Providing care services across several departments and care givers creates the complexity of the patient pathways, as it deals with different departments, policies, professionals, regulations and many more. One example of complex patient pathways (CPP) is one that exists in integrated care, which most literature relates to health and social care integration. The world population and demand for care services have increased. Therefore, necessary actions need to be taken in order to improve the services given to patients in maintaining their quality of life. As the complexity arises due to different needs of stakeholders, it creates many problems especially when it involves complex patient pathways (CPP). To reduce the problems, many researchers tried using several decision tools such as Discrete Event Simulation (DES), System Dynamic (SD), Markov Model and Tree Diagram. This also includes Direct Experimentation, one of techniques in Lean Thinking/Techniques, in their efforts to help simplify the system complexity and provide decision support tools. However, the CPP models were developed using a single tools which makes the models have some limitations and not capable in covering the entire needs and features of the CPP system. For example, lack of individual analysis, feedback loop as well as lack of experimentation prior to the real implementation. As a result, ineffective and inefficient decision making was made. The researcher also argues that by combining the DES and SD techniques, named the hybrid simulation, the CPP model would be enhanced and in turn will help to provide decision support tools and consequently, will reduce the problems in CPP to the minimum level. As there is no standard framework, a framework of a hybrid simulation for modelling the CPP system is proposed in this research. The researcher is much concerned with the framework development rather than the CPP model itself, as there is no standard model that can represent any type of CPP since it is different in term of its regulations, policies, governance and many more. The framework is developed based on several literatures, selected among developed framework/models that have used combinations of DES and SD techniques simultaneously, applied in a large system or in healthcare sectors. This is due to the condition of the CPP system which is a large healthcare system. The proposed framework is divided into three phases, which are Conceptual, Modelling and Models Communication Phase, and each phase is decomposed into several steps. To validate the suitability of the proposed framework that provides guidance in developing CPP models using hybrid simulation, the inductive research methodology will be used with the help of case studies as a research strategy. Two approaches are used to test the suitability of the framework – practical and theoretical. The practical approach involves developing a CPP model (within health and social care settings) assisted by the SD and DES simulation software which was based on several case studies in health and social care systems that used single modelling techniques. The theoretical approach involves applying several case studies within different care settings without developing the model. Four case studies with different areas and care settings have been selected and applied towards the framework. Based on suitability tests, the framework will be modified accordingly. As this framework provides guidance on how to develop CPP models using hybrid simulation, it is argued that it will be a benchmark to researchers and academicians, as well as decision and policy makers to develop a CPP model using hybrid simulation.

This article considers emergence in the context of systems of systems, examining the earlier proposed tri-layered architecture in some depth. In contrast with healthcare reform, a social media phenomenon, the emergence of topics in the Twitter user community, is shown not to satisfy a critical condition of the architecture. Nevertheless, detection of topic emergence is shown to offer insights into the design of Emergence Behavior Observers.

Class of 2006 Abstract / Objectives: To assess predictors of systolic blood pressure control in the Southern Arizona Veterans Affairs Health Care System. Methods: 6185 patients were followed over a 2 year period and predictors of blood pressure control were examined using univariate and multivariate analyses. Primary independent variables assessed were age, gender, race, antihypertensive medication class, and comorbidities. The primary dependent variable was systolic blood pressure. Results: Sixty percent of patients studied had controlled hypertension. Significant predictors of better blood pressure control were the presence of coronary artery disease, use of loop diuretics, not using miscellaneous antihypertensive agents, lower age, and not of Hispanic descent or not an African-American. Conclusions: Frequency of systolic blood pressure control was found to be higher than previously reported. In contrast, age, sex, and race were significant predictors of control as reported elsewhere. Lastly, coronary artery disease, loop diuretics, and miscellaneous antihypertensive agents were found to be the only other significant predictors of systolic blood pressure control. These results suggest that there is largely no difference between the major antihypertensive medications class with respect to blood pressure control.

The Diploma paper " The Health Care Providing System in Switzerland" describes the development, structure and typical aspects of health care providing system in Switzerland. The Diploma paper concentrates on identification of the key factors which helped Switzerland health care providing system to reach very high quality and also ensured large availability of the services. The work is divided into theoretical and practical part. Theoretical part describes Swiss Confederation and its health care providing system. The practical part offers the comparison with the system in Czech Republic. The finale part is devoted to the key factors which could be implemented into the Czech system and which would be helpful for its further development.

Student Number : 8910202A - MPH research report - School of Public Health - Faculty of Health Sciences / An increasing number of people are migrating to South African urban centers (GJMC, 2000). There are various reasons that can be attributed to this migration; including the hope of finding employment and better living conditions. Recent urban migrants find themselves faced with the basic problem of lack of shelter and, depending on the migrant’s situation, they may choose to live in indoor shacks within the city center, backyard shacks in the black townships or join the growing number of informal settlement dwellers (GJMC, 2000). The number of informal settlements continues to grow at an alarming rate in Johannesburg (CEROI, 2000). This poses unique health care challenges as well as presenting the health care system with unusual disease conditions associated with general lack of infrastructure and services (CEROI, 2000). It has been established that the proportion of HIV infected patients is higher in people living in informal settlements when compared to people living in private houses (SAHR, 2000). Thus, it is expected that more people will be presenting with HIV and AIDS related illnesses in an informal settlement health center as compared to well-developed residential areas. This study aimed at exploring the prescribing patterns of health care givers for patients attending a health center in an informal settlement as well as to determine the major disease patterns prevalent in the area. The study was carried out in Davidsonville and OR Tambo clinics as well as Bophelong and Hikhensile clinics in Ivory Park. The study covered regions five, one and two respectively according to Gauteng metropolitan services area classification (GJMC, 2000). The findings of the study will help the appropriate policy makers improve the Essential Drug List and inform public health officials in formulating strategies that may lead to health status improvement for people living in informal settlements.

This thesis address one of the most important topics for the human being; health. Specifically, the research is about the deficiencies of the health system in Mexico. This paper shows the importance, how the system works and its current situation in the country. The purpose of this research is, based on the Pareto principle (20% vs 80%), to find how to solve most problems with the least possible investment.   It was found that the common denominator in the problems was the process and flow of information of the patients; specifically, the health records. The researchers address the issue at first explaining in a deep way the health records to highlight their importance in the health care system. In order to corroborate this finding in the literature; The researchers designed an interview, which was applied to physicians from the two main health institutions in Mexico in order to collect the necessary information to develop the thesis.   Since the design of the research is qualitative; the necessary social context is given to be able to understand the analysis and the results; likewise, the authors explain in detail the methodology used.   In spite of other important factors that were found such as the lack of results despite the investment and deficiencies in the infrastructure; It was concluded that, in fact, most of the problems were derived from the problems of health records. These results are important because it gives a parameter of what must be corrected first in order to have the expected results and a better health system.

Este estudo teve como objetivo compreender e desvelar o sistema de referência e contra-referência, no contexto do Sistema Único de Saúde do município de Botucatu/SP/BR, a partir da experiência de enfermeiras que vivenciam essa prática. Para tanto, optei pela pesquisa qualitativa, modalidade do fenômeno situado, vertente metodológica da fenomenologia. Seguindo essa trajetória fenomenológica, cheguei às descrições das treze enfermeiras entrevistadas através da questão: \"Gostaria que você discorresse sobre a sua vivência e percepção em relação ao sistema de referência e contra-referência no Município de Botucatu\". Inicialmente, realizei um breve histórico do Sistema Único de Saúde no Brasil, contextualizando, a seguir, o sistema de referência e contra-referência, para depois explicitar os fundamentos metodológicos utilizados. A construção dos resultados deu-se a partir da análise e compreensão individual dos depoimentos (análise ideográfica) e, também, através da interpretação das convergências evidenciadas entre todos os depoimentos (análise nomotética). Evidenciei nessa análise treze temas, os quais foram reduzidos a três categorias: o funcionamento do sistema de referência e contra-referência, as possibilidades de encaminhamento e fatores estruturais do sistema local. As convergências obtidas permitiram vislumbrar um caminho que indica, enquanto essência deste estudo, que embora o sistema de referência e contra-referência no Município de Botucatu apresente problemas estruturais com precária organização, ocultando dificuldades de integração entre os serviços e, em alguns casos, desproporção demanda/oferta de serviços, existem reais possibilidades de melhoria do mesmo, uma vez que o Município conta com os três níveis de complexidade e, no momento, existe um fator de impulsão, que é o financiamento de propostas através do Programa UNI / This study aimed to understand and to care counter-reference and reference system upon the context of the Health Unique System in Botucatu-SP, Brazil from the nurses who experience this practice. I adopted a qualitative research, situated fenomena model, methodologically derived from phenomenology. Following this phenomenology course, I reached the descriptions from 13 nurses interviewed on the following question: \"I would like you to elucidate your experience and perception regarding counter-reference and reference system in Botucatu\". At first I performed a brief record about the Health Unique System in Brazil contextualizing as it follows counter-reference and reference system to explicit methodological basis afterwards. Results were obtained from analysis and individual comprehension from evidences (ideographic analysis) and also through the interpretation of the attested convergencies among all the evidences (nomothetic analysis). I attested 13 themes in this analysis, and they were reduced into 3 categories: counter-reference and reference system operation, guiding possiblities and local system structural factors. The convergencies allowed to glimpse at a way which indicates that although counter-reference and reference system in Botucatu show structural problems with scarce organization, hiding integrations difficulties among services, and in some cases, disproportion demand / supply, there are real betterment possibilities once the city has three complexity levels, and at the moment there is an impulsion factor, which is the proposals sponsoring through UNI Project

Este trabalho tomou como objeto de estudo a relação entre saúde, Estado e ética no âmbito do Sistema Único de Saúde brasileiro. Utilizando os espaços público e privado como categorias de análise, teve como objetivo verificar como a reforma do setor saúde, especificamente a legislação complementar Norma Operacional Básica de 1996 (NOB/96), que tem servido de base à reforma, e a Lei n. 9.637/98, que cria as Organizações Sociais e o Programa Nacional de Publicização, coadunam-se com o princípio ético, presente na Constituição “saúde é direito de todos e dever do Estado". A análise baseou-se na legislação do SUS. Observou-se que o direito à saúde não está garantido na reforma do setor saúde, pois a concepção de Estado presente no SUS e aquela da reforma são diferentes. A análise mostrou ainda que a atual reforma tende a privatizar a saúde tanto na forma dos Programas da Saúde da Família e do Agente Comunitário da Saúde como através da transformação dos equipamentos de saúde de maior complexidade em organizações públicas não-estatais, submetendo a assistência à saúde às leis do mercado. Esse processo faz parte da reforma liberalizante do Estado brasileiro e acompanha a crescente privatização do espaço público, na contemporaneidade, que permite que o poder político seja ocupado por agências internacionais que impõem suas normas aos Estados nacionais. / This study took as a general object the relationship among health, State and ethics under the scope of the Brazilian Health Care System (BHCS). Utilizing public and private spheres as analytical categories, it had a particular objective of verifying how the health reform - particularly the complementary legislation Basic Operational Norm/96 and the law n. 9.637/98, that creates Social Organizations and the National Publicizing Program -, is in accordance with the ethical principle of the Constitution health is a citizen right and a State duty. Analysis was based on the BHCS legislation. It was observed that the right to health is not guaranteed by the health reform, mainly because its conception of State is different from that of the Constitution. Analysis shows yet that the current reform tends to privatize health care through both the Health Family Program and Community Health Agent Program and through the transformation of high complex health services in non-state health organizations. This process is part of the Brazilian State liberalizing reform and follows closely the growing privatization of public sphere on contemporary societies, that has being allowing international agencies to occupy political power by imposing their norms to the National States.

Healthcare in the Czech Republic is currently undergoing reform changes. The aim of the thesis is to evaluate the upcoming changes in the reimbursement of health care in hospitals. To achieve the goal is used as the literature, as well as proposed legislation and the case law. The practical part of the thesis focuses on the hospitals. Emphasis is placed on the analysis of mechanisms fixed costs reimbursement of health care and reimbursement of health care by the DRG method. The potential impact of reform measures is presented on the example of an extremely costly medical care (orphan drugs). Based on the information and analysis are in the final part of the thesis describes the effects of health reform on financing health care in hospitals. At the same time also outlined a possible solution to save the cost of medical equipment in the field of medicines.

A reforma sanitária, ocorrida após a constituição de 1988, criou o Sistema Único de Saúde (SUS), descentralizando a gestão em saúde pública no Brasil e delegando mais autonomia e responsabilidade aos municípios. Esta descentralização traz inúmeros benefícios, pois aproxima a gestão das realidades locais. Os municípios são peculiares e podem apresentar dificuldades em atingir os mesmos padrões de serviços de saúde dos demais entes federados e, eventualmente, incorrer na desigualdade em saúde. Para garantir a integralidade no atendimento, as Redes Regionais de Atenção à Saúde (RRAS) articulam o sistema de maneira a satisfazer os diferentes níveis de complexidade. Procurou-se nesta pesquisa encontrar padrões espaciais destoantes na distribuição de recursos de saúde no estado de São Paulo, de maneira a caracterizar eventuais desigualdades em saúde. Os dados foram analisados por RRAS e por aglomerados de munícipios de atributos similares. Os resultados indicam diferenças regionais nos vários aspectos pesquisados, sobretudo na cobertura por equipes de saúde da família, no acesso aos serviços de saúde e na oferta e ocupação de leitos. Estas diferenças variam conforme se dista da capital do estado e estão associadas à renda e à presença da saúde suplementar. / The health care reformulation, which started after the constitution of 1988, created the Unified Health Care System (SUS), decentralizing the management of public health care in Brazil and delegating more autonomy and responsibility to counties.This decentralization brings numerous benefits because it approaches the county management to local area realities. Counties have different features and may have difficulties achieving the same health care standards of other federative entities and possibly create health care inequalities. To ensure comprehensiveness in health care, the Regional Health Care Networks (RRAS) articulate the system in order to provide the different levels of complexity. It is aimed in this research to find dissonant spatial patterns in health care resources distribution in the state of São Paulo, in order to characterize any inequalities. The data was analyzed by the RRAS and clusters of counties of similar attributes. Results indicate regional differences in several aspects of the research, mostly in family health care teams coverage, access to health care services and availability and bed occupancy rate. These differences vary according to how distant from the state capital the county is and are associated with income and health insurance attendance.