<p> This study investigated correlations between patient-centered qualities of primary-care providers (N = 64) and how those qualities correlated with 3 quantifiable patient-health outcomes as assessed through the aggregate data available in the electronic health records (EHR): Controlling high blood pressure, low density lipoprotein (LDL) management for diabetics, and hemoglobin A1c poor control for diabetics. Patient-centered qualities were defined as having the qualities of empathy, cultural competence, and mindfulness&mdash;the ability to be present in the moment in a nonjudgmental and accepting way. Through an online survey process, primary-care providers (PCP) completed the Jefferson Scale of Physician Empathy (JSE), the Cultural Competence Assessment (CCA), and the Freiburg Mindfulness Inventory (FMI). Providers were also asked about their level of Motivational Interviewing (MI) training and the level of MI use. OCHIN provided the researcher with the health outcomes data of the hypertension and diabetic patients on the panels of the participating PCPs. The correlations between provider scores on the surveys and the patient-health outcomes data were examined using Pearson's product-moment correlation coefficient (Pearson's r). Results showed a significant positive correlation between % diabetic LDL controlled and cultural competence (<i>r</i> = .285, <i> p</i> &le; 0.05). Cultural competence was also non-significantly positively correlated with % blood pressure (BP) &lt; 140/90 (<i>r</i> = .205). The research revealed a non-significant negative correlation between cultural competence and % HbA1c poor control (<i>r</i> = -.172).</p>

Canadian tuberculosis surveillance includes chest X-ray screening of permanent resident applicants. This study was designed to assess such screening from a cost minimization perspective (cost per case of active TB detected and treated) and a cost effectiveness perspective (incremental cost per case prevented). The two strategies compared were no screening program (passive detection of active pulmonary TB) and screening for active and inactive pulmonary TB. The cost per case of active TB via passive detection was estimated to be $7675.87. Between 1 June 1996 and 1 June 1997, 12898 applicants underwent screening chest X-rays at the Montreal Chest Institute, among whom 16 cases of active TB were detected and treated and 322 cases of inactive TB were detected. The cost per case detected and treated through screening was $31419.33. 56% of those with inactive TB were prescribed preventive treatment, and 76% of these individuals were compliant. The incremental cost per case prevented through the screening program was calculated to be $16376.09. Thus from a cost minimization perspective, no screening was preferable to screening, but from a cost effectiveness perspective, when the benefit of cases prevented through screening was considered, the screening program appeared to be worthwhile in comparison to other health interventions.

Colombia is a developing country with high mortality rates from trauma. The Valle de Aburra region centred around the city of Medellin has particularly high rates of intentional trauma. Improving emergency medical services could reduce mortality rates. / At the time of this investigation, there was no pre-hospital emergency care services in the Valle de Aburra. Thus, this thesis examines predictors of mortality from a case series of 1395 persons presenting to the Emergency department of the Hospital Universitario San Vicente de Paul (HUSVP). Overall mortality for this series was 9.31% and 37.5% of these deaths were retrospectively identified as preventable. Mortality for injuries involving the central nervous system (CNS) was higher at 14.4%. Using the TRISS method, higher than expected death rates were noted from pedestrian-motor vehicle incidents and trauma associated with firearms use. / Determinants of mortality and length of stay were identified using logistic regression. These included factors associated with the mechanism and site of injury and also with the process of care, both pre-hospital and in-hospital. / Based on these identified determinants, policies for integrated pre-hospital and hospital emergency care in the Valle de Aburra can be developed. Regionalizing these services could be expected to reduce both mortality rates and preventable deaths.

<p> This dissertation is comprised of three essays that explore the connections between buildings and their impacts on outcomes associated with occupant health. The essays are: 1. The Effect of Certified Green Office Buildings on Occupant Health: A Systematic Review and Meta-Analysis, 2. Understanding Evidence-Based Design Through a Review of the Literature, 3. Future Directions for Evidence-Based Design in Health Care Facilities.</p><p> Essay one, entitled The Effect of Certified Green Office Buildings on Occupant Heath: A Systematic Review and Meta-Analysis, explores the connections between certified green office buildings and their impacts on occupant health via the application of a systematic review and meta-analysis. An extensive literature search was conducted to locate any studies that examined the health of occupants in conventional buildings versus the health of the same populations after a move into a certified green building. The literature review followed the Cochrane Collaboration protocol for conducting systematic reviews. The results of a meta-analysis of the two studies uncovered by the systematic review show a positive relationship between certified green office buildings and improved occupant health (SMD 1.09), yet there was insufficient power (CI -0.88, 3.05) to prove causality.</p><p> Essay two, entitled Understanding Evidence-Based Design Through a Review of the Literature, relates the current understanding of the concept of Evidence-Based Design (EBD), as specifically related to health care facilities, through the vehicle of an annotated bibliography of the relevant literature. EBD lacks a universally agreed upon definition, but one of the stronger definitions from the architecture discipline states that evidence-based design is a process for the conscientious, explicit, and judicious use of current best evidence from research and practice in making critical decisions, together with an informed client, about the design of each individual and unique project. The outcomes of primary concern with health care facilities tend to fall into three categories&mdash;patient/family outcomes, staff outcomes and fiscal outcomes.</p><p> The thirty-one annotated articles reveal that the concept of EBD is quite complex, especially as it relates to the gathering and assessment of data and how such data is used to inform the building project. The bulk of the complexity lies with the word `evidence.' The current literature suggests disparity among researchers and practitioners over the collection, assessment and incorporation of evidence related to the collection, analysis and incorporation of evidence into building projects that seek to have a positive impact on the three main outcome categories of interest in healthcare facilities&mdash;patient outcomes, staff outcomes and fiscal outcomes.</p><p> Essay three, entitled Future Directions for Evidence-Based Design in Health Care Facilities, anticipates the future of evidence-based design as related to the design and construction of health care facilities. Reimbursement policies are driving health care to include more community based and customer services oriented delivery models. Pay based on performance&mdash;quality and efficiency of health care delivered&mdash;as well as customer satisfaction are taking on new importance and will drive designers of health care facilities to develop ever new methodologies for gathering and assessing evidence.</p>

<p> Short-sighted cost containment strategies and lack of proactive policies in Canadian health care have brought about a national nursing workforce shortage. A shortage in staff creates challenges in terms of access to, quality of, and cost of care for Canadians in a universal health care system. The focus of this quantitative correlational study was to determine the relationship between retention and both nurses&rsquo; views of leadership styles and attitudes towards unions in a Canadian acute care setting. The study supports the findings that contingent reward leadership styles and transformational leadership have a positive relationship to retention in a Canadian acute care setting. The study also supports that laissez-faire leadership has a moderately high negative linear relationship to retention. In addition, the study revealed that nurses&rsquo; attitudes towards unions have no relationship to retention. The implications of these findings for nursing leadership were also reviewed.</p>

The rapid growth of medical sciences and technologies created the need to manage data generated by sophisticated medical equipment (e.g. lab results, vital signs, etc.). This class of equipment, especially in the modern Intensive Care Unit (ICU), emits large quantities of latient data which medical staff usually records on log sheets. / This thesis presents a database design that allows abstract definition of data types, and offers a unified view of data during the development phase, distinct levels of data management and a higher degree of system flexibility. This database model is an implementation of a database for a Patient Data Management System (PDMS) developed for use in the ICU of the Montreal Children's Hospital. The PDMS has a variety of application modules that handle and process various types of data according to functionality requirements.

The purpose of this thesis was to analyze factors related to labour market survival and withdrawal behaviour in the profession of Occupational Therapy in Ontario from 1997 to 2006. To provide a portrait of the OT labour market in Ontario overall, and in relation to sector and age, three types of analysis were used: descriptive statistics (including “stay, switch, and leave” analysis), “Stickiness” and “Inflow” analysis, and survival analysis. The largest proportion of OTs worked in the Hospital sector, which had a great ability to retain OTs according to the “Stickiness” analysis. However, when controlling for other variables using survival analysis, none of the sector variables had a significant effect on survival. The youngest and oldest age groups had the highest propensity of leave, due to mobility, family commitments, and retiring (oldest group only). Overall, the profession in Ontario had a strong ability to retain OTs working in the profession during the study period.

Nonvalidated practices are characterized by a therapeutic intent and a relative lack of evidence to support their adoption into the practice of medicine. They occupy a continuum of progressive departures from the standard of care, bounded on the one extreme by validated practices and on the other by research. Presently, nonvalidated practices are performed largely at the discretion of physicians, and this approach has been justified by appeal to the notions of professional autonomy and societal beneficence. Current guidelines do not require any special form of monitoring of nonvalidated practices. However, the principle of non-maleficence favours the adoption of a novel monitoring system which would assure the protection of patients and society. This novel monitoring system should be based on a review which is proportionate, prospective, and primarily local but with an important national element. As well, such a system should be based largely on the existing hospital practice committees.

Background. Hospital performance indicators serve as a mechanism for making health care providers accountable to their patients. One indicator adopted by several jurisdictions is hospital mortality rates among patients with acute myocardial infarction (AMI). Despite potentially serious repercussions poor results can have on how a hospital is judged, there remains considerable variation in the methods used to measure and compare this indicator. The purpose of this study is to estimate the extent to which methods used to define AMI mortality outcomes and to deal with transferred AMI patients impact on hospital performance ratings. / Methods. Using Quebec's Med-Echo hospital discharge records and vital statistics for 91,633 AMI patients admitted between 1992 and 1999, hospital rankings were compared using three methods to define AMI mortality outcome (in-hospital death, death within 7 days of admission, and death within 30 days of admission) and using three methods to handle transfers (excluding all transfers, including transfers while assigning the outcome to the initial hospital, and including transfers while assigning the outcome to the receiving hospital). / Findings. There was discordance in hospital quintile classification 34% to 43% of the time when using pairwise comparisons of outcomes, and 23% to 32% of the time when using pairwise comparisons of ways to deal with transfers. Using hospital ranks to identify significant outliers as a method for evaluating hospitals, 5 hospitals were identified as "best performers" at least once, whereas 11 hospitals were identified "worst performers" at least once. One hospital was among the "worst performers" regardless of which among the six hierarchical analyses was used, while another was among the "best" using all but one analysis. The absolute difference in significantly high or low hospital mortality rates exceeded the clinically relevant benchmark of 1%. / Conclusions. The methods used to define AMI mortality outcome, or to deal with transfers had an impact on which hospitals were identified as "outliers". Hospital reputations can be damaged by such findings. Furthermore, although this study was limited to comparing the impact on rankings based on AMI hospital mortality rates, other indicators of hospital performance may be influenced to a greater degree based on the methods used to deal with transferred patients.

Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2007. / Title from PDF t.p. (viewed Nov. 18, 2008). Source: Dissertation Abstracts International, Volume: 67-12, Section: A, page: 4627. Adviser: Pravin K. Trivedi.