Class of 2013 Abstract / Specific Aims: The purpose of this study was to determine what characteristics are most often associated with patients who are readmitted to a hospital for care within a 30-day time period for one of the five applicable conditions listed in the Hospital Readmissions Reduction Program, including heart failure, pneumonia, myocardial infarct, vascular procedures, and chronic obstructive pulmonary disease. Methods: This study was a retrospective chart review of patients who had a 30-day inpatient hospital readmission to a tertiary referral teaching hospital in Tucson, Arizona during the period from January 1, 2012 to June 30, 2012. Patient demographics and other characteristics thought to influence readmission were collected, including sex, age, race, type of insurance, number of applicable diagnoses at first admission, and number of medications prescribed at first discharge. “Applicable diagnoses” included: congestive heart failure (CHF); pneumonia (PN); myocardial infarct (MI); vascular procedures (VP); and chronic obstructive pulmonary disease (COPD). Main Results: Of the 1,102 patients included in this study, only 5% were readmitted for one of the five applicable conditions. The largest proportion of patients who were readmitted for the same diagnosis were in the 21 to 40 year old category, whereas the largest proportion of patients who were readmitted for different diagnoses were in the greater than 40 year-old category. The results of the multiple regression analysis showed that none of the independent variables predicted 30-day readmissions with the exception of Asian race (p=0.008, n=8) and other race (p=0.012, n=57). In addition, the only significant predictor of 30-day readmission was the diagnosis at initial admission (p<0.05). Conclusion: In our sample, only 5% of patients readmitted at 30-days were readmitted for an applicable condition. This means the majority of readmissions include diagnoses that are not currently affected by the changes to Medicare reimbursement, though other diagnoses are likely to be added to the list in the coming years. Our study provides evidence that specific patient demographic characteristics are not closely linked to 30-day readmissions. Therefore, it may be necessary to turn the focus away from targeting specific patient populations and towards improving efforts in the areas of discharge planning and quality of care for all patients.

There is an increasing need for day care services for children in most major urban centres on this continent due to marked changes in the patterns of family life, especially the tendency for women to be gainfully employed after marriage. For children under three years of age, family day care is generally considered to be the preferable type of care outside the home. There is an awareness of the need for this type of care in Vancouver, and also an awareness of the limited facilities available. The Department of Day Care Services of The Family Service Centre, in Vancouver, is an agency, which offers both group day care and family day care service. Because there are some parents who make frequent changes in family day care arrangements for their children, and because agency policy prefers that the duration of agency care be at least one year, agency, staff members feel concern about the use being made of family day care services. Also, since the literature based on psychiatric research suggests that frequent changes of substitute mothers is potentially damaging to children, the social workers at the agency are anxious to know whether there are causal factors in the terminations which could be eliminated. The study has been designed as an experience survey, which makes use of a control group defined operationally as stable, and two groups representing short term care and multiple placements. It was expected that there would be identifiable differences between these groups, some of which might prove to be significant. The study has three main objectives. The first objective is to discover the extent of the problem. The second objective is to identify, if possible, the factors involved in early termination of service and frequent replacements. The third objective is to design an instrument which would be of value in future research. In other words, although this was to be at first an experience survey, it also became a pre- evaluative study. Data have been collected from family day care case files and from information supplied by agency staff members. An instrument has been designed for the collection of data from the files. Our findings indicate that a number of factors appear in the family day care cases in various combinations but, of these, only two have proved to be significant. The families in the stable group are significantly more concerned about the quality of care their children receive. Also, in the stable group, there is a significantly higher frequency of adequate communication between the day care mothers and the natural mothers. Our experience with this study has allowed us to conclude tentatively, that early closing or replacement of children is generally due to factors beyond the control of the agency. It is possible, however, that methods could be developed by the agency to encourage better communication between the natural mother and the family day care mother. More research on parental motivation for using day care is indicated. / Arts, Faculty of / Social Work, School of / Graduate

A study of the attitudes of 40 mothers toward their child care arrangements tested hypotheses concerning the conditions of economic and child care necessity under which mothers of two socio-economic groups would be satisfied with their arrangements. It was hypothesized that the satisfaction with an arrangement would be associated inversely with economic necessity and child care necessity. A prediction was also made that the mothers' expressive satisfactions with the child care arrangements (benefits to the child and relationship to the sitter) would only be realized after the instrumental necessities of convenience and dependability of the arrangement were met. Interest in this study developed from Perry et al. (1967) where satisfaction with child care arrangements of employed mothers was studied. However, this study broadened the area of investigation to include all mothers using child care arrangements. A sample of 40 mothers was chosen, 20 from an upper middle class residential area, and 20 women receiving Aid to Dependent Children. The attitudes of these women were assessed through an interview schedule, a Likert scale of satisfaction items, and an independent rating by the interviewer. Four case studies of two mothers from each group were used to enrich the study with further descriptive data on the respective life styles of the two socioeconomic groups. No difference was found between the two samples in the level of satisfaction with the child care arrangement. However, the groups did differ in the pattern of satisfactions reported. Guttman scale patterns of the four subscales (convenience, money, benefits to child, and relationship to sitter) were reversed for the two groups. This difference in patterns was interpreted as a reflection of the socioeconomic standing and life circumstances of the mothers.

No description available.

No description available.

No description available.

This research project addressed the need for an adult day services (ADS) program in La Paz, Bolivia. Adult day services are community-based programs that provide a variety of services to functionally impaired adults through an individual plan of care. Adult day services are structured, comprehensive programs that offer services during any part of the day but fewer than 24 hours. I examined professionals' perceptions and attitudes about the needs of old adults in La Paz and the importance and viability of implementing an ADS program to meet those needs. The political economy of aging perspective provided the theoretical framework for this study. This theory focuses on the way that values and prevalent societal attitudes influence people's views of the aged population and the type of programs they believe should be developed for the care of that population. The review of literature addresses the needs assessment process and the U.S. model for ADS. An overview of the current situation of the elderly population in La Paz is presented in order to portray the context in which new programs for seniors would be developed in that city. Study participants, who provide a variety of services to old adults and their families in La Paz, completed interviews regarding (a) their perceptions of the needs of the old adults of La Paz, (b) the significance of developing a new program for their care, and (c) the feasibility of implementing an ADS program. I used descriptive and associational statistics to assess the attitudes and perceptions of respondents, the similarities and differences among their responses, and possible influences on their viewpoints. I extracted common themes in answers to the open-ended questions by employing qualitative techniques. The results of the interviews revealed that although professionals perceive that societal views of old adults are very negative in La Paz, they also believe this segment of the population is in great need of services that provide better, more adequate physical, emotional, social, and medical care than the services that exist today. Professionals also believed that it is crucial to develop new programs that address these issues and they considered ADS to be a viable alternative to institutionalization. However, their ideas about the structure and activities offered by an ADS program were quite different than those of the standard U.S. model. In order for the implementation of an ADS program to be successful in Bolivia it would have to be adapted to the cultural and economic context of that country. / Master of Science

The aim of this research was to examine developmental, parental and pedagogical factors influencing young children's (aged 4-5 years) engagement levels in group musical activities in child care centres. / Thesis (PhD)--University of South Australia, 2009

The aim of this research was to examine developmental, parental and pedagogical factors influencing young children's (aged 4-5 years) engagement levels in group musical activities in child care centres. / Thesis (PhD)--University of South Australia, 2009

Thesis (Ed. D.)--University of New South Wales, 1999. / Also available online.