Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.

Innovative primary care models that deliver comprehensive primary care to address medical and social needs are an established means of improving health outcomes and reducing healthcare costs among persons living with chronic disease. Care management is one such approach that requires providers to monitor their respective patient panels and intervene on patients requiring care. Health information technology (IT) has been established as a critical component of care management and similar care models. While there exist a plethora of health IT systems for facilitating primary care, there is limited research on their ability to support care management and its emphasis on monitoring panels of patients with complex needs. In this dissertation, I advance the understanding of how computational methods can better support clinicians delivering care management, and use the management of human immunodeficiency virus (HIV) as an example scenario of use. The research described herein is segmented into 3 aims; the first was to understand the processes and barriers associated with care management and assess whether existing IT can support clinicians in this domain. The second and third aim focused on informing potential solutions to the technological shortcomings identified in the first aim. In the studies of the first aim, I conducted interviews and observations in two HIV primary care programs and analyzed the data generated to create a conceptual framework of population monitoring and identify challenges faced by clinicians in delivering care management. In the studies of the second aim, I used computational methods to advance the science of extracting from the patient record social and behavioral determinants of health (SBDH), which are not easily accessible to clinicians and represent an important barrier to care management. In the third aim, I conducted a controlled experimental evaluation to assess whether data visualization can improve clinician’s ability to maintain awareness of their patient panels.

Indiana University-Purdue University Indianapolis (IUPUI) / BACKGROUND: The pathophysiology of diabetes mellitus and the need for vigilant monitoring of serum glucose levels lends itself well to prompt medical intervention by healthcare providers that can significantly reduce morbidity and mortality and improve patient quality of life. The effect of intervention in diabetes can be assessed by following objective laboratory measurements such as hemoglobin A1C, which is abnormal with poorly controlled diabetes and returns to normal with proper management. There are mobile technologies now available that allow for self-monitoring and intervention in this patient population. Using a systematic approach this paper will assess the benefits of Short Message Services and mobile technology in managing patients with diabetes and improving adherence and other outcomes. OBJECTIVE: To assess the benefits and disadvantages the use of mobile technology could have in the management of diabetes. METHODOLOGY: A systematic review of articles on this topic was performed. A total of 759 articles were initially identified by searching various search engines, from which only 39 articles met all of the inclusion/exclusion criteria of this systematic review. FINDINGS: The initial review of literature indicated that the use of mobile technology in patients with diabetes resulted in improved disease outcomes as indicated by parameters such as a decrease in hemoglobin A1C, and an increase in sustainable blood glucose levels. CONCLUSION: Mobile technology is found to be a promising tool in the management of diabetes, but further research is needed because there is a lack of reliable studies, trials, and systematic reviews. Physicians and other healthcare professionals are rapidly adopting mobile technology for use in clinical practice because they understand the rising phenomenon of mobile technology.

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016. / The delivery of healthcare services should be of a high standard for everyone. For people in the location of Mantunzeleni this is not the case as there are still challenges that they go through in order to gain access to sufficient healthcare services. The location consists of four villages and the other nine which surround the four, in total this makes thirteen villages that are served by one clinic. These villages are divided by forest, rivers and mountains, people have to cross these and walk long distances to get to the clinic. Gaining access to basic healthcare services in rural areas has never been easy, hence this study seeks to understand the role telehealth could play to help improve the situation. It has been reported in the literature that telehealth has potential to address some of the problems experienced by healthcare service providers located in the rural areas. Research questions were posed to address the problem of limited access to healthcare services of under-served communities in rural areas. The study adopted an interpretive approach to understand how the people using healthcare services in the setting attach meaning to their experiences of the healthcare service. The study therefore seeks to understand how telehealth could improve healthcare service delivery through the participants’ views, perceptions and experiences. The research strategy for this study is a single case study without attempting to generalise the findings. Qualitative data was gathered using unstructured interviews, observations and co-design methods. The current state of telehealth and challenges of healthcare services in rural under-served communities was established through a review of relevant literature. It was important to actively involve the respondents in the research process for them to feel a sense of ownership. Data was analysed using a thematic analysis. The findings revealed the challenges currently hampering the delivery of healthcare in the research setting include poor infrastructure, high cost, the shortage of medical professionals, travelling distance, time management and lack of communication about the services. It was also revealed the role telehealth could play a role to improve access to healthcare and the findings indicate that the nurses feel that extending the healthcare service to include alternative access methods to health information, education and expertise could lead to a sense of appreciation, knowledge gain, dealing with distance problems and improved referrals, cost saving to improve healthcare service delivery.

Indiana University-Purdue University Indianapolis (IUPUI) / Objectives: To examine the effect of a collaborative care program for late-life depression on risk of diabetes among depressed, older adults. Method: We conducted a 9-year follow-up study of 160 older, primary care patients with a depressive disorder but without diabetes enrolled at the Indiana sites of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial. Results: Surprisingly, the rate of incident diabetes in the collaborative care group (22/80 = 27.5%) was twice the rate observed in the usual care group (11/80 = 13.7%). Cox proportional hazards models adjusted for randomization status (HR = 1.94, p = .076), demographic factors (HR = 1.94, p = .075), and additionally for diabetes risk factors (HR = 1.73, p = .157) indicated that the risk of incident diabetes did not differ between the collaborative care and usual care groups, with collaborative care patients remaining at a nonsignificant increased risk. Conclusions: Our novel findings suggest that depression may not be a casual risk factor for diabetes and that depression treatment may be insufficient to reduce the excess diabetes risk of depressed, older adults.

Text in English / Lack of knowledge and skills among health care providers for provision of integrated TB/HIV activities for better health outcomes for co-infected patients is a public health concern. A qualitative, non-experimental, explorative and descriptive research design based on the phenomenological philosophical tradition by Heidegger to broaden hermeneutics was conducted. The study was conducted at Mopani district to explore and describe the experiences of eligible nurse managers relating to the implementation of the TB/HIV activities at management level. A purposive sample of 14 participants was recruited and consent form obtained. An unstructured interview guide, with a grand tour question, was used to conduct face to face individual interviews. Tesch’s method of analysis was employed until two themes, five categories and ten subcategories emerged from the data. The major findings were on challenges experienced by nurse mangers such as shortage of resources, poor planning, lack of support by management and patient related challenges. Recommendations were based on the findings to encourage staff retention strategies, adequate funding for TB control programs, support by management, co-joint planning, team work and effective tracing strategies. / Health Studies / M.A. (Health Studies)

This project examines the role of immunization registries and their effect on a health care delivery system. Recent efforts to attain coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide community-based childhood immunization registries.

Indiana University-Purdue University Indianapolis (IUPUI) / Although interprofessional education (IPE) opportunities can help prepare students for future practice and patient-centered care, many health professions students in the country are not educated in an environment with opportunities to learn with, from, or about students from other health professions. With upcoming curricular changes at the Indiana University School of Medicine (IUSM) and the Indiana University School of Nursing (IUSN), IPE remains at the forefront of these changes in both schools. To date, few studies have explored student, faculty, and administrators’ conceptualizations of IPE prior to formal implementation. Additionally, previous studies have not compared IPE conceptualizations across these groups. This multiple-case study explores and compares how groups of stakeholders from the IUSM (Indianapolis) and the IUSN (Indianapolis) conceptualize IPE. Data collection included the examination of discipline-specific public documents and one-on-one interviews (N=25) with pre-licensure students, clinical faculty, and administrators from each school. Coding and extraction of themes transpired through within-case and cross-case analysis and data supported the following findings: the ‘business of medicine’ may prevent IPE from becoming a priority in education; stakeholders’ conceptualizations of IPE are shaped through powerful experiences in education and practice; students desire more IPE opportunities at the institution; stakeholders at the IUSN have a long-standing investment in IPE; and the institution requires a ‘culture shift’ in order to sustain IPE efforts. The findings suggest that IPE belongs in all education sectors and IPE efforts deserve reward and reimbursement. The findings also insinuate that leadership, roles, and team training education belong in IPE and IPE culture requires all individuals’ (e.g., student, faculty, administrators, patients) commitment. Importantly, the institution must continue IPE development, research, and dissemination. These findings can help shape curricula as time progresses, increase the likelihood of developing a successful new curriculum, and prompt ongoing reflection about IPE. This information can influence how institutions approach IPE and may lead to a more successful and informed IPE curriculum in the first years of implementation. And, hopefully what is learned through IPE will be translated into healthcare practice environments.