Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1995. / Source: Masters Abstracts International, Volume: 45-06, page: 2939. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 91-92).

Thesis (M.N.)--Memorial University of Newfoundland, 2002. / Bibliography: leaves 171-178.

Thesis (M.S.H.P.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The Accountable Care Act (ACA) will expand coverage to millions of Americans. Health insurance plans designed to contain costs and incentivize patients may pose risks that deter members from utilizing recommended services despite provisions such as zero-cost-sharing intended to encourage their use. We evaluated trends (from 2007 to 2011) in health insurance plan type and initial colorectal cancer (CRCA) screening per current guidelines. We hypothesized that consumer-directed and high-deductible health plans (CDHP/HDHP) would be associated with decreased and delayed CRCA screening, and a shift toward lower-cost screening options. Using Thomson MarketScan® data, we analyzed commercial claims for 989,038 American adults (prior colectomy or CRCA excluded) over a full three-year period (starting in January of the fiftieth birthday-year) to assess for CRCA screening (colonoscopy, sigmoidoscopy, or stool test). Using logistic regression, we found that CDHP/HDHP members showed increased likelihood of having had any CRCA screening compared to Preferred Provider Organization (PPO) members, in both Massachusetts (Odds Ratio [OR] 2.321, 95% Confidence Interval [CI] 1.788-3.014) and the Nation (OR 1.640, 95% CI 1.602-1.678). Of those screened, CDHP/HDHP patients were more likely to receive colonoscopy than other recommended alternatives compared to PPO (Massachusetts OR 1.289, 95% CI 1.007-1.651; U.S. OR 1.225, 95% CI 1.192-1.259). Using linear regression, we found that CDHP/HDHP patients were only slightly older at screening compared to PPO, and the difference, while statistically significant, was likely too small to be clinically meaningful. We conclude that contrary to our expectations, CDHP/HDHP members have not been deterred from seeking and obtaining appropriate and timely initial CRCA screening, and they have not chosen lower-cost options. These findings may reflect the newly insured effect, although one limitation of this study was the inability to adjust for selection into CDHP/HDHP. Further study should determine whether CDHP/HDHP members subsequently experience unexpected financial burdens related to CRCA screening that affect future utilization of recommended care. In the pursuit of lower costs through better outcomes, attention should be paid to designing simple and affordable plans with easily understandable features that encourage both patients and providers to follow recommended guidelines while considering the cost-effectiveness of available options. / 2031-01-01

Thesis (M.S.H.P.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / IMPORTANCE: With greater access to health care through health care reform it is important to know if quality of care for similar complaints differs across clinical settings. OBJECTIVE: Develop and pilot a chart review instrument to measure quality of care for patients presenting with urethritis and vaginitis. METHODS: List of sexually transmitted infection (STI) quality of care measures was reviewed by a panel of five STI experts representing Emergency Department (ED), Obstetrics/Gynecology (Ob/Gyn), Family Medicine (FM), Primary Care (PC) and Infectious Disease. Panel members grouped each measure into “standard” or “exceeds standard of care” in evaluation and management of male patients with penile discharge/dysuria or female patients with vaginal discharge. The chart review instrument was piloted on 50 charts per gender from the STI Clinic and matched charts, by patient presenting complaint, age, gender, and visit date, from PC, FM, ED, and Ob/Gyn (for vaginal discharge) in the same large safety-net hospital in Massachusetts. RESULTS: Twenty-four and 34 final measures in male and female patients, respectively, were selected on plurality of expert panel member’s categorization into “standard of care”. Measures were grouped into 7 clinical domains: history, examination, laboratory testing, additional screening, assessment, treatment, and counseling. Performance on the 7 domains ranged from 3.16-4.36 on male patients and 3.17-4.40 on female patients, with the highest scores in the STI Clinic. However, each clinical setting had particular documentation strengths and weaknesses: STI Clinic scored higher on laboratory testing, additional screening, and counseling, but scored lower on examination and assessment; ED scored higher on examination and treatment; PC and FM scored higher on laboratory testing for male patients and on examination and treatment for female patients; Ob/Gyn scored higher on treatment. All sites other than the STI Clinic scored poorly on additional screening and counseling. CONCLUSIONS: An instrument to discern standard of care and identify strengths and weaknesses in specific domains of clinical documentation for patients presenting with STI complaints can be rapidly developed and implemented to evaluate quality of care across care settings. Further research is needed on whether these findings can be integrated into site-specific quality improvement processes and linked to cost analyses. / 2031-01-01

M.Cur. / The rationalization of nursing colleges was implemented to change the manner in which the state institutions were administered for the purpose of improving service delivery, reduce state expenditure and maximize the utilization of these state institutions by making them accessible to all eligible users. The nurse educators’ experiences in this regard had to be explored and described because people react differently even to the best of intentions. The following research questions that gave direction to the research study were formulated. • What are the experiences of the nurse educators following the rationalization of the nursing colleges in Gauteng? • What are the supportive guidelines that can be formulated to assist the nurse educators cope in the nursing college that has undergone the rationalization process? The purpose of the research was to describe the supportive guidelines that might assist the nurse educators cope in the receiving nursing college that had undergone the process of rationalization. The objectives that would enable the fulfillment of the research purpose were formulated. The objectives of the study were: • To explore and describe the experiences of the nurse educators in a nursing college that has undergone the process of rationalization. • To conceptualize the experiences of the nurse educators • Describe the supportive guidelines to assist the nurse educators cope in the nursing college that has undergone the process of rationalization. A qualitative, contextual, exploratory, descriptive and phenomenological research design was used to address the research questions and objectives (Mouton 1998). The study was conducted in two phases. Phase one focused on the description and exploration of the nurse educators’ experiences following the rationalization of nursing colleges in Gauteng. Phase two focused on the conceptualization of findings and the description of the supportive guidelines. The method of selecting the participants of the study was purposive so that participants who met the criteria could be included in the study. The sample was obtained from the target population of thirty six nurse educators who were deployed from the nursing colleges that were closed down and those who were employed in the nursing college before the implementation of the rationalization of nursing colleges in Gauteng. A pilot study of four nurse educators was done. The four nurse educators were not included in the focus group interview. Twelve nurse educators from General Nursing Science, Midwifery, and Psychiatry and some of the managers (HOD’s) participated in the study. Community Nursing Science nurse educators were not available due to work commitment outside the nursing college. A focus group interview (Krueger 1994) was conducted within ethical considerations. Audio tapes were used to capture the data. Field notes of the gestures and emotions expressed by the nurse educator during the interview were taken. Tech’s (in Cresswell 1994) protocol to systematically process the contextual data was utilized. Trustworthiness was maintained to ensure credibility of the study (Lincoln & Guba 1985.) The two categories, seven sub categories and the related themes that emerged from data analysis were conceptualized and supported by relevant literature. The two main categories were positive experiences and negative experiences. The sub-categories of the positive experiences were: sharing of resources, empowerment of the nurse educators, collaboration of the receiving nursing college with the community to improve nursing education and acquisition of trans- cultural knowledge. The sub- categories of the negative experiences were: fear, perceived behavior of the authorities concerned with rationalization of nursing colleges in Gauteng and aspects pertaining to racial issues. These categories and their related themes were conceptualized and supported by relevant literature. Guidelines that would assist the nurse educators cope in the receiving nursing college were formulated. It is recommended that the authorities concerned with the rationalization of nursing colleges in Gauteng and the management of the receiving nursing college should consider the guidelines to assist the nurse educators cope in the receiving nursing college and in future rationalization of the nursing college. In conclusion, the study has sheared light on the importance of conducting a research before implementing a major change such as rationalization of state institutions to ensure sustenance of the objectives of the change. The employees’ wellbeing should be considered because the success of the rationalization depends on them. Rationalization of institutions, whether public or private, requires effective management to facilitate a reasonable integration process.

This thesis investigates the treatment quality of medical services in the hospital sector from different angles: theory, measures and application in China. This thesis includes three essays. The first essay (Chapter 2) is a critical review about the quality assessment. It shows that the environmental performance index is suitable for measuring treatment quality. The second essay (Chapter 3) introduces alternative approaches to environmental performance indices to solve the infeasibility problem of current measures. Environmental performance indices are measures to evaluate the production of undesirable outputs relative to desirable outputs. My new measures are more accurate using the sequential frontier and various reference vectors. The last essay (Chapter 4) is an empirical case study in the Chinese hospital sector that examines how the degree of government involvement and the degree of market competition affect the performance of treatment quality. Using the environmental performance indices of Essay 2 to evaluate treatment quality, I find that the performance of treatment quality of Chinese hospitals improved during the 2009-2014 period. Therefore, the marketisation of hospitals and government subsidies contribute to this sustained improvement

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Thesis (Ph. D.)--University of Wisconsin--Madison, 2001. / Includes bibliographical references (p. 517-547). Also available on the Internet.

published_or_final_version / Public Administration / Master / Master of Public Administration

Thesis (Ph. D.)--University of Wisconsin--Madison, 2001. / Includes bibliographical references (p. 517-547).