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191	Use of Opioids for Pain Management in Nursing Homes: A Dissertation Pimentel, Camilla B. 06 April 2015 (has links) Nursing homes are an essential yet understudied provider of cancer-related care for those with complex health needs. Nine percent of nursing home residents have a cancer diagnosis at admission, and it is estimated that one-third of them experience pain on a daily basis. Although pain management is an essential component of disease treatment, few studies have evaluated analgesic medication use among adults with cancer in this setting. Use of opioids, which are the mainstay of pain management in older adults because of their effectiveness in controlling moderate to severe pain, may be significantly related to coverage by the Medicare Part D prescription drug benefit. However, little is known about Medicare Part D’s effects on opioid use in this patient population. A limited body of evidence also suggests that despite known risks of overdose and respiratory depression in opioid-naïve patients treated with long-acting opioids, use of these agents may be common in nursing homes. This dissertation examined access to appropriate and effective pain-related health care services among US nursing home residents, with a special focus on those with cancer. Objectives of this dissertation were to: 1) estimate the prevalence, and identify resident-level correlates, of pain and receipt of analgesic medications; 2) use a quasi-experimental research design to examine the relationship between implementation of Medicare Part D and changes in the use of fentanyl patches and other opioids; and 3) to estimate the prevalence, and identify resident-level correlates, of naïve initiation of long-acting opioids. Data on residents’ health status from the Resident Assessment Instrument/Minimum Data Set (versions 2.0 and 3.0) were linked with prescription drug transaction data from a nationwide long-term care pharmacy (January 2005–June 2007) and the Centers for Medicare and Medicaid Services (January–December 2011). From 2006 to 2007, more than 65% of residents of nursing homes throughout the US with cancer experienced pain (28.3% on a daily basis), among whom 13.5% reported severe pain. More than 17% of these residents who experienced daily pain received no analgesics (95% confidence interval [CI]: 16.0–19.1%), and treatment was negatively associated among those with advanced age, cognitive impairment, feeding tubes, and restraints. These findings coincided with changing patterns in opioid use among residents with cancer, including relatively abrupt 10% and 21% decreases in use of fentanyl patches and other strong opioids, respectively, after the 2006 implementation of Medicare Part D. In the years since Medicare Part D was introduced, some treatment practices in nursing homes have not been concordant with clinical guidelines for pain management among older adults. Among a contemporary population of long-stay nursing home residents with and without cancer, 10.0% (95% CI: 9.4–10.6%) of those who began receiving a long-acting opioid after nursing home admission had not previously received opioid therapy. Odds of naïve initiation of these potent opioids were increased among residents with terminal prognosis, functional impairment, feeding tubes, and cancer. This dissertation provides new evidence on pharmaceutical management of pain and on Medicare Part D’s impact on opioid use in nursing home residents. Results from this dissertation shed light on nursing home residents’ access to pain-related health care services and provide initial directions for targeted efforts to improve the quality of pain treatment in nursing homes. Opioid Analgesics Medicare Part D Neoplasms Nursing Homes Pain Pain Management Dissertations, UMMS Analgesics, Opioid Anesthesia and Analgesia Geriatrics Health Services Administration Neoplasms Oncology Pain Management Palliative Care Pharmaceutical Preparations
192	Use of various health care providers and the associated clinical and humanistic outcomes in an ambulatory Medicare population Mai, Yvonne M. 01 January 2016 (has links) Background: The use of complementary and alternative medicine (CAM) and other non-physician health care providers (dentists, optometrists, etc.) has steadily increased in the United States; however, the associated outcomes reported in the Medicare beneficiary population are limited. Objective: To evaluate the utilization of different healthcare providers by Medicare beneficiaries and assess resultant beneficiary outcomes. Methods: Fourteen outreach events targeting Medicare beneficiaries were conducted throughout Northern/Central California during the 2014 open enrollment period. Trained student pharmacists (working under licensed pharmacist supervision) provided beneficiaries with comprehensive medication therapy management (MTM) services. During each intervention, demographic, quality-of-life, health behavior and health provider/service utilization data were collected. Results: Of 620 respondents, 525 (84%) and 84 (14%) reported using at least one non-physician healthcare professional or CAM provider, respectively. Beneficiaries who reported using non-physician healthcare providers were significantly (p < 0.05) more likely to indicate being ‘very confident’ in managing their chronic health conditions. The number of providers seen with prescriptive authority was positively correlated with the number of prescription medications taken (r s =0.342, p < 0.001). The total number of providers seen was positively correlated with the number of drug-related issues identified (r s = 0.179, p < 0.001). Conclusion: Many beneficiaries have multiple chronic conditions and increasingly utilize a variety of healthcare professionals. As such, bridging the communication chasm between these professionals can improve humanistic outcomes and minimize medication related issues of Medicare beneficiaries. Coordinated care, a key strategy for improving healthcare delivery under the Affordable Care Act, is a step in the right direction. Pharmacy sciences Health education Health and environmental sciences Education Health outcomes Medicare Medication therapy management Chemicals and Drugs Chemistry Medical Pharmacology Medicinal-Pharmaceutical Chemistry Medicine and Health Sciences Pharmaceutical Preparations Pharmacy and Pharmaceutical Sciences Physical Sciences and Mathematics
193	Incidence and Treatment of Brain Metastases Arising from Lung, Breast, or Skin Cancers: Real-World Evidence from Primary Cancer Registries and Medicare Claims Ascha, Mustafa Steven 23 May 2019 (has links) No description available. Oncology Epidemiology Biostatistics Health Sciences Medicine Neurology brain metastases cancer oncology real-world evidence SEER Medicare claims reproducibility epidemiology biostatistics lung cancer breast cancer melanoma
194	The nursing home five star rating: How does it compare to resident and family views of care? Williams, Anthony R. 18 October 2012 (has links) No description available. Aging Health Care Public Policy Long-Term Care LTC Nursing Home Quality Domains Quality Ratings Quality Nursing Home Compare NHC Star Ratings CMS Resident Satisfaction Family Satisfaction Consumer Satisfaction Consumer Guide Ohio
195	Navigating the Health Care Labyrinth: Portraits of the Socioeconomically Disadvantaged Crawford, Thomas C. 05 February 2014 (has links) No description available. Health Care Health Care Management health care access commercial insurance discrimination emergency department disparities labyrinth outcomes socioeconomic status social class uninsured underinsured portraiture phenomenology
196	Home Parenteral Nutrition and the Individual and Family Self-Management Theory Napoleon, Betty J. 03 June 2015 (has links) No description available. Nursing Nutrition
197	Πολιτικές για τη σχολική υγιεινή στην ελληνική εκπαίδευση (1911 – 1949). Μια ιστορικο-συγκριτική προσέγγιση Λεβεντάκης, Χαράλαμπος 27 December 2010 (has links) Η πραγματοποίηση αυτής της μελέτης έγινε με σκοπό να διερευνήσει τις θεσμικές ρυθμίσεις, τις διαδικασίες και τους τρόπους με τους οποίους σχεδιάσθηκε, συγκροτήθηκε, οργανώθηκε και ασκήθηκε η εκπαιδευτική πολιτική για την Σχολική Υγιεινή στη χώρα μας κατά την περίοδο 1911 - 1949. Η εργασία εστιάζεται στη συγκέντρωση, αξιολόγηση και θεματολογική ταξινόμηση του πρωτογενούς υλικού με την μέθοδο της ιστορικής έρευνας (ιστορικοσυγκριτική ανάλυση: Καζαμίας, 2002) με στόχο την κατανόηση με φαντασία (Carr, 1983) και την ερμηνεία των ιστορικών τεκμηρίων (ιστορική ερμηνευτική προσέγγιση: Πυργιωτάκης, Ι. & Παπαδάκης, Ν., 1998). Με την ενδελεχή διερεύνηση των ιστορικών μας τεκμηρίων επιχειρούμε την ανασύνθεση της ιστορικής πραγματικότητας, αλλά και την ανάλυση και ερμηνεία των γεγονότων σε μια χρονική περίοδο (1911-1949) που καλύπτει την περίοδο, όπου παρατηρούνται οι σημαντικότερες πολιτικές κοινωνικής πρόνοιας και αντίληψης στο χώρο της σχολικής υγιεινής. Η δική μας, επομένως προσέγγιση δεν είναι γεγονοτογραφική (Δημαράς, 1988), δε μένει στο τι έγινε αλλά επιχειρεί και απαντήσεις στα γιατί; Ερμηνεύει (ερμηνεύουσα ιστορία: Δερτιλής, 1995) στηριγμένη σε θεωρητικές προσεγγίσεις περί Κράτους Πρόνοιας και Νέας Αγωγής. Χρησιμοποιώντας την ποιοτική ανάλυση περιεχομένου (Berelson, 1952), εξετάσαμε τις διαφοροποιήσεις που υπήρξαν για τη θεσμική εξέλιξή της στις χρονικές περιόδους – τομές και για τις εξής παραμέτρους – κατηγορίες ανάλυσης: την υγιεινή των διδακτηρίων, του μαθητή, των διδασκόντων, την σχολιατρική υπηρεσία και τον σχολιατρικό έλεγχο, τα μέτρα σχολικής μέριμνας που ελήφθησαν από το κράτος με ιδιαίτερες αναφορές στα μαθητικά – σχολικά συσσίτια καθώς και στην δημιουργία θεσμών ευρύτερης κοινωνικής αντίληψης όπως: οι παιδικές εξοχές – μαθητικές κατασκηνώσεις, τα υπαίθρια σχολεία, τα σχολικά λουτρά, τα μαθητικά ιατρεία – σχολικές κλινικές και τα κέντρα μαθητικής αντίληψης. Επίσης, τη διδασκαλία του μαθήματος της υγιεινής και τέλος, την εκλαΐκευση και τα περιοδικά σχολικής υγιεινής, ξεκινώντας από τις δύο βενιζελικές περιόδους, προχωρώντας στη μεταξική περίοδο και συνεχίζοντας στη μεταπολεμική περίοδο μέχρι και το 1949. Ιστορικοί, πολιτικοί, οικονομικοί, επιστημονικοί και γεωγραφικοί παράγοντες επηρέαζαν την υγεία των παιδιών, η οποία ήταν συνυφασμένη με τις πολιτισμικές και κοινωνικές συνθήκες και τους όρους διαβίωσης κάθε κοινωνικής ομάδας ή ατόμου σε κάθε εποχή στην χώρας μας. Εν κατακλείδι, η πρόβλεψη υπηρεσιών υγιεινής για τα παιδιά της σχολικής ηλικίας, σύμφωνα και με τις επιστημονικές επιταγές, κατείχε υψηλή προτεραιότητα στα προγράμματα υγειονομικής και κοινωνικής πολιτικής του κράτους, χαρακτηριζόμενη όμως, συχνά, από μια αναντιστοιχία των νομοθετημάτων με την πορεία υλοποίησης και εφαρμογής τους. Ως αιτίες αυτών των αναντιστοιχιών, πέραν των εσωτερικών πολιτικών αντιφάσεων, μπορούν να εντοπισθούν η πολιτική ρευστότητα της εποχής και η οικονομική δυσπραγία όσον αφορά στα δημοσιονομικά μεγέθη του Ελληνικού δημοσίου / The purpose of this study is to investigate the institutional regulations, processes and modes of planning, formation, organization and making education policy for the school sanitation and hygiene in Greece during the period 1911-1949. The study focuses on the collection, evaluation and thematic classification of the primary sources with the method of historical research (comparative-historical analysis: Kazamias, 2002) in order to comprehend with imagination (Carr, 1983) and to interpret the historical presumptions (an interpretive-historical approach: Pyrgiotakis, I. & Papadakis, N. 1998). Through the detailed research of our historical documents, we are attempting not only to recompose the historical reality but also to analyse and to interpret the facts during the period 1911-1949, a period characterized by the most important welfare state policies in the area of the school sanitation and hygiene. Thus, our approach is not a fact-based approach (Dimaras, 1988), it does not confine itself to what happened but it also attempts to provide answers to “why”. It interprets (interpreting history: Dertilis, 1995), based on welfare state and new education theoretical approaches. Using the qualitative content analysis (Berelson, 1952), we examined the differentiations of the institutional progress in the periods-sections and for the following parameters-analysis categories: school sanitation, students’ hygiene, teachers’ hygiene, medical and health service/control in school, medicare and perception measures in schools on behalf of the state (with special references to school lunch mess and to the creation of wider social perception institutions like: childhood countries-student camps, outdoor schools, student baths, student health centers-student clinics and the centers of student perception), hygiene education, popularization and the school hygiene magazines, from the two “venizelians” periods, the metaxian and the post war period to 1949. Historical, political, financial, scientific and geographical factors were affecting the children’s health, connected to the cultural and social conditions and the living conditions of every social group or individual during all epochs of our country. In conclusion, the health services for school age children were having a big priority in sanitation and social policy programs, characterised although quite often by discrepancy between laws and their implementation. This is due not only to the internal political contradictions but also to the political fluidity of that era and to the economic recession related to the greek state financial sizes. Μαθητικά συσσίτια Υπαίθρια σχολεία Κράτος πρόνοιας Νέα αγωγή Υγιεινή των μαθητών 371.709 495 School sanitation School lunch mess Outdoor schools Hygiene education Welfare State New education Teachers’ hygiene Students’ hygiene
198	美國《病人保護暨可負擔醫療法》之研究 / A study on American “Patient Protection and Affordable Care Act” 李照華, Li, Jhao Hua Unknown Date (has links) 美國前總統歐巴馬於2010年簽署之法案「病人保護暨可負擔醫療法」（Patient Protection and Affordable Care Act, PPACA）又稱「歐巴馬醫療法」（Obamacare），主要目的之一在於提升對人民醫療照顧的保障，擴大人民的醫療照顧覆蓋面，並讓醫療保險成為可負擔的，具體改革面向主要在公共醫療照顧的範圍擴大、對人民強制納保規定，與對於商業醫療保險之各種規制，而從歐巴馬醫療法內容中，得以探討美國如何在維持既有醫療照顧體系架構、商業醫療保險為主導的模式中，透過對商業醫療保險的規制來成就相當於社會保險所實現的社會安全，並與我國作比較，雖然主要採取之醫療照顧模式不同，但同樣在促成全民納保的社會國目的之達成，兩國背後的立法背景、操作上有何異同，以及會遇到之爭議與困境何在，並且進一步思考是否有讓我國在處理目前制度問題的值得參考之處。本文先論述美國傳統對於醫療照顧的心態與背景，並介紹美國的醫療照顧制度與衍生的問題，並從中了解醫療照顧之相關權利、全民納保觀念在美國的發展狀況，接著介紹歐巴馬醫療法的發展過程與實際內容，聚焦在擴大醫療照顧覆蓋面與令醫療保險成為可負擔之相關規定，並了解幾個重要的聯邦最高法院對歐巴馬醫療法之違憲審查判決中對爭議的處理，之後觀察歐巴馬醫療法如何透過對商業醫療保險的規制來讓其能成就社會安全功能，並追蹤後續歐巴馬醫療法實施後之成效與未來可能變化。對照我國，在介紹我國全民健康保險之發展與內容後，比較兩國在促成全民納保的背景、立法與釋憲過程中的爭議為何且如何處理、全民納保的操作內容，以及醫療照顧相關權利的承認與否、商業醫療保險的角色等，也從中討論是否有我國在解決現今全民健保之問題上可參考之面向。病人保護暨可負擔醫療法歐巴馬醫療法醫療照顧醫療保險醫療救助聯邦醫療保險醫療人權健康權 Obamacare Health care Health insurance Medicaid Medicare Right to health care Right to health
199	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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