Hong Kong's aging population has, increased demand for vascular services. Currently, vascular surgery is subsumed under general surgery. The workload on both general surgery and vascular surgery is demanding and hence, not conductive to the development of vascular surgery. The volume of surgery, particularly emergency surgery provided by the Hospital Authority units varies significantly. The collaboration and differentiation of labor at present is not well defined in many centers. This may lead to unnecessary competition and duplication of resources in the long run. This project examined if there is room for improvement in the present situation and provides evidence for relevant service reconfiguration and discusses how Hong Kong can learn from some overseas examples to enhance quality of services delivered to patients. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Community Medicine / Master / Master of Public Health

Recent federal legislation has incentivized hospitals to focus on quality of patient care. A primary metric of care quality is patient readmissions. Many methods exist to statistically identify patients most likely to require hospital readmission. Correct identification of high-risk patients allows hospitals to intelligently utilize limited resources in mitigating hospital readmissions. However, these methods have seen little practical adoption in the clinical setting. This research attempts to identify the many open research questions that have impeded widespread adoption of predictive hospital readmission systems. Current systems often rely on structured data extracted from health records systems. This data can be expensive and time consuming to extract. Unstructured clinical notes are agnostic to the underlying records system and would decouple the predictive analytics system from the underlying records system. However, additional concerns in clinical natural language processing must be addressed before such a system can be implemented. Current systems often perform poorly using standard statistical measures. Misclassification cost of patient readmissions has yet to be addressed and there currently exists a gap between current readmission system evaluation metrics and those most appropriate in the clinical setting. Additionally, data availability for localized model creation has yet to be addressed by the research community. Large research hospitals may have sufficient data to build models, but many others do not. Simply combining data from many hospitals often results in a model which performs worse than using data from a single hospital. Current systems often produce a binary readmission classification. However, patients are often readmitted for differing reasons than index admission. There exists little research into predicting primary cause of readmission. Furthermore, co-occurring evidence discovery of clinical terms with primary diagnosis has seen only simplistic methods applied. This research addresses these concerns to increase adoption of predictive hospital readmission systems. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

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

Includes one computer disk in Work 6 format. / System requirements for accompanying computer disk: Mackintosh or IBM-compatible computer. Other requirments: Microsoft Word 6 or compatible Word Processor. / Bibliography: leaves 241-270. / xiii, 270, [47] leaves ; 30 cm. + 1 computer disk (3 1/2 in.) / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Graduate School of Management, 1999

M.Cur. / Quality health service delivery is a necessity in any health care service and is the responsibility of the management, but it is often not accomplished due to a variety of reasons. The most important determinant is the personnel of the health care service and their level of motivation to provide quality service. The aim of this study was the describing of motivation guidelines for the delivery of quality health service. The study was qualitative and contextual. The research strategy was explorative and descriptive. The study is based on the Botes research model and the Nursing Theory of Wholeness. Several measurements were taken to increase credibility. It is regarded as a prerequisite to explore, describe and implement a quality improvement programme for the specific health service, before motivation guidelines could be described for quality health service delivery. The quality improvement programme was based on literature, with recognition of the context of the health service. The determinants of quality health service delivery were discussed as well as the aim, reasons, prerequisites, contents and principles of the quality improvement programme and the quality improvement process. The realisation of the quality improvement programme was also discussed. The exploring, description and implementation of the quality improvement programme in the health care service is followed by the exploring and describing of factors which motivate and/or demotivate personnel to deliver quality health care service, by means of naive sketches obtained from open questionnaires of two samples. It was verified for accuracy during a feedback interview. The results are used to describe motivation guidelines which is confirmed by literature.

The relationship between Public Administration and the people is one that requires legitimacy and compromise in order to solve complex problems. Individuals with intellectual and developmental disabilities (IDD) and their families during the last fifty years have put forth an agenda that calls for the advancement of rights for the disabled and more integration into the larger society. In this arena, government, with post civil rights legislation like the 1990 Americans with Disabilities Act (ADA), plays a huge role in promoting social awareness and bringing down barriers of stigmatization, understanding, and access. This struggle is fought on many fronts. A significant part of the effort focuses on moving the locus of long-term care of the disabled, including the IDD population, from an institutional setting to the least restrictive setting that will foster social ties and integration. Since the early 1980s as part of this effort to deinstitutionalize the disabled, legislation at both the federal and state level has supported and incentivized the creation of Home and Community Based Service (HCBS) programs. HCBS waivers, as they are typically called, are also promoted as a means of containing government expenditures for long-term care. However, the effectiveness of these waivers is poorly understood. The critical questions being - Do HCBS waivers promote and create an environment that increases awareness of the needs of IDD individuals? Do the programs help reduce stigmatization, promote understanding, and increase access to services and activities that foster social interaction? Or, do HCBS waivers create a new "iron cage" where the intellectually or developmentally disabled are once again relegated to existing as second class citizens? In this research, programs are mapped and then evaluated to paint a better picture of how HCBS waivers change long-term care. / This research combines qualitative and quantitative approaches to triangulate on these phenoamea as a means to investigate when and how HCBS waiver programs facilitate, promote, or stifle the social integration of those with IDD. How does social integration manifest itself in the quality long-term care of those who often cannot take care of themselves? / by Enrique M. Perez. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

In order to improve the quality of care, there is urgent need to involve patients in their own healthcare. So to make patient centered health care system Personal Health Records are proposed as viable solution. This research discusses the importance of a Patient Centric Health Record system. Such systems can empower patients to participate in improving health care quality. It would also provide an economically viable solution to the need for better healthcare without escalating costs by avoiding duplication. The proposed system is Web-based; therefore it has high accessibility and availability. The cloud computing based architecture is used which will allow consumers to address the challenge of sharing medical data. PHR would provide a complete and accurate summary of the health and medical history of an individual by gathering data from many sources. This would make information accessible online to anyone who has the necessary electronic credentials to view the information. / by Vishesh Ved. / Thesis (M.S.C.S.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

Background: A global cervical cancer health disparity persists despite the demonstrated success of primary and secondary preventive strategies, such as cervical visual inspection (VI). Cervical cancer is the leading cause of cancer incidence and death for women in many low resource areas. The greatest risk is for those who are unable or unwilling to access screening. Barriers include healthcare personnel shortages, cost, transportation, and mistrust of healthcare providers and systems. Using community health workers (CHWs) may overcome these barriers, increase facilitators, and improve participation in screening for women in remote areas with limited access to clinical resources. Aim: To determine whether the accuracy of VI performed by CHWs was comparable to VI by physicians or nurses and to consider the affect components of provider training had on VI accuracy. Methods: A systematic review and quantitative meta-analysis of published literature reporting on VI accuracy, provider type, and training was conducted. Strict inclusion/exclusion criteria, study quality, and publication bias assessments improved rigor and bivariate linear mixed modeling (BLMM) was used to determine the affect of predictors on accuracy. Unconditional and conditional BLMMs, controlling for VI technique, provider type, community, clinical setting, HIV status, and gynecological symptoms were considered. Results: Provider type was a significant predictor of sensitivity (p=.048) in the unconditional VI model. VI performed by CHWs was 15% more sensitive than physicians (p=.014). Provider type was not a significant predictor of accuracy in any other models. Didactic and mentored hours predicted sensitivity in both BLMMs. Quality assurance and use of a training manual predicted specificity in unconditional BLMMs, but was not significant in conditional models. Number of training days, with ≤5 being optimal, predicted sensitivity in both BLMMs and specificity in the unconditional model. Conclusion: Study results suggest that community based cervical cancer screening with VI conducted by CHWs can be as, if not more, accurate than VI performed by licensed providers. Locally based screening programs could increase access to screening for women in remote areas. Collaborative partnerships in “pragmatic solidarity” between healthcare systems, CHWs, and the community could promote participation in screening resulting in decreased cervical cancer incidence and mortality. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

The extent to which customers are satified with the care they receive from the health professionals has been an important area of interest for researchers, managers and health care workers. The physiotherapy cerebral palsy clinic at Mulago Hospital in Kampala Uganda provides physiotherapy services for parents/caregivers of children with cerebral palsy. The parents/caregivers visit the clinic seeking physiotherapy services that will address their problems and those of the child. The purpose of this study was to explore the satisfaction that the parents/caregivers of children with cerebral palsy get from utilising the physiotherapy services at the clinic and to identify the barriers/problems that they encounter that might affect their attendance.