Global ETD Search

1	Utilization of Depot Fluphenazine and Haloperidol in a Community Mental Health Center: A 12-Month Retrospective Analysis of Compliance, Hospitalization Data, and Cost of Care for Patients with Schizophrenia Kelley, Lindsey January 2005 (has links) Class of 2005 Abstract / Objectives: This retrospective study investigated the relationship between compliance, hospitalizations rates, and cost of care in an outpatient behavioral health facility over a 12-month period for schizophrenic patients treated with depot antipsychotic medications. Methods: Databases from COPE Behavioral Health Center in Tucson, AZ were utilized for administration of depot injections, hospitalizations, and cost of care for patients between July 1, 2003 and June 30, 2004. Results: Records were utilized for 103 patients receiving depot antipsychotics (n = 34 fluphenazine decanoate, n = 69 haloperidol decanoate). Increased number of injections received per year was associated with lower number of hospitalizations per year (p = 0.025 fluphenazine and p = 0.001 haloperidol). Also, increased number of hospitalizations was associated with increased total cost of care (p = 0.001 fluphenazine and p < 0.001 haloperidol). Implications: Patients with schizophrenia who received a greater number of depot antipsychotic injections had a lower number of hospitalizations during a 12-month period. Improved adherence with depot antipsychotics may improve clinical outcomes and reduce the total cost of care in patients with schizophrenia. Schizophrenia Community Mental Health Center Patient Compliance Hospitalization Rate Cost of Care
2	Comprehensive Direct Medical Costs Associated with Six Months of Care Status Post Acute Rejection Events in Renal Transplant Recipients: A Single Center Retrospective Matched Case Control Analysis Cavanaugh, Teresa M. 17 July 2009 (has links) No description available. Biomedical Research Economics Health Health Care Immunology cost rejection kidney transplantation cost of care
3	Children with Special Health Care Needs: Comparison of the Effects of Home Care Setting, Prescribed Pediatric Extended Care Setting, and Long-Term Care Setting on Child and Family Health Outcomes and Health Care Service Use Caicedo, Carmen 27 March 2013 (has links) Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL TM Generic Core Module for child health and functioning, PedsQL TM Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings. children with special health care needs medically complex medically fragile family health and functioning cost of care burden time burden prescribed pediatric extended care medical day care
4	Analýza systému zdravotnictví USA / Analysis of the U.S. Health Care System Kožušková, Kateřina January 2013 (has links) The thesis is dealing with financial aspects of the U.S. health care system. The main reasons are excessively high costs and less beneficial outputs of the system compared to other developed countries. The topic is more than up to date especially with regard to the latest changes in American health care and the neverending discussion about the necessity of further reforms aiming especially at fiscal sustainability of the system.The introduction is devoted to a brief description of basic models of health care system. It also introduces the approach of the United States to health care and provides an overview of the structure and participants of American health care. Moreover, the thesis provides details about the latest reform of the system. The main objective of the thesis is analysis of main factors that contributes to high growth of health care costs. Technological development, consolidation of markets and ineffective setting of health care reimbursement are identified as some of the main contributors to high cost in the U.S. health care system.
5	Health for community dwelling older people : trends, inequalities, needs and care in rural Vietnam Van Hoi, Le January 2011 (has links) Background InVietnam, the proportion of people aged 60 and above has increased rapidly in recent decades. The majority live in rural areas where socioeconomic status is more disadvantaged than in urban areas.Vietnam’s economic status is improving but disparities in income and living conditions are widening between groups and regions. A consistent and emerging danger of communicable diseases and an increase of non-communicable diseases exist concurrently. The emigration of young people and the impact of other socioeconomic changes leave more elderly on their own and with less family support. Introduction of user fees and development of a private sector improve the coverage and quality of health care but increase household health expenditures and inequalities in health care. Life expectancy at birth has increased, but not much is known about changes during old age. There is a lack of evidence, particularly in rural settings, about health-related quality of life (HRQoL) among older people within the context of socioeconomic changes and health-sector reform. Knowledge of long-term elderly care needs in the community and the relevant models are still limited. To provide evidence for developing new policies and models of care, this thesis aimed to assess general health status, health care needs, and perspectives on future health care options for community-dwelling older people. Methods An abridged life table was used to estimate cohort life expectancies at old age from longitudinal data collected by FilaBavi DSS during 1999-2006. This covered 7,668 people aged 60 and above with 43,272 person-years. A 2007 cross-sectional survey was conducted among people aged 60 and over living in 2,240 households that were randomly selected from the FilaBavi DSS. Interviews used a structured questionnaire to assess HRQoL, daily care needs, and willingness to use and to pay for models of care. Participant and household socioeconomic characteristics were extracted from the 2007 DSS re-census. Differences in life expectancy are examined by socioeconomic factors. The EQ-5D index is calculated based on the time trade-off tariff. Distributions of study subjects by study variables are described with 95% confidence intervals. Multivariate analyses are performed to identify socioeconomic determinants of HRQoL, need of support, ADL index, and willingness to use and pay for models of care. In addition, four focus group discussions with the elderly, their household members, and community association representatives were conducted to explore perspectives on the use of services by applying content analysis. Results Life expectancy at age 60 increased by approximately one year from 1999-2002 to 2003-2006, but tended to decrease in the most vulnerable groups. There is a wide gap in life expectancy by poverty status and living arrangement. The sex gap in life expectancy is consistent across all socioeconomic groups and is wider among the more disadvantaged populations. The EQ-5D index at old age is 0.876. Younger age groups, position as household head, working, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on HRQoL that is mainly due to reduction in physical (rather than mental) functions. Being a household head and working at old age are advantageous for attaining better HRQoL in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical functions. Long-term living conditions are more likely to affect HRQoL than short-term economic conditions. Dependence in instrumental or intellectual activities of daily living (ADLs) is more common than in basic ADLs. People who need complete help are fewer than those who need some help in almost all ADLs. Over two-fifths of people who needed help received enough support in all ADL dimensions. Children and grand-children are confirmed to be the main caregivers. Presence of chronic illness, age groups, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, and poverty status are determinants of the need for care. Use of mobile teams is the most requested service; the fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than did the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require free services is 2 to 3 times higher than those willing to pay full cost. Households are willing to pay more for day care and nursing centres than are the elderly. The elderly are more willing to pay for mobile teams than are their households. ADL index, age group, sex, literacy, marital status, living arrangement, head of household status, living area, working status, poverty and household wealth are factors related to willingness to use services. Conclusions There is a trend of increasing life expectancy at older ages in ruralVietnam. Inequalities in life expectancy exist between socioeconomic groups. HRQoL at old age is at a high level, but varies substantially according to socioeconomic factors. An unmet need of daily care for older people remains. Family is the main source of support for care. Need for care is in more demand among disadvantaged groups. Development of a social network for community-based long-term elderly care is needed. The network should focus on instrumental and intellectual ADLs rather than basic ADLs. Home-based care is more essential than institutionalized care. Community-based elderly care will be used and partly paid for if it is provided by the government or associations. The determinants of elderly health and care needs should be addressed by appropriate social and health policies with greater targeting of the poorest and most disadvantaged groups. Building capacity for health professionals and informal caregivers, as well as support for the most vulnerable elderly groups, is essential for providing and assessing the services. / Aging and Living Conditions Program / Vietnam-Sweden Collaborative Program in Health, SIDA/Sarec older people elderly health health status life expectancy health-related quality of life EQ-5D mobility self-care usual activities pain discomfort anxiety depression activity of daily living basic ADL instrumental ADL intellectual ADL non-communicable diseases need of care health service model of care mobile team day care centre nursing centre inequalities cost of care socioeconomic education marital status living arrangement household head working status living area wealth quintile poverty line community cohort study household survey focus group discussion qualitative research rural Vietnam developing country Asia người cao tuổi y tế thực trạng sức khỏe hy vọng sống chất lượng cuộc sống EQ-5D đi lại tự chăm sóc hoạt động thường xuyên đau khó chịu lo lắng trầm cảm hoạt động hàng ngày bệnh không lây nhiễm nhu cầu chăm sóc dịch vụ y tế mô hình chăm sóc đội lưu động trung tâm chăm sóc ban ngày trung tâm dưỡng lão bất bình đẳng chi phí chăm sóc kinh tế xã hội giáo dục hôn nhân sắp xếp cuộc sống chủ hộ tình trạng làm việc khu vực sống ngũ phân thịnh vượng chuẩn nghèo cộng đồng nghiên cứu theo dõi dọc điều tra hộ gia đình thảo luận nhóm tập trung nghiên cứu định tính nông thôn Việt Nam nước đang phát triển châu Á

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