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Wilson, Nicola Ann. "Modelling intermediate care services as part of an integrated care pathway". Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20290.
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This study explores the implications of implementing enhanced or redesigned intermediate care initiatives in the Western Cape of South Africa from the 2014/15 financial year onwards. Using a dynamic modelling methodology, we developed an empirical model of an integrated care system to explain the linkages, relationships and interactions among service components and analyse the implications of one of the proposed Healthcare 2030 policy interventions - intermediate care - on hospital admissions, waiting times and length of stay of all patients. We tested and compared a number of alternative intervention points using a simulation model parameterised with service component data from the Department of Health Information Systems. The findings from the study show the inconsistencies between the perceived structure and the available data from the respective service components that describe the resultant behavioural effects on an integrated care system, especially when care pathways cross organisational boundaries. The main managerial learning was around the existence and nature of organisational boundaries that require joint working and sharing of information. We conclude from the simulation results for the alternative scenarios tested that the implementation of enhanced or redesigned intermediate care initiatives can moderate the rate of growth in the demand for hospital services by reducing a percentage of hospital readmissions.
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Stokes, Jonathan. "Multimorbidity and integrated care". Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/multimorbidity-and-integrated-care(28e8922f-42a6-4359-b01d-81ccdaf9bdbe).html.
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Background: Health systems internationally face a common set of challenges: ageing populations, increasing numbers of patients suffering from multiple long-term conditions (multimorbidity) and severe pressure on health and care budgets. ‘Integrated care’ is pitched as the solution to current health system challenges. But, in the literature, what integrated care actually involves is complex and contested. Aims: 1. What does ‘integrated care’ currently look like in practice in the NHS? 2. What is the effectiveness of current models of ‘integrated care’? 3. To what extent are there differential effects of ‘integrated care’ for different types of multimorbidity? Methods: The thesis utilises routinely collected data, systematic review and meta-analysis, combined with quasi-experimental methods (difference-in-differences, and subgroup analysis, difference-in-difference-in-differences). Results: The current implementation of the concept of integrated care is predominantly carried out through multidisciplinary team (MDT) case management of ‘at risk’ (usually of secondary-care admissions) patients in primary care. This approach, however, has not proven capable of meeting health outcome and utilisation/cost aims. Patient satisfaction, though, is consistently improved by the approach. There might also be positive spill-over effects of increased team-working through MDTs for the wider practice population. There does not appear to be a multimorbidity subgroup which benefits significantly more than others in terms of secondary-care utilisation or cost. However, patients at the end of life and/or those with only primary-care sensitive conditions might benefit slightly more than others. Conclusions: Integrated care, in its current manifestation, is not a silver bullet that will enable health systems to simultaneously accomplish better health outcomes for those with long-term conditions and multimorbidity while increasing their satisfaction with services and reducing costs. The current financial climate might mean that other means of achieving prioritised aims are required in the short-term, with comprehensive primary care and population health strategies employed to better prevent/compress the negative effects of lifestyle-associated conditions in the longer-term.
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Friedman, Nicole Lisa. "Impactful Care: Addressing Social Determinants of Health Across Health Systems". PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/5073.
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There is emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity, inadequate or unstable housing, and lack of access to transportation may increase the risk of developing chronic conditions, reduce an individual's ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. In response, work on social needs is happening across large health systems in the United States, but the pace of progress is slow and accountability is diffuse.
The goal of this applied research project is to examine Kaiser Permanente Northwest's patient navigator program as a case study for how health systems can transform into organizations that bridge clinical, social and behavioral health and redefine what it means to be a prevention-oriented delivery system. Kaiser Permanente Northwest (KPNW) provides high quality, patient-centered care to over 550,000 medical members and 240,000 dental members in Oregon and Southwest Washington. In conjunction with the Care Management Institute, KPNW created a patient navigator administered, social needs screening tool called "Your Current Life Situation" (YCLS). This thesis focuses on the data collected from this screening tool with an emphasis on operations management, workflows, and the technical tools that have been supported to do this work. The analysis also uses semi-structured qualitative interviews from patient navigators, physicians, social workers, community organizations and members to better understand the experience of social needs screening in clinical practice and its impact on members and community partners as they receive referrals for services outside the health care delivery system. Through using anthropological theory and methods, I seek to help health systems think and act differently by elevating the voice and experience of the community and translating vulnerable populations' needs into a language that can be integrated into multiple systems of care.
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Bosire, Joshua. "Designing an integrated surgical care delivery system". Diss., Online access via UMI:, 2007.
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Chang, Ting-Huan. "Determinants of hospital affiliation with health care networks". Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2007. https://www.mhsl.uab.edu/dt/2008r/chang.pdf.
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Carney, Philip Sheridan. "Managed healthcare and integrated delivery systems: A model for getting ahead of the change curve". CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2103.
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Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.
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Heslop, Liza. "An ethnography of patient and health care delivery systems : dialectics and (dis)continuity". Monash University, Faculty of Education, 2001. http://arrow.monash.edu.au/hdl/1959.1/8764.
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Park, Hyo Ri. "Whole Care+: An integrated health care for the elderly living in their homes". Research Showcase @ CMU, 2011. http://repository.cmu.edu/theses/22.
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The elderly experience their health getting significantly deteriorated as they age. They suffer not only from chronic diseases but from various geriatric diseases such as high blood pressure, arthritis and cardiovascular disease. Their mental health also retreats creating challenges for the elderly from the loss of short term memory to dementia. Furthermore, after they retire, the elderly’s social network decreases as their social activities are inevitably limited to a small group of people like families and friends.
With the face of such impairments in their physical, mental and social health, many elderly cannot help but are being institutionalized or sent to specialized places like nursing homes, which provide them professional care. However, a study indicates that most Americans prefer to stay in their homes as they get older since they can maintain their social connections to neighbors and friends, be close to their medical caregivers in town as well as attain emotional comfort and security with familiar surrounding and environments. On top of that, Americans of all ages value on keeping their ability of independence and autonomy by controlling their lives in general.
Various health care-aid devices and services appear to offer specific support to health care activities for the elderly in their homes. However, such aids have more focused only on when the elderly’s health is degraded or on very specific areas such as tracking health data like blood pressure, blood sugar and calorie intakes.
The elderly need comprehensive understanding about their health problems, healthy daily habits and timely interactions with their families and caregivers, in order to keep independent living safely in their places. Smart Home technology has much potential to support the elderly’s independent living as well as interactions with others. To better understand this, we conducted a user-centered design project which looks at the management of the elderly’s health enabled by Smart Home technology.
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Delcarme, Brian. "The development and institutionalisation of an integrated health care waste information system". Doctoral thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/10359.
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Includes bibliographical references.Waste management generally in South Africa is poorly defined and practised, and the inadequate management of health care waste (HCW) has been recognised by the South African government as a significant environmental and public health risk. The literature revealed that an integrated health care waste information system (IHCWIS) serves as an important intervention to address the issue of poor health care waste management (HCWM). The overall key research question which this research asked was: "How does an IHCWIS develop and become institutionalised among health care waste generators?" The aim of the research was to gather empirical data to understand how the development and institutionalisation of an IHCWIS contributes to effective HCWM.
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Giddy, Janet. "The implementation of an integrated prevention of mother-to-child transmission of HIV (PMTCT) programme at McCord Hospital, South Africa, 2003-2013". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16567.
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Includes bibliographical referencesIntegration is an important emerging health systems issue, which has relevance to different health programmes. Improving prevention of mother-to-child transmission of HIV (PMTCT) programs in South Africa would reduce preventable maternal and infant morbidity and mortality, assist with achieving Millennium Development Goals 4 and 5, and help in the response to the WHO call for the elimination of MTCT, the new international PMTCT goal. Integrating PMTCT care into routine maternal and child health programmes has been recommended as a way to optimize PMTCT care. The Part B literature review in this dissertation examines the reasons why PMTCT programmes need to engage with integration as an issue, challenges to implementing integrated programmes, followed by a discussion of the benefits and lessons to consider in planning integrated PMTCT programmes. Theoretical concepts and frameworks such as Atun's framework, complexity, Theory of Change and innovation in health systems are discussed, as they have key relevance to the research findings. Lessons about implementing health system changes can be learned from programmes which have done so successfully. Using Case Study methodology, the process of developing the fully integrated longitudinal clinic at McCord Hospital is described in Part C, and reflections on the experience of providing integrated care are captured through qualitative interviews with the staff. Recommendations regarding innovation and change within complex systems are made, emphasizing the need to understand contexts which are receptive to change and the importance of leadership in managing change.
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Thrasher, Evelyn Byrd Terry Anthony. "Examining strategic fit for the interorganizational network an empirical investigation of the health care integrated delivery system /". Auburn, Ala., 2006. http://hdl.handle.net/10415/1300.
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Rawabdeh, Ali Ahmad Awad. "An integrated national health insurance system for Jordan : costs, consequences and viability". Thesis, Keele University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337091.
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Arguably, in common with many other nation states, Jordan could be said to have drifted into different ways of paying for health services without always foreseeing the long run consequences of taking the strategic direction necessary. In part, of course, as in many developing countries, the financing of Jordan's health care services has been influenced by its colonial past. This partly explains why, historically, Jordan has attempted not only to provide wholly free services, but to provide privileged access to medical services, not only to the military personnel but also to public servants in general. With world economic instability and recent economic difficulties, notwithstanding the opportunities created by Jordan signing the peace treaty with Israel, and the unclear but likely stark future conditions facing the Jordanian economy, it is highly improbable that Jordan will continue to be in a position to sustain, from central government monies, a health system which currently consumes about7percent of the GDP. Financing strategies will, therefore, have to address the heightened expectations for rising health expenditures. Options under active consideration at this time include: introducing or extending the present system of user charges; community financing (participation ); (increased) use of the private sector; public or private health insurance; and, improving efficiency in the use of hospital and community resources. These are all financing options open to the Jordanian government to adopt, whether singly or in combination, to generate more resources for the health system and to make better use of existing resources. Examining the range of different modalities of health services' financing reveals, not surprisingly, that there are advantages and disadvantages in each financing scheme. Nevertheless, depending on Jordan 's circumstances, some of the approaches may be more appreciated than others: that is from a political, cultural, socio-economic, or strictly fiscal point of view. This thesis focuses upon one particular health financing approach, "National Health Insurance (NU)", and is aimed to lead the government of Jordan to rigorously explore the concept, consider the options, and develop an implementation strategy benefiting, where appropriate, from other countries' experiences with systems of NHI. Specifically, the thesis first provides an overview (or situation analysis) of the healthiness of the Jordanian economy, its key demographic and epidemiological characteristics, and salient features of the Jordanian health sector. This is followed by a largely theoretical discussion of the principles of insurance, and its potential relevance to the unpredictability and uncertainty of health and disease. Methodological problems inherent in public or private health insurance schemes are highlighted, and then considered in a comparative context, drawing on lessons and experience around the globe. The thesis considers as its basic premise that a system of national health insurance is both desirable and feasible for Jordan as it faces the next millennium. To test that premise, the study is conducted by means of a series of investigations emphasising both secondary and primary sources of data, and a range of quantitative and qualitative research methods including: content and document analysis; experimental and survey methods; interviews; and questionnaires. The conclusions drawn from the evidence supports the contention that the introduction of NM is potentially both desirable and feasible in Jordan but subject to meeting very strict conditionalities, not least government ownership of the scheme, and the willingness to address the present choice and diversity in health service provision through health sector reform. These matters are as much political as technical matters. On the more technical front, nonetheless, the design of an appropriate NHI is shown to raise critical issues regarding: coverage; benefits; organisation and management; costing and financing; and, provider payment mechanisms. Various technical options are discussed in the thesis, and were consulted upon with key decision makers in Jordan. Further directions of research and development are also identified, which likely have applicability beyond the specifics of Jordan itself.
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Jenkins, Juliette Swanston. "Community Health Worker's Perceptions of Integration into the Behavioral Health Care System". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6908.
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Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl's five stream confluence policy process theory and Lipsky's street level bureaucracy theory provided the foundation to explore the perceptions of the CHWs about their integration into the behavioral health care system; the problems, policies, processes, and programs that impacted their ability to be integrated into the behavioral health team; and their function as a street level bureaucrat to facilitate their integration. A deductive iterative coding approach was used, culminating in the identification of the following 6 themes: health system utilization of CHW behavioral health integration, official policy recognition of the CHW profession, accountability for CHW integration, CHW practice support, integrated health care team management of physical and mental health and behavior, and building the CHW profession. The social change implications of this study are that CHWs' integration into the broadly defined, integrated, physical and mental behavioral health team can support having a more cost-effective way toward having healthy people and communities because they link the community to health and social services and advocate for quality care.
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Lotz, Joshua. "A discussion of the role of Chinese Medicine in the modern health care system". Columbus, Ohio : Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1222089481.
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Ow, Yong Lai Meng. "Policy transfer and translation : integrated care development in SingHealth (SGH campus) Regional Health System (RHS) in Singapore". Thesis, University of Bristol, 2018. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.743041.
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Koppenhaver, II Kenneth E. "Effects of an Integrated Electronic Health Record on an Academic Medical Center". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2666.
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The debate about healthcare reform revolves around a triple aim of improving the health of populations, improving the patient experience, and reducing the cost of care. A major tool discussed in this debate has been the adoption of electronic health record (EHR) systems to record and guide care delivery. Due to low adoption rates and limited examples of success, the problem was a lack of understanding by healthcare organizations of how the EHR fundamentally changes an organization through the interactions of people, processes, and technology over time. The purpose of this case study was to explore the people, processes, and technology factors that change as a result of an EHR implementation. Complexity theory was used as the lens to evaluate the effects of the EHR on the holistic system of healthcare. Data were collected using semistructured interviews and observations of physicians, nurses, and administrators, as well as document reviews of organizational documents related to the EHR. Data were analyzed using open coding to identify themes and patterns of usage that redesign or restructure institutional resources. The results of this study demonstrated positive changes in the interactions of healthcare providers with increasing collaboration on process changes and reliance on EHR for communication. These findings may positively affect government policy and the organizational approach to adoption and ongoing use of EHRs to create organizational change beyond the implementation of such systems, thus benefiting both health care employees and patients.
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Hauke, Adam J. "An Integrated System for Sweat Stimulation, Sampling and Sensing". University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1535371796736114.
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Ibrahim, Abdul Razak. "An integrated performance measurement system of healthcare services : an empirical study of public and private hospitals in Malaysia". Thesis, University of Strathclyde, 2002. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=23752.
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The purpose of this study is to explore performance measurement systems in the healthcare services in Malaysia. This study postulates a framework based on an analysis of the existing literature in the field and on the empirical evidence collected during fieldwork. This framework provides a useful perspective for studying performance measurement in developing countries such as Malaysia. Moreover, identification of gaps in the field enables both academics as well as practitioners to improve the existing systems, thereby creating more robust and better surveillance in the healthcare industry. The findings show that in order for systems to operate efficiently, three major components must work together, namely strategy formulation and deployment, internal control systems, and managing processes. The empirical framework developed in the study represents an amalgamation of approaches used in organisations. One of the findings is that top management commitments, people involvement, and structure to accommodate change process are the catalyst for measurement systems to work. Further analysis reveals (survey) that 80% of users are not satisfied with their measurement system. This means that there is a need for further research in the future. Performance measurement is in its embryonic stage in Malaysia as the survey reveals domains accomplishment of less than 50%. The healthcare industry is inevitably growing and the Malaysian government needs to address the importance of measuring performance in the long run. Learning from another country's experience is the best way forward. The thesis also provides a context in which performance measurement works. There are two contexts applied: healthcare industries and Malaysia. Both contextual elements are important; healthcare has special attributes that make it different from other industries, while Malaysia has unique properties that provide a fresh look at healthcare. The key to successful performance measurement is to ensure congruence in all elements of the systems: context (Malaysia and healthcare) and content (organisations where systems exist). Then integration can be accomplished.
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Yung, Fiona Yuet-Ching. "A middle manager's response to strategic directives on integrated care in an NHS organisation : developing a different way of thinking about prejudice". Thesis, University of Hertfordshire, 2013. http://hdl.handle.net/2299/11563.
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This thesis examines a middle manager’s response to strategic directives on integrated care in a National Health Service (NHS) organisation and the development of an awareness of prejudice that acknowledges its relationship to the process of understanding. The research focuses on an integration of two community NHS trusts and an NHS hospital trust into one integrated care organisation (ICO). A change programme was initiated and promulgated on an assumption that integrating the three organisations would facilitate integrated care. However, despite the use of organisational change approaches (such as communication plans and systematic approaches to staff engagement), implementing the strategy directives in practice remained problematic. What emerged during the integration process was resistance to change and a clear division in the different ways of working in the community NHS trusts versus the community and hospital trusts – differences that became apparent from the prejudices of individuals and staff groups. The proposition is that prejudice is an important aspect of relationships whose significance in processes of change is often overlooked. I argue that prejudice is a phenomenon that emerges in the processes of particularisation, which I describe as an ongoing exploration and negotiation in our day-to-day activities of relating to one another. Our pejorative understanding of the term ‘prejudice’ has overshadowed more subtle connotations, which I propose are unhelpful in understanding change in organisations. However, I suggest a different way of thinking about prejudice – namely as a process that should be acknowledged as a characteristic of human beings relating to one another, which has the potential to generate and enhance understanding. The research is a narrative-based inquiry and describes critical incidents during the integration process of the three organisations and focusing on interactions between key staff members within the organisation. In paying attention to our ongoing relationships, there has been a growing awareness of disconnection from traditional management practices, which advocate systematic approaches and staff engagement techniques that are designed to encourage cooperation and reduce resistance to proposed change. This thesis challenges assumptions surrounding prejudice and how middle managers traditionally manage organisational change in practice in their attempts to apply deterministic approaches (which assume a linear causality) to control and influence human behaviour. I have taken into consideration a hermeneutic perspective on prejudice, drawing on the work of Hans Georg Gadamer, and have argued from the viewpoint of the theory of complex responsive processes. This offers an alternative way of thinking about management as social processes that are emergent in our daily interactions with one another, that are not based on linear causality, or on locating leadership and management with individuals. It provides a way of taking seriously the relationships between individuals by paying attention to what emerges from the interplay of our expectations and intentions. This leads to a different way of thinking about the relationship between prejudice and strategic directives, which I argue are not fixed instructions but unpredictable articulations of our gestures and responses that emanate from social interaction and continually iterate our thinking over time. This paradoxically influences how we make generalisations and particularise them in reflecting on and revising our expectation of meaning I suggest that it is not possible to predetermine a strategic outcome; and that traditional management practice, which locates change with individuals – and reduces aspects of organisational life, such as resistance, into a problem to be fixed – obscures our capacity to understand the processes of organisational change in the context of a much wider social phenomenon. I therefore conclude that my original and significant contribution to the theory of complex responsive processes and to practice is encouraging a different way of thinking about prejudice – as a process that can be productive and generate understanding, when considered as encompassing our expectations of meaning, linked to our own self-interests. This then opens up possibilities for transforming ourselves in relation to others – and, through this process, to transform the organisations in which we work.
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Creary, Stephanie Joyce. "Making the most of multiple worlds: Multiple organizational identities as resources in the formation of an integrated health care delivery system". Thesis, Boston College, 2015. http://hdl.handle.net/2345/bc-ir:104562.
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Thesis advisor: Michael G. PrattIn spite of an undeniably vast and multidisciplinary body of research on mergers and acquisitions (M&As) spanning more than 50 years, extant scholarship provides little insight into how two organizations that have struggled to integrate rebound from failure in their relationship. This dissertation examines two organizations—AMC Hospital and Community Hospital—that achieved this outcome nearly 16 years after they legally merged. To understand this phenomenon, I conducted an inductive, longitudinal qualitative study of these two organizations and their members using interviews, archival data, and observations as my data sources and grounded theory techniques to analyze the data and build theory. Extending prior research on M&As, multiple organizational identity management, and identities as resources in organizations, I advance the notion of multiple identity resourcing by examining how the negotiation of multiple organizational identities fostered greater resource sharing and generation during post-merger integration. Additionally, I elaborate prior research on meaning construction during strategic change by examining how managers’ interpretations of the power and intimacy dynamics in the merger relationship influenced their strategizing, which affected organizational-level episodes of success and failure during the integration process. More broadly, I demonstrate how practices at both the level of the merger relationship and the level of strategy implementation enable successful performance during post-merger integration
Thesis (PhD) — Boston College, 2015
Submitted to: Boston College. Carroll School of Management
Discipline: Management and Organization
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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital". VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
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Silva, Keila Silene de Brito e. "Avaliação da integralidade no cuidado ao câncer de colo uterino: uso da condição marcadora em um estudo misto". Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-12042013-111803/.
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Este trabalho teve como objetivo avaliar a integralidade no cuidado ao CCU em um município de grande porte populacional e com tecnologia de distinta complexidade disponível. Foi utilizada uma metodologia mista (quanti-quali). Para a abordagem quantitativa utilizou-se a base de dados secundários referentes à citologias e biópsias do sistema de informação municipal e regional. A análise e os testes estatísticos foram realizados pelo software PASW statistic 17.0. A abordagem qualitativa foi realizada por meio de entrevistas semi-estruturadas com usuárias, profissionais e representantes da gestão. Os dados qualitativos foram submetidos a uma análise de conteúdo realizada com o software NVivo 9.0. Na análise dos dados secundários, identificou-se que a cobertura de Papanicolau é insuficiente, sendo concentrada em mulheres mais jovens. As biópsias realizadas são equivalentes à quantidade de citologias alteradas. Os diagnósticos mais graves, tanto de citologias quanto de biópsias, prevalecem em mulheres com idade mais avançada. A abordagem qualitativa indica como potencialidades: o acolhimento, o acesso breve a serviços de média e alta complexidade, o papel ativo da gestão municipal de saúde e como fragilidades: a dificuldade para marcação das consultas na atenção básica, a falta de preparo dos profissionais para dar o diagnóstico, a contra referência tardia por parte do serviço terciário, o incentivo ao uso do Pronto-Atendimento e a formação focada na especialidade. Constata-se neste estudo que os principais gargalos para efetivação da integralidade no município investigado estão concentrados no primeiro nível de atenção à saúdeThis study aimed to analyze the completeness in the Cervical Cancer care in a city with a large population and with enough technology health equipment available to the people. It was used a mixed methodology (quantitative and qualitative). For the quantitative approach it was used the database regarding cytology and biopsy exams registered in the city. The analysis and statistical tests were performed by the statistic software SPSS 17.0. A qualitative approach was performed through interviews with users, professionals and members of the health system. Qualitative data were submitted to content analysis performed by the software NVivo 9.0. In the analysis of the content, it was found that coverage of Pap test is insufficient and is concentrated in younger women. The biopsies are equivalent to the amount of the cytology with abnormal results. The severe diagnosis, from both cytology and biopsies, are prevalent in older women. A qualitative approach indicates potentialities: the good reception of the patient, the fast access from both medium and high complexity health services, the active role of municipal health. Weaknesses: the difficulty in scheduling an appointment with a doctor, lack of training to inform the patient about the diagnosis, the encouragement to use emergency care and the overspecialization of the health professionals. It appears from this study that the main gaps for having a complete integrate healthcare system in the investigated city are concentrated in the first level of health care
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Elahi, Behin. "Integrated Optimization Models and Strategies for Green Supply Chain Planning". University of Toledo / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1467266039.
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D'ADAMO, ANTONELLA. "Logiche di public governance dei sistemi sanitari e sociosanitari regionali". Doctoral thesis, Università degli Studi di Roma "Tor Vergata", 2008. http://hdl.handle.net/2108/426.
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Il termine governance è utilizzato con sempre maggiore frequenza per indicare le norme, i processi e i comportamenti con cui le aziende e le amministrazioni pubbliche costruiscono e realizzano politiche, strategie e azioni.
La ricerca, nel tentativo di approfondire la conoscenza sulle logiche di public governance e sull’applicazione delle stesse ai sistemi sanitari e sociosanitari regionali, cercherà di analizzare l’evoluzione del fenomeno secondo una duplice prospettiva. Da un lato, attraverso l’analisi della letteratura e la sistematizzazione delle azioni che stanno alimentando il dibattito intorno al tema della integrazione. Dall’altro, attraverso la definizione di logiche di governance nel processo di integrazione dei sistemi sanitari e sociosanitari.
Il principale obiettivo della ricerca è quello di proporre la sperimentazione di un modello organizzativo di integrazione sociosanitaria e la ricerca di strumenti di governance che consentano lo sviluppo e il funzionamento di un sistema integrato di servizi sanitari e sociosanitari.The term governance is used with an increasing frequency to indicate the rules, processes and behaviour through which public administrations define and implement policies, strategies and actions. The research aims at improving the knowledge on the application of the public governance framework to regional health and social care systems. It will analyse the evolution of the phenomenon through a double perspective. On the one hand, it will be carried out a review of the literature regarding the integration of health care with social care. On the other hand, it will contribute to identify public governance issues in that process of integration. The main aim of the research is to propose an organizational model of health and social care integration, based on public governance principles and tools which can enable the development and good functioning of an integrated system of health and social care services.
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Gazana, Odwa. "The role of telehealth in enhancing access to healthcare services in an under-resourced setting: A case of Mantunzeleni in Eastern Cape Province". Thesis, Cape Peninsula University of Technology, 2015. http://hdl.handle.net/20.500.11838/2399.
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Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016.The delivery of healthcare services should be of a high standard for everyone. For people in the location of Mantunzeleni this is not the case as there are still challenges that they go through in order to gain access to sufficient healthcare services. The location consists of four villages and the other nine which surround the four, in total this makes thirteen villages that are served by one clinic. These villages are divided by forest, rivers and mountains, people have to cross these and walk long distances to get to the clinic. Gaining access to basic healthcare services in rural areas has never been easy, hence this study seeks to understand the role telehealth could play to help improve the situation. It has been reported in the literature that telehealth has potential to address some of the problems experienced by healthcare service providers located in the rural areas. Research questions were posed to address the problem of limited access to healthcare services of under-served communities in rural areas. The study adopted an interpretive approach to understand how the people using healthcare services in the setting attach meaning to their experiences of the healthcare service. The study therefore seeks to understand how telehealth could improve healthcare service delivery through the participants’ views, perceptions and experiences. The research strategy for this study is a single case study without attempting to generalise the findings. Qualitative data was gathered using unstructured interviews, observations and co-design methods. The current state of telehealth and challenges of healthcare services in rural under-served communities was established through a review of relevant literature. It was important to actively involve the respondents in the research process for them to feel a sense of ownership. Data was analysed using a thematic analysis. The findings revealed the challenges currently hampering the delivery of healthcare in the research setting include poor infrastructure, high cost, the shortage of medical professionals, travelling distance, time management and lack of communication about the services. It was also revealed the role telehealth could play a role to improve access to healthcare and the findings indicate that the nurses feel that extending the healthcare service to include alternative access methods to health information, education and expertise could lead to a sense of appreciation, knowledge gain, dealing with distance problems and improved referrals, cost saving to improve healthcare service delivery.
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Lexima, Marie Mirna. "Underserved Patients' Perspectives on How the EHR Impacts Their Health". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1902.
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Our modern health care system requires technology that can deal with multidisciplinary and complex processes, operations, and situations. The EHR, by far, is one of the greatest health information technology innovations that satisfy these requirements because of its efficiency and the effectiveness of its features. This study sought to develop an in-depth understanding of how underserved patients' perspectives about their health and illness, can contribute to greater use of the EHR. It also sought to improve their health outcomes and maintain sustainable change in the lives of the underserved. A quantitative non-experimental design study was conducted over a 6-week period outside of three different internal medicine clinics, one in the Northwestern and the two others in the Southeastern regions of Washington, DC. Surveys were distributed directly to patients coming out of these health clinics, and participants sent their responses via mail. Data collection included 215 surveys out of 560, but, only 155 fit the overall study categories. A strong level of significance in the relationships between clinical outcome measures and the EHR was identified at a 95% confidence interval. There were considerable health determinants that demonstrated the essence of patients' perspectives and the need for its incorporation into health outcomes measures for the underserved populations. The study also identified sets of environmental health predictors which acted as facilitators and contributors to a holistic health management model designed to contribute to the needs of the underserved communities. The holistic health model and the individual care plan model derived from the study are applicable at the level of the underserved population. It can help achieve sustainable health outcomes that will save lives and promote better health.
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Sheriff, Nathirulla. "Time Synchronization In ANT Wireless Low Power Sensor Network". Thesis, Tekniska Högskolan, Högskolan i Jönköping, JTH, Data- och elektroteknik, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-15068.
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Short range wireless data communication networks that are used for sport and health care are sometimes called Wireless Body Area Networks (WBANs) and they are located more or less on a person. Sole Integrated Gait Sensor (SIGS) is a research project in WBAN, where wireless pressure sensors are placed like soles in the shoes of persons with different kinds of deceases. The sensors can measure the pressure of the foot relative to the shoe i.e. the load of the two legs is measured. This information can be useful e.g. to not over or under load a leg after joint replacement or as a bio feedback system to help e.g. post stroke patients to avoid falling. The SIGS uses the ANT Protocol and radio specification. ANT uses the 2.4 GHz ISM band and TDMA is used to share a single frequency. The scheduling of time slots is adaptive isochronous co-existence i.e. the scheduling is not static and each transmitter sends periodically but checks for interference with other traffic on the radio channel. In this unidirectional system sole sensors are masters (transmitters) and the WBAN server is the slave in ANT sense. The message rate is chosen as 8 Hz which is suitable for low power consumption. Hence in the SIGS system, it is necessary to synchronize the left and the right foot sensors because of low message rate. In our thesis, we found a method and developed a prototype to receive the time synchronized data in WBAN server from ANT wireless sensor nodes in SIGS system. For this thesis work, a hardware prototype design was developed. The USB and USART communication protocols were also implemented in the hardware prototype. The suitable method for time synchronization was implemented on the hardware prototype. The implemented method receives the sensor data, checks for the correct stream of data; add timestamp to the sensor data and transmit the data to the Linux WBAN server. The time slots allocation in the ANT protocol was found. Alternative solution for the time synchronization in ANT protocol was also provided. The whole SIGS system was tested for its full functionality. The experiments and analysis which we performed were successful and the results obtained provided good time synchronization protocol for ANT low power wireless sensor network and for Wireless Bio-feedback system.
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Patail, Shoaib Chotoo. "Implications of a national immunization registry an alliance to win the race for the future care and accuracy of pediatric immunization". CSUSB ScholarWorks, 2004. https://scholarworks.lib.csusb.edu/etd-project/2600.
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This project examines the role of immunization registries and their effect on a health care delivery system. Recent efforts to attain coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide community-based childhood immunization registries.
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Damore, Deborah Rose. "H.H.S.C. Spiritual Health Care Centre, integrated spiritual health care graduate academic programme". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0015/MQ55440.pdf.
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Zhang, Yanzhen. "Health care systems in China /". This resource online, 1994. http://scholar.lib.vt.edu/theses/available/etd-07102009-040227/.
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Hall, Julie. "Using integrated care pathways in mental health care : a case study". Thesis, University of Nottingham, 2010. http://eprints.nottingham.ac.uk/12749/.
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Background: Integrated Care Pathways (ICPs) are prearranged processes of care which are being increasingly used to deliver mental health services. The literature reveals difficulties in their development and implementation, and a lack of empirical evidence to support their use. Aims: The aim of this research was to investigate how an ICP has been used to manage mental health care in one selected mental health Trust in England. Methods: A case study approach was adopted with several units of analysis. The views of healthcare professionals using semi structured interviews; the experiences of service users and carers using focus groups; contrasting hospital episode and performance statistics with a comparison Trust and documentary analysis of the ICP. Findings & Discussion: Of the healthcare professions, only nurses used the ICP. No professionals used the ICP to support clinical decision making and risk management. However, just over two-thirds (67.2%) of the interventions described in the pathway were delivered. There was no statistically significant difference when comparing performance indicators for an equivalent episode of care between the ICP Trust and non ICP Trust. Service user and carers' experiences revealed that peopled did not feel that their care was individualised to them, although amongst them they had different perceptions of the care process. Conclusions: Mental health ICPs need to reflect the relationships between stakeholders, variability of illness and individual ways of living if they are to provide a framework for managing care in the future that accords with the needs of people using mental health services.
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Rajani, Kanth T. V. "GERASOS-A Wireless Health Care Systems". Thesis, Halmstad University, School of Information Science, Computer and Electrical Engineering (IDE), 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-963.
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The present development of the demography of elderly people in the western world will generate a shortage of caregiver’s for elderly people in the near future. There are major risk that the lack of qualified caregivers will result in deterioration in the quality of elderly care. One possible
solution is the use of modern information and communication technology (ICT) to enable staff to work more efficiently. However, if ICT system is introduced into the elderly care it must done in a way which is acceptable from a humane perspective while at the same time increasing the efficiency of the personal that working in elderly care centers. This thesis investigates the
technical feasibility of using a wireless mesh network for a social alarm system, in the elderly care. The System as such is not intended to replace the staff at an elderly care center but instead is intended to reduce staff workloads while providing more time for elderly care.
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Singh, Kalvinder. "Security for Mobile Health Care Systems". Thesis, Griffith University, 2013. http://hdl.handle.net/10072/367683.
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The ageing population and the increase in chronic diseases have placed a considerable
financial burden on health care services. Mobile health care systems can play an important
role in reducing the costs. The pervasiveness of smart phones and the evolution of Internetof-
Things are increasing the potential for mobile health care systems to remotely manage
the health of a patient or the elderly. Smart phones and small devices, such as body sensors,
are used to remotely monitor patients suffering from chronic diseases and allow them to
have relatively independent lives. A mobile health care system may require a degree of
real-time monitoring or data collection. For instance, a medical emergency will require
data sent to medical staff as quickly as possible, rather than the data sent after a few
hours or days. The problem will be more complex if there is a requirement that commands
sent to body sensors need to be in real-time. If the system recognises a possible medical
emergency, it may need to notify other devices immediately to start recording data or to
actuate (for example, an insulin pump and a defibrillator).Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Information and Communication Technology
Science, Environment, Engineering and Technology
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Newbury, Brian. "Integrated health, safety and environmental management systems". Thesis, University of South Wales, 2000. https://pure.southwales.ac.uk/en/studentthesis/integrated-health-safety-and-environmental-management-systems(6a947bb5-bda0-4466-9cb6-f02ad514cb9a).html.
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The continued rise in accident and ill health statistics throughout the member states of the European Union indicate that the standards of occupational health, safety and environmental control require further improvement to minimise the current level of loss. Management systems are regarded as an effective means of reducing this loss by continuously improving standards. Whilst there is much discussion and debate about the possibilities of integrating management systems, at present, there are no national or international published integrated management standards, although some multi-national companies have introduced their own internal integrated standards. The research explored the development of an integrated health, safety and environmental (HSE) management system within a range of industrial organisations. This included the development of tools for successful implementation of integrated systems, specifically for significance review, risk assessment and auditing. Resources and accreditation constraints precluded exhaustive testing of all clauses within the proposed integrated management standard. However, analysis of key aspects of the standard revealed: 1. The introduction and use of separate health, safety and environmental (HSE) management systems improved the standards of risk control within organisations. 2. Organisations perceived that there were clear business advantages in some form of integration of existing standards. 3. The developed integrated HSE standard was technically possible in the area of policy development, process operations, working instructions and documentation. However, the integration of risk assessment and audit tools gave limited advantages compared to existing separate systems. 4. The proposed integrated HSE standard complied with both individual European member states national legislative requirements and European/World-wide management standard criteria. In summary this thesis represents an original contribution to the field of integrated management systems. The thesis also identifies areas of further work that will increase the knowledge base, scope of application of the work carried out.
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Polaha, Jodi, W. T. III Dalton, S. Allen, A. Enlow, N. Bagwell y S. Cumpston. "Pediatric Wellness and Integrated Health Care in Rural Appalachia". Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/6610.
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Zvonkovic, Jessica. "Development of the Attitudes Toward Integrated Health Care Scale". OpenSIUC, 2015. https://opensiuc.lib.siu.edu/theses/1663.
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This study created and tested a measure of the attitudes of health care providers toward integrated health care (IHC). Phase one of this scale development involved contacting experts in IHC to rate the quality of the items and provide qualitative feedback regarding content of the measure. The instrument was further revised based on this expert feedback. The final phase of instrument development was a field test of the measure with a larger, more representative sample of Physicians, Nurses, and Psychologists. Exploratory Factor Analysis (EFA) was used to determine the factor structure of the measure and to inform the final item composition of the measure. The Attitudes Toward Integrated Health Care scale (ATIHC) appears to be a reliable, valid, and potentially useful instrument for researchers and health care settings to use to assess professionals attitudes toward health care integration. It taps general positive and negative attitudes as well as ideas about characteristics that facilitate health care integration. Since there is now a base knowledge of health professional's attitudes toward IHC, work needs to be completed to better discern which items will differentiate between participants with positive and negative attitudes. Further, it will be essential to highlight items having the largest practical implications in health settings. In order to determine the most relevant questions to be included in the ATIHC and the corresponding most appropriate factor structure, further research should be completed with a larger and more representative sample of participants who posses a wider range of attitudes.
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Akuamoah-Boateng, Agyenim. "Competence of Behavioral Health Clinicians in Integrated Care Settings". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5443.
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Collaborative efforts between medical and behavioral health professionals is required to simultaneously treat individuals with medical and mental health disorders. However, there is lack of focus on the competencies and trainings needed by behavioral health clinicians (BHCs) transitioning to integrated primary care (IPC) settings. The purpose of this qualitative interpretive phenomenological study was to describe the lived experiences of BHCs who have transitioned from specialty outpatient behavioral healthcare settings to IPC settings. Semi-structured interview questions were used to collect data. Using interpretive phenomenological data analysis approach, themes and the shared meanings and experiences of 8 licensed BHCs were explored. Seven participants had graduate degrees and 1 participant had post-graduate degree. All participants had at least a year of experience working in IPC settings, worked full-time in North Carolina, and had over a year of experience in traditional behavioral healthcare settings. Results indicated that participants shared experiences in 5 themes: (a) clinical experience, (b) effective communication, (c) collaboration with primary care providers(PCPs), (d) continued education and trainings, and (e) care coordination. The outcome of this research will inform institutions, administrators, and credentialing boards to consider implementation of defined competencies for BHCs in community health centers that operate on IPC principles to ensure collaborative efforts between BHCs and PCPs in order to help provide effective holistic and affordable health care in a systems-based approach.
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Tucker, Helen Jean. "Integrated care : the presence, nature and development of integrated care in community health services in England and Ireland". Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/56879/.
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Background: Integrated care is a policy imperative in health and social care services globally, and yet there are reported difficulties in defining, developing and sustaining this way of working. Research Question: This research explores staff views and experiences of the presence, nature and development of integrated care in two programmes of community services. Method: A case study approach was adopted using secondary analysis of qualitative data from staff questionnaires using themed content analysis and pattern matching, with findings triangulated with documentary sources. The study considers the presence and nature of integrated care using the conceptual framework “to what extent integrated care is for everyone (inclusive) and not just for some (exclusive)” as interpreted from the literature. The development of integrated care was explored using systems theory for the management of change in a complex environment. Findings: A meta-analysis of the two case studies demonstrated that integration was present in all 66 services within the two programmes. The nature of integrated care varied and was demonstrated as multiple types (in community hospitals) and processes (in community services). The most frequently reported type was multidisciplinary working. The processes most teams chose to develop were information sharing systems. The development of integration within the case studies was affected by a number of factors, such as commitment and staffing. Conclusion: This study provides new evidence of the presence, nature and development of integration within a wide range of established services spanning all ages. From this and other measures, the extent to which integrated care is presented as “exclusive” can be questioned. These findings have informed the development of a framework of five principles, reflecting whether integrated care is: for everyone, extensive, enduring, can be enabled and essential. The implications and application of this research for policy, service development and training are discussed, and proposals for further research include testing the applicability of this framework and widening this study.
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Colombani, Françoise. "Modélisation de la coordination des soins infirmière en cancérologie : de l’analyse conceptuelle au transfert vers les décideurs". Electronic Thesis or Diss., Bordeaux, 2024. http://www.theses.fr/2024BORD0113.
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Face aux mutations démographiques, à la progression des maladies chroniques dont le cancer, et en réponse à la fragmentation des systèmes de santé actuels, la coordination des soins est devenue une priorité de Santé publique mondiale. Les patients atteints de cancer sont particulièrement à risque de recevoir des soins mal organisés en raison de la complexité de leur prise en charge, impliquant de multiples équipes médicales, infirmières, médico-sociales et sociales sur une durée prolongée. Ce défaut de coordination se fait au détriment de la qualité et de l’efficience des soins. Les progrès en matière de coordination des soins ont été limités par l'absence de définition commune et un manque de précision sur les modalités de sa mise en œuvre. En France, de nouvelles fonctions de coordination infirmière en cancérologie ont été introduites, sans conceptualisation préalable, conduisant à une grande diversité d'actions et d’intitulés de poste. Cette hétérogénéité entrave la reconnaissance, la compréhension de leurs actions et l'évaluation de leur performance. Face à l’absence d’analyse fine du périmètre d’action de ces professionnels et de cadre théorique de la coordination des soins, ce projet de thèse vise, en trois volets, à modéliser l’intervention infirmière de coordination des soins en cancérologie et trouver les leviers pour une prise en compte de ces résultats dans la politique nationale de coordination des soins en France. Le premier volet, conceptuel, a permis de développer un cadre de référence innovant centré sur les activités de coordination au moyen d’une scoping review et d’une méthode de consensus structurée (groupe nominal) ayant inclus des décideurs, des organisateurs et des patients partenaires. Le deuxième volet centré sur les pratiques, a produit un modèle opérationnel de l’intervention infirmière de coordination des soins en cancérologie exerçant en établissement de santé, en confrontant les attendus théoriques (cadre du volet 1) aux pratiques et aux représentations que ces infirmiers, leurs patients, aidants et partenaires professionnels avaient de cette intervention de coordination. L’enquête de terrain a consisté en une étude mixte multicentrique nationale par triangulation d’informations qualitatives (observations, entretiens, focus groups), et quantitatives (échelles validées) des pratiques, contextes, perceptions et attitude au travail des infirmiers de coordination en cancérologie en France. Le troisième volet a été dédié au transfert des résultats vers les décideurs via l’organisation d’un séminaire national de travail impliquant l’ensemble des acteurs du champ (régulateurs, administrateurs d’hôpitaux, associations professionnelles, chercheurs, infirmiers, patients partenaires). Son objectif était de présenter en avant-première les résultats de la modélisation, partager les expériences d’autres équipes de recherche sur le sujet, et décliner le modèle opérationnel en actions concrètes, par la construction par consensus d’une fiche de poste et la définition des éléments minimaux d’accompagnement managérial et prérequis à la prise de fonctions de ces infirmiers. Ce projet de thèse a produit des connaissances nouvelles sur la coordination des soins, en général et plus spécifiquement en cancérologie, sur le plan conceptuel (cadre de référence), interventionnel (modèle opérationnel) et translationnel (fiche de poste). Les travaux présentés dans cette thèse ouvrent ainsi la voie à un déploiement optimal de ces fonctions pour la décision publique en santé à l’évaluation de l’impact de ces interventionsFaced with demographic changes, the rise of chronic diseases including cancer, and in response to the fragmentation of current healthcare systems, care coordination has become a priority in global public health. Cancer patients are particularly at risk of receiving poorly organized care due to the complex nature of the disease and its management, which involves multiple medical, nursing, socio-medical, and social teams operating at different levels of the healthcare system over an extended period. This lack of coordination affects the quality and efficiency of care. Progress in care coordination has been hindered by the lack of a common definition and precision on how it should be implemented. In France, new nursing coordination functions in oncology have been introduced without prior conceptualisation, leading to a wide variety of actions and job titles. This heterogeneity hampers the recognition, understanding of their actions, and the evaluation of their performance. In the absence of a detailed analysis of the scope of action of these professionals and a theoretical framework for care coordination, this thesis project aims, in three parts, to model nursing care coordination intervention in oncology and to identify ways to implement these results into the national health policy of care coordination in France. The first part (conceptual) allowed the development of an innovative reference framework focused on coordination activities through a scoping review and a structured consensus method (nominal group technique) involving decision-makers, organizers, and patient partners. The second part, focusing on practices, produced an operational model of hospital-based cancer coordination nurses’ intervention, by comparing theoretical expectations (framework from part 1) with the practices and perceptions that these nurses, their patients, caregivers, and professional partners had of this coordination intervention. The field survey consisted of a national multicenter mixed-method study through a triangulation of qualitative (observations, interviews, focus groups) and quantitative (validated scales) information on practices, contexts, perceptions, and attitudes towards work among oncology care coordination nurses in France. The third part was dedicated to transferring results to decision-makers through the organisation of a national workshop involving all stakeholders in the field (regulators, hospital administrators, professional associations, researchers, nurses, patient partners). Its objective was to present the modelling results, share experiences from other research teams on the subject, and translate the operational model into concrete actions through consensus-building of a job description, and defining the minimum elements of managerial support and prerequisites for these nurses' functions. This thesis project has generated new knowledge on care coordination, both in general and more specifically in oncology, at a conceptual level (reference framework), interventional level (operational model), and translational level (job description). The work presented in this thesis thus paves the way for optimal deployment of these functions for public health decision-making (implementation of the job description, standardisation of training), and research evaluation of the effects and impact of these interventions
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Zhang, Peng. "Multi-agent Systems in Diabetic Health Care". Licentiate thesis, Karlskrona : Blekinge Institute of Technology, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-00263.
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This thesis discusses how Multi-agent Systems (MAS) should be designed in the context of diabetic health care. Three fields are touched: computer science, socio-psychology and systems science. Agent Technology is the core technology in the research. Theories from socio-psychology and systems science are applied to facilitate the discussion about computer agents. As the integration of socio-psychology and systems science, Activity Systems Theory is introduced to give a synthesized description of MAS. Laws and models are introduced with benefits on both individual agent and agent communities. Cybernetics from systems science and knowledge engineering from computer science are introduced to approach the design and implementation of the individual agent architecture. A computer agent is considered intelligent if it is capable of reactivity, proactivity and social activity. Reactivity and proactivity can be realized through a cybernetic approach. Social activity is much more complex, since it considers MAS coordination. In this thesis, I discuss it from the perspectives of socio-psychology. The hierarchy and motivation thinking from Activity Systems Theory is introduced to the MAS coordination. To behave intelligent, computer agents should work with knowledge. Knowledge is considered as a run-time property of a group of agents (MAS). During the MAS coordination, agents generate new information through exchanging the information they have. A knowledge component is needed in agent’s architecture for the knowledge related tasks. In my research, I adopt CommonKADS methodology for the design and implementation of agent’s knowledge component. The contribution of this research is twofold: first, MAS coordination is described with perspectives from socio-psychology. According to Activity Systems Theory, MAS is hierarchically organized and driven by the motivation. This thesis introduces a motivation-driven mechanism for the MAS coordination. Second, the research project Integrated Mobile Information Systems for health care (IMIS) indicates that the diabetic health care can be improved by introducing agent-based services to the care-providers and care-receivers. IMIS agents are designed with capabilities of information sharing, organization coordination and task delegation. To perform these tasks, the IMIS agents interact with each other based on the coordination mechanism that is discussed above.
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Patterson, Jan. "Consumers and complaints systems in health care /". Title page, contents and summary only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09php3174.pdf.
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Ngowi, Epiphania. "Assessing palliative care policies in Africa: Implication for paediatric palliative care". Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32956.
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Around the world, there are millions of children who need palliative care from the moment they are diagnosed with life-threatening and life-limiting illnesses, yet very few children have access to palliative care services. In many African countries, where palliative care is still new, many children with chronic illnesses continue to experience needless pain and suffering. The World Health Assembly Resolution 67.19 made a clear call for governments around the world to implement palliative care policies. Such policies should support the “comprehensive strengthening of health systems to integrate evidence-based, costeffective and equitable palliative care services in the continuum of care, across all levels of care”. However, despite these frequent calls, no specific policies target the provision of paediatric palliative care in Africa. This dissertation consists of three parts. Part A is the study protocol, which consists of the introduction and the study methodology. The study is qualitative in nature and it adopted the Walt and Gilson framework for extraction of data and analysis of palliative care policies in Africa. The study used publicly available policy documents, which were identified and obtained from government websites, international agencies' websites and through communication with palliative care experts. An excel spreadsheet was used to extract data, which was analysed thematically. Part B is a literature review of available published and unpublished work pertaining to paediatric palliative care in Africa. It provides the historical background of palliative care and defines palliative care and paediatric palliative care as well as exploring the general literature on paediatric palliative care, and the evidence on the existence of palliative care policies in Africa. Part C is a journal manuscript. It follows the structure and guidelines of the journal of the Health Policy and Planning. The manuscript begins with introduction and the study methods. Further, the study used publicly available policy documents on palliative care in Africa published from 2002 until 2018. An appropriate conceptual framework was chosen, and the results of the policy analysis are provided and followed by the discussion section and conclusions. The study findings indicate that few palliative care policies exist in Africa, and children's palliative care needs are not adequately included and addressed. The findings further show that there was no single policy targeting paediatric palliative care, and children were included among the larger population. As such, palliative care needs were not sufficiently addressed. Only three policies (South Africa, Zimbabwe, and Malawi) clearly address paediatric palliative care needs. The study, therefore, argues that for children with life threatening and life-limiting conditions to be free from pain, African governments need to formulate specific policies that will guide the provision of paediatric palliative care. This study is likely contribute to policy making processes, acts as a reference document for academics and students and provides an advocacy tool for activists, nongovernmental organizations (NGOs), and civil society organizations (CSOs) working on children's welfare and human rights issues more broadly. Further, the findings of the study may contribute to formulating specific palliative care policies for children, particularly in African countries that lack such policies.
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Eisenbrandt, Lydia L., Jill D. Stinson y Carrie C. LeMay. "Mental Health Training for Medical Students: Implications for Integrated Care". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/7945.
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Shafer, Joseph Aron. "Utilization and Intensity of Integrated Behavioral Health Services Within a Primary Care Setting". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2381.
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Integrated behavioral health care within primary care has become a popular style of health care delivery within the United States. However, individuals with a behavioral health concern face several barriers in using these services. The purpose of this quantitative study was to identify key factors accounting for individuals' utilization and intensity of behavioral health services. Andersen's behavioral model of health care use and the integrated theory of health behavior change served as the theoretical framework. It was hypothesized that gender, age, race, ethnicity, family size, payer type, poverty level, and certain preexisting medical conditions (obesity, diabetes, hypertension, and tobacco use) would determine behavioral health care utilization and intensity. A secondary data analysis of 315 individuals who used behavioral health services within primary care was performed; the study setting was at the Center for Health, Education, Medicine, and Dentistry, located in Lakewood, New Jersey. Among the individual variables examined, only a preexisting condition of hypertension reached statistical significance, showing that those individuals were more likely to attend multiple sessions, Ï?2 (1) = 5.77, p = .02. Payer type was also found to be predictive of behavioral health care intensity. Medicare recipients were more likely to attend multiple behavioral health care sessions (74%) than were Medicaid recipients (59%) and those who were uninsured (25%). By providing insights about the barriers faced by individuals, study findings may help patient advocates and health care professionals to provide individuals with better health care. This study has implications for positive social change, as study findings may assist the United States health care system in its shift toward an integrated behavioral health care style of health care delivery.
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Kollberg, Beata. "Performance Measurement Systems in Swedish Health Care Services". Doctoral thesis, Linköping : Department of Management and Engineering, Linköpings universitet, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-9302.
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Belli, Paolo Carlo. "Incentives and the reform of health care systems". Thesis, London School of Economics and Political Science (University of London), 2006. http://etheses.lse.ac.uk/1854/.
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This thesis is a study of the reform of health systems from an international and an economic perspective. Its main unifying theme is to investigate the role played by incentives in the performance of health systems and their reform. In the first part, the thesis reconsiders the economic reasons that form the basis for public intervention in health markets, both in financing as well as in service provision. In fact, one of the key elements introduced with health reforms in the last few years has been greater competition in health insurance and provision, among private as well as public providers. It is thus interesting to start the analysis by revisiting the effects of competition in health markets on the basis of more recent contributions in microeconomic theory, our aim being to ascertain what would be the major deficiencies of unregulated markets, and to investigate into the impact of different public corrective measures. Chapter 2 looks at the effects of competition in the health insurance market and at the impact of different forms of public intervention to correct market failures. Chapter 3 presents a model of oligopolistic competition between two health providers, and it investigates the potential role of quality and/or price regulation as a means to extend coverage/improve quality beyond the point reached in correspondence to the market equilibrium. Then, the thesis focuses on the new resource allocation, contracting mechanisms and payment systems for providers (RAP reforms) implemented over the last few years, within the public sector, or intended to discipline the relationship with health care providers. Chapters 4 gives an introduction to the RAP reforms, their justification and main components. Chapter 5 focuses on payment systems and on efficiency issues, while Chapter 6 on the equity consequences of RAP reforms. Chapter 7 and 8 look at the health reforms implemented over the last decade in the former socialist countries. The evolution of health systems in those countries provides interesting lessons, illuminating the major weaknesses and limitations of the health reform model that has been prevailing and proposed world-wide over the last decade. Chapter 8 presents a qualitative study of the impact of the health reforms in Georgia, focusing specifically on the phenomenon of out-of-pocket payments, formal and informal, which currently are the prevalent source of funding for health in the region. A concluding chapter (Chapter 9) summarises some of the main findings of the thesis.
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Eriksson, Jens y Olov Jacobsen. "Brain activity sensors and health-care systems control". Thesis, KTH, Skolan för elektro- och systemteknik (EES), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-199346.
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Salway-Jensen, Barbara Kay y Barbara Kay Salway-Jensen. "Culturally Sensitive Technology-Enhanced Mental Health Screening in Integrated Primary Care". Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/621823.
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The integration of primary care and mental health care is a requirement of the Patient Protection and Affordable Care Act of 2010 and has challenged primary care providers to address gaps in the quality of care provided for patients with mental health issues. Vulnerable populations, such as the American Indian people experience gaps in quality health care, especially communication gaps and language barriers. This quality improvement project used a survey design to explore the potential for primary care providers to adopt a culturally sensitive electronic mental health, screening tool to bridge communication gaps and language barriers. Primary care providers recruited from the Northern Arizona University (NAU) Campus Health Services clinic evaluated the concept of a touch screen iPad technology to implement the Patient Health Questionnaire-9 (PHQ-9), which screens for depression using audio options in English and in the Navajo language to accommodate American Indian patients. A PowerPoint overview of the iPad technology was sent via email to the NAU providers and included; the PHQ-9 screening results, which are to be immediately accessible in the patient's electronic health record along with a screening report. The screening report included the PHQ-9 depression score, interpretation of the score, best treatment choices, and a graph for monitoring patient progress. This survey results concluded providers perceive the iPad technology for mental health screening to be useful in their integrated primary care clinic. A modified Technology Acceptance Model (Davis, 1989) was used to evaluate the providers' perception of the iPad Technology, and the University of Arizona's Qualtrics survey system provided data analysis of the survey results.
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Petersen, Inge. "From policy to praxis : rethinking comprehensive integrated primary mental health care". Doctoral thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/7895.
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Bibliography: p. 222-256.In this dissertation I have provided an academic interrogation of the gap between policy principles for comprehensive integrated primary mental health care in South Africa, and the implementation theoreof. I argue, theoreically, that the current add-on approach, which emphasizes care for patients with serious mental illness, will not achieve the vision for comprehensive integrated primary mental health care in South Africa. I suggest that this trajectory is a product of the reformist approach to the implementation of primary health care, and suggest that what is needed is a shift towards a comprehensive discourse of care at the primary level. My research aimed at developing an understanding of how such a shift could be achieved.
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Noble, Marilynn. "Integrating Health Care Systems to Maintain Quality Care and to Manage Cost". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6851.
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The rising cost of health care in the Philippines is a concern for the Department of Defense and TRICARE beneficiaries. The purpose of this quantitative cross-sectional research study was to determine the efficacy and acceptability of a different method to deliver health care to increase access to health care and decrease out-of-pocket costs while maintaining quality of care for TOP Standard beneficiaries who receive health care under the Philippine Demonstration. Secondary data was used to determine the acceptability of an alternative reimbursement methodology to decrease cost but maintain access to quality care. The Andersen's behavioral health care model and the Donabedian quality health care model were used to interpret the study results. A data set of 180 participants was evaluated using a cross-sectional quantitative methodology. Two Spearman correlations were used to examine the relationship between financial burden and satisfaction (r = .41, p < .001) and financial burden and confidence (r = .44, p < .001). Linear and binary regressions assessed the effects of age and gender on satisfaction with health care finder functionality when requesting a waiver (F (2,26) = 1.22, p = .313, R2 = .09). A computation of one-sample t-tests to determine the impact of a closed network, beneficiary out-of-pocket cost, and quality health care in Demonstration areas found the beneficiaries were satisfied with the demonstration. An analysis of the claims data pre and post demonstration showed a difference in the patients' out-of-pocket expenses and the acceptability and preference for a closed network. Social change was demonstrated by a decrease in the cost for TRICARE standard beneficiaries in the Philippines.