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<p> Low back syndrome affects 20% of people, and it is estimated that 30% of patients are unable to return to work after surgery. The monitoring of health care outcomes could improve the delivery of health services. The health performance conceptual framework, derived from the Donabedian model, was used to evaluate the functional outcome, clinical recovery, response to surgery, and physician performance of the surgical management of lumbar spine degeneration. A quantitative study (n=685) was undertaken using an administrative database in a repeated-measures design. The clinical and functional outcome improvements were analyzed using t tests. Surgical complexity on health outcome was examined with ANOVA. Predictors of patient satisfaction was explored using Pearson's correlation and regression analyses. The results demonstrated highly significant improvements in functional (mean change 30%; ODI=16.79 &plusmn; <i> SD</i> 19.92) and clinical recovery (mean change 50%; modified-JOA=6.983 &plusmn; <i>SD</i> 2.613) with surgery at 3 months; a >50% positive response to surgery; and a > 90% patient satisfaction, sustained over a 2 year period. Complexity of surgery did not impact health performance. Strong correlations between the health performance metrics were detected up to 6-months from surgery. Poor clinical recovery and persistent functional disability were predictive of patient dissatisfaction. The social change implications for health policy are that a constellation of health performance metrics could predict the potential for functional and clinical recovery based on presurgery disability while avoiding medical expenditures for procedures with no health benefit; aid in health quality monitoring, peer comparisons, revision of practice guidelines, and cost benefit analysis by payers.</p>

Saudi Arabia has witnessed rapid development in economic, cultural and social aspects since the discovery of oil a few decades ago. This development involves all the governmental sectors including national parks. The need for national parks has become inevitable. Asir National Park was established to provide recreational sites and to preserve the unique natural and cultural features of the park. Research evaluated the impact of human activities of logging, grazing, hunting, land development and elimination and negligence of traditional architecture on Asir National Park features. A questionnaire, interviews and field observations were conducted to investigate the impact of these activities on Asir National Park. Asir National Park suffers a great deal of pressures from human activities. The local population depends on the park as their source of livelihood and as a traditional habit. The study illustrates the most affected zones where action should be taken to preserve park features.

<p> Hospital performance metrics are an indicator of leadership performance. However, there is inadequate research on whether physician or nonphysician chief executive officers (CEOs) perform better in the U.S. hospitals. The purpose of this study was to examine which type of leaders is better. Leadership trait, situational leadership, and leadership behavior theories constituted the theoretical foundation. The key research question examined the relationship between a hospital&rsquo;s outcomes, which in this study, included hospital net income, patient experience ratings, and mortality rates, and the type of CEO in that hospital: physician or non-physician. A quantitative, causal comparative design was used to answer this question. Three hypotheses were tested using multivariate analysis of variance. The dependent variable was hospital outcomes: hospital net income, patient experience ratings, and mortality rates. The independent variable was the type of hospital CEO: physician and nonphysician. Datasets from 2014-2015 were used, which were publically available on the websites of U.S. based hospitals, research organizations, and journals. A sample of 60 hospitals was drawn from U.S. non-federal, short-term, acute care hospitals, based on number of staffed beds (<i>n</i> = 60). No significant differences were found between nonphysician and physician CEOs on hospitals&rsquo; net income (<i>p</i> = .911), patient experience ratings <i>(p</i> = .166), or mortality rates (<i> p</i> = .636). Thus, the null hypotheses were retained. Findings suggest that physician and non-physician CEOs may produce similar outcomes in the hospitals they lead. Based on these findings, hospital boards can view CEO applicants equally when considering whom to hire and understanding U.S. hospital leadership.</p>

<p> High patient no-show rates increase health care costs, decrease healthcare access, and reduce the clinical efficiency and productivity of health care facilities. The purpose of this exploratory qualitative single case study was to explore and analyze the managerial intervention strategies healthcare administrators use to reduce patient no-show rates. The targeted research population was active American College of Healthcare Executives (ACHE), Hawaii-Pacific Chapter healthcare administrative members with operational and supervisory experience addressing administrative patient no-show interventions. The conceptual framework was the theory of planned behavior. Semistructured interviews were conducted with 4 healthcare administrators, and appointment cancellation policy documents were reviewed. Interpretations of the data were subjected to member checking to ensure the trustworthiness of the findings. Based on the methodological triangulation of the data collected, 5 common themes emerged after the data analysis: reform appointment cancellation policies, use text message appointment reminders, improve patient accessibility, fill patient no-show slots immediately, and create organizational and administrative efficiencies. Sharing the findings of this study may help healthcare administrators to improve patient health care accessibility, organizational performance and the social well-being of their communities.</p>

Cost containment measures instituted in the early 1980s are responsible for moving the health care industry to a more competitive composition. As a result of placing hospitals in a more cost conscious environment, they will no longer be able to finance uncompensated care through cross-subsidization. In three separate empirical studies, this dissertation investigates issues concerning the consequences procompetitive actions may have on the provision of hospital care to the poor. / In the first study, Certificate of Need (CON) regulation is likened to regulation allocated on a public interest standard. To test this analogy, probit analysis is used to isolate the objectives of CON regulators as reflected in their decisions regarding hospital investment applications. The results reveal some tendency for regulators to favor hospitals providing relatively large amounts of uncompensated care. This suggests that the benefits of CON protection are used to reward hospitals for providing uncompensated care. / The second study examines efficiency among hospitals providing different levels of uncompensated care. If the few hospitals providing the majority of uncompensated care are relatively inefficient, a more competitive market may force them to change their mode of operation, be bought out, or even close down. Estimates of a multiproduct cost function indicate that hospitals providing relatively large amounts of uncompensated care are less efficient on average. Thus, competition in the health care industry will not only affect the financing of indigent care, but also the providers. / The third study offers a more accurate depiction of those who generate uncompensated care and the hospitals that provide it. Previous studies have relied on characteristics of the uninsured population to make inferences about those who generate uncompensated care. A unique survey from Florida includes patient characteristics along with the amount of uncompensated care generated. Estimates from a type-two tobit model indicate that many of the conclusions derived from studies of the uninsured also hold true for the indigent. Of particular interest is the result that many of the indigent are employed but uninsured. Thus, policies aimed at the employed uninsured are likely to be effective at alleviating the problem of uncompensated care. / Source: Dissertation Abstracts International, Volume: 50-03, Section: A, page: 0742. / Major Professor: Gary Michael Fournier. / Thesis (Ph.D.)--The Florida State University, 1989.

This dissertation investigates the effects of market forces and government regulation on the innovation decision of firms. Using Florida data on the adoption of high technology equipment in hospitals I analyzed the effects of market share, concentration, ownership including teaching status, cost and revenue, background demand such as population and income of the relevant market. / In addition, the effects of regulatory changes such as Prospective Payment System (PPS) and Certificate of Need (CON) deregulation were investigated using dynamic Weibull regression model. The Model shows the impact of explanatory variables on the likelihood of innovation and changes in the marginal probability of adoption flowing through time. / The result of estimation shows that leading firms in more competitive markets adopt earlier than others. Teaching status of a hospital, which offers technological advantage, encourages it to innovate earlier than others. The behavioral change of regulating agency rather than official deregulation appeared to affect innovation decision of firms. It is hoped that this study will better clarify the relative importance of the key variables as well as the usefulness of dynamic econometric modelling approaches so that policy makers may obtain clearer intuition about how hospitals approach major adoptions, and what factors to consider in shaping innovation policies. / Source: Dissertation Abstracts International, Volume: 52-03, Section: A, page: 1013. / Major Professor: Gary M. Fournier. / Thesis (Ph.D.)--The Florida State University, 1991.

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<p> Continuous changes within the health care industry and continuing medical education regulations within the United States (US) provide opportunities for Accreditation Council for Continuing Medical Education (ACCME) accredited providers to enhance the continuing medical education provided to the physicians. Blended CME, Inc.&rsquo;s sole purpose is to allow accredited providers an opportunity to enhance physician knowledge, competence, and performance in order to narrow professional practice gaps and to produce measurable improvement in patient outcomes. This business plan shows how Blended CME intends to provide quality consulting services to accredited providers, while at the same time being a profitable organization. Blended CME utilizes a rigorous educational planning process that draws on the experience of multi-disciplinary experts in physician education, practice-based learning, and system-based practice.</p>

In this thesis we discuss three models that are used to estimate vehicle busy probabilities when call service time depends on call location and the serving vehicle. The first model requires an assumption that each vehicle operates independently of the other vehicles. The second model approximately corrects for the independence assumption. The third model also approximately corrects for the independence assumption, however it assumes that all vehicles have an equal busy probability. We evaluate model bias by comparing the estimates from each model with estimates from a simulation model. We use extremely long runs to ensure that the simulation is both accurate and precise. Our results suggest that the model using the independence assumption performs poorly as the system utilization increases. The correction models, however, perform well over a wide range of system sizes and utilizations. (Abstract shortened with permission of author.)