Dissertations / Theses on the topic 'Shared care'
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1
Landon, Kelly S. (Kelly Suzanne) Carleton University Dissertation Sociology and Anthropology. "Caregivers take care! A literary anthology of journey toward shared care." Ottawa, 2000.
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2
Landon, Kelly S. "Caregivers take care!, a literary anthology of a journey toward shared care." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ57669.pdf.
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Stockwell-Smith, Gillian Barbara. "‘Shared Care’ An Early-Intervention, Self-Management and Empowerment Approach to Community Dementia Care." Thesis, Griffith University, 2015. http://hdl.handle.net/10072/366764.
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Dementia is a progressive, life limiting condition that, as cognitive and functional capacity decline, has an increasing impact on the health and quality of life of the person with the condition and their family caregivers (AIHW, 2012). It is a condition that is cloaked in stigma and misunderstanding, factors that have the potential to isolate those living with the condition from sources of practical and emotional support (Alzheimer's Australia, 2012). Recent advances in the treatment of dementia have not resulted in a cure or substantially altered the disease progression, which accentuates a need for early psychosocial intervention (Prince, Bryce, & Ferri, 2011). A proactive approach with interventions offered at the beginning of the disease/care trajectory is seen as a way to develop the coping resources of the person with dementia and their caregiver, to prevent or delay progression into a more dependent or critical period (Bates, Boote, & Beverley, 2003; Clare, Kinsella, Logsdon, Whitlatch, & Zarit, 2010; Moon & Betts Adams, 2012). Early-intervention also creates a window of opportunity for involving the person with dementia whilst they are still able to participate in planning discussions (Alzheimer's Australia NSW, 2012; Cooper et al., 2012; Whitlatch, Judge, Zarit, & Femia, 2006).Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
Griffith Health
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Nompozolo, Nikiwe Nomapelo. "The value of shared corporate services in improving patient care." Thesis, Rhodes University, 2009. http://hdl.handle.net/10962/d1003844.
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This case study was undertaken from mid 2003 to December 2005. It investigates the influence of the Corporate Services Centre (CSC) on customer (patient) service quality in the East London Hospital Complex (ELHC). This approach was justified on the basis that even though most patients do not have enough knowledge of clinical practices in order to make an accurate assessment on their quality, the same patients would readily appreciate factors such as faster turnaround times, drug availability and cleanliness. The study focuses on both service providers and end users for a quality health service delivery by looking at the potential of the shared corporate services centre. This was done by identifying important areas for improvements, such as response times, waiting periods and other aspects of the various services. The ELHC was formed from the merger of Frere and Cecilia Makiwane Hospitals, with a distance of 26km between the two institutions. The complex itself was in its infancy stages, having had to go through a process of re-engineering, rationalisation and standardisation of the two hospitals. The study seeks to answer the following key question: What has been the contribution of the corporate service centres in relation to health care service quality? The study examines the impediments to the realization of full potential of the Corporate Services Centre (CSC) through expedited decision-making and improved turnaround times. The main functions of the CSC were Procurement and Asset Management; General Administration (including but not limited to Transport, Office equipment, Patient Administration, Office Support, and Professional Secretariat Support); Financial Management and Administration; and Human Resource Management and Human Resources Administration. The study recommends that the CSC, to justify its existence, needs to consult with the clinicians and the patients to better understand what their needs and aspirations are. The study also emphasizes that the CSC is there purely to remove the administrative load and ease the processes and the biggest mistake is to make it an authority over the hospital, instead of being a support. Finally, it was realized that a lot of structural changes, business processes and organisational cultural changes are essential if one wants to create an impact through shared corporate services.
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Lagerqvist, Anton. "Decision Support in Shared Decision-Making for Patient-Centered Care." Thesis, Högskolan i Gävle, Avdelningen för datavetenskap och samhällsbyggnad, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-29864.
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Healthcare decisions should be evidence-based and patient-centered. Patient-centered care is about providing quality care with the patient as the focus. The provider has to incorporate the patient’s values, preferences, and objectives into the clinical decision. Traditionally, clinical decisions were made by the provider alone. Healthcare decisions are complex, due to the multiple objectives and potential serious outcomes, making it difficult for the provider to facilitate shared decision-making with the patient. Decision support software can assist with decision-making, by letting the patient incorporate their preferences and perform the decision analysis. Annalisa is a decision support software that has been developed for this purpose. The objective of this thesis is to analyze Annalisa, from a multi-criteria decision analysis (MCDA) perspective and to discuss the tool’s ability to assist with healthcare decisions in a patient-centered care setting. Annalisa’s elements and method were reviewed, using information from the developers. The input data and results from two healthcare studies using Annalisa were used to analyze the tool from a MCDA and patient-centered care perspective and discuss the tool’s ability to provide aid in healthcare decisions. The tool’s method of simple additive weighting (SAW) was compared to the expected utility function using a decision tree. The developers of Annalisa focused on the simplicity and ease of use, rather than creating a new kind of decision support tool. The two example studies indicated problems with the tool’s ability to incorporate the patient’s preferences and values. However, considering that one of the goals with using a decision aid software in healthcare is to assist with decision analysis after the patient has been presented with the information in the traditional healthcare decision guide, Annalisa makes an interesting attempt to provide aid in that next step of the decision-making process.
6
Lavoie, Josée G. (Josée Gabrielle). "Public health politics in Nunavik health care : shared concepts, divergent meanings." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=69633.
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In Nunavik, the question of self-determination in health care is becoming increasingly embedded in the community health discourse, which is used by both health planners and Inuit alike to negotiate diverging positions. While health planners envision northern health care as a subset of the Quebec system, Inuit perceive it as a vehicle to ends that transcend conventional health issues. This thesis will provide an overview of the development of Nunavik health services since the James Bay agreement, focusing on how the use of the community health discourse serves to promote, but also shapes and limits regional and community self-determination.
7
Venditti, Silvia. "Shared resources, calm appliances. Sustainable interaction and care in housing context." Thesis, Malmö högskola, Fakulteten för kultur och samhälle (KS), 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-21877.
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Today’s environment conditions have reached a critical stage that challenges us to revertthe current paradigm of production and waste into new ways to fulfill needs. The wholesociety needs a shift away from the individual ownership, being it one big reason of environmentalcrisis.This thesis project is an exploration into the field of sustainability in housing contexts thatseeks a different approach in the matter by encouraging the collective use of resources.The resulting design is a product service system that uses indeed a combination of artifactsand services to enhance and augment behaviors towards sustainability, by usingcalm technology as main touchpoint with the users. This means that the project tries toestablish a dialog with the user at a level that presents a valuable aesthetic of interactionbecause of the fluency of communication.
8
Anderson, Benjamin Michael. "Patient Experience and Readmissions Among Medicare Shared Savings Programs Accountable Care Organizations." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5539.
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In 2011, Medicare patients represented the largest share of total readmissions and health costs when compared to all other patient categories. Because patient-centered care drives the use of health services, the U.S. Patient Protection and Affordable Care Act outlined improving the patient experience to reduce readmission rates; however, the relationship between patient experience and readmissions is not well understood. Grounded in systems theory, the purpose of this correlational study was to determine if the relationship between patient experience and readmission rates in Medicare Shared Savings Program accountable care organizations. Data from the Consumer Assessment of Healthcare Providers and Systems survey were gathered from the Centers for Medicare and Medicaid datasets to analyze patient experience measurements and readmission rates, while accounting for variation among Medicare service regions, number of assigned beneficiaries, and performance year. Using multiple linear regression to analyze the data, the model was used to predict Medicare's all-condition readmission rate (per 1000), R-²= .242, F (13, 634) 15.59, p < .001. The research question was answered partially; variation in the patient experience domain did not support all hypotheses. Because the Medicare population represents the fastest growing patient population within the U.S. health care system, continuous evaluation of policy and performance provides an evidence-based analysis to health administrators and providers who have pivotal roles in the creation of positive social change. Findings may be used to improve quality and service while reducing costs, which contributes to the sustainability of the U.S. Medicare program and its beneficiary population.
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Grutters, Janneke Petronella Christina. "Health technology assessment of organizational innovation in health care the case of shared care in hearing aid provision /." Maastricht : Maastricht : Universiteit Maastricht ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=9519.
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Sheets, Anna M. "Use of a Shared Decision-Making Aid in Pediatric Autism Spectrum Disorder." Xavier University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1525290115971692.
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Gallagher, Christine Leigh. "Shared learning in health care professional education : an evaluation of third year medical, nursing, occupational therapy, physiotherapy and podiatry students' shared learning experiences." Thesis, University of Southampton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.409854.
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Bjerregaard, Kirstien. "The shared experience of care : a social identity approach to understanding the motivation of people who work in social care." Thesis, University of Exeter, 2014. http://hdl.handle.net/10871/16321.
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Widely viewed as under-valued and under-paid, yet sentimentalized as working more for love than money, the social care workforce is a fundamental economic and social resource; the importance of which is growing in line with the rapidly aging, global and national population (Care Quality Commission, 2012; DoH 2009; International Helptheaged, 2013). Classic motivation theories, which focus on economic and individualistic work motives, fail to fully account for the high rates of satisfaction and commitment among care workers, (Skills for Care 2007, 2013; Stevens et al 2010). Yet a growing body of empirical research demonstrates that health and social care workers’ motivation is related to patient/client satisfaction and wellbeing (Maben et al., 2012). Moreover the quality of the relationship between the carer and client contributes to the motivation and the wellbeing of both (Wilson, 2009; Wilson et al., 2009). Therefore this thesis seeks to better understand the collective and relational aspects of care workers’ motivation. It does this by detailing a program of research which examines care workers motivations through a social identity lens that asks ‘what’s in it for us’ as well as ‘what’s in it for me’ (Haslam 2004). A social identity perspective on motivation focuses on how workers experience themselves and their work at a personal, relational and organizational level (Ashforth et al 2008; Ellemers et al., 2004). In doing so it offers a multi-dimensional, theoretical framework through which to understand the dynamics of care workers’ motivations. Moreover, this framework offers an empirically proven psychological framework for explaining why adopting a relationship-centered approach to care is pivotal for organizations to achieve a compassionate care culture. The first study explored care workers’ experience of work and inquired about what they did and why it mattered to them. Semi-structured interviews were conducted with 19 care workers who worked in residential and domiciliary care settings. A thematic analysis of the transcripts identified four overarching themes that contributed to care workers’ motivation, those of fulfillment’, ‘belonging’, ‘valuing’ and ‘pride’. These motives were found to be actualized in their shared experience of caring, particularly with clients and also with co-workers and as an organizational member. The findings of the study shed light on the content of care workers’ personal, relational and social identities and the interactions between them. Care workers primarily emphasized the meaningfulness of their work in terms of its caring nature. They expressed this is terms of their personal attributes, their relational role with clients and their perceptions of how the organisation treated them. This led us to hypothesize that their identification with the organisation is likely to increase to the extent they feel the organisation ‘cares’. Indeed to build on and harness care workers’ identities at work, the findings suggest that organisations need to place care workers’ relationships with clients at the heart of what they do. The second study was a longitudinal quantitative analysis of care workers’ motivations which consolidated and extended the findings of the first study. It had two parts, the first part was an examination of how care workers’ motivations are shaped by their sense of identity, and the second part tested how a professionalization intervention affected their motivation. To achieve this we administered an organisational survey at two time points, one year apart (T1 n = 643, T2 n = 1274, T1 & T2 n = 204). Analaysis of the survey responses assessed what it was that incentivized care workers (love and/or money), the relationship of this to work outcomes (i.e. job satisfaction, pride, stress, turnover intentions and positivity about professionalisation) and the extent to which it was affected by patterns of identification. We also examined variation in responses over time as a function of whether or not people had undertaken professional qualifications in the intervening period (so that, in effect, undertaking a qualification constituted an experimental treatment). This meant that the study had a quasi-experimental design in which we could examine the putative impact of exposure to a professionalisation intervention on organizational identification and motivation (for a similar logic see Lim & Putnam, 2010). In line with the five main hypotheses that were generated from the findings of Study 1 and from predominant findings in organisational and social identity research; the results showed first (H1), that care workers’ collective identification with different groups at work, was positively related to their motivation (Ellemers et al., 2004). More specifically, their work motivation was predicted by their identification with (a) the people they care for (client identification), and (b) the care organization they work for (organisational identification). Furthermore, although care workers indicated strongest identification with clients, it was their identification with the organisation that was the most proximal indicator of increased motivation. Second (H2 & H3), although care workers were most incentivized by their relationships with clients and the least incentivized by the pay; the extent to which either led to improved work outcomes was mediated by client and organisational identification. Where being incentivized by relationships with clients led to improved work outcomes, client identification predicted organisational identification, whereas client identification played a lesser role in mediating the likelihood of being incentivized by pay leading to improved work outcomes. In addition (H4), care workers’ identity varied as a function of the work context. More specifically, whether they worked in residential / nursing home care or in domiciliary care affected the nature and extent of their relational identification with their clients and the congruence between client identification and organizational identification (Ashforth et al 2008, Haslam et al 2003). Finally (H5), care workers’ motivations were enhanced by the professionalization intervention of undertaking a qualification, to the extent that it built on and maintained meaningful work-related identities. In particular, the results showed that, care workers’ motivation increased as a result of undertaking a qualification to the extent that the training increased identification with the organisation and other groups at work (Pidd 2004). Study 3 further investigated the effects of identification on motivation, learning and performance by examining the likelihood of professionalisation training being transferred to the workplace. A 2 × 2 longitudinal study evaluated the effects of a new generic professionalisation (NGP) training program, that tapped into distal work identities, and a standard localized professionalisation (SLP) training program, which spoke more to localised identities, on participants’ identification and motivation at work. Overall the findings indicated that compared to the NGP, the SLP (H1) maintained and strengthened participants’ work identification. Furthermore compared to the SLP, the NGP was associated with (H2) a reduction in trainees’ perception of the relevance and usefulness of the training, (H3) a reduction in motivation to enact the training, and (H4) a reduction in trainees’ immersion in the program. Moreover the findings demonstrated that (H5) the reduction in motivation to transfer learning associated with the NGP relative to the SLP, was explained by the reduction in identification it engendered, which in turn reduced participants’ sense of relatedness within the training context. These findings imply that learning is more likely to be applied when it (a) has relevance to identities which are more meaningful to participants, in this case local identities, (b) is delivered by people with whom care workers identify, (c) is validated by others in the workplace environment with whom the participants’ identify. Taken together, this program of research demonstrates that care workers’ motivations can be understood through a social identity perspective that incorporates the collective, relational and personal dimensions of providing care. It concludes by considering how organisations can tap into, harness, strengthen and develop care workers’ identification at work as a means of enhancing their motivation and retaining professional care staff. Through bridging theoretical and applied concerns, this research has wide-reaching implications for developing and maintaining compassionate work cultures within care organisations and other helping professions.
13
Overland, Jane Elizabeth. "Factors that affect the delivery of diabetes care." Thesis, The University of Sydney, 2000. http://hdl.handle.net/2123/365.
Full textAbstract:
Diabetes is emerging as a major threat to health, with global economic and social implications. Recent research has shown that the morbidity and mortality associated with diabetes can be reduced by timely and effective treatment. However, unless people with diabetes have access to this treatment, the impact of diabetes will continue to rise. This thesis therefore explores the current standards of care which people with diabetes receive. It also looks at factors likely to impact on delivery of diabetes care. Studies were conducted at two levels. In the studies described in Chapters 2 and 3, general data applicable to all or nearly all patients with diabetes were collected. This approach substantially eliminates selection bias but precludes the ability to examine clinical outcomes. In the other studies, detailed in Chapters 4, 5 and 6, specific aspects of diabetes care pertaining to more select groups of diabetic subjects were examined. This approach allows clinical parameters to be examined in more detail but is more subject to selection bias. It is hoped that the combination of these two approaches provides a more balanced view of the topic under examination. In Australia, the Medicare Program, a single government controlled universal health insurance fund, provides access to medical services for all residents. Medicare occasions of service data therefore represent the most comprehensive source of information regarding health service utilisation in Australia. The data does not account for people receiving diabetes care through public hospital based services. However, a survey of public hospitals within NSW (n=198), described in Chapter 2, showed that the number of individuals in this category is relatively small and represents only 5.2% of the diabetic population. Using Medicare item codes, and with the permission and assistance of the Commonwealth Department of Health and Aged Care, data were extracted on attendance to medical practitioners and utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997. All data were stratified by the presence of diabetes, gender and age group. Individuals were deemed to have diabetes if an HbA1c, which can only be ordered for a person with known diabetes, had been performed over the 5-year period and the sample size adjusted for the incidence of diabetes. Once adjusted, the number of people with diabetes in NSW for the individual years 1993 to 1997 were 143,920, 156,234, 168,216, 177,280 and 185,780. Comparison with 1996 census data confirmed a 91.7% capture of the total NSW population (5,495,900/5,995,545 individuals). The data were retrieved for NSW as a whole and for individual postcodes. Postcodes were then classified by population density as either major urban, urban or rural. On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. As seen in Chapter 2, a large proportion of people with diabetes were also under the care of specialists and consultant physicians, up to 51.2% and 41.8% respectively, a 3 to 4 fold increase when compared with their non-diabetic counterparts. In regard to geographical location, once adjusted for age and gender, the odds ratio of attending a specialist was only slightly higher for people with diabetes living in areas of high population density when compared to people with diabetes living in rural areas. This ratio reached as high as 1.85 in regard to attendance to consultant physicians (Chapter 3). The odds ratio for the non-diabetic population was similar indicating that the difference in access to consultant physicians was not disease specific. Analysis of results showed that despite the increase in service utilisation, large proportions of people with diabetes were not routinely monitored in regard to diabetes and its complications across the State. By 1997, HbA1c was still not performed in over 40% of people with diabetes each year and only 11.6% of the diabetic population had undergone microalbuminuria estimation. Interestingly, the differences in levels of monitoring between rural and urban areas were surprisingly small. Monitoring of diabetes and its complications did improve in all parts of the State over the study period. However, the greatest improvement was seen in rural areas, despite rural patients having fewer attendances to general practitioners and fewer patients attending specialist care. In the face of finite resources and the rising prevalence of diabetes, an increasing number of patients will need to rely on general practitioners to provide diabetes care regardless of where they live. A 'shared care' approach which encourages and supports general practitioners to manage patients with diabetes, while giving them access to specialist services for those patients that require them, is increasingly being advocated as a way of maximising efficacy while minimising costs. Yet if health care professionals leave undone what they think is done by others, shared care can become neglected care. Chapter 4 reports a detailed audit of 200 randomly selected shared care patients who were assessed on two or more occasions. This study showed that the majority of specialist treatment recommendations are implemented by general practitioners. Doctors formally registered with the Diabetes Shared Care Programme and those who write longer referral letters were more likely to implement recommendations than their counterparts. Moreover, the average HbA1c and the complication profile of these patients were similar to those found in various studies around the world. This suggests that diabetes can be well managed by a shared care approach that is adequately integrated. To overcome the problem that data is lacking on those patients that did not return for specialist review, a further 200 shared care patients who were lost to follow up from the shared care system were traced. Information regarding whether treatment recommendations had been implemented was sought from both the referring doctor and the patient. Overall, information on 182 of the 200 patients could be obtained. As discussed in Chapter 5, comparison of the returned and non returned patients' demographic and clinical profiles at time of their initial specialist review showed that general practitioners differentiated between the 'more complicated' patients, choosing to re-refer those with macrovascular disease, while maintaining the care of 'less complicated' patients. Re-referral for specialist review was also dependent on the patient remaining under the care of their original doctor. Encouragingly, general practitioners seemed to take a more active role in the non-returned group. They included more details regarding type and duration of diabetes in the referral letters of patients who were not re-referred for specialist review. They also implemented more treatment recommendations in the non-returned group, with the difference in implementation rate for metabolic recommendations reaching statistical significance. This study also showed that movement of patients between doctors raises concern regarding continuity of care. The multi-factorial nature of diabetes means that best practice is not easily accommodated within a single appointment. Thus continuity of care becomes an important issue. To assess the current status, 479 consecutive patients referred to the Royal Prince Alfred Hospital Diabetes Centre in a 6-month period were recruited and underwent a detailed clinical assessment. They were also questioned regarding the number of general practitioners they attended and the length of time they had been under the care of the referring doctor. The results outlined in Chapter 6 showed that the majority of people with diabetes (87.7%) attended only one general practitioner and had been under the care of that doctor medium to long term. Younger patients, who were relatively healthy apart from the presence of diabetes, were more likely to attend several general practitioners or have changed their general practitioner within the last year. This lack of continuity had little difference on acute outcomes such as glycaemic and blood pressure control. Appropriately, continuity of care increased with increasing age and the increasing prevalence of diabetes complications, mainly macrovascular disease. These studies indicate that further efforts are required to improve the overall standard of diabetes care within Australia. At present there is a heavy dependency on specialist services. As the population ages and the number of people with diabetes increases, much of this burden will fall on general practitioners, as is already evident in rural areas. When provided with appropriate support and infrastructure, general practitioners are able to maintain standards of care through referral of patients with more complex medical problems and by maintaining the degree of continuity appropriate to the patient's needs. However, the collection of relevant information to monitor future trends in diabetes services provision is important. As shown in this thesis, Medicare data represents an easy and cost effective method with which to do so.
14
Overland, Jane Elizabeth. "Factors that affect the delivery of diabetes care." University of Sydney. Medicine, 2000. http://hdl.handle.net/2123/365.
Full textAbstract:
Diabetes is emerging as a major threat to health, with global economic and social implications. Recent research has shown that the morbidity and mortality associated with diabetes can be reduced by timely and effective treatment. However, unless people with diabetes have access to this treatment, the impact of diabetes will continue to rise. This thesis therefore explores the current standards of care which people with diabetes receive. It also looks at factors likely to impact on delivery of diabetes care. Studies were conducted at two levels. In the studies described in Chapters 2 and 3, general data applicable to all or nearly all patients with diabetes were collected. This approach substantially eliminates selection bias but precludes the ability to examine clinical outcomes. In the other studies, detailed in Chapters 4, 5 and 6, specific aspects of diabetes care pertaining to more select groups of diabetic subjects were examined. This approach allows clinical parameters to be examined in more detail but is more subject to selection bias. It is hoped that the combination of these two approaches provides a more balanced view of the topic under examination. In Australia, the Medicare Program, a single government controlled universal health insurance fund, provides access to medical services for all residents. Medicare occasions of service data therefore represent the most comprehensive source of information regarding health service utilisation in Australia. The data does not account for people receiving diabetes care through public hospital based services. However, a survey of public hospitals within NSW (n=198), described in Chapter 2, showed that the number of individuals in this category is relatively small and represents only 5.2% of the diabetic population. Using Medicare item codes, and with the permission and assistance of the Commonwealth Department of Health and Aged Care, data were extracted on attendance to medical practitioners and utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997. All data were stratified by the presence of diabetes, gender and age group. Individuals were deemed to have diabetes if an HbA1c, which can only be ordered for a person with known diabetes, had been performed over the 5-year period and the sample size adjusted for the incidence of diabetes. Once adjusted, the number of people with diabetes in NSW for the individual years 1993 to 1997 were 143,920, 156,234, 168,216, 177,280 and 185,780. Comparison with 1996 census data confirmed a 91.7% capture of the total NSW population (5,495,900/5,995,545 individuals). The data were retrieved for NSW as a whole and for individual postcodes. Postcodes were then classified by population density as either major urban, urban or rural. On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. As seen in Chapter 2, a large proportion of people with diabetes were also under the care of specialists and consultant physicians, up to 51.2% and 41.8% respectively, a 3 to 4 fold increase when compared with their non-diabetic counterparts. In regard to geographical location, once adjusted for age and gender, the odds ratio of attending a specialist was only slightly higher for people with diabetes living in areas of high population density when compared to people with diabetes living in rural areas. This ratio reached as high as 1.85 in regard to attendance to consultant physicians (Chapter 3). The odds ratio for the non-diabetic population was similar indicating that the difference in access to consultant physicians was not disease specific. Analysis of results showed that despite the increase in service utilisation, large proportions of people with diabetes were not routinely monitored in regard to diabetes and its complications across the State. By 1997, HbA1c was still not performed in over 40% of people with diabetes each year and only 11.6% of the diabetic population had undergone microalbuminuria estimation. Interestingly, the differences in levels of monitoring between rural and urban areas were surprisingly small. Monitoring of diabetes and its complications did improve in all parts of the State over the study period. However, the greatest improvement was seen in rural areas, despite rural patients having fewer attendances to general practitioners and fewer patients attending specialist care. In the face of finite resources and the rising prevalence of diabetes, an increasing number of patients will need to rely on general practitioners to provide diabetes care regardless of where they live. A 'shared care' approach which encourages and supports general practitioners to manage patients with diabetes, while giving them access to specialist services for those patients that require them, is increasingly being advocated as a way of maximising efficacy while minimising costs. Yet if health care professionals leave undone what they think is done by others, shared care can become neglected care. Chapter 4 reports a detailed audit of 200 randomly selected shared care patients who were assessed on two or more occasions. This study showed that the majority of specialist treatment recommendations are implemented by general practitioners. Doctors formally registered with the Diabetes Shared Care Programme and those who write longer referral letters were more likely to implement recommendations than their counterparts. Moreover, the average HbA1c and the complication profile of these patients were similar to those found in various studies around the world. This suggests that diabetes can be well managed by a shared care approach that is adequately integrated. To overcome the problem that data is lacking on those patients that did not return for specialist review, a further 200 shared care patients who were lost to follow up from the shared care system were traced. Information regarding whether treatment recommendations had been implemented was sought from both the referring doctor and the patient. Overall, information on 182 of the 200 patients could be obtained. As discussed in Chapter 5, comparison of the returned and non returned patients' demographic and clinical profiles at time of their initial specialist review showed that general practitioners differentiated between the 'more complicated' patients, choosing to re-refer those with macrovascular disease, while maintaining the care of 'less complicated' patients. Re-referral for specialist review was also dependent on the patient remaining under the care of their original doctor. Encouragingly, general practitioners seemed to take a more active role in the non-returned group. They included more details regarding type and duration of diabetes in the referral letters of patients who were not re-referred for specialist review. They also implemented more treatment recommendations in the non-returned group, with the difference in implementation rate for metabolic recommendations reaching statistical significance. This study also showed that movement of patients between doctors raises concern regarding continuity of care. The multi-factorial nature of diabetes means that best practice is not easily accommodated within a single appointment. Thus continuity of care becomes an important issue. To assess the current status, 479 consecutive patients referred to the Royal Prince Alfred Hospital Diabetes Centre in a 6-month period were recruited and underwent a detailed clinical assessment. They were also questioned regarding the number of general practitioners they attended and the length of time they had been under the care of the referring doctor. The results outlined in Chapter 6 showed that the majority of people with diabetes (87.7%) attended only one general practitioner and had been under the care of that doctor medium to long term. Younger patients, who were relatively healthy apart from the presence of diabetes, were more likely to attend several general practitioners or have changed their general practitioner within the last year. This lack of continuity had little difference on acute outcomes such as glycaemic and blood pressure control. Appropriately, continuity of care increased with increasing age and the increasing prevalence of diabetes complications, mainly macrovascular disease. These studies indicate that further efforts are required to improve the overall standard of diabetes care within Australia. At present there is a heavy dependency on specialist services. As the population ages and the number of people with diabetes increases, much of this burden will fall on general practitioners, as is already evident in rural areas. When provided with appropriate support and infrastructure, general practitioners are able to maintain standards of care through referral of patients with more complex medical problems and by maintaining the degree of continuity appropriate to the patient's needs. However, the collection of relevant information to monitor future trends in diabetes services provision is important. As shown in this thesis, Medicare data represents an easy and cost effective method with which to do so.
15
Nordin, Annika. "Expressions of shared interpretations - Intangible outcomes of continuous quality improvement efforts in health- and elderly care." Doctoral thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-37302.
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This thesis is anchored in improvement science, the research field of improvement. Improvement science describes and explores improvement in real-life contexts and “system of profound knowledge” (Deming, 2000) is a cornerstone. Performance measures, including their variation over time, are fundamental in the research and evaluation of outcomes of continuous quality improvement efforts (CQI efforts). However, the strong emphasis on operationalisations and measurements risks overshadowing other kinds of outcomes to which CQI efforts can lead. Research has shown that it is advantageous that those performing change have some kind of “sharedness”, e.g. shared cognitions, understanding, knowledge, interpretations or frame of reference. Despite the diversity of concepts and scientific studies, “sharedness” is mainly described as a prerequisite for change. This thesis addresses the call to broaden the scientific approach in improvement science and to take advantage of knowledge developed since Deming's time. It has a point of departure in the presumption that CQI efforts also lead to intangible outcomes; qualitative effects that are not easily captured with traditional performance measures. The concept “Expressions of shared interpretations” is used to study “sharedness” as intangible outcomes. The overall aim with this thesis is to explore Expressions of shared interpretations as intangible outcomes of CQI efforts from the perspective of clinical microsystems and healthcare professionals. The specific aims are to examine and establish how Expressions of shared interpretations develop, influence CQI efforts and change over time. Using a qualitative approach, this thesis comprises four papers, based on three studies. The empirical context is healthcare and welfare organizations providing care: hospital clinics in county councils/regions and nursing homes in municipalities. The studies include time periods from one to three and a half years, totalling six years. Expressions of shared interpretations inherently mean that the methods for data analysis need to be based on commonalities or patterns in the data. In this thesis three methods are used: qualitative content analysis, thematic analysis and directed content analysis. To examine time-related changes, year-to-year comparative analyses of themes and categories are done. To explore Expressions of shared interpretations, different theoretical frameworks are used: team cognitions (Paper 1), sensemaking theory (Paper 2), cognitive shifts (Paper 3) and programme theories (Paper 4). A directed content analysis is applied in a meta-analysis of the results presented in the four papers. The results indicate that Expressions of shared interpretations develop as intangible outcomes of CQI efforts and a general programme theory of CQI efforts in health- and elderly care is developed, illuminating how Expressions of shared interpretations change and influence CQI efforts. The general programme theory incorporates the PDSA cycle and describes the complex, interconnected and continuous development of Expressions of shared interpretations. It also illuminates how Expressions of shared interpretations provide change performers with momentum to engage in forthcoming PDSA cycles and how sensemaking is a central activity. CQI efforts in health- and elderly care are characterised by a “just get on with it” attitude, while in this thesis, thoughtfulness is emphasized. Existing improvement tools support collaboration, creativity and analysis of critical aspects of the operations, yet none of the improvement tools help change performers gain understanding of the CQI effort as such. To address this, this thesis suggests that change performers complement the use of improvement tools with an inquiring mind, that they collaborate in thoughtful dialogues and that leaders function as inquirers. To support this posture, the widely used Model for improvement is complemented with a fourth question: What are our assumptions? The question pinpoints the need to be thoughtful in every step of the CQI effort, not just in the analysis of the problem at hand.
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Maclean, Niall. "Towards politically relevant forms of communitarianism : communal shared understandings and the problem of health care distribution." Thesis, University of Oxford, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.419055.
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Nilsson, Åsa. "Towards a shared understanding : Exploring encounters in hospital care from the perspectives of nurses and patients." Licentiate thesis, Luleå tekniska universitet, Omvårdnad, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-63355.
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The overall aim of this licentiate thesis was to describe encounters in hospital care from the perspectives of nurses and patients. It focuses specifically on nurses’ views of shortcomings in patient-care encounters in one hospital (I) and the meanings of participation in hospital care as narrated by patients (II). Three focus group discussions with 15 registered nurses were conducted, and data were analyzed using thematic content analysis (I). Narrative interviews were conducted with 15 patients in hospital care, and the interviews were analyzed with a phenomenological hermeneutic interpretation (II). This licentiate thesis shows that a shared understanding is considered as central for both the nurses and the patients in the hospital-care encounter. The nurses demonstrate the need to understand, to create space, and also to be available for vulnerable patients. The patients describe the need to be understood and to understand their own situations. This thesis suggests that positive encounters in hospital care imply that nurses need to take responsibility for creating a mutual dialogue where the patient experiences himself or herself as a co-creator in a trustful context. When nurses acknowledge and confirm the vulnerability of their patients, it becomes possible to support them to participate in an active manner. A well-functioning team, as well as a coherent environment, is, in this thesis, understood as a precondition for positive hospitalcare encounters.
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Forman, D. "Shared learning : monitoring the attitudinal changes of staff and students on undergraduate health care professional programmes." Thesis, Sheffield Hallam University, 2000. http://shura.shu.ac.uk/19656/.
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The aim of this investigation was to monitor attitudinal changes of staff and students participating in undergraduate professional programmes to the implementation of shared learning over a four-year period. The programmes being studied were the BSc. Occupational Therapy, BSc. Diagnostic Radiography and BSc. Therapeutic Radiography Honours degrees. Each validated programme contained some syllabus areas that were taught together i.e. were shared across the professions. Initially, after a review of the existing literature on this issue, a questionnaire was designed as a research tool to enable both qualitative and quantitative data to be collected and analysed. The quantitative sections of the questionnaire were checked for reliability throughout the four years and achieved positive Cronbach Alpha results ranging from .7083 to .8984 in the four main concepts under investigation, namely the Pitfalls, Benefits, Curriculum Aspects and Social Aspects of the shared programmes. Over the four year period a total of 418 student questionnaires were collected and analysed. In addition to the quantitative data collected, qualitative data were also collected from the questionnaire from extracts of the minutes of Course Committee and Examination Board meetings and from videos of tutorials and seminars. All of these were analysed. The results showed fluctuations in the attitudes of both staff and students to shared learning over the four year period, but all those who participated showed a net favourable change in attitude by the end of the research investigation.
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Gault, Barry. "Punters and providers in the North of Scotland : a study of shared experiences." Thesis, Robert Gordon University, 2007. http://hdl.handle.net/10059/242.
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The research was carried out during a time when residential provision for people with learning difficulties in the north of Scotland was changing from being hospital based towards being community centred. The aim was to utilise an understanding of the dynamics of past provision to shed light upon present practice and planning for the future: focussing upon that form of ‘difference’ which has been given the name ‘learning difficulty’. The research utilised records, interviews, narratives and discussion groups to explore the experiences of providers of services, service users and those who were close to them. The research sought to go beyond description; to facilitate respondents in sharing their understanding of the organisation of care services and how it had an effect upon their life chances and self concept. The design of the research, which made use of multiple sources of evidence, was qualitative in its approach. It was undertaken within four ‘sites of interest’: The archive or the historical record of provision at Lhangbyde Hospital.. Through semi structured interviews with ‘Providers’ A ‘Punters’ discussion forum located within a self advocacy group. A set of ‘Intimate Narratives’. The method had its roots in constructivist, reflective and post modern currents of thought which confronted the difficulty inherent is making an epistemological distinction between what is out there in the world and the categories of meaning which are resident in the human mind. The goal was to produce texts which promoted dialogue rather than monologue, were evocative rather than definitive, In chapter 8 some ‘Intimate Narratives’ from the researcher’s own life experience as a father and as a facilitator and adviser within a self advocacy organisation were presented directly as stories of everyday experience. In the final two chapters of the thesis an attempt was made to synthesise the overall findings of the research, and to assess their implications for future policy and practice. In chapter 9, under the heading of ‘Reading the Chart: understanding the past and present as a foundation for future planning’ the findings from the four ‘sites of interest’ were gathered together under seven explanatory themes, with the section entitled ‘Gaining a Voice’ achieving an overall pre-eminence.. The last chapter in the thesis (Chapter 10), under the title of ‘The Future Course’ detailed a plan for change and development based on a synthesis of findings. In addition the role of future research in promoting change was examined. The thesis concluded with a ‘plain language’ summary of recommendations.
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Low, Lenora W. Y. "Promoting Shared Decision Making Through Patient Education of Labor Inductions." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/1905.
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The induction of labor is medically indicated for many conditions in which delivering the baby outweighs the risk of continuing the pregnancy. Patients admitted for the induction of labor require adequate information to actively participate in decision making that affects their plan of care. The purpose of this quality improvement project was to improve the quality of healthcare delivery and promote patient engagement by providing consistent education using a teaching tool. The project question addressed the impact of a labor-induction teaching tool on improving patient education, participation, and overall satisfaction. The Plan-Do-Study-Act (PDSA) model was used to plan, implement, and evaluate the labor-induction teaching tool in a 9-room labor and delivery unit that averages approximately 1,500 births per year. The teaching tool content was obtained from existing patient education information from the organization's resource library. The nurses piloted the teaching tool for all patients admitted for the induction of labor for 3 weeks. Patient comments supported the use of the teaching tool to improve knowledge, increase participation in decision making, and enhance overall satisfaction. The nurses voluntarily completed an online survey that indicated the teaching tool was easy to use, positively impacted workflow, and supported informed choice. Patient charts were audited and showed a 94% compliance with documentation of education. The success of the teaching tool in improving patient education and decision-making capacity supports the development of other teaching tools, encourages patient and family-centered care, and improves the delivery of quality care.
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Tegelberg, Alexander. "Managers and health professionals in the acute care chain : – A need for a shared understanding in the care of patients with acute abdominal pain." Licentiate thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-437640.
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Background: Managers and health professionals, so-called stakeholders, at the system and clinical level in the acute care chain, are responsible for providing safe and high-quality care encompassing both nursing and medical aspects. In patients with acute abdominal pain (AAP), high-quality nursing care has been described as not always being delivered across the entire acute care chain. This patient group frequently seeks care across the acute care chain and the care procedures and quality may differ widely. The quality of nursing care provided to patients can be understood through the framework Fundamentals of Care. The framework is divided into three dimensions: establishing a relationship with the patient, integration of the patient’s fundamental care needs, and context of care. Stakeholders are one important part of the context of care and a prerequisite for delivery of high-quality care. Aim: The overall aim was to explore managers’ and health professionals’ understanding of managing and conducting care of patients with AAP across the acute care chain. Method: Individual interviews with open-ended questions were used in two studies and data were analysed with a conventional qualitative content analysis method. Participants represented ambulance services, emergency departments, and surgical departments. Managers at head nurse level (n=11) and operational level (n=6) at four hospitals were included in Study I. Registered nurses (n=11) and physicians (n=8) at five hospitals were included in Study II. Results: In Study I, managers described the adult patient group as challenging and heterogenous. The managers reflected on themselves as role models. Guidelines were used to organise care, but they often had a medical focus and the managers referred to others as being responsible for the guidelines. Managers who were registered nurses focused on the medical care of patients with AAP, while managers who were physicians underlined the value of nursing care to improve patient outcome. In Study II, health professionals described dedication to applying evidence-based practices. However, they used personal experience over guidelines in care provision. They described organisational barriers to delivering high-quality care, such as varying competence among colleagues, lack of available patient beds, and lack of collaboration across the acute care chain. Conclusion: The stakeholders’ perspectives complemented each other, but their descriptions of managing and conducting care of patients with AAP did not always fit together, which revealed a gap in the everyday clinical practices as well as structural issues at the system level. These empirical descriptions of differing understanding may reveal some of the reasons why patients with AAP do not always experience high-quality care. To optimise patient care across the acute care chain, stakeholders need a shared understanding to meet patients’ fundamental care needs and enable provision of high-quality nursing and medical care.
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Quirk, Alan. "Obstacles to shared decision-making in psychiatric practice : findings from three observational studies." Thesis, Brunel University, 2007. http://bura.brunel.ac.uk/handle/2438/5464.
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This thesis aims to make contributions at substantive, methodological and theoretical levels. First, the findings from three observational studies are combined to identify obstacles to the use of shared decision-making in modern psychiatric practice. Particular attention is paid to how patients' choices about their treatment are facilitated or constrained by the actions of mental health professionals. A typology of pressure is constructed, based on detailed analyses of how pressure is applied and resisted in routine encounters (outpatient consultations) and "crisis' situations (assessments for compulsory admission to hospital, and ward rounds in acute inpatient care). Findings from two ethnographies and one conversation analysis (CA) study are presented. 'Meaning' is central to the write-up of each set of findings, however while the analytic focus of the ethnographies is 'insider' knowledge and meanings, in the CA study it is gn the activities that make those meanings possible in the first place. The methodological contribution of the thesis stems from its demonstration of how to produce a coherent, unified research account from two very different versions of qualitative inquiry. Despite the potential for analytic inconsistency, the thesis arguably has far greater force and persuasiveness as a result of the attempt to combine, compare and contrast findings from three studies. It is contended that a sound theoretical base for sociological research may be created by combining Goffman's micro-sociology with Foucault's analyses of disciplinary power/knowledge in one of a number of ways. A Goffmanian 'home base' is adopted for this thesis, with Foucauldian thinking applied to add a historical, 'macro' dimension to the analysis that Goffman's work so conspicuously lacks. Foucault's work also provides the conceptual tools for examining the more subtle form of control through expertise that would be missed in a purely Goffmanian study.
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Dunwoody, Danielle R. "The Common Meanings and Shared Practices of Sedation Assessment in the Context of Managing Pain with an Opioid| A Phenomenological Study." Thesis, State University of New York at Buffalo, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10823510.
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This dissertation, composed of three manuscripts, provides a foundation for the evaluation of advancing sedation and excessive respiratory depression in terms of managing post-operative patient?s pain with opioids. The first manuscript provides a framework for the concept of sedation in terms of how it is assessed and applied to post-operative pain management. The second manuscript is a qualitative review of the literature regarding the assessment of opioid induced sedation and advancing respiratory depression in regards to managing patient?s pain. The third manuscript provides the dissertation study examining expert nurses? common meanings and shared practices with sedation in the context of postoperative pain management with opioids. Using Heidegger?s interpretive phenomenological methods, interviews with expert post-anesthetic care unit nurses were conducted to capture the missing practical knowledge behind the nursing gestalt approach to managing patient?s pain. The third manuscript is currently being prepared for submission to a journal focusing on pain management nursing. Further research studies are warranted.
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Jones, Chris. "The effectiveness of an innovative shared care scheme in managing chronic kidney disease and the impact of routine nephrology care on the rate of progression." Thesis, University of Southampton, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.436964.
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Lippa, Katherine Domjan. "Cognition of Shared Decision Making: The Case of Multiple Sclerosis." Wright State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=wright1463576554.
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Lester, Curtis L. "A model of shared-servant style pastoral care leadership for lay leaders of Greater Bethany Baptist Church (Georgia)." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2000. http://digitalcommons.auctr.edu/dissertations/AAIDP14649.
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The opportunity existed in the Greater Bethany Baptist Church to develop and implement a Lay Pastoral Care Ministry. The pastor had participated in a two-year clinical experience in the past and was eager to equip and empower lay leaders and potential leaders through training for the Pastoral Care Ministry. Presented in this dissertation are the design, implementation, and evaluation of a group of lay leaders' training experience. It is my hope that the results of this study may be used as a training manual for shared-servant style pastoral care leadership for lay leaders.
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Hicks, Amanda, Brenda Louw, Rachel Cross, Michelle Katte, and Melissa Miesner. "Parental Perceptions of Shared Book-Reading in Infants With Clefts." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/2123.
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A survey was conducted to determine parental perceptions regarding shared book-reading with their young children with cleft palate. The results describe parents' engagement in shared book-reading with their children and their perceptions of the importance thereof in language and speech development. Clinical applications for early intervention are proposed.
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Kidd, Heather M. "The development, implementation and evaluation of a shared care model of nursing in a tertiary hospital using participatory action research and practice development." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/2411.
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For the last decade there has been a growing body of international evidence demonstrating the adverse effects on patient care caused by the continued international shortage of registered nurses (RN). One solution being explored in hospitals in Australia is to change their staffing mix by recruiting more graduate RNs, enrolled nurses (EN) and introducing unregulated workers (nursing assistants) as a strategy to increase the nursing workforce. To assist with managing the varied skill mix, hospitals have investigated team nursing as an alternative to the established RN dependent patient allocation model of nursing delivery. There is no conclusive evidence that demonstrates the impact of one model of care as compared to another in terms of satisfaction, quality and cost of care.Major deficits exist in team based nursing research. These are largely due to the small scale of the studies; focus on its use in medical and surgical wards and limited evaluation measures for staff and patients’ satisfaction and patient outcomes. Consequently, these studies have not demonstrated team nursing as an effective model in supporting nurses deliver care nor as a model that ensures the provision of quality patient care. This study addresses these deficits and provides a strong evidence base for the use of team based nursing in tertiary hospitals to both support nursing staff and contribute to positive patient outcomes.The purpose of this study was to develop, implement and evaluate a team based model (subsequently coined Shared Care Model or SCM), that supported the different levels of skill mix in the provision of safe care for patients admitted to 21 nominated wards (571 beds) at the study hospital. The impact the SCM had on nurses’ workload, team approach to organisation and provision of nursing care, culture of support, nursing rounds, bedside and board handover were investigated. In addition, the impact the SCM had on patient satisfaction, patient complaints and adverse incidents was investigated.The philosophical base for this study was critical social theory and the methodology participatory action research (PAR), underpinned by principles and processes of emancipatory practice development (ePD). Data instruments included validated staff and patient satisfaction questionnaires and the study hospital’s clinical incident and complaint management’s electronic systems and databases.The major findings of the study were statistically significant increases in learning opportunities and more manageable workloads associated with a less experienced nurse working with a more experienced nurse. However, this did not have an overall statistically significant effect on improving the culture of support nor ensuring manageable workloads. Statistically significant reductions were found in the four major adverse events measured of medications, falls, injuries and behaviour. Patient satisfaction was statistically significantly improved in relation to discharge planning and there were significant reductions in complaints associated with the manner in which patient were treated by nurses. Despite maintaining high levels of patient satisfaction throughout the study period there were statistically significantly more complaints in relation to the quality of clinical care. These findings establish that combinations of RNs of different levels of experience when working together as a team either in pairs or with unregistered staff provides safe patient care for a diverse range of clinical specialities.
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Zhang, Hui. "Modeling Multi-level Incentives in Health Care: A Multiscale Decision Theory Approach." Diss., Virginia Tech, 2016. http://hdl.handle.net/10919/79467.
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Financial incentives offered by payers to health care providers and patients have been identified as a key mechanism to lower costs while improving quality of care. How to effectively design incentive programs that can align the varying objectives of health care stakeholders, as well as predict programs' performance and stakeholders' decision response is an unresolved research challenge. The objective of this study is to establish a novel approach based on multiscale decision theory (MSDT) that can effectively model and efficiently analyze such incentive programs, and the complex health care system in general. The MSDT model captures the interdependencies of stakeholders, their decision processes, uncertainties, and how incentives impact decisions and outcomes at the payer, hospital, physician, and patient level.
In the first part of this thesis, we study the decision processes of agents pertaining to the investment and utilization of imaging technologies. We analyze the payer-hospital-physician relationships and later extend the model to include radiologist and patient as major stakeholders in the second part of this thesis. We focus on a specific incentive program, the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs). The multi-level interactions between agents are mathematically formulated as a sequential non-cooperative game. We derive the equilibrium solutions using the subgame perfect Nash equilibrium (SPNE) concept and the backward induction principle, and determine the conditions under which the MSSP incentive leads to the desired outcomes of cost reduction and quality of care improvements. In the third part of this thesis, we study the multi-level decision making in chronic disease management. We model and analyze patients' and physicians' decision processes as a general-sum stochastic game with perfect information and switching control structure. We incorporate the Health Belief Model (HBM) as the theoretical foundation to capture the behavioral aspect of agents. We analyze how incentives and interdependencies affect patients' engagement in health-promoting activities and physicians' delivery of primary care services. We show that a re-alignment of incentives can improve the effectiveness of chronic disease management.Ph. D.
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Bergeron, Véronique. "May the real surrogate stand up: a pluralist critique of the shared decision-making model in neonatal intensive care." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=21987.
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Abstract May the Real Surrogate Stand-Up: A Pluralist Critique of the Shared Decision-Making Model in Neonatal Intensive Care In the fast-paced environment of the neonatal intensive care unit (NICU), decisions about the health care of newborns involve multiple - and sometimes competing - normative forces. Informed by critical legal pluralism, this thesis offers an analysis of the normative interactions that emerge when parents and health care professionals meet at the bedside of a critically ill newborn. Using the shared decision-making model favored by the Canadian Paediatric Society (CPS) in its 2004 position statement on treatment decisions regarding infant, children and adolescents, I claim that in the NICU context consent is not sought in cases of medical certainty, where the best interest of the patient has already been ascertained according to medical norms. Consequently, the "shared" component of decision-making occurs only after the cause for decision-making has been determined by the child's health care team and presented to the child's surrogate decision-makers. Using ethnographic studies on the lived experience of parents in NICU, I question the marked difference between the authority given to parents by Canadian legal and medical guidelines and the authority they are allowed to exercise in fact at their child's bedside. I conclude by a critical reflection on the emergence of plural law in the NICU trough dynamics of parental resistance or conformity to accepted medical norms.Résumé Que le véritable substitut se lève: Une critique pluraliste des décisions partagées aux soins intensifs de nouveau-nés À l'unité des soins intensifs néonataux, les décisions portant sur le traitement des nouveau-nés impliquent une multitude d'influences normatives dont certaines peuvent entrer en compétition. Mettant à contribution le pluralisme juridique critique développé par Martha-Marie Kleinhans et Roderick Macdonald, cette thèse offre une analyse des interactions normatives qui émergent lorsque parents et personnel traitant se rencontrent au chevet d'un nouveau-né à l'état de santé précaire. En me basant sur le modèle de décision partagée favorisé par la Société Canadienne de Pédiatrie dans son énoncé de position sur les décisions médicales concernant les enfants et les adolescents, je soutiens qu'en contexte de soins intensifs néonataux, le consentement des parents n'est recherché qu'en cas d'incertitude ou de neutralité thérapeutique et non lorsque l'intérêt de l'enfant peut être adjugé avec certitude en vertu de critères médicaux. Par conséquent, la dimension « partagée » du processus décisionnel ne prend place que lorsque le personnel traitant estime qu'une incertitude suffisante justifie l'implication des parents dans le processus décisionnel. À l'aide d'études ethnographiques sur l'expérience vécue des parents à l'unité des soins intensifs néonataux, je souligne la différence marquée entre l'autorité décisionnelle donnée aux parents par le droit formel canadien, incluant les directives médicales, et l'autorité qu'ils exercent de facto au chevet de leur enfant. Je conclue par une réflexion critique sur l'émergence du pluralisme juridique aux soins intensifs néonataux par les dynamiques d'accommodement ou de résistance des parents envers les normes médicales en vigueur.
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Byng, Richard Norman. "The evaluation of Mental Health Link, an intervention to develop shared care for patients with long-term mental illness." Thesis, King's College London (University of London), 2005. https://kclpure.kcl.ac.uk/portal/en/theses/the-evaluation-of-mental-health-link-an-intervention-to-develop-shared-care-for-patients-with-longterm-mental-illness(7278b3ca-eba5-4148-8c2d-2e9c71f2c781).html.
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Macyk, Irene. "Staff Nurse Engagement, Decisional Involvement, Staff Nurse Participation in Shared Governance Councils and the Relationship to Evidence Based Practice Belief and Implementation." Thesis, Adelphi University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10610423.
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A nurse's use of evidence-based practice (EBP) is imperative if the goal is for quality and safe care that is safe. Patient quality care is directly correlated to the degree to which hospital nurses are active participants in decision making. Nurses possess the skills that should promote their presence in decision-making forums using evidence-based strategies. Both evidence-based practice (EBP) and participatory Shared Governance Models, independently, have been found to promote improved patient outcomes (Kramer & Schmalenberg, 2004). Shared governance models include formal councils that address recruitment and retention, policy and procedure development, professional practice challenges, quality improvement initiatives and research opportunities. A nurses' Decisional Involvement (DI) and participation in a Shared Governance Council (SGC) may serve as a venue to best utilize Evidenced-Based Practice (EBP) skills with the overall goal of improving care outcomes.
The aim of this research was to determine the relationship of staff nurse engagement, DI and its impact on participation in a SGC and the relationship to EBP. A quantitative non-experimental correlational, on-line survey design was utilized. A total of 156 staff nurses from two (2) Magnet® recognized hospitals in the Northeastern region of the United States was studied.
Results revealed a significant positive relationship between participation in a SGC and staff nurse engagement, actual DI, age, years of experience and professional certification. Additionally, nurses that participated in a SGC had a significantly higher self-reported EBP implementation. Exploratory logistic analysis revealed EBP implementation, staff nurse engagement, full time work status and participation in IDRs were significant predictors of participation in a SGC. A multiple regression analysis resulted in EBP belief, staff nurse engagement, and participation in a SGC explaining 34.5% of the variability of predicting EBP implementation. The findings give beginning support to the importance of creating an infrastructure that fosters staff nurse engagement and participation in a SGC to promote EBP implementation.
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Lupaszkoi, Hizden Thomas. "Creating a community of practice to prevent readmissions : An improvement work on shared learning between an intensive care unit and a surgical ward." Thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-30244.
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Background ICU readmissions within 72 hours after discharge from the intensive care unit (ICU) is a problem because this leads to higher mortality and longer hospital stays. This is a particular problem for the hospital studied for this thesis because there are only three fully equipped ICU beds available. Aim To prevent readmissions by introducing nursing rounds as a concept of “communities of practice” (CoP) and to identify supportive and prohibitive mechanisms in the improvement work and knowledge needed for further improvement work in similar settings. Methods Questionnaires, focus groups, Nelson’s improvement ramp, and qualitative content analysis. Results There were no readmissions from the participating ward after the nursing rounds started, but the reason for this is not clear. The staff experienced the nursing rounds as valuable and they reported greater feelings of confidence, increased exchange, and use of their own knowledge. Discussion The findings presented here support that hypothesis that CoP builds knowledge that can improve patient care. The information provided to the participants during the improvement project was identified as the most supportive mechanism for improvement work, and a lack of resources was seen as the most prohibitive mechanism.
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MacLure, Katie. "An exploration of ehealth and digital literacy in pharmacy practice." Thesis, Robert Gordon University, 2014. http://hdl.handle.net/10059/1011.
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The aim of this research programme was to explore ehealth technology in pharmacy practice in Scotland and, by doing so, contribute original knowledge to this area. Strategists worldwide believe technology has the potential to promote quality, safety and efficiency in healthcare. This has been reflected in national ehealth policies designed to support collaborative working between medical and non-medical healthcare practitioners and, more recently, the whole health and social care team. A meta-narrative systematic review was conducted to explore and contextualise research related to healthcare professionals’ views of the adoption of ehealth technologies to support shared care. Findings indicate the importance of organisational development and training for core and optional ehealth services with pharmacists particularly under-represented in ehealth research. Socio-technical systems theory and the computer supported cooperative working framework were adopted to explore healthcare practitioners’ perceptions of ehealth in relation to integrated care. Findings from the review indicate ehealth research continues to focus on doctors and nurses. No ehealth application was perceived to be an unqualified success with the socio-technical gap still evident. Multiple case studies were conducted to develop explanatory theory around the digital literacy experiences, education and training related needs of pharmacy staff in the NHS Grampian area. Digital literacy levels were self-reported as basic with mixed views on the need for formal education and training. Findings indicate organisational and social factors may act as restraining forces against implementation of technology in pharmacy and associated digital literacy training. A final theory testing, systematic review was conducted into digital literacy training experiences of pharmacy staff applying Kirkpatrick’s four level model. It found a lack of evidence of specific, measurable digital literacy levels but indications that suggest digital literacy should be included in pharmacy education at all levels and career stages. This research provides novel insight into ehealth and digital literacy in pharmacy practice. Combined ehealth, education and pharmacy research has been demonstrated to be an under-researched area therefore these findings contribute original knowledge.
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Shay, Laura Aubree. "Patient Perceptions of Shared Decision Making: What Does It Mean and How Does It Affect Patient Outcomes?" VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/546.
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Introduction: Shared decision making (SDM) has been advocated as an optimal approach to medical decision-making. Yet, little is known about how patients perceive SDM and whether patient-defined SDM is associated with patient outcomes. Methods: This three-manuscript dissertation used a mixed-methods approach including a systematic literature review and both qualitative and quantitative research methods. The aims were to: (1) systematically review the patient outcomes studied in relation to SDM and identify under what measurement contexts SDM is associated with which types of patient outcomes; (2) use in-depth, qualitative interviews to develop a conceptual model of patient-defined SDM and compare this to recent decisions that patients labeled as shared; and (3) apply the model of patient-defined SDM to the context of colorectal cancer screening. Results: Study 1 found that 39 studies measured SDM and evaluated it with a patient outcome, and only 43% of patient outcomes assessed were significantly associated with SDM. Patient reports of SDM were most likely to be associated with outcomes. Study 2 found that patients’ conceptual definition of SDM included four components: exchange of information, active listening, patient-self advocacy, and a personalized physician recommendation. Patient descriptions of recent decisions labeled as shared ranged from very simple recommendations through complex interactions, with the only commonality among shared decisions being that the patient and physician ultimately agreed. Study 3 found that the most commonly observed component of patient-defined SDM was patient self-advocacy (76%) and least common was a personalized physician recommendation (23%). Only 9% visits contained all four patient-defined SDM components. In adjusted models, physician provision of information around the process and potential side effects of colorectal cancer screening was associated with an increase in screening. There were differences in screening rates by the patient’s initial verbal response to the physician recommendation with those who initially refused being least likely to be screened (40%) and patients who did not verbalize a response to the recommendation being most likely to be screened (70%). Discussion: Findings across the three studies highlight the complexity of studying and measuring SDM and emphasize the importance of the patient’s perspective on SDM.
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Shoemaker, Esther Susanna. "Childbirth Decision Making Processes: Influences on Mode of Birth After a Previous Caesarean Section." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/35504.
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Background: An increasing proportion of Canadian women are experiencing a Caesarean section (CS) and a subsequent repeat CS. While CS can be necessary and lifesaving for mothers and their infants in some situations, it is also associated with greater morbidity risks to women and infants than vaginal birth. Clinical practice guidelines recommend the involvement of pregnant women in making decisions about mode of birth and shared decision making improves the informed consent process. This research examines the factors that influence mode of birth after a previous CS.
Methods: Two cross sectional descriptive studies and a prospective pre-post cohort study with control were conducted to investigate the high use of repeat CS at the levels of health care providers, maternity care clients, and the organizational structure of a birthing unit.
1. Interviews and surveys with obstetricians, family physicians, midwives, and nurses were conducted to investigate the attitudes, values, and perceptions that guide their care practices for clients with a previous CS. The specific research question was: What are the factors that influence the practices of maternity care providers (obstetricians, family physicians, midwives, and nurses) regarding mode of birth after a previous CS? Data was analyzed using iterative deductive and inductive coding.
2. Interviews and surveys were conducted during pregnancy and after giving birth with healthy women who have had a previous CS to explore their decision making processes regarding mode of birth after a previous CS. The specific research question was: How do women eligible for a VBAC make decisions about their upcoming mode of birth? A thematic framework approach was used for data analysis.
3. Data from the Better Outcomes Registry and Network (“BORN”) Ontario was analyzed to examine the effectiveness of a hospital based strategy on overall proportions of CS and within Robson groups 1, 2a, and 5. The Caesarean section reduction (CARE) strategy includes interventions that target health care providers, pregnant women, and hospital policies.
Results:
1. Maternity care providers would recommend a vaginal birth after CS (VBAC) for healthy pregnant women with a previous CS. They had different perceptions of the safety of birth to the health of women and infants and different approaches to engage in decision making during consultation. Providers believed women make their decision about mode of birth outside of the clinical consultation and often prior to their subsequent pregnancy.
2. The main themes that influenced the decisions of maternity care clients about mode of birth were mothers’ experiential reasoning regarding mode of birth and recovery, experiential knowledge from significant others, scheduling of CS regardless of the mode of birth decision, rating and prioritizing risks, fear of risks, and decisional conflict. When women discussed the factors that impacted their decisions about mode of birth six to eight weeks after they had given birth, the main themes were the recovery experience and fear related to the mode of birth. A lack of time during consultation was identified as a major barrier inhibiting shared decision making, specifically among clients of obstetricians. Other barriers included reliance on routine obstetric practices that are not evidence based.
3. Proportions of CS decreased at the intervention hospital by 3.9% (p=0.0006), from 30.3% (n=964) in 2009/10 to 26.4% (n=803) in 2012/13. During the same time frame, proportions of CS in the control group were stable with 28.1% (n=23,694) in 2009/10 and 28.2% (n=23,683) in 2012/13. Within the Robson classification system, the proportions of repeat CS among all low risk women with a previous CS decreased at the intervention hospital by 5.6% (p=0.0044) from 84.3% to 78.7%. In the control group, also fewer women had a repeat CS over the study period, but the decrease was smaller with 3.9% (p<0.0001) from 84.5% to 80.6%.
Conclusion: A true shared decision making process addresses the power imbalance between providers and women through an incorporation of the clinical expertise of providers and the experiential expertise of pregnant women before reaching a decision about mode of birth. The use of routine obstetric practices that are not evidence based inhibited women to make decisions about their mode of birth. The introduction of the CARE strategy to a hospital birthing unit was associated with improvements in proportions of CS and VBAC among low risk women.
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Glass, Katherine Elizabeth. "Patient Perceptions of Electronic Health Records (EHRs) in Outpatient Healthcare Visits: A Survey of the State of Ohio." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1337784101.
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Murphy, Kate. "Clozapine, concomitant medications and consumers: Assessing the accuracy of medication records and the lived experience of people prescribed clozapine under shared care arrangements." Thesis, Griffith University, 2018. http://hdl.handle.net/10072/381000.
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Schizophrenia is a serious long-term mental illness associated with significant morbidity and mortality. Clozapine is the most effective antipsychotic medication for the treatment of schizophrenia, however, due to potentially life-threatening haematological adverse effects, its use is restricted to people who have not responded to an adequate trial of at least two other antipsychotic medications. The high risk of adverse effects, associated mandatory monitoring and prescribing restrictions all mean that clozapine consumers often continue to be managed in a secondary care public mental health (MH) service.
In people stabilised on maintenance treatment living in the community, a shared care model, involving collaboration between a psychiatrist in secondary care, a general practitioner (GP) and community pharmacy in primary care is a management option. The aim of shared care is to lessen the burden on the consumer and on the secondary care service by allowing the GP to undertake the majority of monitoring and reduce the frequency of secondary care appointments.
While this may appear to be an ideal arrangement, discrepancies in medication information at transitions of care from one health service to another are common and contribute to prescribing errors. Where clinicians do not have full medication information there is potential for inappropriate clinical decision-making and the consumer can be exposed to adverse drug events (ADEs), which are defined as any harm occurring during drug therapy.
The overall aim of the study was to generate information and form recommendations to optimise communication pathways and access to accurate medication information between and for stakeholders (secondary care, general practice and community pharmacy) and consumers of a clozapine shared care service. The study was designed to assess the completeness and accuracy of consumer medication records held by shared care stakeholders and to describe the experiences of the consumers.
This was an exploratory mixed methods study undertaken in two parts. Firstly, a quantitative approach was used to examine secondary and primary care medication records in a public MH service setting. Fifty-five consumers (aged 18–65 years) prescribed clozapine under shared care were eligible to participate. Information from medication and dispensing records was used by a pharmacist to compile a best possible medication history for each consumer. Discrepancies were identified through reconciliation of stakeholder records with the medication history. Discrepancies were defined as an omission, addition, or administration discrepancy (difference in dose, frequency, or clozapine brand).
Thirty-five consumers who had previously consented to review of their medication records were then eligible to participate in Part Two of the study. Participants completed a semi-structured interview that included a number of questionnaires. The questionnaires focused on beliefs about illness and medicines, adverse effects, medication adherence and treatment burden, while the interview focused on advantages and disadvantages of clozapine, shared care, and communication pathways. Analysis was descriptive and thematic.
In Part One, 35 (63.5%) consumers consented to review of their records. Overall, 32 of the 35 consumers had at least one discrepancy in their records, with a mean of 4.9 discrepancies per consumer. Of 172 discrepancies, 127 (73.8%) were omissions. Primarily, concomitant medicines were omitted in 19/35 (54%) of secondary care records, while clozapine was omitted in 13/32 (40.6%) of community pharmacy records. In Part Two, 10/35 (28.6%) consumers agreed to participate in an interview. Findings included a low level of treatment burden with minimal adverse effects and medium-to-good adherence. Four inter-related themes surrounding treatment in the clozapine shared care program were identified: (i) understanding of illness and recovery; (ii) positive outcomes of treatment; (iii) treatment burden and acceptance and (iv) communication pathways. All participants described a positive experience with treatment in the clozapine shared care program, citing the efficacy of clozapine and the GP relationship as major benefits. Other findings included the fact that consumers were mostly unaware of any communication that took place between their shared care clinicians and assumed that clinicians had access to accurate medication information.
In summary, discrepancies were highly prevalent in the shared care medication records of clozapine consumers in this service, however participants reported positive treatment outcomes. Improved documentation and timely access to accurate and complete medication records for shared care stakeholders is needed to reduce the risk for suboptimal clinical decision-making and ADEs. Expanding the pharmacist's role in this setting could improve timeliness and accuracy in medication-related documentation and communication and make shared care an option for a wider group of clozapine consumers.Thesis (Masters)
Master of Philosophy (MPhil)
School of Human Serv & Soc Wrk
Griffith Health
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Sadowski, Christina. "The lived experience of security and contentment for latency aged children in shared care, post-separation : a descriptive phenomenological enquiry." Thesis, Federation University Australia, 2012. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/164893.
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"As a result of complex social, economic and legislative factors, the number of children in shared time arrangements (in which children spend equal, or near-equal time, with both parents post-separation) has risen steadily and incrementally in Australia and internationally. Despite the increasing numbers of children in this arrangement, conceptualisations of and discussions about shared care remain largely devoid of children's perspectives about their experiences. As a result, little is known about how children experience this way of living. This study used a descriptive phenomenological approach to explore latency aged (aged 8-12) children's lived experience of security and contentment, and their absence, in a shared care time arrangement." "Interviews were conducted with sixteen children across a diversity of living arrangements (levels of parental cooperation and conflict; self-selected and Court-ordered; day-to-day patterns) who had current or recent experience living in shared care. From this pool of interviews, the eight richest and detailed protocols were selected for descriptive phenomenological analysis. Through a process of detailed analytic exploration of these eight individual descriptions of phenomena under investigation (security and contentment in shared care; the absence of security and contentment in shared care), the core constituents of each phenomenon were discerned. From these, General Structures representing the essence, or the invariants common to all experiences under investigation, were identified. This thesis introduces a child-generated phenomenology of security and contentment, and their absence, in shared care. This phenomenology is based on the careful analysis of children's pre-reflective narrative descriptions, describing core aspects of this arrangement that contribute to their felt security and contentment, and core aspects that compromise it. Ultimately, this thesis presents the child's lived experience of feeling securely shared by parents in the context of a shared time living arrangement. "Doctor of Philosophy
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Nyarambi, Dumisa M. "Shared Decision-Making for Contraceptive Counseling Among Women Seeking Services at Safety Net Clinics in South Carolina and Alabama." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/etd/3958.
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Shared decision-making (SDM) for contraceptive counseling and method initiation is a hallmark of patient-centered care; SDM is associated with patient satisfaction, method continuation, and the prevention of pregnancy and short inter-pregnancy intervals. To achieve a high-quality experience for women Person-centered approach to counseling is the preferred approach to achieve SDM. Demographic factors and women’s perceptions of their providers have been linked to decision-making. Literature is lacking on SDM practices in safety net clinics, particularly in local health departments. Exploring these constructs is important to inform practices and policies for family planning. This research aimed to examine: 1) the influence of sociodemographic factors on SDM; 2) the influence of SDM on contraceptive method choice; and 3) the effect that women’s perceptions of their providers might have on SDM and associated contraceptive method choice, among non-white women in South Carolina and Alabama. Secondary data were from a longitudinal study that surveyed women of reproductive age (16 to 44 years) from the two states. The data used for this research were collected from non-white women between October 2018 and September 2020 as part of a larger evaluation effort. Bivariate and multinomial analyses were conducted to assess associations and relationships. In Study 1, significant differences in SDM were observed for income and age, with younger women and lower income women having increased odds of engaging in SDM compared to older and higher income counterparts. In Study 2, multinomial analysis indicated that, compared to those who maintained autonomy over their decision, those whose decisions were shared and provider-driven had higher odds of choosing a short-acting method over a less effective method (OR = 1.608 and OR = 2.314, respectively). In Study 3, associations between SDM and women’s perceptions of providers were observed. Compared to those who maintained decision-making autonomy and had positive perceptions of providers, those who engaged in SDM and those whose decisions were least autonomous were more likely to choose a short-acting method over other, less effective contraceptive methods. There is need to further examine whether SDM is underutilized in these settings.
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Jamu, Styn Mosai Herbut. "Systems approach to managing chronic occupational respiratory disorders| Shared path for improving the pneumoconiosis screening program for South African ex-miners in Botswana." Thesis, Central Michigan University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10090096.
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Pneumoconiosis is a chronic and slowly progressive parenchymal lung disease. Estimates suggest that about 68,000 ex-miners in Botswana will develop or have already developed pneumoconiosis. However, most of these cases do not know they have the disease because of the poor quality of care in primary healthcare settings and weak implementation of the Occupational Diseases in the Mines and Works (ODMW) Act.
This dissertation was a health service research framed from the systems approach using the chronic care model as a theoretical tool. The study employed a concurrent, convergent parallel mixed method research which combined quantitative and qualitative methods of inquiry. The quantitative arm of the study evaluated whether the Botswana primary care settings meet ‘reasonably good standards’ of the pneumoconiosis quality of care measured on the chronic care model. The chronic care model measures quality of care on a 0 to 11 scale, where “0” denotes lack of quality care and “11” stands for optimal quality of care. Reasonably good quality of care comprises scores between 6 and 8 on the scale. The qualitative arm of the study assessed the implementation of the ODMW Act in the Botswana primary healthcare settings. The study mixed quantitative and qualitative results at the interpretation stage to determine the extent to which quality of care for pneumoconiosis and the ODMW Act implementation promote equitable access to pneumoconiosis services among ex-miners in Botswana. (Abstract shortened by ProQuest.)
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Harris, Marianne DeMeo. "A Retrospective Study Comparing Shared Medical Appointments with Usual Health Care on Clinical Outcomes and Quality Measures in Veterans with Type 2 Diabetes." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1374523214.
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Farrington, Grace. "Shared reading : a practice-based study of The Reader Organisation reading model in relation to Mersey Care provision and the English literary tradition." Thesis, University of Liverpool, 2014. http://livrepository.liverpool.ac.uk/18917/.
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This thesis is a study of the literary practice of shared reading as practised by The Reader Organisation (TRO) in its Get into Reading (GIR) project. The first and shorter half of the thesis offers an introductory location of the key elements of GIR practice within TRO’s sense of the English literary tradition. The first two chapters thus examine the foundations for the reading of poetry (in chapter one with regard to the Elizabethan lyric) and prose (in chapter two in relation to Victorian realism) within GIR. Part two investigates the actual praxis of shared reading aloud in groups. Chapters three to five provide an account of the methodology and findings of research into the practice of GIR. ‘Bibliotherapy’ is problematised here as a term which, whilst it appeals to the idea of the relevance and use of books, and points to the existence of a place for reading within a specifically prescribed area, also risks narrowing down the idea of the shared reading model. Chapters three and four, forming the central part of the thesis, set out the terms of a literary-critical analysis of transcripts collected from GIR sessions, and outline the discovery within these transcripts of evidence of a varied model of literary thinking prompted by the reading-group leaders trained by TRO. Chapter three concentrates on the group-session transcripts; chapter four on individual case-studies across sessions. These chapters provide the focus for the thesis as a study of the non-specialist responses of real readers to what literature is. A toolkit is offered to identify certain tools and values that are implicit within the experience. It is to be hoped that future studies might refine, correct, or build upon the analyses set out in these chapters in particular through the use of established formal techniques such as conversation and discourse analysis. But the initial aim here was to investigate the phenomena in literary terms ahead of any such alignment with the categories of linguistics. In chapter five the findings of the present study are consolidated through a series of individual interviews with a number of the participants, offering their experience at another level and in reflective aftermath. Increasingly GIR is being introduced as a form of intervention within modern mental health care, and the thesis closes with a consideration of the place of shared group reading within the context of health and the languages of cure or therapy.
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Baughn, Daniel. "Care for the socially disadvantaged: The role of race and gender on the physician-patient relationship and patient outcomes in a safety net primary care clinic." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2882.
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Compared to the general population, socially disadvantaged patients have higher rates of chronic illness and require more complex medical care. They also endorse higher levels of psychological distress and tend to engage in behavioral risk factors such as poor diet, physical inactivity, and smoking. These issues are particularly concerning given that this population tends to adhere less to medical recommendations, has limited access to health resources, and receives poorer treatment from providers. In an effort to address this disparity, The Affordable Care Act will expand health care access to an additional 23 million uninsured and 17 million underinsured Americans. However, simply expanding access to health care without examining and improving upon factors related to the physician-patient relationship would not fully address the health care needs of this population. This study sought to improve the quality of care received by socially disadvantaged patients by better understanding the role of race and gender on the physician-patient communication process and patient outcomes in a safety net primary care clinic. The study sample consisted of 330 low-income, uninsured/underinsured African American and White patients and 41 resident physicians. Overall, African American patients and their doctors and White doctors and their patients were viewed as engaging in the highest levels of communication. South Asian physicians, and male South Asian physicians in particular, had the lowest levels of communication and the patients of these providers experienced less improvement in their physical health. Patient education level influenced physicians’ perceptions of their patients to the extent that patients with higher educational levels were viewed as engaging in lower levels of communication. Last, indicators of a good physician-patient relationship were associated with higher levels of patient reported adherence. Practice implications and areas for future research are discussed.
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Fuseya, Yoshinori. "Perspectives on End-of-Life Treatment among Patients with COPD: A Multicenter, Cross-sectional Study in Japan." Kyoto University, 2020. http://hdl.handle.net/2433/252978.
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Yeh, Yu-Ting, and 葉雨婷. "Integrating Patients Education into Diabetes Shared Care." Thesis, 2004. http://ndltd.ncl.edu.tw/handle/24203432169499688328.
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碩士臺北醫學大學
醫學資訊研究所
92
Diabetes is the fourth leading causes of death in Taiwan. This indicates severely threatening our health. However the current reimbursement policy of the Bureau of National Health Insurance is based mainly on the volume of medical services, and not on the quality of care or patient education service. As a result healthcare providers do not devote significant resources to educating or informing patients. Empowering diabetes with self-care knowledge is therefore desirable. In this paper we describe a web-based diabetic education assistant system that can facilitate diabetic education, and remind patients to take appropriate actions on predefined conditions by sending them short messages through their mobile phones. This research also has recruited total of 274 subjects, in which each subject has been assigned to either the control or the experimental group randomly. The study is monitored via number of hospital visits and average days between each visit for all patients to show whether diabetic patients have changed their life styles and attitudes after web-based diabetic education assistant system implementation. Moreover, the difference between the control and experimental groups can also be seen in the difference of HbA1C and glucose AC analyzed by statistical programs. In short, the purpose of the research is to further prove the effectiveness of the web-based diabetic education assistant system.
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Petker, Carla Jane. "Stories of self-care lessons learned and shared /." Master's thesis, 2009. http://hdl.handle.net/10048/473.
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Thesis (M.Ed.)--University of Alberta, 2009.Title from pdf file main screen (viewed August 10, 2009). "A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Education in Counselling Psychology, Educational Psychology, University of Alberta." Includes bibliographical references.
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Ge-LinChiu and 邱智鈴. "Developing Hospice Palliative Home Care and Shared Care Nurses Educational Program in Taiwan." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/41439903922671936323.
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碩士國立成功大學
護理學系碩博士班
99
The goal of this study is to analyze the problems and setbacks of hospice home care and hospice shared care in Taiwan. The data sources originate from 97 participants in three district (northern, central, and southern) training camps organized by the Society of Taiwan Hospice Palliative Care in Taiwan, including demography, clinical practices, setbacks, pretest questionnaires, and results from the symptom control exam. I incorporated in the study secondary data analysis, along with descriptive statistics, inferential statistics, and qualitative content analysis in order to provide an understanding of the current status, difficulties, the knowledge and skills and attitudes of the home care and shared care nurses in the study. An analysis of the data from the focus group shows that the current problems existing within our hospice nursing staff can be summed up in the following ways: 1) lack of professional ability, 2) increased workload due to the multiple roles our hospice nurses play, 3) insufficient support from the medical team, 4) lack of passion and enthusiasm in the new nursing staff, and 5) rare role models. In my research, I made use of scenario questions, not only to get at the knowledge, skills and attitudes of nurses nowadays, but also to define the gap between the present state and the ideal situation. What came out of the analysis was that there was no correlation between the number of years of nursing work and the knowledge, skills and attitudes of those nurses providing hospice home care and hospice shared care. In other words, their knowledge, skills, and attitudes did not correlate with their seniority. The statistical outcome showed that the more senior nurses did not exhibit better clinical reasoning than the more junior nurse. Further analysis showed that the ability to solve problems and think logically was not proportional with seniority. Contrary to what one would expect those with much greater seniority in hospice scored lower on the exam than nurses with less seniority. Senior nurses were influenced by North America Nursing Diagnosis Association (NANDA) training. It has been shown that this educational background often results in rigid thinking which restricts a nurse’s ability to think logically and deliberately solve problems. Thus, my goal is to develop a well-rounded system that may be incorporated into the training of hospice nurses, not only to facilitate the development of new skills and acquisition of new knowledge, but also to encourage proper attitudes towards hospice care. Using this system, nurses can advance their nursing skills in an interactive environment, using versatile forms of learning. In sum, my greatest wish is that this proposed program can be used clinically to cultivate nurses with greater compassion in their hospice work. Furthermore, nurses who perform hospice shared care and hospice home care can be equipped with proper and adequate skills and know-how that will improve the quality of care given to the terminally ill.
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盧菀淇. "The effect of diabetes shared care model on health care expenditures and quality." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/28581933151869851218.
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Moore, P., Gerry R. Armitage, J. Wright, S. Dobrzanski, N. Ansari, I. Hammond, and Andy J. Scally. "Medicines Reconciliation Using a Shared Electronic Health Care Record." 2011. http://hdl.handle.net/10454/6371.
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Objective: This study aimed to evaluate the use of a shared electronic primary health care record (EHR) to assist with medicines reconciliation in the hospital from admission to discharge.
Methods: This is a prospective cross-sectional, comparison evaluation for 2 phases, in a short-term elderly admissions ward in the United Kingdom. In phase 1, full reconciliation of the medication history was attempted, using conventional methods, before accessing the EHR, and then the EHR was used to verify the reconciliation. In phase 2, the EHR was the initial method of retrieving the medication history-validated by conventional methods.
Results: Where reconciliation was led by conventional methods, and before any access to the EHR was attempted, 28 (28%) of hospital prescriptions were found to contain errors. Of 99 prescriptions subsequently checked using the EHR, only 50 (50%) matched the EHR. Of the remainder, 25% of prescriptions contained errors when verified by the EHR. However, 26% of patients had an incorrect list of current medications on the EHR.
Using the EHR as the primary method of reconciliation, 33 (32%) of 102 prescriptions matched the EHR. Of those that did not match, 39 (38%) of prescriptions were found to contain errors. Furthermore, 37 (36%) of patients had an incorrect list of current medications on the EHR.
The most common error type on the discharge prescription was drug omission; and on the EHR, wrong drug. Common potentially serious errors were related to unidentified allergies and adverse drug reactions.
Conclusions: The EHR can reduce medication errors. However, the EHR should be seen as one of a range of information sources for reconciliation; the primary source being the patient or their carer. Both primary care and hospital clinicians should have read-and-write access to the EHR to reduce errors at care transitions. We recommend further evaluation studies.