Thesis (M.P.H.)--University of Michigan, 1945.

Thesis (M.S.P.H.)--University of Michigan, 1942.

Thesis equivalent (M.P.H.)--University of Michigan, 1948.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis (Ph. D.)--Rutgers, 1999. / Vita. Includes bibliographical references (leaves 305-319).

Cheung, Lai-shan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 153-162). / Abstracts in English and Chinese. / Acknowledgments --- p.i / Abstract --- p.ii / List of Figures --- p.iv / Abbreviations --- p.iv / Chapter / Chapter One --- Introduction --- p.1 / Chapter Two --- New Public Management: Its Theoretical Underpinnings and Their Inadequacies --- p.23 / Chapter Three --- The Content of the Managerial Reform: The New Philosophy of the Hospital Authority --- p.64 / Chapter Four --- De-mystifying the Culture: Delineating the Managerial Reform from the Participants´ة Sense --- p.99 / Chapter Five --- Conclusion --- p.146 / Bibliography --- p.153 / Appendix I --- p.163

The use of computed tomography (CT) in the care of patients has grown dramatically since its introduction over 30 years ago. The vast majority of the utilization research has focused on factors associated with the variable use in the outpatient and emergency department settings. This has left much of the inpatient use and variation understudied. This study has multiple aims. The first is to characterize the inpatient variation across multiple states and markets. The second is to evaluate the relationship between inpatient CT use and commercial payers across these areas. The third is to develop a model to evaluate the relationship between inpatient CT use and the characteristics of markets, hospitals, and patients. The study uses a four-state convenience sample of cross-sectional data for hospitals. It included non-Federal, acute care hospitals that reported the performance of inpatient CT exams during 2015 (N=181). The literature review was used to justify the inclusion of variables in the study. The descriptive analyses were used to justify the appropriateness of the variables and methodology for testing. A comparison of means demonstrated the significant differences for inpatient utilization between states. A univariate general linear model demonstrated a negative relationship with a hospital’s proportion of commercially insured patients and the inpatient utilization rate. An ordinary least squares multivariate linear regression was used to test for variable significance within each of three constructs: markets, hospitals, and patients. The results indicated that inpatient CT rates were positively associated with higher level of insurer concentration (market), positively associated with system centralization (hospitals), and negatively associated with a hospital’s increasing proportion of minority patient discharges (patients). The study serves an important function in identifying varying patterns of CT utilization across the full spectrum of inpatients across multiple states, regardless of payer. It also creates new knowledge about how the characteristics of these markets, hospitals, and patients are related to inpatient use. It also provides implications for administrators, researchers, and policy makers. The additional knowledge and understanding provided by this research have the potential to lead to improvements in the appropriate and equitable use of inpatient CT exams.

Hospitals worldwide are under pressure to perform and models abound to remedy poor performance. Reform, however, is contested, uneven and slow. One reason is that few models address a core issue in reform: the management of clinical work. A further reason is that stakeholder groups, specifically policymakers, managers and clinicians, limit opportunities for collaborative problem solving as they seek to impose their own frame of reference in the struggle for control. I hypothesise that performance will be relatively better in hospitals that have in place strategies of agreement to set the objectives of reform, such as participative problem identification, problem solving and decision making, together with a method to manage clinical work. This hypothesis was tested in twelve public hospitals in three Australian states between 1999 and 2001 using both quantitative and qualitative research methods. Government and hospital policy documents were assessed and semi-structured interviews were conducted to gauge the attitudes and practices of managers and clinicians regarding health care reform. The results of the research show that hospitals with inclusive strategies for change, principally strategies of agreement, joint education and skills development, team-based incentives to direct and reward effort and a method of clinical work management, performed better than those without. Findings indicate that policy was developed and communicated as a rational top-down process that tended to exclude diverse views. Although the effect of different jurisdictional policy processes on hospital performance was not clear, they had considerable impact on the environment of reform. Cost containment and patient safety dominated as policy objectives. These alone did not engage clinician interest or address service quality. The connection between the quality of care and its cost did not appear to be understood. Organisational structures and processes necessary to support reform, that is communication forums for objective setting and performance review, integrated clinical and corporate accountability systems and organisational capacity building were not in place in the majority of hospitals studied. An organisational model of clinical work management was developed to improve cost-effectiveness by balancing clinical autonomy and clinical accountability based on the research results.

Thesis (M.A.(Applied))--Victoria University of Wellington, 2006. / Includes bibliographical references.

Thesis (Ph. D.)--York University, 1998. Graduate Programme in Philosophy. / Typescript. Includes bibliographical references (leaves 351-366). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pNQ27298.