<p> This convergent parallel mixed-methods study was conducted to examine the attitudes of emergency medical services (EMS) stakeholders based on the &ldquo;EMS Agenda for the Future.&rdquo; A sample of 104 accident and emergency (A&amp;E) doctors, prehospital EMS providers, and A&amp;E nurses in Barbados participated. The tripartite model of attitudes (beliefs, affect, and behavior) was used as the theoretical underpinning. Data collected using electronic surveys and information from semi-structured interviews were analyzed. affect and belief measures exists across the three groups of EMS stakeholders. The application of regression models confirmed that a significant relationship between affect and belief measures of the EMS stakeholders existed. A significant relationship also exists between belief and behavior measures of prehospital EMS providers. This research places on improving public health by addressing the beliefs, affect, and behaviors of EMS stakeholders.</p><p>

<p> The purpose of this systematic review was to examine the factors associated with clinicians' effectiveness as first-time healthcare managers. The high demand for clinicians to become healthcare managers has been predicated on their strong clinical knowledge and their credibility among their peers. While existing medical expertise and credibility among peers are crucial when transitioning into management, there are other factors that could impact clinicians' effectiveness as first-time managers. Utilizing a conceptual framework that incorporates motivation theory, social identity theory, leader&ndash;follower theory, and leader&ndash;member exchange theory, this research sought to identify factors associated with the effectiveness of clinicians as first-time healthcare managers. Evidence from 67 studies was analyzed using a thematic synthesis approach. The following six major factors were identified as factors that are associated with clinicians' effectiveness as first-time healthcare managers: (1) clinicians' motivation to transition into management, (2) clinicians' ability to detach from their social identity as clinicians and adopt a new social identity associated with their new role, (3) quality and convenience of formal developmental programs, (4) utilization of succession planning, and (5) cultural alignment. Based on the findings of this study, implementation of evidence-based succession planning programs would allow organizations to identify current and future open management positions, to systematically screen high-potential clinicians who are motivated to solve healthcare issues and achieve excellence, and to provide convenient and high-quality in-house management training and mentorship programs prior to role transition.</p><p>

<p> Lung cancer is the leading cause of cancer death in the United States and survival rates of American Indian and Alaska Native (AIAN) patients are worse than those of non-Hispanic White (NHW) patients. A contributing factor to the worse outcomes may be lower healthcare utilization of AIAN patients. But improving healthcare utilization of AIAN to levels used comparable to those of NHW might increase costs of their care to amounts comparable to those of NHW. <b>Objectives:</b> 1) To examine differences in total healthcare costs and healthcare utilization 12 months following lung cancer diagnosis between AIAN patients and NHW patients, 2) To examine differences in total healthcare costs and healthcare utilization during the end-of-life period (last 6 months of life) between AIAN patients and NHW patients who died from lung cancer or any cause, and 3) To compare the incidence of depression disorder 60 months after cancer diagnosis and determine depression treatment utilization among those with a depression disorder. <b>Methods:</b> The Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset was used. Patients included in the study were those age 65 years and older, diagnosed with lung cancer between 2000 and 2011, Part A coverage, Part B coverage and no managed care plan before. Diagnosis and procedure codes were used to identify costs, utilization, and depression diagnoses. The propensity score matching method was used to balance groups. A generalized linear model (GLM) was used for costs analysis and the negative binomial regression model was used to analyze healthcare utilization. A Cox proportional hazards regression model was used to identify risk factors for new diagnosis of depression. <b>Results:</b> Being AIAN was associated with lower total healthcare costs 12 months following lung cancer diagnosis. In contrast, being AIAN was not associated with total healthcare costs six months before date of death among patients diagnosed with lung cancer and &le; 6 month survival time. The incidence of diagnosis of depression disorder 60 months after lung cancer diagnosis was 3.67% for AIAN patients and 6.16% for NHW patients. The mean number of depression treatment visits suggests higher utilization among AIAN patients compared with NHW patients. AIAN patients were not at increased risk for depression after cancer diagnosis. <b>Conclusions:</b> The healthcare utilization of AIAN patients with lung cancer could be improved while keeping costs of care no higher than those of NHW patients. But any improvements of health care use would need to take account of the variability among AIAN patients receiving health care 12 months following cancer diagnosis, in the last six months of life, and after depression disorder diagnosis.</p><p>

<p> The purpose of this project was to fund a mobile wellness program for the homeless in Los Angeles County, California. This program will collaborate with service providers in the selected planning areas to promote and support the services of the program to the homeless. The host agency of this proposed project is the John Wesley Community Health Institute, located in Los Angeles County, California. </p><p> After conducting a review of the literature, the grant writer designed a program to provide primary care, behavioral health, and case management services to the homeless population. Specifically, this project will fund a mobile health clinic to offer services to four Service Planning Areas (SPAs) in Los Angeles County. The Annenberg Foundation was determined to be the most appropriate match for funding of the project. </p><p> The actual submission or funding of this grant was not required for the successful completion of the project.</p><p>

Some owners of small to medium-sized managed care businesses lack strategies to address the effects of healthcare regulations on their businesses. The purpose of this multiple case study was to identify strategies that owners of small to medium-sized managed care businesses used to address the financial effects of healthcare regulations on their businesses. The conceptual framework for this study was profit maximization and adaptation in changing contexts. Data were gathered from company documents, observations, and semistructured interviews with 5 home healthcare business owners in Los Angeles County, California. Data were coded to identify themes from the narrative segments. Key themes that emerged from the data analysis include home health strategic management, application of business strategies, healthcare reform, and strategic business processes. The implications of this study for social change include the potential to catalyze economic, intellectual, and social developments that improve community health and wellness programs and related activities in home health.

The Balanced Budget Act of 1997 introduced the new payment methodology for Medicare managed care plans. However, many managed care organizations started to withdraw from the Medicare market after the implementation of the Act, adversely affecting the accessibility to managed care plans for Medicare beneficiaries. The objective of the study is to examine the determinants of Medicare plus Choice Coordinated Care Plan withdrawal in the post-BBA era. Data on HMO plans for the years 1999 to 2002 were obtained from various sources for the pooled cross section and time series analyses. Samples were organized as per county, per contract, and per county-contract units. Several factors, including organizational attributes, geographic characteristics, performance measures, plan attributes, the degree of market competition, and time, were used for this study. Binomial logit model, multinomial logit model, and negative binomial regression model were employed for data analysis The results demonstrated that factors such as a higher level of M+C payment rate, higher out-of-pocket premiums, the provision of drug coverage, for-profit MCOs, contracts serving large amounts of counties, and a higher number of competitors in the service areas, would increase the probability of contract withdrawal. On the other hand, a higher number of M+C CCP enrollment, higher inpatient care capacity in counties, and more preventive care for enrollees offered by MCOs would reduce the probability of contract withdrawal. The selection effect of MCOs in choosing the service areas based on the demographic factors was detected. In addition, counties experiencing lower payment growth after the BBA tended to have lower numbers of M+C CCP contracts. Though contracts whose service areas had a smaller variance of payment growth after the BBA were found to be less likely to experience termination, they were more likely to experience partial withdrawal. This study advised policymakers to devise a more flexible reimbursement system, to develop a monitoring system to investigate weak contracts, and to develop policies for helping MCOs alleviate the problem of contract withdrawal while controlling the quantity and quality of care for beneficiaries / acase@tulane.edu

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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.

Thesis (Ph.D.)--University of California, San Francisco, 2009. / Source: Dissertation Abstracts International, Volume: 70-04, Section: B, page: 2211. Adviser: Robert Newcomer.