Continuity of care (COC) refers to the delivery of seamless services, continuous caring relationships, and information sharing across care providers. A disruption in COC—that is, care fragmentation (CF)—is an important cause of inefficiency in the Canadian healthcare system; such disruption leads to increased healthcare costs and reduced quality of care. Addressing this issue is particularly challenging among older adults, who often have medically complex needs; such patients can require many care transitions across multiple care settings. An effective strategy for COC improvements is to optimize discharge planning among older adults. However, this is hampered by the imperfect understanding of older patients’ needs, which are associated with their health complexity. Therefore, making early predictions about the patients’ health complexity and incorporating this information into discharge planning decisions can potentially improve COC. In this thesis, I develop data-driven predictive–prescriptive analytics frameworks that leverage machine learning (ML) approaches and a rich, massive set of longitudinal data collected over a decade. The first essay in this dissertation studies the early prediction of older patients’ complexity in hospital pathways using ML. It also examines whether we can conduct accurate prognostics with current information on patient complexity. The second study examines how two common measures of patient complexity—multimorbidity and frailty—concurrently affect post-discharge readmission and mortality among older patients. It also investigates the dependency of the outcomes on other essential socio-demographic factors. Finally, the third study examines the feasibility of predicting patients at risk of fragmented readmission—that is, readmission to a different hospital than the initial one. It uses this predictive information to derive optimal policies for preventing CF while addressing disparities in the decision-making process. The findings highlight the feasibility, utility, and performance of predicting patient complexity and important adverse outcomes, potentially undermining COC. This thesis shows that advanced knowledge and explicit utilization of this information could support decision-making and resource planning toward a targeted allocation at the system level; moreover, it informs actions that affect patient-centered care transition at the service level to optimize patient outcomes and facilitate upstream discharge processes, thereby improving COC. / Thesis / Doctor of Philosophy (PhD) / The aging population in Canada is growing significantly relative to the population as a whole, and several challenges are involved in providing aging people with proper healthcare services. One of these challenges is disruptions in continuity of care. Older adults are often medically complex or frail; they may have multiple diseases and require many care transitions across healthcare settings. Poor continuity of care among these patients leads to health deterioration during care trajectories, resulting in reduced quality of care and increased healthcare costs and inefficiencies. This thesis includes three essays that provide practical insights and solutions regarding the issue of continuity of care disruptions, spanning from predicting the issue to strategies to prevent it in a data-driven manner.

The issues and concerns facing recreation managers, academicians, and other practitioners are now often complex and important enough that solving them requires more than the sum of parts from social and physical disciplines. To that end, this dissertation document identifies and addresses three research projects that in varying proportions draw from the social and ecological aspects of recreation management. The first of three articles in this dissertation examined approximation of cross sectional soil profiles on foot trails. Monitoring this ecological indicator with current field techniques can be expensive and time-consuming for managers. Therefore, this article described a modified procedure for assessing trail soil loss and discusses several potentially useful geometric curves for approximating the cross-section of a trail at a given sampling point and in aggregate across a trail network. Differences in profiles for each study area and implications for inventorying and monitoring were discussed. The second article examined integration of soundscape and hiker spatial modeling. GPS data were used to generate a spatial model of hiker travel, soundscape modeling software calibrated with field data was used to generate a spatial model of sound, and the models were integrated in a geographic information system to provide insights for baseline and an alternative management option scenario. The findings suggested that small changes in soundscape, based on altered management practices, can have large effects on visitors' hiking experiences in terms of soundscape. The third article discussed an observational study examining several integrative and additive, information/education and site management approaches to preventing natural resource damage along backcountry trails. Video surveillance equipment unobtrusively captured hiker behaviors within the study area for each treatment. The findings suggested that direct, obtrusive measures (e.g., low symbolic rope fencing) in some cases can outperform multiple concurrent measures that are less direct and/or obtrusive. Implications on aesthetics, experiences, and management decision-making were discussed. / Ph. D.

The amount of information involved in many decision making situations has increased dramatically in recent years and support of some kind is often needed. Consequently, fields like Business Intelligence (BI) and Decision Support Systems (DSS) have advanced. Decision analysis applications belong to the latter category and aim to support decision making activities in businesses and organizations, and provide more clearly structured decision material to use as a basis for decisions. In spite of a belief in their potential, their employment is still limited in practice, which could partly be attributed to the fact that they are incomplete to support decision processes sufficiently in real settings. At present, e.g., the specification and execution of the elicitation of input data is often left to the discretion of the user. Yet, this involves quite a few problematic elements and is of importance for the quality of the process as a whole. This thesis focuses on more practically useful elicitation of information in decision analysis applications than what is offered today. A process model emphasizing the importance of structured elicitation of adequate input data throughout decision processes is also suggested. In order to further define the problematic aspects of elicitation, three empirical studies were conducted. The problems with eliciting precise decision data suggests that using imprecise values within elicitation is a more realistic and useful approach to strive for. Based on theory and the findings of the studies, a weight elicitation method for imprecise statements and noisy input was formalized into the Cardinal Rank Ordering of Criteria (CROC) method. This method is both compatible with an adapted prescriptive decision making model, focused on a more structured elicitation component, as well as algorithms for dealing with such data. The CROC method was employed and validated in two real-life cases, which is not so common within decision analysis research. / Mängden information i många beslutssituationer har ökat markant under senare år och det finns ofta behov av någon form av stöd. Följaktligen har områden som Business Intelligence (BI) och Beslutsstödssystem (BSS) avancerat. Beslutsanalysverktyg tillhör den senare kategorin och syftar till att fungera som stöd vid beslutsfattande inom företag och organisationer och tillhandahålla mer strukturerat underlag för beslut. Trots en tro på deras potential, så är deras användande begränsat i praktiken, vilket delvis kan tillskrivas det faktum att de är inkompletta för att stödja beslutsprocesser i tillräcklig utsträckning i verkligheten. För närvarande förutsätts, t.ex. ofta att användaren själv klarar av att specificera och utföra utvinningen (eliciteringen) av input data. Detta involverar dock ett antal problematiska delar och dess kvalité är av vikt för hela processen. Denna avhandling fokuserar på mer praktiskt användbar elicitering av information i beslutsanalys-applikationer än vad som finns att tillgå idag. En processmodell som betonar vikten av strukturerad elicitering av adekvata indata genom hela beslutsprocessen föreslås också. För att ytterligare definiera de problematiska aspekterna av elicitering utfördes tre empiriska studier. Problemen med att utvinna precisa beslutsdata antyder att användandet av oprecisa värden inom elicitering är en mer realistisk och användbar ansats att sträva efter. Baserat på teori och resultaten av studierna formaliserades en vikteliciterings-metod för oprecisa utlåtanden och osäkra indata i Cardinal Rank Ordering of Criteria (CROC) metoden. Metoden är både kompatibel med en anpassad preskriptiv beslutsmodell fokuserad på en mer strukturerad eliciteringskomponent samt algoritmer för att hantera denna typ av data. CROC-metoden användes och validerades i två riktiga fall, vilket inte är så vanligt inom beslutsanalys forskning. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 4: Accepted. Paper 7: Submitted. </p>

Academic advising has undergone tremendous changes since its origin in higher education. The notion of faculty performing clerical tasks in order to aid students strictly in academics has been challenged. Today, academic advising is considered one of the best vehicles for promoting intellectual, personal, and social development of students. It is a service that links students' academic and personal worlds and, hence promotes holistic development. However, little is known about professional advisors, specifically to what extent professional advisors use an approach to advising that can be characterized as developmental. The purpose of this study was to observe and identify the behaviors that occur during academic advising sessions between professional academic advisors and students, and compare these behaviors to the models and definitions of developmental advising proposed in the literature. Qualitative research methods, including observations and interviews, were employed. Ten advisors were observed in 35 actual advising sessions in an effort to identify advising behaviors, which were later used to develop and define advising styles. In addition, each advisor was interviewed about his or her philosophy of advising. Results of the study found that the developmental-prescriptive continuum does not accurately reflect actual advising practice. Most advisors' style reflected a mix of developmental and prescriptive behaviors. However, the characteristics of advising proposed in the literature (e.g.,content, personalization, and decision-making) were useful in identifying and defining new advising styles. Another important finding dealt with personalization. While most advisors stated students are different and have different needs, and some advisors were observed to personalize the advising session, none of the advisors were observed to alter their style in accordance with students' differences. This suggests there may be a difference between personalization and individualization of advising. Recommendations for practice include assessment of advisors' behaviors and philosophies in addition to student perceptions. Also, there is a need to develop new models of advising. The data from this study recommend the development of an advising model that considers the importance of the advisor-advisee relationship that is dynamic and that reflects stages or phases of advising instead of distinct advising styles. The information gathered from this study lends itself to further research about the advising styles used with specialized student populations, suggesting the need for individualization as well as personalization of advising. / Master of Arts

No description available.

In recent years, a significant change in the pharmacist’s scope of practice is the expansion of prescriptive authority (PA). In Saskatchewan, pharmacists adopted an interdependent prescribing model to support interprofessional collaboration, public safety though the optimal use of drug therapy, and the optimization of pharmacy competencies. In acquiring this new prescriptive authority, the community pharmacist also assumes new responsibilities and obligations, as well as transforming their relationships with patients and physicians. The purpose of this research is to assess rates of adoption by pharmacists of PA (Level 1 and Minor Ailments Prescribing) within community pharmacy practice in Saskatchewan. To gain a better understanding of how pharmacists are responding to new and evolving models of practice, this study proposes to measure their experiences with PA services and how it is affected by aspects of their professional practice. To investigate the study’s research questions, a cross-sectional study using a mail-in questionnaire with an online option was initiated. All registered community pharmacists in Saskatchewan (998) were asked to participate in the study. Of the 998 distributed questionnaires, 501 were returned back by the respondents yielding a response rate of 51.3 percent. The results disclose that a vast majority of respondents agreed or strongly agreed that they were confident in their ability to provide Level 1 (94%) and Minor Ailment (75%) prescribing. Respondents indicated that 74.2 percent of the time they actually provide Level 1 (L1) prescribing services to their patients and slightly more than half (52.5%) of the time provided Minor Ailment (MA) prescribing services. The majority of respondents (81.4 %) indicated that on average it took twenty minutes or less to provide MA prescribing service to their patients. Most pharmacist respondents strongly supported the statement that the pharmacies they worked at consistently provided Prescriptive Authority services (L1- 90% Strongly Agreed or Agreed, MA- 52.9% Strongly Agreed or Agreed) and that they get full support from managers (L1- 95.6% Strongly Agreed or Agreed, MA- 88% Strongly Agreed or Agreed) for their involvement in PA services. Respondents indicated some concern regarding the limited knowledge of patients on what pharmacists can do for them as a prescriber. In terms of overall relationships with patients, respondents indicated that patients were satisfied with the services pharmacists provide as a prescriber. Respondents reported that they had a good relationship with physicians. However, they did express concerns about their limited interactions with physicians as MA prescribers. Respondents generally reported supportive environments and positive interactions with patients and physicians. However, while expressing confidence in their ability to provide all prescriptive authority services, Level 1 services that supported traditional dispensing services were generally more consistently provided, supported, and perceived as being valued by patients and physicians compared to Minor Ailment Prescribing. The results also support the notion that pharmacists are highly confident to provide PA services to the patients and their relationships with the patients and physician improved day by day. Nevertheless, there is little evidence to suggest that patient’s level of knowledge about pharmacist’s new role; pharmacist’s interaction with physicians and physicians’ knowledge on PA have affected the provision of Prescriptive Authority services.

Recent work on the role of norms in the use of causal language by ordinary people has led to a consensus among several researchers: The consensus position is that causal attributions are sensitive to both statistical norms and prescriptive norms. But what is a statistical norm? We argue that there are at least two types that should be distinguished-agent-level statistical norms and population-level statistical norms. We then suggest an alternative account of ordinary causal attributions about agents (the responsibility view), noting that this view motivates divergent predictions about the effect of information about each of the two types of statistical norms noted. Further, these predictions run counter to those made by the consensus position. With this set-up in place, we present the results of a series of new experimental studies testing our predictions. The results are in line with the responsibility view, while indicating that the consensus position is seriously mistaken.

The undergraduate major change or declaration process can be cumbersome for students who find themselves in unknown territories when making decisions or seeking help during this transition. One of the most challenging groups of students to assist through this transition are those who are denied access to their intended program of study. These students are often pursuing selective degree programs with limited enrollment and competitive admission requirements. Research on students pursuing selective degree programs is largely outdated, with most studies being older than ten years. The purpose of this qualitative study was to explore how undergraduate students experience leaving selective health profession interest areas in dental hygiene, nursing, and radiologic sciences at a public research university located in Tennessee. This qualitative study included the experiences of 12 third and fourth-year college students at one institution who applied for a selective degree program, were not accepted, and remained enrolled at the institution. It included semi-structured, open-ended individual interviews to investigate these undergraduate students’ experiences when undergoing an undergraduate major change away from a selective degree program. The results aligned with the theoretical framework of Schlossberg’s transition theory (Schlossberg, 1981; Schlossberg, 1991; Schlossberg et al., 1995). The students leaving selective health profession interest areas in dental hygiene, nursing, and radiologic sciences placed importance on college and career choice, experienced change of major difficulties, used campus and other support resources, and developed new strategies for success throughout the change of major process. Recommendations for further study include expanding the sample size and adding other selective degree programs to gain a more holistic picture, developing studies at multiple institutions that follow students throughout the entirety of their undergraduate careers, and investigating students’ coping strategies to identify ways to foster resiliency.

Long-term care facility network in Ontario, and in Canada as a whole, encounters critical issues regarding balancing demand with capacity. Even worse, it is faced with rising demand in the coming years. Moreover, there is an urgent need to provide long-term care for patients in their own language (particularly French). This study proposes a dynamic Mixed-Integer Linear Programming model based on the current standing of the long-term care system in Ontario, which simultaneously optimizes the time and location of constructing new long-term care facilities, adjusting the capacity (namely, human resources and beds) of each facility dynamically, and the assignment of patients to the facilities based on their demand region, gender, language, and age group over a finite time horizon. We apply the diversity-support constraints, based on patients’ gender and language, to save patients from loneliness and to comply with the Canadian values of providing care. Finally, we validate the model by performing a case study in Hamilton, Ontario. An extensive set of numerical analyses are explored to provide deeper insights into the whole issue. One set of such analysis is an extensive simulation study to examine the effect of distributional uncertainty in some of the input parameters on the optimal results, hence providing a much more realistic understanding of the optimization model. / Thesis / Master of Science (MSc)

This study was designed to explore the advising styles that are currently perceived and preferred by African American and White students in the College of Engineering at Virginia Tech. The high attrition rate of African Americans in the engineering colleges both nationally and at Virginia Tech makes it critical to investigate what can be done to increase retention. The lack of awareness of academic advising preferences could be a major component in the high attrition of African American students in the College of Engineering at Virginia Tech. Moreover, increased awareness and understanding for advisors, faculty, administrators and even students will befall, and in turn strengthen retention. The purpose of this study was to determine; (a) the current advising African American and White students in the College of Engineering at Virginia Tech are perceiving; prescriptive versus developmental; and (b) what the preferences are for advising African American and White students in engineering; prescriptive versus developmental. This study specifically examined the comparisons between race, gender, classification, grade point average (GPA), and major. The instrument that was administered via the Internet is called the Academic Advising Inventory (Winston & Sander, 1984). This four-part instrument measures the level of the developmental or prescriptive advising that occurs between students and advisors and student satisfaction with advising in the College of Engineering. The sample consisted of a total of 373 undergraduate engineering students, 265 (71%) males and 108 (29%) females. African Americans made up 35% (n = 132) of the sample and Whites 65% (n = 241). The sample consisted of 25% (n = 93) African American males, 10% (n = 39) African American females, 46% (n = 172) White males, and 19% (n = 69) White females. A two-way analysis of variance (ANOVA) and t-tests were conducted to analyze differences in advising style when categorized by race, gender, classification, GPA, and major. The results revealed a significant difference between the style of academic advising currently perceived by African American and White engineering students. The majority of the African Americans reported receiving prescriptive advising and the majority of the Whites reported receiving a developmental style of advising. The results also indicated that the majority of the African American males (55%) perceived receiving a prescriptive style of advising. When looking at African Americans when categorized by classifications, all reported receiving a prescriptive style of advising. The junior class of African Americans was the only group that is borderline prescriptive/developmental. The ANOVA test also indicated a significant interaction between race and GPA. Results showed that African Americans engineering students in the GPA categories of 1.0-1.9 and 2.0-2.9 reported receiving prescriptive advising, while the 3.0-3.9 category of African Americans reported receiving developmental advising. This data was not consistent with White students in the GPA category of 1.0-1.9. All White students regardless of GPA reported receiving a developmental style of advising. All engineering students regardless of race, gender, classification, GPA, or major preferred a developmental style of advising. African American females significantly preferred a more developmental style of advising than the other groups. A Chi square test of independence also indicated that a significantly large portion of African American students felt that their academic advisor did not understand them. / Ph. D.