No description available.

<p> Managed care through a series of comprehensive health care services is a trend in today&rsquo;s healthcare; and it includes specialized services that can provide plenty of opportunities to many healthcare organizations. Private Medical Service of San Diego currently does not have the necessary medical equipment to provide a comprehensive pain management and the ability to retain availability and flexibility to grow at its own pace and convenience. The new business plan is to acquire fluoroscopic equipment that will be staged in-house to equip its interdisciplinary pain management program. This will help increase the efficacy and safety of the pain management procedures as well as a potential for good profit.</p>

Though racial classifications may serve as a mechanism for identifying and correcting disparities among various groups, using such classifications in a clinical setting to detect and treat patient needs can be problematic. This report explores how medical professionals and researchers use race in health care for purposes of data collection, risk assessment, and diagnosis and treatment options. Using mixed race individuals as an example, it then discusses some of the problems associated with using race to group individuals, assess risk, and inform patient care. Finally, it discusses how certain components of personalized medicine, such as genetic testing, Electronic Health Records, and Rapid Learning Systems could help address some of the concerns that arise from the application of race in a health care setting. / text

No description available.

No description available.

Background: Socioeconomic factors and gender may influence the quality of care received by patients with diabetes. Millions of people are diagnosed with diabetes and rates are expected to increase. The management of diabetes in primary care is important in optimizing health for all. Objectives: To investigate whether the selected diabetes quality of care indicators (haemoglobin A1c, low-density lipoprotein, blood pressure, abumin to creatinine ratio (ACR), and prescribed medication) are significantly different between those persons living in least and most materially and socially deprived neighbourhoods. Methods: A cross-sectional study design with a population sample of patients with diabetes from a primary care practice in Southeast Ontario. De- identified patient data from electronic medical records were retrieved from the Canadian Primary Care Sentinel Surveillance Network. Combined material and social deprivation scores were based on the Pampalon Deprivation Index. Results: The patients with diabetes largely resided in either the most or the least deprived neighbourhoods. Patients with diabetes living in the most deprived neighbourhoods were less likely than patients with diabetes living in the least deprived neighbourhoods to have their low-density lipoproteins within normal range (RR=0.84; CIs 0.73-0.98; p-value=0.026). There was no difference in management of diabetes between least and most deprived patients with diabetes regarding haemoglobin A1c, blood pressure, ACR, and medication prescribed; these were positive result for the clinical practice. Women with diabetes were less likely than men with diabetes to have their low-density lipoproteins under control (RR=0.71; CIs 0.62-0.81; p-value <0.001) and be prescribed ACE inhibitors or ARBs (RR=0.79; CIs 0.69-0.90; p-value <0.001). However, women with diabetes were more likely to have their most recent haemoglobin A1c within normal range (RR=1.24; CIs 1.10-1.40; p-value <0.001) and have their most recent ACR within normal range (RR=1.25; CIs 1.05-1.50; p-value=0.015). Conclusion: This study found that the quality of care for patients with diabetes was not influenced by whether a person lived in a deprived neighbourhood or not. However, the study identified some important gender differences related to whether a person’s diabetes was under control. The reason for these differences is unknown. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-09-27 13:37:55.755

It is widely claimed that nurses are leaving the profession in large numbers. This is often cited as a result of a decline in commitment. However, in this thesis I argue that these commonplace understandings are mistaken. Through a qualitative analysis of in-depth interviews with 28 practising and ex-nurses, I paint a complex picture of how individual nurses’ range of commitments need to be understood within the broader contexts and discourses of British nursing, workplaces and society. Participants in this study demonstrate powerful and conflicting feelings towards their work. A passionate commitment, often rooted in a concern for the welfare of others, is reinforced by the intense personal rewards that nursing offers, and a dominant occupational discourse of total commitment. This commitment demands a high level of physical and emotional endurance, a willingness to prioritise nursing over all else, and to sacrifice one’s own needs in the service of others. However, these positive feelings are often accompanied by intense negative feelings of frustration, fear and powerlessness centring on participants’ inability to fulfil their working commitments, and to balance them with other commitments in their lives. This thesis centres on the premise that nursing involves a life on the boundaries, a place of uncertainty and conflict as well as of challenge and opportunity. Nurses frequently find themselves caught on the boundaries between conflicting ideas and commitments, trying to fulfil expectations that are mutually exclusive. At the same time, they are faced with the task of negotiating their own boundaries in order to function in a world of limitless demands. Within a working role that has no clear boundaries they must seek to establish the nature and scope of their responsibilities in order to function. In an occupation that demands limitless commitment, they must negotiate the boundaries between their commitment to nursing and to other roles beyond the sphere of work. They must also negotiate the boundaries of the self, determining the extent to which they are willing or able to give of themselves, balancing expectations of the super-nurse with the limits imposed by being human. These negotiations occur in an environment of constant change, of conflicting ideals and high stakes where there are often no right answers. The task is further complicated by the organisational limits to nurses’ authority, by a persistent discourse of the submissive and obedient nurse, and by the risks involved in challenging a dominant discourse of strength and coping. The complexity of nurses’ situation leads them to adopt a range of survival strategies. Some stay and endure, while others seek respite in new posts or specialities. Those who lose hope may take advantage of childbearing to slip out unnoticed. Contrary to the popular belief in a mass exodus of nurses indicating a loss of commitment, it is often those with a powerful sense of commitment to caring for others who find the strength to leave nursing and seek satisfaction in other fields of work.

<p> User acceptance and usage of technology is an established field of academic inquiry with distinct applications to health information technology adoption. Healthcare systems lag behind in technological advancements related to information systems. The recent push toward health information exchange (HIE) systems to enable the sharing of electronic medical records (EMR) between healthcare organizations has many working to upgrade to the latest EMR system technology. Healthcare organizations strive to lower costs, improve patient care, streamline processes, and meet regulatory requirements. Leading EMR systems promise the realization of attaining these goals. User acceptance and usage of technology is a challenge when implementing new technology. In more recent years, a growing need appeared to study user acceptance and usage behavior in healthcare organizations. The central question of this study is: What deeper understanding can be developed when evaluating the similarities and differences of healthcare and business users&rsquo; experiences and behaviors through the lens of the unified theory of acceptance and usage of technology (UTAUT)? A subset of related research questions focuses on factors influencing users&rsquo; acceptance and usage, similarities and differences among healthcare users, and similarities and differences between healthcare and non-healthcare users. This study explores participants&rsquo; experiences using a comparative cross-case approach applying the theoretical framework of the UTUAT by Venkatesh, Morris, Davis, and Davis (2003). Twenty-one participants were interviewed to ascertain their lived experiences of learning and using computer systems. Areas of inquiry included new system implementations; the importance of factors in the UTAUT model such as effort expectancy, facilitating conditions, performance expectancy, and social influence; and the impact of these on users&rsquo; experiences. The majority indicated sub-elements of facilitating conditions and effort expectancy as critical factors. Training is dominant among the majority of cases, while ease to learn and use, process alignment, and time are interwoven with training and usage experiences. Social influence and voluntariness of use were seldom observed, with shared experiences being circumstantial and situational. The success of EMR systems hinges on how the foundational system is built, which involves understanding detailed clinical and business processes, and ensuring the new system is built on forward-thinking practices. </p>

<p> Alternative healthcare programs have been steadily flooding the health care market, with the most notable being mobile health. Mobile health, more popularly known as mHealth, is expected to generate upward of $59 billion dollars. This is astonishing, considering the mHealth market is still in its infancy as an alternative healthcare model. Still, there are over 100,000 mHealth smartphone applications and platforms on the market. The concept of offering affordable medical services that are accessible to anyone, at any time and in any place appeals to the mission and purpose of healthcare organizations. However, a large number of the studies and publications on mHealth are associated with the technologies behind mHealth and provide very little information on the practices and challenges associated with implementing mHealth, especially within a medical facility. For this reason, it was important to learn from executive health IT professionals who have successfully implemented mHealth services within the US healthcare system. Accordingly, the purpose of this study was to identify the practices used and challenges faced by CIOs in implementing mHealth technologies. The study also obtained recommendations CIOs believe are associated with successful mHealth services.</p><p> This was a qualitative study that used a phenomenology lens focused on the viewpoint of CIOs and the growing phenomenon of mHealth as a part of the U.S. healthcare system. This approach allowed the research to obtain data on the lived experiences of seven CIOs through semi-structured interviews who were identified as top experts by <i>Becker Hospital Review</i> publications. The analysis of their experiences revealed 13 best practices for mobile health implementation. The findings in this study aimed to identify how mHealth services could expand access to medical services by outlining key considerations and resources required for successful implementation.</p>

<p> A significant amount of evidence existed in support of the positive effect on the quality of healthcare that resulted from transitioning to electronic health information systems, equally compelling evidence suggests that the development process for electronic health information systems falls short of achieving its potential. The objective of this research was to assess the existing HIT standards and health information management (HIM) principles to determine if they are robust enough to inform the development of national and international interoperability standards. The research question asked; How do HIT standards and HIM principles and practices influence the quality of EHR performance? This study&rsquo;s goal was to maintain focus on the collaborative challenges revealed by the lack of understanding and shared vision that commonly exists between HIM professionals, HIT developers, and HIT vendors that obstruct synergy and enfolding of health information standards-based capabilities and HIM practice (business) standards. The complex electronic health record (EHR) universe proved well suited for testing by a combination of complexity science and the unified theory of acceptance and use of technology (UTAUT) information management theories. Through analysis of research literature and qualitative interviews, the research identified nine factors defined into drivers and barriers that influenced the actions of healthcare organizations; leadership, patient focus, planning, communication, alignment with lifecycle models people, processes, dynamics, training and user input, change management standard adoption, and recognition of the power of technology. Analysis of the data obtained from exploratory qualitative interviews of health information technology professionals selected from a professional healthcare management organization supported conclusions that leadership, collaboration, planning, and training limiters, have a direct impact on EHR system success or failure.</p><p>