Tesi sul tema "Quality of care"
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1
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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2
Mongado, Blair Coja. "Essays in Child Care Quality". Diss., Virginia Tech, 2007. http://hdl.handle.net/10919/26186.
Testo completoAbstract (sommario):
This research investigates three topics in child care quality, motherâ s labor supply, and early childhood development. In the first study, we evaluate how child care quality influences the potential impacts of mothersâ labor supply on child development. Although, previous studies have acknowledged the importance of the quality of child care, none have integrated quality in analyzing the effects of maternal employment. We find that the negative effect often found in past studies is largely due to the use of low quality child care.
The question we ask in the next study is, "What are the effects of child care quality on child development?" In this study we tried to separate out the contribution of initial child ability in child test scores of development from the effects of other inputs, particularly child care quality. We show that even after resolving endogeneity issues, we still find that child care quality has a significant positive effect on early cognitive development.
The third study investigates the determinants of householdsâ demand for child care, particularly, child care quality. We determine if householdsâ choices regarding child care quality, as well as quantity, respond to economic factors. A familyâ s condition is defined by the combination of family choices on motherâ s work status, mode and payment type of child care, and childâ s age. We group families by condition and estimate demand for child care quality and hours by group. The results indicate that higher income will lead to higher quality for non-working mothers but lower quality for some working mothers. Demand for quality by non-working mothers are more price sensitive than working mothers. Wage effects on quality are positive only for users of home-based care. Demand for quality is more sensitive to economic factors when the child is around 3 years old than at 6 months. These results suggest that the form, target and timing of financial assistance need to be considered for it to be effective in promoting the use of quality care.Ph. D.
3
Yildiz, Ozkan. "A Comprehensive Model For Measuring Health Care Process Quality: Health Care Process Quality Measurement Model (hpqmm)". Phd thesis, METU, 2012. http://etd.lib.metu.edu.tr/upload/12614318/index.pdf.
Testo completoAbstract (sommario):
Similar to the manufacturing sector, process improvement gains much attention in health care sector. Measuring process quality is one of the most important components of process improvement and numerous healthcare quality indicator models are developed to achieve this aim. Existing quality models focus on some specific diseases, clinics or clinical areas. Although they contain structure, process, or output type measures, there is no model which measures the quality of health care processes comprehensively. As a result, hospitals cannot compare quality of processes internally and externally. To bring a solution to the above problems, we developed Health Care Process Quality Measurement Model (HPQMM), and it is applied in three public hospital&rsquos laboratory and assessment processes. We observed that, the developed model determines weak and strong aspects of the processes, gives a detailed picture for the process quality, extends the quality aspects of existing models, and provides quantifiable information to hospitals to compare their processes with multiple organizations.
4
Fortune, Darla. "An Examination of Quality of Work Life And Quality of Care Within a Health Care Setting". Thesis, University of Waterloo, 2006. http://hdl.handle.net/10012/2798.
Testo completoAbstract (sommario):
Unsatisfactory working conditions and job stress may be indicative of working in a society where work-life balance is a desired, but often elusive, goal (Duxbury & Higgins, 2001; Smola & Sutton, 2002; Sturges & Guest, 2004). Working conditions in the healthcare sector are reported to be particularly problematic and stress inducing compared to other work sectors (Yassi, Ostry, Spiegel, Walsh, & de Boer, 2002). In fact, quality of work life (QOWL) among healthcare workers is believed to have deteriorated to the point where it is impeding the capacity of the system to recruit and retain staff needed to provide effective patient care (Koehoorn, Lowe, Rondeau, Schellenberg, & Wager, 2002). The purpose of the study was to examine the experiences of healthcare staff who participate in QOWL initiatives aimed to provide employees with creative, educational, and fun activities designed to address feelings of stress. This study included thirteen staff members from disciplines that comprise the Health Care Team at a facility specializing in aging and veteran's care. Data were collected through conversational interviews with staff from each of the following disciplines: nursing, recreation therapy, physiotherapy, creative arts, clinical nutrition, social work, audiology, occupational therapy, and pastoral care. The data were deconstructed into common themes through an open-ended process, which lead to the identification of common experiences across the data provided by the staff. Upon further comparison of the themes, it was identified that work demands were believed to detract from care provision and strained manager relations were believed to minimize quality of care. However, a strong professional identity was evident as staff described being able to rise above adversity and use their skills and competencies to provide quality care to residents. The data also suggested QOWL initiatives seem to be valuable because they provide opportunities for staff to interact socially. This interaction helps foster and strengthen connections amongst staff, which they feel transfers to the work place through improved working relationships. Participants described feelings of personal gratification that can be derived from team cohesiveness. They also acknowledged the carry over value that team work brings to residents by way of improved care provision. Furthermore, the relationships that staff members develop with one another were viewed as sources of strength, particularly in times of increased stress. In addition to the social element associated with the QOWL initiatives, these initiatives also seem to address a need for restoration, humour, and balance within the work day. Without planned opportunities for rejuvenation and humour appreciation, participants admitted that they would seldom take the time to incorporate these into their work day. Therefore, QOWL initiatives can provide staff with a reason to take a break and find their balance. The findings indicate the factors affecting QOWL are varied and complex. The findings also indicate that there can be a paradoxical nature to work within a health care setting. Paradoxes exist in relation to the provision of professional care and the provision of minimized care. Paradoxes also exist in relation to the expressed need for restoration, humour, and balance and the low priority staff will place on taking time to fulfill these needs.
5
Steel, Nicholas. "National Population Evaluation Of Quality Of Health Care: Developing And Using Quality Of Health Care Indicators". Thesis, University of East Anglia, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.490364.
Testo completoAbstract (sommario):
Background: Good quality health care can improve individual and population health. This study aimed to assess the receipt of effective health care interventions by middle aged and older people with common chronic diseases and health problems. Methods: 119 quality indicators were reviewed by an expert panel. Approved indicators were developed into a structured questionnaire for the English Longitudinal Study of Ageing (ELSA). 8,688 participants aged 50 years and over were interviewed in 2004-5 in England, of whom 4,419 reported diagnoses of one or more of 14 study conditions. Outcome measures were the percentage of indicated interventions received by eligible participants for 39 indicators, and aggregate scores. Receipt of hip or knee joint replacement was analysed as an example ofhow receipt could be compared with need, in 7,101 people aged 60 yrs or older in ELSA 2002-3, and 14,807 adults aged 60 years or over in the USA Health and Retirement Study 19982004. Results: Participants were eligible for 19,450 person-disease level quality indicators, and received 62.4% (95% confidence interval 61.5 to 63.3) of all recommended care items. Receipt of indicated care varied substantially by condition, from warfarin 'monitoring at 100.0% (92.0-100.0) to osteoarthritis at 29.0% (26.0-31.9). Indicators were more likely to be achieved for general medical (75.0%, 73.8-76.3) than geriatric conditions (56.1 %, 54.6-57.7). There were few associations between quality achievement and socio-economic factors. Factors associated with lower likelihood of receipt ofjoint replacements, relative to need, were living in the North, being a woman, or being poorer, in England, and in the USA were being Black or less educated. Interpretation: Deficits in the receipt of effective health care for chronic conditions appeared common. Shortfalls were most marked in areas associated with frailty, but few areas were exempt. Efforts to improve care have substantial scope to achieve better population health.
6
Svartbo, Boo. "The elusive quality of health care". Doctoral thesis, Umeå universitet, Institutionen för samhällsmedicin och rehabilitering, 2000. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-96909.
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7
Hebert, Christopher J. "Measuring Quality of Care for Hypertension". Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1231883022.
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8
Cronsioe, Carl. "Optimization of Quality in Home Care". Thesis, KTH, Optimeringslära och systemteori, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-209671.
Testo completoAbstract (sommario):
As the older population grows larger there is a growing need to provide health care at home. This services are generally done without operational research. As more people will require home care there will be a need to increase the efficiency of the service while keeping the quality high. The purpose of this thesis is to investigate how we can use operation research in home care as well as define how we can model the quality and use those quality parameters in order to offer the best possible service. The model uses VRP with Time windows in order to schedule the routes and incorporates service requirements at the customers. A solution is obtained by first constructing an initial solution that fulfills the duration constraint. Then it uses a local search with a dynamic insertion heuristic to improve on the solution. Tabu search is used as a meta-heuristic to prevent the solution the get stuck in a local minima. The solver is used in order to optimize the quality parameters. The result obtained can be used to help home care providers to determine the level of quality they can supply with a limited budgetNär den äldre befolkningen blir större växer behovet av att tillhandahålla vård i hemmet. Denna tjänst använder i allmänhet inte systemteori. Eftersom fler människor kommer att behöva hemtjänst kommer det att finnas behov av att öka effektiviteten samtidigt som kvaliteten hålls hög. Syftet med denna avhandling är att undersöka hur vi kan använda systemteori och optimering inom hemtjänst samt definiera hur vi kan modellera kvaliteten och använda dessa kvalitetsparametrar för att erbjuda bästa möjliga service. Modellen använder VRP med Time windows för att schemalägga rutterna och inkorporerar servicebehov hos kunderna. En lösning erhålles genom att först bygga en initial lösning. Sedan använder den en lokal sökning med en dynamisk heuristisk för att förbättra lösningen. Tabu search används som en meta-heuristik för att förhindra att lösningen fastnar i lokala minima. Algoritmen används för att optimera kvalitetsparametrarna. Resultatet kan användas för att hjälpa leverantörer av hemtjänst att bestämma vilken kvalitetsnivå de kan leverera med en begränsad budget
9
Kirkegaard, Amy J. "Quality Management in Primary Care Dietetics". Thesis, Griffith University, 2022. http://hdl.handle.net/10072/420903.
Testo completoAbstract (sommario):
Background: Health is influenced by many determinants, including the social and physical environment, economic factors, and individual characteristics. Diet and nutrition play a critical role in health, both in the prevention and treatment of non-communicable diseases, with dietary risk factors alone causing 5.3% of the total disease burden in Australia. Dietetic care has been shown to improve consumer outcomes, demonstrating its role in addressing the burden caused by poor diet. While quality has been extensively explored in tertiary and, to a lesser degree, in primary healthcare settings, there is limited research exploring quality in primary care dietetics.
The overarching aim of this doctoral research program was to explore quality management in primary care dietetics through the lens of complexity science. Five aims were addressed in four sequential stages of research using a qualitatively driven mixed methods design. The five aims were: i) to describe and evaluate the literature on quality improvement strategies used to enhance health outcomes achieved by dietetic care that is delivered in the primary care setting (Stage 1); ii) to explore primary care dietetics through the lens of complexity science (Stage 2); iii) to explore how healthcare consumers describe nutrition care (Stage 3); iv) to explore how healthcare consumers and professionals describe dietetic care (Stage 3); and v) to develop a theoretical approach to quality management for primary care dietetic services (Stage 4). The research was designed and executed from a pragmatic philosophical positioning and, consequently, focused on exploring quality with a solution- and action-orientated purpose.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Health Sci & Soc Wrk
Griffith Health
Full Text
10
Fickel, Jacqueline Jean. "Quality of care assessment : state Medicaid administrators' use of quality information". Full text (PDF) from UMI/Dissertation Abstracts International Access restricted to users with UT Austin EID, 2002. http://wwwlib.umi.com/cr/utexas/fullcit?p3077639.
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11
Chavez, Maria Magdalena. "Improving Diabetes Care in Family Care Practice: A Quality Improvement Project". Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/593612.
Testo completoAbstract (sommario):
Type 2 diabetes mellitus (T2DM) is a chronic and debilitating disease contributing to the rise in healthcare associated costs in the United States (ADA, 2013a; USDHHS, 2013). T2DM management is complex and requires an ongoing multi-system approach (Goderis et al., 2010). In this quality improvement project, the DNP student led a team in a family care practice setting through a systematic quality improvement process, the PDSA cycle, for the improvement of performance rates of quality indicators including A1C testing, LDL testing, and performance of comprehensive foot examinations. The QI team developed a multi-component intervention to include utilization of an electronic type 2 diabetes mellitus (T2DM) decision support tool. The expected outcome was to increase current performance rates of A1C testing, LDL testing, and comprehensive foot examinations at a family care practice by at least 10% within four weeks of implementing the intervention. A1C testing improved from a pre-intervention median of 70.97% to a post-intervention median of 91.38%, an increase of 20.41%. LDL testing improved from a pre-intervention median of 74.19% to a post-intervention median of 91.38%, an increase of 17.19%. Comprehensive foot examinations improved from a pre-intervention median of 58.06% to a post-intervention median of 84.48%, an increase of 26.42%. While results demonstrate a trend of improvement, the duration of the intervention was insufficient for statistical significance. The QI project served as a first systematic change process for the family care practice and a model for future change processes at the clinic. This project highlights the DNP's role in utilizing evidence-based research and applying a systematic change model for quality improvement in the primacy care practice setting.
12
Flores, Cristina. "The quality of care in residential care facilities for the elderly". Diss., Search in ProQuest Dissertations & Theses. UC Only, 2007. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3261238.
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13
Youn, Kyung II. "ORGANIZATIONAL SLACK, EFFICIENCY, AND QUALITY OF CARE IN ACUTE CARE HOSPITALS". VCU Scholars Compass, 1995. https://scholarscompass.vcu.edu/etd/5059.
Testo completoAbstract (sommario):
The relationship between technical efficiency and quality of care in hospitals is studied in the context of resource availability in hospital organizations. The resource availability of hospitals is conceptualized by organizational slack.
An integrated model is developed encompassing the source of organizational slack, its impact on technical efficiency and on quality of care, and its impact on the relationship between efficiency and quality. Organizational threat as an environmental factor affecting the level of slack is measured by the level of competition and regulation. Organizational slack is measured using financial and operational indicators of the hospitals. Technical efficiency is estimated by efficiency "scores generated using the Data Envelopment Analysis. Mortality rates of Medicare patients are used as the proxy for quality of care in individual hospitals.
The sample is composed of 832 urban, not-for-profit hospitals in the United States. The data are compiled from the Health Care Finance Administration data set and the American Hospitals Association annual survey data set. Hypotheses are tested using ordinary least squares regression and logistic regression.
The analysis reveals that the level of and change in organizational slack have a negative relationship with efficiency and a positive relationship with quality of care. The results also indicate that environmental threat has a negative effect on level of slack, and efficiency has a negative effect on quality of care.
The findings are discussed in terms of the theoretical implications for the concept of organizational slack and the implications for health policy and hospital management.
14
Kiessling, Anna. "Quality of care and quality of life in coronary artery disease /". Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-205-5/.
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15
Habjanic, A. (Ana). "Quality of institutional elderly care in Slovenia". Doctoral thesis, University of Oulu, 2009. http://urn.fi/urn:isbn:9789514291869.
Testo completoAbstract (sommario):
Abstract
Elderly people, because of the frail health condition and consequent problems, have in most cases substantial difficulties living at home. Despite the need for widened nursing home custody, the field of quality institutional elderly care in Slovenia in the past did not undergo comprehensive research.
The purpose of this two-part study was to investigate the quality of institutional elderly care and elderly care offered in Slovenian nursing homes. Additional purpose was to evaluate nursing staff members about their willingness, knowledge, skills and importance to meet residents’ physical and psychosocial nursing care needs. Also, a part of this research was bound for recognition of maltreatment and nursing staff members’ well-being.
The qualitative and quantitative research methods were used. The quality of institutional elderly care and elderly care offered were researched by interviewing the parties involved in elderly care, residents, relatives and nursing staff members (N=48). The data for quantitative research was collected by surveying nursing staff by using a structured questionnaire (N=148). All data have been collected in three public and one private nursing home located in two major cities of Ljubljana and Maribor. Collected data was examined by content analysis method and statistical analysis, to corroborate findings across data sets, reducing the impact of potential biases that can exist in a single study. Triangulation was used to approach to data analysis to synthesize data from multiple sources.
Main categories of quality institutional elderly were formulated as attentive care, optimal custody and holistic approach. The most important issue of quality institutional elderly care was formulated as meeting needs on time. Nursing staff members were found to be better skilled in meeting physical than psychosocial needs of residents. Maltreatment was recognised as neglect of care due to postponed duties or hastiness in nursing interventions resulting in discomfort of residents. Factors in connection to quality of institutional elderly care were expressed as quality of nursing care, friendly relationship, meaningful activities, pleasant dwelling environment and versatile assistance.
The obtained findings were presented in form of proposals to improve quality of institutional elderly care in Slovenian nursing homes, and could be used to develop institutional elderly care and improve dwelling. In addition many specific terms have been extracted during the analysis process that may contribute to development of gerontological nursing care rationale in Slovenia.
16
Chana, Navtej. "Quality of care amongst hospital nursing staff". Thesis, University of Oxford, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.531831.
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17
Williams, Cynthia. "Home Care Quality Effects of Remote Monitoring". Doctoral diss., University of Central Florida, 2014. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/6383.
Testo completoAbstract (sommario):
Despite concerted efforts to decrease costs and increase public health, the embattled U.S. health care system continues to struggle to alleviate these widespread issues. Because the problem of hospital utilizations among patients with heart failure is posited to increase as the population ages, innovative methodologies need to be explored to mitigate adverse events. Remote monitoring harnesses the strength of advanced information and communication technology to affect positive changes in health care quality and cost. By reaching across geographical boundaries, remote monitoring may support increased access to less costly services and improve the quality of home health care.
The purpose of the study was to examine the home care quality effects of remote monitoring technology in patients with heart failure and to provide an economic justification for its adoption and diffusion. It compared remote monitoring as a potential intervention strategy to a standard no-intervention group (without remote monitoring). Specifically, it analyzed remote monitoring as a viable strategy to decrease hospital readmissions and emergency department visits. It also compared the cost of remote monitoring against the current standard-of-care.
The theoretical framework of Donabedian's Quality Model was used in the evaluation of remote monitoring. A retrospective posttest only, case control study design was used to test the degree which remote monitoring was effective in promoting health care quality (hospital readmissions and decreased emergency department visits). Retrospective chart reviews were performed using electronic medical records (EMR). Analysis of Variance, Path Analysis, Automatic Interaction Detector Analysis (Dtreg), and Cost Outcomes Ratio were used to test the hypotheses and validate the proposed theoretical model.
No significant difference was noted in remote monitoring and usual care groups. Results suggested that remote monitoring does not statistically lead to a decrease in heart failure-related hospital readmissions and all-cause emergency department visits. Results of the cost ratio analysis suggested that there was no statistically significant difference in the net income between usual care and remote monitoring; however, data suggest that there were significant increases in cost and intensity of nursing utilization for the remote monitoring intervention. The Automatic Interaction Detector Analysis showed that the unfavorable results in hospital readmissions were due to a decrease in collaborative care and patient education prior to the recommendation for hospitalization.
The role of nursing care, whether in hospital or community-based care, in heart failure management is critical to quality outcomes. As the field continues to consider the use of technology in health care, decision makers should think through the process of patient care such that preventable hospital readmissions are decreased and patients received quality care.Ph.D.
Doctorate
Health and Public Affairs
Public Affairs; Health Services Management and Research Track
18
Jackson, Anne Margaret. "Explaining hydrotherapy outcomes : quality in health care". Thesis, University of Surrey, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324076.
Testo completo
19
Symons, Nicholas. "Quality of care in emergency general surgery". Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/18617.
Testo completoAbstract (sommario):
There are more than 600,000 emergency general surgery admissions per year in England. These patients comprise about 50 percent of general surgical workload but make up 80-90 percent of all general surgical deaths. In recent years surgical colleges and societies in the UK have warned of significant variability in the quality of care between hospitals but, to date, little formal evaluation of the quality of care in emergency general surgery exists. This thesis uses the Structure/Process/Outcome quality assessment framework, devised by Avedis Donabedian, to examine quality of care in emergency general surgery across all three of these domains. A study of high risk emergency general surgical admissions using the administrative Hospital Episode Statistics dataset demonstrated significant variability in 30-day in-hospital mortality between NHS Trusts. Investigation of NHS Trust structure was performed using data from the Department of Health. There were significant differences in the provision of intensive care beds and in the utilization of computed tomography and ultrasound scanning between low mortality and high mortality NHS Trusts. The process of care was assessed using an explicit checklist for the admission phase of care and using ethnographic field notes for patients’ subsequent hospital stay. Across 5 London hospitals, process reliability during admissions to hospital was poor, with nearly 20% of recommended processes omitted. Failures in the process of care were also common in subsequent ward based care. Failures were considered to be highly preventable and frequently caused harm to patients or delayed their discharge. Overall, this thesis has identified significant variability in the quality of care for emergency general surgical patients in structure, process and outcomes. While the thesis does not evaluate every single aspect of patient care it demonstrates the degree of improvement required in emergency surgical care and provides some recommendations for future quality improvement.
20
Lee, Yuna Swatlian Hiratsuka. "Fostering creativity to improve health care quality". Thesis, Yale University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10633255.
Testo completoAbstract (sommario):
Eliciting and evaluating new ideas to improve the quality of health care are important processes for health care organizations. Creativity, which refers to the generation of novel and useful ideas, is required for innovation and is valued by many organizations. Health care staff (e.g., primary care providers, nurses and medical assistants) can be an important source of creative ideas. In my dissertation, I conducted a longitudinal, mixed methods study of 220 improvement ideas generated over 18 months by improvement team members from 12 federally qualified community health centers. I also analyzed the experiences of 2,201 patients cared for by these individuals. I used data from patient surveys, quality improvement team meeting transcripts, staff surveys and wearable sociometric sensors.
Part one of this research draws on organizational theory to develop hypotheses and tests empirically the impact of creative idea implementation on patient care experiences, the relationship between idea creativity and implementation, and moderators of this relationship. Results suggest that the implementation of creative ideas is positively associated with better patient care experiences, but such ideas are less likely to be implemented. Three staff-level characteristics - more collaborative relationships, longer organizational tenure, and higher network centrality (a more central position in the organization's social network) – increase the likelihood that staff's creative ideas will be implemented. Part two of this research assesses the health care staff characteristics associated with idea creativity. The results show that staff with a peripheral perspective on care delivery (behavioral health provider and medical assistant), and staff with lower satisfaction and who have a shorter organizational tenure, are significant correlates of idea creativity. Part three of this dissertation focuses on the tactics that quality improvement leaders use to foster idea creativity, evolution, and implementation in their groups. The results suggest that the leader tactic of brainstorming is associated with groups having more creative, rapidly implemented, low-engagement ideas, which might be an effective tactic for leaders seeking disruptive change. The tactic of group reflection on process is associated with slower implemented, high-engagement ideas, which might help leaders elicit well-considered and deliberated solutions. I develop a conceptual framework for understanding creativity in health care organizations based on these findings, which may help scholars and health care professionals improve their understanding of health care innovation and how better to facilitate the expression and implementation of creative ideas.
This dissertation contributes to health services and organizational research by elucidating how creativity in health care organizations is fostered and facilitated, and how it affects outcomes. Understanding how creative ideas may improve the organization and delivery of quality care could facilitate efforts to discover and evaluate new ideas regarding the quality of health care delivery.
21
Mee, Jenny. "Australian home care quality : a political tango". Thesis, Federation University Australia, 2020. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/179509.
Testo completoAbstract (sommario):
The performance of Australian home care and how it is enacted has been significantly impacted by the economic and political challenges since the announcement of the Aged Care Reforms in July 2012 and the launch of the National Disability Insurance Scheme in July 2013. As a result, the home care business arena has changed, and the effects are being felt as the marketplace shifts, and businesses adapt to new policy directions. The purpose of this research study was to investigate the social context of Australian home care, and to collect information regarding how home care (under the various auspices of government funded and privately funded) service provision is enacted in terms of quality during this time of change. The qualitative research process for this study involved critical reflexive practice and face-to-face semi-structured interviews of 10 home care business leaders from the states of Queensland and Victoria. In listening to the voices of the participants, this research study sought to develop new discursive approaches in order to understand the practice of caring for the Australian community’s most vulnerable people – those who are frail, aged, and for those who have ill-health or a disability. The analytical framework adopted for this study used a post-structural discourse analysis, which was informed by the work of French philosopher Michel Foucault and other contemporary theorists. The philosophical framework of governmentality and discourse analysis helped to situate the voice of the participants at a time when new ideas and the ways of conducting the business of home care are emerging. In using this approach to analyse the data, it became apparent that the discursive practices that had been instituted by government in the home care sector had been constructed to remove progressive inclusionary policies that were contrary to the democratic principles of governing. The research study’s findings reveal the problematic changes that impact on business but more so for consumers as the rules are interpreted. By using the metaphor of ice dancing, the study problematized the leadership of government and the challenges participants faced in maintaining quality service provision in the home care arena. What emerged was the dance of a political tango. These leaders in the arena revealed the importance of knowing when to lead and when to push back. Like the different genres of tango, there are different ways of viewing the world of home care and performing in its different spaces, and there are other ways of viewing quality in caring service provisions. By participating in the research, the participants highlighted the need of being inclusive to hearing and seeing all performers in the arena of home care regardless of social or geographical positioning. This research concludes that hearing and acting on the voices from the wider home care arena continues to be necessary in order to inform future policy direction for quality performance improvements for Australia’s consumers of home care and to move away from home care traditions of governing and ruling. The research additionally advocates for more inclusive governing approaches through more even distribution of power in consultative processes, research, oversight in the marketplace and access to resources for all groups. This thesis is a contribution to creating a new political dance in the space of Australia’s home care politics.Doctor of Philosophy
22
Lynch, Dorine A. "Basic Quality Care Blood Pressure Teaching Plan". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7821.
Testo completoAbstract (sommario):
Hypertension (HTN) is a leading risk factor for cardiovascular disease complications, disability, and mortality. Delayed detection of HTN increases the risk of the patient developing heart disease, renal failure, and stroke, which are among the leading causes of death in the US. Educating healthcare providers is, therefore, necessary to ensure accuracy when measuring blood pressure (BP) to improve the likelihood of early detection and commencement of treatment. The BP teaching project involved the development of an evidence-based teaching program to educate nurses at an East Coast Veterans' Administration Center on the guidelines of measuring BP. The practice-focused question addressed whether the literature would support a continuing education program in BP measurement to improve the nurses' knowledge and skills necessary to promote patients' quality of life related to HTN. The evidence-based literature supported education and provided the information used to develop the teaching modules. The frameworks guiding the project included practice modules grounded in quality improvement and, more specifically, the plan, do, study, and act cycles. The findings indicated a highly significant increase in nurses' knowledge of BP measurement after the educational session (p< 0.001). The implications for positive social change included improving the health outcomes of veterans and promoting HTN management in the East Coast VA primary care centers.
23
Magner, MaryBeth. "The Effects of Managed Care on the Quality of Dental Hygiene Care". TopSCHOLAR®, 1998. http://digitalcommons.wku.edu/theses/344.
Testo completoAbstract (sommario):
Managed care has become a prominent mechanism for insuring dental care. Empirical research suggests that managed dental plans provide lower quality care to patients. However, few studies have specifically addressed the effects of managed care on the quality of dental hygiene care. Thus, in this study the researcher examines whether dental hygienists deliver a lower level of treatment to managed care patients than to those who are not subject to managed care. Questionnaire data were gathered from 193 members of the American Dental Hygienists' Association residing in the Chicago area. The primary independent variable, managed care, was measured with an item that asked the respondents to indicate the percentage of patients they treat that are insured by a managed dental plan. The questionnaire also contained items that measured the frequency in which the respondents perform 23 tasks that are indicators of quality of dental hygiene care. Principal components factor analysis of these 23 items yielded the study's two dependent variables: periodontal procedures and appointment time. Regression analysis of the data revealed a significant negative relationship between managed care and appointment time. This relationship may be attributable to an economic incentive on the part of dentist-employers who control the amount of time scheduled for dental hygienists' patients. Dentist-employers may reduce the time available for managed care patients in order to allow longer appointments for more profitable fee-for-service patients. The study results did not support the notion that managed care affects the extent to which dental hygienists perform periodontal procedures. These mixed results suggest that future research should examine the relationships between managed care and other aspects of quality of dental hygiene care not addressed in the current study.
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Daskein, Robyn. "Nursing Documentation and Quality of Care in Residential Aged Care in Queensland". Thesis, Griffith University, 2008. http://hdl.handle.net/10072/367277.
Testo completoAbstract (sommario):
Little is known about the relationship between registered nurses’ (RNs’) knowledge of nursing documentation, their attitudes towards this documentation, and how they perceive the importance of the forms used in the documentation process within residential aged care. The current study has several aims. This investigation sought to gain a measure of RNs’ knowledge of, and attitudes towards documentation, and assess their perception of the importance of forms used to document care.
There were two phases of study. Study 1 utilised a cross-sectional, retrospective design with a large sample of RNs (n = 360) who completed Edelstein’s (1990) modified questionnaire to identify factors that influence nurses’ documentation in residential aged care in Queensland. A factor analysis was undertaken to extract influencing factors.
The second study developed and tested a conceptual model of nursing practice and quality of care to determine relationships between the factors under investigation. This phase used a smaller sample of RNs (n = 46). Participating RNs were asked to provide personal characteristics (e.g. age, gender, first nursing qualification and studies in aged care) and to complete Edelstein’s (1990) modified questionnaire. A chart audit was conducted on residents’ records where the resident required interventions for challenging behaviour. Relatives of residents whose charts were audited also completed a survey to measure their perceived satisfaction with care of their family member. Finally, a model of the relationships between documentation and outcome measures was developed on the basis of prior literature and previous empirical studies. This model was labelled “The Nursing Practice and Quality of Care Model”. This model was then tested with a smaller sample of RNs, seeking to find out if it appropriately represented the relationships that exist between RN documentation and outcomes.
Edelstein’s (1990) modified questionnaire was demonstrated to have acceptable reliability and validity. Results of Study 1 revealed that RNs working in aged care in Queensland have high levels of knowledge about documentation, and consider the forms they use to document care to be very important, but have mixed attitudes towards documentation. Several issues influenced the results for the knowledge and attitude scales. These included knowledge factors such as care-reporting guidelines, nurse time issues, legal issues and quality of reporting. Attitudes were influenced by charting, practice and policy issues. These findings provide important information on what variables affect RNs’ documentation.
The RN participants in Study 2 were comparable to the national and state figures for RN aged care demographics (Hsu, Moyle, Creedy, & Venturato, 2005; Richardson & Martin, 2004). Overall, the findings of Edelstein’s (1990) modified questionnaire in Study 2 were consistent with Study 1, although different relationships were found between the knowledge and attitude factors. The chart audit revealed that although RNs did complete most items on the forms, no form was fully complete, and suggests that RNs are not generally fully compliant with nursing documentation requirements in residential aged care. Relatives of aged care residents were generally happy with the level of care for their family member, but felt that individual issues such as leisure and activity programs, meals, and dining services could be improved.
Analysis of “The Nursing Practice and Quality of Care Model” involved structural equation modeling (SEM) to determine the relationship between experiences, knowledge and attitudes toward nursing documentation, compliance with writing nursing documentation and relatives’ satisfaction. Testing revealed that the model was generally a good fit; however, only some variables predicted to be included in the model were significant. Of greatest interest was the strong predictive relationship between care reporting guidelines and caring behaviour, which suggested that the more RNs knew about documentation, the better they were able to care for residents with challenging behaviour. Positive attitudes to policy issues by RNs, and high completion of charting review items also predicted better outcomes for residents. RNs who had studies in aged care showed a relationship with quality issues suggested that the more education RNs completed the more they knew about quality issues. However, there were some significant negative predictive relationships between variables such as quality issues and caring behaviour that were not anticipated. Overall results suggest that some RN documentation factors did significantly predict residents’ quality of care. This is an important step forward in finding ways to improve the care of residents in aged care facilities.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
Griffith Health
Full Text
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Glover, Gloria. "Relationships Between Nursing Resources, Uncompensated Care, Hospital Profitability, and Quality of Care". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7142.
Testo completoAbstract (sommario):
The value-based purchase requirement of the Patient Protection and Affordable Care Act puts pressure on hospital leaders to control cost while improving quality of care. The resource dependency theory was the theoretical framework for this correlational study. Archival data from the Centers for Medicare and Medicaid Services collected from 166 acute care urban hospitals for the Fiscal Year 2016. Multiple linear regression analysis was used to determine the relationship between nursing salaries per patient day, cost of uncompensated care as a percentage of net patient revenue, percentage of net income from patient services, and overall patient satisfaction for quality of care received. The multiple regression analysis results indicated the model as a whole to significantly predict overall patient satisfaction for quality of care for the Fiscal Year 2016, F (3,162) = 13.788, p = .000, and R2 = .203. In the final model, all 3 independent variables significantly predicted overall patient satisfaction for quality of care. Nursing salaries per patient day and percentage of net income from patient services were significant positive predictors of overall patient satisfaction for quality of care. Nursing salaries per patient day (� = .366, t = 5.120, p = .000) accounted for a higher contribution to the model than percentage of net income from patient services (� = .169, t = 2.374, p = .019). The cost of uncompensated care as a percentage of net patient revenue displayed a significant negative relationship with overall patient satisfaction for quality of care (� = .176, t = 2.458, p = .015). The implications of this study for positive social change include the potential to enhance the quality of care for patients while maintaining local hospitals' financial viability.
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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.
Testo completoAbstract (sommario):
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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Wallace, Amanda. "Effects of Telemedicine in the Intensive Care Unit on Quality of Care". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1612.
Testo completoAbstract (sommario):
The growing concern over the nursing shortage has affected the intensive care unit (ICU) and how these units provide quality care, adhere to best practices, and maintain high satisfaction scores. Implementing telemedicine technology allows the ICU to have additional staff available, via cameras at an offsite location, to assist with patient care. The purpose of this project was to evaluate the potential benefits of telemedicine application used within an ICU on quality of care, adherence to best practices, and satisfaction, as evidenced by data from the hospital's telemedicine dashboard. The goals of this project were to reduce length of stay, increase staff satisfaction, and increase compliance with best practices. The diffusion of innovation theory was used to bring about successful change among team members in the ICU. The Focus Plan, Do, Study, Act methodology was used to determine what improvements were needed in the ICU. The evaluation of the telemedicine unit demonstrated early signs of positive progress. Actual length of stay (3.25 days) from the hospital's telemedicine dashboard was less than the predicted length of stay (3.8 days), and adherence to best practice was at or above target (95%) when compared to all telemedicine units across the nation, as provided by the telemedicine dashboard. Implementing a telemedicine unit will bring about a transparency and standardization of Intensive Care services, leading to positive social change in the organization. This social change, combined with the success of the unit, can influence other non-academic healthcare institutions to pursue telemedicine technology.
28
Gunnarsdottir, Sigrun. "Quality of working life and quality of care in Icelandic hospital nursing". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2006. http://researchonline.lshtm.ac.uk/682349/.
Testo completoAbstract (sommario):
This thesis is a study about nurses' working environment in an Icelandic hospital (LSH), and its relationship with nurse job satisfaction, nurse burnout and nurse assessed quality of patient care. The study focuses on ways in which nurses' working environment can be improved to meet increasing health care demands and nurse shortages with the ultimate goal of providing high-quality patient care. Previous studies show positive relationships between supportive management, professional autonomy, adequate staffing and good inter-professional relationships, on one hand, and nurse job satisfaction, nurse burnout and quality of patient care, on the other. The first part of the study is a cross-sectional survey among a large sample of hospital nurses using an instrument previously employed in international studies. The second part is a series of focus group interviews with a sub-sample of the survey to further expand the survey findings. The study shows that working environment factors and nurse job outcomes are favourable for Icelandic nurses compared to nurses in five other countries. In this study the most important predictors of better nurse and patient outcomes are managerial support at the unit level, adequate staffing and good nurse-doctor working relationships. It is suggested that intrinsic job motivation, independent nursing practice, high educational background and supportive working environment of Icelandic nurses may contribute to their quality of working life and the quality of care they give their patients. The major contribution to knowledge from this study is to re-emphasise the important role of supportive frontline management, adequate staffing and good nurse-doctor working relationships, and to indicate the importance of intrinsic job motivation. Five new sub-scales to the key instrument are revealed, and a revised model on key determinants of nurse and patient outcomes is developed. -
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English, Christine. "Judging quality : parents' perspectives of the quality of their child's hospital care". Thesis, Northumbria University, 2017. http://nrl.northumbria.ac.uk/31608/.
Testo completoAbstract (sommario):
Background - UK healthcare has adopted various improvement strategies from business including using satisfaction surveys. However, the way patients form and express judgements of quality care can be more complex than customer purchases. Research in adult patient satisfaction has found capturing patient opinion challenging; however, adult service- user views continue to underpin quality care guidance across healthcare. Development of knowledge to include parental views of quality care is important to inform future guidance specific to children’s services. Methods - This study aimed to examine how parents determined the quality of care provided when their child was hospitalised, factors influencing perceptions of care and whether these judgements changed over time. Using a grounded theory approach, data were collected through a series of in-depth interviews (22) with nine parents following their child’s hospitalisation. Findings - The substantive grounded theory - Parenting in an alien hospital world: on guard and on behalf offers new perspectives on the complex psychosocial processes underlying parents’ quality judgements. When their child was hospitalised parents landed in an ‘alien’ world but continued to try 'to parent' (protect and advocate) their child. Parents' experiences were characterised by landing; moving from being' new parents' to 'old hands'; searching for and judging the 'clues' and facing dilemmas of how best to respond to professionals. Parents were found to use an escalating level of signals to prompt health professionals to respond to their queries and concerns Parents' personal lens altered through their transitional journey and this, together with their perception of professionals' power impacted on their chosen responses to professionals and their quality judgements. Parents held two views of care quality: ‘at the time’ and a final ‘on balance’ view. The final view recognised their own heightened emotions and reflected their current transition. Conclusions - Ultimately parents judge hospital care as high quality when they perceived health professionals acted as their allies in their parenting roles as protectors and advocates for their child in the alien hospital world. Health professionals could improve parents' experiences and quality judgements of care by early recognition and response to their 'signalling' and by explicitly acting as parental allies.
30
Senot, Claire. "Combining Conformance Quality and Experiential Quality in the Delivery of Health Care". The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1397407599.
Testo completo
31
Martin, Sedeeka. "Quality care during childbirth at a midwife obstetric unit in Cape Town, Western Cape: Women and midwives’ perceptions". University of the Western Cape, 2018. http://hdl.handle.net/11394/6892.
Testo completoAbstract (sommario):
Magister Curationis - MCurGlobally, there has been significant progress in reducing preventable maternal deaths and disability, and growing attention on improving the quality of care in maternal health care facilities. The World Health Organization (WHO) describes quality care as delivering healthcare that is effective, efficient, accessible, acceptable, patient–centred, equitable and safe (WHO, 2014). Midwives are the backbone of midwifery and therefore the primary care giver for pregnant women accessing maternal care and women’s ability to access quality midwifery care during the antenatal, labour and postnatal period is the key component in midwifery care. The Primary Level Protocol of South Africa is under the umbrella of the Primary Health Care System, and according to this system low risk women are expected to seek antenatal, intrapartum and postnatal care from the nearest Midwife Obstetric Unit (MOU). The choice a woman makes regarding access to maternity care depends on the social norms in her society and what services are offered. However, the services that are available may not meet the needs of pregnant women. Women may need detailed information about the availability of the maternity care system in order to make an informed decision on where to access the health system. The gap between the perceived needs of pregnant women and the care provided by midwives can be bridged by listening to women to create a reciprocal understanding of quality care. In South Africa, limited research has been conducted on midwives and women’s perceptions of maternity care. In the absence of such information, this study was conducted at an MOU in the Western Cape, with the aim of exploring women and midwives’ perceptions of quality care during childbirth.
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Prater, Laura C. prater. "Advance Care Planning: Implications for Health Care Quality at the End of Life". The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1534344349446923.
Testo completo
33
Parand, Anam. "The role of acute care managers in quality of care and patient safety". Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/11677.
Testo completoAbstract (sommario):
Healthcare managers have a responsibility for the standard of their services and patient care delivered. Their work is thought to be essential in achieving and improving high quality care and patient safety. However, little is empirically known about their role in this. This thesis investigates acute care managerial work and impact in the context of quality of care and patient safety. It draws upon power and work-activity group theories and literature from other industries to guide investigation and elucidate findings. The introductory Chapters (Chapters 1-3) provide the background context of quality of care and patient safety, relevant management theory, and literature on the role of acute care managers in quality and safety. A systematic literature review in Chapter 4 illustrates a case for empirical research on this topic and suggests areas for further investigation. Chapters 5 and 6 report a case study investigation of the senior manager’s dimensions of involvement in a quality and safety improvement collaborative. These Chapters present self-reports of 17 Chief Executive Officers and 18 Medical Directors across 20 NHS hospitals on their actions and contributions to the UK Safer Patients Initiative (SPI). From this, a model of five principle dimensions of involvement emerged. Corroborating this model, Chapter 7 reports the staff perspective of their senior managements’ role in SPI, comprising interviews with 36 staff also involved in the SPI programme across the 20 hospitals. To explore the work of the acute care middle manager in quality and patient safety, 36 interviews with general managers, service and divisional managers across two NHS Trusts and two specialities reveal their relevant training/learning, demands, choices and constraints (Chapter 8). This informed two follow up surveys that further quantified the interview findings and explored theoretical power and role constructs. The first survey presents the views of 100 middle managers from 10 NHS Trusts on their quality and safety-related time, learning, activities, power and impact (Chapter 9). The second survey reports 60 clinical staff views on the same items, illustrating some divergence on critical constructs (Chapter 10). The thesis closes with a final Chapter (Chapter 11) comprising a summary of the key findings per Chapter and the overarching themes from the thesis. Methodological limitations/strengths, wider implications for managers and policy makers, and future research are considered. The Chapter ends with concluding remarks on the critical work performed by acute care managers across organisational levels for the daily preservation of quality and patient safety and its improvement.
34
Newell, Amy Noël Abell Ellen Elizabeth. "Quality in family child care the voice of the family child care provider /". Auburn, Ala, 2009. http://hdl.handle.net/10415/1632.
Testo completo
35
Kocman, David. "Quality matters : re-formatting the boundaries of care in Czech social care policy". Thesis, University of Kent, 2013. https://kar.kent.ac.uk/47654/.
Testo completoAbstract (sommario):
This thesis deals with knowledge about the mechanics and effects of quality reforms in public service as advanced by critical policy studies. Critical policy studies have identified managerialism and marketization of public services as key conditions in introducing quality reforms. The argument has been built in opposition to proponents of quality who argue that marketization, when introduced to services, enhances their quality. In contrast, critical studies have shown that quality reforms have restructured organizational contexts of public services where quality acted mainly as a rhetorical figure, and where improvements remain dubious. The real effects of quality reforms, they argue, are increased control over practitioners’ labour process and de-professionalization. This thesis is a case study of a recent Czech social care reform. The Czech case is a case of a quality reform without marketization and managerialism, yet with a similar outcome in the form of managerialised care. As such, the Czech case offers an opportunity to further our knowledge about the mechanics of quality reforms provided we make a methodological step outside the analytics of managerialism. The thesis undertakes this methodological shift by drawing on Actor Network Theory. The question this thesis asks is how could managerialised care be achieved without either marketization or managerialism? Methodologically, the thesis argues that mapping social alliances among policy actors is necessary but in itself not sufficient to explain the outcome. The thesis traces the Czech quality reform from its inception as a policy project at the Ministry of Labour and Social Affairs to its circulation in social care sector. The Czech case shows how articulating quality service in quality standards re-organised care by extending (both conceptually and practically) its boundaries. Care traditionally understood as interactional bodywork was extended horizontally to include practices and forms outside the practitioner-client interaction (such as support planning), and it was extended vertically shifting the agency in care from an equipped practitioner to an equipped service. The contribution of the thesis is twofold. It shows that quality has gained a life in its own outside the managerialist causation model and may not necessarily follow in the footsteps of marketization and managerialism. Mainly, the thesis shows that quality is a complex shibboleth able to re-format the content of practitioner work rather than merely re-structure organizational contexts of public service provision.
36
O'Connor, Pauline. "Providing quality care : exploring contextual influences and ethical issues inherent in the delivery of quality care for people with dementia". Thesis, University of Edinburgh, 2006. http://hdl.handle.net/1842/29304.
Testo completoAbstract (sommario):
Findings are based on the work and experiences of twenty-four carers who were observed and interviewed during the course of caring for twenty female patients living with severe dementia. Based on a grounded theory approach to data collection the following five themes or aspects of care delivery emerged providing a focus for an in-depth analysis of how care was delivered: the management of care according to daily and weekly scheduled tasks; the promotion of the physical needs of patients over other aspects of care; communication difficulties in patient-carer encounters; environmental issues relating to the location, layout and design of the study site; and the management of patients with challenging behaviour. The findings revealed that the overall approach to care had its roots in well established prescribed methods of nursing practice, which were sustained by three independent but related factors: staff training, previous work experience and carers’ understanding of dementia. These factors seemed to be foundational to issues identified of an ethical nature in terms of the management of aspects of patient care. The ethical concerns explored in the study were primarily associated with assumptions made by carers regarding the inability of the patients to make choices or express preferences for example with respect to care and the management of their environment. While the study recognises the physical health and cognitive functioning of patients it recommends carers become aware of alternative practices underpinning a new culture of dementia care. The study concludes that combining the essential elements of the organic model with respect to diagnosis and medical treatment with an approach that is cognizant of a patient’s history, biography and subjective experiences is likely to ensure the delivery of improved quality care.
37
D'Ambruoso, Lucia. "Care in obstetric emergencies : quality of care, access to care and participation in health in rural Indonesia". Thesis, University of Aberdeen, 2011. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=165859.
Testo completoAbstract (sommario):
Study Setting: Two rural Indonesian districts served by the national midwife-in-the-village programme. Methods: Three critical incident audits of maternal mortality and severe morbidity: confidential enquiry, a verbal autopsy survey, and a participatory community-based review. Results: A range of inter-related factors contributed to poor quality and access. When delivery complications occurred, many women and families were un-informed, un-prepared, found care unavailable, unaffordable, and relied on traditional providers. Social health insurance was poorly promoted, inequitably distributed, complex, bureaucratic, and often led to lower quality care. Public midwives were scarce in remote areas and lacked incentives to provide care to the poor. Emergency transport was often unavailable and private transport incurred further expense. In facilities, there was reluctance to admit poor women, and ill-equipped, under-staffed wards for those accepted. Referrals between hospitals were also common. Examining adverse events from user and provider perspectives yielded multi-level causal explanations. These were used to develop a conceptual model relating structural arrangements (such as decentralisation, commodified care and reductions in public funding) to constrained service provision and adverse health consequences. Conclusions and recommendations: A policy shift towards healthcare as a public good may provide a route to reduce available maternal ill-health. Engaging with those who require and provide critical care in routine assessments can inform more robust health planning, and promote inclusion and participation in health.
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Plauché, Leneé Michele. "Eliminating waste in US health care: evaluating accountable care organizations as a model for quality sustainable care". Thesis, Boston University, 2013. https://hdl.handle.net/2144/12191.
Testo completoAbstract (sommario):
Thesis (M.A.)--Boston UniversityIn 2011, the United States spent $2.7 trillion in health care expenditures, accounting for 17.9 percent of the Gross Domestic Product (GDP). Health care spending increased by 3.9 percent in 2011 and is expected to surpass 20 percent of GDP by 2020. An investigation of national trends in health spending conducted by the Institute of Medicine (IOM) estimates that approximately 30 percent of US health expenditures—that is, about $750 billion—is wasteful spending. Analysis of spending trends suggests waste in health care falls into one of six categories: (1) failures in care delivery; (2) failures in care coordination; (3) overtreatment; (4) administrative complexity; (5) pricing failures; (6) and fraud and abuse. A sustainable level of health spending would be one that grows at the same rate as the GDP; this would require cutting health care expenditures by an estimated $2.2 trillion by 2020. Distributing these cuts across the spectrum of wasteful spending by specifically targeting cost-containment efforts toward those areas of waste, it is possible—albeit challenging—to create a more solvent health care system. The Patient Protection and Affordable Care Act of 2010 (ACA), landmark legislation of the Obama administration, introduced extensive policy changes and addressed the unsustainable trajectory of Medicare with the debut of the Accountable Care Organization (ACO). The novel ACO design aims to bring hospitals and physician groups into partnerships with the common goal of providing quality, affordable care to a defined population of patients with the introduction of a Shared Savings Program and a triple aim of: (1) improving population health; (2) providing higher quality-care experiences; and (3) moderating per-capita health care cost increases. The ACO has the potential to address each of the six areas of waste specified by the Institute of Medicine, bringing health care expenditures down to sustainable levels, while also increasing the quality of care and the efficiency of US health care overall. The ACO model is promising, but poses its own challenges as a largely untested health system structure, and will require extensive efforts to refine and perfect the model in order to be a feasible answer to the US health care crisis.
39
Whiteford, Chrystal Michelle. "Early child care in Australia : quality of care, experiences of care and developmental outcomes for Australian children". Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/81298/1/Chrystal_Whiteford_Thesis.pdf.
Testo completoAbstract (sommario):
In early childhood research, one of the most debated topics is that of early child care. This thesis draws upon data from Growing Up In Australia: The Longitudinal Study of Australian Children to explore the role of early child care in Australia. It examines the quality of early child care accessed by infants, the patterns of child care use across the early years and the impact of early child care experiences on academic, social-emotional and health outcomes at 6 to 7 years of age. Results indicate child care experiences vary considerably and suggest early child care experiences may have both positive and negative impacts upon later developmental outcomes.
40
Urassa, David Paradiso. "Quality Aspects of Maternal Health Care in Tanzania". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distrubutör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4221.
Testo completo
41
Petersson, Håkan. "On information quality in primary health care registries /". Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/tek805s.pdf.
Testo completo
42
Ekström, Anette. "Amning och vårdkvalitet = Breastfeeding and quality of care /". Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-240-3/.
Testo completo
43
Murton, Catherine S. "Profiling the quality of end of life care". Connect to this title online, 2007. http://etd.lib.clemson.edu/documents/1202410105/.
Testo completo
44
Momanyi, Kevin. "Enhancing quality in social care through economic analysis". Thesis, University of Aberdeen, 2019. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=240815.
Testo completoAbstract (sommario):
Population ageing has motivated policy makers around the world to focus on how best to organise health and social care services to meet an aniticipated growing demand on services. Two popular initiatives are reablement and telecare. Reablement is an approach within homecare that enables older individuals with social care needs to improve their functional performance and live independently. Telecare, on the other hand, involves use of devices to monitor individuals' health and safety, and provide response when needed. This thesis investigates the effectiveness of reablement and telecare by conducting a comprehensive review of the literature and undertaking three empirical studies. It is composed of six chapters. The first chapter presents a theoretical model that links the demand for reablement and telecare to various outcomes. The model is estimated using a strategy that controls for the effects of confounding variables and unobservable factors, and is general in the sense that it nests several other estimation strategies and study designs as special cases. The next chapter contains the literature review. Chapters 3, 4 and 5 present the three empirical studies. The first study investigates the effect of telecare on independent living at home; the second study determines the relationship between the use of telecare and admission to hospital, while the third study determines the relationship between telecare use and the length of stay in hospital. Chapter 6 concludes the thesis and provides some suggestions for further research. Unlike the results of the previous studies, the findings from this thesis suggest that the treatment effects are not homogenous across the poulation and also vary depending on the type of telecare device under consideration.
45
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.
Testo completoAbstract (sommario):
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.
46
Scharpf, Tanya Pollack M. S. "Functional Status and Quality in Home Health Care". Case Western Reserve University School of Graduate Studies / OhioLINK, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=case1112905040.
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47
Minich, Lisa. "Quality of Diabetes Care: Linking Processes to Outcomes". University of Cincinnati / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1291051784.
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Lee, Hyang Yuol. "Quality of care: Impact of nursing home characteristics". Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3352465.
Testo completoAbstract (sommario):
Thesis (Ph.D.)--University of California, San Francisco, 2009.Source: Dissertation Abstracts International, Volume: 70-04, Section: B, page: 2206. Advisers: Mary A. Blegen; Charlene A. Harrington. Includes supplementary digital materials.
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Mattila, Marja-Leena. "Quality-related outcome of pediatric dental health care". Turku : Turun Yliopisto, 2001. http://catalog.hathitrust.org/api/volumes/oclc/48714198.html.
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Hutchinson, Allen. "Exploring safety, quality and resilience in health care". Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/6574/.
Testo completoAbstract (sommario):
There still appears to be much to do to make the National Health Service in England a safer place for patients. Hospitals, in particular, are complex organisations in which staff and processes are under the twin simultaneous demands of an increasingly aged society and severe financial constraints. While much health care is well delivered, there remains a need to predict, and to explore, where and why problems occur. This thesis presents work which has refined methods and tools that can be used at health system and organisation levels to explore some key safety and quality issues in health care. The six publications presented and discussed here were published during a seven year period between 2006 and 2013. They explore three important issues relating to safer health care – safety culture and incident reporting, prospective hazard analysis, and the use of improved case note review methods to evaluate the safety and quality of care in hospitals. Two principal approaches to data access are presented in the publications. At the system and organisation level, information from large data sets was used to investigate the relationships between markers of safety and quality. At the health care provision level, data has been gathered about the work of health care professionals using mixed-methods approaches. The publications are discussed across two inter-related concepts – healthcare safety and healthcare resilience. While the study of safer healthcare has a long history the concept of healthcare resilience is still being developed. Resilience is concerned with the way in which organisations and people can adjust and maintain their functioning in the face of challenge or adversity. Although the presented publications themselves do not explicitly consider research into resilience, this theme is used to reflect on the study results and their potential value to health services.