Thesis (M.S.)--Pennsylvania State University, 2008. / Mode of access: World Wide Web.

The ambulatory care facility is a new phenomenon in the British Columbia health care delivery system. Therefore, not only is its planner faced with the uncertainty of predicting future need, but also the perplexity of not having the very basis for his predictions: past utilization data from existing facilities. Moreover, there is no real agreement on what services should be provided in an ambulatory care facility. This thesis attempts to at least partially allay these uncertainties by setting down a format for planning an ambulatory care facility in and for the community of Delta, B. C. The planning method was divided into four parts: ambulatory care definition, data assemblage, data projection and facility simulation. Delta practitioners and several health care consultants co-operated in the production of an exhaustive list of medical, surgical and dental procedures defining ambulatory care. In accordance with this list, data was assembled regarding the number of ambulatory procedures regularly performed for Delta residents, by Delta practitioners. Medical and surgical data was taken from Provincial Department of Health computer data files; while dental data was gathered by questionnaire. The data trend for each procedure was then projected to the Target Years 1978 and 1982. Following these initial steps, a General Purpose Simulation System (G.P.S.S.) analysis was performed on the data gathered. Other information required for the simulation was gathered through questionnaires to Delta practitioners and private conferences with health care consultants. The results from the simulation were expressed in "work areas" (i.e. examination rooms, stretcher-beds, etc.) required in the major departments or service areas. The simulation analysis could only be completed for the Surgical Day Care Services area, because the data from Provincial computer data files, relevant to other departments or service areas, was found to be insufficient. The main problem encountered was an imprecise identification of patients' geographic origin; which in some instances made it impossible to identify procedures performed for Delta residents. Detailed suggestions for improving the method are presented in the Discussion. However, one should at least do the following: endeavour to use more than two years of data to project the trend in the Provincial computer data files; and explain the questionnaires circulated to practitioners by giving individual person-to-person instructions, rather than group verbal and individual written instructions. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The rising costs of health care and the lack of integration between parts of the delivery system has led to discussion and experiments on new forms of delivering care. Governments have included the development of ambulatory care in new statements of objectives and goals in the hope that expenditures might be reduced through the reduced use of acute care hospital beds. This is a study of the experience surrounding an acute care hospital's attempts to have a Medical Day Care Program accepted by the government as an adjunct to the existing Ambulatory Care Services of the hospital. As Director of Nursing at the hospital it was possible to follow the sequence of events, concept development, proposal design, ministry involvement, implementation and evaluation. A diary was kept for one year following implementation of the program as a pilot project and project documents have contributed to the analysis of events. What was not readily apparent were the many forces outside the hospital which were impacting on the likelihood of the proposal's acceptance. Since Ambulatory Care was the health policy of the 1970's it was puzzling to find the Ministry of Health unresponsive to a proposal which seemed most appropriate. In attempts to resolve the puzzle regarding the lack of interest in ambulatory care at the hospital level, other developments in the province were reviewed. Planning models were explored seeking explanation for inconsistencies observed between stated government objectives and government behavior in relation to the development of hospital ambulatory care. More satisfactory explanations were found in a political model than in planning models, in the light of actual developments. Some conclusions are drawn about the impact of political realities on management functions in health care institutions. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The purpose of this research was the development of an instrument to measure the complexity of nursing care requirements in ambulatory care settings. Charles Perrow's sociological theory of organizations was adapted to nursng in order to define the complexity concept. Four research questions were investigated in this study. These questions related first, to the construct validity of the instrument's activity category system; second, to the criterion validity of the complexity weighting system; third, to the equivalent reliability to the instrument and fourth, to the instrument's clinical generalizability. Construct validity was evaluated through the regression of subjective estimations of complexity on the individual categories which make up the 154 ratings that contained measurement error, 641 independent client ratings remained for analysis. This data indicated that the classification instrument accounted for 52 percent of the total nursing care complexity in the ambulatory setting. An 18 variable equation was as statistically effective in explaining complexity as was the original 44 variable equation. Criterion validity was examined by comparing empirical complexity weights established through the regression of subjective complexity estimations on activity categories with theoretical weights determined by nurse experts in a Delphi exercise. Kendall's tau, a measure of rank association, was used for analysis. This examination revealed no statistically significant direct association between empirical and theoretical sets of complexity weights. Equivalent reliability was investigated by looking at the percent agreement among six trained raters using the classification instrument. The data indicated agreement on ratings was above 90 percent which met the criterion pre-established for interrater reliability. Finally, by a graphical analysis of residuals from regression equations, instrument generalizability across clinical services was examined. The Ambulatory Care Client Classification Instrument was not found to be generalizable in explaining the complexity of nursing care requirements across the clinical services used in this research.

Thesis (Ph. D.)--Georgia State University, 2008. / Title from file title page. Upkar Varshney, committee chair; Peter Meso, Yi Pan, Anu Bourgeois, committee members. Electronic text (192 p. : ill. (some col.)) : digital, PDF file. Description based on contents viewed Sept. 23, 2008. Includes bibliographical references (p. 184-192).

Thesis (M.A.)--York University, 2008. Graduate Programme in Kinesiology and Health Science. / Typescript. Includes bibliographical references. Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR45926

No description available.

Thesis (M.H.A.)--University of Michigan, 1961.

Thesis (M.H.A.)--University of Michigan, 1961.

Thesis (Ph. D.)--University of Texas at Austin, 1999. / Vita. Includes bibliographical references (leaves 175-183). Available also in a digital version from Dissertation Abstracts.