Thesis (M.S.)--University of Michigan, 1995.

Thesis (Ph. D.)--Rand Graduate School, 2002. / Includes bibliographical references (p. 64-70).

nÃo hà / Este trabalho teve por objetivo realizar um estudo analÃtico relativo à sustentabilidade financeira dos beneficiÃrios da carteira de uma operadora de planos de saÃde. A amostra investigada no estudo à de uma operadora de plano de saÃde vinculada ao Banco do Nordeste do Brasil S.A. (BNB) e à composta por 38.875 usuÃrios, ativos, entre os anos de 2011 e 2013. Especificamente, buscou-se nesse trabalho aplicar tÃcnicas de classificaÃÃo de insustentabilidade financeira de beneficiÃrios de uma operadora de planos de saÃde, identificando o modelo de melhor ajustamento e os principais determinantes de insustentabilidade. As tÃcnicas estatÃsticas de classificaÃÃo supervisionada empregadas foram a regressÃo logÃstica, as Ãrvores de classificaÃÃo e o classificador de vizinhos mais prÃximos. AlÃm disso, foi empregada a curva ROC para comparar os desempenhos das tÃcnicas utilizadas, sendo a Ãrea abaixo da curva (AUC), a principal medida observada. Os resultados obtidos mostraram que a maior parte da amostra à composta por beneficiÃrios sustentÃveis. O modelo de regressÃo logÃstica obteve precisÃo de 68,43% com AUC de 0,7501, as Ãrvores obtiveram 67,76% e AUC de 0,6855, enquanto o classificador dos vizinhos mais prÃximos teve uma precisÃo de 67,22% e AUC de 0,7258. As variÃveis apontadas como mais importantes pelos dois primeiros modelos, considerando uma anÃlise conjunta, sÃo a Idade e o Tipo de Plano, dentre aquelas que definem o perfil do usuÃrio e a Receita, Consulta e Odontologia, daquelas que definem o histÃrico de utilizaÃÃo do usuÃrio / This study aimed to carry out an analytical study on the financial sustainability of the beneficiaries of the portfolio of managed care plans. The sample investigated in the study is a health plan operator linked to the Banco do Nordeste do Brazil SA (BNB) and consists of 38,875 members, assets, between the years 2011 and 2013. Specifically, we sought to apply techniques that work financial unsustainability classification of beneficiaries of a managed care plans, identifying the model best fit and the main determinants of unsustainability. The technical classification statistics were supervised employed logistic regression, classification trees and the classifier closest neighbors. Furthermore, the ROC curve was used to compare the performance of the techniques used, and the area under the curve (AUC), the main extent observed. The results showed that most of the sample is composed of organic recipients. The logistic regression model obtained precision of 68.43% with AUC of 0.7501, the trees obtained 67.76% and AUC of 0.6855, while the classifier of the closest neighbors had an accuracy of 67.22% and AUC of 0.7258. The variables identified as most important by the first two models, considering a joint analysis, are the Middle and the Plan type, among those that define the user profile and the Revenue Consultation and Dentistry, those that define the user use history

Orientadores: Roberta Cunha Rodrigues Colombo, Maria Cecilia Jayme Bueno Gallani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T16:08:54Z (GMT). No. of bitstreams: 1 Pinto_CristianoJoseMendes_M.pdf: 11508571 bytes, checksum: 3c11ab6f502e13fad691910fcd7f1e96 (MD5) Previous issue date: 2004 / Resumo: Este estudo teve como objetivo identificar, a partir da Teoria do Comportamento Planejado (TPB), os fatores que contribuem para a formação da intenção comportamental do enfermeiro para realizar o estudo hemodinâmico por meio do cateter de artéria pulmonar (CAP). Os dados foram obtidos por meio de entrevista semi-estruturada junto a 23 enfermeiros de Unidades de Terapia Intensiva de dois hospitais públicos e um privado do município de Campinas-SP. A natureza exploratória deste estudo com o emprego de questões abertas permitiu uma análise de caráter qualitativo dos dados coletados, que foram apresentados de acordo com as Unidades Temáticas Centrais: Crenças de Atitude, Normativas, de Controle e Gerais. A análise das entrevistas evidenciou que entre as Crenças de Atitude destacam-se as crenças afetivas negativas e positivas em relação ao comportamento e aquelas relativas às vantagens e desvantagens da realização do estudo hemodinâmico. Na unidade Crenças Normativas, foram evidenciados os referentes sociais positivos para a execução do comportamento: médico, enfermeiro, paciente, bem como os fatores estimuladores do comportamento: "responsabilidade do enfermeiro no cuidado do paciente" e "interesse na recuperação do paciente"; como referentes negativos: equipe médica e serviços de educação continuada, e, como fatores que desestimulam: "déficit de conhecimento", "dificuldades para execução do procedimento" e "pequena utilização dos dados do estudo hemodinâmico pela equipe médica". Dentre as Crenças de Controle, destacaram-se os fatores facilitadores e/ou dificultadores: material, equipamento, número de profissionais, conhecimento, tempo, sobrecarga de atividades, equipe de enfermagem e médica. Os dados obtidos subsidiarão a construção de uma escala psicométrica para a compreensão e predição do comportamento em estudo / Abstract: The purpose of this study was to identify, by means of the Theory of Planned Behavior (TPB), the elements leading to the development of nurses' behavioral intention when performing a hemodynamic study in patients through pulmonary artery catheter (PAC). Data were obtained by using semi-structured interviews made with 23 Intensive Care Unit nurses from two public and one private hospitais in the city of Campinas, São Paulo state, Brazil. The exploratory nature of this study allowed a qualitative sort of analysis of the data collected, which were then presented according to the following Central Theme-based Units: Attitude, Normative, Control and General Beliefs. The analysis of the interviews highlighted that, conceming the Attitude Beliefs, there are positive and negative aftective beliefs regarded to both behavior and to the advantages and disadvantages in carrying out the hemodynamic study. As to the Normative Beliefs Unit it is possible to emphasize some positive social references present in the behavioral response such as the physicians, nurses and patients, as well as some elements proved to stimulate behavior: nurses' responsibility towards the patients' care and interest in the patients' recovery; among the negative references are: the medical staft and continuing education services; regarding the non-stimulating elements we can mention: knowledge deficit, difficulties in carrying out the procedures and low use of the hemodynamic study data by the medical staft. The Control Beliefs displayed some elements which can either facilitate and I or make the behavior difticult: material, equipment, number of professional people, knowledge, time, tasks overload, nurse and medical staft. The data obtained will enable the creation of a psychometric scale which will be used to understand and predict the behavior presently studied. / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

No description available.

Improvement of patient care in any hospital depends primarily on the quality of nursing care. Nursing care is enhanced by the nursing process, which outlines the nursing activities to be provided for a patient. The purpose of this study was to determine to what extent the nursing process could improve the quality of nursing care, and to explore the knowledge limitations of nursing staff in implementing the nursing process, nursing care planning and proper documentation. Quantitative research, making use of an exploratory, descriptive and contextual design was conducted, utilising a structured questionnaire for data collection. Registered nurses (n=120) employed at a Referral Hospital in Tanzania served as the respondents. The findings revealed a lack of knowledge in understanding and applying the concepts of the nursing process, especially in formulating the nursing diagnosis. Recommendations pertaining to a focused in-service training programme, integrating theory and practice, were made to enhance the effective implementation of the nursing process. / Health Studies / M.A. (Health Studies)

Psychology / M.A. (Clinical Psychology)

Thesis (MBA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: This report provides a broad overview of the health industry, and the dental industry in particular, identifying trends and searching for possible solutions to problems posed by these trends. It attempts to offer perspectives of importance to all the stakeholders in health care - the patients, the providers of care and third party payers. The current focus of healthcare industry is not actually the health of the patient. Practitioners (the providers) focus too much on treatment, while insurance companies and governments (the payers) emphasise cost containment. As national health care costs spiral, it is ironic that the main reasons for the dramatic health improvements over the last few decades are improvements in socio-economic factors and changes in lifestyle, rather than better treatment. The willingness of insurers to cover new or improved services has acted as a continuing stimulus to cost-increasing advances in medical technology and in tum to spending growth. Managed care has evolved to attempt to improve resource allocation in health care. Thirdparty private-sector regulators have wrested power from government regulators. Their gain in power relative to private practitioners has shifted the power balance from the supply side to the demand side of health care. By leveraging their power in the use of information technology, the practitioner has been forced into a defensive, reactive stance. Managed care is being implemented by profit-driven third parties that benefit from the cost savings. As health providers are the ones who have to implement the cost-savings; it is proposed that they are the ones who should manage healthcare. The ideal would be a coordinated approach with funders and service providers working toward a common goal. Financial accountability is forcing dental practitioners to evaluate their mode of practice in a critical manner. Promoting health, by educating and evoking behaviour change will create a better world for current and future generations. There is a shift in focus from the health of the individual at all costs, to the health of the population. There should be a special emphasis on the dental health of children for whom prevention offers the most gain in outcome. Evidence-based care evolved from the search for the best care, in terms of quality and price, outcome and process, and attempts to reduce variability and subjectivity in clinical decisions, by using systematic reviews of quality evidence to increase objectivity. Emphasis on improved outcomes provides earlier, more valuable, long-term improvements for a patient, than the later, short-term benefit of a cure. Because most canes and gum disease is preventable, dental health professionals should accentuate health promotion and education of patients. The benefits would be to the advantage of all stakeholders in health. A focus on prevention for children could be the ideal form of dental private practice to instil oral wellness in children. / AFRIKAANSE OPSOMMING: Hierdie verslag is 'n breë oorsig van die gesondsheidsindustrie, en van die tandheelkunde industrie in besonder om tendense te identifiseer en na moontlike oplossing te soek vir probleme wat hieruit mag spruit. Dit poog om perspektiewe aan te bied wat van belang is vir die betrokke rolspelers - die pasiënte, die diensverskaffers en die befondsers. Die huidige fokus van gesondheidsorg is nie eintlik die gesondheid van die pasiënt nie. Die die voorsieners van sorg fokus meestal op behandeling, terwyl versekeringsmaatskappye en die regering (die betalers) fokus op die besnoeing van koste. Terwyl nasionale gesondheidskostes styg, is dit ironies dat die belangrikste redes vir die dramaties verbetering in gesondheid oor die laaste paar dekades eerder verbeteringe in sosioekonomiese faktore en veranderinge in leefwyse is as beter behandeling. Die bereidwilligheid van versekeraars om nuwe en verbeterde dienste te dek, is die oorsaak van die aanhoudende stimulus vir mediese tegnologiese vooruitgang en koste stygings. Bestuurde sorg het ontwikkel om te probeer om bron toewysing in gesondheidsorg te verbeter. Derde party privaatsektor-reguleerders het die mag van regering-reguleerders ontruk. Hul invloed, relatief tot die van privaat praktisyns, het die mags-ewewig verskuif van die voorsienings- na die aanvraagkant van gesondheidsorg. Deur die gebruik van hulle voordeel op die gebied van inligtingstegnologie, het hulle die praktisyn in 'n defensiewe houding gedwing. Bestuurde Gesondheidsorg word beheer deur winsgedrewe derde partye wie baat vind by kostebesparings. Aangesien gesondheidsverskaffers die kostebesparings moet implementeer, word daar aanbeveel dat hulle gesondheidsorg moet bestuur. 'n Gesonde samewerkings ooreenkoms tussen befondsers en diensverskaffers is wenslik. Finansiële verantwoordelikheid dwing tandartse om hulle praktyke krities te evalueer. Daar is 'n fokus verskuiwing vanaf die gesondheid van die individu, ten alle koste, na die gesondheid van die bevolking. Besondere klem behoort geplaas te word op die mondgesondheid van kinders, vir wie voorkoming die meeste baat inhou. Bewys-gebaseerde Gesondheidsorg het ontwikkel uit die soektog na die beste sorg in terme van kwaliteit en koste, uitkoms en proses, en pogings om wisselvalligheid en subjektiwiteit in kliniese besluite te verminder. Klem op beter resultate gee vroeër, meer waardevolle langtermyn verbeteringe vir die pasiënt, as die later kort-termyn voordele van genesing. Omdat tandbederf en tandvleissiektes voorkombaar is, behoort tandheelkundiges die bevordering van mondgesondheid te beklemtoon. Voorkoming by kinders word gesuggereer as die ideale vorm van privaat praktyk om mondgesondheid te bevorder.

The introduction of Education, Health and Care (EHC) plans proposed in the Children and Families Act 2014 has aimed to give parents and children who are going through the assessment process greater control and choice in decisions, and enhance the multi-professional collaboration between education, health services and social care. This research seeks to evaluate to what extent parents’, children and young people’s, and professionals' experiences correspond to these values at an early stage of implementation. The methodology of this thesis is based on a realistic evaluation framework informed by the work of Pawson and Tilley (1997). Realistic evaluation aims to construct a programme theory which links three distinct broad aspects of a programme: its context, mechanisms and outcomes (C-M-Os). This research employs a programme theory of how an EHC assessment is conducted and has been developed from the current literature on person-centred theory. Person-centred theory has been chosen because of its corresponding value base to the SEND reforms and the recommendation of its use in a number of government policy documents including the SEND Code of Practice (DfE, 2014). The programme theory has been used to devise questionnaires that have sought to gain professionals' experiences of the assessment process, particularly in relation to multi-agency working, and their perceptions of the person-centred nature of the assessment. In addition, five case studies have explored these issues in more depth to ascertain whether the EHC assessment process in this authority is meeting the core aims of the Children and Families Act 2014. Semi structured interviews and card sorting tasks were devised using the programme theory and conducted with a total of one child, five families and five professionals from five individual EHC assessments. This analysis goes beyond a description of the facilitating factors and barriers to person-centred support and examines how person-centred outcomes arise from specific contexts and mechanisms. Findings suggest that experiences of face-to-face multi-professional collaboration were positive within the EHC assessment group. Nevertheless, professionals expressed frustration that in some cases colleagues were not able to attend meetings due to time constraints, capacity within their services and the commissioning arrangements of their services. Parental and professional experiences of the process appear to be positive. The research demonstrates one case study where a person centred planning approach was utilised very successfully from the perspective of all involved. However, there are significant concerns raised in both phases of this study as to the way in which children and young people are provided with opportunities of contributing to their EHC assessment. The findings are relevant to the development of the EHC assessment process in the local authority (LA) in which I am employed, and will contribute to the debate about the role of educational psychologists (EPs) in evaluating this national policy.

Adolescents with Type I and Type II diabetes need to monitor blood glucose and food intake, administer insulin, and participate in activities including physical education during school hours to maintain glycemic control. Glycemic management programs (GMPs) exist for the improvement of diabetes management during school hours. The purpose of this project was to evaluate a GMP in a school system in a rural area in the Southeastern United States. The goal was to determine if the existing GMP met objectives and to make recommendations for continuation, revision, or discontinuation of the GMP. The logic model provided the basic framework for the evaluation of the GMP by using a graphic flowchart depicting health outcomes prior to and after the implementation of the program. The review consisted of approximately 2,100 students from 9th to 12th grade, and out of those students there were 77 participants from 2010 and 89 participants from 2015 with diagnosis of diabetes. A t-test outcome evaluation found the updated GMP was associated with the lowering of hemoglobin A1c readings. Mean A1c in 2009 was 8.6% (180 - 190 mg/dl), with the mean decreasing to 7.2% (150 mg/d) in 2015. Changes in the program led to 1-to-1 care management based on children's individual needs and parental involvement. Findings show that the GMP improved glycemic management by empowering and individualizing care. This project contributes to positive social change by contributing to data from the Diabetes Prevention Program Research Group study showing that prevention of onset of Type II diabetes mellitus in adults and adolescents is successful through early detection of prediabetes in childhood.