The problem of overcrowding is one of the serious issues that almost every emergency department (ED) in Taiwan has to face on daily basis. ED crowding results in adverse medical outcomes, decline in quality of care, and lack of the ability to provide instant medical care. One of the viable (but not necessarily preferable) solutions to ED overcrowding is ambulance diversion (AD). That is, ambulances would bypass the ED¡¦s unable to provide emergency medical service, and send patients to another emergency department. In many medical systems, ambulance diversion is being seen as a standard operating procedure, whose effectiveness needs to be carefully studied before making a sound policy. In this research, an input-throughput-output simulation model is proposed for simulating ED operation. A computer simulation program is developed based on this model to evaluate various AD initiating criteria, patient-blocking rules, and AD intervals. The crowdedness index, the patient waiting time for service, and the percentage of adverse patients were assessed to determine the impact of various AD policies. By appropriate parameter settings, this simulation model can represent medical resource providers of different scales. The results we obtained may offer insights for making effective AD policies.

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The study examined the relationship between building conditions and overall student behavior as well as the relationship between building conditions and the behaviors of student subgroups that include Caucasian, African American, Hispanic, and Students with Disabilities (SWD). The study controlled for over-crowdedness, socioeconomic status, and attendance. The study included 10 school facilities in a medium-sized school division in Virginia. Building conditions were determined through facility engineering and educational condition. Facility Condition Indexes (FCIs) described facility engineering conditions. The Revised Commonwealth Assessment of Physical Environment (CAPE) instrument initially developed by Cash (1993) and revised by Cash and Earthman (2019) assessed facility educational conditions. The CAPE instrument provided overall, structural and cosmetic facility condition scores and was administered to principals. Student behavior was determined by student overall behavior indexes as well as subgroup-based behavior indexes representing the ratio of discipline incidents divided by student population. School-specific over-crowdedness indexes were utilized. Free and reduced lunch percentages were used as a measure of socioeconomic status. For attendance, the study used attendance indexes described by the percentage of students who were absent for at least 10% of the academic year. To establish the potential relationships between building conditions and student behavior in each student subgroup, the study used quantitative analysis utilizing hierarchical multiple-variable regression and analysis of variance (ANOVA) through the Statistical Package for Social Sciences (SPSS). The researcher conducted individual single-predictor and multiple-variable hierarchical regression models. ANOVA was utilized to explain the total variance in the regression model, and the variance due to each predictor. The researcher identified regression relationships, their statistical significance, and interpreted results to reach a conclusion addressing each research question. Potential relationships between building conditions and student behavior were highlighted. The study identified that higher numbers of disciplinary incidences were related to higher absenteeism rates within all student groups. Further, lower numbers of Hispanic student disciplinary incidences were associated with poorer student populations. In terms of facility conditions, lower numbers of Hispanic student and SWD disciplinary incidences were associated with improved cosmetic facility conditions and lower numbers of SWD disciplinary incidences were associated with improved overall facility conditions. / Doctor of Education / The study examined the relationship between building conditions and overall student behavior as well as the relationship between building conditions and the behaviors of student subgroups that include Caucasian, African American, Hispanic, and Students with Disabilities (SWD). Over-crowdedness, socioeconomic status, and attendance were mediating factors. The study included 10 school facilities in a medium-sized school division in Virginia. Building conditions were determined through facility engineering and educational condition. Facility Condition Indexes (FCIs) described facility engineering conditions. The Revised Commonwealth Assessment of Physical Environment (CAPE) instrument initially developed by Cash (1993) and revised by Cash and Earthman (2019) assessed facility educational conditions. The CAPE instrument provided overall, structural and cosmetic facility condition scores and was administered to principals. Student behavior was represented by the ratio of discipline incidents divided by student population for overall students and student subgroups. School-specific over-crowdedness measures were utilized. Free and reduced lunch percentages were used as a measure of socioeconomic status. For attendance, the study used the percentages of students who were chronically absent. To establish the potential relationships between building conditions and student behavior in each student subgroup, the study used quantitative analysis utilizing hierarchical multiple-variable regression and analysis of variance (ANOVA) through the Statistical Package for Social Sciences (SPSS). The researcher assessed the impact of each facility condition individually as well as collectively on student behavior. ANOVA was utilized to explain the total contribution attributed to each predictor. The researcher identified relationships, their statistical significance, and interpreted results to reach a conclusion addressing each research question. Potential relationships between building conditions and student behavior were highlighted. The study identified that higher numbers of disciplinary incidences were related to higher absenteeism rates within all student groups. Further, lower numbers of Hispanic student disciplinary incidences were associated with poorer student populations. In terms of facility conditions, lower numbers of Hispanic student and SWD disciplinary incidences were associated with improved cosmetic facility conditions and lower numbers of SWD disciplinary incidences were associated with improved overall facility conditions.