Adults with intellectual disability (ID) have a higher rate of falls than the general population, and changing health behaviors through exercise program could enhance health and reduce falls in this population. However, the feasibility study of fall prevention based on the theoretical framework for adults with ID has not been explored to date. This study examined the feasibility of a home-based exercise intervention for people with ID living in a residential setting. We provided an 8 week intervention consisting of a training workshop for support workers and sessions for adults with ID devoted to behavior reward, education about fall prevention and exercise, and exercise training. Adults with ID (n = 33) and support workers, including caregivers (n = 3), staff (n = 8), and one administrator, participated in this study. Adults with ID significantly improved physical performance, self-efficacy for activity, fall efficacy, and support from friends and support workers. There were no significant changes in free-living PA. There was no adverse event during the intervention, and the average adherence rate was sufficient. Adults with ID, support workers, and an administrator were satisfied with the program and had the intention to continue the program. The intervention was feasible and perhaps efficacious for adults with ID living in group-homes.

Background: Place of death is a commonly reported indicator for assessing palliative care quality, but does not provide details of healthcare service utilization at the end-of-life, such as acute care. In particular, early palliative care has shown to reduce acute care service use, but findings are mostly limited to cancer patients with few population-based data available. Objectives: The purpose of this research is to: 1) explore place of care trajectories in the last 2 weeks of life in a general population and among distinct illness cohorts, and 2) investigate whether early versus late palliative care affects acute care use and other publically-funded services in the last 2 weeks of life. Research Design: A retrospective population-based cohort study using linked administrative health data to examine all Ontario decedents between April 1st, 2010 and December 31st, 2012. Methods: Descriptive statistics were used to examine place of care trajectories and service utilization trends in the last 2 weeks of life. Multivariable logistic regression analyses were conducted to assess in the 2 weeks before death: 1) the odds of using an acute care setting (yes/no), and 2) the odds of time spent (≤1 week or >1week) in acute care settings among users. Results: Overall, 235,159 decedents were identified. About 32% had cancer, 31% had organ failure, and 29% had frailty. Overall, 29% of decedents used a hospital two weeks before death, but this increased to 61% on the day of death. Those with cancer were the largest users of palliative-acute hospital care, while those with organ failure were the largest users of acute- hospital care. Assessing palliative care timing, 27% were early palliative care recipients, 13% were late. About 45% of early recipients had a community-based palliative care initiation, 74% of late recipients had a hospital-based initiation. Late recipients were more likely to use acute care settings; this was further modified by disease: comparing late to early recipients, cancer decedents were nearly two times more likely to spend >1 week in acute care settings (OR=1.84, 95%CI:1.83-1.85), frailty decedents were three times more likely (OR=3.04, 95%CI:3.01-3.07), and organ failure decedents were four times more likely (OR=4.04, 95%CI:4.02-4.06). Conclusion: Place of care trajectories differ greatly by disease cohort. Exploring place of care trajectories can provide details not evident when reporting solely place of death. Furthermore, early palliative care was associated with reduced acute care service use in cancer and non-cancer patients. Late initiations were associated with greater acute care use, and had the largest effect on those with organ failure and frailty, suggesting potential opportunities for improvement in non- cancer populations. / Thesis / Master of Science (MSc)

Introduction: Nursing homes throughout the U.S. have faced unprecedented challenges in recent years because of staffing shortages, and under-investment, especially since the COVID-19 pandemic. To gain insight into the current state of nursing homes, this study examined nursing home characteristics, quality, and accessibility from a national, regional and state perspective. Methods: This cross-sectional study used secondary data from the Centers for Medicare and Medicaid Services, American Community Survey, Medicare Beneficiary, and the Tennessee Department of Health. Nursing home characteristics and quality were assessed through bivariate and multivariate regression in the U.S. Assessment of HHS Region 4 nursing home characteristics and quality by state cut points were conducted with bivariate analysis. Finally, spatial analysis was conducted to determine nursing home accessibility in Tennessee. Results: In multivariate analyses of all U.S. facilities, non-metropolitan facilities are at 1.27 higher odds of being a 1-star overall rated facility and 0.86 lower odds of being a 5-star facility as compared to metropolitan facilities. When weighted health inspection scores were recategorized by more strict state cut points, 42.45% of HHS Region 4 facilities decreased in health inspection star ratings, while those that were recategorized by more lenient state cut points lead to a 26.64% increase in star ratings. Finally, in the state of Tennessee a mean of 14.9% of county areas are not within 30-minute drive to any nursing home facilities, with 66.4% of county areas being further than a 30-minute drive to a 5-star rated (highest quality) facility. Discussion: Findings from this study show that differences exist in nursing home characteristics that relate to facility quality. Additionally, health inspection 5-star ratings can vary across states, which can make comparison of quality challenging from a consumer perspective. And finally, accessibility to nursing homes can vary throughout a state by metropolitan and non-metropolitan status of the county. An understanding of nursing homes in metropolitan and non-metropolitan communities along with nursing home quality, characteristics of the facility, and characteristics of county populations can enable policymakers to create more equitable policy solutions for nursing homes and the communities they serve.

No / Patients have the potential to provide feedback on the safety of their care. Recently, tools have been developed that ask patients to provide feedback on those factors that are known to contribute to safety, therefore providing information that can be used proactively to manage safety in hospitals. The aim of this study was to investigate whether the safety information provided by patients is different from that provided by staff and whether it is related to safety outcomes. Data were collected from 33 hospital wards across 3 acute hospital Trusts in the UK. Staff on these wards were asked to complete the four outcome measures of the Hospital Survey of Patient Safety Culture, while patients were asked to complete the Patient Measure of Safety and the friends and family test. We also collated publicly reported safety outcome data for 'harm-free care' on each ward. This patient safety thermometer measure is used in the UK NHS to record the percentage of patients on a single day of each month on every ward who have received harm-free care (i.e. no pressure ulcers, falls, urinary tract infections and hospital acquired new venous thromboembolisms). These data were used to address questions about the relationship between measures and the extent to which patient and staff perceptions of safety predict safety outcomes. The friends and family test, a single item measure of patient experience was associated with patients' perceptions of safety, but was not associated with safety outcomes. Staff responses to the patient safety culture survey were not significantly correlated with patient responses to the patient measure of safety, but both independently predicted safety outcomes. The regression models showed that staff perceptions (adjusted r(2)=0.39) and patient perceptions (adjusted r(2)=0.30) of safety independently predicted safety outcomes. When entered together both measures accounted for 49% of the variance in safety outcomes (adjusted r(2)=0.49), suggesting that there is overlap but some unique variance is also explained by these two measures. Based on responses to the Patient Measure of Safety it was also possible to identify differences between the acute Hospital Trusts. The findings suggest that although the views of patients and staff predict some overlapping variance in patient safety outcomes, both also offer a unique perspective on patient safety, contributing independently to the prediction of safety outcomes. These findings suggest that feedback from patients about the safety of the care that they receive can be used, in addition to data from staff to drive safety improvements in healthcare. TRIAL REGISTRATION NUMBER: ISRCTN07689702.

This thesis addresses the question of the design, production and use of information graphics in health technology assessment (HTA). Drawing on previous research in both information design and health policy, it describes a comprehensive design process for creating new visual presentations that can inform health policy-makers. The thesis begins by introducing, and functionally defining the terms ‘information graphics’ and ‘health technology assessment’ in Chapter 1. It then offers a methodological discussion of how research can be performed at the intersection between these two diverse fields. This discussion forms Chapter 2 of the thesis. The context of use is surveyed in two studies, which are presented in Chapter 3. These assess the current use of information graphics in HTA, and the information needs of health policy decision-making bodies. This enables a needs-based approach to the design of 10 information graphics, that could be used in hta. These are shown in Chapter 4. Finally, two of these information graphics are empirically tested with two further research studies, forming Chapter 5 and Chapter 6. The thesis is aimed at giving practical advice to those wanting to produce graphical presentations of information in HTA, and to provide the foundation for further original research in information design and HTA. Chapter 7 draws together the research from the rest of the thesis, to make recommendations in light of the combined findings.

Introdução: Um dos objetivos mundiais para a melhoria da qualidade de vida da população é a redução da mortalidade materna. Visto que esta expressa não só contextos relacionados à saúde, mas também, epidemiológico, social e econômico. Uma maneira de promover mudança nas taxas de mortalidade materna é por meio do enfrentamento de barreiras para a melhoria do cuidado obstétrico. Países que já superaram a falta de serviços e de acesso à assistência obstétrica enfrentam problemas relacionados à qualidade da atenção ao parto e nascimento. Como por exemplo, danos a saúde materna e neonatal decorrentes de intervenções desnecessárias ou até desaconselhadas. A utilização da tecnologia móvel por meio de mensagens enviadas às gestantes tem se mostrado eficaz, com melhorias no cuidado durante o pré-natal e pós-parto. Esta dissertação foi desenvolvida por acreditar que o uso de mensagens enviadas às gestantes no pré-natal poderia modificar fatores relacionados à assistência ao parto. Objetivo: Avaliar se mensagens enviadas por celular às gestantes produz efeito sobre a satisfação das mulheres com o atendimento ao parto, sobre o uso de boas práticas no parto e sobre a percepção delas sobre a ocorrência de abuso, desrespeito e/ou maus-tratos durante o parto. Métodos: Esta é uma análise secundária de um ensaio aleatorizado por conglomerados em 20 unidades básicas de saúde (UBS) com maior número de seguimento pré-natal. As 20 UBS foram aleatorizadas (1:1) de forma balanceada, por meio de um software, formando um grupo Intervenção e um Controle, com dez UBS cada. Do grupo Intervenção origina o grupo que efetivamente recebeu a intervenção (grupo PRENACEL). A intervenção compreendeu o oferecimento de um pacote de mensagens enviadas para o celular das gestantes como um complemento ao pré-natal padrão da rede pública. Participaram do estudo mulheres com 18 anos ou mais, com até 20 semanas de gestação, que estavam em seguimento pré-natal nas UBS selecionadas. A coleta de dados foi realizada em quatro maternidades, e para o presente estudo, foram avaliadas mulheres que tiveram partos por via vaginal e sem gestações de alto risco. Os desfechos avaliados foram: a satisfação dasmulheres com o atendimento ao parto; o uso de boas práticas na assistência ao parto e a percepção das mulheres sobre a ocorrência de abuso, desrespeito e/ou maus-tratos. Resultados: Esta pesquisa foi composta por 241 mulheres no grupo Controle e 427 no grupo Intervenção, sendo 63 pertencentes ao grupo PRENACEL. Não houve diferença estatística entre os grupos em relação à satisfação ou uso de boas práticas. Nem sobre a percepção das mulheres sobre a ocorrência de abuso, desrespeito e/ou maus-tratos durante o parto. Encontramos alta satisfação das mulheres com o atendimento e alta frequência de uso de boas práticas durante o parto comparado ao cenário nacional. Já a percepção delas sobre ocorrência de abuso, desrespeito e/ou maus-tratos foi baixa. Conclusão: O uso de mensagens enviadas a gestantes no pré-natal não demonstrou efeito sobre os desfechos avaliados. / Introduction: One of the world\'s goals for improving the population\'s quality of life is to reduce maternal mortality. This is because it expresses not only contexts related to health, but also epidemiological, social and economic. A way to promote change in maternal mortality rates it is by facing barriers to improve obstetric care. Countries that have overcome the lack of services and access to obstetric care face problems related to the quality of childbirth care. As for example, damage to maternal and neonatal health still occurs from unnecessary or non-advisable interventions. The use of mobile technology through messages sent to pregnant women has been shown to be effective, with improvements in antenatal and postpartum care. Objective: To evaluate whether messages sent by cell phones to pregnant women have an effect on women\'s satisfaction with delivery, on the use of good practices during childbirth and on their perception of abuse, disrespect and / or mistreatment during the delivery. Methods: This is a secondary analysis of a cluster-randomized trial in 20 Primary Health Care Units (PHCU) with a higher number of prenatal followup. The 20 PHCU were randomized (1:1) in a balanced manner, using software, forming an Intervention and a Control group, with ten UBS each. From the Intervention group, the group that actually received the intervention (PRENACEL group). The intervention included the provision of a package of messages sent to the pregnant women\'s cell phone as a complement to the prenatal standard of the public network. Participants were women 18 years of age or older, up to 20 weeks of gestation, who were undergoing prenatal follow-up at selected PHCU. Data were collected in four maternity hospitals, and for the present study, women who had deliveries vaginally and without high-risk pregnancies were evaluated. The outcomes evaluated were: the satisfaction of women with delivery; the use of good practices in childbirth care and women\'s perception of abuse, disrespect and / or mistreatment. Results: This study was composed of 241 women in the Control group and 427 in the Intervention group, of which 63 belonged to the PRENACEL group. There was no statistical difference between groups regarding satisfaction or use of good practices. Neither about the perception of women about the occurrence of abuse, disrespectand / or mistreatment during childbirth. We found high satisfaction of women with the attendance and high frequency of use of good practices during childbirth compared to the national scenario. Their perception of abuse, disrespect and / or mistreatment was low. Conclusion: The use of messages sent to pregnant women during prenatal care did not show any effect on the outcomes evaluated.

Introdução: Um dos objetivos mundiais para a melhoria da qualidade de vida da população é a redução da mortalidade materna. Visto que esta expressa não só contextos relacionados à saúde, mas também, epidemiológico, social e econômico. Uma maneira de promover mudança nas taxas de mortalidade materna é por meio do enfrentamento de barreiras para a melhoria do cuidado obstétrico. Países que já superaram a falta de serviços e de acesso à assistência obstétrica enfrentam problemas relacionados à qualidade da atenção ao parto e nascimento. Como por exemplo, danos a saúde materna e neonatal decorrentes de intervenções desnecessárias ou até desaconselhadas. A utilização da tecnologia móvel por meio de mensagens enviadas às gestantes tem se mostrado eficaz, com melhorias no cuidado durante o pré-natal e pós-parto. Esta dissertação foi desenvolvida por acreditar que o uso de mensagens enviadas às gestantes no pré-natal poderia modificar fatores relacionados à assistência ao parto. Objetivo: Avaliar se mensagens enviadas por celular às gestantes produz efeito sobre a satisfação das mulheres com o atendimento ao parto, sobre o uso de boas práticas no parto e sobre a percepção delas sobre a ocorrência de abuso, desrespeito e/ou maus-tratos durante o parto. Métodos: Esta é uma análise secundária de um ensaio aleatorizado por conglomerados em 20 unidades básicas de saúde (UBS) com maior número de seguimento pré-natal. As 20 UBS foram aleatorizadas (1:1) de forma balanceada, por meio de um software, formando um grupo Intervenção e um Controle, com dez UBS cada. Do grupo Intervenção origina o grupo que efetivamente recebeu a intervenção (grupo PRENACEL). A intervenção compreendeu o oferecimento de um pacote de mensagens enviadas para o celular das gestantes como um complemento ao pré-natal padrão da rede pública. Participaram do estudo mulheres com 18 anos ou mais, com até 20 semanas de gestação, que estavam em seguimento pré-natal nas UBS selecionadas. A coleta de dados foi realizada em quatro maternidades, e para o presente estudo, foram avaliadas mulheres que tiveram partos por via vaginal e sem gestações de alto risco. Os desfechos avaliados foram: a satisfação dasmulheres com o atendimento ao parto; o uso de boas práticas na assistência ao parto e a percepção das mulheres sobre a ocorrência de abuso, desrespeito e/ou maus-tratos. Resultados: Esta pesquisa foi composta por 241 mulheres no grupo Controle e 427 no grupo Intervenção, sendo 63 pertencentes ao grupo PRENACEL. Não houve diferença estatística entre os grupos em relação à satisfação ou uso de boas práticas. Nem sobre a percepção das mulheres sobre a ocorrência de abuso, desrespeito e/ou maus-tratos durante o parto. Encontramos alta satisfação das mulheres com o atendimento e alta frequência de uso de boas práticas durante o parto comparado ao cenário nacional. Já a percepção delas sobre ocorrência de abuso, desrespeito e/ou maus-tratos foi baixa. Conclusão: O uso de mensagens enviadas a gestantes no pré-natal não demonstrou efeito sobre os desfechos avaliados. / Introduction: One of the world\'s goals for improving the population\'s quality of life is to reduce maternal mortality. This is because it expresses not only contexts related to health, but also epidemiological, social and economic. A way to promote change in maternal mortality rates it is by facing barriers to improve obstetric care. Countries that have overcome the lack of services and access to obstetric care face problems related to the quality of childbirth care. As for example, damage to maternal and neonatal health still occurs from unnecessary or non-advisable interventions. The use of mobile technology through messages sent to pregnant women has been shown to be effective, with improvements in antenatal and postpartum care. Objective: To evaluate whether messages sent by cell phones to pregnant women have an effect on women\'s satisfaction with delivery, on the use of good practices during childbirth and on their perception of abuse, disrespect and / or mistreatment during the delivery. Methods: This is a secondary analysis of a cluster-randomized trial in 20 Primary Health Care Units (PHCU) with a higher number of prenatal followup. The 20 PHCU were randomized (1:1) in a balanced manner, using software, forming an Intervention and a Control group, with ten UBS each. From the Intervention group, the group that actually received the intervention (PRENACEL group). The intervention included the provision of a package of messages sent to the pregnant women\'s cell phone as a complement to the prenatal standard of the public network. Participants were women 18 years of age or older, up to 20 weeks of gestation, who were undergoing prenatal follow-up at selected PHCU. Data were collected in four maternity hospitals, and for the present study, women who had deliveries vaginally and without high-risk pregnancies were evaluated. The outcomes evaluated were: the satisfaction of women with delivery; the use of good practices in childbirth care and women\'s perception of abuse, disrespect and / or mistreatment. Results: This study was composed of 241 women in the Control group and 427 in the Intervention group, of which 63 belonged to the PRENACEL group. There was no statistical difference between groups regarding satisfaction or use of good practices. Neither about the perception of women about the occurrence of abuse, disrespectand / or mistreatment during childbirth. We found high satisfaction of women with the attendance and high frequency of use of good practices during childbirth compared to the national scenario. Their perception of abuse, disrespect and / or mistreatment was low. Conclusion: The use of messages sent to pregnant women during prenatal care did not show any effect on the outcomes evaluated.

Os atributos da atenção primária à saúde (APS) - acesso, longitudinalidade, integralidade, coordenação, orientação familiar e comunitária e competência cultural - são reconhecidos na literatura internacional como eixos estruturantes do processo de atenção, associados à qualidade dos serviços, à efetividade e a eficiência de suas intervenções. No Brasil, o processo de avaliação da APS encontra-se em fase de implantação, mostrando-se ainda incipiente e necessitando de estudos com rigor metodológico e marco teórico apropriado para que as análises obtidas possam subsidiar as práticas de planejamento e gestão. Desde a década de 1970, o município de Curitiba vem construindo sua rede de atenção primária baseada em dois modelos: um que incorpora médicos especialistas nas áreas básicas de pediatria, gineco-obstetrícia e clínica, além de enfermeiros, auxiliares de enfermagem, agentes comunitários de saúde e profissionais da odontologia e outro que é fundamentado na Estratégia Saúde da Família (ESF) e atua com médicos generalistas e demais profissionais como no modelo anterior. Neste estudo, foram investigadas a presença e a extensão dos atributos da APS no município de Curitiba no ano de 2008, comparando unidades que atuam com o modelo tradicional e ESF, mediante o instrumento PCATool-Brasil aplicado a 490 profissionais médicos e enfermeiros de 90 unidades de atenção primária do município. Os resultados indicam que nas unidades com ESF os escores médios e o percentual de Alto Escore (≥ 6,6) dos atributos acessibilidade, longitudinalidade, integralidade dos serviços disponíveis, integralidade dos serviços prestados, orientação familiar e orientação comunitária são significativamente maiores que nas unidades tradicionais. O mesmo ocorre quando esses atributos são condensados nos escores Essencial, Derivado e Geral da APS. O atributo coordenação, quando avaliado individualmente, apresenta melhor resultado nas unidades com ESF, porém sem significância estatística quando comparado às unidades tradicionais. Os resultados da regressão de Poisson robusta apontam uma associação positiva das unidades com ESF e da formação em medicina de família ou enfermagem comunitária com o Alto Escore da APS. Assim, na avaliação dos profissionais, os resultados evidenciam que em Curitiba as unidades com ESF apresentam maior presença e extensão dos atributos da atenção primária. Pela relevância do tema, indicamos a complementação da pesquisa com a aplicação do inquérito na população assistida pelos dois modelos, o que poderá acrescentar novos subsídios para a gestão municipal. / The attributes of Primary Health Care (PHC) – access to first contact, longitudinally, comprehensiveness, coordination, family and community orientation and cultural competence are recognized in the international literature as structural pillars of the health care process, being associated with service quality and intervention effectiveness and efficiency. In Brazil the process of PHC evaluation is still at the implantation phase, revealing itself to be incipient and in need of methodologically rigorous studies and an appropriate theoretical landmark so that the analyses obtained can support planning and management practices. Since the 1970s, the city of Curitiba has been building its primary attention network based on two models: one that incorporates doctors specialized in the basic areas of pediatrics, obstetrics and gynecology and general medicine and other based on the Family Health Strategy (FHS) that operates with general practitioners. In this study the presence and extension of the attributes of PHC in the city of Curitiba during 2008 were investigated, comparing health centers that operate with the traditional model and those based on the FHS, by means of a structured study using a validated instrument (PCATool-Brazil) applied to 490 medical professionals and nurses from 90 of the city’s primary health care centers. The results suggest that in the Family Health Strategy health centers the average scores and the percentage of high scores (≥ 6.6) in relation to the attributes of accessibility, longitudinally, comprehensiveness of the available services, comprehensiveness of the services provided, family orientation and community orientation are significantly higher than in the traditional health centers. The same happens when these attributes are condensed as the PHC Essential, Derived or Overall Score. When analyzed individually the coordination attribute has better results in the Family Health Strategy health centers, although without statistical significance when compared to the traditional health centers. Robust Poisson regression indicates a positive association between high PHC scores and FHS health centers and academic formation in family medicine or community nursing. As such, in the evaluation of the health professionals the results demonstrate that in Curitiba, the FHS health centers have greater presence and extension of primary care attributes. Due to relevance of the subject, we recommend that this study be complemented by means of a survey of the population attended by the two models, in order to provide additional support information for municipal health service management. / Telemedicina

This research examined if there is a relationship between engagement in quality improvement (QI) and health information technology (HIT) for local health departments (LHDs) controlling for workforce, finance, population, and governance structure. This was a cross-sectional study that analyzed data obtained from the Core questions and Module 1 in the NACCHO 2010 Profile of LHDs. Descriptive statistics, bivariate analyses, and logistic regression analyses were conducted. Findings suggest that LHD engagement in QI has a relationship with utilization of HIT including electronic health records, practice management systems, and electronic syndromic surveillance systems. This study provides baseline information about the HIT use of LHDs. LHDs and their system partners (hospitals, federally qualified health centers, and primary care providers) that utilize HIT as part of their QI decision making may have an easier time of using data to support evidence-based decision making and implementing the provisions of the Patient Protection and Affordable Care Act of 2010 in order to achieve population health for all.

No description available.