<p> Home health care is heavily utilized to assist homebound clientele with a variety of medical needs. Home health services greatest population is the baby boomers. This population has multiple chronic medical problems that requires surgical intervention, disabilities that limit mobility, many suffer from a loss of mental capacities, or they suffer from depression which affects their physical and mental well-being. Because this population will continue to grow over the next several years, there will continue to be a growing need for home health care. RTK Home Health Services proposes to improve the home care delivered to this population by introducing a new psychological concept that is currently helpful in Psychiatry. The goal is to introduce this service during therapy sessions to decrease the emotional perception of pain by meditating. The full name of this service is Mindfulness Based Stress Reduction Techniques. It is accomplished by instituting meditation prior to therapy to convince the client to control and manipulate their perception to pain during therapy.</p><p>

<p> The purpose of this qualitative study was to investigate the influence of the athletic health care team on urban secondary school student-athlete physical health, academic engagement, and academic success. Limited and inconsistent research had been identified that linked student-athlete physical health to academic engagement and success at the time of research. In question is how the presence of an athletic health care team influenced student-athlete health, academic engagement, and academic success. A qualitative intrinsic case study using a face-to-face responsive interview model was deployed for data collection. The population was identified as all student-athletes, coaches, and parents/guardians involved with one urban secondary school district athletic program. Five male student-athletes, two male and one female parent, and three male coaches voluntarily participated in the research study. Data analysis occurred through an iterative process beginning with manual transcription of audio recordings into a Microsoft Word document that was uploaded into the NVIVO 11 computer-assisted qualitative data analysis software for organizing further coding and theme development. A conceptually clustered matrix was further used for data analysis to help identify themes among student-athletes, their parents, and coaches to triangulate responses. The athletic health care team in this research study was found to directly influence student-athlete health, have a minimal influence on academic engagement, but have indirect influence on academic success according to participants. The athletic trainer was the key athletic health care team member contributing to student-athlete physical health, while coach was identified as most dominant figure on academic engagement, with coaches and parents being most powerful on academic success. Additional research is needed to fully understand the collaboration between athletic health services and general health services for the secondary school student-athlete. The variability between health care programing offers an opportunity for standardization that can be replicated and then studied across different settings, such as rural versus urban, or among diverse socioeconomic groups. Future research collaboration between health care and education is also needed specifically in the area of athletic health care team implementation at the secondary school level to fully understand the positive educational impacts that may be achieved. Extending health services beyond than the traditional student and into the extracurricular environment may be a powerful tool that offers additional academic engagement and success opportunities.</p><p>

<p> United States hospitals are faced with fulfilling the triple aim, which require high quality, safe practices, and at lowered cost. The payment model for the Center of Medicaid and Medicare Services and many commercial payers has moved toward a fee-for-value based model, which was a deviation from the traditional fee-for-service system. The new models are either incentivizing healthcare providers for achieving or exceeding quality, safety, and service outcomes; or penalizing them for not adding value or achieving expected outcomes. Ultimately, hospitals are required to be efficient and bend the cost curve or suffer the consequences in their fiscal performance. Surgical services are hospital departments that have the potential to achieve the highest net revenue if efficiency is achieved and sustained. Hospital leaders often contract consultants to support business process change (BPC) efforts with the main goal of attaining long-term sustainable improvements to their operational processes through effective knowledge management. The following study was a retrospective examination of the BPC initiative through the perspectives of a cross section of two case sites surgical service members. The researcher compared and contrasted the surgical team&rsquo;s perceptions of their BPC execution, their journey, and the post initiative performance. Questionnaires, interviews, and document collection were used to collect a rich overview of the BPC phenomenon. The data showed that there are multiple factors that influenced the long-term culture of change, which included transformational leadership, effective knowledge management, and the prioritization of the change initiative. In addition, the participants implied that physician leadership is required to achieve behavioral alignment to expected performance. The outcome of this research resulted in the following recommendations to direct future research. First, further investigation is needed to determine if the Lean methodology is an effective approach to business process change for healthcare organizations, or are there other methods that would prove more beneficial for the healthcare arena. Second, there needs to be more investigation on how healthcare systems can optimize knowledge management processes for retention and transition so when key leaders and knowledge experts leave organizational learning continues. Lastly, there needs to be further investigation into physician leaders&rsquo; influence on business process change, which would include a gap assessment of their current clinical competencies against the business acumen domain of healthcare administration, operational management, and business development.</p><p>

The economic study of incentives in firms has traditionally focused on one type of incentive—pecuniary—and one causal mechanism—the direct effect of incentives on effort. This dissertation uses three randomized field experiments to explore non-traditional incentives, and non-traditional incentive effects, in the setting of health care delivery. The first experiment (jointly authored with Nava Ashraf and Oriana Bandiera) addresses an under-appreciated phenomenon: incentives affect not only the effort of agents on the job, but also the selection of agents into the job. We collaborate with the Government of Zambia to experimentally vary the salience of career incentives in a newly created health worker position when recruiting agents nationally. We find that making career incentives salient at the recruitment stage attracts health workers who are more effective at delivering health services, with administrative data showing an improvement in institutional deliveries, child health visits, and immunization rates in the treatment areas. While career incentives attract agents who differ on observables (e.g., they have higher skills and career ambitions), 91% of the performance gap is due to unobservables. The results highlight the importance of incentive design at the recruitment stage for attracting high performers who cannot be identified on observables alone. The second and third experiments examine the use of non-pecuniary incentives in health care. The second experiment (jointly authored with Nava Ashraf and Oriana Bandiera) studies non-monetary awards. Awards may affect behavior through several mechanisms: by conferring employer recognition, by enhancing social visibility, and by facilitating social comparison. In a nationwide health worker training program in Zambia, we design a field experiment to unbundle these mechanisms. We find that employer recognition and social visibility increase performance, while social comparison reduces it, especially for low-ability trainees. These effects appear when treatments are announced and persist through training. The findings are consistent with a model of optimal expectations in which low-ability individuals exert low effort in order to avoid unfavorable information about their relative ability. The results highlight the importance of anticipating the distributional consequences of incentives in settings in which the performance of each worker affects social welfare. The third experiment turns from extrinsic incentives (such as career opportunities and non-monetary awards) to "intrinsic incentives"—that is, incentives that make work more intrinsically rewarding. In the context of a rural health worker program in India, I develop and test a novel, mobile phone-based self-tracking app designed to increase agents' intrinsic returns to effort. At nine months of follow-up, the self-tracking app leads to a 27% increase in performance as measured by the main job task (home visits). Moreover, the app is most effective when it leverages pre-existing intrinsic motivation: it produces a 46% increase in performance in the top tercile of intrinsically motivated workers, but no improvement in the bottom tercile. Evidence from survey and performance data indicates that the treatment effect is mediated primarily by making effort more intrinsically rewarding, and not by other mechanisms such as providing implicit extrinsic incentives. The results suggest the potential for wider use of intrinsic incentives that may increase performance at low cost, when agents are intrinsically motivated. / Health Policy

<p> <b>Purpose.</b> The purpose of this phenomenological qualitative case study was to explore the experiences of advocates who represent organizations that engage in disability policy advocacy. The study investigated the strategies and activities used by disability rights advocates, including those used when advocating for deinstitutionalization of people with intellectual and developmental disabilities (I/DD), and the recommendations for advocates of the deinstitutionalization of individuals who live in large intermediate care facilities (ICFs).</p><p> <b>Methodology.</b> A phenomenological case study and semistructured interviews were used to explore the strategies and practices of organizations that engage in disability policy advocacy. The researcher used a purposeful sampling approach to interview 5 disability policy advocates with extensive experience for the study. Gen and Wright&rsquo;s (2013) policy advocacy framework was used to guide the development of the interview questions and resulting themes that emerged from the interviews.</p><p> <b>Findings.</b> Advocacy organizations identified three main activities used when advocating for individuals with I/DD: coalition building, information campaigning, and engaging decision makers. When advocating for the deinstitutionalization of people with I/DD, their strategies included coalition building, information campaigning, and reform efforts. The advocates consistently recommended reform efforts, and to a lesser extent, coalition building as strategies and activities to expedite the deinstitutionalization of individuals who reside in large ICFs.</p><p> <b>Conclusion.</b> Reform efforts (pilots, demonstrations, litigation) are consistently recommended for future advocacy efforts in support of expediting the community transition of individuals who reside in large ICFs.</p><p> <b>Recommendations.</b> Future research should explore the activities of advocacy organizations for other populations or in other geographies. This research study has direct implications for individuals who reside in large ICFs and want to move to community living. This study adds to the practice of advocacy in that it will aid the development of future advocates through training targeting practices of successful, highly experienced advocates. </p><p>

<p> Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, direct observation, and a review of discharge documents. Data analysis took place using the modified van Kaam method. Two emergent themes were identified relating to strategies for efficient communications and facilitating effective leadership. Implications for positive social change include the potential to improve health services within the community where access to health care is limited or the need exists for additional hospital beds. Positive leadership strategies in hospitals tend to contribute to the success and wellbeing of employees, patients, communities, and the economy.</p><p>

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.