Master of Public Health - MPH / This thesis aimed to explore systematic health service problems that are related to frequent readmission of persons suffering from severe mental illnesses to Valkenberg Hospital. Reduction of acute and chronic beds in the Associated Psychiatric Hospitals, Western Cape over the past decade has led to increasing pressure for beds and rapid inpatient turnover, many of these inpatients being "revolving door" patients. Integration of mental health service into general health services, an intrinsic part of the comprehensive primary health care approach in South Africa, is supposed to make mental health care more accessible the public, therefore research into why patients are being frequently readmitted at secondary specialist level is indicated. / South Africa

This thesis aimed to explore systematic health service problems that are related to frequent readmission of persons suffering from severe mental illnesses to Valkenberg Hospital. Reduction of acute and chronic beds in the Associated Psychiatric Hospitals, Western Cape over the past decade has led to increasing pressure for beds and rapid inpatient turnover, many of these inpatients being &quot / revolving door&quot / patients. Integration of mental health service into general health services, an intrinsic part of the comprehensive primary health care approach in South Africa, is supposed to make mental health care more accessible the public, therefore research into why patients are being frequently readmitted at secondary specialist level is indicated.

The purpose of this study was to determine the impact of a public smoking ban on the hospital admissions due to acute myocardial infarction in Delaware County, Indiana. The study population consists of all the patients admitted to Ball Memorial Hospital during three 22-month periods with a primary or secondary discharge diagnosis code of acute myocardial infarction (ICD-9-CM) immediately prior to the implementation of the ordinance. Chi-square was conducted for the three 22-month periods of hospital admissions. A significant drop occurred in the number of admissions among nonsmoking patients in Delaware County. The changes in the number of smoking-patient admissions before and after the ban were not significant. / Access to thesis and accompanying PDF permanently restricted to Ball State community only / Department of Physiology and Health Science

This thesis aimed to explore systematic health service problems that are related to frequent readmission of persons suffering from severe mental illnesses to Valkenberg Hospital. Reduction of acute and chronic beds in the Associated Psychiatric Hospitals, Western Cape over the past decade has led to increasing pressure for beds and rapid inpatient turnover, many of these inpatients being &quot / revolving door&quot / patients. Integration of mental health service into general health services, an intrinsic part of the comprehensive primary health care approach in South Africa, is supposed to make mental health care more accessible the public, therefore research into why patients are being frequently readmitted at secondary specialist level is indicated.

Objectives: This thesis addresses patients’ conceptualising of the experience of admission to and discharge from an inpatient mental health unit, and the role of measurable psychosocial constructs in this conceptualisation. Design: An embedded mixed-methods design was employed. Themes developed using thematic analysis were compared and contrasted with standardised assessment ratings. Methods: Twelve adult patients of an acute mental health unit took part in two separate interviews about their experience of admission and discharge, and completed standardised measures of anxiety and depression, social support, attachment style and illness beliefs. Interview data were analysed using social constructionist thematic analysis. Relationships between participants’ contribution to constructed themes and their responses to standardised assessments were discussed in the context of extant literature. Results: A total of fourteen themes were constructed, organised around a central theme of choices, planning and decision making. Many themes were comparable to existing constructs in attachment theory and the literature addressing illness appraisal, including mentalisation, the safe haven, internal working models, self as illness and shame. Standardised assessments supported and enhanced these interpretations. Conclusions: Understanding of the process and adaptation to the inpatient experience can be enhanced by reference to the concepts of attachment theory and social cognition. Incorporation of these concepts into current care practices and future service development may improve the inpatient experience.

Background: Spinal cord injury (SCI) is defined as a low incidence, high cost condition, however there is little information in the UK regarding the incidence, prevalence or associated costs of SCI. Additionally there is little evidence identifying outcomes or issues associated with delays in referral, admission or discharge from an SCIC or the impact of delays in provision of resources on reintegration outcomes. Research Aim: This novel study aims to determine factors and timings which may facilitate or limit successful rehabilitation and community reintegration for individuals with SCI. Map timescales and key indicators in the SCI injury and rehabilitation and reintegration pathways. Establish the impact of delays in provision of required resources on reintegration outcomes. Methods: An observational longitudinal study, collecting data regarding individuals from injury to one year post-discharge. Rehabilitation, reintegration and healthcare systems outcome measures to be evaluated were identified and included: community participation, quality of life, residential situation, readmission rate and vocational activity. Results: Delays in accessing services occur for a variety of issues and can have lasting impact. Many issues can affect progress and may have a more profound effect at particular points of the injury and rehabilitation pathway. At one year post discharge some subjects have fallen short of the identified outcomes; potential reasons for this are discussed in addition to issues that may have facilitated improved outcomes in some subjects. Conclusion: Some assumptions in SCI rehabilitation and reintegration have been challenged and some partially or fully supported. Novel findings have been identified in relation to physical social and psychological barriers or facilitators of outcomes following SCI. Potential areas for further research to increase our knowledge of issues for SCI individuals, SCIC services, acute hospital services and community services are identified.

by Kwok-Fai Mo. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 74-79). / Abstracts in English and Chinese. / Chapter 1 --- Introduction --- p.1 / Chapter 2 --- Statistical Modeling --- p.5 / Chapter 2.1 --- Poisson Regression --- p.5 / Chapter 2.2 --- Overdispersion and Autorrelation --- p.7 / Chapter 2.3 --- Generalized Estimating Equation --- p.9 / Chapter 2.4 --- Zeger's Mehthod --- p.12 / Chapter 2.5 --- Multicollinearity --- p.18 / Chapter 2.5.1 --- The Modified Generalized Estimating Equation --- p.18 / Chapter 2.6 --- Bootstrapping Method --- p.21 / Chapter 2.7 --- The Bootstrap Choice of Ridge Parameter --- p.23 / Chapter 3 --- The Robustness of Zeger's Approach to the Specification of ηt - Simulation Study --- p.26 / Chapter 3.1 --- Introduction --- p.26 / Chapter 3.2 --- Zeger's Algorithm with Varoious Time Series Data --- p.27 / Chapter 3.2.1 --- Data without Multicollinearity --- p.27 / Chapter 3.2.1 --- Data with Multicollinearity --- p.34 / Chapter 3.3 --- Modified Generalized Estimating Equation Approach --- p.40 / Chapter 3.3 --- The Choice of Ridge Paramter in Bootstrap --- p.42 / Chapter 4 --- Real Example --- p.46 / Chapter 4.1 --- Data Structure --- p.46 / Chapter 4.2 --- Model Building --- p.49 / Chapter 4.3 --- Single Pollutant Model --- p.57 / Chapter 4.4 --- Multiple Pollutant Model --- p.62 / Chapter 5 --- Conclusion and Discussion --- p.64 / Appendix --- p.69 / References --- p.74

This dissertation focuses on utilizing data-driven approaches to objectively measure variation in the quality of care across different hospitals, understand how physicians make dynamic admission and routing decisions for patients, and propose potential changes in practice to improve the quality of care and patient flow management. This analysis was performed in the context of Intensive Care Units (ICUs) and the Emergency Department (ED). In the first part, we assess variation in the overall quality of care provided by both urban and rural hospitals under the same integrated healthcare delivery system when augmenting administrative data with detailed patient severity scores from the electronic medical records (EMRs). Using a new template matching methodology for more objective comparison, we found that the use of granular EMR data significantly reduces the variation across hospitals in common patient severity-of-illness levels. Further, we found that hospital rankings on 30-day mortality and estimates of length-of-stay (LOS) are statistically different from rankings based on administrative data. In the second part, we study ICU admission decision-making dynamically throughout a patient’s stay in the general ward/the Transitional Care Unit (TCU). We first used an instrumental variable approach and modern multivariate matching methods to rigorously estimate the potential benefits and costs of transferring patients to the ICU based on a real-time risk score for deterioration. We then used the quantified impact to calibrate a comprehensive simulation model to evaluate system performances under various new ICU transfer policies. We show that proactively transferring the most severe patients to the ICU could reduce mortality rates and LOS without increasing ICU congestion and causing other adverse effects. In the third part, we focus on understanding how physicians make ICU admission decisions for patients in the ED. We first used two sets of reduced-form regressions to understand 1) what and how patient risk factors and system controls impact the admission decision from the ED; and 2) what are the potential benefits of admitting patients from the ED to the ICU. We then proposed a dynamic discrete choice structural model to estimate to what extent physicians account for the inter-temporal externalities when deciding to admit a specific patient to the ICU, to the ward or let him/her wait in the ED. Note that the structural model estimation is still an ongoing process and more investigation is required to fine tune the details. Therefore, we will not discuss the structural model estimation results in this chapter, but only present the modeling framework and key estimation strategy.

This study examined the effect of interdisciplinary discharge planning rounds on timing of social work intervention, length of stay (LOS), and readmission for patients aged 65 and over. Data sources were the medical charts of 449 patients discharged during two corresponding 28 day periods (one before end one after the implementation of rounds) supplemented by Discharge Planning Committee minutes (DPCM) and interviews with four key informants. No significant differences in the timing of social work intervention, LOS, or readmissions were found between the two samples. Qualitative research revealed that essential components were either missing (physician participation), or not uniformly included (family participation) in rounds, and that staff felt that rounds improved communication among the disciplines and contributed to improved efficiency in planning hospital and posthospital services. These findings highlight the need to further study all aspects of the complex discharge planning process to identify factors that would reduce LOS and readmissions.

Nursing is developing a science for explaining our interventions_ Hormones play a vital role in the female response pattern and that must be assessed in order for nursing to justify its actions. This descriptive design studied 30 women between the ages of 30 and 45 examining psychiatric addmissions and premenstrual syndrome (PMS). Two hypotheses were considered: 1) There is no difference in the incidence of admission to psychiatric facilities of women for depression, schizophrenia, or other psychiatric crises during the paramenstruum of their menstrual cycle and 2) There is no difference in the incidence of premenstrual syndrome symptoms among women admitted to psychiatric facilities during their paramenstruum.Data was obtained by questionnaire and chart review. The nominal data was analyzed using chi-square. No significant results were found statistically. The practical significance of the study is that 20 of the 30 women were admitted during their paramenstruum. / School of Nursing