltiplos mercados. O contexto hospitalar, caracterizado pela necessidade de avanços em sistemas e métodos gerenciais que permitam maior acurácia de informações e sustento na orientação à tomada de decisão, passou a, também, interessar-se pelo valor da ERM. Influenciado pelos programas de qualidade e segurança do paciente e de gestão de riscos assistencial, presentes na cultura hospitalar mundial, gestores estratégicos à frente de organizações de saúde começaram a procurar por metodologias que possam ser adaptadas à complexidade de um hospital e apoiem a implementação da ERM. A literatura prévia ao desenvolvimento desta tese não apresenta um modelo que consolida e orienta a operacionalização da ERM em organizações de saúde, mas destaca em múltiplas publicações a necessidade que os hospitais têm de atentar a metodologias que permitam gerir de forma proativa e estratégica seus negócios, que estão expostos a riscos internos e externos. Motivada pela lacuna descrita, esta tese explorou o mercado brasileiro e norte americano através de entrevistas, estudos de caso e survey, e propôs um modelo global de ERM para organizações de saúde: o E2RMhealthcare. Este sugere requisitos para a operacionalização global da ERM e é fragmentado em 4 níveis: risk baseline, education, quantitative e governance que orientam uma implementação gradual, considerando a maturidade de gestão da organização. Formas de como explorar as características do hospital e capital humano para exercer a ERM também foram estudadas, sendo proposto uma relação entre as equipes de avaliação de tecnologias de saúde hospitalar e de ERM no processo de criação de valor da organização através de um mapa de causa e efeito. Como destaque do negócio saúde, essa tese inova propondo o primeiro inventário de riscos corporativos orientado a organizações de saúde que foi validado por gestores de múltiplos países, identificando o risco de ataques cibernéticos como o principal. Por fim, o uso de métodos de análise multicriterial e de custeio por atividade são aplicados como soluções inovadoras para a priorização e avaliação econômica de riscos ao longo dos níveis Baseline e Quantitative do E2RMhealthcare. O avanço do E2RMhealthcare com estas metodologias incorporadas para um software com capacidade de inteligência artificial é deixado como sugestão de trabalhos futuros além da sua real aplicação em múltiplos casos.Since the ISO 31000 publication in 2009 and the COSO guide in 2007 Enterprise Risk Management (ERM) has been applied and adapted to the specificities of different business markets. The hospital context characterized by the demand for advances in management systems and methods that allow to improve information accuracy and to support the decision-making process, also became interested in the value of ERM. Influenced by quality and patient safety and healthcare risk management programs presents in the global hospital culture, managers at the top of healthcare organizations started to look for methodologies that can be adapted to the hospital management complexity to support the ERM implementation. The literature, prior to the development of this thesis, does not present a model that consolidates a guide to operationalize ERM in healthcare organizations. Although emphasizes, in multiple publications, the urgency for methodologies that enable proactive and strategic management of healthcare businesses, which are exposed to internal and external risks. Motivated by the described gap, this thesis explored the Brazilian and American healthcare market through interviews, case studies and survey, and proposed a global ERM model for healthcare organizations: E2RMhealthcare. It suggests requirements for global operationalization of the ERM and is organized in 4 levels: risk baseline, education, quantitative and governance that guide a gradual implementation, considering the maturity of the organization management. Different manners to explore the features of the hospital and human capital to operate the ERM were also studied, and it was proposed a relation between the hospital healthcare technology assessment teams and the ERM in the value creation process of the organization through a cause and effect map. Focusing on the healthcare business, this thesis innovates by proposing the first enterprise risk inventory aimed at healthcare organizations that was confirmed by risk managers from different countries. Cyber-attack was identified as the main enterprise risk in healhtcare. Finally, the use of multicriterial analysis methods and activity-based costing are applied as innovative solutions for prioritization and economic assessment of risks throughout the Baseline and Quantitative levels of E2RMhealthcare. The progress of E2RMhealthcare with these incorporated methodologies for a software with artificial intelligence capacity is left as a suggestion for future studies, in addition to its actual application in multiple cases.
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Sanders-McBryde, Tennie Rene. "Persistence of First-Generation Graduates of a Community College Healthcare Program." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4680.
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Many first-generation students (FGS) succumb to challenges and barriers and ultimately give up on their educational goals. Little is known about FGS who graduate and are successful in their discipline. The purpose of this qualitative study was to explore factors that influenced the persistence of FGS who graduated and are employed in the healthcare field. The theoretical framework consisted of experiential learning, identity development and environmental influence, and social cognitive career theories. The research questions focused on how FGS made decisions to graduate, interpreted their academic learning experiences, and perceived academic support received in the college environment. Data was collected from questionnaires designed by the researcher and emailed to 12 participants, and from college retention, enrollment, licensure, and safety and security reports. Data analysis involved open and axial coding and application of the NVivo software package, whereby 8 themes emerged. Findings indicated that (a) family support, mastering a skill, and challenges and academic successes supported FGS' decisions to graduate; (b) inspiration, vocational interest, and self-awareness defined and described FGS' academic learning experiences; and, (c) faculty and student engagement and environmental support revealed the academic support FGS received in the college environment. The study suggested ways in which the persistence of FGS in community college healthcare programs can be improved. Implications for future research into variables that influence the persistence of FGS were discussed. Improving the retention of FGS and widening the pool of community healthcare workers can impact positive social change by contributing to social welfare and economic development.
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Nohria, Kanishka. "Transformation of the US healthcare system with the advent of wireless sensing technologies." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/118533.
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Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, System Design and Management Program, 2018.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 45-47).
The US healthcare system is looked at from the point of view of various stakeholders and how its current structure has emerged over the years. With the shifting demographics, change in disease mix, ICT revolution and other factors at play, the system is in a state of flux. Sensor technology on the other hand has also progressed over the years to reach a point where low-cost mass-produced smart sensors are becoming omnipresent. A variety of such sensors are now available, and new ones are being developed for specific needs, like for continuous health monitoring systems. New wireless sensing technologies are redefining the care services, processes and customer expectations. This is especially true for chronic disease management and eldercare. We develop a view point to understand at a broad level how the US healthcare system is currently evolving and what role could new technologies, like wireless sensing, play in shaping its near future. These new technologies are slowly gaining foothold in the market and could possibly reach a point of inflection soon where the population starts to adopt them in masses. By creating a new mental model of how various parts in the system interact with each other, we try and develop an understanding of which factors might affect the speed of adoption of these new technologies into the system.
by Kanishka Nohria.
S.M. in Engineering and Management
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Gautam, Sanjay Kumar S. M. Massachusetts Institute of Technology. "Healthcare market outlook and emerging technologies in India." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/100375.
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Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, February 2015.Cataloged from PDF version of thesis.
Includes bibliographical references (page 77).
Usage in information technology (IT) have improved efficiency and quality in many industries. Healthcare has not been one of them. Although some administrative IT systems, such as those for billing, scheduling, and inventory management, are already in place in the healthcare industry, little adoption of clinical IT, such as Electronic Medical Record Systems (EMR-S) and Clinical Decision Support tools, has occurred. India's healthcare information technology market is slow with technology adoption but there is little traction shown in last couple of years. This growth is expected to hit US $1.45 billion in 2018, more than three times the US $381.3 million reached in 2012. The increase in adoption of electronic health records, mHealth, telemedicine, and Web-based services has made electronic patient data expand, necessitating the implementation of robust IT systems in Indian healthcare institutions. Information technology (IT) has the potential to improve the quality, safety, and efficiency of health care. Diffusion of IT in health care is generally low (varying, however, with the application and setting) but surveys indicate that providers plan to increase their investments. Drivers of investment in IT include the promise of quality and efficiency gains. Barriers include the cost and complexity of IT implementation, which often necessitates significant work process and cultural changes. Given IT's potential, both the private and public sectors have engaged in numerous efforts to promote its use within and across health care settings. Delivering quality health care requires providers and patients to integrate complex information from many different sources. Thus, increasing the ability of physicians, nurses, clinical technicians, and others to readily access and use the right information about their patients should improve care. The purpose of this thesis is to assess the current state of healthcare in India and specifically look into the emerging technology trends in healthcare IT. During analysis secondary data has been used. Various articles and research papers published in national and international journals are used. India is hub of IT and its use is increasing in health sector.
by Sanjay Kumar Gautam.
S.M. in Engineering and Management
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Ren, Haiying S. M. Massachusetts Institute of Technology. "Transition to cloud computing in healthcare information systems." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/76507.
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Thesis (S.M. in Engineering and Management)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2012.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 60-63).
This thesis is a study on the adoption of cloud computing in healthcare information technology industry. It provides a guideline for people who are trying to bring cloud computing into healthcare information systems through the use of a framework of tools and processes to overcome both technical and business challenges.
by Haiying Ren.
S.M.in Engineering and Management
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Chaudhary, Anjali S. M. Massachusetts Institute of Technology. "System dynamics approach to healthcare affordability in India." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/105305.
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Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, Engineering Systems Division, 2015.Cataloged from PDF version of thesis.
Includes bibliographical references (pages [66]-[67]).
Affordability of healthcare is a growing concern across the world. For India, with a population of over 1.2 billion people and one third of world's poorest, to provide affordable and sustainable healthcare to all its citizens becomes even more challenging. The country faces the triple burden of controlling communicable diseases, managing non communicable diseases, and limiting the deaths from injury and mental health. The public healthcare system is underfunded and underutilized while the private facilities are unregulated and unaccountable for quality and cost of care. The high reliance of the population on the private facilities, low insurance coverage, and high emphasis on curative care than the preventive care is further making the cost prohibitive for the general population. There is a lot to be desired in the areas of Pharmaceuticals, Medical Devices, and Research and Development for a holistic development of healthcare system in India. This thesis attempts to model the current healthcare system and how different entities of the system interact to influence the affordability. The simulation of the model projects the affordability in the next 50 years. The study also checks the impact of three different policies on the affordability of care.
by Anjali Chaudhary.
S.M. in Engineering and Management
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Okoro, Ngozi Gloria. "An educational program about living with depression." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3813.
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Depression is a common and disabling mental illness, but the loneliness, isolation, and poor quality of life associated with depression may improve with treatment. Depressive patients adhere to their treatment and experience better outcomes when their family members are involved with their treatment. At the project mental health facility, patients with depression had the highest non-compliance rate to treatment and no educational program existed for their families. This observation led to the current practice-focused question which examined how an evidenced-based educational program can be developed for family members or caregivers of patients diagnosed with depression. The purpose of this project was to assemble a team of experts to develop and plan an educational program about living with depression for family members or caregivers of patients diagnosed with depression. This project was guided by Jean Watson's theory of human caring and the view of health as harmony of mind, body, and soul. The educational program was planned using reviewed research studies with the input of a team of local experts consisting of a psychiatrist, a licensed therapist, a mental health nurse practitioner, registered nurses, and medical assistants. The project resulted in a four session educational program, a manual of policies and procedures, and recommendations for implementation and evaluation of the education. The educational program resulting from this project has the potential to improve the health and well-being of patients with depression and their families, decrease the stigma they face, and contribute to positive social change.
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Mahon, Kerrie L. "Strategic change in healthcare: Seeking reliability." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/115475/3/Kerrie%20Mahon%20Thesis.pdf.
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Organisational-wide risks and uncertainty may emerge from the complexity of project and program implementation; particularly in the health sector. When the corporate governance of a program is misaligned to the complex business environment, the efforts of senior management to achieve program reliability are impacted. Explored in this study were adaptable corporate governance approaches and their alignment to high reliability practices for effective management of risks and uncertainty in complex business environments. A range of frameworks were created that help explain how any why positive and negative project and program outcomes emerge due to corporate governance.
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SAKAMOTO, JUNICHI, MD HARUN-OR-RASHID, ONPRASONK SUWATTANA, and ONPRASONK WIDSANUGORN. "HEALTHCARE WORKERS’ KNOWLEDGE AND PRACTICES REGARDING EXPANDED PROGRAM ON IMMUNIZATION IN KALASIN, THAILAND." Nagoya University School of Medicine, 2011. http://hdl.handle.net/2237/15360.
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Ferguson, Andra Lynn. "The Impact of Crisis Alleviation Lessons and Methods Program on Injuries in Healthcare." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1692.
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The purpose of this study was to examine whether Crisis Alleviation Lessons and Methods -© (CALM), as a behavioral crisis management program, was effective in reducing patient and healthcare professional injuries in a long-term residential care setting. This research was needed due to the lack of peer-reviewed scholarly literature on the effectiveness of behavioral crisis management programs, especially on programs using both nonphysical and physical de-escalation techniques, such as CALM. An auto-regressive integrated moving average (ARIMA) time series analysis was performed to examine the effect the implementation of the CALM program (independent variable) had on the rate of injuries to healthcare providers and patients (dependent variables) using archival data from a long-term residential care facility. This time-series model was used to evaluate the relationship between the CALM program and the incidence of injuries to patients and healthcare providers over time. Collectively, the ARIMA model statistically accounted for a total of 32% of the variance in healthcare provider injuries. The findings suggested that the CALM program might be effective in reducing the numbers of injuries to healthcare providers. However, data on patient injuries were not available, which was a major limitation of this study. Findings suggest that CALM may be an effective behavioral crisis management option in other healthcare settings. This study may lead to social change by contributing to the literature on behavioral crisis management programs and the reduction of healthcare provider injuries from behavioral crisis situations. Further research is recommended on the effectiveness of CALM in other settings and on the effectiveness of CALM in reducing the rate of patient injuries.
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Johnson, Verena D. "Program for Healthcare Personnel to Improve Anti-hypertensive Medication Adherence in Black Adults." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/265.
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Medication nonadherence is a healthcare problem that costs the United States billions of dollars annually. The purpose of this project was to propose an evidence-based program for healthcare personnel to increase the rate of medication adherence in hypertensive Black adults who require daily, oral medication. The transtheoretical model of change was used to explain the process of change and to identify approaches to changing non-adherent behaviors related to medications. Motivational interviewing was used to explain the process that nurse-educators would use to guide patients through the stages of change. In the initial step of this quality improvement program, a convenience sample of 9 healthcare personnel were given an overview of the proposed program and asked to provide feedback on the relevance and meaningfulness of the proposed program using a program development evaluation form. Numerical data collected from the evaluation form were gathered using a 5-point Likert-type, scale. The data results were analyzed to determine the relevance and meaningfulness of the proposed program. The analyzed data were reported in frequency and percentages. Descriptive statistics were used. According to the findings, all 9 healthcare personnel supported the use of the proposed program and believed that its content was relevant and meaningful to clinical practice. The findings also revealed that 8 out of the 9 healthcare personnel believed that patients who qualified for the proposed program would be likely to participate. Adoption of this evidence-based program would facilitate social change by improving the rate of medication adherence in hypertensive Black adults and potentially improving their overall health.
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Jog, Chetan R. (Chetan Ravindra). "Healthcare technology, patient engagement and adherence : systems and business opportunity analysis." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/76493.
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Thesis (S.M. in Management and Engineering)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2012.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 63-64).
In the current shift in the US healthcare system, lower cost, higher quality of care, access and safety are the main drivers that are effecting changes. Patient compliance with medication and technology enabled wellness and engagement programs play an important role in ensuring the cost and quality of care is reduced. In a recent study, the overall cost of poor medication adherence, measured in otherwise avoidable medical spending, is close to $310 billion annually, representing approximately 14% of total healthcare expenditures. There have been several studies analyzing the reasons for and impact of non-adherence and solutions to achieve increasing compliance. With the recent wave in healthcare technology, the scope of prescription medication adherence needs to be expanded to include patient engagement and their awareness towards lifestyle changes and managing their own health. This thesis engages in an analysis of these compliance issues and in understanding the relationships among the various stakeholders involved. It also analyses the several technology platforms and solutions from mobile health to "gamification" and social networks from a business, user and regulatory standpoint. It looks into how these newer health technologies helps the individual in adhering and realizing novel insights into their own patterns related to medication, lifestyle and general health. Further, working with a health technology startup catering to the behavioral care market, a real world application of a health technology product that utilizes technology based patient assessment, decision support and patient communication, will be evaluated to explore how it will help in delivering value to several stakeholders.
by Chetan R. Jog.
S.M.in Management and Engineering
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Chitwood, Tara Marshall. "SECOND VICTIM: SUPPORT FOR THE HEALTHCARE TEAM." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1554820138107259.
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Fields, Kellee M. "Community College Healthcare Students’ Conceptions of Empathy: A Program-Wide Mixed Methods Case Study." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1447689608.
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Wong, Man-ying, and 黃文英. "A manual handling operations training program for healthcare workers in preventing back pain and injury." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44626605.
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Ona, Samsiya. "Evidence-Based Preventive Healthcare in the CWB Family Support Homes: The Healthy Learners Pilot Program." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295881.
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Zambia is one of the poorest countries in the world. The school aged population experiences high mortality and morbidity rates from malnutrition, chronic and acute infections. Our long-term goal is to develop an ongoing preventive health program to supplement the CWB educational mission. The pilot program included health screenings, detailed health status and needs survey, interviewing local experts and key stakeholders and a health promotion workshop for the schoolteachers. Follow-up screenings were also conducted in Summer 2013. We screened 455 children and surveyed 223 children with their guardians during the pilot study. The most common diagnoses were GU infections, URTIs, diarrhea and fungal infections. Among the 455 children screened, there were 51 cases of S. haematobium infection. A striking finding from the health status survey is the lack of knowledge on health and sanitation topics and the urgent need to integrate health and nutrition education in the school curriculum. The teachers’ health promotion workshop was effective in increasing teachers’ health literacy. The HLP pilot helped initiate a program to provide school-based healthcare to children with otherwise minimal access to care and to train their teachers in important basic public health topics.
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Jia, Hao. "A web application for Medasolution Healthcare Company customer service system." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2612.
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Medasolution is a virtual company designed by the author to handle Medicare insurance business. The web application (which uses ASP.net and SQL Server 2000) facilitates communication between Medasolution and all its clients: members, employers, brokers, and medicare providers through separate web pages based on their category levels. The program incorporates security so that it follows government privacy rules regarding client information.
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Sargsyan, Alex. "Development of a Healthcare Genetics and Genomics Graduate Certificate Program at a University in Southeastern US." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/8469.
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Jones, Cathy. "Creation of a Diabetic Health Literacy Program for Staff Of a Rural Federally Qualified Healthcare Center." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5633.
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Adult residents in rural communities have a higher incidence of chronic diseases. This fact coupled with low health literacy and a lack of primary and specialty care services makes the management of diseases such as diabetes difficult. The purpose of this doctoral project was to develop a diabetic health literacy program for staff of a rural federally qualified health care center (FQHC) that is the largest primary care center within a 5-county area in a rural mid-Atlantic region of the United States. Most residents have difficulty understanding diabetic information as it is presented to them, which leads to an increase in nonadherence to treatment plans, decreased health stature, increased comorbidities, and an increase in utilization of emergency room and acute care resources. A prior study of 140 randomized adult diabetic patients was the basis for the need of this project. Designed as a staff development in-service to educate nursing and the care provider team, this program integrated health literacy and therapeutic communication techniques into diabetic care. Using the health literate care model universal precautions approach, the project began as a pilot at one of the FQHC's clinical sites by assessing all patients for health literacy using the Newest Vital Sign screening tool. Staff were instructed on the validity of using health literate therapeutic communications as a bridge to adherence to diabetic treatment regimens. The project has potential to improve the overall health and promote positive social change in the rural community.
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Anderson, Sarah, and Loyd Lee Glenn. "Intentional Learning Orientation According To Gender, Age, Rurality, and Program Type." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/66.
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Several studies have found that learning styles differ based on gender, but others found no differences. There are no previous studies on gender differences in intentional learning styles. The purpose of this study, therefore, was to evaluate intentional learning style differences based on gender, demographics, and psychological characteristics.
The participants were junior level nursing students in a research course in two different semesters. The Learning Orientation Questionnaire of Martinez (2006) was administered in February of 2018 and 2019 to participants (n=198) and analyzed using ANOVA.
The LOQ score was significantly different between males and females (p= 0.013). Males had a mean of 2.76 + .89 SD (N=26) but females had an LOQ score of 2.40 + .52 SD (N=169). The LOQ score was not significantly different for students seeking different degrees (p= 0.16). 2nd Degree-seeking students had a mean of 2.43 + 0.37 SD (N=25), LPN-BSN students had a mean of 2.63 + 0.35 SD (N=2), Main BSN students had a mean of 2.44 + 0.62 SD (N=163), RN-BSN students had a mean of 2.5 + 0.70 SD (N=6). Other types of degrees had a mean of 3.5 + 0.35 SD (N=2). The LOQ score was not significantly different for distances that students had to travel to the nearest hospital (p=.54) Students with a distance of 15-30 minutes from their house had a mean of 2.5 + 0.67 SD (N=75). A distance of 30-45 minutes had a mean of 2.62 + 0.63 SD (N=15). A distance of 5-15 minutes had a mean of 2.42 + 0.54 SD (N=86) A distance of less than 5 minutes had a mean of 2.31 + 0.55 SD (N=12). A distance of greater than 45 minutes away had a mean of 2.29 + 0.45 SD (N=9). The LOQ score for the age of responders was not significantly different (p=0.71). Students who were 23 or less had a mean of 2.45+ 0.66 SD (N=103), students who are between 24-29 had a mean of 2.35 + 0.34 SD (N=15), students who are between the ages 30-39 had a mean of 2.63 + 0.38 SD (N=6), students who are older than 40 had a mean of 2.13 + 0.37 SD (N=4), students who preferred not the answer had a mean of 3.0 + SD not available (N=1).
The conclusion is that males and females have varied intentional learning styles. This supports previous studies that found differences in learning style in medicals students and practicing nurses.
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Mousaid, Hassan. "Caregiver coordination as an enabler to a hospital to home initiative within the context of healthcare delivery." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/90695.
Full textAbstract:
Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2013.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 47-48).
The Hospital to Home architecture aims to provide a successful transition for patients leaving the hospital in order to improve health outcomes and minimize hospital readmission. This thesis analyzes the current hospital to home system, explores its flows and proposes a better architecture to improve the patient transition from the hospital to home. It makes a significant contribution by proposing a new architecture based on a patient-centric approach within the framework of the Hospital to Home (H2H) initiative called Caregiver Coordination. In this architecture, we propose the creation of a web and mobile based application that allows patients and caregivers to interact easily with each other to help manage the patient's wellbeing. We include a short summary illustrating how this new architecture can address the two main problems: (1) the decentralization of the discharge plan and (2) the dependency on the interactions among diverse stakeholders. We propose to: 1. Analyze and critique the existing hospital to home architecture 2. Follow an existing architecture pattern/framework 3. Recommend a new architecture 4. Create a Caregiver Coordination application using an open source framework to enable a successful transition of patients from hospital to home
by Hassan Mousaid.
S.M. in Engineering and Management
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Ingabire, Paula. "Convergence of eco-system technologies : potential for hybrid electronic health record (EHR) systems combining distributed ledgers and the Internet of Medical Things towards delivering value-based Healthcare." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/118548.
Full textAbstract:
Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, System Design and Management Program, 2018.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 64-66).
The Healthcare industry, just like any industry, is constantly racing to stay abreast with pace of technological innovations, especially at such a time where the industry is experiencing a strain on the global healthcare infrastructure. Specifically, the evolution of record management systems in the healthcare system has taken a slow and gradual transformation with each stage of transformation carrying over certain aspects and functions of previous stages. A survey of record management practices reveals that record management begun with paper-based records that have since partially been replaced with centralized Electronic Health Records (EHR). With the advent of Electronic Health Records enabled by distributed ledgers, we continue to see the inclusion of traditional paper-based functions beyond centralized EHR functions. Electronic data sharing in the healthcare ecosystem is constrained by interoperability challenges with different providers choosing to implement systems that respond to increasing their productivity. Prioritizing a patient-focused strategy during implementation of EHRs forces providers to implement systems that are more interoperable. A system engineering approach was adopted to guide the development and valuation of candidate architectures from Stakeholder analysis to concept generation and enumeration. Nine (9) key design decisions were selected with their combinations yielding 512 feasible hybrid architectures. In this paper, we proposed a hybrid EHR solution combining distributed ledger technologies and Internet of Medical Things, which contributes towards providing value-based healthcare. Leveraging properties of distributed ledgers and IoMT, the hybrid solution interconnects various data sources for health records to provide real-time record creation and monitoring whilst enabling data sharing and management in a secure manner.
by Paula Ingabire.
S.M. in Engineering and Management
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Zhang, Biao S. M. Massachusetts Institute of Technology. "Decision analysis of novel point-of-care diagnostics for Pediatric Pneumonia : implementation in Developing countries with tiered healthcare systems." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/98001.
Full textAbstract:
Thesis: S.M. in Technology and Policy, Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2015.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 94-99).
Pediatric Pneumonia (PNA) is the single leading cause of death in children under five, accounting for 19% of all childhood deaths worldwide. Due to severe resource constraints on healthcare, the global burden of the disease in children is disproportionately shared by developing countries. In particular, India, having the highest incidence rate of PNA, accounts for more than 30% of the world's neonatal deaths from pneumonia every year. The three-tier referral systems, shared by many other developing countries, has introduced inefficiencies into delivering appropriate healthcare to patients in need. Point-of-care (POC) diagnostics is a type of tool used to assist physicians to make clinical decisions. Its key advantage include the quick turnaround of results, low cost and high diagnostic power could potentially improve India's pressing situation due to pneumonia. Since the disease progresses quickly in infants and babies and transportation of patients within the healthcare system is time consuming, POC diagnostic is crucial in lowering both the mortality of children with pneumonia and the cost of treating PNA. To this effect, we investigate the potential impact of POC diagnostics when implemented in a three-tier referral system. Using India as a case country, I construct a decision tree model that evaluates cost, mortality, and the combined cost-effectiveness in Tree-Age software as a framework which evaluates five implementation strategies of a POC diagnostic for PNA within the Indian public healthcare system. The strategies reflect various prescription decisions and referral patterns in current medical practice in India. I concluded that (1) the diagnostic will result in both higher cost and mortality in areas where the practice is to provide all patients antibiotics and thus not recommended, (2) the diagnostic is very likely to achieve lower cost and mortality when patients do not always receive antibiotics and sometimes are given only symptom-relieving drugs and thus recommended, (3) the diagnostic has great potential in generating savings by limiting patients from being transported to urban hospitals, (4) when dual diagnostic is employed combining POC diagnostics and X-ray, confirming positive cases from the diagnostic by X-ray results in lower cost and confirming negative cases results in lower mortality and (5) the diagnostic can save resources and benefit health outcomes and should be implemented in places where X-ray is not available.
by Biao Zhang.
S.M. in Technology and Policy
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Shvets, Anna. "Program kontinuálního zvyšování kvality péče v soukromém zdravotnickém zařízení na Ukrajině." Master's thesis, Vysoká škola ekonomická v Praze, 2017. http://www.nusl.cz/ntk/nusl-359957.
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The aim of this master s thesis is to establish continual program of health care quality improvement in a private multi-specialty medical facility Nebolejka based in Ukrainian city Kharkov. Thesis is divided into several parts. Theoretical part is focused on quality examination from the healthcare system point of view, deals with the analyses of Ukrainian healthcare system actual state. Practical part is focused on health care quali-ty evaluation in a private clinic Nebolejka. With a use of patient satisfaction survey a program of health care quality improvement was established. Its effectiveness was also verified via repeated patient satisfaction survey in short- term time period. This thesis is primarily useful for medical facility Nebolejka, because improvement of health care quality not surprisingly constitute to better competitive market position.
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Chahal, Jasleen K. "Medical Humanitarianism: Supporting Health Across the Life Course in a Changing Healthcare Climate." Miami University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=miami1595512845722235.
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Salcedo, Maria Victoria Trinidad. "Needs Assessment for a Nurse Practitioner-Led Transitional Care Program." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1450.
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The rising cost of health care and changes in healthcare delivery have prompted a need to improve continuity from the hospital to home. This scholarly project was initiated to assess the impact on patient outcomes related to initiation of a nurse practitioner-led transitional care program (TCP). Using the Diffusion of Innovations and Health Belief Models, the purpose of this study was to identify the impact of a TCP on improving the health of patients with congestive heart failure (CHF), diabetes mellitus Type II (DM II), and chronic obstructive pulmonary disorder (COPD). The impact of the TCP was evaluated by a review of patient satisfaction results, reduction in patient readmission rate, and emergency room consults. Two years of data from a community-based health care program were collated from a sample of 819 individuals with chronic disease between 65- and 85-years-old who had a 30-day hospital readmission after a nurse practitioner home visit and a 30- day readmission for an exacerbation of their CHF, DM II, or COPD. The secondary data were analyzed, using SPSS, to determine changes in rates of readmission. Descriptive statistics were used to represent and compare changes in rates. After implementation of the nurse practitioner home visit program, the 30-day readmission demonstrated an 81.07% reduction and the 30-day readmission for exacerbation of COPD, CHF, and DM II was reduced by 36.77%. The project findings contribute to social change by identifying how a reduction in the frequency of hospitalizations could contribute to decreased health care expenses and improved health outcomes. Home care and chronic health care organizations, as well as advanced-practice nurses working in home care settings, may use the results of the study to establish effective community interventions that reduce health care costs.
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Winn, Lisa. "The relationship between job satisfaction and program traits for wilderness therapists employed at outdoor behavioral healthcare treatment programs : a project based upon an independent investigation /." View online, 2008. http://hdl.handle.net/10090/5946.
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Makinde, Funmilayo. "Transition care management program for improving 30-day hospital readmission in heart failure patients discharged to home healthcare agencies." NSUWorks, 2015. https://nsuworks.nova.edu/hpd_con_stuetd/16.
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Bogel, Marianne. "Closing the Gaps in Rural Healthcare in Texas: A Formative Bounded Case Study." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7601.
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Maldistribution of healthcare professionals persists in remote and rural communities throughout the world. Adoption of a Community Paramedic (CP) program could improve access to quality healthcare for rural communities. The conceptual framework defined rural communities by their distinct characteristics — community efficacy, weaknesses, attitudes, assets, deficits, local culture, and the driving and restraining forces — and not defined by their small populations or distances to cities. The theoretical foundation was a synthesis of theories of Bandura, Rogers, and Lewin. This study assessed community characteristics that may influence the likelihood of success, sustainability, or program failure of the Australian CP model in a single remote Texas border community. In this qualitative formative bounded case study, 3 bounded groups were examined; data collection was by in-person interviews. Group members were purposively selected: 5 residents and 3 EMS members. The 3rd group consisted of 4 randomly self-selected resident interviews, field observations, news articles, and local social media. Data transcripts were coded using theoretical coding based on the conceptual framework and theoretical foundation. Strong individual and group efficacy, efficacy resilience, adaptability, strong communications, overlapping groups, and a strong sense of community program ownership were evident in this study. The probability of establishing an effective CP program based on the Australian model is high based on study findings. Improved access to quality healthcare in remote and rural communities could result in improved health of community members and significant social change.
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Hilliard, David (David John). "Achieving and sustaining an optimal product portfolio in the healthcare industry through SKU rationalization, complexity costing, and dashboards." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/73385.
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Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management; and, (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division; in conjunction with the Leaders for Global Operations Program at MIT, 2012.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 76).
After years of new product launches, and entry into emerging markets, Company X, a healthcare company, has seen its product portfolio proliferate and bring costly complexity into its operations. Today, Company X seeks to achieve and sustain an optimal product offering that meets their customers' needs. Through a six-month research effort, we develop a process for stock-keeping-unit (SKU) rationalization to reduce SKU complexity while maintaining sales volumes. We, also, implement operational models to compute complexity costs associated with SKU complexity and employ SKU portfolio dashboards to monitor SKU development and govern SKU creation. This thesis discusses a process for applying these tools to any healthcare company. Through two case studies, we apply the rationalization process on one pilot brand and develop a dashboard to improve product portfolio management. We expect that the SKU rationalization process will release 38% of avoidable costs associated with the pilot brand. These case studies also provide insight into how to correctly diagnose the cost reduction opportunity associated with SKU complexity, as well as methods for a step-change improvement in lead-times and cost-reduction. Lastly, removal of complexity provides flexibility to capture other business opportunities.
by David Hilliard.
S.M.
M.B.A.
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Rush, Mary Catherine, Todd DO MSMS Leibowitz, Katherine DO Stone, Jodi PhD Polaha, and Leigh MD MPH Johnson. "Medical Scribes in a Family Medicine Residency Program: An Implementation Outcomes Study." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/129.
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The implementation of Electronic Health Records (EHR) has improved medical documentation in terms of accuracy, team communication, and ease of ordering tests and prescriptions; however, charting in an EHR strains the provider/patient relationship and contributes to physician burnout. Medical scribes are a promising potential solution to these problems. Our study aims to demonstrate that implementation of scribes into a medical residency program positively affects provider/patient satisfaction and improves quality and efficiency of EHR documentation. Our study evaluated the effectiveness and utility of scribes in a residency training program utilizing the established implementation framework “RE-AIM,” or Reach, Effectiveness, Adoption, Implementation (quality), and Maintenance. During the study’s initial “Training Phase,” 11 first and second-year Family Medicine residents conducted scribe-facilitated patient visits. Patient and provider satisfaction ratings were collected, note quality was evaluated, and time to note closure was measured. During the subsequent “Choice Phase,” residents were given the option of whether to utilize scribes, and the same data measures were collected. Resident satisfaction ratings during the Training Phase showed an average score of 6.03 (on a 1-7 scale where “7” = “strongly agree” with positive statements), and a pilot sample of 9 patients showed an average patient satisfaction rating of 4.77 (on a 1-5 scale where “5” = “strongly agree” with positive statements). Scribe-facilitated notes coded for quality had an average score of 3.375 (on a 1-5 scale where 5 is “extremely” high quality). Finally, residents’ average time to note closure was decreased by more than 8 hours in scribe-facilitated visits. During the Choice Phase, all 11 participating residents requested scribe-facilitated visits, again with very high patient satisfaction scores (4.67 on a 1-5 scale) as well as high clinician satisfaction scores (6.06 on a 1-7 scale). Choice Phase note quality and note-closure time are currently being assessed. These results demonstrate that scribes improve clinician and patient satisfaction, as well as quality and efficiency of EHR documentation. Limitations include a small sample size of clinicians and patients. Further research is needed with larger sample sizes to determine whether scribes in a medical residency program represent a sustainable and effective intervention.
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Candanedo, Jesica Eileen. "Referral Tracking Pilot and Referral Outcome Rates for the School Health Program in Panama." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4649.
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Background: The School Health Program (SHP) in the Republic of Panama includes preventive healthcare services delivery and referral issuing at elementary schools nationwide. Despite these early prevention efforts, a majority of referrals are apparently not achieving their desired outcome. This idea is supported by the SHP data showing preventable diseases on the rise. Thus, learning the outcome rates of particular referral outcomes may provide a basis for appropriately targeted action.
Methods: Three focus groups were conducted with health workers, medical records staff, and teachers, respectively. Following systems thinking and framework analysis, a pilot plan for referral tracking and referral outcome rates obtainment was developed. Finally, the SHP team was surveyed for their perception on the effectiveness and feasibility of the plan, for future implementation.
Results: Themes related to referral tracking led directly to the development of a referral tracking pilot plan (RTPP). Survey data analysis revealed that the SHP team perceived the RTPP as an effective way to obtain complete referral tracking and referral outcome rates, and they also found it feasible to implement.
Conclusion: Keeping referral records and tracking the SHP referrals is perceived, by those that will be involved in its delivery, as achievable by implementing a RTPP developed from their own recommendations. Once implemented, the resulting obtainment of referral outcome rates may allow them to know if the SHP preventive objective for issuing these referrals is being properly achieved, and to prioritize for targeted action where needed.
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Lower, Tonia L. "Improving healthcare provider knowledge in acute and primary transgender health needs:The implementation of a clinical education program with urgent care and emergency room staff and providers." Otterbein University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1481300755682172.
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Moussa, Edie A. "Contracting Out in a Complex Network: An Effectiveness Analysis of EPC Program I." Diss., Virginia Tech, 2011. http://hdl.handle.net/10919/77973.
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While government contracting out its work continues to proliferate and studies about this phenomenon have increased during the past two decades, still little is known about how effective government sponsored networks are at managing broad and complex networks of primarily non-governmental entities.
This dissertation reports the results of one such investigation, which examined a U.S. federal agency's contracting experiences in evidence-based health care. The Agency for Healthcare Research and Quality (AHRQ) is a unit of the U.S. Department of Health and Human Services (HHS). Among other tasks, AHRQ supports the development and dissemination of evidence about current best practices in health services delivery through its Evidence-based Practice Center (EPC) programs that contract out its work and operate in broad and complex network.
The purpose of this study was to examine the extent to which AHRQ's EPC Program I was effective in supporting the translation of evidence reports and disseminating the products to the public by contracting with public and non-profit entities to do the work. This dissertation also sought to examine the extent to which the evidence reports and derivative products were publicly accessible by operationalizing the objectives articulated in AHRQ's authorizing legislation in a manner consistent with theories of representative democracy and exploring Program I's effectiveness using William T. Gormley's ideas (1989; Gormley & Balla 2003) of bureaucratic control.
The results from this dissertation suggest that a decentralized network was related to overall higher translation and dissemination network effectiveness. Specifically, the findings from this study suggest that a decentralized network was related to overall higher translation and dissemination network effectiveness. Also, weak ties among the network actors when transferring complex knowledge was associated with higher translation and dissemination network effectiveness on the whole.
The findings from this dissertation also contribute to network theory by extending Gormley's bureaucratic control typology (1989; Gormley & Balla 2003) to the network level, and also to the type of control that was available to the Agency over the network. Finally, the results contribute to better understanding of the dynamics that can be associated with the effectiveness of similar programs.Ph. D.
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Goodin, Amie. "EVALUATING STATE POLICY INTERVENTIONS FOR OPIOID ABUSE AND DIVERSION: THE IMPACT ON CONSUMERS, HEALTHCARE PROVIDERS, AND THE U.S. MARKET FOR PRESCRIPTION OPIOIDS." UKnowledge, 2015. http://uknowledge.uky.edu/msppa_etds/14.
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Prescription opioid pain reliever utilization has been increasing since the 1990s, due in part to changes in recommendations for the treatment of chronic pain, but also to abuse and diversion. One innovative policy solution to the abuse and diversion of prescription opioids is state prescription drug monitoring programs (PDMPs), which provide prescribers and other selected parties with patient controlled substance dispensation history; thereby, correcting an information asymmetry problem between prescribers and patients.
The widespread implementation of state PDMPs, which vary in program design and requirements, has resulted in a variety of intended and unintended consequences. Previous PDMP evaluations have suggested such outcomes as the reduction of consumer access to opioids, the influencing of healthcare provider prescribing behaviors for opioids, and the re-shaping of the United States market for prescription opioids. PDMPs may also be associated with unintended outcomes: namely, the restriction of pharmaceutical opioids could be associated with an increase in heroin use, as evidenced by increases in heroin substance abuse treatment facility discharges. The analyses in this project examine the influence of PDMPs on healthcare providers and the market for prescription drugs by comparing trends in opioid utilization in states with varying PDMP features using Medicaid prescription utilization data and commercial insurance claims. The effect of PDMPs on consumers is explored with an analysis comparing substance abuse treatment facility discharge data for heroin abuse with pharmaceutical opioid prescriptions before and after PDMP regulatory change. Finally, the impact of other related opioid policy interventions, opioid overdose medication access laws, are analyzed by comparing opioid overdose mortality across states with differing overdose medication access policies over time. Contributions to the understanding about the impacts of these state-level opioid abuse and diversion policies can be used to improve or amplify intended outcomes and ameliorate unintended consequences.
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Ramachandran, Ambili. "Barriers to healthcare contribute to delays in follow-up among women with abnormal cancer screening: data from the Patient Navigation Research Program." Thesis, Boston University, 2014. https://hdl.handle.net/2144/21242.
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Thesis (M.S.C.E.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.BACKGROUND: Patient navigation programs were designed to address barriers to healthcare among underserved populations in order to reduce delays in cancer care delivery. While emerging data suggest modest effects of navigation on reducing delays, there is limited understanding of the association between barriers to care and clinical outcomes within patient navigation programs. OBJECTIVE: To investigate the impact of barriers on timely diagnostic care in the multicenter Patient Navigation Research Program (PNRP). STUDY DESIGN: Secondary analysis of data from the intervention arms of PNRP centers that navigated women for abnormal breast or cervical cancer screening tests from 2007 to 2010. METHODS: Analyses were performed separately for breast and cervical subjects. The main independent variables were (a) number of unique barriers to care (0, 1, 2, or 3+) documented during patient navigation encounters and (b) presence of socio-legal barriers (yes/no), those social problems related to meeting life’s most basic needs that are supported by public policy, regulation, and programming and thus potentially remedied through legal advice or advocacy. The outcome of interest was median time to diagnostic resolution, or the interval from index screening abnormality to diagnostic resolution, estimated using Kaplan-Meier cumulative incidence curves. Multivariable Cox proportional hazards regression with time to diagnostic resolution as the outcome examined the impact of barriers, controlling for socio-demographics and stratifying by study center. RESULTS: Among 2600 breast screening subjects, three-quarters had barriers to care (25% 1 barrier, 16% 2 barriers and 34% 3+ barriers). Among 1387 cervical screening subjects, slightly more than half had barriers (31% 1 barrier, 11% 2 barriers, and 13% 3+ barriers). Among breast subjects, we found the presence of barriers was associated with less timely resolution for any number of barriers compared to no barriers. Among cervical subjects, only the presence of 2 or more barriers was associated with less timely resolution. Both socio-legal and non socio-legal barriers were associated with delay among breast and cervical subjects. CONCLUSIONS: Navigated women with barriers resolve cancer screening abnormalities at a slower rate compared to those with no barriers. Further research is necessary to maximize the impact of patient navigation programs nationwide.
2031-01-01
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Pereira, Priscila Souza. "Programa de manutenção de edifícios para as unidades de atenção primária à saúde da cidade de Juiz de Fora." Universidade Federal de Juiz de Fora, 2011. https://repositorio.ufjf.br/jspui/handle/ufjf/2146.
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CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
A elaboração e aplicação de um programa adequado de manutenção de edifícios é capaz de minimizar o surgimento de manifestações patológicas e de outros problemas inerentes à edificação, bem como corrigi-los quando ocorrerem. Nesse sentido, este trabalho teve como objetivo principal elaborar um Programa de Manutenção aplicável às Unidades de Atenção Primária à Saúde (UAPS) da cidade de Juiz de Fora. Assim, foram realizados levantamentos in loco, bem como entrevistas não estruturadas para a identificação da problemática atual. Constatou-se a presença de anomalias de diferentes origens e a inadequada manutenção das edificações destinadas às UAPS. Finalmente, obteve-se um Programa de Manutenção abordando questões relativas a Manutenções Preventivas e Corretivas. Desta forma, espera-se colaborar com a melhor organização dos serviços de manutenção nas unidades de saúde, interferindo o mínimo nas atividades externas prestadas à população.
The development and implementation of an appropriate maintenance program of buildings can minimize the appearance of pathological manifestations and other problems inherent in building and correcting them when they occur. In this sense, this work aimed to develop a Maintenance Program applicable to Units of Primary Health Care (UAPS) from the city of Juiz de Fora. Thus, surveys were conducted on-site as well as unstructured interviews to identify the current problems. It was verified the presence of anomalies of different origins and inadequate maintenance of buildings to UAPS. Finally, we obtained a Maintenance Program addressing issues related to Preventive and Corrective Maintenance. Thus, it is expected to collaborate with the best organization of maintenance services at health facilities, with minimal disturbance in outside activities provided to the population.
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Saffore, Lateef Yusef PhD. "What Factors Influence Medicare Reimbursement Payments for Healthcare Providers that Admit Diabetic Patients?" University of Akron / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=akron1303145384.
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Costa, Júlia Gonçalves. "O modo tecnológico da vigilância da saúde e o trabalho das Equipes de Saúde da Família." Programa de pós-graduação em saúde coletiva, 2009. http://www.repositorio.ufba.br/ri/handle/ri/10372.
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Com a implantação do Programa de Saúde da Família (PSF), na década de 90, a discussão da mudança do modelo assistencial da saúde vem ganhando força. O PSF, entendido inicialmente como programa focalizado de atendimento para os pobres, incorpora os princípios e diretrizes da Vigilância da Saúde e assume o discurso de estratégia de mudança do modelo assistencial a partir da atenção básica, na construção do SUS. No entanto, as propostas de mudança do modelo assistencial enfrentam-se com o desafio que é o de mudar as práticas de saúde, o que implica a redefinição do objeto, dos meios de trabalho, das atividades, das relações técnicas e sociais, bem como das organizações e da sua cultura. Um dos pontos centrais trazidos pelo SUS e incorporado pelo PSF, para propor mudanças na saúde, foi apontar a saúde não apenas como ausência de doença, mas relacionada com as condições de vida e de trabalho, o que significa a redefinição do objeto da saúde. Contudo, este novo objeto não tem sido trabalhado, rotineiramente, pelo setor saúde. Tal situação parece se constituir em um dos nós críticos para a mudança da prática dos profissionais. Daí as questões de investigação: como delimitar este novo objeto? Que instrumentos têm os trabalhadores de saúde para lidar com ele? Procurando responder a essas questões foi realizado um estudo de caso, tendo como unidade de análise duas equipes de saúde da família de um município da Região Metropolitana de Salvador-Ba. O objetivo deste estudo é analisar as práticas de saúde de Equipes de Saúde da Família (ESF) segundo o modo tecnológico da Vigilância da Saúde. O referencial teórico utilizado fundamentase na teoria do processo de trabalho em saúde. Foram realizadas entrevistas com trabalhadores de saúde de duas ESF, principais fontes de dados desta pesquisa. As evidências produzidas permitem afirmar que o objeto privilegiado das práticas das ESF investigadas tem sido as doenças e agravos à saúde. As ESF não estão tomando como objeto de suas práticas os problemas de saúde da população de acordo com as diretrizes e princípios da Vigilância da Saúde e da Estratégia de Saúde da Família, que considera os danos, os riscos e os determinantes relacionados ao processo saúde-doença. As evidências indicam, ainda, que apesar dos profissionais das equipes utilizarem alguns dos instrumentos previstos para apreender de forma ampliada os problemas de saúde, o fazem de forma incipiente usando, apenas, para apreender as doenças e agravos à saúde da população. PCom a implantação do Programa de Saúde da Família (PSF), na década de 90, a discussão da mudança do modelo assistencial da saúde vem ganhando força. O PSF, entendido inicialmente como programa focalizado de atendimento para os pobres, incorpora os princípios e diretrizes da Vigilância da Saúde e assume o discurso de estratégia de mudança do modelo assistencial a partir da atenção básica, na construção do SUS. No entanto, as propostas de mudança do modelo assistencial enfrentam-se com o desafio que é o de mudar as práticas de saúde, o que implica a redefinição do objeto, dos meios de trabalho, das atividades, das relações técnicas e sociais, bem como das organizações e da sua cultura. Um dos pontos centrais trazidos pelo SUS e incorporado pelo PSF, para propor mudanças na saúde, foi apontar a saúde não apenas como ausência de doença, mas relacionada com as condições de vida e de trabalho, o que significa a redefinição do objeto da saúde. Contudo, este novo objeto não tem sido trabalhado, rotineiramente, pelo setor saúde. Tal situação parece se constituir em um dos nós críticos para a mudança da prática dos profissionais. Daí as questões de investigação: como delimitar este novo objeto? Que instrumentos têm os trabalhadores de saúde para lidar com ele? Procurando responder a essas questões foi realizado um estudo de caso, tendo como unidade de análise duas equipes de saúde da família de um município da Região Metropolitana de Salvador-Ba. O objetivo deste estudo é analisar as práticas de saúde de Equipes de Saúde da Família (ESF) segundo o modo tecnológico da Vigilância da Saúde. O referencial teórico utilizado fundamentasse na teoria do processo de trabalho em saúde. Foram realizadas entrevistas com trabalhadores de saúde de duas ESF, principais fontes de dados desta pesquisa. As evidências produzidas permitem afirmar que o objeto privilegiado das práticas das ESF investigadas tem sido as doenças e agravos à saúde. As ESF não estão tomando como objeto de suas práticas os problemas de saúde da população de acordo com as diretrizes e princípios da Vigilância da Saúde e da Estratégia de Saúde da Família, que considera os danos, os riscos e os determinantes relacionados ao processo saúde-doença. As evidências indicam, ainda, que apesar dos profissionais das equipes utilizarem alguns dos instrumentos previstos para apreender de forma ampliada os problemas de saúde, o fazem de forma incipiente usando, apenas, para apreender as doenças e agravos à saúde da população.
Salvador
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Elius, Ian M. "Re-engineering graduate medical education an analysis of the contribution of residents to teaching hospitals utilizing a model of an internal medicine residency program /." [Tampa, Fla.] : University of South Florida, 2005. http://purl.fcla.edu/fcla/etd/SFE0001258.
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Pednekar, Priti. "The Impact of Medication Adherence on Healthcare Utilization and Costs among Elderly Patients with Diabetes Who Were Enrolled in a State Pharmaceutical Assistance Program." Thesis, University of the Sciences in Philadelphia, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13856162.
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Objectives: This research identified the potential predictors of medication adherence and studied the impact of medication adherence on healthcare utilization and costs among elderly with diabetes who were enrolled in a State Pharmaceutical Assistance Program (SPAP).
Methods: Pharmaceutical Assistance Contract for Elderly (PACE) programs’ database was used to identify study population and estimate medication adherence as proportion of days covered (PDC) for 12-months post-index observation period (adherent: PDC ≥ 80%; nonadherent: PDC < 80%). Healthcare utilization and costs for the study period were estimated using Pennsylvania Health Care Cost Containment Council’s hospital inpatient discharge records. Healthcare utilization measures included all-cause, diabetes-specific, diabetes-related and diabetes-specific & related number of inpatient hospital admissions and length of stay (LOS). Multiple regression analyzes were performed to determine the predictors of medication adherence and to assess the association of medication adherence with risk of hospitalization, hospital service utilization and costs.
Results: Among 9,497 elderly PACE enrollees with diabetes, 81% were adherent and 21% were hospitalized. Race, marital status, number of unique medications and out-of-pocket payment were the significant predictors of medication adherence. The odds of being hospitalized were higher for nonadherent patients by the factor 2.030 than adherent patients (95% CI: 1.784–2.310). After controlling for covariates, non-adherent patients had significantly a greater number of all-cause (IRR 1.2727; 95% CI 1.1937–1.3569), more diabetes-related (IRR 1.2210; 95% CI 1.0492–1.4210) and more combined diabetes-specific & related (IRR 1.2106; 95% CI 1.0495–1.3965) hospital visits than adherent patients. After adjusting for covariates, LOS for non-adherent patients was longer for all-cause (IRR 1.2388; 95% CI 1.1706–1.3111), diabetes-related (IRR 1.1341; 95% CI 1.0415–1.2349) and for diabetes-specific & related (IRR 1.1271; 95% CI 1.0357–1.2267) hospitalization than adherent patients. GLM models showed that medication nonadherence was associated with significant increase in all-cause hospitalization costs ($22,670 vs $16,383; p < 0.0001) and diabetes-related hospitalization costs ($13,518 vs $12,634; p = 0.0003).
Conclusions: Medication nonadherence was associated with an increased risk of hospitalization, greater number of hospital visits, longer hospital LOS and substantial hospitalization costs among elderly SPAP beneficiaries with diabetes. Utilization of our findings to develop interventions or policies to improve medication adherence would significantly impact the US healthcare system particularly while allocating limited healthcare resources.
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Bölenius, Karin. "Improving venous blood specimen collection practices : method development and evaluation of an educational intervention program." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-87015.
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Background: About 60%–80% of decisions regarding diagnosis and treatment are based on laboratory test results. Low adherence to venous blood specimen collection (VBSC) guidelines may lead to erroneous or delayed test results, causing patient harm and high healthcare costs. Educational intervention programs (EIPs) to update, improve and sustain VBSC practices are seldom evaluated. After testing a self-reported venous blood sampling questionnaire, the overall aim of this thesis was to evaluate the impact of a large-scale EIP on healthcare personnel’s VBSC practices. Methods: The study settings were primary healthcare centres (PHCs) in northern Sweden. Participants were VBSC personnel. Data consisted of a VBSC questionnaire of self-reported practices, records of low-level haemolysis index in serum samples (specimen quality indicator), and interviews reflecting VBSC practices. First, experts on questionnaires and VBSC were consulted, and test-retest statistics were used when testing the VBSC questionnaire for validity and reliability. Thereafter, we evaluated the impact of a short, large-scale EIP with a before-after approach comparing self-reported VBSC questionnaire of two county councils. The personnel of the county councils (n = 61 PHCs) were divided into an intervention group (n = 84) and a corresponding control group (n = 79). In order to test changes in blood specimen quality we monitored haemolysis in serum samples (2008, n = 6652 samples and 2010, n = 6121 samples) from 11 PHCs. Finally, 30 VBSC personnel from 10 PHCs reported their experiences. The interview questions were open-ended with reflective elements and the interviews were analysed by qualitative content analysis. Results: The VBSC questionnaire was found to be valid and could be used to identify risk of errors (near misses) and evaluate the impact of an EIP emphasising VBSC guideline adherence. The intervention group demonstrated several significant improvements in self-reported practices after the EIP, such as information search, patient rest, test request management, patient identification, release of venous stasis, and test tube labelling. The control group showed no significant improvements. In total, PHCs showed minor differences in blood specimen quality. Interviews summarized VBSC personnel experiences in the overall theme: education opened up opportunities for reflection about safety. Conclusion: This thesis is, to our knowledge, the first to evaluate the impacts of a large-scale EIP on VBSC practices. The VBSC questionnaire and monitoring for low-level haemolysis reflected VBSC practices. The frequently occurring near-miss markers made it possible to compare and benchmark VBSC practices down to the healthcare unit and hospital ward. The short, general EIP opened up opportunities for reflection about safety and improved VBSC practices in PHCs with larger deviations from guidelines. EIPs that provide time for reflection and discussion could improve VBSC further. Directed EIPs focused on specific VBSC flaws might be more effective for some near misses in VBSC practices, while some near misses must be changed at a different level in the system. Clinical relevance: Our results indicate that monitoring and counteracting the near misses in VBSC practices is a well-functioning preventive action. We propose that the VBSC monitoring instruments (VBSC questionnaire & haemolysis index) we used and the EIP strategy proposed should be tested in additional countries with different healthcare settings. It is suggested that a national program intended to identify near misses and prevent VBSC errors be developed in the healthcare system. General e-learning programs may be cheaper than, and as effective as, the EIP program and may be performed everywhere and any time. Systematic planning, useful for reflection and with focus on the specific elements in a skill, together with VBSC guidelines, could probably increase improvements. Our studies have led to deeper and extended knowledge of the impact of an EIP on VBSC practices. Our results can be used when considering future VBSC practice interventions. Using a model for practical skills in nursing to describe VBSC in a more holistic and less technical way might highlight VBSC as a practical nursing skill.Bakgrund: Av kliniska beslut angående diagnostik och behandling baseras 60%–80% på laboratorieresultat. Därför är det helt nödvändigt att laboratorieresultat är tillförlitliga. Låg följsamhet till provtagnings anvisningar kan leda till felaktiga och fördröjda analysresultat, förorsaka skada och lidande för patienter och utgöra en stor kostnad för hälso- och sjukvården. Felaktiga provsvar beror till stor del på felaktig provtagning och provhantering och går oftast att undvika. Interventioner som avser att uppdatera och säkra korrekt venprovtagning kan leda till förbättringar men genomförda interventioner har sällan utvärderats. Efter att en enkät för självrapporterad venprovtagning testats för validitet och reliabilitet genomfördes ett omfattande interventionsprogram som utvärderades med hjälp av den testade enkäten och andra utvärderingsmått. Det övergripande syftet var att utvärdera i vilken utsträckning interventionsprogrammet påverkade provtagande personals praktiska utförande av venprovtagning. Metoder: Studierna i denna avhandling omfattade provtagande personal vid hälsocentraler i norra Sverige. För datainsamling användes en enkät som mäter självrapporterad venprovtagning, förekomst av låggradig hemolys (indikator på blodprovets kvalitet) och intervjuer. Initialt testades enkätens förmåga att mäta vad som avsetts (validitet) och testades enkätens förmåga att vid upprepade mätningar vara tillräckligt stabil (reliabilitet) för att användas i interventionsstudier. Därefter utvärderades ett kort men storskaligt interventionsprogram i preanalys inkluderande venprovtagning med före och efter mätningar. Vi jämförde provtagande personal från två landsting vid 61 hälsocentraler. Landstingens personal delades upp i en interventionsgrupp (n=84) och en motsvarande kontrollgrupp (n = 79). För att mäta kvaliteten av blodproverna extraherades uppgifter om hemolys i serumprover (2008, n = 6652 blodprov) och (2010, n = 6121 blodprov) från elva hälsocentraler i ett landsting. Slutligen, intervjuades 30 provtagande personal från 10 hälsocentraler efter att de deltagit i interventionsprogrammet. Intervjuerna var öppna och genererade korta berättelser och analyserades med innehållsanalys. Resultat: Venprovtagningsenkäten befanns vara valid och kan användas för att utvärdera personalens följsamhet till provtagningsanvisningar i venprovtagning och identifiera riskhändelser. Interventionsgruppen visade flera signifikanta förbättringar i självrapporterat utförande av venprovtagning såsom förbättrad informationssökning, vila inför provtagning, remissförfarande, kontroll av patientidentitet, användning av stas och etikettering av provrör. Kontrollgrupen visade inga signifikanta förbättringar. Blodprovskvaliteten visade små skillnader. Provtagande personals erfarenheter från intervjuerna sammanfattades i ett övergripande tema; utbildningsinsatsen öppnade upp möjligheter för reflektion om säkerhet. Slutsats: Avhandlingen är så vitt vi vet den första att utvärdera effekten av ett storskaligt interventionsprogram med hjälp av självrapporterat utförande av venprovtagning och blodprovers kvalitet (låggradig hemolys). Med dessa metoder ökar andelen riskhändelser så att jämförelser kunde göras även på enhetsnivå och avdelningsnivå. Utbildningsprogrammet öppnade upp för reflektioner om säkerhet och förbättrade utförande av venprovtagning vid enheter med större brister. Utbildningsprogram som öppnar upp för reflektion och diskussion kan leda till ökad patientsäkerhet i hälso- och sjukvården. Trots utfallet av resultaten, är riktade utbildningsinsatser för sjukvårdsenheter som uppvisar specifika brister troligtvis mer effektiva än breda utbildningsinsatser. Klinisk betydelse: Interventionsprogram avseende preanalys och venös provtagning förbättrade personalens praktiska utförande. Monitorering av och åtgärder för att minska riskhändelser är väl fungerande preventiva åtgärder. Instrumenten (självrapporterande enkät och hemolys) bör också testas i andra kontexter inom hälso- och sjukvården. Ett externt nationellt program för att identifiera och förebygga riskhändelser bör utvecklas i hälso- och sjukvården. Interventioner i form av e-lärande kan då vara ett alternativ som är billigt och effektivt. Dessutom kan systematisk planering och genomförande med fokus på reflektion av specifika delar i en färdighet vara effektivt för att uppnå förbättringar. Våra studier har bidragit till en djupare och utökad kunskap om effekten av ett interventionsprogram på utförande av venprovtagning. Resultaten kan användas vid framtida planering av utbildningsinsatser. Modeller för praktiskt färdighetsutövande inom omvårdnad kan beskriva venprovtagning ur ett helhetsperspektiv och synliggöra venprovtagning som en viktig praktisk färdighet inom omvårdnad.
Preanalys
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Gould-Johnson, Brenda. "Decreasing Attrition of Novice and Newly Hired Professional Nurses Through Preceptorship." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1966.
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Approval
Walden University
College of Health Sciences
This is to certify that the doctoral study by
Brenda Gould-Johnson
has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.
Review Committee
Dr. Eric Anderson, Committee Chairperson, Health Services Faculty
Dr. Patti Urso, Committee Member, Health Services Faculty
Dr. Jonas Nguh, University Reviewer, Health Services Faculty
Chief Academic Officer
Eric Riedel, Ph.D.
Walden University
2015
Walden University
College of Health Sciences
This is to certify that the doctoral study by
Brenda Gould-Johnson
has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.
Review Committee
Dr. Eric Anderson, Committee Chairperson, Health Services Faculty
Dr. Patti Urso, Committee Member, Health Services Faculty
Dr. Jonas Nguh, University Reviewer, Health Services Faculty
Chief Academic Officer
Eric Riedel, Ph.D.
Walden University
2015
Decreasing Attrition of Novice and Newly Hired Professional Nurses Through Preceptorship
by
Brenda Gould-Johnson
MSN/ED, University of Phoenix, 2012
MPAH, Golden Gate University, 1990
BSN, Norfolk State University, 1986
Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University
November 2015
50
Borges, Lausanne Souza. "Desigualdade e o trabalho de partejar no Brasil: questões para a educação profissional na área materno-infantil." reponame:Repositório Institucional da FIOCRUZ, 2013. https://www.arca.fiocruz.br/handle/icict/8617.
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Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Programa de Pós-Graduação em Educação Profissional em Saúde.
O estudo analisa os condicionantes histórico-sociais da prática de parturizar e a formação dual dos trabalhadores que atuam na área materno-infantil no Brasil. Para tanto, a dissertação considera o trabalho na área referida, à luz das especificidades que o orientam. Na introdução, apresenta-se um breve panorama do trabalho de partejar, discutindo a transmissão deste saber nas distintas civilizações humanas, até ser nominado como função especializada, ou seja, como um ramo tecnocientífico unidimensional restrito ao conhecimento médico da área obstétrica. O Capítulo 1 problematiza o paradigma político-econômico que envolve o parto atual enquanto produto constituído no âmbito da sociedade capitalista, abordando dois pontos: a divisão social do trabalho e a realização de distintas tarefas pelos trabalhadores de saúde; e a comparação, a partir do contexto referido, entre assistência hospitalar tecnocrata e o cuidado domiciliar baseado no saber ancestral das parteiras tradicionais. O Capítulo 2 analisa o Programa de Humanização no Pré-Natal e Nascimento do Ministério da Saúde brasileiro – nos aspectos relacionados à garantia de cuidados profissionais para a gestante no momento do parto – e, neste contexto, a proposta do Programa Rede Cegonha direcionada à qualificação do trabalhador da área materno-infantil. A dissertação conclui indicando, a partir da perspectiva de que o parto não constitui um fato natural e sim um ato socialmente produzido, a necessidade de superar a contradição histórica discutida na formação desigual do trabalhador que atua no âmbito da saúde materno-infantil no Sistema Único de Saúde (SUS).
The study analyses the social and historical conditionants of parturition and the dual formation of workers involved in the maternal and child area in Brazil. For both topics, the dissertation considers the job in the refered area, regarding the specificities the abide it. In the introduction, a brief outlook about midwifery is presented, discussing the transmission of this knowledge amongst distinctic human civilizations, until it is nominated as an expertise, in other words, as an technoscientific unidimensional branch restricted to medical knowledge in obstetrics. Chapter 1 problematizes the political and economic paradigm that involves the nowadays parturiton as a constituted product in the scope of capitalist society, addressing two points: social division of labor and the execution of distinct tasks by healthcare workers; and the comparison, from the refered context, between technocrat hospital assistance and home care based upon traditional midwifes' ancestral knowledge. Chapter 2 analyses the brazilian Healthcare Ministry Prenatal and Birth Humanization Program - in the aspects related to the guarantee of professional care for pregnants in the moment of parturition - and, in this context, the proposal of Rede Cegonha Program towards qualification of maternal and child area worker. The dissertation concludes indicating, from the perspetive that the parturition does not constitute a natural fact but a socially produced act, the need to overcome the historical contradition discussed in the unequal formation of the worker that is involved in the scope of Sistema Único de Saúde(SUS) maternal and child healthcare.