According to the empirical study, it is confirmed that physician satisfaction has great influence on patient satisfaction, and the physician¡Vpatient relationship could also affect health quality. The agreeableness and satisfaction of the healthcare providers (especially the physicians) to reimbursement system therefore should be emphasized especially with the intervention of health insurance. The objective of the study is to investigate the agreeableness and satisfaction of dentists to global budgets and their contributing factors. We survey dentists practiced within the Southern Branch and the Kao-Ping Branch regions of the National health insurance bureau with questionnaire. The primary result is as following: 1. The satisfaction of dentists to global budget after implementation: Male dentists are more satisfied than female detests. Dentists over 40 years old or with more than 15 years of practice experience are more satisfied. Solo practitioners are more satisfied than those who are employed or in partnership. Dentists practiced at Kaohsiung city have better stultification within the Kao-Ping Branch region; while the dentists, work in Jia-yi county are more satisfied than those at Tainan city within the Southern Branch region. Dentists with greater patient volume per day or longer business hours per week are less satisfied. Lastly, dentists whose service points claimed per month didn¡¦t decrease after the implementation of global budget are more satisfied with the system. 2. The agreeableness of dentists to global budget after implementation: Male, older dentists agree more with the reimbursement system. Dentists with more or equal service points claimed per month after implementation agree more with the global budget system. But those increase service hours per week are less agreeable to the system. Within the Kao-Ping Branch region, the dentists practice in Pun-hu county, are more agreeable than those at Kaohsiung city; those work in Jia-yi are more in agreement than those at Tainan within the Southern Branch region. Opened questionnaire indicated that surveyed dentists showed negative feedback on t the appropriateness, equity, and standardization of peer review. They further suggested the operation of dental association should be transparent, and the names of the dental clinics should be made known to the public if there¡¦s fraud. Besides, they also made some constructive suggestions such as the establishment of the public record of the oral cavity examination, periodic oral examination, and improvement of professional medical technology. Theses suggestions should be useful to the dental association for professional and quality improvement, standard protocol development and to the Bureau of the National Health Insurance for policy evaluation.

Infrastructure networks that provide basic services such as transportation, telecommunications, electricity distribution, and water supply and drainage are critical for the smooth functioning of a nation’s economy and its society. To provide efficient and uninterrupted services, these infrastructure networks need to be periodically inspected, upgraded, and maintained. However, infrastructure networks are expensive to operate and maintain; many infrastructure service providers allocate more than half of their total capital investments to network maintenance and improvement. With increasing customer expectations, intensifying global competition, and challenging financial environments, the infrastructure service providers need to develop models that can optimize all of the different factors that must be taken into consideration when making important decisions related to infrastructure network inspection and maintenance. This dissertation, which consists of three essays, focuses on some of the key decision issues associated with inspection and maintenance of these large infrastructure networks. Specifically, the first two essays, respectively, address a project management problem to maintain and expand a large-scale network and a periodic network inspection problem. The third essay, motivated by the computational challenges of the first two problems, addresses the network reduction and approximation problem within the same context. These problems are deterministic optimization problems over large-scale networks, which are very difficult to solve, and have not been extensively studied in the literature. In this dissertation, we introduce new optimization models for each problem, develop theoretical and algorithmic strategies that exploit problem structures to effectively solve the problems, and implement and test these methods on actual problems using data provided by an infrastructure service provider. / text

A significant change is taking place in manufacturing company strategies around the globe. With new monitoring and service methods, new opportunities of product use and service provision emerge. The manufacturing companies once focused on mere product manufacture, now have started to provide ‘systemic solutions’, i.e. products combined with service packages, which are often referred to as Product-Service Systems (PSS). Currently, there is not a well-established feedback mechanism between service and design. The aim of this research is to develop a methodology to capture, represent, and re-use service knowledge to support product design. For the accomplishment of this aim an extensive literature review of the related themes to the research area took place. It was found that the feedback from service to design is fundamental for the enhancement of product performance; however, the existing literature in this area is not adequate. The industrial investigation led to the realisation that there is not an established mechanism in place to show how service knowledge (SK) can be used by designers. An in- depth investigation took place with the collaboration of, in total, four UK manufacturing companies. The author studied both the conceptual and detailed design, focusing on the design requirements (DR) and the design/service features (DF/SF) respectively. The first step was the capture of SK and its representation using Protégé software. Following this, at the conceptual design stage, SK can be re-used through the DR-SK tool. The two main purposes of the tool are the knowledge retrieval by designers, and the identification of gaps in SK. At the detailed design stage, designers can access SK through the DF-SK tool, and the developed knowledge templates. The SKaD framework was created, as a result of the amalgamation among the SKaD methodology, the knowledge templates, and the tools developed to link SK and DR, SF, and DF. Conclusively, the framework was applied on case studies within the pump manufacturing and aerospace industries, and its purpose (to aid designers accessing and re-using SK) was validated by experts within the collaborating organisations. As a result of this research’s findings, the service personnel can capture SK in a structured manner, which can then be re- used by product designers at both the conceptual and detailed design stage.

Study on Service Quality of and Users¡¦ Satisfaction with Nursing Homes for the Aged ¡V Old People¡¦s Apartments in Kaohsiung County Abstract Raising children as insurance against the insecurity of old age has been a deep-rooted concept of the Chinese people. Traditionally, care and nursing of the aged are mostly done in families. However, with the change of social and life styles, as well as the reduction of fertility rate, such kind of concept has been put to a severe test now. In the early stage, a nursing home was mainly the shelter for homeless, solitary and poor old people. The concept of social welfare still remains in the stage of providing relief. Therefore, the old people who lived in the nursing homes were labeled as poor. Besides, ¡§the standard, contents and methods of service provided by the nursing homes also make the general people to halt in hesitation.¡¨ In fact, in addition to physiological satisfaction, the aged will also pursue the psychological satisfaction, i.e., a living worthy of human dignity, at their old age. This is right the ultimate goal to promote the business of nursing homes. Owing to the increasing demand for care and nursing of the aged, the government also encourages the establishment of private nursing organizations for the aged. Hence, the fee-for-service private nursing organizations of ¡§service¡¨ nature emerge gradually, apart from the government-supported nursing organizations of ¡§relief¡¨ nature. The old people who live in such an organization become ¡§welfare consumers¡¨. In Kaohsiung County, the old people¡¦s apartments are run in a fee-for-service mode under the sponsorship of the government, but they have to be responsible for the profit and loss of the apartments by themselves. The purpose of this study is to know the service quality of nursing homes at present and the old people¡¦s satisfaction with the service they received. (1) To understand the service quality of the nursing homes in order to provide a basis of their management for the government. (2) To understand the users¡¦ satisfaction with nursing homes in order to meet the demands of the aged. (3) To discuss the relationship between service quality of the nursing homes and the user¡¦s satisfaction.

Thesis (M.S.W.)--University of Hong Kong, 1975. / Typewritten.

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (p. [55]-60).

Made available in DSpace on 2016-08-29T15:33:29Z (GMT). No. of bitstreams: 1 tese_8359_Doctoral_Thesis_NARDI_2014.pdf: 6283699 bytes, checksum: b714f48398e126539d557c6e84aa0422 (MD5) Previous issue date: 2014-12-10 / Nowadays, the notion of service has been widely adopted in the practice of economic sectors (e.g., Service, Manufacturing, and Extractive sectors), as well as, in the research focus of various disciplines (e.g., Marketing, Business, and Computer Science). Due to that, a number of research initiatives (e.g., service ontologies, conceptual models, and theories) have tried to understand and characterize the complex notion of service. However, due to particular views of these disciplines and economic sectors, a number of different characterizations of service (e.g., service as interaction, service as co-creation of value, and service as capability / manifestation of competence, among others) have been proposed. The existence of these various non-harmonized characterizations, and the focus on a terminological debate about the service concept, instead of about the service phenomena from a broad perspective, make the establishment of a unified body of knowledge for service difficult. This limitation impacts, e.g., the establishment of unified conceptualization for supporting the smooth alignment between Business and IT views in service-oriented enterprise architecture (SoEA), and the design and usage of service modeling languages. In this thesis we define a theoretical foundation for service based on the notion of service commitment and claims as basic elements in the characterization of service relations along service life-cycle phases (service offer, service negotiation, and service delivery). As discussed in this work, this theoretical foundation is capable of harmonizing a number of service perspectives found in the literature. Such theoretical foundation is specified in a well-founded core reference ontology, named UFO-S, which was designed by adopting a sound ontological engineering apparatus (mainly, a well-founded ontology representation language, OntoUML, and approaches of model verification and model validation). As a kind of theory, UFO-S was applied in the analysis of SoEA structuring principles in order to define a commitment-based SoEA view, which remarks social aspects inherent in service relations usually underexplored in widely adopted service-oriented approaches (such as SOA-RM by OASIS, ITIL, and ArchiMate). Based on this, UFO-S was also applied in an ontological analysis of service modeling at ArchiMates Business layer. Such ontological analysis showed some limitations concerned to semantic ambiguity and lack of expressiveness for representing service offerings (and type thereof) and service agreements in SoEA. In order to address these limitations, three service modeling patterns (service offering type pattern, service offering pattern, and service agreement pattern) were proposed taking as basis UFO-S. The usefulness of these patterns for addressing these limitations was evidentiated by means of an empirical evaluation. Finally, we can say that, beyond offering a broad and well-founded theoretical foundation for service able to harmonize service perspectives, UFO-S presented benefits as a reference model in the analysis of SoEA structuring principles, and in the (re)design of service modeling languages.

Objectives: Managed care organizations reduce healthcare costs and may improve patient health outcomes by encouraging better control of prevalent chronic diseases. The purpose of this study was to determine whether changing from a fee-for-service program to a capitated managed care program improved medication adherence for Medicaid patients in Kentucky with hypertension, hypercholesterolemia, or type 2 diabetes. Methods: We conducted a quasi-experimental study of patients enrolled in Kentucky Medicaid to evaluate the impact of transitioning to capitated managed care in November 2011. Medication adherence was measured using the proportion of days covered (PDC) method. Multivariable analyses measured the adjusted differences in adherence as a result of the implementation of capitated managed care. Results: Adjusted analyses indicate an average decrease in PDC by about 17-22 days of therapy coverage in the post-policy time period. However, no significant difference in adherence rate changes between the treatment and control populations were observed. Conclusions: Results indicate clinically inconclusive evidence regarding the immediate effect of the implementation of Medicaid managed care in Kentucky on medication adherence rates in patients with prevalent chronic diseases. There is a need to address the decline in average adherence rates, and the efficacy of Medicaid managed care based on medication adherence.

<p>The objective of this research is to develop recommendations on calibration standards, scanning procedures, and acceptance criteria for phased array ultrasonic testing (PAUT) of complete joint penetration butt welds within the AWS D1.5 Bridge Welding Code. These recommendations include the development of a rational acceptance criteria which is based in engineering analysis and fracture mechanics. It is expected that the updated scanning procedures and acceptance criteria will result in improved reliability for bridges and improved consistency in bridge fabrication quality.</p><p><br></p> <p> </p> <p>While PAUT was included in the 2015 edition of AWS D1.5 in Annex K, the acceptance criteria for this procedure was developed as an adaptation of an existing conventional ultrasonic testing (UT) acceptance criteria in AWS D1.1. Therefore, the acceptance criteria in AWS D1.5:2015 is a workmanship-based criteria and is not based on engineering analysis of the criticality of weld flaws. The scanning procedures and application of PAUT inspections of bridge welds according to this procedure differ greatly from the scanning procedures outlined in AWS D1.5 for conventional UT inspections. Previous research has shown that differences in flaw rejection are possible for PAUT and conventional UT ultrasonic methods under the AWS D1.5:2015 approach.</p><p><br></p> <p> </p> <p>In order to develop recommendations for improved calibration standards, scanning procedures, and acceptance criteria for PAUT within AWS D1.5, this research project utilized both analytical techniques and experimental testing. This research project included determination of target critical flaw sizes for routine detection and rejection through fitness-for-service evaluations. This was followed by a round robin ultrasonic testing program in order to collect data on the variability of inspection results of eleven weld samples with nineteen weld flaws using different ultrasonic inspection techniques. Next, calibration requirements were developed to account for differences in ultrasonic attenuation and shear wave velocity between calibration blocks and test objects. Development of these requirements included experimental testing of base metals and weld metals, along with simulations of ultrasonic inspection using commercial software. Finally, minimum requirements for weld scanning procedures, reference standard reflectors, and corresponding amplitude limits for detection and rejection of target critical weld flaws were developed using ultrasonic inspection simulations and verified through experimental testing of weld samples with known weld flaws.</p>

Componentes e equipamentos utilizados na indústria petroquímica estão suscetíveis a presença de descontinuidades e, por esta razão, diversas pesquisas são desenvolvidas com o intuito de aprimorar e criar novos métodos para evitar, remediar ou controlar estas, de forma a não causarem um dano à integridade estrutural. Neste trabalho é avaliado um conjunto de trincas induzidas pelo hidrogênio (TIH), através do método de elementos finitos, com a finalidade de verificar o fenômeno de união das suas extremidades formando uma trinca contínua do tipo SWC (Stepwise Cracking). Também se verifica a influência do conjunto de trincas à integridade da estrutura com base na metodologia Fitness for Service (FFS) através do uso dos diagramas de avaliação de falhas (FAD – Failure Assessment Diagram) indicados pelas normas API-579 / ASME FFS-1 e BS 7910 além do procedimento CEGB-R6. Os resultados mostram que o efeito de interação entre as extremidades é intenso quando estas se encontram próximas umas das outras, confirmando assim a tendência de união das fissuras. Também se constata que o fenômeno é fortemente influenciado pela pressão interna presente nas TIH, esta causada pela presença de hidrogênio. Em relação à aceitabilidade das descontinuidades, é observado que os resultados da avaliação são influenciados pela maneira como a descontinuidade é caracterizada. / Components and equipments of the petrochemical industry are susceptible to the presence of flaws and, for this reason, several studies are developed aiming to improve and create new methods to avoid, remedy and control these flaws in order they will not cause any integrity damage. In this work a cluster of Hydrogen Induced Crack (HIC) is assessed, using the finite element method, with the goal to verify the union phenomena in their tips forming a Stepwise Cracking (SWC) flaw. Also is verified the influence of the cluster to the integrity of the structure based on the Fitness for Service methodology, using the Failure Assessment Diagrams indicated by the Standards API-579 / ASME FFS-1 and BS 7910, also the CEGBR6 procedure. The results show that the interaction effect among the tip of the cracks is considerably intense when they are near to each other, confirming the tendency of union among them. Also this phenomenon is strongly influenced by the internal pressure in the HIC, caused by the presence of atomic Hydrogen diffused in the structure. In relation to the flaw assessment, it is observed that results are strongly influenced on how the flaw is characterized.