acase@tulane.edu / 1 / Yongkang Zhang

Magister Legum - LLM / South Africa’s main anti-money laundering legislation consists of 2 pieces of legislation, namely: The Financial Intelligence Centre Act (FICA)1 and the Prevention of Organised Crime Act (POCA).2 Money Laundering is often defined as the concealment of funds or property which has been obtained as the result of unlawful activity. It is also defined as giving the unlawfully obtained funds the appearance of legality when in actuality the funds or property is obtained unlawfully. POCA defines unlawful activity which includes any criminal offence in South African law, whether it has occurred in South Africa or elsewhere.3 Any person who has the knowledge of the aforementioned money laundering act or ought to have the knowledge may be guilty of an offence.

Accountable care units (ACU-?¢) provide a new model for integrated patient care. The ACU-?¢ promotes patient centeredness in nursing units as team members work collaboratively with physicians to improve patient outcomes and reduce unwarranted variations. A health system in the southeastern United States incorporated the ACU-?¢ as part of their care model. These units were held accountable for their clinical, service, and cost outcomes but lacked a validation process to demonstrate the effective utilization of their data. The purpose of this DNP project was to create a patient centered care (PCC) certification process, guided by the Donabedian model, that would provide hospital units the opportunity to access their process and quality improvement outcome data and to improve patient care. For this project, 12- key individuals were interviewed to gain their perspectives and input on the development and implementation of the PCC certification process. Results from the interviews were compiled and reviewed for common themes, which included Magnet-?¢ recognition, patient experience, current unit goals, and hospital strategic plan. Using the results of the interviews, a PCC certification procedure was created to outline the steps required to achieve certification; and, an application was developed to provide a standard format for quality and process improvement projects and associated outcomes reporting. The certification procedure will be implemented in the health system in the next fiscal year. Evaluation of the effectiveness of the program and future refinement will be controlled by the Nursing Shared Governance. The project may promote positive social change as the staff nurses on the individual units use the unit metrics to improve patient outcomes and reduce variations in care.

The purpose of this qualitative study was to extend the understanding of the characteristics of a classroom environment that impact students’ engagement in academics and therefore has the potential to positively impact student achievement scores. Data were collected through content analysis to analyze for reoccurring themes to assess how the characteristics of the classroom environment impact student’s achievement. Ten classrooms within the Kingsport City District were observed and analyzed for this study. Six research questions guided this study, and qualitative data were analyzed for reoccurring themes. Findings from this study suggest that implementing certain characteristics in to the classroom environment can positively impact students’ academic success. The development and construction of classroom environments should include such characteristics as positive discipline, well laid out and organized classrooms, accountable talks, collaborative groups, positive teacher student interaction, and learning targets. As a result of this research a recommendation for practice is that districts support the development of classrooms that would positively impact student’s achievement.

In 2011, Medicare patients represented the largest share of total readmissions and health costs when compared to all other patient categories. Because patient-centered care drives the use of health services, the U.S. Patient Protection and Affordable Care Act outlined improving the patient experience to reduce readmission rates; however, the relationship between patient experience and readmissions is not well understood. Grounded in systems theory, the purpose of this correlational study was to determine if the relationship between patient experience and readmission rates in Medicare Shared Savings Program accountable care organizations. Data from the Consumer Assessment of Healthcare Providers and Systems survey were gathered from the Centers for Medicare and Medicaid datasets to analyze patient experience measurements and readmission rates, while accounting for variation among Medicare service regions, number of assigned beneficiaries, and performance year. Using multiple linear regression to analyze the data, the model was used to predict Medicare's all-condition readmission rate (per 1000), R-²= .242, F (13, 634) 15.59, p < .001. The research question was answered partially; variation in the patient experience domain did not support all hypotheses. Because the Medicare population represents the fastest growing patient population within the U.S. health care system, continuous evaluation of policy and performance provides an evidence-based analysis to health administrators and providers who have pivotal roles in the creation of positive social change. Findings may be used to improve quality and service while reducing costs, which contributes to the sustainability of the U.S. Medicare program and its beneficiary population.

Thesis advisor: Curt Dudley-Marling / This qualitative dissertation, informed by sociocultural theory (Gee, 1996; Vygotsky, 1978), examines how a fourth grade teacher and his students learned to participate in Shared Inquiry, a discussion practice where students learn how to build an evidential argument, including a claim that is supported by evidence and justified by a warrant (Toulmin, 1969). Students also learn how to weigh the merits of opposing arguments and how to modify their initial opinions as evidence demands. Over the course of ten weeks, the fourth grade teacher implemented Shared Inquiry as part of the Junior Great Books (JGB) program, offered as a supplement to a district mandated reading program. The teacher was observed while using the JGB program and while providing instruction through the mandated reading program. He participated in action research (Stringer, 2007) to examine how to make Shared Inquiry most successful. This dissertation describes how the teacher's action research enabled his students to become successful with Shared Inquiry, after they initially struggled with the practice. Over time, they learned a new way of engaging, not only with literature, but also with fellow classmates. This dissertation also describes how the fourth grade students learned a different set of literacy practices through the mandated reading program. The argument is made that Shared Inquiry has the potential to be a far more substantively engaging (Nystrand, 2006; Nystrand & Gamoran, 1991, 1997) literacy practice compared to the mandated reading program. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Lynch School of Education. / Discipline: Teacher Education, Special Education, Curriculum and Instruction.

The purpose of this practice inquiry project is to create a model for implementing an outpatient palliative care clinic within an organization of healthcare providers who participate in shared savings for Medicare patients, also known as, an accountable care organization (ACO). The goal of this project is that it can be used by future health care administrators to successfully create and implement an outpatient palliative care clinic. The philosophical nursing foundation for palliative care is discussed to set the groundwork for the model proposed. The benefits of palliative care nursing for patients, families and the ACO are discussed to support the importance of opening an outpatient palliative care clinic. A step by step model has been developed and presented on how to plan and implement an outpatient palliative care program. Tools have been proposed to help successfully and effectively create, implement and evaluate outpatient palliative care clinics within an ACO.

Electronic government (e-Government) is a purposeful system of organized delegation of power, control, management and resource allocation in a harmonized centralized or decentralized way via networks assuring efficiency, effectiveness and transparency of processes and transactions. This new phenomenon is changing the way of business and service of governments all over the world. The betterment of service to citizens as well as other groups and the efficient management of scarce resources have meant that governments seek alternatives to rendering services and efficient management processes. Analog and mechanical processes of governing and management have proved inefficient and unproductive in recent times. The search for alternative and better ways of governing and control have revealed that digital and electronic ways of governing is the best alternative and beneficial more than the mechanical process of governing. The internet, information and communication technology (ICT/IT) have registered a significant change in governments. There has also been an increased research in the area of electronic government but the field still lacks sound theoretical framework which is necessary for a better understanding of the factors influencing the adoption of electronic government systems, and the integration of various electronic government applications. Also the efficient and effective allocation and distribution of scarce resources has become an issue and there has been a concerted effort globally to improve the use and management of scarce resources in the last decade. The purpose of this research is to gain an in depth and better understanding of how electronic government can be used to provide accountability, security and transparency in government decision making processes in allocation and distribution of resources in the educational sector of Ghana. Research questions have been developed to help achieve the aim. The study has also provided detailed literature review, which helped to answer research questions and guide to data collection. A quantitative and qualitative research method was chosen to collect vital information and better understand the study area issue. Both self administered questionnaire as well as interviews were used to collect data relevant to the study. Also a thorough analysis of related works was conducted. Finally, the research concluded by addressing research questions, discussing results and providing some vital recommendations.  It was also found that electronic government is the best faster, reliable, accountable and transparent means of communication and interaction between governments, public institutions and citizens. Thus electronic government is crucial in transforming the educational sector of Ghana for better management of resources. It has also been noted that information and communication technology (ICT) is the enabling force that helps electronic government to communicate with its citizens, support e-government operation and provide efficiency, effectiveness and better services within the educational sector of Ghana.

Background: The United States health care system faces two fundamental challenges: a high growth rate of health care spending and deficiencies in quality of care. The growth rate of health care spending is the dominant driver of our nation’s long-term federal debt, while the inconsistent quality of care hinders the ability of the health care system to maximize value for patients. To address both of these challenges, public and private payers are increasingly changing the way they pay providers—moving away from fee-for-service towards global payment contracts for groups of providers coming together as accountable care organizations. This thesis evaluates the change in health care spending and in quality of care associated with moving to global payment for accountable care organizations in Massachusetts in the first 4 years. This thesis studies the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), a global payment contract that provider organizations in Massachusetts began to enter in 2009. The AQC pays provider organizations a risk-adjusted global budget for the entire continuum of care for a defined population of enrollees insured by Blue Cross Blue Shield of Massachusetts. It also awards substantial pay-for-performance incentives for organizations meeting performance thresholds on quality measures. This work assesses its effect on spending and quality through the first 4 years of the contract. Methods: Enrollee-level claims data from 2006-2012 were used with a difference-in-differences design to evaluate the changes in spending and quality associated with the Alternative Quality Contract over the first 4 years. The study population consisted of enrollees in Blue Cross Blue Shield of Massachusetts plans (intervention group) and enrollees in commercial employer-sponsored plans across 5 comparison states (control group). Unadjusted and adjusted results are reported for each comparison between intervention and control. Changes in spending for all 4 AQC cohorts relative to control were evaluated. In adjusted analyses of spending, I used a multivariate linear model at the enrollee-quarter level, controlling for age, sex, risk score, indicators for intervention, quarters of the study period, the post-intervention period, and the appropriate interactions. For analyses of quality, an analogous model at the enrollee-year level was used. Process and outcome quality were evaluated. Results: Seven provider organizations joined the AQC in 2009, with a total of 490,167 individuals who were enrolled for at least 1 calendar year in the study period. The control group had 966,813 unique individuals enrolled for at least 1 year during the study period. Average age, sex, and risk scores before and after the AQC were similar between the two groups. In the 2009 cohort, claims spending grew on average $62.21 per enrollee per quarter less than control over 4 years (p<0.001), a 6.8% savings. Analogously, the 2010, 2011, and 2012 cohorts had average savings of 8.8% (p<0.001), 9.1% (p<0.001), and 5.8% (p=0.04), respectively, by the end of 2012. Savings on claims were concentrated in the outpatient facility setting, specifically procedures, imaging, and tests (8.7%, 10.9%, and 9.7%, respectively, p<0.001). Organizations with and without risk-contracting experience saw similar average savings of 6.3% and 7.7%, respectively, over 4 years (p<0.001). About 40% of savings were explained by lower volume. Pre-intervention trends were not statistically different between intervention and control (-$4.57, p=0.86), suggesting savings were not driven by inherently different trajectories of spending. No differences in coding intensity were found. In sensitivity analyses, estimates were robust to alterations in the model, variables, and sample. Notably, claims savings were exceeded by incentive payments to providers (shared savings and quality bonuses) in 2009-2011, but exceeded incentives payments in 2012, generating net savings. Improvements in quality among intervention cohorts generally exceeded New England and national comparisons. Quality performance on chronic care measures increased from 79.6% pre-intervention to 84.5% post-intervention in the 2009 cohort, compared to 79.8% to 80.8% for the HEDIS national average, a 3.9 percentage-point relative increase over the 4 years. Analogously, preventive care and pediatric care measures increased 2.7 and 2.4 percentage points relative to control, respectively. On outcome measures, achievement of hemoglobin A1c, LDL cholesterol, and blood pressure control grew by 2.1 percentage points per year in the 2009 cohort after the AQC, while HEDIS averages remained largely unchanged (Figure). Conclusion: After 4 years, physician organizations in the AQC had lower spending growth relative to control and generally outperformed national averages on quality measures. Shared savings coupled with quality bonuses can exceed savings on claims in initial years, but over time, savings on claims may outgrow incentive payments. Incentive payments themselves may serve meaningful purposes, as quality measures may protect against stinting and shared savings may help ease providers into risk contracts. Changes in utilization suggest that this payment model can help modify underlying care patterns, a likely prerequisite for sustainable reform. The AQC experience may be useful to policymakers, insurers, and providers embarking on payment reform. Combining global budgets with pay-for- performance may encourage organizations to embark on the delivery system reforms necessary to slow spending and improve quality.

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