This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers??? value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers??? value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation.

Despite a myriad of studies on fall prevention, patient falls continue to be a longterm problem experienced by health care organisations world-wide. Falls impose a heavy burden in terms of social, medical, and financial outcomes, and continue to pose a threat to patient safety. Because the potential for a fall is a constant clinical safety issue in every health care organisation, protecting the patient from falls and subsequent injuries, and ensuring that the patient care environment facilitates, are fundamental aspects in providing quality care. Moreover, the current international focus on creating a culture of quality care and patient safety requires the implementation of fall prevention programs that decrease the risk of falls. As with other international health care organisations, the National University Hospital (where the principal investigator is working), has been challenged with the issue of how to prioritise and implement quality initiatives across all disciplines. Faced with persistent patient falls that affect care outcomes, fall prevention has been a priority initiative at the hospital since 2003. In response, a nursing task force was established in an attempt to resolve this problem. A root cause analysis undertaken by this task force revealed that the hospital protocol on fall prevention was outdated and not evidence-based. Furthermore, many nurses did not understand the importance of fall prevention, while the administration of the fall prevention program was instituted on an ad hoc basis rather than as a standard of care for all patients. The challenge for this task force, as with other health care professionals, was not only in finding an intervention that was effective, but also identifying who would benefit from its implementation. Although the need to apply current best practices to reduce patient falls is clear from the task force results, evidence of the effectiveness of fall prevention interventions in acute care hospitals is lacking in literature. In addition, there are no published studies on fall prevention in Singapore to support changes in nursing practices. Thus, it becomes apparent that research on fall prevention is greatly needed in Singapore so that an evidence-based fall prevention program can be developed. This topic coincides with the Doctor of Nursing course, which requires the student to gain knowledge through scholarly research on contemporary issues in nursing by undertaking two separate projects related to a single area of interest. Undertaking the two research projects on fall prevention in an acute care inpatient hospital as part of the doctoral studies provided an opportunity to address this deficit in a way that could raise awareness of the importance of fall prevention in Singapore hospitals. This research also provides a platform for the first body of research into fall prevention to be conducted within the Singapore health care environment, which is essential, as international studies are not always necessarily applicable to the Singapore context due to differences in educational preparation, skills-mix, organisational culture and nursing practices. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1321300 / Thesis (D.Nurs.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008

No description available.

Syfte:Syftet med litteraturstudien var att beskriva sjuksköterskors upplevelser av att vårda patienter i livets slutskede på sjukhusavdelningar. Metod:Beskrivande litteraturstudie som baserades på tretton vetenskapliga artiklar. Data inhämtades från databaserna Cinahl och Pubmed. Resultat:Att vårda patienter i livets slut på sjukhusavdelningar är en komplex situation. Sjuksköterskorna beskrev både upplevelser av tillfredsställelse och närhet samtidigt som de kunde känna sig otillräckliga. Relationer till patienter och närstående var betydelsefulla men en distansering var nödvändig för att behålla en professionell yrkesidentitet. Faktorer som påverkade upplevelserna var rädsla för den egna döden, tidigare erfarenheter, tidsbrist och den rumsliga miljön på avdelningarna. En betydande del av upplevelserna var av existentiell karaktär. Slutsats: Blivande sjuksköterskor och yrkesverksamma sjuksköterskor behöver vetskap om hur det kan påverka dem att vårda patienter i livets slutskede. Sjuksköterskor behöver få möjligheter att reflektera över sina upplevelser och sin attityd till döden för att kunna utveckla ett professionellt förhållningssätt. / Aim:The aim of this study was to describe the nurses’ experience of end of life care in a hospital setting. Method:The study was conducted as a descriptive literature study based on thirteen scientific articles retrieved from the databases Cinahl and PubMed. Resultat: End of life care in a hospital setting is a complex situation. Nurses described experiences of satisfaction and closeness at the same time as they had feelings of inadequacy. Relationship with patients and their relatives were meaningful but keeping a professional distance was necessary. Issues impacting on the experiences was nurses own fear of death, previous experiences, lack of time and the hospital environment. A significant part of the described experiences was of existential character. Conclusion: Future and working nurses need more knowledge of how caring for dying people can effect them. Nurses require opportunities to reflect on end of life care experiences and their own attitudes to death, in order to develop a professional approach.

Transformation of service delivery in the Westcoast winelands region's hospitals: challenges and prospects

The present research examines the effect of music therapy on the affect of hospitalised children. It took place on a paediatric ward of a New Zealand public hospital. This study aimed to investigate the role of music therapy in addressing patients’ psychosocial needs. Literature on the impact of hospitalisation, and on the use of music therapy in hospitals and paediatrics was reviewed. The research involved an audit of the therapist’s clinical notes from music therapy sessions over the course of seven months. The clinical notes included measurements of children’s mood from the beginning and end of sessions, using McGrath’s (1990) Affective Facial Scale. It was hypothesised that mood measures following music therapy would be higher than pre-music therapy scores. Statistical analysis of the facial scale data did not show a significant difference between ‘before’ and ‘after’ measures. These results were discussed with regard to a ceiling effect (this is, the measurements indicated patients were at the happy end of the scale before the music therapy session, so there was little room on the scale for mood to improve following music therapy). The measurement of emotion did not prove to be straightforward. The hospital environment may have influenced the patients’ responses in a number of ways. These environmental influences are discussed with reference to examples from the clinical notes. The usefulness of facial scales in this context is discussed, as well as other limitations of the research. Suggestions for future research include the use of other mood measures, and the inclusion of measurements of parental mood and how this affects the child.

This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers??? value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers??? value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation.

The present research examines the effect of music therapy on the affect of hospitalised children. It took place on a paediatric ward of a New Zealand public hospital. This study aimed to investigate the role of music therapy in addressing patients’ psychosocial needs. Literature on the impact of hospitalisation, and on the use of music therapy in hospitals and paediatrics was reviewed. The research involved an audit of the therapist’s clinical notes from music therapy sessions over the course of seven months. The clinical notes included measurements of children’s mood from the beginning and end of sessions, using McGrath’s (1990) Affective Facial Scale. It was hypothesised that mood measures following music therapy would be higher than pre-music therapy scores. Statistical analysis of the facial scale data did not show a significant difference between ‘before’ and ‘after’ measures. These results were discussed with regard to a ceiling effect (this is, the measurements indicated patients were at the happy end of the scale before the music therapy session, so there was little room on the scale for mood to improve following music therapy). The measurement of emotion did not prove to be straightforward. The hospital environment may have influenced the patients’ responses in a number of ways. These environmental influences are discussed with reference to examples from the clinical notes. The usefulness of facial scales in this context is discussed, as well as other limitations of the research. Suggestions for future research include the use of other mood measures, and the inclusion of measurements of parental mood and how this affects the child.

The present research examines the effect of music therapy on the affect of hospitalised children. It took place on a paediatric ward of a New Zealand public hospital. This study aimed to investigate the role of music therapy in addressing patients’ psychosocial needs. Literature on the impact of hospitalisation, and on the use of music therapy in hospitals and paediatrics was reviewed. The research involved an audit of the therapist’s clinical notes from music therapy sessions over the course of seven months. The clinical notes included measurements of children’s mood from the beginning and end of sessions, using McGrath’s (1990) Affective Facial Scale. It was hypothesised that mood measures following music therapy would be higher than pre-music therapy scores. Statistical analysis of the facial scale data did not show a significant difference between ‘before’ and ‘after’ measures. These results were discussed with regard to a ceiling effect (this is, the measurements indicated patients were at the happy end of the scale before the music therapy session, so there was little room on the scale for mood to improve following music therapy). The measurement of emotion did not prove to be straightforward. The hospital environment may have influenced the patients’ responses in a number of ways. These environmental influences are discussed with reference to examples from the clinical notes. The usefulness of facial scales in this context is discussed, as well as other limitations of the research. Suggestions for future research include the use of other mood measures, and the inclusion of measurements of parental mood and how this affects the child.

Thesis (MSc. (Physiology)--Faculty of Health Sciences) - University of Pretoria, 2005. / Includes bibliographical references.