Abstract not available

Dissertation (Ph.D.)--Auburn University, / Abstract. Includes bibliographic references (p.102-113).

Hospital readmission rates are considered to be an important indicator of quality of care because they may be a consequence of actions of commission or omission made during the initial hospitalization of the patient, or as a consequence of poorly managed transition of the patient back into the community. The negative impact on patient quality of life and huge burden on healthcare system have made reducing hospital readmissions a central goal of healthcare delivery and payment reform efforts. In this project, we will focus on COPD (Chronic Obstructive Pulmonary Disease) which is one of the leading causes of disability and mortality worldwide. This project will design and develop a prognostic COPD healthcare management system which is a sustainable clinical decision-support system to reduce the number of readmissions by identifying those patients who need preventive interventions to reduce the probability of being readmitted. Based on patient’s clinical records and discharge summary, our system would be able to determine the readmission risk profile of patients treated for COPD. Suitable interventions could then be initiated with the objective of providing quality and timely care that helps prevent avoidable readmission. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Thesis (M. of Gerontological Studies)--Miami University, Dept. of Sociology and Gerontology, 2005. / Title from first page of PDF document. Document formatted into pages; contains [1], v, 57 p. : ill. Includes bibliographical references (p. 49-51).

Thesis (Ph.D.)--University of Waikato, 2006. / Includes bibliographical references (leaves 254-273) Also available via the World Wide Web.

There is emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity, inadequate or unstable housing, and lack of access to transportation may increase the risk of developing chronic conditions, reduce an individual's ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. In response, work on social needs is happening across large health systems in the United States, but the pace of progress is slow and accountability is diffuse. The goal of this applied research project is to examine Kaiser Permanente Northwest's patient navigator program as a case study for how health systems can transform into organizations that bridge clinical, social and behavioral health and redefine what it means to be a prevention-oriented delivery system. Kaiser Permanente Northwest (KPNW) provides high quality, patient-centered care to over 550,000 medical members and 240,000 dental members in Oregon and Southwest Washington. In conjunction with the Care Management Institute, KPNW created a patient navigator administered, social needs screening tool called "Your Current Life Situation" (YCLS). This thesis focuses on the data collected from this screening tool with an emphasis on operations management, workflows, and the technical tools that have been supported to do this work. The analysis also uses semi-structured qualitative interviews from patient navigators, physicians, social workers, community organizations and members to better understand the experience of social needs screening in clinical practice and its impact on members and community partners as they receive referrals for services outside the health care delivery system. Through using anthropological theory and methods, I seek to help health systems think and act differently by elevating the voice and experience of the community and translating vulnerable populations' needs into a language that can be integrated into multiple systems of care.

The maternal mortality ratio (MMR) and neonatal mortality rate (NMR) have been persistently high in South Africa, with black, poor, rural women and neonates mostly affected. The MMR and the NMR are indicative of the health of the population and reflect deeper issues such as inequitable distribution of the country’s resources, social exclusion, deprivation, and lack of access to quality public services. The purpose of the study was to develop a model to meet the overall health needs of the socially excluded, the deprived and the vulnerable women by listing those factors that influence maternal and child health outcomes. From the point of view that individual reproduction and health decision-making takes place in a milieu comprising multiple socio-economic and cultural factors, this study attempts to add to the body of knowledge on maternal and child health in order to influence policies and interventions. Data was collected through a multi-staged, qualitative research design. The results show how structural factors result in high risk for poor maternal and child health outcomes, suggesting that the high rates of poor health outcomes are evidence of deprivation of women’s needs due to poverty leading to an inability to cope with pregnancy and childbirth. The results are used to develop a model that proposes pathways for policy action to confront both the structural and intermediary determinants of maternal and child ill health and mortality. These pathways operate through integrative and inter-sectorial mechanisms intended at empowering women and enhancing female reproductive health care activities. / Sociology / D.Litt. et Phil. (Sociology)

The prevalence of untreated and undertreated mental health concerns and the comorbidity of chronic conditions and mental illness has led to greater calls for the integration of primary care and mental health. In 2012, the Oregon Health Authority authorized 16 Coordinated Care Organizations (CCO) to partner with their local communities to better coordinate physical, behavioral, and dental health care for Medicaid recipients. One part of this larger effort to increase coordination is the integration of primary care and mental health services in both primary care and community mental health settings. The underlying assumption of CCOs is that organizations have the capacity to fundamentally change how health care is organized, delivered, and financed in ways that lead to improved access, quality of care, and health outcomes. Using the Rainbow Model of Integrated Care (RMIC), this study examined the factors that impact organizational efforts to facilitate the integration of primary care and mental health through interviews with executive and senior staff from three CCOs. The RMIC focuses attention on the different levels at which integration processes may occur as well as acknowledges the role that both functional and normative enablers of integration can play in facilitating integration processes within as well as across levels. The following research question was explored: What key factors in Oregon's health care system impede or facilitate the ability of Coordinated Care Organizations to encourage the integration of primary care and mental health? Using a case study approach, this study drew upon qualitative methods to examine and identify the factors throughout the system, organizational, professional, and clinic levels that support CCO efforts to facilitate the integration of primary care and mental health. Fourteen primary interviews were conducted with executive and senior staff. In addition, eleven secondary interviews from a NIDA funded project as well as twenty-four key CCO documents from three CCOs were also included in this study. The RMIC was successful in differentiating extent of CCO integration of primary care and mental health. Findings demonstrate that normative and functional enablers of integration were most prevalent at the system and organization level for integrating mental health into primary care for these three CCOs. However, there was variation in CCO involvement in the development of functional and normative enablers of integration at the professional and clinic levels. Normative and functional enablers of integration were limited at all of the RMIC levels for integrating primary care into community mental health settings across all three CCOs. The Patient-Centered Primary Care Home model provided CCOs with an opportunity to develop functional and normative enablers of integration for integrating mental health in primary care settings. The lack of a fully developed model for integrating primary care services in community mental health settings serves as a barrier for reverse integration. An additional barrier is the instability of community mental health as compared to primary care; contributing factors include historically low wages and increased administrative burden. System wide conversations about where people are best served (i.e., primary care or community mental health) has yet to occur; yet these conversations may be critical for facilitating cross-collaboration and referral processes. Finally, work is needed to create and validate measures of integration for both primary care and community mental health settings. Overall findings confirm that integrating primary care and mental health is complex but that organizations can play an important role by ensuring the development of normative and functional enablers of integration at all levels of the system.

The maternal mortality ratio (MMR) and neonatal mortality rate (NMR) have been persistently high in South Africa, with black, poor, rural women and neonates mostly affected. The MMR and the NMR are indicative of the health of the population and reflect deeper issues such as inequitable distribution of the country’s resources, social exclusion, deprivation, and lack of access to quality public services. The purpose of the study was to develop a model to meet the overall health needs of the socially excluded, the deprived and the vulnerable women by listing those factors that influence maternal and child health outcomes. From the point of view that individual reproduction and health decision-making takes place in a milieu comprising multiple socio-economic and cultural factors, this study attempts to add to the body of knowledge on maternal and child health in order to influence policies and interventions. Data was collected through a multi-staged, qualitative research design. The results show how structural factors result in high risk for poor maternal and child health outcomes, suggesting that the high rates of poor health outcomes are evidence of deprivation of women’s needs due to poverty leading to an inability to cope with pregnancy and childbirth. The results are used to develop a model that proposes pathways for policy action to confront both the structural and intermediary determinants of maternal and child ill health and mortality. These pathways operate through integrative and inter-sectorial mechanisms intended at empowering women and enhancing female reproductive health care activities. / Sociology / D.Litt. et Phil. (Sociology)

Thesis (MPhil)--Stellenbosch University, 2012. / Introduction Under-5 year mortality in South Africa is increasing and effectiveness of primary care is a key factor. Adherence to IMCI guidelines by primary care nurses is critical. The IMCI guidelines provide a standardized integrated approach to delivering quality care. Nurses in South Africa are currently using a paper-based guideline. The automated guideline in the format of a convertible personalised computer tablet aimed to improve training in IMCI and the quality of clinical decision making. The automated guideline was designed to systematically guide the nurse through the algorithms thus reducing errors and making care more effective. This study evaluated the use of automated guidelines in improving the training of nurses. Methods A sample size of thirty Professional Registered Nurses (PNs) was selected from the one year Postgraduate Diploma in Clinical Nursing Science at Stellenbosch University. Observational study design compared 15 PNs who used and 15 who did not use the automated guidelines during training. Nurses were compared in terms of their knowledge of IMCI after classroom based teaching and adherence to IMCI in clinical training practices. Results Both groups improved their knowledge of IMCI, but were not significantly different at the end of the classroom teaching. Nurses in the automated group showed significant improvement in their clinical practice (p<0.05): gathering information on HIV risk (50% vs. 93%) or immunisations (68% vs. 93%); making a complete assessment of the patient (61% vs. 100%), prescribing correct medication (50% vs. 85%), correct dose (42% vs. 85%) and safety netting (78% vs. 96%). Conclusion The use of automated guidelines showed potential for improving adherence to IMCI in the Western Cape. Further research is needed to determine if the widespread use of the automated version by PNs translates into better quality of care and improved health outcomes.