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1
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 Part B is a literature review of available published and unpublished work pertaining to paediatric palliative care in Africa.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.
2
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.
3
Frankema, Sander Pieter Gerard. « Quality in trauma care systems ». [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/10548.
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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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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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Xu, Shaoqiu. « Chromatic systems for the care community ». Thesis, University of Liverpool, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.406631.
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Vanhook, Patricia M. « State Stroke Systems of Care-Tennessee ». Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/7449.
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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
Full Text
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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.
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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.
11
Song, Jun. « Point-of-Care Systems for Cellular Analysis ». Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:14226047.
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Cellular analysis is a vital part of diagnostics testing for most diseases. The development of modern technologies has led to great advancement in this task. However, the use of cellular analysis systems is limited mainly to laboratories and clinics due to their high cost and large size. Providing affordable and accessible diagnostic testing to the majority of population in the developing world and resources-limited regions remains a technical challenge.
To overcome this challenge, cost-effective and portable point-of-care (POC) systems have emerged in recent years as a priming approach. This thesis focuses on the development of such POC systems for the purpose of cellular analysis. These systems include sub-pixel resolution holographic imager for cellular profiling and microfluidic platforms for sorting cell populations in clinical samples and capturing single cells.
First, a new lens-free holographic system is reported as a portable imaging tool for fast screening and profiling of individual cells. Compared to conventional microscopy, this system is cheaper in cost, and portable; it can provide fast automatic detection over a large field-of-view and profile cells for in terms of their molecular properties.
To enhance the resolution of the lens-free holographic system, a novel sub-pixel resolution enhancement method has been developed. Typical lens-free holographic systems are limited in resolution by the pixel size of their inherent image sensors. The developed method can overcome this limitation by applying compressive sensing strategy to the reconstruction process. Compared to other resolution enhancement methods for lens-free holography, this method does not require additional hardware or multiple exposures in measurement, thus provides the potential for fast imaging of sub-pixel targets. It can also be further applied to other nonlinear holographic imaging systems.
In addition to cell imaging, novel microfluidic platforms were also developed to address the challenges in separating and capturing scant cells in blood or other fluid samples from patients.
A single-cell capturing system is developed for the detection of lymphoma from cerebral spinal fluid (CSF) samples. Compared to existing single-cell capturing systems, this chip offers the advantage of antibody-free trapping mechanism, large number of sites for high throughput screening, and special geometry that size-selectively captures lymphoid cells.
Blood sample usually contains a variety of cell populations which makes it difficult to sort low abundant cell for clinical diagnosis. To achieve high efficiency separation of cell populations in blood stream, a hybrid magnetic-microfluidic cell sorting system was developed. Compared with previous work, the new system achieved higher separation efficiency without damaging target cells; it is also easier to assemble and thus eliminates additional training needed for device operation.
These POC systems provide versatile approach for fast, cheap and accurate disease diagnosis. With further customization specific to the diseases and more clinical testing, they can be applied as powerful tools for more accessible healthcare in low-income and resources limited regions.
12
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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Abrahams, Nina. « Factors that influence patient empowerment in inpatient chronic care : Early implementation experience with a diabetes care intervention in South Africa ». Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29393.
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The burden of non-communicable diseases is growing rapidly globally and especially in low and middle-income countries. However, health systems around the world are not appropriately prepared for this increase in need for chronic care. Research suggests that health models that emphasise self-management and empowering patients to care actively for their disease are integral in non-communicable disease treatment as patients live with their disease well beyond contact with health services. Adherence and health-seeking behaviour literature suggest multiple factors within the lives of patients and within health systems that enhance or constrain patient empowerment interventions. However, in depth understanding of these factors are lacking in the South African context and especially in the inpatient setting as most research focuses on the role of primary care. This research used interviews with stakeholders in an upcoming inpatient diabetes intervention as a lens to qualitatively explore empowerment factors in further detail within the South African inpatient context. The study highlights multiple barriers to patient empowerment, namely the low socio-economic contexts of many South Africans who then struggle to access appropriate healthcare information and services and often have financial and emotional priorities that take precedence over their chronic illness. In addition, health services are bound by a shortage of resources and staff and ineffective communication systems which affects health professionals’ ability to implement patient empowerment strategies. It also highlights the unique barriers found in inpatient care as the hospital emphasises short-term acute treatment – losing potential engagement time with patients. The study suggests that patient and provider contexts make encouraging patient engagement in long term chronic care difficult. However, knowledge of these factors can be harnessed to improve chronic care interventions in low- and middle-income countries.
14
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.
16
Prueller, Hans. « Distributed online machine learning for mobile care systems ». Thesis, De Montfort University, 2014. http://hdl.handle.net/2086/10875.
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Telecare and especially Mobile Care Systems are getting more and more popular. They have two major benefits: first, they drastically improve the living standards and even health outcomes for patients. In addition, they allow significant cost savings for adult care by reducing the needs for medical staff. A common drawback of current Mobile Care Systems is that they are rather stationary in most cases and firmly installed in patients’ houses or flats, which makes them stay very near to or even in their homes. There is also an upcoming second category of Mobile Care Systems which are portable without restricting the moving space of the patients, but with the major drawback that they have either very limited computational abilities and only a rather low classification quality or, which is most frequently, they only have a very short runtime on battery and therefore indirectly restrict the freedom of moving of the patients once again. These drawbacks are inherently caused by the restricted computational resources and mainly the limitations of battery based power supply of mobile computer systems. This research investigates the application of novel Artificial Intelligence (AI) and Machine Learning (ML) techniques to improve the operation of 2 Mobile Care Systems. As a result, based on the Evolving Connectionist Systems (ECoS) paradigm, an innovative approach for a highly efficient and self-optimising distributed online machine learning algorithm called MECoS - Moving ECoS - is presented. It balances the conflicting needs of providing a highly responsive complex and distributed online learning classification algorithm by requiring only limited resources in the form of computational power and energy. This approach overcomes the drawbacks of current mobile systems and combines them with the advantages of powerful stationary approaches. The research concludes that the practical application of the presented MECoS algorithm offers substantial improvements to the problems as highlighted within this thesis.
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Eriksson, Jens, et 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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Jasie, Lauren. « Theorizing punishment rules and care in penal systems / ». Diss., Connect to the thesis, 2008. http://hdl.handle.net/10066/1576.
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Mycroft, Matthew. « An Information System for Health Care Quality Measures ». Digital Commons at Loyola Marymount University and Loyola Law School, 2016. https://digitalcommons.lmu.edu/etd/426.
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The Patient Protection and Affordable Care Act (PPACA) is slowly transforming the U.S. Health Care System from a fee-for-service structure, which reimburses providers based on the quantity of patient encounters, to a new structure that emphasizes the value of care. Since value can be interpreted differently among various stakeholders, quality measures have been established by government and nonprofit sources. These quality measures serve as agreed-upon criteria by which to measure the achievement of value in health care. While these measures help to improve the quality of health care, they can also be burdensome to physicians and health care organizations. Implementation of quality measurement programs requires the involvement of highly intelligent people who think about what to measure, what to focus on, and how to accomplish outcomes. Thus, the process of selecting measures and compiling recommendations (reports) can be time consuming, complicated, and expensive.
Applying SELP coursework fundamentals, key process activities outlined by INCOSE, and the DoD Architectural Framework, a quality measure information system was developed. The primary business objective (top level requirement) of the project was to reduce the cost and improve the quality of the measure selection and report generation processes. First, fundamental systems engineering principles were applied to understand the problem, conduct a lean analysis, identify stakeholders' needs, and derive a set of requirements to meet the primary business objective. Subsequently, five alternative solutions were evaluated to identify a preferred solution that could best meet the primary business objective while minimizing risk. The DoD Architectural Framework and course material from Integration of Hybrid Hardware and Software Systems (SELP 560) was then applied to develop, represent, and understand the information system architecture. Finally, leveraging Management Information Systems Coursework (MBAA 609), a system prototype was created utilizing Microsoft Access.
The system prototype demonstrated a capability to reduce the cost and improve the quality of the health care quality measure selection and report generation processes. Utilizing pre-selected associations between various quality measures and categories of care, comprehensive quality measure reports can be generated in a matter of seconds for many categories of medical care. These comprehensive reports serve to educate users about various quality measures and to aid administrators in the development of comprehensive quality measurement programs. In one particular example, health care organizations will utilize the generated quality measure reports for the purpose of redesigning compensation and incentive pay for physicians and health care executives. In this particular example, estimates show that the system prototype is expected to reduce the labor associated with measure research and selection by approximately 49%, resulting in thousands of dollars of estimated savings. Additionally, the system will automate complicated measure search processes, which will increase the quality and consistency of the reported data.
20
Hong, Wing-yee Veronica. « A comparative study of healthcare financing systems in US, UK and HK ». Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41709858.
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Bosire, Joshua. « Designing an integrated surgical care delivery system ». Diss., Online access via UMI:, 2007.
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22
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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Chong, Stéphane. « The future of primary care : an engineering system approach to fix the U.S. health care system ». Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/51654.
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Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2009.Includes bibliographical references (p. 75-78).
The ailing U.S. health care system faces two tremendous challenges: a rising health care bill and a growing number of uninsured individuals. Several policies have been enacted to tackle these challenges but they are short-term patchwork solutions rather than long-term holistic solutions needed to address structural issues. Despite the market-based aspect of the U.S. healthcare system, self-correction of structural inefficiencies is unlikely to happen. A new care model has to disrupt the current care system. In line with this observation, we propose to analyze the potential of a new primary care delivery as a solution to address the two key challenges threatening to destabilize the U.S. health care. Based on our analysis of the literature, we note that chronic diseases account for a large proportion of the health care bill. Yet, the delivery model to provide chronic care, where primary care plays a central role, is inefficient, fragmented and insufficient. Compounding these ailments, primary care is facing its own crisis resulting from the shortage of generalist doctors and the inflating demand for primary care services. As primary care is critical for the continuity and coordination of medical care, resolving the urgent situation facing this branch of practice should be a top priority to improve quality of care while reducing health care costs. Every stakeholder in the current health care system should collectively contribute to the primary care model redesign endeavor.
(cont.) To this end, we apply an engineering system approach to devise an appropriate course of actions for health care businesses, health care providers and policy-makers in redesigning primary care. We discuss insights gained through a collaborative project with a local hospital to model and simulate a new primary care practice. These insights were geared to guide decision-makers in the design of care processes, resources allocation and appointment rules. In conclusion, we show that primary care has a critical role to play in the much-needed revolution of the U.S. health care system. It will require active collaboration of health care providers, business leaders and policy-makers to enable this disruptive change.
by Stéphane Chong.
S.M.in Technology and Policy
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Pedarla, Padmaja. « E-Intelligence Form Design and Data Preprocessing in Health Care ». Thesis, University of Waterloo, 2004. http://hdl.handle.net/10012/945.
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Clinical data systems continue to grow as a result of the proliferation of features that are collected and stored. Demands for accurate and well-organized clinical data have intensified due to the increased focus on cost-effectiveness, and continuous quality improvement for better clinical diagnosis and prognosis. Clinical organizations have opportunities to use the information they collect and their oversight role to enhance health safety.
Due to the continuous growth in the number of parameters that are accumulated in large databases, the capability of interactively mining patient clinical information is an increasingly urgent need to the clinical domain for providing accurate and efficient health care. Simple database queries fail to address this concern for several problems like the lack of the use of knowledge contained in these extremely complex databases. Data mining addresses this problem by analyzing the databases and making decisions based on the hidden patterns.
The collection of data from multiple locations in clinical organizations leads to the loss of data in data warehouses. Data preprocessing is the part of knowledge discovery where the data is cleaned and transformed to perform accurate and efficient data mining results. Missing values in the databases result in the loss of useful data. Handling missing values and reducing noise in the data is necessary to acquire better quality mining results.
This thesis explores the idea of either rejecting inappropriate values during the data entry level or suggesting various methods of handling missing values in the databases. E-Intelligence form is designed to perform the data preprocessing tasks at different levels of the knowledge discovery process. Here the minimum data set of mental health and the breast cancer data set are used as case studies. Once the missing values are handled, decision trees are used as the data mining tool to perform the classification of the diagnosis of the databases for analyzing the results. Due to the ever increasing mobile devices and internet in health care, the analysis here also addresses issues relevant hand-held computers and communicational devices or web based applications for quick and better access.
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Abd, Hamid Harris Shah. « Situation awareness amongst emergency care practitioners ». Thesis, Loughborough University, 2011. https://dspace.lboro.ac.uk/2134/9114.
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The increase and changes in the demand for emergency care require pro-active responses from the designers and implementers of the emergency care system. The role of Emergency Care Practitioner (ECP) was introduced in England to improve the delivery of emergency care in the community. The role was evaluated using cost-benefit approach and compared with other existing emergency care roles. An analysis of the cognitive elements (situation awareness (SA) and naturalistic decision making (NDM)) of the ECP job was proposed considering the mental efforts involved. While the cost-benefit approach can justify further spending on developing the role, a cognitive approach can provide the evidence in ensuring the role is developed to fulfil its purpose. A series of studies were carried out to describe SA and NDM amongst ECPs in an ambulance service in England. A study examined decision-making process using Critical Decision Method interviews which revealed the main processes in making decision and how information was used to develop SA. Based on the findings, the subsequent studies focus on the non-clinical factors that influence SA and decision making. Data from a scoping study were used to develop a socio-technical systems framework based on existing models and frameworks. The framework was then used to guide further exploration of SA and NDM. Emergency calls that were assigned to ECPs over a period of 8 months were analysed. The analysis revealed system-related influences on the deployment of ECPs. Interviews with the ECPs enabled the identification of influences on their decision-making with respect to patient care. Goal-directed task analysis was used to identify the decision points and information requirements of the ECPs. The findings and the framework were then evaluated via a set of studies based on an ethnographic approach. Participant observations with 13 ECPs were carried out. Field notes provided further insight into the characteristics of jobs assigned to the ECPs. It was possible to map the actual information used by the ECP to their information needs. The sources of the information were classified according to system levels. A questionnaire based on factors influencing decision-making was tested with actual cases. It was found that the items in the questionnaire could reliably measure factors that influence decision-making. Overall, the studies identify factors that have direct and indirect influences on the ECP job. A coherent model for the whole emergency care systems can be developed to build safety into the care delivery process. Further development of the ECP role need to consider the support for cognitive tasks in light of the findings reported in this thesis.
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Ndlovu, Linda. « Health care providers' experience of research activities in public sector health facilities in the Western Cape Province of South Africa ». Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32951.
Texte intégralRésumé :
There is a significant amount of public health research conducted within provincial health facilities in South Africa, whose findings have a positive impact on the delivery of health services. This includes clinical, epidemiological, health systems and health services research, often initiated by post‐graduate students, independent academics researchers, as well as research institutions. Although researchers commonly commit to providing feedback to the provincial department and facilities, there is little evidence to confirm that research feedback is subsequently provided. Little contextualized empirical evidence is available to guide action, particularly for frontline health care providers, who often have the responsibility to host these research activities. The aim of this study was to explore the experiences of healthcare providers with research activities hosted in health facilitiesin the Western Cape province of South Africa. A mixed-method, cross-sectional study was conducted utilising an online survey (n= 19), and semi-structured interviews (n=3) with frontline health care providers (research gatekeepers). Descriptive analyses characterized respondents and their experience of research. Qualitative thematic analysis took on an inductive approach by identifying themes as they emerged from the data and cross comparing these with findings from the scoping literature review. Findings provided insight into how research conduct is experienced by those on the frontline in public health facilities on the provincial district platform. This is particular to the Western Cape province, which has a specific health department administration system. The following themes emerged: perception of research burden on services, understanding of the research approval process, autonomy to deny researchers access to the health facility due to overburden of research, the frequency or occurrence of research feedback after completion of a project, and interpersonal dynamics between researchers and gatekeepers as it relates to research conduct in facilities. This research reports on empirical evidence of perspectives from frontline health care providers on their experience with health research in a particular provincial context. The findings could form the basis of a study with a much larger sample size to inform how research feedback can be translated in a way that directly impacts on the uptake in the frontline.
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Lejonlid, Katarina. « Interaction Design of User-SuppliedData in Health Care Systems ». Thesis, Uppsala universitet, Institutionen för informationsteknologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-335668.
Texte intégralRésumé :
Health care staff contribute to quality registers in order to improve health care and to provide data for research. The largest registry center is Uppsala Clinical Research(UCR) which supports over twenty national registers, for instance SWEDEHEART and SENIOR Alert. The purpose of this thesis is to create a design hypothesis for a highly usable interface to the forms developed by UCR. The first step was understanding the potential for improvement through analyzing the system and observing users. This showed that the design should increase the learnability of the system and minimize errors. Two prototypes of an overview side panel were created that were presented to the users. An overview panel with process indication was the preferred design. The design was implemented in the evaluation phase using a simpleform with grouped variables. The design hypothesis of an overview panel serves as a highly usable interface to the forms developed by UCR. The results showed that there are many aspects to consider, because the users have to gather information from many systems and sometimes paper forms. The implemented design could bepresented to users and be further evaluated in an iterative design manner according to human-centered design.
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Lee, Fock Choy. « A quantitative performace measurement framework for health care systems ». Diss., Columbia, Mo. : University of Missouri-Columbia, 2006. http://hdl.handle.net/10355/4583.
Texte intégralRésumé :
Thesis (M.S.) University of Missouri-Columbia, 2006.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file viewed on (June 26, 2007) Includes bibliographical references.
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Stahr, H. « Heuristics and soft systems of health care risk management ». Thesis, University of Salford, 2000. http://usir.salford.ac.uk/2045/.
Texte intégralRésumé :
The formal management of risk was an idea in its early stages of introduction into the National Health Service when this research started. In this thesis I document the development of my thinking as an acute hospital risk manager over the last five years as I developed the Trust's risk management system. Using Action Learning as the research approach, I explored theories and concepts and tested them in the fire of real world action and reflective questioning of experiences. The definition of risk is explored in relation to health care, as are the approaches used to manage these risks. A key finding is that risk management decision making does not generally fit into either programmed or non-programmed decision making models but neither do decision makers guess. Decision makers tend to use heuristics, which are simple rules of thumb, which generally help them make the right decision with minimum mental effort. However, heuristics also tend to be applied inappropriately and can result in an organisation being exposed to unacceptable levels of serious risk. A number of key heuristics are identified and they appear to fall into two general types, B-heuristics and E-heuristics. The B-heuristics are 'basic' in form and can be summarised as a simple sentence while, E-heuristics have an 'extended' form which can be summarised as a list of related simple sentences. Knowledge of heuristics helped in the design of the Trust's risk management which has been implemented and its effectiveness tested in the field. This field testing has demonstrated that the worst effects of heuristics can be mitigated by effective soft-system design.
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Preece, Alun David. « Comparative approaches to building expert systems for health care ». Thesis, Swansea University, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.277502.
Texte intégral
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Mazza, Jessica. « Organizational culture in children's mental health systems of care ». [Tampa, Fla] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002351.
Texte intégral
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Mat, Taib Mohamad Zainuddi. « A systems enquiry within public health care in Malaysia ». Thesis, Loughborough University, 2005. https://dspace.lboro.ac.uk/2134/7781.
Texte intégralRésumé :
The overarching reason for studying the Malaysian Public Healthcare system is to investigate service delivery in all its forms. This research study will explore information management approaches applied to strategic, policy and operational requirementsf rom the level of the Ministry of Health, Malaysia (MoHM) through to the level of a State Hospital. In fact, six levels of recursion can be identified and at each level the interaction of information management systems (IMS) with information and communicationt echnologies( ICTs) are explored. The research is underpinned by its primary aim, this is to investigate the current IMS at the MoHM and suggest its advantages and limitations. To address the aim of the study requires the use of Beer's Viable Systems Model (VSM), here principally used in its diagnostic mode of enquiry. The strength of the VSM is its ability to model multi-recursive systems. Data and information that comprise the research inputs were gathered via questionnaire survey (441 responses, representing a response rate of approximately 71.13%), semi-structured interviews (with five top management officers of the public health system), document analysis, and personal observations. Findings reveal that the MoHM does not have the requisite variety to enable the successful realisation of an effective and efficient IMS. From the VSM diagnostic enquiry, issues raised concerning infrastructure, info-structure, and various aspects that relate to the human elements of the system. It is clear from the findings that the scope of the IMS, as well as its widespread adoption throughout MoHM and beyond, need to be addressed to allow further integration of information-based activities. An information architecture is urgently required to accommodate the technological change suggested. By combining these conclusions service delivery at MoHM will be greatly enhanced.
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Crane, Elizabeth. « Health Care Systems Factors Affecting Breast Cancer Treatment Choices ». Thesis, The University of Arizona, 2010. http://hdl.handle.net/10150/156910.
Texte intégralRésumé :
The purpose of this research was to explore and describe health care systems factors that influence treatment decisions for women with breast cancer in the United States (U.S.) and Norway. The specific aims of the study were to: (a) explore and describe how health care systems processes create barriers and facilitators of breast cancer treatment decisions for patients diagnosed with breast cancer in the US and Norway; and (b) compare and contrast the US and Norwegian system processes to identify advantages and disadvantages of each system as they relate to breast cancer treatments. A descriptive qualitative design was used to address the research aims and questions. Data were collected from key informants from the US and Norway. Content and matrix analysis were the primary descriptive and comparative approaches used for this study. First and second order matrices were created to display and analyze data obtained from key informant interviews. Findings indicate that financing allopathic care is a significant barrier for breast cancer patients within the US and financing CAM therapies are challenging in both countries. While allopathic treatment guidelines for breast cancer care are clearly outlined in both the US and Norway, both countries currently lack CAM treatment guidelines for use in this patient population, leading to inconsistent recommendations provided for patients. There are also significant barriers that prevent patient access of CAM providers, particularly by patients in an in-patient, hospital setting. Ultimately, when evaluating care and treatment plans for women diagnosed with breast cancer, health care providers should appreciate and acknowledge the significant system factors that may act as barriers or facilitators of care.
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Åbonde, Anton, et Amnér Simon Salas. « Using embedded systems to optimize the care of indoor plants ». Thesis, KTH, Skolan för elektroteknik och datavetenskap (EECS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-289658.
Texte intégralRésumé :
Over the last few years the interest in indoor plants has increased. Whether they are used for decorating, as mood boosters or sometimes as food in cooking, people want to come closer to nature by bringing it into their homes. However removing plants from their natural habitat could have negative implications on their well-being. In order to achieve an optimal environment, the current location for the plants need to emulate their native environment. Taking sunlight and watering into consideration isn’t always enough: temperature, humidity, soil nutritional level and soil pH level are also factors that needs to be monitored. This thesis covers the creation of a prototype that measures sunlight, temperature and humidity, compares the measurements to a database of plant needs, and then displays the result on a website. The aim is to enable a more effective care of indoor plants. In the end a system was created that can take measurements, are capable of comparing the two sets of data and then visualize the result on a website for the user.Under de senaste åren har intresset för inomhusväxter ökat. Oavsett om de används för att dekorera, som humörförstärkare eller ibland i matlagning vill människor komma närmare naturen genom att föra den in i sina hem. Att ta bort växter från deras naturliga livsmiljö kan dock ha negativa konsekvenser för deras välbefinnande. För att uppnå en optimal miljö måste den nuvarande platsen för växterna emulera deras ursprungliga miljö. Att tänka på solljus och vattning är inte alltid tillräckligt utan temperatur, luftfuktighet, jordens näringsnivå och jordens pH-nivå är andra faktorer som också behöver ses över. Det här examensarbetet omfattar skapandet av en prototyp som mäter solljus, temperatur och luftfuktighet, jämför mätningarna med en databas över växtbehov och sedan visar resultatet på en webbplats. Syftet är att göra det möjligt för användaren att effektivisera skötseln av inomhusväxter för växternas välbefinnande såväl som för sitt egna. I slutändan skapades ett system som kan utföra mätningarna och är kapabelt att jämföra dessa två samlingar data som sedan visar resultatet på en webbplats för användaren.
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Court, Lara A. « Integration of palliative care in African health systems : a systematic review ». Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29188.
Texte intégralRésumé :
Millions of people need palliative care worldwide for symptoms associated with life-threatening illnesses, yet few receive it. This is particularly true in low-and-middle income countries, meaning that most are left without support and pain relief at the end of their life. Access to palliative care is now being understood as a human right and the ethical responsibility of health systems. This has resulted in increased international focus and a call to integrate palliative care into health systems to promote access, and inversely to strengthen health systems. Yet how to do this in low-and-middle income countries is unclear. This study used scoping and systematic review methods to provide synthesised evidence on the approaches and interventions being used to integrate palliative care into African health systems, as well as describe lessons that can be learnt from these efforts. 40 articles were identified in the systematic review that described 51 different interventions that integrated palliative care into part of the health system in one or more African countries. The integration of palliative care services was rarely linked to health systems strengthening and concepts associated with integration were used inconsistently, if used at all. Core themes emerged on facilitators and barriers to the integration of palliative care into health systems. Facilitators included the use of a system-wide approach, the creation of sustainable partnerships, and making the patient central to integration interventions. The health system also needs to be able to support integration. This requires the presence of necessary policies and resources for palliative care, together with sufficient health workers who are trained and motivated to provide palliative care. Findings provide contextual evidence to guide implementors and decision makers seeking to integrate palliative care into health systems in Africa, as well as other low and-middle income countries.
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Hernandez, Cynthia Lynn. « Adapting the Lean Enterprise Self Assessment Tool for health care ». Thesis, Massachusetts Institute of Technology, 2010. http://hdl.handle.net/1721.1/62768.
Texte intégralRésumé :
Thesis (S.M. in Engineering and Management)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2010.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 61-63).
The Lean Enterprise Self Assessment Tool (LESAT) is a product of the Lean Advancement Initiative (LAI) and the Massachusetts Institute of Technology. This tool has been applied by many organizations to gage their progress toward lean enterprise management, however applying this tool in health care organizations has been inhibited by language and underlying assumptions from product manufacturing. An adaptation of the LESAT specifically for health care is proposed. Review of the literature and special reports on health care are used in determining the recommended changes. "Product life cycle" is reinterpreted as a health care service cycle and context specific enterprise level processes and practices are presented. Comparison to other industry measures shows the content the LESAT for health care to cover all key issues and practices for high quality health care delivery.
by Cynthia Lynn Hernandez.
S.M.in Engineering and Management
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Bergdahl, Otto, Peter Arvidsson, Viktor Bennich, Hakan Celik, Petter Granli, Gunnar Grimsdal et Johan Nilsson. « Visual Care : Utveckling av en webbapplikation för att visualisera vårdprocesser ». Thesis, Linköpings universitet, Institutionen för datavetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-140180.
Texte intégralRésumé :
Rapporten beskriver hur produkten Visual Care har tagits fram. Produkten är en webbapplikation för visualisering av statistik från kunden Region Östergötland. Målet med applikationen är att hjälpa anställda på Region Östergötland att planera behandling av cancerpatienter. Syften med den här rapporten är att analysera projektgruppens utvecklingsmetoder och processer för att ta fram produkten Visual Care. Produkten kommer inte att användas av Region Östergötlands anställda, utan kommer istället att användas som en prototyp och inspiration för framtida projekt av kunden.This report is about the production of the web application Visual Care. The product is a tool for visualising statistics provided by the customer Region Östergötland. The goal of the application is to help employees at Region Östergötland to plan treatment of cancer patients. The purpose of this report is to analyze the group's development process for the product. The product will not be used by the employees of Region Östergötland, but will instead be used as an inspiration for future projects by the customer.
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Ling, Meng-Chun. « Senior health care system ». CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2785.
Texte intégralRésumé :
Senior Health Care System (SHCS) is created for users to enter participants' conditions and store information in a central database. When users are ready for quarterly assessments the system generates a simple summary that can be reviewed, modified, and saved as part of the summary assessments, which are required by Federal and California law.
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Moore, Michael David. « Problems of tort litigation as a means of patient and consumer protection in health care systems ». Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/58522.
Texte intégralRésumé :
Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2009.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 53-57).
The U.S. health care system relies on tort litigation as a means of protecting patients and consumers from medical malpractice. The system of tort litigation has contributed to the U.S. having the highest health care spending per capita of any nation, but it has not resulted in superior quality of care. This work argues that tort litigation in health care is actually detrimental to patient safety and that the deterrent effect that it is meant to provide is circumvented by elements inherent in tort law. The possibility of settlement without admission of guilt creates a mechanism by which litigation is encouraged by economic incentives, but actual malpractice is not effectively discouraged. Furthermore, the system limits the operational knowledge gained through adverse events by removing these events and the actions that created them from the public discourse. Various proposed and enacted reforms to medical tort litigation are considered and it is found that dysfunctional interactions between professionals of different disciplines constitute a major obstacle to effective system reform. Finally, a modular view of the health care system is presented as a step toward identifying and reforming these interactions.
by Michael David Moore.
S.M.
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Shefali, Shweta. « Disruption of the group health insurance in light of the Affordable Care Act - system approach ». Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/90725.
Texte intégralRésumé :
Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2014.Cataloged from PDF version of thesis.
Includes bibliographical references (page 127) and index.
Our current Healthcare system has multiple problems and it is widely perceived that it is not able to provide quality affordable healthcare to all Americans; millions of Americans are without Health Insurance. The Affordable Care Act (ACA) was signed into law to achieve goal of 'quality affordable care for all American'. The ACA has focus on Individual Health Insurance and the provision of Health Exchange Marketplaces to find and purchase Health Insurance. Disruptive Innovation is a phenomenon in which a new entrant company disrupts the existing established company. As ACA and Health Exchanges have provided level playing field for all companies - new entrants and established - will this lead to disruption of Healthcare? Disruptive Innovations is analyzed from System Approach point of view. Disruption is not limited to two companies; Disruptor System disrupts the existing system including incumbent company. Disruption will be spearheaded by new entrant Disruptor Company and disruption will take place at system level. The existing Healthcare System and Possible Disruptor Systems are defined and investigated. Relative advantage and disadvantages to these two systems with regard to ACA regulations are analyzed. Elements of the healthcare disruptor system are analyzed and information present in the public domain about Health Exchange enrolment after the end of first enrollment seasons is studied to find out who could be possible disruptor and whether disruptor system formation has started.
by Shweta Shefali.
S.M. in Engineering and Management
41
Van, Wyk Gerrit Christian Burggraf. « Medicine and medical process as a learning system ». Master's thesis, University of Cape Town, 1996. http://hdl.handle.net/11427/17214.
Texte intégralRésumé :
Bibliography: pages 150-158.Health care systems all over the world are in crisis. The presenting symptom is a cost spiral that is out of control. Money supply is finite, and if this problem continues the system will eventually collapse. There are a number of causes associated with the problem that are usually analysed by reduction, an approach based upon an assumption of simple linear causal relations. This study shows the problem to be the dialectic opposite, in other words these problems are all interrelated through complex causal interactions. Therefore, the health care system is a complex social system and solutions to its problems may be found in terms of the interactions in such a system. An investigation into the history of the health care system shows that the system started with a simple one on one interaction between patients and physicians. At the time of its initiation, very little empirical knowledge was available about illness. After the renaissance, this changed dramatically with a subsequent increase in the ability to diagnose, but also in the complexity to treat illness. However, modern beliefs about illness and illness processes do not reflect the complexity of this knowledge. Beliefs about both illness and knowledge contribute to the process of diagnosis (medical decision making, or problem solving). Furthermore, the expectations, wants, and needs of patients and physicians, as well as the decision environment, increases the complexity and difficulty of this decision making process. These decisions initiate treatment processes that are ultimately represented in the health care system as cost. Therefore, the patient-physician system as the simplest initial interaction is an event that ultimately affects cost. This system is not functioning efficiently at present and a system of inquiry that can improve it may make a contribution to an improved system, and therefore a saving in cost. Altering the diagnostic system from a linear into a circular process, in other words into a learning system, improves both decision making and the use of knowledge. However, an inquiring system is needed in addition that can enhance the rigour of this process. Charles West Churchman devoted a large part of his work to knowledge and the way we acquire knowledge, in other words inquiring systems. His belief is that problem solving ought to be approached in a comprehensive way in order to minimise the risk for making incorrect decisions. Furthermore, because decisions are made upon incomplete information, the solutions will be the cause of new problems. Therefore, problem solving is a never ending cycle of learning. In order to have as complete information as possible about the problem, we have to: know the history of the problem, take a broad view that includes the environment of the problem (use a systems approach), and consider all the alternative solutions to the problem. Virtually all of our knowledge is based upon underlying assumptions. In order to test the validity of the knowledge we use for inquiry and decision making, it is important to test the assumptions upon which the knowledge is based. This is valid in regard to empirical knowledge as well. Finally, according to Churchman, decision making has to be ethical. Therefore, we have to do all we can to ensure that the implementation of the decision will improve the situation, not only now, but also in the future. The application of Churchman's approach to the patient-physician interaction, assists in the synthesis of a more comprehensive world view of health care and illness. This study shows that this leads to important changes in the negative interactions identified as contributing to the health care crisis. In terms of Churchman's approach, the role of physicians can be seen as managers of illness. Their purpose is therefore to plan for the improvement of illness (the problem) in an ethical way. Such planning should include the values of patients in deciding upon appropriate treatment. It is the submission of this study that only a methodology that is able to address complex human systems, such as a systems approach, and a comprehensive philosophy of inquiry, such as that of C West Churchman is appropriate to address the current problems of the health care system.
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Leon, Natalie H. « District health systems development : functional integration at joint primary health care facilities in the Western Cape ». Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/10769.
Texte intégralRésumé :
Bibliography: leaves 65-68.South Africa has embarked on a range of health sector reforms since the start of the democratic government in 1994. The Primary Health Care approach has been accepted as a way of delivering cost effective, efficient and accessible comprehensive health care at the primary care level. The district health system has been promoted as the best model for the delivery of primary health care because it decentralizes power to the local, district level and it is able to integrate fragmented primary care services under one management and governance structure. In the absence of a formal, legal district health system, provincial and local government authorities have made efforts towards functional integration in primary health care. The establishment of shared health facilities with the aim of providing integrated, comprehensive health care is part of the effort towards functional integration. This study investigates the level of functional integration in joint health facilities between Local Authority (LA) and the Provincial Administration of the Western Cape (PAWC).
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Rowland, Emily. « Influences of the Neonatal Intensive Care Unit Microsystem on Mothers' Experiences ». Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32418.
Texte intégralRésumé :
The goal of this project was to explore mothers’ experiences of caring for infants in the Neonatal Intensive Care Unit (NICU) using a microsystem perspective. This perspective focuses on the structure, processes and people and in so doing allows for a critical exploration of how these elements work together to influence mothers in the NICU. The research framework involved an institutional ethnography to explore care delivery, relationships, and discourses in the NICU. Data was collected using nonparticipant-observations, interviews, and collection of discourse artifacts. There is clear evidence that caring for an infant in the NICU can result in significant increases in maternal stress and associated outcomes. Results from triangulation of the data indicated that being separated from the infant and learning to mother in the unit were particularly salient experiences retold by the mothers. These experiences were affected – either positively or negatively – by different elements of the microsystem including consistency in communications, increased opportunities for mothers’ inclusion in decision-making and infant care and lastly, access to more support resources. Implementing improvements to the microsystem could better empower mothers adjusting to parenthood within the NICU context.
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Siraj, Shabna. « ARCTIC : An IoT-based System for Child Tracking in Day Care ». Thesis, Luleå tekniska universitet, Institutionen för system- och rymdteknik, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-73315.
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Karlsson, Johan. « Information structures and workflows in health care informatics ». Doctoral thesis, Umeå universitet, Institutionen för datavetenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-33829.
Texte intégralRésumé :
Patient data in health care have traditionally been used to support direct patient care. Although there is great potential in combining such data with genetic information from patients to improve diagnosis and therapy decisions (i.e. personalized medicine) and in secondary uses such as data mining, this is complex to realize due to technical, commercial and legal issues related with combining and refining patient data. Clinical decision support systems (CDSS) are great catalysts for enabling evidence-based medicine in clinical practice. Although patient data can be the base for CDSS logic, it is often scattered among heterogenous data sources (even in different health care centers). Data integration and subsequent data mining must consider codification of patient data with terminology systems in addition to legal and ethical aspects of using such data. Although computerization of the patient record systems has been underway for a long time, some data is still unstructured. Investigation regarding the feasibility of using electronic patient records (EPR) as data sources for data mining is therefore important. Association rules can be used as a base for CDSS development. Logic representation affect the usability of the systems and the possibility of providing explanations of the generated advice. Several properties of these rules are relatively easy to explain (such as support and confidence), which in itself can improve end-user confidence in advice from CDSS. Information from information sources other than the EPR can also be important for diagnosis and/or treatment decisions. Drug prescription is a process that is particularly dependent on reliable information regarding, among other things, drug-drug interactions which can have serious effects. CDSS and other information systems are not useful unless they are available at the time and location of patient care. This motivates using mobile devices for CDSS. Information structures of interactions affect representation in informatics systems. These structures can be represented using a category theory based implementation of rough sets (rough monads). Development of guidelines and CDSS can be based on existing guidelines with connections to external information systems that validate advice given the particular patient situation (for example, previously prescribed drugs may interact with recommended drugs by CDSS). Rules for CDSS can also be generated directly from patient data but this assumes that such data is structured and representative. Although there is great potential in CDSS to improve the quality and efficiency of health care, these systems must be properly integrated with existing processes in health care (workflows) and with other information systems. Health care workflows manage physical resources such as patients and doctors and can help to standardize care processes and support management decisions through workflow simulation. Such simulations allow information bottle-necks or insufficient resources (equipment, personnel) to be identified. As personalized medicine using genetic information of patients become economically feasible, computational requirements increase. In this sense, distributing computations through web services and system-oriented workflows can complement human-oriented workflows. Issues related to dynamic service discovery, semantic annotations of data, service inputs/outputs affect the feasibility of system-oriented workflow construction and sharing. Additionally, sharing of system-oriented workflows increase the possibilities of peer-review and workflow re-usage.
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Liu, Xia. « A requirement engineering framework for assessing health care information systems ». Thesis, University of Ottawa (Canada), 2010. http://hdl.handle.net/10393/28534.
Texte intégralRésumé :
Health care is increasingly being provided by collaborative teams that involve multiple health care providers at multiple locations. To date, most of that collaboration is on an ad-hoc basis via phone calls, faxes, and paper based documentation. However, Internet and wireless technologies provide an opportunity to improve this situation via electronic data sharing. These new technologies make possible new ways of working and collaboration but it can be difficult for health care organizations to understand how to adopt new technologies while still ensuring that their policies and objectives are being met. It is also important to have a systematic approach to validate that e-health processes deliver the performance improvements that are expected. Using a case study of a palliative care patient receiving home care from a team of collaborating healthcare providers and organizations, we introduce a framework for assessing health care information systems based on requirements engineering. Key concerns and objectives were identified and modeled. Business processes which will use the new health care information system are modeled in terms of these concerns and objectives to assess their impact and ensure that electronic data sharing is well regulated and effective. The work in the thesis is design-oriented research to show the utility of our proposed requirement engineering framework compared to existing evaluation approaches for healthcare IT. The approach is evaluated based on a set of criteria drawn from our literature review and a gap analysis of our case study for palliative care.
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Lindgren, Helena. « Decision support in dementia care : developing systems for interactive reasoning ». Doctoral thesis, Umeå : Datavetenskap Computing Science, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1138.
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Dartington, Timothy. « Developing a systems psychodynamic approach to health and social care ». Thesis, University of East London, 2010. http://roar.uel.ac.uk/2602/.
Texte intégralRésumé :
This introductory essay takes an historical developmental view to my published work, from my early career as a social researcher at the Tavistock Institute (1970-76), through further research and consultancy projects in health and social care systems in the public and not-for-profit sectors of the UK, and finally (2001-2007) to an involuntary participant observation of the dynamics of care in my own family. The review is in two sections. In the first part I describe the methodology of a systems dynamics approach to understanding organizations, and my contribution to that methodology in relation to systems of care around vulnerable people. In the second part I explore the development of my thinking about the dynamics of care systems with particular attention to six key publications from 1979 to 2010 (Appendix A), which together make the body of work submitted for examination.
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Field, Kenneth Spencer. « Modelling health care utilization : an applied Geographical Information Systems approach ». Thesis, University of Northampton, 1998. http://nectar.northampton.ac.uk/2708/.
Texte intégralRésumé :
This research has emanated from the geographical concerns raised by organisational change in the British National Health Service (NHS), namely the ongoing debate relating to health and health care inequalities. This thesis develops a flexible, portable and predictive model of health care utilization capable of assisting improved health care planning and analysis. In so doing it contributes to the current resurgence in medical geography. An applied approach to this research is identified which builds upon methods of modelling spatial patterns and processes in geography and the upsurge of interest in Geographical Information Systems (GIS) technology. In these terms, the use of GIS is central to the research; it supports construction and application of the model; facilitates a wide range of analyses; and provides a basis for visualisation and interpretation of model results. The value of modelling in analysing relationships between health inequalities and the location and allocation of health care is identified through a discussion of previous NHS policy initiatives and previous research. From this, a conceptual model of utilization is developed which incorporates components of need, accessibility and provision. A patient survey of asthmatics and diabetics informs the development of the model and validates the choice of indicators used to measure utilization. Indicators of need, accessibility and utilization are thus defined and subsequently measured using a signed chi-square scoring method. The model was developed and tested for primary care General Practitioner services in the Northampton District Health Authority area and outcome measures are proposed and evaluated. Rigorous testing of the model’s sensitivity and robustness is undertaken and potential for its simplification explored. Components are critically evaluated through a comparison with alternative methods of determining spatial inequalities in disadvantage. The potential of the model of utilization for health care planning and analysis is extensively demonstrated through the application of a variety of modelled scenarios. Emergent issues from the research are considered and potential for future geographical research in this area of study, and the impact upon research agendas more generally, is explored
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Warren-Adamson, Chris. « An enquiry into family centres as complex systems of care ». Thesis, University of Southampton, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.496175.
Texte intégral