The predicted impact of a potential future influenza pandemic was modelled for South Africa using a multi-state Markov transition model based on key parameters from the pandemics of the twentieth century. The number of individuals falling into each of the following categories was predicted for each week in the pandemic: healthy (uninfected); infected (no treatment); infected (out-patient treatment); infected (hospital admission); infected (ICU admission); healthy (flu recovery) and dead. Four scenarios were modelled. The Mild and Severe Pandemic Scenarios were then applied to estimations of current hospital and ICU bed spare capacity in each province to provide a prediction of the impact of a pandemic on hospital capacity. The Mild Pandemic Scenario, based on the 1957 and 1968 pandemics, showed a 9.1% total infection rate and a 0.13% mortality rate. Hospital bed capacity is stretched close to capacity, but does not exceed capacity in any province. ICU bed capacity is exceeded for all provinces during the peak of the pandemic (3-7 weeks). The Severe Pandemic Scenario, based on the 1918 pandemic, had a 22% total infection rate with a 2.5% mortality rate. Hospital and ICU bed capacities were exceeded in all provinces for much of the pandemic. / Dissertation (MBA)--University of Pretoria, 2010. / Gordon Institute of Business Science (GIBS) / unrestricted

No description available.

Healthcare is of critical importance in maintaining people’s health and wellness. It has attracted policy makers, researchers, and practitioners around the world to .nd better ways to improve the performance of healthcare services. One of the key indicators for assessing that performance is to show how accessible and timely the services will be to speci.c groups of people in distinct geographic locations and in di.erent seasons, which is commonly re.ected in the so-called wait times of services. Wait times involve multiple related impact factors, called predictors, such as demographic characteristics, service capacities, and human behaviors. Some impact factors, especially individuals’ behaviors, may have mutual interactions, which can lead to tempo-spatial patterns in wait times at a systems level. The goal of this thesis is to gain a systematic understanding of healthcare services by investigating the causes and corresponding dynamics of wait times. This thesis presents a data-driven complex systems modeling approach to investigating the causes of tempo-spatial patterns in wait times from a self-organizing perspective. As the predictors of wait times may have direct, indirect, and/or moderating e.ects, referred to as complex e.ects, a Structural Equation Modeling (SEM)-based analysis method is proposed to discover the complex e.ects from aggregated data. Existing regression-based analysis techniques are only able to reveal pairwise relationships between observed variables, whereas this method allows us to explore the complex e.ects of observed and/or unobserved(latent) predictors on waittimes simultaneously. This thesis then considers how to estimate the variations in wait times with respect to changes in speci.c predictors and their revealed complex e.ects. An integrated projection method using the SEM-based analysis, projection, and a queuing model analysis is developed. Unlike existing studies that either make projections based primarily on pairwise relationships between variables, or queuing model-based discrete event simulations, the proposed method enables us to make a more comprehensive estimate by taking into account the complex e.ects exerted by multiple observed and latent predictors, and thus gain insights into the variations in the estimated wait times over time. This thesis further presents a method for designing and evaluating service management strategies to improve wait times, which are determined by service management behaviors. Our proposed strategy for allocating time blocks in operating rooms (ORs) incorporates historical feedback information about ORs and can adapt to the unpredictable changes in patient arrivals and hence shorten wait times. Existing time block allocations are somewhat ad hoc and are based primarily on the allocations in previous years, and thus result in ine.cient use of service resources. Finally, this thesis proposes a behavior-based autonomy-oriented modeling method for modeling and characterizing the emergent tempo-spatial patterns at a systems level by taking into account the underlying individuals’ behaviors with respect to various impact factors. This method uses multi-agent Autonomy-Oriented Computing (AOC), a computational modeling and problem-solving paradigm with a special focus on addressing the issues of self-organization and interactivity, to model heterogeneous individuals (entities), autonomous behaviors, and the mutual interactions between entities and certain impact factors. The proposed method therefore eliminates to a large extent the strong assumptions that are used to de.ne the stochastic properties of patient arrivalsand servicesinstochasticmodeling methods(e.g.,thequeuing model and discrete event simulation), and those of .xed relationships between entities that are held by system dynamics methods. The method is also more practical than agent-based modeling (ABM) for discovering the underlying mechanisms for emergent patterns, as AOC provides a general principle for explicitly stating what fundamental behaviors of and interactions between entities should be modeled. To demonstrate the e.ectiveness of the proposed systematic approach to understanding the dynamics and relevant patterns of wait times in speci.c healthcare service systems, we conduct a series of studies focusing on the cardiac care services in Ontario, Canada. Based on aggregated data that describe the services from 2004 to 2007, we use the SEM-based analysis method to (1) investigate the direct and moderating e.ects that speci.c demand factors, in terms of certaingeodemographicpro.les, exert onpatient arrivals, whichindirectly a.ect wait times; and (2) examine the e.ects of these factors (e.g., patient arrivals, physician supply, OR capacity, and wait times) on the wait times in subsequent units in a hospital. We present the e.ectiveness of integrated projection in estimating the regional changes in service utilization and wait times in cardiac surgery services in 2010-2011. We propose an adaptive OR time block allocation strategy and evaluate its performance based on a queuing model derived from the general perioperative practice. Finally, we demonstrate how to use the behavior-based autonomy-oriented modeling method to model and simulate the cardiac care system. We .nd that patients’ hospital selection behavior, hospitals’ service adjusting behavior, and their interactions via wait times may account for the emergent tempo-spatial patterns that are observed in the real-world cardiac care system. In summary, this thesis emphasizes the development of a data-driven complex systems modeling approach for understanding wait time dynamics in a healthcare service system. This approach will provide policy makers, researchers, and practitioners with a practically useful method for estimating the changes in wait times in various “what-if” scenarios, and will support the design and evaluation of resource allocation strategies for better wait times management. By addressing the problem of characterizing emergenttempo-spatial waittimepatternsinthe cardiac care system from a self-organizing perspective, we have provided a potentially e.ective means for investigating various self-organized patterns in complex healthcare systems. Keywords: Complex Healthcare Service Systems, Wait Times, Data-Driven Complex Systems Modeling, Autonomy-Oriented Computing(AOC), Cardiac Care

No description available.

No description available.

No description available.

Background: Glaucoma is a chronic, progressive eye disease and the second cause of blindness in the world. To measure the patients’ perspective in randomised controlled trials (RCTs), patient-reported outcome measures (PROMs) are increasingly being used. However, the use of PROMs in glaucoma trials is low suggesting there may be a reluctance to use PROMs. Objectives: To explore three methodological challenges of using PROMs in RCTs in glaucoma: 1) PROM selection; 2) characterising glaucoma severity; and 3) interpreting PROM scores in terms of minimal important difference (MID). Methods: Vision PROMs used in glaucoma studies were identified and content validated using a systematic review approach and categorised by a new PROM taxonomy. Existing visual field staging systems (VFSSs) based on standard automated perimetry were systematically identified and quality assessed with a new tool developed for this review using a consensus method. The performance of four high quality visual field staging systems were evaluated and referenced against an experienced ophthalmologist in a diagnostic test accuracy study. A pilot study using the social comparison approach was undertaken to test the feasibility of an anchor-based approach in determining the MID of a vision PROM in a glaucoma population. Results: Thirty-three vision PROMs were identified and categorised, according to content into impairment, disability, status and satisfaction measures. Twenty-three VFSSs were identified but evaluation of quality assessment, particularly performance, was affected by poor VFSS reporting. The diagnostic accuracy study demonstrated suboptimal performance of the four highest quality staging systems. The pilot study to determine the MID for a vision PROM found the social comparison method to be a feasible approach in a glaucoma population. Conclusion: This thesis demonstrated how to select a PROM and identified difficulties with characterising glaucoma severity. Future research needs include development of robust methods for characterising glaucoma severity and full scale evaluation of MIDs in PROMs in glaucoma.

The present research, consisting of two studies, was designed to examine the primary health care experiences of gay men in Australia and assess doctors? attitudes and training with regard to gay men and their health care. In the first study, 195 gay men were surveyed regarding their health issues and their primary health care experiences. The most important health concerns of gay men were stress and depression followed by HIV/AIDS, body image disorder and other sexually transmissible infections. Including those participants who were unsure, approximately one-half reported experiencing homophobia and almost one?quarter reported experiencing discrimination in the provision of health care. Despite this, respondents were generally satisfied with their primary health care, although respondents felt that all GPs should receive additional undergraduate medical education regarding gay men?s health. In the second study, 25 doctors (13 gay specialists and 12 non-gay specialists) were surveyed regarding their knowledge of gay men?s health and their comfort working with gay men. Non-gay specialist GPs were less comfortable treating gay men, reported poorer communication and were more homophobic than their gay specialist counterparts. Further, doctors perceived their medical education regarding gay men?s health has been inadequate. Together, the results of the two current studies suggest that disclosure of sexuality is an important issue for both gay men and doctors, and has the potential to impact on the quality of health care that gay men receive. In order to improve the level of disclosure, the pervasiveness of homophobia and discrimination in primary health care must be reduced. Finally, the results indicate that medical education must be updated to reflect current knowledge regarding the health issues of gay men. Failure to address these issues will condemn gay men to continued health inequality.

Cultural competence is a topic that concerns social scientists and medical anthropologists who pay attention to demographic changes and health disparities. This study demonstrates practical approaches to developing cultural competence in medical education by using factors from the social environment to develop protocols for action. With current concerns in domestic and global health care, it is evident that health care organizations struggle to deliver culturally appropriate services. Additionally, educational institutions also struggle to evaluate culturally applied medical practices and competencies. Unlike medical competence, cultural competence is seldom evaluated, and as a result, a gap exists in health care delivery. The purpose of this research is to examine the changes in self-assessment of physician assistant (PA) medical students and graduates, as indications of changes in their medical practice and attitudes. Key objectives explore how PA medical students self-assess their own cultural competence; what factors impact their evaluation, and if change indicates cultural competence. The methodology consisted of a qualitative approach designed to conduct focus group discussions, in-depth interviews, and field work, while results of existing quantitative data was used to inform the study. Triangulation methods substantiated the findings along with environmental and data analysis to provide rigor to this investigation. Participants were students and graduates from a Physician Assistant Studies Program in Oregon. Major findings showed changes in participants' cultural competence self assessment due to a change in self-awareness, exposure and experiences with diverse underserved populations, in domestic and international encounters with the real world. In conclusion, change in self assessment had actually occurred, but the change in the quantitative results really portrayed a level of development on a cultural competency continuum, but not cultural competence itself. It followed from these findings that using components which influenced change along with external and internal environmental factors, provided a basis for a model to establish procedures for action. This strategic model, the praxis of cultural competence, takes critical elements or protocols to move medical students from theory to practice. From the results of this study we can see evidence of closing the gap between the theory of cultural competence and culturally competent practices. / Graduation date: 2005

Univ., Diss.--Perpignan, 2003.