No description available.

The Medicare Participating Physician Program was enacted in 1984 in an effort to increase physician assignment of Medicare claims, and thereby reduce beneficiary out of-pocket expenses. The program offers the physician the security of near-certain payment on all claims, although at rates that are in many cases, at levels substantially, less than actual physician fees. This paper examines the economic factors that influence the physician's decision on participation. Physicians of the Medical Society of Prince William County, Virginia, were surveyed for information relevant to making the participation decision and the responses tabulated and used as input to a regression equation estimated using the logit technique. Physicians are more likely to participate the higher the relative price received for participating and the lower the probability of payment by Medicare-eligible patients. Additionally, salaried physicians are more likely to partiCipate than those who are self-employed. / Master of Arts

This study investigated the influence of nutrition education services, measured by duration of participation and frequency of nutrition counseling, on maternal nutritional performance, and pregnancy outcome, in 100 pregnant teenagers enrolled in the WIC program in North Carolina. Data on prenatal weight gain, rate of weekly weight gain, gestational duration and birth weight of infants born to these teenagers was retrieved from medical records. Twenty-four hour recalls, conducted before and after counseling, were analyzed. for energy and nutrient content. Results indicated that initiation of prenatal care by trimester was earlier, and duration of participation was longer, than was reported in the literature. Mean weight gain and gestational lengths were found to be comparable to results from studies on similar populations. Rate of weekly gain was significantly higher than that recommended for adult pregnant women. Energy, protein and iron intakes showed significant improvement after counseling, and, were comparable to RDA values. However, calcium intake was found to be significantly lower than the RDA. Mean infant birth weight was found to be 47.2 gm heavier than the state average; this was not statistically significant. Although a strong correlation. between counseling and. pregnancy outcome was not evident, the incidence of low birth weight was substantially lower in this population, especially among the subgroup of black infants. A decreased incidence of poor outcome of pregnancy among underweight gravidas, was also indicative of the influence of nutrition education on this high risk group. Nutrition intervention appears to have been indirectly influential in optimizing fetal outcome through improved maternal weight gain, and an extended gestation. In addition, early and appropriate prenatal care measures, probably helped reduce the race specific, risk differential for adverse outcomes. The results from this study also indicated that a very small percentage of teens chose to breast feed. Further studies are, however, recommended to identify predictors of the feeding choice, to help increase incidence of breast feeding among teens. / Master of Science

The Chinese health care system is presented in this thesis. In the past ten years, the Chinese health care system has drawn the attention of interested people. However, most studies explored the system in limited aspects. They do not take into account the Chinese health care system as a whole. This thesis aims at describing the health care system as a whole through examining its external and internal environments. The external environment includes the factors of history, culture, politics, economy and demography, which has influenced and shaped the development of the health care system in China. The internal environment is considered as the aspects which are directly related to the purposes of public health. Six selected aspects with regard to the internal environment of the health care system are discussed and analyzed. They are health care administration, medical education, health care delivery, health insurance, health costs and public health. Through exploring and examining the system, this thesis seeks to answer the three main questions: how did the health care system work?, what were the effects of health care on the public?, and how did the health system use limited money to provide effective health care?. Many information data published by the Chinese government and other literatures are also presented to help answer these questions. / Master of Science

No description available.

Most Americans will die in a hospital or skilled care facility. Despire diligent efforts by local citizens groups, state and national foundations, and healthcare providers to inform the public about their legal rights, only 15% of patients have advanced directives in the form of a living will or health care proxy (Haynor, 1998). Advanced directives that are available are often out-dated, ambiguous, incomplete, unacknowledged, or disregarded by both healthcare providers and family members. An educational program was offered to the residents of a low-income senior housing complex to introduce the "Five Wishes" advanced directive developed by the Commission on Aging with Dignity. The program involved informing the participants about advanced directives, identifying communication strategies for the participants when talking with their physician and family about their wishes, encouraging and assisting participants to complete an advanced directive, and identifying ways to distribute their completed directive. The program was attended voluntarily by thirty-two residents. Results of the anonymous program evaluations revealed the program provided good information about advanced directives, that the information was useful, and that the participants felt more knowledgeable about advanced planning. The majority of participants stated they felt comfortable discussing their wishes with their physician and family, and most wished to complete an advanced directive. Nurse practitioners are in a unique position to provide education, support, and guidance for patients regarding advanced directives. Advanced care planning should be an integral part of the patient's health care. The longitudinal relationships formed through continued health care provision give primary care practitioners the opportunity to help patients remain in control of their care throughout their lives and to keep the patients informed of changes in self-determined healthcare laws and health policies.

No description available.

The purpose of this integrative literature review was to provide a compilation and review of literature related to perinatal outcomes of clients with antepartum or intrapartum oligohydramnios and management decisions applied to these clients. This paper is intended to synthesize and summarize the most current knowledge retrieved in these topics between the years of 1990- 2000. A general search using key terms was conducted, and yielded 63 prospective articles comprised of full articles, abstracts, and literature reviews. Seventeen articles on oligohydramnios, amniotic fluid volume measurements, and perinatal outcomes were retained out of the 35 that were found. The search for the literature discussing management of oligohydramnios produced 9 articles, of which 3 were found to be pertinent to this project. Twelve of the total 39 articles retained were literature reviews and were used for citation and identification of additional information material to this topic. Seven of the 39 articles were retained for the sole purpose of enabling the author to provide a descriptive, thorough review on the relevant concepts of this review. Studies reviewing amniotic fluid volume/oligohydramnios and perinatal outcomes suggest great variance among likelihood of adverse perinatal outcomes. Studies reviewing management of oligohydramnios suggest amnioinfusion may have obstetrical and perinatal benefits for the client with oligohydramnios. Aggressive management including indication for cesarean section related to fetal distress and labor induction were implied with minimal discussion on conservative management for these clients.

This investigation concerns the problem of current health care utilization by aged blacks. Utilizing Andersen's model, the volume and pattern of physician utilization associated with selected predisposing, enabling, and need variables is described for an aged population of 163 interviewed blacks residing in Census Tract 212, Denton, Texas, in 1972. None of the six socio-demographic, economic, or health status variables analyzed, through use of Somers' dyx, allowed substantial reduction .of error in predicting a physician visit in the past year. Representing need, selfrated health status was the best predictor variable. Its proportional reduction in error increased from 17 percent to 30 percent, for those with five to seven years education, and to 23 percent, for those reporting the least income.

Thesis (Ph.D.)--University of the Witwatersrand, Faculty of Commerce, Law and Management, School of Economic & Business Sciences, November 2016 / Community Health Workers or “CHWs” are often the only link to healthcare for millions of people in the developing world. They are the first point of contact with the formal care system, and represent the most immediate and cost effective way to save lives and improve healthcare outcomes in low-resource contexts. Mobile-health or ‘mHealth’ technologies may have potential to support CHWs at the point-of-care and enhance their performance. Yet, there is a gap in substantive empirical evidence on whether the use of mHealth tools enhances CHW performance, and how their use contributes to enhanced healthcare service delivery, especially in low-resource communities. This is a problem because a lack of such evidence would pose an obstacle to the effective large-scale implementation of mHealth-enabled CHW projects in low-resource settings. This thesis was motivated to address this problem in the Kenyan community health worker context. First, it compared the performance of CHWs using mHealth tools to those using traditional paper-based systems. Second, it developed and tested a replicable Technology-to-Performance Chain (TPC) model linking a set of CHW task and mHealth tool characteristics, to use and user performance outcomes, through four perspectives of Task-Technology Fit (TTF), namely Matching, Moderation, Mediation, and Covariation. A quasi-experimental post-test only research design was adopted to compare performance of CHWs using an mHealth tool to those using traditional paper-based systems. A primary structured questionnaire survey instrument was used to collect data from CHWs operating in the counties of Siaya, Nandi, and Kilifi, who were using an mHealth tool to perform their tasks (n = 257), and from CHWs operating in the counties of Nairobi and Nakuru using traditional paper-based systems to perform their tasks (n = 353). Results showed that CHWs using mHealth tools outperform their counterparts using paper-based systems, as they were observed to spend much less time completing their monitoring, prevention, and referral reports weekly, and report higher percentages of both timeous and complete monthly cases. In addition, mHealth tool users were found to have more positive perceptions of the effects of the technology on their performance, compared to those using traditional paper-based systems. An explanatory, predictive, research design was adopted to empirically assess the effects of a ‘fit’ between the CHW task and mHealth technology (TTF) on use of the mHealth technology and on CHW user performance. TTF was tested from the Matching, Moderation, Mediation, and Covariation ‘fit’ perspectives using the cross-sectional survey data collected from the mHealth tool users (n = 257). Results revealed that there are various unique ways in which a ‘fit’ between the task and technology can have significant impacts on use and user performance. Specifically, results showed that the paired-match of time criticality task and technology characteristics impacts use, while that of time criticality and information dependency task and technology characteristics impacts user performance. Results also showed that the cross-product interaction of mobility task and interdependence technology characteristics impacts use, and that of mobility task and interdependence and information dependency technology characteristics, impacts user performance. Similarly, the cross-product interaction of information dependency task and time criticality technology characteristics impacts user performance. Moreover, results showed that a perceived ‘fit’ between CHW task and mHealth technology characteristics partially and fully mediates the effects of user needs and tool functions on use and user performance, whereas ‘fit’ as an observed pattern of holistic configuration among these task and technology characteristics impacts use and user performance. It was also found that the perfect ‘fit’ between CHW task and mHealth tool technology characteristics leads to the highest levels of use and user performance, while a misfit leads to a decline in use and user performance. Notably, an over-fit of mHealth technology support to the CHW task leads to declining use levels, while an under-fit leads to diminishing user performance. Of the four ‘fit’ perspectives tested, the matching and cross-product interaction of task and technology characteristics offer the most dynamic insights into use and user performance impacts, whereas user-perception and holistic configuration, were also shown to be significant, thus further reinforcing these effects. Tests of a full TPC model revealed that greater mHealth tool use had a positive effect on the effectiveness, efficiency, and quality of CHW performance in the delivery of patient care. Moreover, it was found that ‘facilitating conditions’ and ‘affect toward use’ had positive effects on mHealth tool use. Furthermore, a perceptual TTF was found to have positive effects on mHealth tool use and CHW performance. Of note, this perceived TTF construct was found to be simultaneously a stronger predictor of mHealth tool use than ‘facilitating conditions’ and ‘affect toward use’, and a stronger predictor of CHW performance than mHealth tool use. Consequently, TTF was confirmed as the central construct of the TPC. The findings constitute significant empirical insights into the use of mHealth tools amongst CHWs in low resource settings and the extent to which mHealth contributes to the enhancement of their overall performance in the capture, storage, transmission, and retrieval, of health data as part of their typical workflows. This study has provided much needed evidence of the importance of a ‘fit’ between CHW task and mHealth technology characteristics for enabling mHealth impacts on CHW performance. The study also shows how these inter-linkages could improve the use of mHealth tools and the performance of CHWs in their delivery of healthcare services in low-resource settings, within the Kenyan context. Findings can inform the design of mHealth tools to render more adequate support functions for the most critical CHW user task needs in a developing world context. This study has contributed to the empowerment of CHWs at the point-of-care using mHealth technology-enabled service delivery in low-resource settings, and contributes to the proper and successful ‘scaling-up’ of implemented mHealth projects in the developing world. / MT 2018