Abstract not available.

This thesis examines the access of health care facilities in nine provinces of China between the years 1989 and 2004, evaluating the effect of demographic, financial and geographic factors. Equity in social welfare has long played a major role in shaping China's national policies. However, continued pursuit of the GDP-led development orientation in China since the late 1970s has resulted in increasing urban-rural and intra- and inter-regional socio-economic disparities, raising multiple causes for concern from an equity perspective and suggesting the trends that should be closely monitored. While there is a consensus about the need and importance of access equity, little geographic research has been conducted in this area. In light of these issues, using China Health and Nutrition Survey this study addressed the following two objectives: (1) to describe the geographic and financial disparities in access to clinics and hospitals in nine provinces of China during the 1989-2004 period, and (2) to explore the demographic, socio-economic and geographic factors affecting access to health care. Results of the analysis show that between 1989 and 2004 the accessibility gap between hospitals and clinics in terms of geographic indicators has decreased, while the gap in financial accessibility has increased, making urban hospitals the least accessible facilities. Access to both hospitals and clinics in urban and rural areas is mostly conditioned by geographic factors, namely the travel method, region of residence and the availability of health care facilities. Patients who were able to reach the facilities on foot were more likely to enjoy better access than those who were not able to do so. Similarly, residents of western China (Guangxi and Guizhou) along with the provinces with higher availability of health care facilities also tended to have better potential access than their counterparts. Several important contributions essential for informing public decision- and policymaking stem from this thesis, leading to a better understanding of issues related to the accessibility of health care in nine provinces of China. While, typically, the determinants of accessibility have been attributed to the financial or demographic characteristics of patients, this research has identified geographic factors as being of the foremost importance in the accessibility of health care. This important finding provides grounds for further geographic research on accessibility issues in China. While our conceptual framework was designed for studying the accessibility of health care in China, it can be potentially applied to any country with regional, provincial or neighborhood disparities in access.

Using a conceptual framework for effective surveillance and through and exploratory case study informed by key informant interviews and document reviews, this thesis explores the capacity for environmental public health surveillance systems in remote Aboriginal communities to detect and monitor the health outcomes related to a changing climate. The findings demonstrate that several activities associated with effective surveillance systems are being performed in Nunavut, including formal and informal data collection approaches to health and environmental information. Nevertheless, this thesis also reveals that the existing health surveillance and environmental monitoring systems are carried out in a manner that involves very little data integration. Recommendations include the investigation of the feasibility of integrating existing data for health-related climate impacts on Nunavummiut and to research and develop the appropriate partnerships between all stakeholders (community, government, academia, others) to better integrate existing health surveillance and environmental monitoring systems.

Health care is increasingly being provided by collaborative teams that involve multiple health care providers at multiple locations. To date, most of that collaboration is on an ad-hoc basis via phone calls, faxes, and paper based documentation. However, Internet and wireless technologies provide an opportunity to improve this situation via electronic data sharing. These new technologies make possible new ways of working and collaboration but it can be difficult for health care organizations to understand how to adopt new technologies while still ensuring that their policies and objectives are being met. It is also important to have a systematic approach to validate that e-health processes deliver the performance improvements that are expected. Using a case study of a palliative care patient receiving home care from a team of collaborating healthcare providers and organizations, we introduce a framework for assessing health care information systems based on requirements engineering. Key concerns and objectives were identified and modeled. Business processes which will use the new health care information system are modeled in terms of these concerns and objectives to assess their impact and ensure that electronic data sharing is well regulated and effective. The work in the thesis is design-oriented research to show the utility of our proposed requirement engineering framework compared to existing evaluation approaches for healthcare IT. The approach is evaluated based on a set of criteria drawn from our literature review and a gap analysis of our case study for palliative care.

No description available.

No description available.

No description available.

This study had two purposes: (1) to formulate and test for sensitivity and comparability of Resource variables based on data collected across multiple sites; (2) to formulate and test for sensitivity and comparability of Fiscal variables based upon data collected across multiple sites. This exploratory descriptive study utilized data collected during the Differentiated Group Professional Practice project. Global analysis was utilized in creation of nurse Resource and Fiscal variables. Correlational statistics were utilized to evaluate performance of Resource and Fiscal variables within the project model. The Professional Practice index of Autonomy demonstrated a positive relationship with the nurse Resource variables of Retention and Stability. Increases in Professional Practice indices demonstrated negative relationships with Fiscal variables. Satisfaction demonstrated relationship to Resource or Fiscal variables.

A quasi-experimental design was used to examine the differences in myocardial infarction (MI) patients' self-care behaviors, satisfaction, knowledge, and feelings of security after participation in a structured cardiac teaching program presented by one designated patient educator. Thirty subjects diagnosed with first time uncomplicated MIs were randomly assigned to the experimental group (n = 15) or the control group (n = 15) which received conventional unstructured teaching. Four self-report questionnaires were developed and used. Patient satisfaction with teaching was greater for the experimental group (t = -2.65; df = 28; p ≤ 0.05). No differences were found between groups regarding information retained at time of discharge from the hospital or two weeks later, or in readiness for post-hospital self-care. Self-care behaviors were improved clinically in both groups, but somewhat more in the experimental group. The findings suggest this structured cardiac teaching program presented by one designated patient educator enhanced patient satisfaction and may have improved self-care.

<p> Leaders within the long-term care industry face a myriad of challenges as the U.S. population ages at exponential rates. Long term care is an industry that requires strong, well-developed leaders; yet, while Directors of Nursing (DONs) are viewed as key leaders in the long term care setting, few studies have focused on their leadership styles. The goal of this quantitative, non-experimental research was to determine if a relationship existed between leadership styles, personnel retention, and job satisfaction. Based on findings from this study, the `PST2 Leadership Model' was developed. This model is unique as it conceptualized various leadership theories and offers suggestions for implementation of specific leadership styles. This model may prove useful as an important teaching instrument within the long term care arena. As healthcare leaders and stakeholders continue to evaluate salient matters within the long term care community, it is prudent to utilize research such as this and comparable studies to guide the decision making process as this evidence may contribute to the viability of a challenged long term care system.</p>