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As the percentage of elderly adults within the U.S. continues to grow, long-term care options will increase. Facing increased competition from other forms of long-term care, many nursing homes are seeking innovative models to enhance management and clinical care practices. The Teaching Nursing Home model, first established in the 1970s, is one in which academic institutions partner with nursing homes to create information exchanges between the nursing home and the school. Currently, nursing schools throughout the country work with nursing homes to create clinical training sites for nursing students. The partnership is also used to encourage research among school faculty and to assist nursing homes in their management of best practices. This study examined the impact of these relationships on nursing home quality. Twenty teaching nursing homes were matched with twenty nursing homes that are not engaged in this practice. Using nursing home quality scores published by the Centers for Medicare and Medicaid Services, mean outcomes for the matched pairs were compared using T-tests. Regression analyses were also performed to test whether quality improves over time within a teaching nursing home. The results from the T-tests performed did not show overall quality differences between the matched pairs. However, when analyzed regionally, some significance was observed for teaching nursing homes in the Upstate NY region (p<0.1). The study discusses some of the differences in design of the teaching nursing homes within that region and the impact that may have on results. Time as a teaching nursing home did not appear to affect quality for nursing homes in this study. Possible explanations for these insignificant results are discussed in the Summary, Discussion and Limitations section of the study. Overall, the findings from this study suggest that the Teaching Nursing Home model can add value to nursing homes by offering them research and professional training opportunities with academic institutions. Within the study, recommendations are made to further explore the impact of these partnerships on nursing home quality and to encourage the development and use of the model through policy changes. / Business Administration

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Master of Science / Department of Industrial & Manufacturing Systems Engineering / Malgorzata J. Rys / Emergency department (ED) overcrowding is a nationwide problem affecting the safety and preparedness of our health care system. Many hospital EDs face significant short and intense surges in demand on a daily basis. However, the surge in demand during disaster event is not short and intense, but it is a sustained one. In order to meet this sudden surge as defined above, hospital EDs need to be more prepared and efficient to cater to increased volume of demand involving huge uncertainties. This thesis looks at the creation and use of discrete event simulation modeling using ARENA 10.0 software. In this thesis, an attempt is made to show how the different arrival patterns and time durations for which victims keep arriving affect the EDs ability to treat the patients. It is shown, how the model can be used to estimate additional resources that would be required to accommodate additional patients within the ED. Various shapes of arrival distributions were tested for different time durations. It was found that the arrival distribution with parameters (3, 4), (3, 3), (4, 2) and (2, 4) did not challenge the institutional capacity. In other words, the hospital was able to treat all the patients without compromising the quality of care up to 24 hours. However, distribution with parameter (3, 2), (2, 2), (3, 1), (1, 2), (2, 3), (2, 1), (1, 4), (1, 3), (1, 1) and (0.5, 2) did affect the system performance. Under these distributions, there was at least one patient who was either dead, LWBS or diverted. This indicates the immediacy with which victims arriving under these distributions overwhelmed the limited resources Our aim was to study, how many more resources would the ED need in order to have zero critical expire, zero Left without Being Seen (LWBS) and zero patients diverted. Arrival distribution (1, 2) was randomly selected to study this objective and it was found that for a 24 hours of simulation run time, an additional of two full trauma resources were required in order to have zero critical expire in trauma rooms area and additional of five ED beds and three nurses were required in treatment area for patients with moderate severity to have zero LWBS. With these additional resources, the ED was also able to treat all the non disaster related patients thereby having zero patients diverted. The same procedure can be used to determine the number of additional resources ED would require to treat all the victims arriving with the rest of the arrival distribution for different time periods. The simulation model built would help the emergency planners to better allocate and utilize the limited ED resources in order to treat maximum possible patients. It also helps estimate the number of additional resources that would be required in a particular scenario.

<p> The purpose of this project was to locate a potential funding source and write a grant to create a psycho-educational group for family members of adults with a mental health diagnosis. With this program, family members can receive guided and educated support. The additional support they receive will assist them in becoming more supportive to their loved ones who have mental illnesses. The group would take place at Alma Family Services in Long Beach, California. A search was conducted to locate an appropriate funder for this project. The Ralph M. Parsons Foundation had specific criteria about what type of agencies they fund, which was met by the agency and the program. </p><p> Individuals who experience mental health challenges face many difficulties during their lives. The support of knowledgeable, understanding, and caring family members may reduce some of life's challenges for individuals who experience mental illness. If funded, the program would benefit families who need psycho-education about mental illness and assistance with mental health questions. The actual submission and/or funding of this grant was not a requirement for the successful completion of the project.</p>

Commentators on U.S. health care policy have noted that the relative weakness of government institutions has left the allocation and financing of health care services to powerful interest groups. Until recently, the actions of state organizations as a major explanation for the organization of the market was seldom used. This dissertation evaluates the efficacy of a state centered approach to explaining Florida's health care politics. / Florida is used as a case study because of the dynamics of its economy, politics, and demography and its effect on the state's health care issues. Four questions guide the research. First, what are the State of Florida's interests in the market? Second, what strategies have state organizations pursued in Florida's interests? Third, to what degree do non-state organizations influence the development of the legislation? Finally, what conditions facilitate the involvement of Florida's state organizations in the health care services market? / Legislation regarding the enactment and continuance of Florida's Medicaid program, Florida's strategy for financing uncompensated hospital care, the financial arrangements for purchasing services, Florida's certificate of need licensing program, and Florida's regulation of hospital budgets is examined over a 28 year period, 1965 to 1993. / The investigation found that the interests of the State, defined by well accepted principles of its appropriate role, were strong enough to enable state agencies to successfully promote legislation authorizing and expanding Florida's Medicaid and indigent hospital care programs. Furthermore, on behalf of Florida's economic interests as a payer in the health care market, state agencies were successful in promoting legislation for alternative financial arrangements than fee for service and legislation regulating the capacity of the industry to produce health care services. / State agencies were successful in promoting these strategies when the interests of influential health care provider organizations were fragmented and, in some circumstances, when these organizations were united in their opposition to legislation promoting state strategies. In these circumstances, state agencies' efforts, influenced by federal monetary incentives, federal policy examples, and other state policy examples, set the agenda for the development of these strategies, not policy initiatives developed in the Legislature. / Source: Dissertation Abstracts International, Volume: 57-03, Section: A, page: 1344. / Major Professor: Allen Imershein. / Thesis (Ph.D.)--The Florida State University, 1996.

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu