<p> The Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act or the ACA, introduced legislation that mandated all large employers to offer health insurance to their employees or a monetary penalty will be assessed. The mandate inherently impacted employers with older workers. This paper analyzed how California employers viewed their older workers specific to the ACA through qualitative interviews. Sample size of ten (<i>N </i>=10) participants in the study: eight employers and two professionals managing health insurance plans. Themes emerged from participant employers who viewed their older workers as valuable and like family, while the age of the older workers did not influence the participant employers during the decision making process to offer a health plan in light of the ACA's mandate. </p>

Length of hospital stay was analyzed in Ile-de-France, for 1147 patients with drug poisoning, diabetes mellitus, head trauma, varicoses veins, urinary calculus, gall-stone disease, or myocardial infarction. The explanatory variables (socio-demographic, hospital, and clinical characteristics) were different from one diagnosis to another; the percentage of variance explained laid between 13% and 26%, depending on the specific diagnosis. Results confirm that length of stay is more than a managerial indicator; it also contains clinical-epidemiological information. Results from multiple linear regression, logistic regression, and Cox model were compared for diabetes mellitus and myocardial infarction. From a managerial point of view, logistic regression provided operational information, whereas results from multiple linear regression, as an explanatory method, were disappointing. Cox model was less interesting since there is not censoring data in this study population. The use of administrative data for research is discussed.

Thesis (doctoral)--Göteborg University, 2004. / Errata slip inserted. Includes bibliographical references.

Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2006. / "Title from dissertation home page (viewed July 16, 2007)." Source: Dissertation Abstracts International, Volume: 67-10, Section: A, page: 3907. Adviser: Pravin Trivedi.

<p> It has been estimated that by 2020 nearly one-third of all Americans (almost 160 million people) will have at least one chronic disease to manage and the cost of health care will consume over 20 percent of the GDP. The Obama Administration responded to this pending crisis by passing the Patient Protection and Affordable Care Act (PPACA) in 2010. This major legislation aims to instill patient-centered, accountable care into the health care delivery system. Specifically, the United States government is on a mission to reduce the utilization of expensive inpatient care, while increasing access to primary care for all Americans, thereby lowering the total cost of health care.</p><p> Primary care practices organized around the principles of the patient-centered medical home (PCMH) can better manage their patients, especially their patients with chronic conditions; and become accountable for their care. In 2008, the National Committee for Quality Assurance (NCQA) released practice-level recognition standards based on the seven Joint Principles of the PCMH, to aid doctors seeking to transform their practices into effective patient-centered delivery systems.</p><p> The results of several published studies have touted the successes (e.g., reduced emergency department visits, reduced hospitalizations) of the PCMH model at individual practice sites. These localized successes demonstrated that the principle tenets of the PCMH model&mdash;care coordination, team-based care, population management&mdash;helped lower utilization of more expensive health care services within the specific practice settings evaluated. However, there has been no study to determine if these core tenets are having a broader impact on the health care delivery system within a community.</p><p> One hypothesized outcome of a health care system centered on the PCMH care model is better care coordination and more effective, whole-person care management across the continuum of health care; resulting in a more efficient system that can prevent avoidable hospitalizations.</p><p> This dissertation proposal seeks to understand if the increasing numbers (density) of recognized PCMH practices in communities affect avoidable hospitalizations related to ambulatory care sensitive conditions (ACSC), as measured by the AHRQ Composite Prevention Quality Indicators (PQI). The research has two purposes: </p><p> 1. Establish constructs and hypotheses to measure the effect of the increasing numbers of NCQA-Recognized PCMH practices in communities (counties).</p><p> 2. Using an outcomes-based measurement approach, investigate the relationship between growing densities of NCQA-Recognized PCMH practice doctors among all primary care doctors (PCD) in a community and the associated impact on the utilization of inpatient care, specifically related to ACSCs, as measured by the AHRQ Composite PQIs.</p><p> The research is quasi-experimental in design and is based on a retrospective (2008&ndash;2011) analysis of existing data from the NCQA PCMH program, the AHRQ Composite PQI and the Centers for Medicare &amp; Medicaid Services (CMS) National Provider Identification (NPI) databases. Analysis will link NCQA-Recognized PCMH practices (independent variable), AHRQ Risk Adjusted Composite PQIs (dependent variable), and the CMS NPI (total PCDs) on Federal Information Processing Standard (FIPS) identifiers across 114 state and county-level geographical areas in Vermont and North Carolina. The research will inform the following hypotheses:</p><p> 1. Does the research literature support the measurement construct proposed in this study?</p><p> 2. Communities with concentrations of recognized PCMH practices among primary care practices will have lower risk-adjusted avoidable hospital admission rates.</p><p> 3. The use of technology and care coordination will have a greater predictive correlation on risk-adjusted avoidable hospital admission rates than other PCMH capabilities.</p>

<p>Objectives: First, to identify the core Electronic Health Records (EHR) functionalities available to physicians who work in private and public health care facilities in Trinidad and Tobago and the extent to which physicians are using each function. Second, to understand the rate of adoption of Electronic Health Records in private and public hospitals/clinics, and finally, to identify the barriers to adoption of Electronic Health Records in private and public hospitals/clinics in Trinidad and Tobago. Background: The two largest public hospitals in Trinidad and Tobago, Port of Spain General Hospital and San Fernando General Hospital, utilized paper medical records. In Trinidad and Tobago, there is little known about the EHR functions available and being used, adoption rates, and barriers to adoption of EHR in the private and public sectors. Method: Electronic Health Records (n = 130) questionnaires were sent to number of health care practices in the private and public facilities in the five regions of Trinidad and Tobago, in order to understand availability and use of EHR, adoption rates, and barriers to the use of EHR. Results: The most commonly available function for the private and public physicians was Health Information and Data with respective scores of 58% and 29%. Sixty-three percent of the private physicians who adopted EHR reported using the Result Management and Order Management functions. The public physicians who had adopted EHR reported they were not utilizing the Decision Support, Result Management, and Order Management functions. There was no statistical difference between private and public physicians for the available and used functions. A total of 53 private and 19 public physicians responded to the survey (55% response rate). Thirteen (25%) private physicians reported adopting EHR and 2(11%) public physician reported adoption of EHR. Private and public physicians cited start-up cost and technical limitations of systems as the barriers to their practices' adoption of EHR. Conclusion: Findings showed the same availability and use of core functionalities, as well as adoption rate among the private and public facilities, and slightly fewer barriers in the private practices. A larger sample is merited to understand if there is any statistically significant difference between the two groups.

<p> Millions of women are diagnosed with breast cancer every year in the United States. In San Bernardino County breast cancer rates are increasing each year among Asian American women. It is considered to be the second leading cause of death compared to other cancers among Asian women. In the Inland Empire, there is a lack of health services aimed specifically at Asian Americans. The foundation aspires to be culturally competent and bring breast cancer awareness to all women. Through an expansive service that includes a navigation program lead by breast cancer survivors, outreach to local health care institutions for breast cancer screenings, as well as offering mental health counseling and seminars to help women and their families cope with their diagnosis as well as post-treatment care. The Breast Cancer Foundation for Asian American Women (BCFAAW) is a not-for-profit organization that aims to provide education, support, and advocacy for the Asian community throughout the Inland Empire. </p><p>

<p> Employee burnout has been a toxic concern in today&rsquo;s American workforce. The prevalence of stress in the healthcare workplace is costing America billions of dollars and leading to medical errors, absenteeism, and turnover. Research indicates that human-animal bond provides physical, physiological, and psychological health benefits for professionals. This project will present the benefit of human-animal interactions (HAI) therapy in promoting the well-being in healthcare professionals. It will address services which will deliver to healthcare employees in the convenience of their workplace as well as educate the reader about the role animals play in humans&rsquo; lives. A combined minimal overhead cost and scientifically-proven health benefits of HAI, overall enhanced feelings of employee well-being and decreased animal abandonment are the strengths to this project. Finally, a discussion outlining the market, feasibility, legal and regulatory considerations and the proposal of financial analysis to deliver the project&rsquo;s value with specific services from the human-animal interactions program.</p><p>

<p> Assistive technology may delay cognitively impaired elders&rsquo; need for long-term institutionalization, and the promote independence. Its use is on the rise, yet the gap between the needs of the cognitive impaired elderly and what developers of the assistive technologies design, manufacture, and implement, remains to be filled. Using Inayatullah&rsquo;s 6-pillar approach, as the guide to the future of assistive technology, the purpose of this qualitative study was to explore how assistive technologies may fulfill the daily functional needs of the cognitively impaired elderly with Alzheimer&rsquo;s or other dementia by 2037. Data were collected from a focus group of 10 seniors at a senior center in a large mid-Atlantic city, as well as survey data from with 5 family members of the cognitively impaired elderly and 16 technology developers from an engineering society. These data were coded according to the thematic content analysis and causal layered analysis. The future triangle analysis served as a second layer of analysis. Findings indicated that the most desirable outcome for 2037 is that of the &ldquo;happy retiree,&rdquo; characterized by flourishing cultural and financial opportunities, and the least desirable is that of the &ldquo;struggling pensioner&rdquo; characterized by monetary gains of the social elite at the expense of the poor and working class. The most expected outcome, though, is the &ldquo;caring robot&rdquo; that is characterized by the use of technology and artificial intelligence to promote equitable social and health care benefits to aging citizens. Positive social change may be achieved through recommendations to state, local, and national policy makers that support the improvement in the elders' well-being, the delay of hospitalization, and greater support for the duties of family members, and greater caretaker independence.</p><p>

<p> The purpose of this research was to identify common adaptations family members make and to identify areas where additional nursing interventions or support might be helpful for families. A qualitative approach using descriptive case studies was applied to study the recipients and their families. The Roy Adaptation Model (RAM) was used as a framework to collect data and to analyze it. The RAM was used to analyze various stimuli and how the family and recipient made adaptations within the four conceptualized areas of the RAM model. Structured interviews were conducted to collect the data. The demographic data and structured interview data was processed with thematic analysis. Data was arranged into categories and then themes after reflection. Recommendations on adaptions families experience and how nursing could contribute to positive adaptations were discussed. Family Transplant Syndrome was identified as a name for common characteristics shared by all the family cases.</p><p>