Primary Health Care (PHC) plays a vital role in decentralization of health care services. PHC is designed to ensure health care coverage at the community level through the involvement of the community in improving their healthy living. PHC offers treatment and care in continuum that is supported by a facility-linked home- based care system and a referral system. While PHC is global, its operation and functioning in the area of community health provisioning varies across communities. The main objective of this study is to find out whether PHC is effective or not in Roma Valley, Lesotho. The study was carried out in Roma Valley, in the Maseru district of Lesotho. The population for this study includes the nurses under the department of PHC, village health workers, Chiefs and out-patients from four different villages. Out of this, a sample of thirty individuals was selected. The data for this study was collected through qualitative research technique, particularly oral interviews and written records or secondary data sources. The analysis revealed that nurses and village health workers respond to the social needs and health problems of the community and community members are also involved in improving their health status. Village health workers face many challenges in their engagement in this system such as not being given incentives for what they do and often uncooperative disposition of some community members including their leaders. It was also found that they operate under a lot of stress due to lack of resources.

<p> Historically the relationship between Allopathic and Osteopathic physicians with Chiropractors has been strained at best. Since the Patient Protection and Affordable Care Act specifically list&rsquo;s Chiropractors as part of Accountable Care Organizations this strained relationship will not be in the best interests of patient care. Chiropractors are a small part of the health care puzzle so they will need to integrate into the larger health care arena and work alongside their Allopathic and Osteopathic counterparts. To accomplish this, the attitudes and beliefs of these Allopathic and Osteopathic Physicians were ascertained so that Chiropractors can possess the information required to transition into Accountable Care Organizations as seamlessly as possible. This study, with limitations including small sample size, determined the attitudes and beliefs of Allopathic and Osteopathic physicians towards Chiropractors and then determined the steps that they would suggest to help with Allopathic and Osteopathic collaboration with Chiropractors for future patient care. </p><p> The Survey used to ascertain the attitudes and beliefs of Allopathic and Osteopathic physicians was obtained with permission from Busse et.al. (2009). Three different research questions were analyzed using several different items from the Survey. Overall the Allopath&rsquo;s and Osteopath&rsquo;s had a negative view of Chiropractors including the attitude that Chiropractors should not be involved in Medical Homes or Accountable Care Organizations as stated in the Patient Protection and Affordable Care Act. Additionally there was no statistically significant relationship between Allopathic and Osteopathic attitudes or beliefs and their willingness to collaborate clinically with Chiropractors based on age, gender, Allopathic or Osteopathic education, years in practice, and specialty. In the written response aspect of the survey barriers to collaboration included Chiropractors anti-vaccine stance, non-evidence based treatment, and over treatment of patients. Key Words: Chiropractor, Allopath, Osteopath, Collaboration, Patient Care.</p>

Statistical Process Control (SPC) methods, developed in industrial settings, are increasingly being generalized to medical service environments. Of special interest is the control chart, a graphic and statistical procedure used to monitor and control variation. This dissertation evaluates the validity of the control chart model to improve medical quality. The research design combines descriptive and causal comparative (ex-post facto) methods to address the principal research question, How is the control chart model related to medical quality? Hospital data were used for patients diagnosed with Community Acquired Pneumonia (CAP). During the initial research phase, five medical quality "events" assumed to affect CAP medical quality indicators were pre-specified by hospital staff. The impact of each event was then evaluated using control charts constructed for CAP quality indicators. Descriptive analysis was undertaken to determine whether data violated the statistical assumptions underlying the control chart model. Then, variable and attribute control charts were constructed to determine whether special cause signals occurred in association with the pre-specified events. Alternative methods were used to calibrate charts to different conditions. Sensitivity was computed as the proportion of event-sensitive signals. The descriptive analysis of CAP indicators uncovered "messy," and somewhat complex, data structure. The CAP indicators were marginally stable showing trend, seasonal cycles, skew, sampling variation and autocorrelation. Study results need to be interpreted with the knowledge that few events were evaluated, and that the effect sizes associated with events were small. The charts applied to the CAP indicators showed limited sensitivity; for three chart-types (i.e. XmR, Xbar, and P-charts), there were more false alarms than event-associated signals. Conforming to expectation, larger sample size increased chart sensitivity. The application of Jaehn Decision Rules led to increases in both sensitivity and false alarm. Increasing subgroup frequency from month, to week samples, increased chart sensitivity, but also increased data instability and autocorrelation. Contrary to expectation, the application of hybrid charting techniques (EWMA and CUSUM) did not increase chart sensitivity. Study findings support the conclusion that control charts provide valuable insight into medical variation. However, design issues, data character, and causal logic provide conditions to the interpretation of control charts.

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<p> Delay of health care negatively impacts patient satisfaction and contributes to an inefficient healthcare system by increasing the use of the emergency room for non-urgent conditions. Policymakers argue that long waits will result in delays in diagnosis and treatment, and these delays negatively affect individual health.</p><p> California is a diverse state and comprises of people from various ethnic backgrounds. Consequently, there are cultural, linguistic and various other underlying reasons which contribute towards the delay in health care.</p><p> Apart from this, California has a wide range of people, which varies in socioeconomic status and there is a large segment which delays health care due to lack of health insurance. This study focuses on analyzing the reasons behind the delay in health care among California residents and proposes remedies which can help mitigate the problem.</p>

<p> The purpose of the study was to determine whether there were associations between hospital costs and hospital size, hospital location, hospital ownership type, and Group Purchasing Organization (GPO) participation. The 2008 American Hospital Association annual survey responses were used as the instrument for a retrospective secondary study. Analyzing results from the various tests employed in this study showed there was a statistically significant association between hospital costs and hospital size. There were statistically significant differences between the means when comparing cost with hospital location and ownership type. There was not an association between hospital costs and GPO participation, likely as a result of the unadjusted cost metric used. Further research using a time series approach would help determine the true association of GPO participation. Expanding the criteria to identify whether the hospitals participate in a regional alliance may also return different results relative to cost and GPO participation.</p>

<p> The purpose of this study is to investigate the relationship and pattern of Computerized Physician Order Entry (CPOE) implementation among various ambulatory care settings. With the increasing focus on cost reduction and improved efficiency of the healthcare industry, successful CPOE implementation would benefit many providers. The research entails an analysis of practice setting characteristics that may provide insight to the future of CPOE full adoption. Through secondary data analysis on the responses collected from the Electronic Medical Records Supplemental Survey (within the 2009 National Ambulatory Medical Care Survey), four hypotheses are tested in this study: (a) use of CPOE will be greater in primary practices as opposed to specialists, (b) use of CPOE will be greater amongst group practices and less in solo practices, (c) private practice setting types will have greater implementation patterns of CPOE compared to other setting types, and (d) practices with greater private insurance reimbursements will have greater CPOE utilization. All four hypotheses were tested using a chi-square analysis in order to better examine the relationship between utilization patterns of CPOE and medical care practice characteristics. Although results showed that there are significant associations between CPOE use and practice specialty, type, setting, and type of major payer, there is still a strong lack of adoption in the ambulatory care setting as a whole. The study provides some insight into what types of practices may have lucrative qualities in the future, however the data is reflective of a time when many changes are expected to effect the industry. Not every medical practice has adopted or successfully implemented the first stages of CPOE, however the benefits and the future of healthcare show that many practices will soon be on their way in order to stay profitable.</p>

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