The purposes of this study were (1) to identify the factors present in negligence suits found in case law involving prehospital care providers and (2) based on those factors, to develop a typology of causation of legal actions that could be used by postsecondary educators to emphasize specific areas in the initial training and continuing education of EMTs and paramedics. An additional purpose was to provide data which could be used to develop standards and protocols for quality assurance programs. / Using traditional legal research methods, 182 state and federal cases were identified. It was found that lawsuits involving prehospital care providers and systems have been increasing. A marked increase since 1981 was noted. / Elements of alleged negligence were identified, coded, and ultimately used to develop a typology of causation. The four major categories of causation were, in decreasing order of frequency, (1) treatment and care issues; (2) ambulance accidents; (3) dispatch and transport issues; and (4) other issues, such as training, staffing, and administration. Although alleged treatment and care negligence was the most frequent category, it involved a myriad of types of patient scenarios. On the other hand, the number one most frequent single cause of alleged negligence was ambulance accidents. / Implications of the typology for postsecondary educators, administrators, policy makers, and others were discussed. It was suggested that the typology be used to emphasize and/or alter certain aspects of educational curricula, such as driving skills, assessment skills, spinal immobilization, and others. / Legal precedents set down by the courts were dissected in order to view trends. Precedents, such as, immunity issues, emergency vehicle status, guest statutes, common carrier status, constitutional issues, and duty of care were discussed. The similarities and differences found in case law regarding these precedents were also evaluated. / Source: Dissertation Abstracts International, Volume: 53-03, Section: B, page: 1275. / Major Professor: Louis Bender. / Thesis (Ed.D.)--The Florida State University, 1992.

No description available.

<p><bold>Background:<bold> Hospital adoption of health information technology (HIT) systems is promoted as essential to decreasing medical error and their associated 44,000 annual deaths and $17 billion in healthcare costs (Institute of Medicine, 2001; Kohn, Corrigan, & Donaldson, 1999). Leading national healthcare groups, such as the Institute of Medicine, Agency for Healthcare Research and Quality, Institute for Healthcare Improvement, and the Leap Frog Group continue to advocate for increased use of HIT (AHRQ, 2010; Beidler, 2010; Institute of Medicine, 2001; Page, 2003; The Leapfrog Group, 2009), such as provider order entry and electronic health record systems, as a way to improve healthcare quality in hospitals. Even under intense pressure to adopt HIT, however, a mere 2% of US hospitals report having a comprehensive electronic health record system. Further, more than 50% of US hospitals have only rudimentary HIT systems (Jha et al., 2009). With the ARRA HITECH Act of 2009, the pressure on hospitals to quickly adopt HIT and achieve meaningful use is mounting.</p><p>While a large body of literature exists about HIT implementation, the majority is anecdotal case reports. The remaining studies investigated attitudes about HIT or the impact of HIT on patient care processes and outcomes. Thus, best strategies for implementing HIT in hospitals remain unknown. Study design choices, such as the use of self report data, retrospective data collection methods, subjects from single care units or single healthcare professions further limit our understanding HIT implementation in complex hospital care settings.</p><p><bold>Methods:<bold> This prospective, longitutdinal case study used a novel approach, sensemaking, to understanding how project teams may work to implement HIT in an academic medical center. Sensemaking, defined as the social process of establishing the meaning of events and experiences (Weick, 1995), is associated with learning and problemsolving in research studies of healthcare and nonhealthcare settings. Through direct observation and document review I observed project team social interaction and activities over the course of the 18 month preimplementation phase of an HIT implementation project in a single tertiary care hopsital.</p><p><bold>Conclusions:<bold> In this study, I described team actions and activities that enhanced clinician team member sensemaking including: frequent, collective interaction with HIT and focusing team members' attention on specific aspects of HIT function. Further, study findings demonstrated that team members' perceptions of HIT and care processes varied across healthcare professions, management levels, and departments. Supportive social interaction from team leaders and members encouraged team member participation and resulted in members' voicing observations, perceptions and attitudes about the HIT and hospital care processes. Sensemaking of HIT teams not only resulted in identification of needed HIT design changes, but also revealed assumptions and information which may prove critical to successful HIT implementation in hospital care environments. Based on study findings, I suggested strategies for selecting and preparing HIT team members as well as for HIT team activities. This study advanced our understanding of how project teams function and bring about change in complex hospital care environments by not only identifying HIT implementation issues within but also describing the link between team member social interaction and implementation actions.</p> / Dissertation

Thesis (Ph.D.)--Brown University, 2008. / Vita. Advisor : James A. Morone.

Thesis (Ph.D.)--Brown University, 2008. / Vita. Includes bibliographical references.

Thesis (Ph.D.)--Lehigh University, 2009. / Adviser: Shin-Yi Chou.

Not much has changed for the migrant farmworker in the last thirty years. In one of the wealthiest countries on earth, migrant farmworker health status remains comparable to that found in Third World countries because of poor sanitation, poor nutrition and exposure. Current estimates show that migrant clinics are serving less than 20% of this population, leaving about 2,000,000 farmworkers without medical care. The barriers to health care for this population are numerous. This study will focus on the barrier to care resulting from lack of continuity in care due to poor inter-clinic communication. In this study it has been shown that computer disks and a standard word-processing program can be used to create a portable medical health history for the migrant to improve inter-clinic communication. In the process of carrying out this study, it was also shown how other barriers to care for this vulnerable population might be removed as well.

The Health Care Finance Administration is challenged with improving enrollment into the alternative managed health care system called Medicare+Choice. The current Medicare cohort is knowledgeable about where to obtain information about Medicare+Choice, but they cannot recall the terminology or comprehend the concepts of the program. This study attempts to improve older adult recall and comprehension of Medicare managed care written text, with the goal of improving their attitude toward Medicare managed care. Older adults (n = 49) from a community located in the Southwest were randomly assigned to one of three study conditions. Analysis of Variance, Tukey HSD, and correlation analysis were conducted on questionnaire responses measuring for recall, comprehension and attitude. An "Elderspeak Process" improved older adult recall of specific terms, words, and phrases about Medicare and Medicare managed care. Medicare managed care organizations can use the process to simplify information about their managed care programs to knowledgeable older adults.

<p> The conditions that allowed early MFTs the freedom to creatively explore different interventions and theories of change are no longer available in today&rsquo;s mental health care system. Although there are many benefits to the structure of managed behavioral healthcare organizations, a thorough review of the literature demonstrates that many therapists working in managed care agencies struggle with maintaining their theoretical creativity, claiming third-party payers&rsquo; service requirements and paperwork a barrier to their creativity. A phenomenological transcendental research method was utilized to understand the phenomenon of successfully combining creativity and accountability in the practice of marriage and family therapy from the perspective of six creative MFTs who have effectively incorporated creative therapeutic techniques into their work, while adhering to the structured requirements of managed care. </p><p> The findings and themes of the study were organized into two categories. The themes in the Textural / Content Category (description and purpose of therapeutic creativity at a managed care agency) are: (1) Creatively combining the needs of the clients, the different professional entities, insurance companies and you as a therapist, (2) Translating post-modern information into the medical model language that meets the third-party payers&rsquo; requirements, (3) Completing documentation with clients, (4) Incorporating technique from a range of therapy models, (5) Keeping clients engaged through a variety of resources and activities, and (6) Utilizing metaphors and themes to uncover patterns of relational dynamics and behaviors. The themes in the Structural / Supportive Conditions Category (factors that allow the balance of creativity and accountability to occur) are: (1) Systemic understanding of how the therapeutic and business systems of managed behavioral healthcare interact together, (2) Having a supportive network of colleagues, (2a) Supportive group of coworkers within the job setting, (2b) Supportive network of MFT colleagues outside of the work setting, (3) Desire to make a difference in peoples&rsquo; lives, (4) Continuous education on all aspects of the mental health field, (5) Employers&rsquo; support of creative therapy, (6) Self-reflection, (7) Self-care, and (8) Organization and time management.</p>

This dissertation consists of three papers, two quantitative and one mixed-methods. Paper 1 uses cross-sectional and logistic regression analyses of survey data to assess Americans' opinion on the use of cost effectiveness research (CER) in government health coverage decisions, and to examine the factors predicting approval or disapproval of specific decisions. I use vignettes drawn from real international decisions to assess opinions. I find that opposition to a CER agency is widespread, with partisan affiliations playing a significant role. In general, Republicans are more likely to oppose a government agency playing a role in cost effectiveness determinations. With regards to specific examples, Americans hold even greater opposition, with no significant differences by political affiliations.