Dissertations / Theses: 'Modern Health Care Facilities'

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Pijnenburg, Martien Pijnenburg M. A. M. "Sources of care : Catholic healthcare in modern culture : an ethical study /." [S.l. : s.n.], 2010. http://dare.ubn.kun.nl/dspace/handle/2066/74928.

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Kundu, Suvendu. "Health care practices among the hill kharia of district Purulia and Bankura West Bengal." Thesis, University of North Bengal, 2018. http://ir.nbu.ac.in/handle/123456789/2822.

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Kundu, Suvendu. "Health care practices among the hill kharia of district Purulia and Bankura, West Bengal." Thesis, University of North Bengal, 2018. http://ir.nbu.ac.in/handle/123456789/3609.

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Maredza, Andrew. "Profit incentives and technical efficiency in the provision of health care in Zimbabwe: an application of data envelopment analysis and econometric methods." Thesis, University of Fort Hare, 2009. http://hdl.handle.net/10353/294.

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This study examines issues surrounding efficiency in the Zimbabwean health sector with specific emphasis on for-profit hospitals in order to find out whether they are significantly more efficient than non-profit hospitals. The study attempts to explore the significance of profit incentives on efficiency. This study uses the Data Envelopment Analysis (DEA) methodology to examine hospital efficiency scores for the 100 hospitals in the sample classified as for-profit, mission and public. Outputs of the study include inpatient days and outpatient visits. The number of beds, doctors and nurses were used to capture hospital inputs. The findings indicated that there was a marked deviation of efficiency scores from the best practice frontier with for-profit hospitals having the highest mean PTE of 71.1 percent. The mean PTE scores for mission and public hospitals were 64.8 percent and 62.6 percent respectively. About 85 percent, 83 percent and 91 percent of the for-profit, mission and public hospitals were found to be operating below their average PTE. More than half of the hospitals are being run inefficiently. Of more importance to this study is the fact that the hypothesis of for-profit hospital superiority was accepted implying that for profit hospitals are significantly more efficient than the non-profit category. The study indicated that the amount of inputs being used could be decreased substantially without decreasing the quantity of outputs achieved. In each of the hospitals included in the study, the total input reductions needed to make inefficient hospitals efficient are more than 50 percent. These input savings could go a long way in achieving other health concerns without mobilizing additional resources in the sector

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Lundberg, Stefan. "Facilities Management and Health Care at Home." Doctoral thesis, Stockholm : Technology and Health, KTH, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-4306.

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Bae, Crystal. "Emergency care assessment tool for health facilities." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20990.

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Includes bibliographical references
To date, health facilities in Africa have not had an objective measurement tool for evaluating essential emergency service provision. One major obstacle is the lack of consensus on a standardized evaluation framework, applicable across a variety of resource settings. The African Federation for Emergency Medicine has developed an assessment tool, specifically for low- and middle-income countries, via consensus process that assesses provision of key medical interventions. These interventions are referred to as essential emergency signal functions. A signal function represents the culmination of knowledge of interventions, supplies, and infrastructure capable for the management of an emergent condition. These are evaluated for the six specific clinical syndromes, regardless of aetiology, that occur prior to death: respiratory failure, shock, altered mental status, severe pain, trauma, and maternal health. These clinical syndromes are referred to as sentinel conditions. This study used the items deemed "essential", developed by consensus of 130 experts at the African Federation for Emergency Medicine Consensus Conference 2013, to develop a tool, the Emergency Care Assessment Tool (ECAT), incorporating these using signal functions for the specific emergency sentinel conditions. The tool was administered in a variety of settings to allow for the necessary refinement and context modifications before and after administering in each country. Four countries were chosen: Cameroon, Uganda, Egypt, and Botswana, to represent West/Central, East, North, and Southern Africa respectively. To enhance effectiveness, ECAT was used in varying facility levels with different health care providers in each country. This pilot precedes validation studies and future expansive roll out throughout the region.

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Dean, Lesa. "Dental Care in Long-Term Care Facilities of Warren County, Kentucky." TopSCHOLAR®, 1986. https://digitalcommons.wku.edu/theses/2252.

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Many physical changes occur as one ages, including changes associated with the oral cavity. A review of the literature suggests that the provision of dental care to institutionalized elderly patients presents problems due to a variety of factors. The purpose of this study is to assess the level or dental care provided to residents of long-term care facilities located in Warren County, Kentucky. In addition, secondary objectives Include the ascertainment of who provides dental care to residents and the amount or in-service dental training made available to staff members of the facility. Each administrator of the long term care facilities located in Warren County participated in an *interview conducted by the author. During the interview, information was obtained for a 21 item questionnaire concerning the facility, the number and age range or the residents, and types of dental services provided within the facility. Results obtained from the questionnaire indicated that 77 percent or the residents in long-tern care facilities in Warren County are 70 years of age or older. No significant differences were noted in the types or dental services provided to residents. However, the dental services provided ranged from those that were obtained in a private dental office via transportation or the resident to outside dental facilities to routine oral hygiene measures carried out by staff members employed by the facility. The findings revealed significant differences in the dental status of the MRDD residents when compared to the nursing home residents. Other findings indicated that none of the long-term care facilities had dental operatories or dental radiographic equipment on the premises. Additional research would be required in order to address uncertainties discovered in the study. A followup to the questionnaire Interview with the consulting dentists may be included to determine to what capacity and to what extent they are utilized by the facilities. Other recommendations include the utilization of entrance dental examinations to determine if services offered do meet the needs of the residents and periodic dental examinations to aid in detection and thus reduce the prevalence of dental diseases in this population.

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Golovkova, Anita. "Návrh ABC modelu na příkladu zdravotnického zařízení." Master's thesis, Vysoká škola ekonomická v Praze, 2017. http://www.nusl.cz/ntk/nusl-360510.

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The thesis deals with the issue of the formation of the ABC model in healthcare facilities. The aim of this work is the formation of the ABC model on the example of the Infectious Department of the selected teaching hospital. The work is divided into theoretical and practical part. In the framework of the theoretical part are summarised findings from literature review regarding the Activity-Based Costing method and its application in medical organisations. In the practical part are already constructs of the ABC model itself, based on an annual data basis using a procedure adapted to the medical facilities.

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Flores, Cristina. "The quality of care in residential care facilities for the elderly." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2007. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3261238.

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Fashant, Crystal Saric. "Environmental Performance in Long Term Care Facilities." Thesis, Metropolitan State University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10742619.

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This research examines the physical operations of a health care sector called long term care facilities. Long term care refers to organizations that provide onsite nursing care for people with long-term illnesses, elderly people who need continuous medical supervision, or for those in long-term rehabilitation programs. Most specifically, this research looks at the performance of the physical buildings (i.e. facilities) and how this performance impacts the external environment. Using secondary data from the organization Practice Greenhealth, this study addresses the following two research questions.

1. What is the combined current state of environmental performance at the long term care facilities that have applied for a Practice Greenhealth award?

2. What are the proposed environmental key performance indicators for the long term care sector?

Based on this research, a model is suggested for future researchers interested in the environmental performance of long term care facilities. The model suggests six drivers for improving environmental performance in long term care; (1) maintain compliance with environmental regulations, (2) reduce costs, (3) meet expectations of parent organization, (4) increase market competitiveness, (5) engage stakeholders, and (6) improve patient outcomes. Four environmental improvement categories are then established; (1) waste, (2) energy, (3) water, and (4) engagement initiatives, along with each categories’ associated indicators. Finally, this study develops a concise environmental performance survey that could be used by any long term care facility looking to make improvements to its environmental performance over time.

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Boucher, Duane Eric. "An information privacy model for primary health care facilities." Thesis, University of Fort Hare, 2013. http://hdl.handle.net/10353/d1007181.

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The revolutionary migration within the health care sector towards the digitisation of medical records for convenience or compliance touches on many concerns with respect to ensuring the security of patient personally identifiable information (PII). Foremost of these is that a patient’s right to privacy is not violated. To this end, it is necessary that health care practitioners have a clear understanding of the various constructs of privacy in order to ensure privacy compliance is maintained. This research project focuses on an investigation of privacy from a multidisciplinary philosophical perspective to highlight the constructs of information privacy. These constructs together with a discussion focused on the confidentiality and accessibility of medical records results in the development of an artefact represented in the format of a model. The formulation of the model is accomplished by making use of the Design Science research guidelines for artefact development. Part of the process required that the artefact be refined through the use of an Expert Review Process. This involved an iterative (three phase) process which required (seven) experts from the fields of privacy, information security, and health care to respond to semi-structured questions administered with an interview guide. The data analysis process utilised the ISO/IEC 29100:2011(E) standard on privacy as a means to assign thematic codes to the responses, which were then analysed. The proposed information privacy model was discussed in relation to the compliance requirements of the South African Protection of Personal Information (PoPI) Bill of 2009 and their application in a primary health care facility. The proposed information privacy model provides a holistic view of privacy management that can residually be used to increase awareness associated with the compliance requirements of using patient PII.

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Berk, Emre. "Admission and discharge policies for progressive health care facilities /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/8807.

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Droti, B. "Availability of health care for older persons in primary care facilities in Uganda." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2014. http://researchonline.lshtm.ac.uk/2021054/.

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Background. This thesis evaluated the health care available and delivered to older persons (≥50years) at primary care facilities in Uganda in order to identify gaps and weaknesses and to suggest potential solutions for improving the quality of their care. Methods. The study was conducted in 48 primary care facilities across Uganda. It involved structured interviews with the persons in-charge of the facilities to determine what health care was provided at their facility; analysis of the numbers of outpatients attending the clinics to determine the absolute and relative caseloads due to older persons; structured interviews with health workers to determine their knowledge, attitudes and practices regarding the care of older persons; and structured exit interviews with older persons and younger adults (35-49 years) to determine their perceptions of the services they had received from the facility. Study participants were selected through a multistage stratified random sampling method designed to give a representative sample of Ugandan government primary care clinics and outpatients. Data were analysed using methods for complex multistage surveys. Findings. Availability of services: The study found important gaps and weaknesses in the availability of services, equipment and amenities that were considered to be particularly important for the care of older persons and that were enquired about in the study. Availability was particularly low for non-communicable diseases and at lower level (levels II and III) primary care facilities. Caseload: A total of 11,847 out of 140,338 total visits (8%) were made by older persons. Infectious illnesses (63%), as opposed to chronic non-communicable diseases (32%), were the most commonly diagnosed illnesses among the older persons. Knowledge, attitudes and practices of health workers: In total, 145 health workers (92% of target) were interviewed. Using predefined criteria, 32% of them were classified as having poor knowledge of geriatrics and 68% as having at least satisfactory knowledge. Most of them (97%) were classified as having neutral attitudes towards older persons. Although hardly any of them (0.6%) was classified as having bad practices overall; a substantial proportion reported not giving older persons and younger adults autonomy (46-49%), health education (15-35%), prompt attention (19-30%), and or screening for diseases that are common in older persons (14-17%). Perceptions of older persons and younger adults of the services they had received: In total, 244 older persons (96% of target) and 96 younger adults (100% of target) were interviewed. Although only 16-17% were classified as having received poor treatment overall, a substantial proportion reported not being screened for common diseases found in older persons (65-70%), receiving prompt attention (66-76%), having autonomy (70-80%), or receiving health education (30-39%). Only 1-2% perceived they had received poor service from the primary care facilities. Generally, older persons were not treated differently from younger adults (p=0.52) and their perceptions of the services were similar (p=0.21). Conclusion. There were important gaps and weaknesses in services important for the care of older persons, and in the knowledge, attitudes and practices of the health workers. The Ministry of Health should therefore investigate how they might improve services for older persons at all levels of primary care facilities.

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Keise, Kay. "Preventing Falls in Long-Term Care Facilities." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7813.

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Falls and related injuries have affected residents in long-term care facilities for many years. It has been well-established that patient fall prevention includes staff education and hourly rounding in addition to adequate risk assessment. These steps, taken together, have the potential to decrease a 52.7% fall rate on the long-term care pilot unit. The purpose of this quality improvement project was to: (a) educate staff on the process of properly performing hourly rounding and (b) and achieve a decreased incidence of falls from the current fall rate. Thus, the practice-focused question for the project addressed whether rounding hourly on patients in a long-term care facility would decrease the numbers of falls and related injuries. The conceptual framework used for this evidence-based project was the Institute for Healthcare Improvement's rapid cycle improvement. A sample size of 40 residents' fall rates were compared for a 6-week period before the intervention of hourly rounding to the fall rates after 6 weeks of full implementation of the rounding process. A Wilcoxon Signed Ranks test (z = -4.169, p < .001) showed that there was a statistically significant improvement in staff knowledge when mean pretest scores (75.9%) were compared to posttest scores (94.5%). Nursing staff were also evaluated on competencies, and 100% of the staff successfully completed the competency checklist on the first attempt. Post project fall rates revealed a decreased fall rate by 22% over a 6-week period post implementation. Nursing leadership should ensure that staff are continually educated on policies being implemented to ensure an effective outcome. Having hourly rounding as a permanent policy can decrease the patient's fall rate and improve patient safety, a positive social change.

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Jiang, Caroline Yueh Wen. "The implementation of oral health regulation in long-term care facilities." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/42100.

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Background: Poor oral health in long-term care (LTC) facilities is rampant and currently there is no effective strategy for improving daily oral healthcare in most of them. The government of British Columbia has implemented an oral health regulation for joint responsibility between dental professionals and LTC administrators to maintain the daily oral healthcare of residents in their care; however, it seems that conflicting priorities persist and are a barrier to achieving optimal oral health for residents. Research Questions: How has the governmental regulation on oral healthcare in LTC been developed, implemented and sustained? Methods: I conducted a secondary analysis of open-ended interviews with 14 LTC administrators undertaken before the regulation was implemented. Subsequently I conducted similar interviews with five government officials and five administrators to explore how the regulation was developed and implemented. Participants for interviews were selected purposefully to obtain a comprehensive response to my questions. I used a constant comparison technique to analyze relationships between the various perspectives, and I determined the trustworthiness of my findings by triangulating them with published literature on this topic, and by allowing participants to comment on them. Results: Before the regulation was implemented administrators emphasized a need for constant reminders, continuing education and administrative accountability to maintain the daily oral healthcare in LTC facilities. Government officials developed the regulation so that facility residents would receive a clinical examination annually by a dental professional. However, LTC administrators seemed unaware of this regulation, and when brought to their attention did not expect it to be assessed by government inspectors. This disregard for regulation was confirmed by the inspectors who explained that they do not enquire about daily oral healthcare of residents unless there is a written recommendation from a dental professional for treatment of specific mouth problems. Conclusions: The regulation to manage oral healthcare in LTC facilities is not being implemented or sustained as intended because of inadequate collaboration between dental professionals, administrators, and government inspectors.

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Garcia, Alvarez Angel. "Interstitial space in health care facilities : planning for change & evolution." Thesis, Massachusetts Institute of Technology, 1989. http://hdl.handle.net/1721.1/73765.

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Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Architecture, 1989.
Includes bibliographical references (v. 2, leaves 287-299).
Hospitals are most useful material for architectural research for they exhibit all the problems encountered in other building types in an acute and easily measurable form. Health Care Facilities house the greatest range of functions within their operations and are subject to continuous changes through their life spans, requiring specific design strategies aimed at flexibility. These functions include offices, training schools, factories, warehouses, residential buildings, restaurants, etc. as well as many specifically clinical departments like operating theatres and pathology laboratories. The range of functions demand first, a wide variety and highly sophisticated services, which amounts to more than 40% of the building volume; and second, a high degree of interdependence and uncertainty in future uses. In this context, there are three overriding requirements in hospitals: fast design, provision for change & growth, and lifecycle economy. Interstitial Space is considered as a solution to these demands and found to be an appropriate design response. The Systems Approach is used as the methodology to analyze and organize the design and construction process within the general frame of systems thinking. Sources of information include all major reports and studies on the concept of Interstitial Space published in US, Canada, and UK; and inputs from professionals of health care planning firms in New York and the Boston area on the general issue of flexibility, and on the Interstitial Space concept in particular. This thesis is organized in three parts, each with three sections. Part one provides a reference to the General Systems Theory, a description of the Systems Approach and the performance concept in buildings. Part two addresses the problem of hospital design: first, it presents the general process of hospital planning; second, it discusses the problem of changes occurring in Health Care Facilities during their life spans; and third, a summary of design strategies for flexibility follows. Within this frame of analysis, part three discusses the Interstitial Space concept. First, the basic arguments leadings to its application; second, the design considerations in light of the different subsystems building up the system; and third, life-cycle cost implications.
by Angel Garcia Alvarez.
M.S.

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Webster, Elizabeth Natalie. "Health care Facilities as a Predictor of Breast Cancer Survival Rates." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6145.

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The disparity between survival rates for Black and White women with breast cancer is well documented and has been examined in terms socioeconomics, environment, tumor type, and genetics. However, there is little examination of the role of health care facilities in cancer disparities. Health care facilities are representative of societal norms and beliefs that include location, quality of care, finance, policies, and staffing; therefore, they are a proxy for social justice and social change. The purpose of this study was to examine correlations between health care facility type; social determinants of cancer such as poverty, culture, and social justice; and breast cancer survival rates. Using the social determinants of cancer theoretical framework, the breast cancer survival rate of 4,087 Black and White women in Georgia between the ages of 45 and 69 was studied. The relationship between breast cancer survival and predictors including race, income, health care facility type, grade, and tumor type (4 sub-variables) were examined using the Kaplan-Meier Method, log-rank test, and Cox proportional hazard model. The log-rank test suggested no statistically significant difference in the survival functions among patients in different health care facilities (Ï?2(2) = 0.0150, p = 0.9926). The Cox proportional hazard model suggested no statistically significant relationship between breast cancer survival and health care facility type, after controlling for other predictors (Ï?2(2) = 0.3647, p = 0.8333). This result indicates that healthcare facilities do not influence breast cancer survival rates, however, given the persistent health outcome disparities further research in the area is warranted.

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Donaldson, Audley St Claire. "Modern health care it's implications for the Caribbean church /." Theological Research Exchange Network (TREN), 1985. http://www.tren.com.

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Manthalu, Gerald Herbert. "The impact of user fee exemption on maternal health care utilisation and health outcomes at mission health care facilities in Malawi." Thesis, University of Aberdeen, 2014. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=214843.

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The Government of Malawi has entered into agreements with Christian health association of Malawi (CHAM) health care facilities in order to exempt their catchment populations from paying user fees. These agreements are called service level agreements (SLAs). Government in turn reimburses the CHAM health care facilities for the health services that they provide. The agreements started in 2006 with 28 out of 166 CHAM health care facilities and increased to 68 in 2010. The aim of the exemption policy is to guarantee universal access to a basic package of health care services. Although the agreements were designed to cover every health service in the basic health care package, only maternal and neonatal health services are included due to limited resources. The main objective of this thesis was to evaluate the impact of the health care financing change on health care utilisation and health. The specific objectives were as follows: first, to examine whether health care facility visits for maternal health care changed due to user fee exemption; second, to evaluate whether user fee exemption affected the choice of the health care provider where women living in the catchment areas of CHAM health care facilities with user fee exemption sought maternal health care; third, to analyse the effect of user fee exemption on birth weight and; fourth, to explore and apply novel methods in the evaluation of user fee exemption. The gradual uptake of service level agreements by CHAM health care facilities provided a natural experiment with treated and control health care facilities. An additional control group comprised of other demographic groups apart from pregnant women and neonates at CHAM health care facilities with service level agreements. In household survey data, individuals were assigned to treatment and control groups based on their proximity to either a CHAM health care facility with SLA or a CHAM health care facility without SLA. This proffered the unique opportunity to estimate the effect of a single treatment on multiple outcomes. The difference-in-differences (DiD) approach was used to obtain causal effects of user fee exemption. It was implemented in the context of fixed effects, switching regression and multinomial logit models across different chapters. Health care facility level panel data for utmost 146 health care facilities for a maximum of 8 years, 2003-2010, were used. The data were obtained from the Malawi health management xiii information system (HMIS). Linked survey data were also used. Malawi demographic and survey data for 2004 and 2010 were linked to health care facility data and then merged. Analyses that utilised health care facility data showed that user fee exemption had led to increases in first antenatal care visits in the first trimester, first antenatal care visits in any trimester, average antenatal care visits and deliveries at CHAM health care facilities with SLAs. Results from survey data showed that the probability of using a CHAM health care facility with user fee exemption for antenatal care increased, the probability of using home antenatal care declined and the probability of not using antenatal care also declined due to user fee exemption. The probability of delivering at a CHAM health care facility with SLA also increased while the probability of delivering at home declined. User fee exemption did not affect the choice of where to go for postpartum care. Results of the effect of user fee exemption on birth weight were not reported because of potential endogeneity bias arising from lack of instrumental variables for antenatal care. The key policy messages from this thesis are that the user fee exemption policy is an important intervention for increasing the utilisation of maternal health care and needs to be extended to as many CHAM health care facilities as necessary. User fee exemption is not enough, however. Other factors such as education of the woman and her husband/partner, wealth status and cultural factors are also important. This thesis has contributed to the body of knowledge in the following ways. First, it has generated evidence on the impact of user fee exemption on maternal health care utilisation and birth weight in Malawi. Second, with respect to maternal health care utilisation, the thesis has looked at variables that capture the whole maternal health care process from early pregnancy to postpartum care and in a policy relevant way. Third, the thesis has evaluated the effect of user fee exemption on a variable that have not been looked at before, first antenatal care visits in the first trimester. Fourth, the thesis has examined the effect of a single treatment on multiple outcomes in a methodologically unique way. Treatment effects, which were the changes in the probabilities of using different alternatives summed up to zero, thus showing where any increase in the probability of using the outcome of interest came from. Fifth, this thesis is first to use disequilibrium theory of demand and supply in health economics. Application of this theory entailed using switching regression models with unknown sample separation, a seldom used estimation method in health economics. This was an important contribution to the methods xiv of analysing aggregate health care utilisation. Sixth, the STATA program that was written for the estimation of the disequilibrium models was itself a very important contribution to the methods for estimating aggregate supply and demand.

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Temmers, Lynette. "Factors influencing the collaboration between community health workers and the public primary health care facilities in delivering primary health care services." University of Western Cape, 2019. http://hdl.handle.net/11394/7655.

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Master of Public Health - MPH
Community health workers (CHWs) are integral to improve Primary health care (PHC) coverage, utilising their unique skills within the community to make services accessible and equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South Africa, has set priorities and requirements for the provision of funding to Non-profit organisations (NPOs) for forming coalitions with the Health Department to deliver various aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are underscored by a strong sense of intersectoral collaboration to work together to attain sufficient and sustainable progress. Collaboration between CHWs and PHC facilities is important in aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring UHC

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Munedzimwe, Fadzai Eunice. "Medicine stock Management at primary health care facilities in one South African province." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27822.

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As nations are encouraged to move towards achieving Universal Health coverage (UHC), access to essential medicines needs to be prioritized. In ensuring access to medicines, an important factor to be considered is the uninterrupted availability of essential medicines at the primary health care (PHC) level which is usually the first point of entry into the health system for patients. If South Africa is to move towards achieving UHC, the government must address the issue of unavailability of medicines due to frequent stock outs at the public health facilities. The increase in prevalence of HIV/AIDS and TB has resulted in an increase in the demand for medicines used in the management and treatment of these diseases. Surveys have revealed the extent of stock outs and shortages of medicines used in the management of HIV and TB in South Africa. It has also been predicted that the burden of disease in relation to these diseases is likely to increase in the coming years therefore, it is important for the South African government to address the issues of stock outs. Using a qualitative multiple case study approach, we explored the factors which may influence the management of medicine stock thus causing medicine stock outs at four PHC facilities in two of the districts in the study province. A conceptual framework on the factors influencing medicine stock outs at health facilities was developed from reviewing literature on the subject and this was used to guide data collection and analysis. Our findings revealed that the factors influencing the management of medicine stock leading to medicine stock outs include the lack of capacity in terms of human resources and physical resources at the PHC facilities. Insufficient supervision and support from the district level also had an influence as health workers at the facilities did not always follow the recommended procedures for medicine stock management. We also found that there were gaps in communication between the health workers at the facilities and stakeholders at other levels, particularly the pharmaceutical depot from which the facilities obtained their medicines. The inadequate information systems contributed to this gap in communication. Whilst many studies have focused on the factors that may influence the availability of medicine at higher levels, this study focused on what may influence it at the ground level, the PHC facility level. We anticipate that our findings will inform policy makers on how the availability of medicines at PHC facilities may be improved by focusing on improving the processes in medicine stock management at this level.

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PonceVega, Jose A. "Leadership Strategies for Implementing Quality Improvement Initiatives in Primary Care Facilities." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6265.

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Health care spending accounts for 17.7% of the gross domestic product in the United States, and it is expected to continue rising at an annual rate of 5.3%. Despite high costs, health care quality lags behind other high-income countries; yet, over 70% of change initiatives fail. The purpose of this multiple case study was to explore strategies primary care leaders use for implementing quality improvement initiatives to improve patient outcomes and reduce waste in primary care facilities. The target population consisted of 3 health care leaders of 3 primary care facilities in southern California who successfully implemented quality improvement initiatives. The conceptual framework for this study was Kotter's 8-step of change management. Data were collected through face-to-face semistructured interviews with senior health care managers, document review, and quality reports. Member checking of interview transcripts strengthened the credibility of the findings. Data analysis included Yin's 5-phase process, which consisted of compiling, disassembling, reassembling, interpreting, and concluding the data. Themes emerged from the use of methodological triangulation of data. The themes included communication, leadership support, inclusive decision-making, and employee recognition. The implications of the findings of this study for positive social change include assisting primary care leaders in improving strategies for implementing quality improvement initiatives to increase efficiency, reduce health care cost, and improve patient and community health.

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Dusenberry, Jean Lee. "A Mental Health Care Center for Grady Memorial Hospital." Thesis, Georgia Institute of Technology, 1994. http://hdl.handle.net/1853/24137.

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Dreiling, Jeremy B. "An evaluation of ultraviolet germicidal irradiation (UVGI) technology in health care facilities." Manhattan, Kan. : Kansas State University, 2008. http://hdl.handle.net/2097/651.

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Gutridge, Kerry. "Assisted self-harm in mental health care facilities : an ethically acceptable approach?" Thesis, University of Bristol, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601002.

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The aim of the thesis is to establish whether "assisted self-harm" is ethical or moral, when used in adult acute inpatient environments; in other words, whether it is consistent with how people should live their lives and treat others. "Assisted self-harm" refers to management strategies for self-harm which strive to reduce/limit, rather than stop, the behaviour. Strategies include offering advice on safer places to injure or allowing/providing sharp implements. In the project I used an "empirical ethics" approach, combining philosophical analysis with empirical studies to produce normative, not descriptive, conclusions. I conducted individual qualitative interviews with 5 patients and 20 inpatient or home intervention mental health professionals. Two focus groups were conducted: (I) with people from adult community services (n=4); and (2) with people from a specialist service for personality disorder (n=12). The interviews provided descriptive data about people's motivations, reasons and intentions when they self-injure, as well as predictive data about the possible consequences of allowing injury and participant-driven arguments for or against the approach. This data was used to complement theoretical analysis of the key concepts "autonomy", "responsibility" and "harm" and was integrated into my own arguments, to provide recommendations for action. Based on the combined analysis, I argue that "assisted self-harm" is justifiable in the shortterm as a means to reduce long-term harm, provided that five conditions are met. Thus, where the patient: is using self-injury primarily to manage distress; is injuring in a way which is associated with a low probability of physical damage (given the presence of appropriate support, such as advice on technique); possesses sufficient mental acuity after injury to engage with therapy; has an honest and open relationship with staff who are familiar with their history; and is capable of injuring in private, then "assisted self-harm" m.ay be an appropriate and effective approach.

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Kim, Paul. "Emergency care assessment tool for health facilities: a validity study in Cameroon." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29865.

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Background To date, health facilities in Sub-Saharan Africa have not had an objective measurement tool for evaluating comprehensive emergency service provision. One major obstacle is the lack of consensus on a standardised evaluation framework, applicable across a variety of resource settings. The African Federation for Emergency Medicine (AFEM) developed an assessment tool specifically for these settings - the Emergency Care Assessment Tool (ECAT) - that assesses provision of key medical interventions. These interventions are referred to as signal functions for the six sentinel conditions that occur prior to death: respiratory failure, shock, altered mental status, severe pain/trauma, and dangerous fever. A signal function represents the culmination of knowledge of interventions, supplies, and infrastructure capable for the management of an emergent condition. Previous studies aimed at the refinement and context modification of the ECAT have already been performed in multiple African countries. We undertook a validation study to help determine the applicability of the tool in assessment of emergency services throughout the continent. Aims and Objectives The aim of this study was to determine the content, construct, and face validity of the AFEM Emergency Care Assessment Tool in Cameroon. To achieve this, the study had the following objectives: (1) Employ the ECAT in district, regional, and central hospitals in Cameroon. (2) Use direct observation to determine whether the signal functions can be performed in these facilities. Methods This was an observational study at a convenience sample of five hospitals in Cameroon: three district, one regional, and one central. The goal of this study was to validate the instrument, not the facility, and so the sample size was related to the number of signal functions witnessed rather than the number of facilities visited. The tool was administered with the Head of Emergency at each facility. This completed ECAT was then compared with direct observations of the signal functions, a process which was conducted by the partner local emergency care specialists accompanied by the ECAT researcher. Results In general, the higher the level of facility, the greater the emergency care capacity and the greater the number of signal functions that could be performed correctly and consistently. Discrepancies in funding, supplies, resource allocation, and care delivery ability were apparent through ECAT results, expounding on barriers to care delivery, and direct observation. McNemar tests on the ECAT results versus direct observation at each facility yielded statistically significant support for tool validation at the national level emergency unit as well as two of the district level emergency units. Concordance between reported and observed signal functions could not be achieved at the regional facility and one of the district facilities. Conclusions The ECAT has good potential for facility level assessment of emergency care provision, and collects meaningful information that can guide effective improvements in the delivery of emergency care.

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Owusu-Amankwah, Emmanuel. "WILLINGNESS-TO-PAY FOR ATTRIBUTES OF HEALTH CARE FACILITIES IN RURAL KENTUCKY." UKnowledge, 2018. https://uknowledge.uky.edu/agecon_etds/64.

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Background: As rural hospitals in Kentucky face insolvency, stakeholders must assess the value of rural hospitals as well as alternatives such as rural clinics and private physician offices. Objective: To identify the value of attributes of healthcare facilities based on Kentucky’s rural residents’ willingness-to-pay (WTP). Methods: A survey instrument was created and distributed to ten counties in rural Kentucky. A conditional logit model was used to obtain baseline values and then a mixed logit model was used to address heterogeneity among consumers in estimating WTP. WTP values incorporated respondents’ demographic characteristics and their health status from self-reported frequency of use of medical services and distance from these services. Results: The results indicate that on average respondents were willing to pay $69.90 each year for the attribute of a facility that treats patients whether they have health insurance or not, compared to a facility that only accepts patients with private health insurance. Uninsured residents were willing to pay $81.15 for this attribute level. Conclusion: The study suggests that uninsured residents value this attribute level of a facility that grants them access to care. Stakeholders may justify such welfare benefit amounts in support of the establishment or maintenance of such a facility.

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LaPrade, Keith. "Effective Nurse Recruitment Methods for Long-Term Care Facilities." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7550.

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Nurse recruitment is a challenge for long-term care (LTC) leaders. Some owners of LTC businesses lack knowledge of how to attract, market, and hire qualified nurses to help ensure success. The purpose of this multiple case study was to explore the methods and strategies LTC leaders used to recruit nurses. The target population consisted of leaders of 3 LTC facilities who were responsible for recruiting nurses. This selection was based on findings that organization leaders experienced a downsizing of more than 20% of their personnel. The conceptual framework was the motivation-hygiene theory. Working conditions were influenced by Herzberg's 2-factor principles of job dissatisfaction. I focused on analyzing the participant data, public documents, and performance outcomes that demonstrated the effectiveness of participant recruitment strategies. Data were collected from semistructured interviews. I compared the motivational hygiene theory factors that influenced employee job satisfaction and dissatisfaction identified with the conceptual framework and any new studies published since beginning my study. Results of data coding and analysis revealed 3 major themes: communicating job descriptions to new LTC recruits, hiring for nurseâposition fit to address turnover, and making the position attractive by offering competitive wages and benefits. Successful recruiting strategies included ensuring nurse position fit, contacting qualified candidates, and work conditions designed to meet candidates' needs, expectations, and requirements. Results of this study might contribute to social change by providing recruitment strategies to ensure quality nursing services in LTC and strategies necessary to sustain business operations.

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Kemp, Linzi J. "Organisational team : modern and postmodern perspectives of primary health care." Thesis, Manchester Metropolitan University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271244.

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Elkins, Jeananne Sharp. "Diverse facilities, aging residents| Assisted living through the lens of the 2010 National Survey of Residential Care Facilities." Thesis, The Texas A&M University System Health Science Center, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3587509.

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In the late 1980's assisted living emerged as a self-proclaimed new style of providing long-term care and supportive services. Assisted living as espoused by its early proponents and by industry leaders embodied certain specific philosophical tenets, such as dignity, autonomy, meeting scheduled and unscheduled needs and aging in place, in their daily operations. These tenets distinguished assisted living from other forms of institutional care such as nursing home care. In the past twenty years the assisted living industry has matured and grown substantially. However, despite the maturing of the industry and the general agreement on the basic tenets little is known about the degree to which the industry embodies these principles.

In addition public policy and consumer preferences have grown in their focus on substituting assisted living for nursing home care. Moreover, the degree to which assisted living can and does substitute for nursing home care has been largely unexamined. Elder care advocates and researchers have more and more called attention to the increasing acuity level of assisted living residents.

This study consists of three related components, each of which will broaden the understanding of current assisted living facilities and their residents. The first study examines person environment fit in assisted living. Lawton's theory of person environment fit, has largely defined the construction and physical environment of assisted living since the 1980's. Changes in Lawton's theory were proposed by Guiata and Jones in the Journal of the American Medical Association in 2012 in reaction to the increased level of dementia in assisted living residents. A third non-theoretical analysis using exploratory factor is designed assist with development of new constructs in person environment fit theory. The second study examines changes in assisted living facilities and residents from 1999 to 2010. This study uses the only two national surveys of assisted living, The 1999 National Survey of Assisted Living and the 2010 National Survey of Residential Care Facilities. This study will examine both facility level and resident level characteristics to explicate resident acuities and to examine the degree to which facilities are accommodating these acuities. The third study examines facility characteristics associated with discharge of residents from assisted living facilities. Understanding resident discharge from assisted living will give a better understanding how assisted living facilities meet scheduled and unscheduled needs of residents as well as embody the philosophical concept of aging in place.

The contribution of this research is improved understanding of the current assisted living facilities and residents and better understand the importance of facility characteristics in person environment fit and in aging in place. This contribution is significant because assisted living residents are a vulnerable population with no protection under federal statutes and limited protection in most states. If indeed, as advocates and researchers assert, assisted living residents mirror nursing home residents in acuity then this research will assist with developing policies to protect this vulnerable population.

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Irvin, Renee A. "Quality of care, asymmetric information, and patient outcomes in U.S. for-profit and not-for-profit renal dialysis facilities /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/7489.

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Emerson, Andrew. "Hospital hostels : an evaluation of four psychiatric care facilities in Hampshire." Thesis, University of Southampton, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.239475.

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Irish-O'Brien, William Henry. "A qualitative case study| Educational preparedness of nurse executives in long term care facilities." Thesis, University of Phoenix, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10262367.

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Directors of nurses in long-term care are faced with significant changes in the healthcare industry. The responsibilities of the position have evolved and now require director of nurses to have additional skill sets that were not previously associated with the expectations of the position. The purpose of this qualitative descriptive case study was to explore the perception of 8 directors of nursing in long-term care facilities in the Downstate Area of New York State. This research was guided by the following questions: What are the perceptions of directors of nurses or nurse executives in long term care facilities? Who may or may not be educated in graduate level business, particularly in the area of business decision making and fiscal responsibilities? How can registered nurses in leadership and executive positions enhance their educational preparedness as they pursue the responsibilities associated with their roles? A case study is an in-depth examination of individuals, organizations, or processes that seek further theoretical understanding. Several pertinent and relevant themes were identified such as; a) the review of the nursing curriculum, b) the need for standardized requirement to practice as a director of nurses, c) self-direction in ongoing education, mentorship and, d) training in business and fiscal responsibilities. Additionally, sub themes emerged during this qualitative study which included; a) organizational responsibility, b) director of nursing demanding change, and c) accelerated nursing programs.

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Shreffler, Mary Jean. "Residents' views on access to care in frontier communities with medical assistance facilities /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/7225.

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LaPerrière, Barbara P. "Sources of stress for children of parents in long-term care facilities." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=69731.

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A stress, appraisal, and coping framework was used to explore the sources of stress for adult children of elderly parents residing in long-term care facilities and their perceived self-efficacy in managing the stressful events of caregiving. Sixty-four daughters and sons of parents in three long-term care facilities completed interviews and questionnaires. Events related to the parents' behaviour and cognitive status were more frequently appraised by their children as stressful and were appraised as more stressful than those related to assisting parents with activities of daily living or to events associated with the long-term care facility itself. Characteristics of the parent were more significantly related to the appraisal of caregiving events as stressful than were those of the adult child or the caregiving situation. In general, adult children were most confident in managing the stress associated with assisting their parents with activities of daily living and least confident in dealing with the stress related to interactions between their parents and the staff and between themselves and the staff. Practice implications for nurses working in long-term care facilities are discussed.

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Zeilani, Ruqayya Sayed Ali. "Experiencing intensive care : women's voices in Jordan." Thesis, University of Nottingham, 2008. http://eprints.nottingham.ac.uk/10483/.

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This study explores women's experiences of critical illness in Jordanian intensive care units. A narrative approach was employed to access Jordanian women's stories of their critical illness and to study how these accounts changed during the period following their discharge from intensive care. The study was conducted in two hospitals in a major Jordanian city. A purposive sample of 16 women who had spent at least 48 hours in intensive care was recruited over a period of six months, with each woman taking part in between one and three interviews during the six month period. Two focus group discussions were also conducted with 13 ICU nurses drawn from the hospitals in which the women had been patients. These had the aim of encouraging discussion about the development of new supportive care strategies for critically ill women in Jordanian intensive care units. The study findings revealed three main areas: the women's experiences of suffering and pain; their experience of body care; and the impact of the ICU experiences on their lives after discharge home. Experiences of suffering were pervaded with physical, emotional, social and temporal dimensions, interlinked with pain that was often severe, overwhelming, and disturbing to their sleep. The notion of 'nafsi' suffering was employed to describe emotional and social losses, such as loss of family support, which the women experienced. The notion of 'vicarious death' was used to explain the mortal fear women experienced in witnessing the death of others. Loss of body control, the unfamiliar ICU environment, and the sudden onset of illness made it difficult for the women to make sense of their experiences. This study shows that cultural norms and religious beliefs shape the ways in which these Muslim women made sense of their bodies. An analysis of the concept of 'bodywork' is presented: the 'dependent body' captures the women's experiences of changes of their physical status, which meant that from being care providers, they became those in need of care. This involved the experience of a sense of paralysis or disablement, and a complete dependence on their family or nurses. The 'social body' describes the women's feelings and emotions toward their family members. The latter assisted in the care of the women's bodies, but distress, frustration and a sense of loneliness were experienced by the women as a result of the loss of verbal communication with their relatives. The 'cultural body' describes the effect of cultural norms and Islamic religious beliefs on the women's interpretation of their experiences, and the interpretation of male nursing care in the ICU. The 'mechanical body' describes the women's experiences of the ICU machines as extensions of their bodies, and the senses of limbo and ambiguity they encountered during their ICU stay. The recovery period raised many physical, emotional, social, and spiritual issues, which in turn impacted on the women's experiences of their everyday lives. Weakness and tiredness accompanied with difficulties in eating and sleeping made some women feel frustrated and uncertain about their health. Some felt they were a burden upon their families. The meaning of the critical illness experiences were interpreted by some women as an opportunity to value family unity and neighbours' support. For other women, the illness experiences gave them lessons which strengthened their role as mothers and helped them to think positively about their future. This study highlights the importance of considering the cultural and religious preferences among Muslim women in critical care settings. The study recommendations focus on the need to base nursing care on an understanding of the physical, emotional, social, and religious elements of suffering, by exploring the potential of a palliative care approach for nursing critically ill people.

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Leon, Natalie H. "District health systems development : functional integration at joint primary health care facilities in the Western Cape." Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/10769.

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Bibliography: leaves 65-68.
South Africa has embarked on a range of health sector reforms since the start of the democratic government in 1994. The Primary Health Care approach has been accepted as a way of delivering cost effective, efficient and accessible comprehensive health care at the primary care level. The district health system has been promoted as the best model for the delivery of primary health care because it decentralizes power to the local, district level and it is able to integrate fragmented primary care services under one management and governance structure. In the absence of a formal, legal district health system, provincial and local government authorities have made efforts towards functional integration in primary health care. The establishment of shared health facilities with the aim of providing integrated, comprehensive health care is part of the effort towards functional integration. This study investigates the level of functional integration in joint health facilities between Local Authority (LA) and the Provincial Administration of the Western Cape (PAWC).

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Ibrahim, Ahmed D. "The development of a procurement strategy for primary health care facilities in Nigeria." Thesis, Loughborough University, 2007. https://dspace.lboro.ac.uk/2134/12679.

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The Federal Government of Nigeria (FGN) introduced the Ward Health System (WHS) in 200 I to facilitate the provision of sustainable and integrated Primary Health Care (PHC) services by revitalising the principle of community co-ownership and co-management of PHC facilities. To date, the extent to which the WHS scheme has achieved its objectives remains questionable and a strong case for further re-examination of its structure, process and function, including its overall place in the PHC subsystem has been made. The FGN has also shown considerable interest in attracting the private sector to boost investment and efficiency in the healthcare sector, although it is yet to formulate any strategies towards actualising that desire. Accordingly, this research aimed at developing a sustainable procurement strategy that will facilitate the achievement of community co-ownership or co-management of PHC facilities in Nigeria, was launched. The research utilised the best practices within the UK Local Improvement Finance Trust (LIFT) procurement strategy for integrated primary and social care facilities to recommend practices that can facilitate the achievement of sustained improvement in the Nigerian context. A variety of qualitative and quantitative research methods were employed including interviews, questionnaire survey and focus groups. Strategic evaluation of the WHS model was conducted in Nigeria through exploratory interviews. The investigations indicated that the planning and implementation of on-going strategies lack focus, impact and sustainability. Consequently, further exploratory interviews were undertaken in the UK to investigate some key implementation issues on the LIFT schemes that can be used to promote sustained improvements in the Nigerian context. The best practices identified relate to stakeholder identification, analysis, engagement and aligrunent; defmition of processes, roles, responsibilities and accountabilities; periodic reviews throughout the whole-life cycle of each project; and some new project roles and tasks. Accordingly, a procurement strategy based on the Public-Private Partnership (PPP) principle that will be responsive to the peculiar needs of the host community and have adequate accountability structure for sustaining PHC facilities in Nigeria was proposed. This proposal falls in line with the new macroeconomic strategy adopted for growth and the health reform agenda of the present government, which have variously emphasised the expansion of the approach to improving healthcare delivery through increased private sector participation, whenever feasible. It is expected that the active participation of various components of the communities will offer considerable social and economic benefits such as social inclusion, employment and training opportunities for the members of the host communities in addition to the attainment of other fundamental philosophies of PHC provisioning. In addition, a supplementary questionnaire survey was carried out in Nigeria to investigate the perceptions of Nigerian professionals on the success and risk factors associated with the use of PPPs for infrastructural developments in Nigeria. The results show that seven out of the top ten most important PPP risk factors in Nigeria are endogenous (risk events and consequences of which occur within the system boundaries of the project being considered). The results also show that while the majority of the endogenous risk factors could be assigned to the private sector partner, the public sector should retain political and site acquisition risks, while relationship-based risks should be shared between the private and public sector partners. The three most important PPP success factors in Nigeria were found to be favourable legal framework, well-organised public agency to negotiate on behalf of government and strong private consortium: The comparison of the fmdings of this study with similar previous study in the UK suggests commonalities in the success factors of PPP projects. On the basis of the results of the exploratory interviews and questionnaire survey, focus groups were held to assess the appropriateness of the proposed procurement strategy in the light of on-going procurement and healthcare reforms and recent legislative developments. On the basis of the positive feedback obtained from the validation, a modified procurement strategy was put forward. However, the. need for developing a comprehensive framework for achieving continuous improvement that will make learning followed-through from plarming, design and construction into occupancy, and post occupancy to become a natural part of the process of procuring PHC facilities was highlighted.

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Hirsch, Fabiane Monique. "The communication environments of severely aphasic individuals living in long-term care facilities." Diss., The University of Arizona, 2001. http://hdl.handle.net/10150/289701.

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Aphasia has a significant negative impact on an individual's ability to communicate in his or her daily living environment. When this environment offers limited communication opportunities, as is generally believed to be the case in long-term care facilities such as nursing homes, aphasic individuals may suffer doubly. These individuals have to deal not only with limited communication abilities, but they also have few avenues to use spared abilities. This investigation characterized the communication environments of three severely aphasic nursing home residents by determining their interactants (i.e., people with whom they interacted), where interactions took place, what information content was communicated in these interactions, and why this communication occurred. Data collection relied on direct observation of the aphasic individuals in their daily living environments and semi-structured interviews with their interactants. Findings revealed that all three aphasic individuals interacted with a wide variety of people, from those one would expect, such as nurses, to those who are not so obvious, such as hairdressers and maintenance staff members. The majority of communication occurred with Certified Nursing Assistants (CNAs). With respect to communication locations, most communication occurred either in the aphasic individuals' own rooms, in their dining rooms, or in the hallways of their nursing homes. Communication content was categorized as either Social Communication, Activities of Daily Living (ADL) Communication, Medical and Physical Well-being Communication, and Facility Survival Skills Communication. For all three aphasic individuals, Social Communication and ADL Communication were the primary topic areas. To answer the question of why communication occurred, interactions were characterized as either instrumental (task-based) or affective (socially-based). The aphasic individuals varied in the ratios of these two types of communication. Possible contributing factors to the different profiles included the length of time each individual had to adapt to both the sequelae of his or her stroke and his or her nursing home environs, as well as individual personality characteristics. Clinical implications from the findings are suggested.

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Mendez, Beverlyn G. "Disability Policy Advocates on Strategy, Deinstitutionalization, and Moving from Intermediate Care Facilities." Thesis, University of La Verne, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10623483.

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Purpose. The purpose of this phenomenological qualitative case study was to explore the experiences of advocates who represent organizations that engage in disability policy advocacy. The study investigated the strategies and activities used by disability rights advocates, including those used when advocating for deinstitutionalization of people with intellectual and developmental disabilities (I/DD), and the recommendations for advocates of the deinstitutionalization of individuals who live in large intermediate care facilities (ICFs).

Methodology. A phenomenological case study and semistructured interviews were used to explore the strategies and practices of organizations that engage in disability policy advocacy. The researcher used a purposeful sampling approach to interview 5 disability policy advocates with extensive experience for the study. Gen and Wright’s (2013) policy advocacy framework was used to guide the development of the interview questions and resulting themes that emerged from the interviews.

Findings. Advocacy organizations identified three main activities used when advocating for individuals with I/DD: coalition building, information campaigning, and engaging decision makers. When advocating for the deinstitutionalization of people with I/DD, their strategies included coalition building, information campaigning, and reform efforts. The advocates consistently recommended reform efforts, and to a lesser extent, coalition building as strategies and activities to expedite the deinstitutionalization of individuals who reside in large ICFs.

Conclusion. Reform efforts (pilots, demonstrations, litigation) are consistently recommended for future advocacy efforts in support of expediting the community transition of individuals who reside in large ICFs.

Recommendations. Future research should explore the activities of advocacy organizations for other populations or in other geographies. This research study has direct implications for individuals who reside in large ICFs and want to move to community living. This study adds to the practice of advocacy in that it will aid the development of future advocates through training targeting practices of successful, highly experienced advocates.

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Zedan, Haya Saud. "Discharge summary communication from secondary to primary care." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/12980/.

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Studies were conducted in Nottingham, UK to assess quality of discharge summary communication sent from secondary to primary care using updated processing methods. Objectives (1) Assess available evidence on effectiveness of interventions aiming to improve discharge information communication specifically introducing computerised discharge summaries (2) Assess differences in discharge summary quality using new processing methods (3) Obtain perspectives of secondary care on discharge communication issues, identifying points of weakness and primary care views on discharge information communicated from hospital. Methods (1) Systematic review of literature on effectiveness of interventions aiming to improve discharge summary information communication (2) Before and after studies of two different discharge summary types in three departments within Nottingham University Hospitals NHS Trust (3) Qualitative interviews with key stakeholders (N=27) and observations in 3 sites. Results The systematic review returned 21 interventions with emphasis on the introduction of computerised systems to improve quality (timeliness and completeness of discharge summaries). Nine studies significantly improved the completeness of the discharge summary. Ten studies significantly increased the timeliness of the generation of the document and the transfer of information. The three before and after studies produced varying results; the HCOP findings suggested improvements post-intervention in completeness of summaries; this was not statistically significant. In Nephrology, computerisation significantly speeded up the timeliness of discharge summaries but there was no significant difference in completeness between the two types. In Paediatrics, computerisation increased the number of summaries not completed, and the handwritten summary was significantly faster. Computerised discharge summaries contained more information- this was statistically significant. The qualitative study identified issues with understanding the concept of discharge, the purpose and importance of the discharge summary, and organisational issues around the ability to balance the demands for completeness and timeliness, a lack of leadership and user-centred design of the electronic discharge system. Conclusions The literature reviewed found examples of the potential computerisation has on discharge documentation quality. The research studies conducted showed that the introduction of computerisation into the discharge documentation process produced mixed results in quality (completeness and timeliness) of discharge summaries communicated from secondary to primary care. Slight improvements were found in the before and after studies and staff feedback was positive. The success of such interventions depends largely on increased clinical leadership and user-centred design. An established link to patient safety is needed to increase awareness of the importance of discharge summary communication and justify major system change.

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Noncungu, Thabani Mishack. "Investigating health education needs of pregnant women in their first antenatal visit at primary health care facilities in Khahyelitsha." University of the Western Cape, 2017. http://hdl.handle.net/11394/5777.

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Magister Curationis - MCur
The use of health education during antenatal care of pregnant women has been a commonly used strategy in improving maternal health worldwide. However the health education strategy sometimes does not prove to be effective in promoting maternal health, especially in Sub-Sahara Africa.

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Ismail, Noor Azina. "Statistical methods for the improvement of health care." Thesis, Queensland University of Technology, 1999.

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Tsawe, Mluleki. "Utilization of health care services and maternal education in South Africa." University of the Western Cape, 2014. http://hdl.handle.net/11394/4358.

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Magister Philosophiae - MPhil
The importance of maternal health care services cannot be stressed enough. Maternal health services are important in reducing pregnancy-related complications as well as maternal and infant deaths. This study was concerned with investigating the relationship between maternal education and maternal health care utilization. Furthermore, the study aimed to investigate the rates of maternal health care use, the reasons for non-use of maternal health services, as well as the determinants of maternal health care use. Primary data was used from selected areas (Tsolo, Qumbu and Mqanduli), which fall within the O.R. Tambo district in the Eastern Cape Province. Simple random sampling was used (with a structured questionnaire) to study maternal health care use among the sampled women. To analyse this data, univariate, bivariate, and multivariate techniques were employed. The results indicated that maternal education was not statistically significant with antenatal and postnatal services, but the percentages were important in explaining the use of maternal health care services in relation to maternal education. Women with higher levels of education reported higher rates of antenatal and delivery care utilization, while those with lower levels of education reported higher rates of postnatal care use. Access factors, such as transport, payment and distance to health facilities, also played an important role in the use of maternal health care services. It was recommended that the Department of Health implement mobile clinics and centralize health care facilities as this will bring essential health services closer to the communities. Women in the study area also need to be educated about the importance of these services, more particularly pertaining to postnatal care.

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Tsetswa, Mncedisi Patrick. "Assessment of the quality of primary health care services rendered at Moses Mabida Clinic." Thesis, Nelson Mandela Metropolitan University, 2009. http://hdl.handle.net/10948/880.

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Health is a basic human right enshrined in the South African Constitution. It is the responsibility of government to ensure that the nation is healthy because good health is a prerequisite for social and economic development as well as an outcome of that process. Special attention on the healthcare needs of rural communities should be given because these communities were the worst affected by the legacy of the apartheid regime. Moses Mabida community is no exception. Since the advent of democracy, work has been done to ensure that adequate primary health care services are delivered to previously disadvantaged communities such as Moses Mabida. To monitor progress on health care service delivery, evaluation of these services is needed. The evaluation of these services will help identify the strengths and weaknesses so as to come up with quality improvement strategies, hence this study. This study takes form of an assessment survey involving a literature review and a survey of members of the Moses Mabida community who depend on the clinic for their health care needs. The literature identified best practice models of primary health care and these were used as an analytic tool to determine to what extent the primary health care services at Moses Mabida comply with national and international standards. It has been shown that the primary health care services at Moses Mabida Clinic largely comply with national and international standards although several recommendations have been presented for consideration.

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Salisbury, T. T. "Improving care in longer term mental health facilities : international differences in quality and service user experiences of care." Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1380946/.

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Background Although mental health problems are highly prevalent across the world, relatively little is spent on mental health care and a large number of individuals with mental health problems go untreated. The World Health Organization has pressed for countries to increase mental health expenditure and deinstitutionalisation of care in the hope of improved care. However, there is limited evidence regarding the relationships between national characteristics of mental health care provision and quality of care. Aim The aim of this study was to evaluate, in a European sample, the association between national mental health expenditure and the deinstitutionalisation of care and 1) the quality of longer term psychiatric and social care and; 2) service user ratings of care. Method Facility managers were interviewed using the Quality Indicator for Rehabilitative Care (QuIRC). Service users in each facility provided ratings of autonomy, life satisfaction, experience of care and therapeutic milieu. Mental health expenditure and deinstitutionalisation were measured using national mental health budgets and a novel quantitative tool, respectively. Multilevel models were developed to evaluate relationships between expenditure, deinstitutionalisation, quality of care and service user ratings of care. Results Increased mental health expenditure and deinstitutionalisation were significantly, positively associated with all QuIRC domains, except social interface. Increased expenditure and deinstitutionalisation were also significantly associated with more positive service user ratings of autonomy and experience of care. No associations with service user ratings of life satisfaction or therapeutic milieu were found. Conclusions Results suggest that financial investment in and deinstitutionalisation of longer term mental health care are integral to the provision of higher quality care. Lack of available data on country-level variables and the cross-sectional nature of the study design limit generalisability. Future work should include a variety of national, facility and service user variables in order to build more robust models with improved generalisability.

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Arrieta, Terreros Juan Manuel. "The development of a low-powered and portable erythrocyte aggregometer for point-of-care use." Thesis, Griffith University, 2017. http://hdl.handle.net/10072/370745.

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It is well known that the cardiopulmonary system is crucial for the delivery of oxygen to various bodily tissues as well as for the removal of metabolic waste. In addition, the cardiopulmonary system has a vital role in regulating bodily temperature, as well as assisting in the transport of various hormones and nutrients to bodily tissues. Whole blood is a two-phase suspension, consisting of plasma (liquid phase) and numerous cellular components (solid phase); given that erythrocytes are the primary cellular component, the unique mechanical properties of blood can be explained by the characteristics of red blood cells (RBC). RBC tend to form three-dimensional microstructures (rouleaux) when under low shear conditions. The rate and magnitude of RBC aggregation can be quantified using photometric methods, which measures the amount of light passing through a blood sample for a discrete time period. The quantification of specific aspects of RBC aggregation, such as the extent of the aggregation, the time course of aggregation, and the magnitude of the aggregating forces, has been shown to be important from a clinical perspective. Analysis of the RBC aggregation process provides valuable information, which can be utilised to determine the presence of various adverse health conditions (e.g., sepsis, diabetes mellitus and myocardial ischemia). Therefore, RBC aggregation analysis – as a possible health indicator – may play a crucial role in the clinical management in several patient groups. The Laser-Assisted Optical Rotational Cell Analyser (LORCA®) and the Myrenne® aggregometer are photometric instruments commercially available for quantifying RBC aggregation. Disadvantages of these systems include elevated cost and lack of portability (i.e., size, weight, power consumption). The Myrenne aggregometer is possibly the most extensively adopted hemorheological analyser; however, the absence of a temperature control and the inability to provide information about the time course of RBC aggregation, represents a significant disadvantage in regards to experimental research. In this context, a new instrument which is designed to overcome the major limitations of current commercial aggregometers may have an important impact in the health care domain. Low cost, portability, low-power consumption, computer independency, and built-in graphic interface are the cardinal features of a newly-developed instrument described in the present thesis. Furthermore, the portable capillary tube RBC aggregometer (PCA) is able to analyse the aggregation time course and provide relevant parameters. The design of the PCA facilitates an intuitive way to control its operation through the various phases of the aggregation process. Moreover, the PCA’s integrated graphic interface allows the user to visualise the aggregation curve in real time during the data collection process. The engineering process of the present device was conceived as the result of the latent need to bring low-cost specialised equipment to remote regions where budget, transportation facilities and/or power supply restrictions are major limitations for use of current technologies. Blood samples from 43 individuals were analysed to compare the results yielded by the new newly-developed aggregometer, those produced by a commercial device, and the measurements obtained using the erythrocyte sedimentation rate (ESR) technique. The results obtained with the new PCA showed an enhanced signal quality evidenced by a superior signal-to-noise ratio when compared to that yielded by the Myrenne aggregometer. In addition, the precision assessed for the PCA from the aggregation index at 120 seconds (AI120) and aggregation half-time (T ½) measurements reflected a good reliability of the instrument. Furthermore, a strong correlation between PCA and the Myrenne aggregometer for the AI120 parameter was found. An unexpected finding allowed this study to hypothesise that the PCA may be able to predict ESR measurements due to the sedimentation phenomenon observed on the blood sample contained in the capillary tube. Unusual aggregation curves were obtained as a result of the RBC reorganisation being detected by the PCA’s infrared sensor. Based on these results, it was possible to obtain the linear equations to predict the ESR in a fraction of the time required for the traditional practice (i.e., Westergren method). Moreover, the possibility to predict ESR by using a small blood sample (~50 μl) at a fraction of the current required time (i.e., 5 min) will expand the PCA’s applicability in a wide range of scenarios. The significance of this study is represented by the overall performance of the PCA as a modern medical tool. Given that the newly constructed PCA accurately determines various RBC aggregation parameters, it may be suitable for use as a regular screening tool, and assist in the early detection of particular diseases. Importantly, utilising the newly constructed PCA device at point-of-care (i.e., health care facilities) would promote the use of preventative medicine.
Thesis (Masters)
Master of Medical Research (MMedRes)
School of Medical Science
Griffith Health
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Nunn, Dianna R. "Using adaptive problem solving to reduce hospital readmissions from skilled nursing facilities." Thesis, California State University, Dominguez Hills, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1524282.

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Unplanned readmissions back to the hospital are a burden financially and a strain on patients and their families, healthcare organizations, and government payers. Readmissions from skilled nursing facilities account for approximately one-fifth of total rehospitalizations. This project uses the Plan, Do, Study, Act (PDSA) cycle to implement an adaptive problem solving plan to determine the root cause of individual unplanned readmissions from skilled nursing facilities back to the hospital. The plan details past readmission administrative data using descriptive statistics, the roles and responsibilities for the collaborative partnership between care sites, the content of adaptive problem solving, and the use of rigorous reflection and review for continuous improvement. The project provides a disruptive patient centered care approach for problem solving the complexities of readmissions to the hospital for healthcare organizations to consider as readmission rates are tied to reimbursement and quality outcomes.

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Pruksapong, Matana. "Development of a model for assessing the quality of an oral health program in long-term care facilities." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/1529.

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Background: There is little information on how the quality of oral health services in long-term care (LTC) facilities is conceptualized or assessed. Objectives: This study aims to develop a model for assessing the quality of oral healthcare services in LTC facilities. Methods: This study is divided into four main steps. Firstly, I examined literature for existing concepts relating to program evaluation and quality assessment in healthcare to build a theoretical framework appropriate to dental geriatrics. Secondly, I explored as an ethnographic case study a comprehensive oral healthcare program within a single administrative group of 5 LTC facilities in a large metropolis by interviewing 33 participants, including residents and their families, nursing staff, administrators and dental personnel. I also examined policy documents and made site visits to identify other attributes influencing the quality of the program. Thirdly, I drafted the assessment model combining a theoretical framework with empirical information from the case study. And lastly, I tested the feasibility and usability of the model in another dental geriatric program in northern British Columbia. I applied the assessment model by conducting 15 interviews with participants in the program, made site-visits to the 5 facilities, and reviewed documents on the development and operation of the program. Results: A combination of theory-based evaluation and quality assurance provided six sequential and iterative steps for quality assessment of oral health services in LTC. The empirical information supported the theoretical framework that a program of oral healthcare in a LTC context should be assessed for quality from multiple perspectives; it should be comprehensive; and it should include the three main attributes of quality - capacity, performance, and outcomes. Participants revealed 20 quality indicators along with suggested program objectives which encompass eight quality dimensions such as effectiveness, efficiency, and patient-centered. Conclusion: The model provides a unique system for assessing the quality of dental services in LTC facilities that seems to meet the needs of dental and non-dental personnel in LTC.

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Davey, G. K. "Access to health care facilities in rural Oxfordshire, with particular reference to the elderly." Thesis, Oxford Brookes University, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.384608.

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