Thesis--Ph. D., University of Hong Kong, 1983. / Also availalbe in microfilm.

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2002. / Includes bibliographical references.

published_or_final_version / Public Health / Master / Master of Public Health

No description available.

Introduction: Surgical treatment is the cornerstone of the management of colorectal cancer (CRC). This study described the structures of care at Ontario hospitals performing CRC surgery. Methods: Patients diagnosed with CRC undergoing surgery were identified from 2003-2007. Data linkage identified all institutions performing CRC surgery. Multiple hospital level structures were measured. For the final year of our study, the impact of these structures on 30-day mortality was evaluated. Results: 20,784 patients underwent CRC surgery. Each year, between 106 and 109 institutions performed at least one CRC operation. There was variation in hospital level structures of care. After adjustment for patient characteristics, no hospital level structures were independently associated with 30d mortality. Conclusions: Although variation in surgical care and patient outcomes is likely related to variation in processes and structures of care, after adjusting for covariates, our study did not show any significant relationship between hospital level structures and 30-day mortality.

Introduction: Surgical treatment is the cornerstone of the management of colorectal cancer (CRC). This study described the structures of care at Ontario hospitals performing CRC surgery. Methods: Patients diagnosed with CRC undergoing surgery were identified from 2003-2007. Data linkage identified all institutions performing CRC surgery. Multiple hospital level structures were measured. For the final year of our study, the impact of these structures on 30-day mortality was evaluated. Results: 20,784 patients underwent CRC surgery. Each year, between 106 and 109 institutions performed at least one CRC operation. There was variation in hospital level structures of care. After adjustment for patient characteristics, no hospital level structures were independently associated with 30d mortality. Conclusions: Although variation in surgical care and patient outcomes is likely related to variation in processes and structures of care, after adjusting for covariates, our study did not show any significant relationship between hospital level structures and 30-day mortality.

Introduction: The Family Health Team (FHT) is an Ontario-based initiative that aims to provide primary care through multidisciplinary teams of healthcare professionals. Little is known about variability between and within teams, and whether certain organizational characteristics are associated with quality of patient care. Objectives: (1) To describe FHT-level organizational characteristics for seven FHTs in Southeastern Ontario. (2) To examine the role of physician-level organizational characteristics in predicting: (a) Up-to-date colorectal cancer screening and (b) episodic patient-centredness for patients within seven FHTs in Southeastern Ontario. Methods: This study employed linked datasets obtained from surveys of seven FHTs, 115 health care providers (including 41 family physicians) and 998 patients, as well as a chart abstraction. Statistical analyses included performing subject-specific multilevel multivariate modeling. Results: (1) FHTs varied on characteristics including length of time of practice operation, number of patients, existence of personnel policies, team makeup and team climate. (2) (a) Patient uptake of colorectal cancer screening was associated with average duration of regular routine visit OR=0.88 per minute (95% CI 0.83-0.94), patient gender male OR=2.00 (95% CI 1.22-3.28), general checkup in past 2 years OR=9.03 (95% CI 5.18-15.73), travel time less than or equal to 20 minutes OR=1.53 (95% CI 0.94-2.48), and usually see regular provider OR=0.40 (95% CI 0.19–0.87). Patient uptake or physician recommendation of colorectal cancer screening demonstrated similar associations, with the absence of travel time and the addition of team climate (family physician and nurses) OR=5.88 (95% CI 0.98-35.24), patient occupational status employed vs. retired OR=0.49 (95% CI 0.23–1.02), patient occupational status not employed vs. retired OR=0.42 (95% CI 0.16–1.13), and patient smoking status never vs. ever OR=0.59 (95% CI 0.37–0.96). (b) Episodic patient-centredness was associated with patient born in Canada 0.1119 (95% CI -0.0040-0.2278), seeing regular healthcare provider today 0.1449 (95% CI 0.0426-0.2472), physician-patient gender concordance 0.1019 (95% CI 0.0128-0.1910), and appointment length 0.006929 (95% CI 0.003554-0.010304). Discussion: Further research is needed to examine predictors of the quality of patient care at the practice, physician and patient levels. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-09-27 15:21:12.794

This thesis analyzes the degree of cultural relevance in the Asha Gram Mental Health Program in Barwani, India. The focus is on the role of community mental health workers as bridges between a professional culture of psychiatry and the local cultural understandings of mental health. Processes of cultural interaction are analyzed on a continuum from negotiation, defined as interaction without fundamental cultural change, to accommodation, defined as interaction with cultural change. Accommodation at the level of the vision of mental health disorders was limited while there was an active negotiation that resulted in some transformation of the social vision. Negotiation with communities at the level of relationships underpinned this transformation and contributed to a social accommodation with local forms of relationships. Although, professional and class power were important obstacles to achieving cultural relevance, the Program also demonstrates the necessity to subvert this power in order to create social change.

This study is a qualitative, cross-cultural research on advice giving for mothers in maternity and child health services in Scotland and Finland. It has been accomplished through local case studies using ethnographic methods. The main objective is to analyse how in these service systems motherhood, women's daily life, and their responsibilities for children's welfare and health are defined and organised, and how these definitions vary across social and cultural contexts. Methodologically, referring to the feminist methodology by Dorothy E. Smith, it is emphasised that beginning from the local and particular, from the everyday practices of health professionals, can provide more general understanding of the social relations that organise motherhood in the two societies. Empirical results of the study are presented under six substantial themes: The first theme discusses different professional groups as service providers and the relationships between them. Second theme concentrates on the clinic and the home as the physical settings of service provision and their professional and cultural meanings. Third section discusses the relationship and interaction between health professionals and their clients. Next two themes are related to the standards of motherhood: expectations for proper motherhood, child care, and family relations of the mothers. The last theme analyses possible conflicts between women's everyday experience and professional expertise in motherhood. The general conclusions drawn from the research suggest that motherhood is socially organised at four different but interrelated levels, named in this study as interactional level, institutional level, welfare state level, and socio-cultural leveL. Advice giving for mothers in maternity and child health care is related to family policy measures, social class and gender systems, historical and cultural tradition, customs, and ways of thinking in a certain society. This complexity underlines the relevance of qualitative approach in comparative research.

This study is an exploratory investigation of the construct of organizational effectiveness. The multiple-constituency approach to effectiveness is used as the major theoretical framework for exploring and understanding meanings and measures of effectiveness. Pragmatically, it presents a conceptual framework and process for community-based health services (CBHS) providers, showing how an effective measurement of organizational effectiveness can be realized. Theoretically, it advocates the multiple-constituency approach as a viable alternative for examining effectiveness through an investigation of both the normative and descriptive elements embodied in this approach to organizational effectiveness. / Four local CBHS organizations were drawn on for the study sample. The methodological design comprised 40 semistructured interviews and 9 focus group interviews with a total of 115 respondents from 10 constituency groups (i.e., managerial staff, direct service staff, board members, a funding organization, a local organization, service users, volunteers, a school partner, hospital partners, and a self-help organization partner). A Delphi process was also conducted with the participation of 7 expert panel members. These experts possessed expertise in the areas of performance measurement and CBHS delivery. The Delphi process required completing 3 iterative rounds of the Delphi questionnaire before consensus was achieved. / The analysis and categorization of the qualitative interviewing data showed that the meaning of organizational effectiveness is contingent on the constituency being asked to describe it. This means that competing and sometimes conflicting values and conceptions are embedded in organizational attributes, which in turn influence measures of effectiveness. The qualitative findings and analysis also supported an initial conceptual framework for defining and measuring the effectiveness of CBHS organizations composed of 120 effectiveness criteria distributed among 6 dimensions and 18 composite categories. These dimensions are service development and delivery, support and resource acquisition, organization design and process, adaptation to the changing environment, organization development and improvement, and corporate governance. / The converging pattern of the results after the 3 iterative rounds of the Delphi questionnaire demonstrated that a satisfactory level of consensus had been reached among the expert panel on the criteria of effectiveness within the initial framework. This further substantiated and established the validity of the conceptual framework for future applications. Mapping analysis confirmed clearly that the 68 important and consensual effectiveness criteria within the final conceptual framework of the performance of CBHS organizations, drawn from supposedly incompatible perspectives, are nonetheless used simultaneously in organization practice. The findings further suggested an inward focus of CBHS organizations in Hong Kong, in respect of perspectives on organizations and organizational effectiveness. In addition, the engineered-rationality, resource dependency, population ecology, and organization development perspectives on organizations dominate the definitions of effective CBHS organizations. In conclusion, the results of this study caution against a simple-minded approach to improving organizational effectiveness and suggest that the effectiveness of CBHS organizations is in fact a multidimensional construct. Indeed, the design, planning, management, and evaluation of a CBHS organization can be seen as an ongoing process of balancing and compromising alternate concerns and interests of multiple constituencies within the fluid and sometimes contradictory construct of organizational effectiveness. / Thesis (PhDBusinessandManagement)--University of South Australia, 2004.