Research Objectives Heart failure (HF) is a common condition in persons older than 65 years. Existing literature indicated that hospital readmission rates after discharge for heart failure patients are immensely high. However, previous studies showed that almost half of the early hospital readmissions could be prevented. Moreover, Angiotensin-converting enzyme (ACE) inhibitor and Angiotensin receptor blocker (ARB) are the commonly used medications for heart failure patients to control blood pressure. Nevertheless, studies indicated that these two medications could also cause the risk of hospital readmission. Little studies examined the associations of medication use and hospital readmission of heart failure patients in Taiwan. This study aims to investigate the influence factors of hospital readmissions among heart failure patients in Taiwan. Study Design We collected the data from National Health Insurance (NHI) database during the period from year 2000 to 2006. Based on the rule of Bureau of National Health Insurance in Taiwan, the 14-day readmission is considered as a poor quality indicator. We categorized readmissions into 4 groups (14-day, 30-day, 180-day and over 180-day) and evaluated each group¡¦s demographic, hospital characteristics, medical resource utilization, Charlson Comorbidity Index and medication utilizations of ACE inhibitor and ARB. We conducted descriptive analyses by using chi-square and t tests and applied multivariate logistic regression analyses to estimate the probabilities of hospital readmissions of heart failure patients. Population Studied Patients aged 50 or older with heart failure were identified based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Principle Findings Among 1920 heart failure patients, 19.9% of them were readmitted within 14 days, 7.6% were readmitted within 30 days and 26% were readmitted within 180 days. The medical resource utilizations such as average inpatients cost per patient, average outpatients cost per patient, total medical cost, average of inpatients times per patient and average of outpatients times per patient were significantly higher in patients with readmissions than those without readmission. Age, Charlson Comorbidity Index, patients who had been treated with ACE inhibitors and patients who had been treated with ARB were significantly affected the probabilities of readmissions. Conclusion The heart failure patients with readmissions had significantly higher medical resource utilizations than those without readmission. The medication uses of ACE inhibitors or ARB were significantly affected the probabilities of hospital readmissions. By understanding more about the influence factors of readmissions among heart failure patients, we may provide continue improvements of quality of care and reduce unnecessary medical costs. This study results provide useful reference for policy-makers to establish effective disease management program and appropriate health care financing arrangement in the future.

Research Objectives: Osteoporosis has become a significant public health problem in recent years, especially with the growth of the elderly population. Osteoporotic fractures exact a terrible toll on the population with respect to morbidity, cost, and to a lesser extent mortality. These effects can lead to psychological problems, social consequences, functional limitations, and poor quality of life. Thus, knowledge regarding osteoporotic fractures is needed to evaluate the impact of osteoporotic fractures on society, to identify high-risk populations, and to help policymakers to allocate resources accordingly. This study aims to investigate the influence factors of hospital readmissions among osteoporotic fractures patients in Taiwan, and the study results are expected to increase our understanding of the magnitude of the elderly population suffering from osteoporotic fractures and to urge policymakers to develop effective national prevention strategies. Study Design: Using Taiwan¡¦s National Health Insurance database, we identified elderly patients with a hospitalization for osteoporotic fractures between 2001 and 2007. We divided readmissions into different groups (14-day, 30-day, 180-day and over 180-day) and evaluated each group¡¦s demographic, hospital characteristics, and Charlson Comorbidity Index. The claims data are also used to calculate the health services utilization of osteoporotic fractures among those elderly patients with or without readmission of osteoporotic fractures. The data analyses were carried out by Chi-square test, t test, multiple linear regression and multivariate logistic regression. Population Studied: Patients aged 50 or older with osteoporotic fractures were identified based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Principle Findings: Among 5483 osteoporotic fractures patients, 6.9% of them were readmitted within 14 days, 34.7% were readmitted within 30 days and 13.9% were readmitted within 180 days. The medical resource utilizations were significantly higher in patients with readmissions than those without readmission. Age and Charlson Comorbidity Index were significantly affected the probabilities of readmissions. Conclusion: From the perspective of health policy, the issue of osteoporotic fractures will become increasingly important in the future. This national study will help raise awareness of osteoporotic fractures and hopefully motivate public health policy makers to develop effective national prevention strategies against osteoporosis to prevent osteoporotic fractures.

The quality of care in nursing homes has been evaluated from many varying perspectives, but few studies have analyzed quality in light of complaints made to state survey agencies by residents, their family members, or other individuals interacting with the nursing home. This study analyzed complaints, investigation of complaint allegations, and complaint-related deficiency citations to determine their effect, if any, on the quality of care in nationwide nursing homes. Using the Online Survey Certification and Reporting (OSCAR) survey dataset for facility characteristics and the complaint investigation dataset for outcomes of complaint investigation, analyses conducted included descriptives, correlations, conceptual mapping for complaint-related deficiencies, chi-square tests of independence, t-tests, and generalized estimating equations. At baseline, approximately 66% of nursing homes were for-profit and roughly 53% belonged to a chain membership, while the average percent of residents receiving Medicaid for care reimbursement was 60%. Results indicated that nursing homes differed significantly by profit status and chain membership on whether a complaint was received and whether a deficiency citation was issued following a complaint investigation. Additionally, certain facility and resident-aggregated characteristics, as indicated by odds ratios, were associated with an increase in the likelihood of receiving a complaint or a complaint-related citation. With respect to facility characteristics, for-profit nursing homes and those nursing homes belonging to a chain membership were found to have more complaints and more complaint-related deficiency citations than nonprofit nursing homes and non-chain facilities. Resident-aggregated characteristics, such as a nursing home having more residents restrained, more residents with a catheter, or more residents with a diagnosis of depression, indicated a greater likelihood of receiving a complaint or complaint-related deficiency citation in longitudinal analyses. While additional research could aid in interpreting the effect of complaints on quality of care in nursing homes, study results indicate several facility and resident-aggregated factors that may aid in better understanding of quality of care and improve the training of surveyors and nursing home staff to improve quality of care for residents.

BACKGROUND: Radical prostatectomy is the surgical procedure performed on men with clinically localized prostate cancer. In recent years, radical prostatectomy quality indicators have been recommended, but the feasibility and validity for many of these listed surgical quality indicators have yet to be examined. We tested the convergent construct validity of these quality indicators by assessing their associations with hospital volume, a variable repeatedly associated with the quality of surgical care, for prostate cancer patients treated with radical prostatectomy. OBJECTIVES: (1) To assess variations in quality indicators by hospital volume; and (2) To investigate whether certain explanatory variables account for some of the variation observed in Objective 1. METHODS: This was a retrospective cohort study using medical chart review data that had already been collected as part of a parent study. The study population consisted of a stratified random sample of prostate cancer patients diagnosed between 1990 and 1998 in Ontario, who were treated by radical prostatectomy with curative intent within six months of diagnosis (n = 645). The feasibility of using this data to assess a number of quality indicators was explored, and where possible, variables were developed for analysis. Ultimately, detailed analyses were performed for the quality indicators: total blood transfusions of three units or greater, length of hospital stay, and use of non-nerve-sparing surgical technique. RESULTS: Even using high-quality chart data, it was not feasible to evaluate all of the quality indicators that were explored. For blood transfusions of three units or greater, length of hospital stay, and use of non-nerve-sparing surgical technique, worse outcomes were generally apparent with decreasing hospital volume, both before and after adjusting for the effect of explanatory variables. CONCLUSIONS: We demonstrated convergent construct validity for three quality indicators (blood transfusions, length of hospital stay, and non-nerve-sparing surgery). If their validity is further demonstrated in future studies, these indicators could be used for quality assessment and could provide feedback to surgeons, surgical department heads, hospital administrators, and quality councils by suggesting areas for quality improvement in surgical care, such that future outcomes can be optimized. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2007-08-23 17:53:33.166

At the Primary Health Care Centre in Vännäs (VPHCC), northern Sweden, a development work was implemented in 1976-1980. The overall purpose was to enhance primary health care planning. In trying to improve health care delivery cooperation with community members was initiated and some organizational changes like a new appointment system, a new medical record and local care programs for some common diseases were introduced. Official statistics were also used for comparative purposes. The aims of the work were postulated (increased accessibility, higher continuity, more equitable distribution and enhanced cooperation) and suitable methods were designed. From postal surveys, chartreviews and administrative data (from hospitals, out-patient clinics and health centres) figures and information were collected. Accessibility was studied by waiting room time which was reduced and continuity, analyzed with a new concept - visit based provider continuity - was improved. The question of equitable distribution was studied by the consultation rates at different out-patient clinics. It seemed as if the local development work changed the patterns of utilization but some important issues were not decisively answered. Repeated postal surveys reflected the question of equitable distribution and the cooperation between the VPHCC and the community members. Positive responses were recorded in aspects like telephone accessibility and health care information. In a tracer study of diabetes the quality of care was studied. The local care program was actually implemented in the daily practice but the question of care quality needs further penetration. Within the frames of the development work new methods in the health care planning were introduced. Our work started from the prerequisits of the VPHCC and other health centres might find other ways of planning for care provision. On a general level, however, the structure of our work - defining aims, means and evaluation methods - can be used by others. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1986, härtill 6 uppsatser.</p> / digitalisering@umu

Patienter med ögonsjukdomar är en stor patientgrupp som förväntas öka, då många av sjukdomarna är åldersrelaterade och befolkningen i världen blir allt äldre. Ett stort antal av patienterna kommer att förekomma på olika vårdavdelningar där de vårdas av annan orsak. Omvårdnad är sjuksköterskans huvudansvar och hennes profession medför att riktlinjer och lagar ska följas i samband med yrkesutövning. Syftet med pilotstudien var att undersöka sjuksköterskors erfarenheter av att ge omvårdnad till inneliggande patienter med olika ögonsjukdomar i anamnesen. Pilotstudien genomfördes med en kvalitativ metod och datainsamlingen skedde genom intervjuer. Data analyserades med kvalitativ innehållsanalys. Resultatet sammanställdes i tre kategorier: Att erfara bristfälligt ansvarstagande, Att erfara behov av prioriteringar och Att erfara okunskap om ögonsjukvård. Sjuksköterskorna erfor bristfälligt ansvarstagande och de ansåg omvårdnadsarbetet med patienter med olika ögonsjukdomar i anamnesen som svårt. De ansåg sig sakna tillräckligt med kunskap och arbetsbelastningen ledde till att de var tvungna att prioritera på ett sätt som inte gynnade patientgruppen. Sjuksköterskorna uttryckte ett behov av mer utbildning inom detta område. Mer kunskap skulle kunna bidra till att de upplevde en ökad trygghet i sin yrkesroll och leda till en högre patientsäkerhet. Pilotstudien visar att det finns förbättringspotential för att höja patientsäkerheten och som bör följas upp i en fullskalig studie. / Patients with ocular diseases are a large group which is expected to increase since many of the ocular diseases are age-related and world population is aging. These patients are found in various wards where they are inpatients because of other causes than ocular diseases. Nursing care is the nurse´s major responsibility and they are obliged to follow guidelines and laws regularizing their profession. The purpose of this pilot study was to investigate nurses´ experience of providing care for inpatients with any ocular disease, in their anamnesis. The pilot study was conducted using a qualitative content analysis using interviews. The results were compiled into three categories; Experiencing inadequate accountability, Experiencing the need for priorities, and Experiencing the ignorance of ophthalmology. The nurses in the pilot study experienced nursing care to patients with various eye diseases in history difficult. They thought they lacked sufficient knowledge and because of the workload which made them prioritize in a way which did not benefit the patients. The nurses expressed a need of more education in ophthalmic care. More knowledge would support them in experiencing an increased security in their profession and lead to improved patient safety. The pilot study shows that there is potential for improvement to enhance patient safety and should be followed up in a full scale study.

Aim: The overall aim of the present thesis was to describe and evaluate IT support in dementia care from the perspectives of staff and relatives. More specifically, it was to examine staff members’ satisfaction with work, life satisfaction and sense of coherence before and after increased IT support, to describe staff members’ opinions and perceptions of IT support during the process of implementation, to describe relatives’ opinions of IT support and to compare relatives’ perceptions of their irritations with care and life satisfaction before and after increased IT support. In addition, three questionnaires were further developed and tested among staff working in elderly care, and then used in the staff evaluation. Methods: A quasi-experimental design with baseline assessments and follow-ups and experimental and control groups was used in two studies to investigate the outcomes of IT support. A descriptive design was used to study staff views on IT support, and a correlative design was used in the methodological study. Participants were 33 staff members and 22 relatives in the evaluation, 14 staff members in the descriptive study and 299 staff members in the methodological study. Data collection methods were questionnaires and group interviews. The IT support consisted of passive passage alarms, fall detectors, sensor-activated night-time illumination of the lavatory, movement detectors, email communication, an Internet website and additional computers. Findings and conclusions: Staff job satisfaction and perceived quality of care increased in the experimental group. The relatives were generally positive about the IT support, and the experimental group showed a decrease in practical/logistical irritations. Staff described ‘moving from fear of losing control to perceived increase in control and security’ and ‘constant struggling with insufficient/deficient systems’. Conclusions are that IT support can be a resource in dementia care as perceived by caregivers if IT support is incorporated into the care system.

In this thesis, I describe the behavioural ecology of an Australian passerine, the Southern Emuwren Stipiturus malachurus (Maluridae). The southern emu-wren is threatened in several parts of its range, and yet information on the species’ breeding biology, habitat use and mating system is lacking. These data are fundamental to effective conservation management. My research investigated the breeding behaviour and habitat ecology of a population of southern emu-wrens in Portland, Victoria, Australia, over three breeding seasons (2000/01, 2001/02 and 2002/03). also collected data pertaining to habitat use from populations located in Anglesea and Lower Glenelg National Park (Victoria, Australia). Southern emu-wrens commonly formed socially monogamous pair bonds, although cooperative breeding was observed for the first time in this species, where male offspring within several families delayed breeding to help raise younger siblings. Successful nests produced 1.8 fledglings on average, however, a nest had only a 56% chance of success during incubation and nestling phases. Nest failure was mainly attributed to depredation and snakes were identified as major nest predators. The slow breeding rate of the southern emu-wren is typical of a small passerine in the Southern Hemisphere. Nevertheless, adult mortality was unusually high. In one breeding season the adult population was reduced by 50%. The population recovered when individuals dispersed from the adjacent coastal heathland to fill territory vacancies. This highlights the vulnerability of populations to local catastrophe, and potential extinction if spatial separation of populations exceeds the species’ dispersal capacity.

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 33-35).

Background: To improve and develop the psychiatric care it is important to evaluate the patient’s experiences. Regarding inpatient psychiatric care the patients’ experiences of satisfaction and quality of care is researched to a relatively small extent. For this reason, it can be difficult to identify important development areas.  Aim: The overall aim with this study was to measure the patients’ experiences of quality of care and satisfaction with inpatient psychiatric care.   Method: Cross-section study with a quantitative approach. Data was collected from one survey with questionnaires and analysed with descriptive and non-parametric statistic methods.  Main result: Regarding satisfaction patients estimated 3,0 of 4,0 in median on all the questions and around 3,0 in average. A slightly higher average (3,2) was seen in questions regarding if the patient would recommend the business to a friend, and how pleased the patients were with the extent of the help they had received. Regarding the experience of quality of care the highest ratings were seen in the dimensions Secluded environment and in Encounter. The lowest ratings were seen in Support. There were no significant differences between the subgroups regarding satisfaction. Neither were there any significant differences in the subgroups regarding quality of care, besides if the patient had previous inpatient care. This led to lower ratings for the experience of Secure environment. Correlation was seen between many of the dimensions and the questions about satisfaction.  Conclusion: This study shows that the participants are pleased in general with inpatient psychiatric care, even though there are low ratings in several areas. To improve the psychiatric care there is a need for further studies to get a broader picture