Thesis (Ph.D.)--University of California, San Francisco, 2009. / Source: Dissertation Abstracts International, Volume: 70-04, Section: B, page: 2206. Advisers: Mary A. Blegen; Charlene A. Harrington. Includes supplementary digital materials.

Thesis (Ph.D.)--University of California, San Francisco, 2009. / Source: Dissertation Abstracts International, Volume: 70-04, Section: B, page: 2211. Adviser: Robert Newcomer.

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2009. / Source: Dissertation Abstracts International, Volume: 70-06, Section: A, page: . Adviser: K. Peter Kuchinke. Includes bibliographical references (leaves 241-252) Available on microfilm from Pro Quest Information and Learning.

<p> <b>Background:</b> Social and health supports provided during young adulthood can have long lasting health implications. Racial and ethnic minorities will soon comprise the majority of this population in the US and are more likely to experience poverty with poor access to health services. Oral health has been identified as a health disparity for young adults in the general population as well as those living with HIV (YALWH). Identifying and addressing barriers to oral healthcare are important for the long-term improvement of overall health outcomes for YALWH.</p><p> <b>Methods:</b> This mixed methods cross-sectional study includes: 1) an in-person quantitative survey and a semi-structured qualitative interview of YALWH between the ages of 17 and 25 years of age, 2) an online and in person survey of general and pediatric dentists and clinical dental hygienists and 3) a focus group with dental clinic support staff of a hospital based dental clinic.</p><p> <b>Results:</b> YALWH expressed the importance of oral health in their lives; a clean mouth and straight white teeth impacts how they judge others and, they assume, how others judge them. Barriers to care identified across all study groups included dental insurance, HIV disclosure and dental fear.</p><p> <b>Conclusions:</b> Oral healthcare for YALWH can be affected by individual and systemic factors including provider communication skills, provider knowledge of HIV, limitations of healthcare delivery systems and the expectations of the individual patient. These factors are important considerations for health policy makers and oral health professionals in their efforts to address oral health disparities for YALWH.</p>

<p> Heart failure patients who visit the Emergency Department often because of chronic nature of their illness require a specific plan of care. Successful engagement requires that nurses identify and act on factors to facilitate transition across the care continuum. This study was undertaken to examine the relationship of three major quality care indicators: social support, perception of nurse caring, and patient satisfaction among patients with heart failure admitted to the emergency department. The study further explored the association of these indicators with demographic and illness variables of the study participants.</p><p> The Quality Caring nursing framework was used as the theoretical framework for the study. A total of 115 adult participants, 71 males and 44 females who were admitted in the emergency department of two public hospitals in the mid-Atlantic region of the United States were recruited. Data were collected using a survey package consisting of four instruments: the Medical Outcomes Study (MOS) Social Support Survey measuring perceived social support, the Caring Assessment Tool (CAT) measuring nurse caring, and the Consumer Emergency Care Satisfaction Scale (CESS) measuring satisfaction with care in the emergency department.</p><p> Although the major study hypotheses that high levels of social support would be associated with caring and with patient satisfaction were not supported, there were significant associations found between aspects of social support, caring measure and the demographic and illness measures such as marital status and the number the number of household members. Also, those who were employed perceived more social support than those who were unemployed and those who were retired had a significantly higher perception of caring.</p><p> These findings challenge nurse clinicians, educators, and administrators to further investigate the roles of social support, caring and patient satisfaction in multiple aspects of chronic illness.</p>

The purpose of this study was to examine the decision-making process of individuals who use the energy healing modalities of homeopathy, reflexology, acupuncture, and Jin Shin Jyutsu. A qualitative design was selected because the personal nature of decision-making was best accessed through self account. Content analysis was used to examine the data because it both describes and quantifies phenomena. The study sample comprised nine volunteers who met study requirements. Data provided limited initial support of the motivating factors suggested in Astin's (1998) study. However, after consideration of all qualitative data, the original categorical definitions of dissatisfaction with conventional medicine, desire for personal control, and philosophical congruence were amplified or clarified. Additional motivating factors were also described and defined in this study. Therefore, this study identified healing system attributes, outcome, pleasure, timing, and recommendation as factors influencing the decision to use alternatives.

The use of herbal remedies (HR) as complementary and alternative medicines (CAM) appears to be popular despite the limited evidence of their safety and efficacy. The overall purposes of this investigation were to (1) investigate the relationship between regular use of HR and self-reported health status, (2) evaluate this relationship when the HR use was concomitant with pharmaceutical use, and (3) describe consumer beliefs, behaviors, and characteristics related to HR use. A national random-digit dialed telephone survey of 1,500 adult English- and Spanish-speaking Americans was conducted. The survey yielded a response rate of 40.4%. The prevalences of HR use and HR-pharmaceutical concomitant use were 17.1% and 7.9%, respectively. Multivariate modeling indicated that HR use was not associated with health status but was independently associated with race/ethnicity ("other" compared with White adjusted OR = 0.38, 95% CI 0.16-0.85), educational attainment (greater than high school diploma/GED compared with a high school diploma/GED or less adjusted OR = 2.05, 95% CI 1.47-2.87), and urbanicity (Metropolitan Statistical Area- [MSA]-4 compared with MSA-5 adjusted OR = 2.14, 95% CI 1.05-4.34). Among HR users, HR-pharmaceutical concomitant use was independently associated with health status (MCS-12 score adjusted OR = 0.95, 95% CI 0.92-0.99; PCS-12 score adjusted OR = 0.96, 95% CI 0.93-0.99), race/ethnicity (non-White compared with White adjusted OR = 0.26, 95% CI 0.11-0.62), and age (adjusted OR = 1.02, 95% CI 1.01-1.04). Over 45% of HR users reported that they were motivated to use HR for health maintenance. In contrast, HR non-users reported most commonly that the motive to not use HR was because they did not have any health problems that required their use (43.6%). Adult Americans were estimated to have spent between 7.9 and 15.7 billion per year out-of-pocket on HR. Respondents agreed that the government should become more involved in regulating HR safety and efficacy (p < 0.005). In conclusion, this investigation provided evidence that HR and HR-pharmaceutical concomitant use were prevalent across a variety of sociodemographic groups. Furthermore, the evidence indicated that consumers were willing to spend sizeable amounts out-of-pocket for largely unproven preventive agents/therapies, suggesting that the demand for these products would continue.

Despite the time and resources focused on health care outcomes, few empirical links exist between healthcare activities, healthcare costs and outcomes of care. As a result, outcome evaluations that take into account the characteristics of the healthcare system as well as the desires of a number of stakeholders may have relevance to knowledge development as well as to implementation of needed changes in health care delivery. Using the framework of General Systems Theory (von Bertalanffy, 1968) and a modification of the model proposed by the American Academy of Nursing Expert Panel (Mitchell, Ferketich, Jennings, 1998), this investigation addressed broad categories of outcomes, including clinical and financial aspects, and examined the factors influencing them in a condition-specific population. Further, the contextual characteristics of the healthcare organization and the work group were examined and compared to the effects of the individual patient characteristics on cost, length of stay and morbidity/mortality outcomes. Organizational factors included structural characteristics such as volume and technology availability, work unit factors included perceived collaboration, access to power structures and control over nursing practice and individual patient factors included pre-hospital health conditions and socio-economic status. For this study outcomes consisted of adverse events, derived length of stay and direct costs. This study used a non-experimental, descriptive design. Contextual regression analysis indicated that organizational structure variables had a greater influence on cost and the work group-level variables had a greater influence on derived length of stay than did the individual-level variables. Total average costs for cardiac catheterization procedure and associated post-procedure hospitalization were 3758 (range 777-12,796). While the study has several limitations, the findings add to the body of knowledge that explains how the processes of nurses' work influence the outcomes of that work. The findings deserve consideration by nurse executives and others interested in enhancing work environments and patient care outcomes.

The dissertation is on the impact of information technology (IT) on the economy. Theoretical and empirical analyses are reported in order to explain the productivity "paradox" surrounding IT. The techniques used in the study cover a wide range from simple deterministic production functions to panel data techniques and data envelopment analysis. The empirical study is set in the health care industry. A hospital, which is the the unit of analysis, is an organizational entity that provides an appropriate context for the study of the interactions between information technology, technological advancements, organizational factors and regulation. Overall, it was found that IT contributes in a positive manner to the production of healthcare services. However, measurement problems including "quality" of IT capital due to technological developments can lead to the underestimation of IT productivity. It is also seen that regulation plays a major role in the manner in which costs are allocated to input factors. In particular, the effect of the Prospective Payment System (PPS) legislated in 1983 is investigated. One of the findings of the cost function analysis is that, since PPS, hospitals have been moving toward cost containment. Non-parametric analyses is used to determine the allocative inefficiency in IT with respect to other inputs. The different techniques serve as means to triangulate the measure of IT impact on productivity and efficiency, and in addition, develop the theory underlying production techniques.

As an exciting information technology-based innovation, telemedicine has potential to enhance physicians' patient care and management, improve healthcare organizations' operations and performance, and cause a paradigmatic shift in health care toward a progressively emerging digital practice. Previous research has concentrated on technology developments and clinical applications and therefore offers limited discussion of technology management. Managing telemedicine technology in healthcare organizations is so complex and dynamic that it has been an important factor in the failure of many early telemedicine attempts. This dissertation research directly addressed organizational management of telemedicine technology. To deal with complexity and dynamism, the research took a multi-phase approach, using a research framework built upon a well-established theoretical foundation. Case study was used in the exploratory phase to provide detailed understanding of the underlying technology implementation process and to generate specific research questions or models for the subsequent descriptive/explanatory phase. Systematic linkage of these investigations was safeguarded by desired methodological triangulation. Findings from the case study and substantiating interviews identified technology acceptance, adoption and evaluation as problematic areas in organizational technology management. Findings of a survey study administered to most physicians practicing in public tertiary hospitals in Hong Kong suggested that perceived usefulness and ease of use, self-efficacy, and subjective norms were important to their accepting telemedicine technology. Similarly, a survey conducted with hospital executive officers, chiefs of service and center directors of all Hong Kong public healthcare establishments indicated that service needs, attitudes of medical staff, and the technology's benefits, risks and compatibility were essential to organizational technology adoption. In addition, results of an evaluative experimental study showed that the clinical decision- making of physicians can be improved through use of appropriate telemedicine technology. The combined findings suggested that these separate technology management issues were closely interrelated rather than isolated. Effects of a technology on physicians' patient care and management practice have important impacts on their technology acceptance, which, in turn, needs to be considered by their affiliating organization when making an adoption decision.