<p> Time-Drive Activity-Based Costing (TDABC) is a bottom-up costing approach that involves calculating a unit cost of supplying capacity (Capacity Cost Rate) and estimating time spent performing an activity. TDABC has been implemented in healthcare; however, most of the studies have been conducted at a project or departmental level. A pilot study based on the TDABC principles was performed for proof of concept at UT MD Anderson Cancer Center. In the pilot study, the TDABC cost was first calculated manually and later by software. The goal of this research study was to evaluate the feasibility of devising and implementing an effective / reliable / robust system of cost measuring to provide the true costs of patient care delivery institution-wide in an academic medical center. Chapter one provides a literature review of costing methods and costing in healthcare, a brief introduction of TDABC, and the significance of this study. Chapter two describes and analyzes the pilot study. Chapter three includes the review of conceptual models in the literature and the development of a conceptual model of implementing TDABC institution-wide in healthcare. Chapter four describes the methodology of generating practical and validated recommendations for an institution-wide implementation of TDABC and the final recommendations. Chapter five provides a brief summary of the current study, research and operational implications, as well as limitations and the future research. </p><p> The five recommendations generated are listed below: &bull; Gain top management support and horizontal and vertical collaboration, &bull; Educate and motivate staff to have an accurate concept of costing and an awareness of costing at all times, &bull; Understand existing information systems and develop a strategy to collect process, activity, resources and time information effectively and efficiently, &bull; Assess the current condition of the institution and determine the right timing of implementation by top management, &bull; Consider future enhancements with new technology such as a real-time location system</p>

Patients with terminal illness may benefit greatly from hospice and palliative care. Studies of patients with chronic terminal illness revealed that those who did not received palliative or hospice care experienced poor quality medical care characterized by untreated symptoms, unmet spiritual and personal care needs, increased burden for the caregiver, and low patient and family satisfaction (Meier, 2011). According to the World Health Organization (2011), palliative care is offered at the time of diagnosis alongside potentially curative treatment and can be utilized during the trajectory of illness until death. Hospice is a Medicare benefit considered the model for quality, compassionate care during the last 6 months of life and is available to all patients regardless of age, religion, race, or illness (Medicare Hospice, 2011). This study examined why patients with non-cancerous terminal illness were not receiving timely palliative or hospice care by interviewing primary care providers. A systemic literature review suggested possible barriers including confusion between palliative and hospice care, lack of understanding about the scope and intent of hospice care (McAteer & Wellberry, 2013), prognostic uncertainty, timing, and no clear point to originate a referral (LeMond & Allen, 2011). Insufficient training for primary care providers, including the lack of familiarity with various prognostic tools that aid in determining eligibility for the patient with a non-cancerous, terminal diagnosis might also be a barrier to referral (McAteer & Wellberry, 2013). Lastly, primary care providers lacked confidence in communicating the need for advanced care planning in non-cancerous terminal illnesses according to a survey done by Karlekar, Collier, Paish, Olson, & Elsay (2014). The findings of this study confirmed the available literature. Much work is needed to educate providers and incorporate palliative care and hospice guidelines in academic institutions and in practice. Regulatory issues need continuous attention as the landscape of coverage, payment, and reimbursement changes rapidly. Further research is needed so that this vulnerable population will benefit from early interventions and a better understanding and acceptance of their non-cancerous terminal illness.

No description available.

No description available.

Frailty poses a complex challenge for some people through their experience of ageing. In Wales, devolution requires organisations to use a whole systems approach with a model of partnership to deliver public services. An integrated care approach is offered to meet the service user focus or ‗value demand‘ which impacts on clinical, professional, organisational and policy levels within the system. Therefore, the aim of this study was to explore whether there was a difference between integrated health and social care day services and non- integrated health and social care day services. In doing so, answering the questions, how were these services different, what were the differences as perceived by the participants, why were they different, what could be learned from this study and how could health and social care services integrate in practice? The study utilized Gadamer‘s interpretative hermeneutics with a single intrinsic case study design. Using this approach ensured that the unique voice of the individual lived experience was heard and interpreted within the whole system of the study. The participants were service users, carers and staff in a day hospital, an outpatient clinic, day centre, reablement team and a joint day care facility. The methods included a survey questionnaire (SF12v2 and London Handicap Scale), in-depth interviews, observations; and historical and service documents; and reflective diary. Data collection occurred January 2005 to December 2006. Quantitative and qualitative data were analysed separately. The qualitative data was analysed using Gadamer‘s five stage approach developed by Fleming et al (2003) and Nvivo 7.0. The embedded quantitative data was analysed using SPSS version 13.0. Triangulation was achieved through the use of a meta matrix which merged the qualitative and quantitative data. The difference between integrated and non integrated services is expressed through the four themes, ‗the study participants‘, ‗commissioning and decommissioning integrated services‘, ‗the journey within day services‘, ‗navigating services and orchestrating care‘. The four themes were developed through a strategy used for interpreting the findings, which was to follow the study questions, propositions and ‗emic‘ questions. The differences between the integrated and non integrated services were in the meaning of their purpose, culture, level of integration, team orientation of practice and the model of service user/carer relationship observed within the services. The thesis identified challenges in respect of integrated working such as concept confusion, negative experiences of care for frail or older people, a vertical gap in knowledge transfer between strategic organisation, the operational services and service users. Mapping each service level of integration and team orientation to the model of service user and carer relationship, found that the level of team orientation and integration does not appear to be proportionate to the service user and carer relationship. The thesis concludes that in order to attempt to answer the question as to whether these day services can integrate in the practice, all levels of the system should focus on the service user/carer relationship. We need to understand service user diagnosis, how its characteristics and effect are interpreted by the service user, carer, professional and wider society in relation to independence and autonomy. It argues that knowledge emerges at this micro level (service user and carer relationship) and how we engage with this relationship and manage the knowledge we gain from it (both vertically and horizontally), will lead us to understand how we can ensure that integration occurs and that services in the future are person focussed.

<p> Express Aid is an Urgent Care Center (UCC) that will be providing non-emergency care for the community of Riverside, California. With the expansion of Medicaid due to the Affordable Care Act (ACA) there has been a surge in Emergency Department (ED) usage which resulted in crowding, increased treatment time, and decreased patient satisfaction. Express Aid offers care ranging from primary care services to non-acute chest pain and functions as a walk-in basis. As a Limited Liability Company, Express Aid will function as a hybrid type of legal structure, which has the limited liabilities of a corporation as well as having the tax advantages and operational flexibility of a partnership. Express Aid will be the first center to open in an area where the population is increasing. Therefore, expenses and revenue will be forecasted based on competitors UCC needs, but will also take into account the future needs of the surrounding community. All forecasted finances are performed accurately by using conservative estimates, which will assist in properly developing an operational strategy.</p>

<p> The prevalence of overweight and obese individuals has been a critical issue which has caused a worldwide concerns for the health threats, since it is burdened due to several linked diseases. This business plan proposes the establishment of a for-profit health clinic named NutriMed that provides a quality care and is mainly patient centered. This clinic provide the care to decrease the prevalence of overweight and obesity among the children of the ages 5 to 19 years. The functioning of this clinic is based on Barlow et al approach for prevention and treatment of obesity using the multidisciplinary team effort, which consist of physician, dietitian, exercise expert, nurse and behavioral therapist. The goal of this health clinic is to improve the health in the Los Angles community especially for children. This is done by identifying the priorities and striving for a patient-centered and evidence based approach to care. While this plan acknowledges the challenges in serving indigent populations, the clinic will contract with Medi-Cal and commit to continuous fundraising efforts to remain financially sustainable in order to improve the health of vulnerable Angelino&rsquo;s children.</p>

<p>Hospital leaders who fail to respond to poor patient satisfaction reports may experience lower organizational performance. The purpose of this qualitative case study was to explore strategies of leaders in private health care settings to improve patient satisfaction. This study may provide strategies that health care leaders in the public setting can apply to improve patient satisfaction and organizational performance. One private health care provider operating in Vancouver, British Columbia, Calgary and Edmonton, Alberta, was selected as both private and public healthcare centers are located in these areas. Data were gathered from 12 participant interviews and from an examination of available physical artifacts such as organizational documents provided by the participants and the company website. Transformational leadership was the underlying conceptual framework for this research. Triangulation was used to ensure the rigorousness of the study. In the study, themes were identified after member checking the transcribed open-ended interview questions. The 5 themes identified were cohesive culture of employee engagement, patient-focused model of care, timely access and follow-up of results and coordination of care, continuous system quality improvement, and employee accountability. These themes underscore the importance of a culture of employee engagement; they also illuminate care that focuses on the patient-care that ensures timely access, follow-up and coordination of care, quality improvement based on patient feedback, and employee accountability. Current publicly-funded hospitals and health care centers may apply these findings to improve patient satisfaction and organizational performance. </p>

<p> Heart disease has been responsible for a significant number of morbidities and mortalities over the last century. As lifestyles and cultures change, so does the approach of management of the disease. With the advent of new technology over the last 6-7 decades the approach towards diagnosing heart diseases has changed a lot. Tools like electrocardiogram, two-dimensional echocardiography, cardiac stress test, Holter monitoring, etc. have become essential in the primary and secondary prevention of heart disease, and also in its management. This clinic is an effort to make these tests easily accessible, affordable and reliable to the patients and potential patients residing in the Orange County area who are at risk for heart diseases.</p>

No description available.