The objectives for this study were to develop a continuity of care scale, to assess the mean level of continuity of care, to assess association between demographic variables and clinical variables with continuity of care, and to assess association between continuity of care and medication adherence among Medicare beneficiaries. A retrospective cohort study was conducted to achieve the objectives using data from the 2015 to 2017 Medicare Current Beneficiaries Survey (MCBS). To be included in the sample, beneficiaries had to have a hyperlipidemia diagnosis, be continuously enrolled in Medicare Part D for six months from start of medication adherence, be continuously enrolled in Medicare Part A and Part B in the preceding year, and had to have at least two prescription claims for hyperlipidemia medications. Beneficiaries were excluded if they had a proxy responder, had an Alzheimer’s disease or dementia diagnosis, were enrolled in Medicare due to end-stage renal disease or disability, or were residing in a long-term care facility. Among 2,120 beneficiaries that met sample selection criteria, 57 percent were aged 75 years or older, 57 percent were female, and 87 percent were White. An overall continuity of care scale was developed using MCBS items that asked respondents about their care experience. Exploratory factor analysis was used to determine subscales of continuity of care using a randomly selected 60 percent of the sample, which yielded three subscales of continuity of care: relational continuity (Factor 1), informational continuity (Factor 2), and management continuity (Factor 3). Confirmatory factor analysis conducted using the remaining 40 percent of the sample validated factor structure of the continuity of care scale. The mean level of overall continuity of care among Medicare beneficiaries was 3.26 out of 4. Medication adherence was assessed using proportion of days (PDC) covered for anti-hyperlipidemia medications. Beneficiaries with a PDC of 80 percent or more were considered medication adherent. Approximately, 81 percent of beneficiaries were adherent to prescribed hyperlipidemia medications. Association between demographic variables and clinical variables with overall continuity of care was assessed using multivariable logistic regression based on purposeful selection of variables method. Older age, low perceived health status, and lower number of prescribed medications were associated with low overall continuity of care. Race and marital status were found to have interaction effect on overall continuity of care. Among non-white beneficiaries, married beneficiaries reported higher overall continuity of care than not-married beneficiaries. Among married beneficiaries, whites reported lower overall 12 continuity of care than non-whites. Association between overall continuity of care and medication adherence was assessed using multivariable logistic regression with purposeful selection of variables method. There was no association found between overall continuity of care and medication adherence.

Health care administration programs have transitioned to using the competency approach to better prepare graduates for workplace success. The responsibility of preparing graduates lies with the program faculty, yet little is known about faculty perceptions of the competency approach. The purpose of this cross-sectional study was to assess the perceptions of graduate-level health care administration faculty about the competency approach, the approach's effect on graduate preparedness, and employer expectations. Adult learning theory and the theory of self-efficacy were used as the theoretical foundations for the study. Faculty demographics related to personal information, workplace/teaching experience, and program information served as the independent variables, while survey item perception ratings were the dependent variables. Nonprobability sampling of graduate-level health care administration faculty (n = 151) was used and data were collected using an online survey developed by the author. Descriptive statistics, independent samples t tests, correlation analyses, and multiple linear regressions were used to examine and describe faculty perceptions. Findings indicated that faculty generally support the use of the competency approach and that it effectively prepares graduates. Teaching in a CAHME-accredited program predicted perceptions about the approach adequately addressing employer expectations (β = .343, p < .05). Issues including need for standardization and use for accreditation versus educational purposes were identified. Social change implications include contributing to professional development efforts for faculty and improving the quality of health care administration graduates and the future leadership of the industry.

No description available.

Immersed in a context of constrained health resources, nurse managers are at great risk of the experience and negative consequences of values clashes and ethical conflict, such as burnout and attrition. Replicating a qualitative descriptive study previously conducted in Canada (Gaudine & Beaton, 2002) this research is aimed at increasing knowledge of the experience of nurse managers’ ethical conflict with their health care organizations in New Zealand. Semi-structured interviews were used to gather data from eight nurse managers in New Zealand, which was analyzed using a general inductive approach to qualitative research. The experience of advocating for values that may be shared by both nursing and the health care organization, such as safety, teamwork and quality patient care, were revealed in the conceptual category of Nursing Management Advocacy. As with their Canadian study counterparts, Isolation was revealed as a key factor that made the experience of ethical conflict worse and involves the social experiences of silencing, employment barriers and invisibility. Support describes the factors that mitigated the experience of ethical conflict and involves personal, professional and organizational support, and are likewise similar to the experiences of Canadian nurse managers. The Bottom Line describes a focal point of the experience of ethical conflict where the health care organizations predominantly fiscal bottom line was confronted and challenged by nurse managers, and where the nurse manager might reach their own bottom line and choose to leave the organization. Being and Becoming Nursing Leaders describes the outcomes of ethical conflict for nurse managers who were not only transformed into nursing leaders, through learning, reflection, and growth but also counted the costs of nursing leadership. This study concludes that supportive colleagues, organizational structures and culture are essential to mitigating the experience of ethical conflict and isolation which nurse managers encounter. The study also concludes that reducing isolation and supporting nurse managers will ensure that nursing values are appropriately represented and articulated in the health care organization’s decision making systems and processes.

The recent trend in health care has been on the development and implementation of clinical guidelines to support and comply with evidence-based care. Evidence-based care is established with a view to improve the overall quality of care for patients, reduce costs, and address medico-legal issues. One of the main questions addressed by this thesis is how to support guideline-based care. It is recognised that this is better achieved by taking into consideration the provider workflow. However, workflow support remains a challenging (and hence rarely seen) accomplishment in practice, particularly in the context of chronic disease management (CDM). Our view is that guidelines can be knowledge-engineered into four main artefacts: electronic health record (EHR) content, computer-interpretable guideline (CiG), workflow and hypermedia. The next question is then how to coordinate and make use of these artefacts in a health information system (HIS). We leverage the EHR since we view this as the core component to any HIS. / PhD Doctorate

No description available.

No description available.

<div> <div> <div> <p>The following study used a liberal feminist lens to address a gap in the literature on contraceptive method use and romantic relationships by examining the association between contraceptive method use and both relationship satisfaction and balance of power. Specifically, it surveyed married women between the ages of 20-49 using either oral contraceptives (OCs) or natural family planning (NFP). Relationship satisfaction was measured using the Couple Satisfaction Index (CSI-4). Balance of power in the relationship was measured using the Relationship Balance Assessment (RBA). It was hypothesized that women using NFP would report higher relationship satisfaction and greater balance of power than women using OCs. Instead, results of the multiple regression analyses indicated that women using NFP experienced significantly lower rates of balance of power in their relationship. There was no significant difference in relationship satisfaction between groups. Additionally, control variables of religious importance and number of children were found to be associated with balance of power. Controls of age and religious importance were found to be associated with relationship satisfaction. Clinical implications, strengths and limitations, and future directions for research were discussed. </p> </div> </div> </div>

Purpose: The purpose of this research was to develop quality and efficiency improvements in the health care administration system of Mauritius. The aim of the study is to describe how the health care services of Mauritius could be improved based on the results obtained during this investigation. Methodology: The health care executives, board members, search firm executives, and health administration managers, as well as several patients, were selected by stratified sampling 1802 participants (quantitative) and by purposive sampling method nine focus groups of nine participants each (qualitative). The population for the qualitative research was comprised of patients and health care professionals selected by the purposive sampling technique. The population was comprised of patients and health care professionals for quantitative phase selected by stratified and the health care professionals for qualitative part selected through purposive sampling technique. Findings: The participants showed a preference for Patients’ Satisfactions, ISO Quality Standards Compliance, workforce efficiency, infrastructure fitness, and adaptability principally experience a better quality of care. Moreover, there was no statistical difference between financial cost and quality of health care was depicted. The outcome of the study: A common aspect, recognised empirically, is the approach regarding enhanced external pressure on the healthcare administrators in their work. Higher administration decisions, patient pressure and judgments made by policymakers have impacted and established the choices prepared by health care managers regarding where to concentrate attempts of growth. In the context of practical implications, health care administrators must properly make new management control systems so that they help healthcare systems in their work. Implications for the healthcare leader’s perceptions are that knowledge from the environment is normally complicated and not easy to define and also transmitted from particular stakeholders. / Health Studies / D. Litt. et Phil. (Health Studies)

Made available in DSpace on 2016-06-02T20:45:41Z (GMT). No. of bitstreams: 1 5314.pdf: 848507 bytes, checksum: 208b20984a132f3ff7f8a57a6b20bd6a (MD5) Previous issue date: 2013-04-08 / This study aims to investigate the organization of the management process in the Family Health Units (FHU) in São Carlos, São Paulo, in the perspective of physicians, nurses and dentists of five Family Health Group (FHG). The study type was exploratory with a qualitative character. It was based on the interview form designated as subject-centered, which is based on the possibility of exploration of issues defined in advance by the researcher of the project. The study is based on reports about the management process experienced by these professionals taking as analytical categories: the Labour Process, the Care Process and the Continuous Education Process. In order to analyse the data, the Content Analysis based on the thematic modality proposed by Bardin (1977) was considered. It was verified that the management was recognized by professionals as an important tool for the consummation of the practices of FHU in the municipality studied, however, it was little developed and its effective implementation has shown itself as a great challenge to the responsible managers. It was identified, in the studied FHU, a management style highly centered on the nursing professionals, what makes necessary a change on the way through the professionaIs of the FHG see their managerial practices and that professionals responsible by the management be stimulated to think in methodologies, knowledge and practices capable of make the management currently employed closer to that proposed by the FHT. / O estudo tem como objetivo investigar a organização do processo gerencial em Unidades de Saúde da Família (USF) no município de São Carlos, São Paulo, na perspectiva dos profissionais médicos, enfermeiros e dentistas de cinco equipes de saúde da família. O estudo realizado foi do tipo exploratório de caráter qualitativo. Baseou-se na modalidade designada como entrevista centrada no sujeito, que se fundamenta na possibilidade de exploração de questões definidas previamente pelo pesquisador deste trabalho. O estudo está sustentado nos relatos sobre o processo de gerência vivenciado por esses profissionais tomando como categorias analíticas: o Processo de Trabalho; o Processo de Cuidado e o Processo de Educação Permanente. Para a análise de dados utilizou-se a Análise de Conteúdo na modalidade temática proposta por Bardin (1977). Verificou-se que a gerência foi reconhecida pelos profissionais como uma ferramenta importante para a efetivação das práticas da USF no município estudado, no entanto, é pouco desenvolvida e sua efetiva implementação mostrou-se um grande desafio aos gestores responsáveis. Identificou-se, nas USF estudadas, uma gerência fortemente centrada nos profissionais enfermeiros, por isso faz-se necessário uma mudança na maneira por meio das quais os profissionais da ESF vêem suas práticas gerenciais e que os profissionais responsáveis pela gerência sejam estimulados a pensar em metodologias, conhecimentos e práticas capazes de tornar a gerência atualmente empregada mais próxima àquela proposta pela ESF.