Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2002. / Vita. Includes bibliographical references (leaves 88-95).

Thesis (M.Sc.)--Memorial University of Newfoundland, 2002. / Bibliography: leaves 82-86.

Michael E. Borus, C. Gregory Buntz, William R. Tash. / Bibliography: p. 129-147.

The accomplishment of pilot implementation of the HIVQUAL-T model, an innovative HIV care quality management tool, has led to an authoritative decision to scale up the use of the model nationwide in Thailand. However, the level of implementing this model varies across target hospitals. Some hospitals have fully adopted the model by conducting quality improvement (QI) activities following performance measurement (PM) results while others have partially adopted only PM or have not used this model at all. The differential level of implementation could be a contributing factor accounting for discrepancies in the quality of care across different HIV ambulatory care facilities. A cross-sectional study was conducted by using two main datasets, including Thailand's national HIV care performance results and an online survey of all public hospitals nationwide. A total of 382 hospitals responded to the survey, accounting for a response rate of 50%. A confirmatory factor analysis (CFA) method was performed to examine the validity of latent constructs developed from the diffusion of innovation theory. Structural equation modeling (SEM) approach was employed to investigate the relationship between the determinants of organizational decision-making and their contribution to organizational outcomes, under the context-design-performance framework. Furthermore, using a panel model of hospitals that reported performance results across a 3-year period, the improvement in HIV ambulatory services performance among the adopters was examined. The results indicated that two innovation attributes--relative advantage and simplicity perceived by HIV care practitioners in hospitals--were found to be positively associated with the level of the HIVQUAL-T model implementation. Two structural characteristics--interconnectedness and organizational slack--appeared to be positively associated with the level of model implementation, while rate of adoption in the region also had significant positive contribution. Ultimately, the extensiveness of the HIVQUAL-T model implementation demonstrated a proportionate impact on the variation in hospitals' HIV ambulatory services performance. It was noted that the implementers considerably improved their performance within two years of implementing the model. The study findings imply that adoption is more likely when individual practitioners assess the innovation and find it to be easy to comprehend and operate and also worthwhile to implement. Furthermore, hospitals' decision making is likely influenced by their relations to external environment. The findings suggest more emphasis on individual and hospital-level capacity building for meaningful use of this quality management initiative, accompanied by an adjustment of performance measurement software with valid, reliable, and interpretable indicators.

No description available.

The utilization of ambulatory services by the health maintenance organization of Florida (HMO), independent practice association (IPA) model, was compared to a fee-for-service population. Each randomly selected group consisted of 250 patients being cared for by the same providers, at the same clinic, during the calendar year 1986. Demographic and clinical data was gathered from the office charts. Frequencies were evaluated by the Statistical Package for the Social Sciences and t-tests were run to substantiate variance at the 0.05 level of confidence. The HMO group is a younger population (t = 0.017), and the males are responsible for the increased utilization of ambulatory services (t = 0.001). Trends of increased utilization are noted across the age groups and the variables. The rate of hospitalization is insignificantly higher for the HMO population and covers a broader range of age groups. Consequently, this HMO IPA model increases the rate of ambulatory service utilization in a younger population without reducing the rate of hospitalization. Cost effectiveness studies and organizational management evaluations are needed.

This is a cross section study of the White elderly patients who attended Addington Hospital, Durban, Out-patient Department during a two week period in July 1985. Screening was by means of systematic sampling, a standard questionnaire was administered to 321 of them and their characteristics and needs were identified. In order to determine the attitudes of the medical and nursing staff who work in Addington Out-Patient Department, a further questionnaire was used. It was found that 88,37% of health professionals did not have a particular leaning towards looking after the elderly, but 88% agreed that the needs of the elderly were different in comparison with other age groups. 92,8% considered that geriatrics is a speciality in its own right. Recommendations are made for a 24 hour community geriatric service, the establishment of day centres to serve the needs of the greater Durban area, and for the establishment of a Chair of Geriatrics at the University of Natal. / Thesis (M.Med.)-University of Natal, 1987.

Thesis (doctoral)--University of Uppsala, 1983. / Includes bibliographical references (p. 38-46).

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 218-226).

Patient perceptions of health care quality are critical to a health care service provider's long-term success because of the significant influence perceptions have on customer satisfaction and consequently organization financial performance. Patient satisfaction affects not only the outcome of the health care process such as patient compliance with physician advice and treatment, but also patient retention and favorable word-of-mouth. Accordingly, it is a critical strategy for health care organizations to provide quality service and address patient satisfaction. The urgent care (UC) industry is an integral part of the health care system in the United States that has been experiencing a rapid growth. UC provides a wide range of medical services for a large group of patients and now serves an increasing population. UC is becoming popular because of the convenient locations, extended hours, walk-in policy, short waiting times, and accessibility. A closer examination of the current health care research, however, indicates that there is a paucity of research on urgent care providers. Confronted with the emergence of the urgent care industry and the increasing demand for urgent care, it is necessary to understand how patients perceive urgent care providers and what influences patient satisfaction and retention. This dissertation addresses four areas relevant to the above mentioned issues: (1) development of an instrument to measure perceived service quality in the urgent care industry; (2) identification of the determinants of patient satisfaction and behavioral intentions; (3) empirical examination of the relationships among perceived service quality, patient satisfaction and behavioral intentions; and (4) comparison of the perceived service quality across several primary urgent care providers, such as urgent care centers, hospital emergency departments, and primary care physicians' offices. To validate this new instrument and examine the hypothesized relationships proposed in this study, an electronic web based survey was designed and administered to college students. Both exploratory and confirmatory factor analysis were employed to assess the reliability and validity of the developed instrument. The contextualized relationships were evaluated using structural equation modeling. The results of this research could potentially contribute to urgent care management and quality improvement.