<p> Diabetes is best described as a disease which affects blood levels and the body cannot regulate or produce enough insulin on its own causing sugar build up in the blood. Diabetes is the seventh leading cause of the death in the United States. Diabetes affects over 29 million Americans, with about 25% of them living with it undiagnosed. Another 86 million people living with pre-diabetes comprise 90% of the population is unaware they are pre-diabetic. Our business, DiaBeaThis Healthcare Clinic, provides health care services to adults 18 years or older who suffer from diabetes or are pre-diabetic. The diabetic services provided for these adults residing in Oceanside, North San Diego County, California. The clinic will provide testing for diabetes, health monitoring, and dietary counseling and will be a source for diabetics to obtain the required medication, supplies, and education needed.</p><p>

<p> The lack of primary care coordination for people with schizophrenia across the continuum of care in a rural Midwest state compromises long-term treatment success. For the purpose of primary care coordination this qualitative study explored perceptions of health care professionals that care for people with schizophrenia regarding expansion of laboratory and/or pharmacy services in the home health care setting. Mental health providers, home health care nurses, pharmacy and laboratory personnel participated in a focus group to identify common themes regarding access to care, care coordination and the utilization of laboratory and/or pharmacy services. A semistructured, open-ended focus group was used to examine the actual experiences of health care practitioners and professionals working with people with schizophrenia in the rural home health care setting. The findings of the focus group demonstrated several common themes. The first theme identified was people with schizophrenia have stigmas about their illness leading to non-compliance and reduced access to care. A second theme identified was the lack of community resources to care for people with schizophrenia. A third theme was the limited knowledge of health care providers to the utilization of home health care in the treatment of people with schizophrenia. The fourth theme was the lack of care coordination, social work and knowledge of the local issues faced by people with schizophrenia. The fifth and final theme was the lack of coordination with laboratory and pharmacy health care specialties. The results of the study may lend interest to more research regarding the utility of expanded home health care services in the care of people with schizophrenia.</p><p>

M.Tech.

M.Tech.

The Military Health Services System (MHSS) is one of the largest health care systems in the United States comprising over 115 hospitals, 471 clinics and an annual operating budget in excess of 15 billion dollars. In 1993, Congress directed the Secretary of Defense to implement a model of health care reform emphasizing the principles of managed care and regional contracting as cost containment tools, while improving the uniformity of aocess and benefit structure. The TRICARE program was proposed by the Department of Defense (DOD) and approved by Congress in 1994. TRICARE presents a triple option of a health maintenance organization, preferred provider organization, or a fee for service indemnity plan. The health maintenance organization option presents the greatest potential for cost savings to DOD through utilization management and large-scale, regional contracting to augment variability in the MRSS access and benefit structure. A twenty-four month population-based time series design presented significant changes in the utilization of ambulatory health services when subjects enrolled in a program grounded in managed competition within a budget. Improved access to an integrated health care system, including shifts to more cost-effective portals was found among the broader population as well as high-risk chronic subjects. The findings validate the theoretical constructs of managed competition under global budgets, previously untested in the literature. The data also refute concerns for high-risk populations to be undeserved and undercared for in managed care models of delivery. The DOD program with its variant of the Health Alliance or Health Insurance Purchasing Cooperative demonstrates that access to a national uniform benefit package, movement toward universal coverage, community rating, and cost-conscious decision making among consumers is a feasible mechanism for achieving the objectives of health care reform. The initial findings from DOD health care reform offer the first empirical and applied outcome evidence from one of the most important theoretical developments in health care policy and economics in the twentieth century.

The objectives of this study were to assess the construct validity and predictive validity of a previously published comorbidity classification scheme designed for use with administrative data. The scheme groups non-primary discharge diagnoses into a set of thirty comorbidity indicators, which may be used to describe and compare populations with respect to burden of comorbid illness. The scheme was developed on a large population of hospitalized patients in California in 1992 (training population) and the predictive effect of the indicators estimated with respect to the outcomes length of stay, hospital charges, and in-hospital death. The current study drew data from the Massachusetts Hospital Case Mix Data Base of 1992 (testing population). The effect of the comorbidity indicators on each outcome was estimated by fitting ordinary least squares regression (OLSR) models of length of stay and hospital charges, as well as logistic regression models of in-hospital mortality, to the testing population. The estimated effect of the comorbidity indicators on each outcome, adjusted for demographics and characteristics of index hospitalization, was compared between the training and testing populations. The characteristics of the testing population were largely similar to those of the training population. The relationship between burden of comorbid illness (as measured by the number of comorbidity indicators per patient) and the outcomes was comparable in the two populations. The estimated adjusted effect of the comorbidity indicators and the predictive ability of the OLSR models were comparable in the training and testing population with respect to the outcomes length of stay and charges. The estimated adjusted effect of the comorbidity indicators on in-hospital death was not comparable in the two populations. The results support construct validity and predictive validity of the comorbidity classification in Massachusetts discharge data in 1992. Other aspects of baseline risk must be accounted for separately. The estimated adjusted effect of the indicators in the training population on the outcomes length of stay and charges, but not in-hospital death, is generalizable to Massachusetts' discharge data and may be further generalizable. Practical application of the comorbidity indicators for comorbidity adjustment in epidemiological research should be further explored.

The purpose of this study was to determine if a shared governance management structure significantly affects the level of job satisfaction of registered nurses who work in hospitals. It was also intended to document which components are identified by registered nurses as impacting on their job satisfaction or dissatisfaction. The index of Work Satisfaction (IWS) was used to measure job satisfaction among two groups of nurses, one working in a hospital with a shared governance management structure (n = 99) and the other working in a hospital without a shared governance management structure (n = 143). IWS results indicated higher levels of satisfaction among nurses at the hospital with the shared governance management structure in three of the six components, namely Autonomy, Task Requirements, and Organizational Policies. Nurses at the hospital with the shared governance management structure were asked to respond to four additional questions. These were designed to measure to what degree nurses perceived shared governance to be working on their unit as well as in their hospital. These nurses were also asked to what degree they valued shared governance for Nursing. Results indicate the majority of nurses perceived shared governance to be "working well" on their unit and at their hospital. The majority also highly valued shared governance for Nursing. The findings of this study suggest that there may be a relationship between job satisfaction of registered nurses and a management structure which encourages decision making at the staff nurse level. Implications for the restructuring of nursing organizations are drawn. Recommendations for further research are provided.

Little research has been done on the phenomenon of caring. Although health professionals express concern about the care they provide to patients, caring has not received the same degree of scholarly inquiry as the study of cures. This study attempts to shed some light on the phenomenon of caring from the patient's perspective. The primary purpose was to discover those experiences that hospital patients perceived to be caring and non-caring. The secondary purposes were to (1) determine if there was a gender difference in patient perception of caring and non-caring experiences, (2) determine if severity of illness was a variable in how patients perceive caring and non-caring, and (3) discover if patients perceive a difference in caring and non-caring in the past five or more years. This study followed an interpretive paradigm of research and analysis. It attempted to both describe human experiences as it appeared, and to understand the significance of the experience to the individual. The interpretation and analysis of findings are presented using metaphors (Chapter 5). Five metaphors are used to describe patients expressions of caring, and four are used to express patients descriptions of non-caring. All patients had some thoughts and ideation about loss, death and dying, regardless of their diagnosis. Findings suggest that nurses may underestimate the patient's desire for frequent surviellance. Care providers who demonstrated a holistic view of the patient and an understanding of the patient's personal needs were perceived to be caring. The emergence of a hierarchy of nursing care and medical care needs are suggested by the data. Patients appear to have a different hierarchy for nursing than for medical care. Although this was not part of the research question, it seems important and worthy of further research.

The primary purpose of this study was to identify the way in which two groups, staff nurses and nurse administrators/managers, each conceptualize the ideal and actual role of the registered nurse practicing at the bedside. Data was examined in order to identify similarities and differences in the opinions of the two groups. A questionnaire with 35 items/situations using a Likert scale was developed. Items/situations were worded to conform to a five-point response format ranging from strongly agree to strongly disagree. The role conception items/situations were designed to measure the respondent's perceptions of what the role should be and perceptions of what actually exists in the practice of the nurse role. The sample of 300 non-management nurses was randomly selected using 50 percent of the professional nurses from each unit. Nurse administrators/managers comprised a smaller number than non-managers, therefore, the questionnaire was given to this entire group. Noteworthy findings of the study include that (a) staff nurses and nurse administrators/managers agreed in their perception of what comprises the actual professional role of the nurse practicing at the bedside, (b) both groups also agreed in their perception of what comprises the ideal professional role of the staff nurse practicing at the bedside, (c) the staff nurses and nurse administrators/managers agreed in their perception of what comprised the actual bureaucratic role of the nurse practicing at the bedside, (d) the groups agreed in their perceptions of what comprised the ideal bureaucratic role of the nurse practicing at the bedside, and (e) there is a significant difference between the ideal and actual role conceptions within both the bureaucratic and professional concepts. Simply stated, the respondents of this study do not believe that nursing is being practiced the way nursing should be practiced. Implications of the study are presented and discussed, and recommendations for further study are provided.

No description available.