<p> This thesis examines the role of limited English proficiency (LEP) as a contributing significant barrier to the mental health access for Chinese living in America. The literature purports that language barriers do present significant challenges to providing timely and effective mental health services worldwide. Additionally, studies highlight two reoccurring themes on the mental health of Chinese Americans, including their underutilization of mental health services and the premature termination of treatment in comparison to other nonminority clients. Using the 2009 dataset from the California Health Interview Survey (CHIS) 2009 Adult Questionnaire, data was analyzed and it was concluded that a relationship exists between mental health status and language proficiency. Further study is necessary to determine where it may be best for health professionals to invest their efforts in the mental health care of this deserving population. It would behoove organizations, communities, and health care leaders to peer deeper into the interconnected relationship between mental health utilization and language proficiency.</p>

<p> This study seeks to determine the payer source for single, elderly women in nursing homes. By determining the payer source for single, elderly women, the next generation of women can prepare for high nursing home costs by saving earlier or investing in long-term care insurance. Studies have shown the primary payer sources for nursing home costs are Medicare and Medicaid. This study hypothesized single women, when compared to married women, would utilize Medicaid and welfare to pay for nursing home costs. Secondary data from the 2004 National Nursing Home Survey was extracted and analyzed for the aforementioned hypotheses. The analysis determined the primary payer sources for elderly women in nursing homes were self-pay and Medicaid. Marital status did not have an impact on the payer sources for single, elderly women in nursing homes when compared to married women.</p>

<p> As the rates of breast cancer continue to increase, researchers and medical professionals struggle to give a definitive cause of the disease or find a cure. Unfortunately, it seems that the chance of having a cancer diagnosis within one's lifetime is only increasing. Since breast cancer is somewhat unpredictable, the medical field has taken the pathway of attempting to minimize the risk of mortality through regular screening mammograms. Even with multiple initiatives to increase mammogram utilization, multiple demographic factors such as race, income status, and insurance coverage continue to be underserved. The present study will focus on income status and insurance coverage as barriers to regular screening mammograms. It is hypothesized that those women with low-income status and no insurance coverage are less likely to receive regular screening mammograms than those women with higher income and some type of insurance. After completing a statistical analysis, both hypotheses were supported.</p>

The purpose of this thesis is to evaluate the medical data management expert system at the Pediatric Intensive Care Unit of the Montreal Children's Hospital. The objective of this study is to provide a systematic method to evaluate and, progressively improve the knowledge embedded in the medical expert system. / Following a literature survey on evaluation techniques and architecture of existing expert systems, an overview of the Patient Data Management System hardware and software components is presented. The design of the Expert Monitoring System is elaborated. Following its installation in the intensive Care Unit, the performance of the Expert Monitoring System is evaluated, operating on real vital sign data and corrections were formulated. A progressive evaluation technique, new methodology for evaluating an expert system knowledge-base is proposed for subsequent corrections and evaluations of the Expert Monitoring System.

The importance of ethnic origin as a factor in delivery of social services has been recognised internationally as relevant at different levels of organization. This study examined 500 dossiers, a random sample of clients referred in 1985 to one hospital social service department in Montreal. Age, gender, status of children, referring hospital service, problems experienced and involvement with community social service agencies were found to be related to ethnic origin, using the Kruskal-Wallis and Pearson chi-squared test. After accounting for differences between ethnic groups in age, type of problem and referring hospital service by the use of logit analysis, ethnic origin significantly affected the changes of involvement with Social Service Centres and Departments of Youth Protection. Among the implications of the results for social services in Montreal were the need for the following: recognition that some ethnic minorities have very different social service needs than the larger ethnic groups; development of skills in cross-cultural social service provision because of the clientele's varied ethnic background; consideration of the impact, desirability and viability of ethnic/socioculturally specific agencies and services. The urgent need for further research is emphasised.

The purpose of this study is to develop and test the validity of an algorithm allowing the classification of the decedents as were dying of, died of and died with BC, using administrative data, for the study of service delivery to the terminally ill. / Validation was carried out through a chart review of a sample of BC decedents extracted from a tumor registry. The algorithm was then applied to the decedents of a cohort of women with BC. The three groups were compared for their distributions of age and place of death. / The validation showed an excellent crude agreement (0.96). Of the 3334 deaths, 2293 were classified as were dying of, 142 as died of, and 949 as died with. The comparison of age showed that women who died with were older than women who were dying of. These two groups differed in their distributions of place of death.

<p>Unplanned readmissions back to the hospital are a burden financially and a strain on patients and their families, healthcare organizations, and government payers. Readmissions from skilled nursing facilities account for approximately one-fifth of total rehospitalizations. This project uses the Plan, Do, Study, Act (PDSA) cycle to implement an adaptive problem solving plan to determine the root cause of individual unplanned readmissions from skilled nursing facilities back to the hospital. The plan details past readmission administrative data using descriptive statistics, the roles and responsibilities for the collaborative partnership between care sites, the content of adaptive problem solving, and the use of rigorous reflection and review for continuous improvement. The project provides a disruptive patient centered care approach for problem solving the complexities of readmissions to the hospital for healthcare organizations to consider as readmission rates are tied to reimbursement and quality outcomes. </p>

This thesis presents a computerized nursing workload management system developed as part of the Patient Data Management System (PDMS) for the Pediatric Intensive Care Unit of the Montreal Children's Hospital. The objective of the Nursing Workload Management System (NWMS) is primarily to reduce the workload of nursing staff by automating the preparation of nursing care plans, generating schedules for the tasks in the plan of care, and providing an audit trail facility to annotate the care delivered to a patient. / The thesis begins with a literature review of contemporary computerized medical information systems followed by an overview of the PDMS. A description of the design and implementation of the Nursing Workload Management System of the PDMS is followed by evaluation and performance results of the system. The evaluation of the performance results is encouraging and further on site testing of the NWMS is recommended. Finally, an outline of future extensions for the system is included.

<p> Recently, the Centers for Medicare and Medicaid Services (CMS) ranked all hospitals based on Medicare readmission rates for heart attacks, heart failure, and pneumonia. CMS offered subsidies to hospitals ranked in the 4th quartile to develop community support services to reduce the problem of potentially preventable readmissions (PPRs). CMS cited 4 of the 5 hospitals in Prince George's County in the 4th quartile. The purpose of this quantitative research study was to investigate the relationship between community support services and the reduction of PPRs in Prince George's County. The Evans and Stoddart field model of health and well-being guided this study with support from Bertalannffy's general systems theory. This study sought to relate community support services to PPRs in Prince George's County in contrast to other Maryland counties. To evaluate relationships between community support services and the reduction of PPAs, secondary data were provided by CMS in conjunction with the Robert Wood Johnson Foundation and the University of Wisconsin. The data included 26 behavioral community support factors from 53,229 Medicare paid claims in Maryland residents from July 1, 2008 to June 30, 2011. Lack of diabetes screening is a community support factor within quality of care. Using multiple regressions, there was a statistically significant relationship found between diabetic screenings and pneumonia readmission rate. The implication for social change is that reimbursement of key screening recommendations to CMS, local government, and hospitals in Prince George's County may reduce readmission rates, thereby positively affecting patients, improving community health, and decreasing health care costs in Prince George's County.</p>

<p> The purpose of this study was to explore the barriers of access to health care amongst the Latino Immigrant population in the United States. This was accomplished by performing a quantitative study analyzing secondary data obtained from the California Health Interview Survey (CHIS). The results revealed that Latino immigrants with lower level of English proficiency had fewer doctor's visits, reported lower levels of acculturation, and the majority were born in Mexico whom reported having no health insurance in the entire year. The variables of gender, citizenship status, general health status, and insurance coverage within the past 12 months had a strong correlation with the utilization of the emergency room. The findings may be beneficial in providing awareness to the barriers Latino immigrants face while accessing health care services in the United States.</p>