Tesi: "Quality of health care"

1

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.

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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&rsquo
s 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.

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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.

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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.

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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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4

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.

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5

Lee, Yuna Swatlian Hiratsuka. "Fostering creativity to improve health care quality". Thesis, Yale University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10633255.

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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.

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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.

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Petersson, Håkan. "On information quality in primary health care registries /". Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/tek805s.pdf.

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8

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.

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9

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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10

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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11

Hutchinson, Allen. "Exploring safety, quality and resilience in health care". Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/6574/.

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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.

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12

Brogienė, Daiva. "Patients' rights to quality in health care and health damage compensation". Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2010. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2010~D_20100507_093057-38617.

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Objects of dissertation: the quality in health care inpatient institutions and health damage compensation in medical malpractice litigation cases. This work is a scientific assessment of the implementation of the patients‘ rights to quality in health care and health damage compensation in Lithuania, where the functioning of two patients' rights is assessed in a systematic and integrated manner, both in the medical and the legal aspect. Research: the modified Picker Institute‘s questionnaire was used for the scientific research of 1917 patients treated in hospitals in order to examine and assess their opinions on the quality of health care provided to them and evaluate the opportunities to realize their right to health care of good quality. The study analyzed 32 medical malpractice lawsuit cases of general jurisdiction courts in terms of the principles of health damage compensation, procedural characteristics and efficiency. Conclusions: statutory regulation of patients 'rights to quality in health care services and health damage compensation in Lithuania meets international and European patients' rights protection principles. The research showed that the vast majority of surveyed patients (nine out of ten) realized their right to quality in health care service in the hospital. However, six out of ten plaintiffs received the health damage compensation, plaintiffs were awarded only nearly a fifth of the requested overall pecuniary and non-pecuniary damages.
Disertacijos objektai: sveikatos priežiūros paslaugų kokybė stacionarinėse asmens sveikatos priežiūros įstaigose ir žalos sveikatai atlyginimas gydytojų civilinės atsakomybės bylose. Šis darbas - pacientų teisių į kokybišką sveikatos priežiūros paslaugą ir žalos sveikatai atlyginimą įgyvendinimo mokslinis vertinimas Lietuvoje. Iki šiolei paciento teisė į kokybišką sveikatos priežiūros paslaugą nacionaliniuose moksliniuose darbuose buvo analizuojama kokybės vadybos aspektu, o teisė į žalos sveikatai atlyginimą buvo vertinama pagal galiojančius teisės aktus ir Lietuvos teismų praktiką. Tai pirmasis mokslinis darbas, kuomet dviejų pacientų teisių funkcionavimas vertinamas sistemiškai ir integruotai, kartu tiek medicininiu, tiek teisiniu požiūriais. Tyrimai. Pritaikius Europos Picker instituto modifikuotą klausimyną tirta 1917 stacionarinėse asmens sveikatos priežiūros įstaigose gydytų pacientų nuomonė apie jiems suteiktų sveikatos priežiūros paslaugų kokybę ir vertintos pacientų galimybės realizuoti teisę į kokybišką sveikatos priežiūros paslaugą. Analizuotos 32 LR bendrosios kompetencijos teismų civilinės bylos dėl žalos sveikatai atlyginimo, vertinant patirtos žalos sveikatai kompensavimo principus, procesinius ypatumus bei efektyvumą, atskleidžiant probleminius paciento teisės į žalos sveikatai atlyginimą įgyvendinimo aspektus. Disertacijos išvadose konstatuojama, kad paciento teisių į kokybišką sveikatos priežiūros paslaugą ir žalos sveikatai atlyginimą įstatyminis... [toliau žr. visą tekstą]

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13

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.

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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.

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Pammer, Christoph. "Quality of Care in Austria and Switzerland : ein Projektvorschlag /". Graz, 2004. http://www.public-health-edu.ch/new/Abstracts/PC_29.03.05.pdf.

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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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Glenn, Annalia. "Do electronic health record components improve the quality of health care in a primary care setting?" Connect to Electronic Thesis (CONTENTdm), 2010. http://worldcat.org/oclc/643296012/viewonline.

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17

Maříková, Irena. "Health Care Quality with the Patient in Relation to Strategic Management in selected Health-Care Organization". Master's thesis, Vysoká škola ekonomická v Praze, 2013. http://www.nusl.cz/ntk/nusl-194060.

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The aim of the thesis is to make the strategic analysis of the specific medical device in relation to quality of health care from the view of its patients. In this thesis are used selected analysis instruments of the strategic management. For finding of the quality of the health care, which the medical device provides, I used investigation through questionnaires. Information I gained through these questionnaires I have evaluated and analysed this data. The medical device I have chosen doesn't wish to be named in my thesis so I will respect the wish of its management. This hospital is located in The Central Bohemian Region, which is also its founder. This institution provides inpatient and outpatient care. The mail strength of the hospital is its employees and their human potential. On the other hand one of the serious weaknesses is the poor marketing productivity. My thesis will be closed with appropriate recommendations for the hospital which will be based on my analyses. The intention of these recommendations is to help the hospital in its future development. My thesis goes from the theoretical part (which explains the issue) and fallows with the practical part.

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18

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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Youn, Kyung II. "ORGANIZATIONAL SLACK, EFFICIENCY, AND QUALITY OF CARE IN ACUTE CARE HOSPITALS". VCU Scholars Compass, 1995. https://scholarscompass.vcu.edu/etd/5059.

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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.

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Batross, Deana J. "Correlation of Health Related Quality of Life and Health Literacy Levels in Patients with Heart Failure". Otterbein University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1461096576.

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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.

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22

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.

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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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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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24

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.

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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

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Cornoc, N. S. "Quality improvement cycle for cardiac failure in primary health care : Elsies River community health centre, Cape Town". Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97226.

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Abstract Introduction The study aimed to assess and improve the quality of care for congestive cardiac failure in a public sector, primary health care setting, in Cape Town. There is currently no literature available on the quality of care for the management of congestive cardiac failure in primary health care in South Africa. Methods A disease register was constructed by identifying patients prescribed Furosemide and checking the medical records. Altogether 95 patients with CCF were identified. The study followed the usual steps for a quality improvement cycle: Formation of an audit team; agreeing on criteria based on current CCF guidelines; collection of data from medical records to measure the criteria; analysis and feedback of results to the staff; critical reflection, planning and implementing change; re-audit of the medical records. Results There was a mean age of 63.4 years, 21% were male and 75% were females. The results of the initial audit revealed suboptimal management of patients diagnosed with CCF: 53% had an aetiological diagnosis recorded in the clinical notes, 24% had a documented functional capacity, 12% of patients had documented precipitating/exacerbating factors, 58% had fluid status documented, and 37% had documentation of their cardiac rate and rhythm. The intervention consisted of feedback on the audit results and critical reflection with the relevant staff members. The doctors were provided with a printed protocol to refer to for the management of CCF. Clinicians were resistant to change and to taking on new tasks in relation to the management of patients with CCF and decided to only focus on improving the clinical assessment of patients. The results of the re-audit after 5-months in 40 patients demonstrated improvement in the clinical assessment criteria: 95% of the patients had an aetiological diagnosis recorded in the notes, 50% had a documented functional capacity, 42% had documented precipitating/exacerbating factors documented, 72% had their fluid status documented, and 85% of patients had their cardiac rate and rhythm documented. None of the five assessment criteria were met at baseline but post-intervention three of the five met the target set and all showed substantial improvement. There was no improvement noted in any of the other criteria, which were not specifically focused on in the plan to improve clinical practice. Conclusion The current quality of care for CCF in primary health care is poor and needs to be improved. The quality improvement cycle led to substantial improvement in the clinical assessment of patients with CCF. Recommendations are made regarding future criteria, which could be included in local audit tools.

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Engström, Sven. "Quality, costs and the role of primary health care". Doctoral thesis, Linköpings universitet, Institutionen för medicin och hälsa, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5198.

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The general aim of this thesis is to describe and analyse the role of primary care in health care systems in terms of health, health care utilisation and costs, and to study the feasibility of retrieval of data from computerised medical records to monitor medical quality. The thesis includes five studies, a systematic literature review, a register study of utilisation of hospital and primary care, a study based on data from computerised medical records of individual patients cost for primary care, and two studies of management of respiratory infections in primary care based on data from computerised medical records of twelve health centres. The general findings of the literature review were that an expansion of the primary care component of the health care system would most likely result in better health, lower hospital care consumption and lower expenses for care. The personal physician and continuity of care were core elements to achieve this, and the significance of the way primary care is organised and funded was evident. In the register study fifty health centres were compared. Age and rates of outpatient hospital visits were the most important factors explaining the variation of rates of hospitalisations between the health centres’ areas. Hospital district also influenced hospitalisation rates in the different health centres’ areas, indicating that the health care structure in the district per se was an important factor. The rates of visits to general practitioners correlated negatively with rates of hospitalisations. The study of costs in primary care showed that the variation in the costs of the individual patients was substantial, also within age groups and within the diagnosis-related Adjusted Clinical Groups (ACG). Age and gender explained a smaller part of the variation in costs per patient in primary care. Adding the ACG weight had a major influence on improving the ability to explain the variation in costs at patient level. The ACG system might be of value in the calculation of weighted capitation in Swedish primary care, but appears to be sensitive to the thoroughness with which physicians register diagnoses. The retrieval of data from computerised medical records comprised a total number of 19 965 encounters for respiratory tract infections i.e. 199 per 1000 inhabitants during the year 2001. Most frequent diagnoses were common cold, acute tonsillitis, and acute bronchitis. The number of antibioticprescriptions was 7 961, accounting for 47% of the episodes. The most commonly prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides (8%). A rapid test was performed in 43% of the encounters: for C-reactive protein (CRP) in 31%; for Group A beta-haemolytic streptococci (StrepA) in 22%; and both tests were performed in 10% of the encounters. The findings in the study indicate that StrepA and CRP tests were used too frequently and often with minor contributions to patient management. The frequencies of tests and of antibiotic prescriptions varied greatly between health centres in a way that hardly could be explained by differences in morbidity. Computerised medical records provided a source of clinical information, which might be a feasible and pragmatic method for studying daily practice, and for follow-up of adherence to guidelines in general practice.

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27

Engström, Sven. "Quality, costs and the role of primary health care /". Linköping : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5198.

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28

Straten, Annemieke van. "Quality of hospital care and health outcomes after stroke". Proefschrift, [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/83805.

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29

Richardson, Samuel Starr. "Quality-based payment in health care: Theory and practice". Thesis, Harvard University, 2013. http://dissertations.umi.com/gsas.harvard:11142.

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Quality-based payment in healthcare—also known as pay-for-performance—is a popular policy intervention aimed at improving healthcare quality. However, there has been little theoretical work characterizing the underlying quality problem or the interaction between pay-for-performance and existing payment mechanisms. Furthermore, there is little empirical evidence that pay-for-performance has a substantial effect on healthcare quality.

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30

Schwartz, Aaron Lawrence. "Measuring Health Care Quality and Value: Theory and Empirics". Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17463148.

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Imperfect information is a pervasive feature of health care markets. Therefore, measuring the quality and value of health care services may inform efforts to improve health care delivery. This dissertation explores several applications of performance measurement in health care: describing national practice patterns, evaluating the effects of payment reforms, and contributing to policies that reward providers for measured performance. Chapter one describes the use of low-value services in fee-for-service Medicare. Drawing from evidence-based lists of services that provide minimal clinical benefit, I develop 26 claims-based measures of low-value services. Applying these measures to Medicare claims, I demonstrate that 42% of beneficiaries received at least one of these services in a year, which constituted 2.7 % of overall annual spending. When more specific and less sensitive versions of the measures were used, I detected low-value service use for 25% of beneficiaries, constituting 0.6% of overall spending. In adjusted analyses, spending on low-value services was substantial even in regions at the 5th percentile of the regional distribution of low-value spending. Adjusted regional use was positively correlated among five of six categories of low-value services. These findings are consistent with the view that wasteful practices are pervasive in the US health care system. The results also suggest that the performance of claims-based measures in supporting policies to reduce overuse may depend heavily on how the measures are defined. Chapter two examines the role of provider organizations in influencing the delivery of low-value services. In Part I of this chapter, I assess whether provider organizations exhibit distinct profiles of low-value service use in fee-for-service Medicare. In one sample of 3,137 large provider organizations and another sample of 250 provider organizations that entered the Medicare Pioneer Accountable Care Organization (ACO) Program or the Medicare Shared Savings Program, I demonstrate that provider organizations’ use of low-value services exhibits considerable variation, substantial persistence over time, and modest consistency across service types. In Part II of this chapter, I evaluate the effects of the Pioneer ACO Program on the use of low-value services. In a difference-in-differences analysis, I compare the use of low-value services between beneficiaries attributed to Pioneer ACOs and beneficiaries attributed to other providers, before (2009-2011) vs. after (2012) Pioneer ACO contracts began. During its first year, the Pioneer ACO program was associated with modest reductions in low-value services, with greater reductions for organizations that had provided more low-value services. The findings in this chapter suggest that provider organizations can influence the use of low-value services by affiliated physicians, and that organization-level incentives can reduce low-value practices. Chapter three analyzes the economic properties of performance measures used in both health care and education policy. Because observable outcomes constitute a noisy signal of performance in these settings, shrinkage estimators are often used to improve measurement accuracy. I demonstrate that these improvements in accuracy come at the cost of reducing a measure’s responsiveness to agent behavior, thereby diluting incentives for performance improvement. In a model of consumers sorting between agents, I show that welfare depends on two components: (1) accuracy of performance signals, which promotes efficient consumer sorting, and (2) incentives for performance improvement, which promote efficient agent effort. Using Monte Carlo simulation, I evaluate the accuracy and incentive properties of various techniques for estimating hospital performance in heart attack mortality. Shrinkage estimators entail substantial incentive distortions, particularly for smaller hospitals, which experience an approximate 50-70% “tax” on improvement. Several estimation techniques, including the methods currently used by Medicare, are dominated on the basis of both accuracy and incentive criteria. I discuss various policy alternatives to shrinkage estimation, such as increasing the timespan of measuring performance.
Health Policy

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31

Badrick, Tony Cecil. "Implementing total quality management in Australian health care organizations". Thesis, Queensland University of Technology, 1997.

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32

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.

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33

Bell, Mary Ann 1953. "Perceptions of quality of care in the nursing home". Thesis, The University of Arizona, 1992. http://hdl.handle.net/10150/291785.

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The purpose of this study was to determine the perceptions of residents, family members, and nursing staff regarding quality of care and the physical environment in the nursing home. Relationships among quality of care, the physical environment, and selected organizational characteristics were then described. The Quality of Care Scale (QoCS) and the Environment Description Scale (EDS) were given to a convenience sample of 100 subjects. A significant difference in perceptions of quality of care was found between the nurse assistants and residents. Significant relationships were obtained between perceptions of quality of care and the physical environment for Registered Nurses, Licensed Practical Nurses, and families. Defining quality of care and determining the significance of the physical environment from the consumer perspective may contribute to both quality of life and quality of care in the nursing home.

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Lindberg, Malou. "Asthma nurse practice in primary health care : quality, costs and outcome /". Linköping : Univ, 2001. http://www.bibl.liu.se/liupubl/disp/disp2001/med695s.pdf.

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35

Magner, MaryBeth. "The Effects of Managed Care on the Quality of Dental Hygiene Care". TopSCHOLAR®, 1998. http://digitalcommons.wku.edu/theses/344.

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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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Liebe-Harkort, Carola. "Oral Health Care and Humanitarian Health Praxis". Thesis, Röda Korsets Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-2276.

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Background: Oral and dental diseases is a major part of the global disease burden. Poor oral health has a significant impact on the general well-being of people. In contrast with prior decades high rates of oral diseases may be found in low- and middle income countries. Populations that are particularly vulnerable are more likely to develop poor oral health. As a consequence of human distress related to war, poverty and natural disasters the accomplishments of humanitarian aid organizations has a direct impact on people´s health and well-being. Purpose: The aim of the present study is to examine the International Red Cross and Red Crescent Movement as well as Doctors without borders concerning documents and guidelines on oral health. A further aim is to explore the knowledge of oral health related topics of delegates from the International Federation of the Red Cross and Red Crescent Societies (IFRC). Method: The study is designed as a literature review and a questionnaire survey. Results: Within the International Red Cross and Red Crescent Movement and Doctors Without Borders there are a limited number of guidelines on oral health and they are rarely mentioned in the same documents as non-communicable diseases (NCDs). The responses of the study revealed that the participants generally have a limited knowledge about measures on oral health in the IFRC. Conclusion: Both the literature review and the questionnaire survey study confirms that there is an absence of clear and specific guidelines on oral health care related activities within IFRC.
Bakgrund: Mun- och tandsjukdomar utgör en stor del av den globala sjukdomsbördan. Dålig mun- och tandhälsa har en stark påverkan på det allmänna välbefinnandet. I motsats till tidigare, ses idag höga frekvenser av karies även i låg- och medelinkomstländer. Populationer vilka befinner sig i extra utsatta kontexter löper större risk att utveckla dålig munhälsa. Som en följd av mänskligt lidande i form av händelser relaterade till krig, fattigdom och naturkatastrofer har aktiviteter utförda av humanitära hjälporganisationer en direkt inverkan på hälsa och välbefinnande. Syfte: Syftet med föreliggande studie är att studera dokument och riktlinjer rörande munhälsa inom Internationella Röda korset och Röda halvmånen och Läkare utan gränser. Ett ytterligare syfte är att undersöka kunskapen om hälsorelaterade frågor kring munhälsa hos delegater från Internationella federationen för Röda Korset och Röda Halvmånen (IFRC). Metod: Studien är utförd som en litteratur-sammanställning och som en enkätundersökning. Resultat: Inom Internationella Röda korset och Röda halvmånen samt Läkare utan gränser återfinns begränsat antal riktlinjer rörande oral hälsa vilka dock sällan nämns i samma dokument som icke-smittsamma sjukdomar (NCDs). Av enkätsvaren i studien framgår det att de medverkande generellt har en begränsad kunskap kring åtgärder rörande munhälsa inom IFRC. Konklusion: Deltagarna i denna studie bekräftar resultaten i litteraturstudien om en avsaknad av tydliga och konkreta riktlinjer för munhygienrelaterade aktiviteter inom IFRC.

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Mgwili, Victoria Nokwanele. "Experiences of the disabled women attending the state-provided reproductive health care services regarding the quality of care rendered by health care professionals in the Eastern Cape". Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/11374.

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The purpose of this study was to explore and describe the experiences of disabled women, attending the state-provided reproduction health services, regarding the quality of care rendered by health professionals in the Eastern Cape. The study was conducted on disabled women at Flagstaff and Lusikisiki self-help group project sites.

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38

Lu, Wei. "Economic determinants of quality of care in nursing homes". Thesis, Wayne State University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3626093.

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This dissertation examines the factors that will affect nursing home quality of care using several national data sources on market regulation, county demographic characteristics, market structural and the characteristics of different types of long-term care providers in 2010.

The first study examines how nine different measures of nursing home care quality respond to the greater levels of local market competition from these alternative providers of long-term care, as well as other nursing homes. Findings reveal that faced with greater competition from assisted living facilities, nursing homes are left to care for more disabled, less healthy patients. Although the nursing home's staff-to-bed ratios rise in response, other measures of care quality decline, such as more process- and outcome-based measures. Competition from home health agencies likewise has mixed effects on nursing home care quality, and competition from other nursing homes in a market tends to decrease care quality. These finding suggest that care quality in nursing homes may continue to erode as the market for alternative, community-based long-term care services expands.

The second study examines the Medicare regulation effects on nursing home quality controlling for the whole long-term care market competition structure. In many local markets nursing homes now compete with assisted living facilities for residents, yet most previous studies of the effects of Medicaid nursing home reimbursement policies on care quality have analyzed nursing homes in isolation, ignoring the presence of nearby competitor firms, and how state regulation of assisted living facilities might also affect care quality in nursing homes. This study uses a richer model specification that accounts for a much broader range of state long-term care regulations as well as the structure of a nursing home's local market. Findings reveal that a higher Medicaid reimbursement rate leads to significant improvements in nine different aspects of nursing home quality, while state certificate-of-need programs for nursing homes lead to a decline in several (but not all) dimensions of it. A large presence of assisted living beds in a local market also tends to reduce nursing home quality, and state regulations regarding assisted living facilities indirectly affect nursing home care quality by altering the nature of local market competition. Overall, these results suggest that state laws related to all long-term care providers, not just nursing homes, are important determinants of nursing home care quality.

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Lindström, Kjell. "Methods for quality development of the primary health care structure /". Linköping : Univ, 2002. http://www.bibl.liu.se/liupubl/disp/disp2002/med719s.pdf.

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40

Villar, Corrales Carlos. "A Goal-Driven Methodology for Developing Health Care Quality Metrics". Thèse, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/19850.

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The definition of metrics capable of reporting on quality issues is a difficult task in the health care sector. This thesis proposes a goal-driven methodology for the development, collection, and analysis of health care quality metrics that expose in a quantifiable way the progress of measurement goals stated by interested stakeholders. In other words, this methodology produces reports containing metrics that enable the understanding of information out of health care data. The resulting Health Care Goal Question Metric (HC-GQM) methodology is based on the Goal Question Metric (GQM) approach, a methodology originally created for the software development industry and adapted to the context and specificities of the health care sector. HC-GQM benefits from a double loop validation process where the methodology is first implemented, then analysed, and finally improved. The validation process takes place in the context of adverse event management and incident reporting initiatives at a Canadian teaching hospital, where the HC-GQM provides a set of meaningful metrics and reports on the occurrence of adverse events and incidents to the stakeholders involved. The results of a survey suggest that the users of HC-GQM have found it beneficial and would use it again.

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Collin, Bagewitz Ingrid. "Prosthodontics, care utilization and oral health-related quality of life /". Malmö : Malmö högskola, 2007. http://dspace.mah.se/handle/2043/3896.

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Bagewitz, Ingrid Collin. "Prosthodontics, care utilization and oral health-related quality of life". Malmö [Sweden] : Malmö högskola, Dept. of Prosthetic Dentistry, Dept. of Oral Public Health, Faculty of Odontology, 2007. http://catalog.hathitrust.org/api/volumes/oclc/122895139.html.

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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.

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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.

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Thesis (M.A.)--Boston University
In 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.

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Marimuthu, Sarojini. "A quality improvement cycle for acute bronchospasm in primary health care: Mitchell's Plain Community Health Centre, Cape Town". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/13805.

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Asthma affects over 300 million people worldwide and is the sixth highest cause of morbidity and mortality in South Africa. Mitchellâ€™s Plain is a large suburb in Cape Town, with a population of approximately 320 000 people. A previous study in 2006 indicated that 15.7% of patients that presented to Mitchellâ€™s Plain Community Health Care casualty were for an acute exacerbation of asthma and 7.8% of total deaths were from acute asthma. There was generally poor adherence to the national guidelines with respect to the management of an acute asthma exacerbation. Aim and Objectives: This study aimed to assess and improve the quality of management of acute bronchospasm at Mitchellâ€™s Plain CHC. Objectives included assessing the current management, comparing it to the national guidelines and implementing strategies to improve care. Method: The study methodology was that of an audit cycle. Eligible patients were identified from the casualty admissions register. A total of 351 patientsâ€™ records were reviewed and compared to criteria based on the national guidelines. The initial findings were presented to the casualty staff that critically reflected; planned and implemented change. Intervention strategies involved raising awareness about the asthma guidelines, the audit tool and the South African Triage Score. A re-audit was performed after 6 months.

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Ekström, Anette. "Amning och vårdkvalitet = Breastfeeding and quality of care /". Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-240-3/.

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Arnetz, Judith E. "Violence towards health care personnel : prevalence, risk factors, prevention and relation to quality of care /". Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-3254-9/.

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Patterson, Jan. "Consumers and complaints systems in health care /". Title page, contents and summary only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09php3174.pdf.

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Rabih, Joyce. "TQM implementation in health care : a proposed framework". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ39974.pdf.

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Mandizvidza, Vimbai. "Quality of current ischaemic stroke care practices in the Cape Metro Health District, South Africa". Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27457.

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The aim of this study was to assess the acute and post-acute services for ischaemic stroke patients in the Cape Metro Health District in relation to the South African ischaemic stroke guideline. Part A: Protocol - The protocol outlines the purpose of the study and highlights the importance of conducting this study by analysing the literature on stroke care in both high and low and middle-income countries. The literature also highlights the gaps in stroke care in South Africa which justify the need for this study. The protocol also outlines the methods of data collection and analysis as well as the ethical considerations. Part B: Literature Review - This expands on the literature on the different components of both acute and post-acute stroke care in both high and low and middle-income countries. It also elaborates on stroke in South Africa and why it is important to conduct this study. Part C: South African Medical Journal manuscript - The manuscript summarises the whole study and includes the literature on stroke care, justification of the study and how the data was collected and analysed. The manuscript also includes the results obtained and sections on the discussion and conclusions.

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