Class of 2012 Abstract / Specific Aims: Health disparities are contributing to differences in access to healthcare and health outcomes among diverse groups in the United States. Causes of health disparities are multifactorial. One approach to minimize health inequalities is through educating future health care professionals. The purpose of this review is to identify and describe approaches for developing health disparities curriculum for health professions programs in the United States. Methods: A systematic review was conducted in April of 2012 to identify articles describing medical and nursing school curricula, educational courses, and activities focusing on health disparities in the United States. The search was conducted by utilizing Medline PubMed database. Articles describing a specific educational course/curriculum in health disparities in medical and nursing undergraduate or graduate programs were included in the review. The review did not take into account continuing education programs. All articles describing educational programs focus on healthcare disparities in the United States. Main Results: The search identified 153 articles focusing on specific health disparities curricula or education programs. Out of those articles 30 were included in the analysis. Results are pending. Conclusions: Anticipated results will aid in identifying successful and effective health disparities curricula for health professions programs in the United States.

The concept of sustainable development is commonly used worldwide. In the public sector, characterized by a rationalization focus, conclusions about the sustainability of lean production (lean), as a management concept for organizational change, are contradictory. This thesis aims to identify conditions promoting sustainable development in the public sector, in particular the healthcare sector, when implementing lean. Two qualitative and one quantitative case study were conducted using longitudinal data collection: focus group interviews, semi-structured interviews, analysis seminars, steering board meetings, and a questionnaire. The empirical data was collected from national lean programs in Sweden. The results describe that socio-technical principles may be used as indicators of sustainability as well as a guide in the implementation of lean in healthcare. Active ownership among stakeholders, a developmental view in the organization, stakeholder participation, organized joint innovative learning activities, role and goal clarity may be conditions influencing the sustainability of lean in the public sector. Furthermore, when supported by a favorable lean context, the results show that the lean tools value stream mapping, standardized work and 5S (housekeeping) may promote a sustainable implementation of lean in healthcare by the promotion of employees and managers’ working conditions and/or employee individual innovation. Visual follow-up boards may inhibit employees and managers’ job satisfaction, when not supported by job resources. Personnel stability, time for development, and information to be able to participate were in this context shown to be central job resources. In conclusion, conditions which may promote sustainable development in the public sector, when implementing lean are: stakeholder values of inclusive social well-being, an implementation process including stakeholder ownership and joint innovative learning, and a favorable lean context: balancing job resources and job demands. Lean tools may empower public healthcare employees to engage in development and counteract a poor implementation process and a poor lean context but only to a limited degree. The lean contexts studied were unfavorable, i.e., a weak implementation process and job resources not balancing the job demands. Hence, the lean implementations studied could not be considered sustainable. / <p>QC 20160901</p>

Purpose – To examine the relationship between outpatient service quality expectation, perception and their effect on satisfaction at Gauteng public hospitals. Problem - Gauteng Public healthcare facilities are perceived to be offering deficient and poor quality service to their outpatient clients. Methodology – The SERVQUAL questionnaire tool is used, it encompasses the six dimensional structures of quality. 406 outpatients at public hospitals are the respondents. Limitations – Data collection environment could have led to the collection of inaccurate data. Data collection errors could exist due to the fact that the field workers had to translate questions for the candidates. These limitations limit the conclusions that can be drawn on the study. Findings/implications – The majority of outpatient expectations are not met. Patients are dissatisfied with the overall service quality provided by their outpatient departments. This has the effect of making patients reluctant to attend such facilities and could lead to treatment non compliance.

The massive use of Internet-based connectivity of devices such as smartphones and sensors has led to the emergence of Internet of Things(IoT). Healthcare is one of the areas that IoT-based applications deployment is becoming more successful. However, the deployment of IoT in healthcare faces one major challenge, the selection of IoT devices by stakeholders (for example, patients, caregivers, health professionals and other government agencies) given an amount of available IoT devices based on a disease(for ex-ample, Asthma) or various healthcare scenarios (for example, disease management, prevention and rehabilitation). Since healthcare stakeholders currently do not have enough knowledge about IoT, the IoT devices selection process has to proceed in a way that it allows users to have more detailed information about IoT devices for example, Quality of Service (QoS) parameters, cost, availability(manufacturer), device placement and associated disease. To address this challenge, this thesis work proposes, develops and validates a novel Semantic sEnsor sElection system(iSEE) for healthcare. This thesis also develops iSEE system prototype and Smart Healthcare Ontology(SHO). A Java application is built to allow users for querying our developed SHO in an efficient way.The iSEE system is evaluated based on query response time and the result-set for the queries. Further, we evaluate SHO using Competency Questions(CQs). The conducted evaluations show that our iSEE system can be used efficiently to support stakeholders within the healthcare domain.

Non-communicable diseases are on the increase worldwide, causing more than 36 million deaths each year. Evidence of the link between the role of nutrition and reducing non-communicable diseases is predominant in the literature. The factors influencing intervention strategies/policies and activities, however, need attention. AIM: The study aims to examine the factors that influence nutrition interventions within the United Arab Emirates’ healthcare system. METHOD: This research adapts an interdisciplinary approach where a triangulation mixed methodology is applied. Both qualitative and quantitative methods are used, through the analysis of ten interviews with policy makers, four case studies and 161 questionnaires. Furthermore, the research framework, which emerged from the literature search and qualitative analysis, is tested and validated by rigorous quantitative analysis using SPSS. The statistical analysis, using factor analysis, MANCOVA and ranking analysis aims to provide solid support for the resulting factors. MAIN FINDING: The study identifies five factors that influence nutrition interventions in a healthcare system, and could enhance the effectiveness of nutrition interventions. The factors are 1) quality and processes, 2) training and use of technology, 3) senior management involvement and responsibility, 4) patient diversity, and 5) multidisciplinary teams. CONCLUSION: This study contributes to the emerging literature on management in nutrition interventions and the theory and importance of preventative measures in relation to nutrition. This study provides a roadmap for policy makers to adopt in order to enhance the role of nutrition interventions in healthcare settings.

The purpose of this project was to learn about Hispanics’ utilization of hospice care and to increase knowledge about under-utilization of hospice services by the Hispanic community. Research in hospice services indicates that the Hispanic community underutilizes end-of-life resources when compared to their majority counterparts, European Americans. Research that has controlled for variables such as socio-demographic characteristics, medical history, prognosis, and access to health care demonstrate Hispanics significantly under-utilizing hospice services. This project was conducted within Southern California in the cities of Riverside and Anaheim which are predominantly Hispanic communities. A quantitative design was used to explore the perspectives of Hispanic individuals and their views on hospice care services. Data was collected through questionnaires. Results indicated correlations between language preferences and gender as possibly having an impact on knowledge and cultural acceptance of hospice care services.

acase@tulane.edu / Background: For the past two decades, Louisiana’s health status has ranked among the lowest in the nation. In 2009, Louisiana was ranked 47th in the nation which indicated marginal improvements from their 49th position in 2008. 1, 2 In addition, the 2009 Commonwealth State Scorecards Report ranked the Louisiana health system performance, in terms of health outcomes, among the poorest in the nation.One reason for this disparity could be attributed to shortages of physicians and other healthcare resources in the state. These shortages were exacerbated by the damage done by the 2005 hurricanes to hospitals and physicians’ practices in New Orleans, and throughout the state.3 Today, 86 percent of Louisiana parishes are designated health professional shortage areas by the Health Resources and Services Administration Shortage Designation Branch (HRSAS). 4 Specifically, 126 areas in Louisiana are considered as primary care shortage areas. 5 Louisiana is ranked 6th in the nation in percent of the population lacking access to primary care. 5According to the Medical Education Commission, approximately 40 percent of Louisiana’s medical school graduates and physicians leave the state after completing their medical residencies. 6 Study Design: Using data from the 2006-2007 Louisiana State Board of Medical Examiners (LSBME) providers’ data set and the 2007-2008 Blue Cross Blue Shield (BCBS) of Louisiana providers’ data to report active physicians by specialty and location in the state, this cross-sectional study analyzed disparities in statewide health system performance, measured by mortality amenable to healthcare (MAHC). Age-adjusted standardized mortality rates (ASMR) from all conditions amenable to healthcare were derived and extracted from the Centers for Disease Control and Prevention (CDC) The Distribution of Physician Workforce in Louisiana: Implications for Outcomes of Care Compressed Mortality File (CMF).7 The CMF is a county-level national mortality and population database spanning the years 1968-2006. The model controlled for sociodemographic factors and health care resources available in the different parishes. Population data were obtained from the 2006-2007 county-specific Area Resource File (ARF). The unit of analysis was the parish. Results: Louisiana is facing a maldistribution of physicians by specialty (primary care vs. specialty care) and geography. Furthermore, throughout Louisiana, health system performance as measured by ASMR from all conditions amenable to healthcare varied widely. Conclusion: Variations in parish physician supply did not explain variations in MAHC. Rather, significant associations were found between socio-economic factors and MAHC / 1 / Maysoun Dimachkie Masri

The central objective of this study is to examine the policy, legal, and constitutional implications resulting from the Chaoulli v. Quebec (2005 1 S.C.R. 791) both for the rights of Canadians within the scope of the publicly funded healthcare system and the configuration of that system. In examining the policy implications the thesis focuses on Quebecs Bill 33, Ralph Kleins Third Way proposal, and the development of national wait time benchmarks. In examining the legal implications the thesis focuses on the so-called copy-cat cases triggered by the Chaoulli case, namely Flora v. Ontario, Murray v. Alberta, and McCreith and Holmes v. Ontario. In examining the constitutional implications of Chaoulli the thesis focuses on the expansion of the interpretation of Section 7 of the Charter of Rights and Freedoms, and the elevation of timely access to healthcare to a Charter right. <p>The study concludes with some observations regarding how Canadas publicly funded healthcare system could evolve in the future and the role of the courts in the evolution of the system. It provides a warning that if appropriate and timely action is not taken by federal and provincial officials to minimize wait times in the publicly funded healthcare system, the implications of Chaoulli will continue to expand through future litigation and judicial decisions. One of the potential outcomes of such litigation and decisions is development of a two-tier or multi-tier healthcare system in Canada.

Despite the ongoing initiatives of quality improvement collaboratives in healthcare which reflect various multifaceted intervention packages, clear evidence of the effectiveness of the model itself is lacking. Little is known about the true impact of the collaborative approach on improvement outcomes or how specific components are actually implemented within participating organizations. This dissertation reports on empirical qualitative research undertaken to investigate “how” healthcare providers and management describe the experience of being involved in a collaborative network for quality improvement. Using a process evaluation of a sample QI collaborative, this research reveals that frontline staff do not feel the need to conform or be identical to their peer organizations; rather they feel that by participating with them that their high level of care is finally recognized. In addition, the existing communication structure is ineffective for staff engagement and a “QI bubble” seems to exist in terms of knowledge transfer and the idea of collaboration bears out more internally in increased intra-team cooperation than externally between organizations or units. Selected theoretical perspectives from the fields of sociology and organizational behaviour are used as an analytic framework from which the author posits that based on the findings from this case study that in fact collaboratives may not actually function by any of the commonly held assumptions of legitimization, communication and collaboration. A conceptual framework for how these constructs are related in terms of QI collaborative design is proposed for future testing. With further work and on-the-ground testing of this model and relational hypotheses, this research can help the QI community develop a more functional theory of collaborative improvement and use mixed methods evaluation to better understand complex QI implementation.

Despite the ongoing initiatives of quality improvement collaboratives in healthcare which reflect various multifaceted intervention packages, clear evidence of the effectiveness of the model itself is lacking. Little is known about the true impact of the collaborative approach on improvement outcomes or how specific components are actually implemented within participating organizations. This dissertation reports on empirical qualitative research undertaken to investigate “how” healthcare providers and management describe the experience of being involved in a collaborative network for quality improvement. Using a process evaluation of a sample QI collaborative, this research reveals that frontline staff do not feel the need to conform or be identical to their peer organizations; rather they feel that by participating with them that their high level of care is finally recognized. In addition, the existing communication structure is ineffective for staff engagement and a “QI bubble” seems to exist in terms of knowledge transfer and the idea of collaboration bears out more internally in increased intra-team cooperation than externally between organizations or units. Selected theoretical perspectives from the fields of sociology and organizational behaviour are used as an analytic framework from which the author posits that based on the findings from this case study that in fact collaboratives may not actually function by any of the commonly held assumptions of legitimization, communication and collaboration. A conceptual framework for how these constructs are related in terms of QI collaborative design is proposed for future testing. With further work and on-the-ground testing of this model and relational hypotheses, this research can help the QI community develop a more functional theory of collaborative improvement and use mixed methods evaluation to better understand complex QI implementation.