BACKGROUND: Health Information Technology (HIT) enhances patient safety, which can also help to reduce health care costs. When it is used to replace the paper-based records, it will alter the workflow of front line workers and facilitate the management of care. The data captured can be shared in a seamless manner throughout the whole patient care journey. Since a significant upfront investment is required in the implementation and the use of the Electronic Health Record (EHR), it is still recognized as one of the major barriers. Despite these factors, governments and private health care provider organizations are all moving to implement a myriad of HITs. Therefore, meaningful use (MU) is an important criterion when assessing HIT utilization. This study focuses on the review and synthesis of evidence relating to the cost and effectiveness of health informatics adoption for health care delivery. Taking these findings into account may increase the likelihood of successful and cost-effective HIT implementation. METHODS: Literature searches of BMJ, Science Direct, and PubMed as well as a manual search for grey literature via Google scholar were performed. The inclusion criteria were any studies, both quantitative and qualitative, that describe the cost-effectiveness of informatics via any type of HIT used during the provision of health care services. English publications from 2003 to 2013 with any type of study setting were included. Through this search, nine articles were chosen for the final analysis. RESULTS: Among the nine selected studies, eight of them concluded that the adoption of HIT may-be-cost-effective to health care delivery. One study found the adoption of HIT not effective. The studies did not provide sufficient and concrete evidence to prove cost-effectiveness of HIT adoption. DISCUSSION: There is insufficient evidence to support the cost-effectiveness of HIT adoption. The cost data from these studies are not available. Data quality, system design, and physician behavior are other concern for MU of health informatics. Health care organization and governments should engage with the end-users (e.g. medical & paramedical personnel and patients) during system design (or selection), adaptation and implementation. CONCLUSION: Stakeholders should be aware of the tradeoffs throughout the implementation process. HIT scope, design, development, implementation, and performance monitoring should be well planned right from the start. In the foreseeable future, formal economics evaluation reports of Cost-Effectiveness Analysis (CEA) should be compulsory for stakeholders investing in Health Information Technologies. / published_or_final_version / Public Health / Master / Master of Public Health

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<p> The food industry has experienced changes in the past several years that include the awareness of food choices. Recently, national advertising campaigns have focused on efforts to increase the public awareness of healthy food choices and calorie intake. The healthy food choice campaigns may prove to be effective with a specific population. However, research studies revealed that residents living in disadvantaged areas lacked the income and/or transportation to access the healthy food options. </p><p> The intent of the Livin&rsquo; the Food Life, LLC organic mobile market/caf&eacute; is to introduce and provide hot prepared, organic foods and fresh organic produce at affordable prices to the low-income children and their families. Livin&rsquo; the Food Life, LLC organic mobile market/caf&eacute; will increase awareness through monthly food demonstrations and the distribution of samples to educate the low-income residents of East and South Los Angeles with the benefits of cooking and consuming organics food products.</p>

<p> Youth Centers play an important part in providing adolescent teens with a social and recreational venue to develop physically and expand mentally. The goal of this project is to develop a business plan related to a community based youth center in Long Beach, CA. This venue will offer services targeted towards the prevention of obesity, chronic health conditions, and mental wellness. The purpose of this plan is to propose a youth center that has programs implemented to prevent and reduce the prevalence of obesity and increase high school graduation rates that lead to secondary education programs. Emphasis will be placed on focusing programs aimed at the Black community because Long Beach lacks organizations that focus on this population. </p>

<p> The changing landscape of health care in the United States provides various opportunities for both providers and patients to adapt the way they give and receive their medical services, especially for those individuals in their senior years. EARS2U intends to capitalize on the aging American population and patients&rsquo; desire to have Audiology services come to them. EARS2U seeks to be the only mobile Audiology and Hearing Aid service in the San Diego and Orange county area that provides mobile access. This business plan will show how EARS2U intends to provide mobile service and become a substantially lucrative company.</p>

Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.

This thesis explores the quality of health care delivery in rural Ghana. In Ghana, the Ministry of Health has been concerned about the quality of health care for sometime, but improvements in quality have been slow to develop and become noticeable: there continue to be complaints about the quality of care given by health workers and received by clients. For their part, health workers have reported the challenges to delivering quality services, while patients describe difficulties of accessibility and technical competence of health workers. It was envisaged that an exploration of the quality of care at the district level would reveal the range of constraints to provision and receipt of quality care, providing an evidence-based analysis incorporating the views of the important stakeholder groups, that could help to contribute to quality improvement in rural Ghanaian health care, especially in primary health care delivery at the local level. The study reported here was carried out in rural Amansie West district in the Ashanti region of Ghana. Using the administrative district as a case study allowed for “multiple sources of evidence gathering”, thus ensuring that the findings are more likely to reflect reality if based on several different sources of information and types of data. The study design was qualitative and involved qualitative data collection methods, including: semi-structured interviews with 66 patients, 25 health workers from seven primary health care facilities and six core members of the district health management team; and focus groups that involved discussions with members from seven communities. These data collection methods explored study participants‟ ideas about the definition of quality of health care, perceptions about the quality of actual health care delivery and feelings about the quality improvement strategy adopted in the primary care facilities studied. Interviews were tape recorded with consent, and translated into English as they were transcribed. Data were analysed manually, using iteration and thematic analysis. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of statements and their meaning to participants. Thematic qualitative analysis of the data suggested that the different provider, recipient and administrative level groups had similar views on what constituted quality of care. In their perceived definitions, all groups tended to emphasise the importance of interpersonal relations, accessibility, technical competence and effectiveness, but these dimensions variously „ranked‟ in importance by stakeholder groups. Perceptions of the quality of actual health care received and the quality improvement process being deployed in Amansie West revealed that many of the obstacles to high quality health care were described as residing within the structure of health care delivery. This study provides new knowledge about perceptions of quality, experience of quality and quality improvement in a rural area of a developing country. It has improved understanding of the differing views held by the different stakeholders. It shows the dimension of understanding about quality added when the views of patients and community members are considered in addition to providers and administrators. Findings suggest improvements could be made to structural aspects of health care provision that could improve quality: for example, appropriate equipment, trained health workers and sufficient numbers of trained workers.

<p> The Institute of Medicine evaluated the U.S. health system in the 1990s and found an extremely expensive system with clinical outcomes that were ranked lower than a number of other industrialized nations. (Institute of Medicine, 2001) In addition, the per capita spending was almost double that of other nations. The U.S. health care system was fragmented, highly technical, and specialty oriented. Even though the primary care system is the backbone of more efficient and less expensive systems in other countries (Landon, Gill, Antodelli, &amp; Rich, 2010). The primary care system was in a downward spiral in terms of morale and number of U.S. medical students entering primary care specialties. To respond to the call of the Institute of Medicine and the ongoing decline of primary care residents, seven primary care organizations including the American Academy of Family Physicians and the American Board of Family Medicine, published a report called the &ldquo;Future of Family Medicine&rdquo; (Kahn, 2004). The report described a new model of family medicine called the patient-centered medical home (PCMH). The model needed to be standardized to evaluate outcomes. Three bodies provide certification: the Joint Commission, the Accreditation Commission for Health Care, and the National Committee for Quality Assurance (NCQA) (Klein,, Laugesen, &amp; Liu, 2013). The NCQA is the organization that most of the practices use for recognition (Landon et al., 2010). Various organizations have conducted studies on the implementation PCMH and found the PCMH model took about two years to implement, consumed practice resources but led to improved quality and some indication of lower costs (AHRQ, 2012). To become the future landscape of primary care, the PCMH model depends on small practices adopting it because a large percentage of family practices have fewer than five providers (Scholle, et al., 2013). The Hamilton Family Health Center (HFHC) of Community Memorial Hospital (CMH) is a small center with the equivalent of three and a half full-time providers and two specialists. The CMH recently became a critical access rural hospital certified for 25 beds, whose average daily census is 15-16 patients. This project was a combination of participatory action research (PAR) and insider action research (IAR). The project can be classifed as PAR because the staff, providers, and patients were involved and had significant input. The project is considered IAR as well because the author was also a provider in the center. The project goal was threefold: (a) achieve level three PCMH status for a small health center with markedly limited resources, (b) identify the process taken to meet this goal and how it can be improved and (c) learn what the changes will mean for the center. The Hamilton Family Health Center has achieved level three, but the project is ongoing because achieving the NCQA standards is only a step to achieving an ideal practice.</p>

The development of palliative care in terms of recognizing the needs of the dying, palliative care becoming a nursing and medical speciality, the involvement of the World Health Organization in palliative care and the continuous development of treatment modalities available to cancer patients creates the expectation that the outcomes for the patient should also be positively influenced. The purpose of the study was to determine the most common symptoms of advanced cancer patients treated in a public and private hospital in Tshwane, and whether advances in palliative care improved the outcomes for these patients by decreasing the prevalence of symptoms experienced. The design of the study was a quantitative survey. The population consisted of patients with advanced cancer receiving palliative treatment as out patients in radiation and medical oncology clinics in a public and private hospital the Tshwane Metropolitan area. The sampling method was convenient and the sample size was 148 participants (n=148). Data was gathered by means of an interview and self report. Data analysis was done by means of descriptive statistics. The results of the study indicated that a high number of patients still experience problems that could have been prevented. Pain was found to be the biggest problem for patients (76.4%) followed by weakness and fatigue (65.5%), nausea and vomiting (65.5%) and a dry mouth (46.6%). Thirst was reported by 41.2% of the sample. The study provides evidence that the development of palliative care did not have a positive outcome for patients by reducing the prevalence of symptoms experienced.

<p> This study examines methods and barriers to minority leadership recruitment in healthcare organizations. Minorities are underrepresented in healthcare organizations at the executive level, even though staff and patient demographics are becoming increasingly diverse. This disparity in minority representation presents the potential for staff and patient needs, interests, and values to be overlooked by senior management and the strategies, policies, and programs they implement. This study conducted interviews with human resources personnel at healthcare organizations identified as top performers to determine whether their organizations engaged in minority recruitment methods, what methods were successful, and what barriers existed to recruitment of minorities. These results were compared to survey data compiled by the Institute for Diversity in Health Management. The results show significant room for improvement in the implementation of comprehensive methods to recruit minority senior management, with significant variation among organizations in the amount and type of methods to recruit minority executives. These findings lead to the conclusion that more pressure needs to be placed on healthcare organizations to identify best practices in minority recruitment and implement these in formal, comprehensive human resources activities related to recruitment, retention, and professional development.</p>