published_or_final_version / History / Doctoral / Doctor of Philosophy

published_or_final_version / Transport Policy and Planning / Master / Master of Arts

The existing District Health Information System in South Africa can be described as a facility based Information System, focusing on the clinics and hospitals and not on the community. Consequently, only those who access health services through these facilities are included in the system. Many children do not have access to basic health and social services and consequently, are denied their right to good health. Additionally, they are excluded from the routine Health Information System. Policy and resource decisions made by the District Managers, based on the current health facility information, reinforces the exclusion of these already marginalised children. The premise behind this research is that vulnerability of children can be tackled using two interconnected strategies. The first is through the creation of awareness of the situation of children and the second through mobilising the commitment and action of government and society to address this situation. These strategies can be supported by designing an Information System for action / an Information System that can be used to advocate and influence decisions and policies for the rights of these children / an Information System that includes all children. An interpretive participatory action research approach, using a case study in a rural municipality in South Africa, was adopted for the study of a child-health Community-Based Information System. The context in which the community is placed, as well as the structures which are embedded in it, was examined using Structuration Theory. This theory also influenced the design of the Information System. As the aim of the research is to change the Information System to include vulnerable children, a Critical Social Theoretical and longitudinal perspective was adopted. In particular, concepts from Habermas, such as the creation of a public sphere and the &rsquo / Ideal Speech Situation&rsquo / , informed the methodology chosen and were used to analyse the research undertaken. <br /> <br /> Based on the research conducted in this municipality, four main changes to the Health Information System were made. These were: &bull / determination of the community&rsquo / s own indicators / &bull / changes in data collection forms / &bull / creation of forums for analysis and reflection, and / &bull / changes in the information flows for improved feedback. Other practical contributions of the research are the development of local capacities in data collection and analysis, the development of practical guidelines on the design of a child-health Community-Based Information System, and the development of strategies for enabling participation and communication. In line with the action research approach adopted, and the desire to link theory and practice, the research also contributed on a theoretical level. These contributions include extending the use of Structuration Theory, in conjunction with Habermas&rsquo / Critical Social Theory, to the empirical context of South Africa / addressing the gap of Community-Based Information Systems in Information System design / extending the debate on participation and communication in Information Systems to &rsquo / developing&rsquo / countries, and developing generalisations from a qualitative case study.

No abstract available.

This thesis reports on research focuses on how to deal with the fact that the organization and processesof today’s health and social care are becoming ever more complex as a consequence of societal trends, including an aging population and an increased reliance on care at home. The overall research goal is to suggest ways in which IT-based solutions can enable and leverage collaboration and coordination insituations where a co-morbid patient is subject to care delivered simultaneously by several different professionals and organizations. Patient-centered care is defined as quality health and social care achieved through a partnership between informed and respected patients, their families, and coordinated health and social care teams who conduct care activities according to jointly determined care plans. Against a background of several years of research on patient-centered collaborative care using adesign science approach, using techniques such as focus groups, interviews, and document studies, the author of the thesis has further pursued the work in a project named CoCare. Results show that the care required in aging societies is both a social and a technical challenge. Meeting this challenge will require a redesign of today's health and social care processes in order to focus more clearly on patient needs and values, and poses demands on information services allowing to share knowledge of the patient’s health and social situation among involved care providers. An important aspect of the increased complexity is that a single patient may need care from several autonomous care providers in parallel, particularly patients with co-morbidities. This clearly requires effective coordination of care activities, which poses further demands on information services to support this task. A set of issues involving patient-centered collaborative care is identified and analyzed. The thesis introduces the notions of the Patient-Centered Care Process (PCCP) and a conglomeration of suchprocesses. A conglomeration comprises a set of PCCPs that concern the same patient, that are overlapping in time, and that share the overall goal of improving and maintaining the health and socialwell-being of the patient. The PCCP is inspired by the well-known PDCA cycle and comprises the four phases of assessing the patient situation (ASSESS), planning care activities (PLAN), performingcare activities (DO) and following up care (CHECK) for the patient. Based on a number of key standards, such as HL7, HISA and CONTsys, the thesis introduces a Patient-Centered Information Model (PCIM). A set of information services, together constituting a Coordination Hub, is proposed. The information services aim to help formal as well as informal carers (including the patient) inconducting care according to the PCCP The thesis contributes to a deeper understanding of care processes and suggests ways to achieve patient-centered collaborative care that better contributes to creating value for the patient as an individual.

國內有關採購案件之決標金額與底價金額之實證研究文獻，多將相關資料逕以迴歸方式直接處理而獲致相關結論，未曾考量樣本偏誤對迴歸結果的影響。本研究利用內政部99年1月至104年8月資訊服務勞務採購案件數據，針對1,061件採購案件資料進行分析，為避免因樣本選擇不當可能產生的估計誤差，我們利用Heckman二階段估計法，先估計押標金對採購案件是否決標的影響，再進一步分析影響決標金額與底價金額的要因。經過選樣誤差修正後，我們發現決標金額與底價金額都有受到選樣誤差的影響，表示過往以計量模型進行決標金額與底價金額影響因素的實證研究，由於未考量押標金的扭曲效果，其研究結果似有再檢視必要。而實證結果也發現，勞務與工程案件之決標金額與底價金額的影響因素並不完全相同，故現行以工程思維為架構的政府採購法，確有再修正之必要。

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