This thesis examines hospitalizations for ambulatory care sensitive conditions among persons with an intellectual disability living in Manitoba from 1999 to 2003. Hospitalizations for ambulatory care sensitive conditions are considered an indicator of access to, and the quality of, primary care. Intellectual disability can be defined as a disability originating before age 18 characterized by significant limitations both in intellectual functioning and in adaptive behaviour as expressed in conceptual, social, and practical adaptive skills. Between 1 and 3% of the population has an intellectual disability. This thesis addressed three objectives: 1) To identify ambulatory care sensitive conditions that are applicable to persons with an intellectual disability; 2) To compare hospitalization rates for ambulatory care sensitive conditions between persons with and without an intellectual disability in Manitoba; 3) To identify factors associated with hospitalizations for ambulatory care sensitive conditions among adults with an intellectual disability living in Manitoba. An online survey of primary care providers with experience working with persons with an intellectual disability found consensus on fifteen ambulatory care sensitive conditions applicable to persons with an intellectual disability. Large discrepancies in hospitalization rates for these conditions were found between persons with and without an intellectual disability. Controlling for age, year, sex, and region, persons with an intellectual disability were 6 times more likely to be hospitalized for an ambulatory care sensitive condition. Future research should investigate reasons for the large discrepancy in rates between persons with and without an intellectual disability. Among adults with an intellectual disability, living in a rural area (odds ratio 1.3; 95% CI=1.0, 1.8), living in an area with a high proportion of First Nations people (odds ratio 2.3; 95% CI=1.3, 4.1), and experiencing higher levels of comorbidity (odds ratio 25.2; 95% CI=11.9, 53.0) were all associated with a higher likelihood of being hospitalized for an ambulatory care sensitive condition. Dwelling in higher income areas had a protective effect (odds ratio 0.56; CI=0.37, 0.85). The results suggest that addressing the socioeconomic problems of poorer areas and specifically areas densely populated by First Nations people would likely have an impact on hospitalizations for ACS conditions for persons with an intellectual disability.

The purpose of this study was to describe the obstetric hospitalization rates of northern and registered Indian women from April 1, 1992 to March 30, 1993 and to compare them with those of southern rural women in Saskatchewan.<p> Saskatchewan Health provided hospital separation data for 100% of northern and registered Indian women and for a 10% sample of southern rural and southern urban women hospitalized with obstetric diagnoses and procedures in 1992/93.<p> The crude, age-specific, and age-standardized hospitalization rates were based on the number of women of reproductive age or the number of deliveries or pregnancies. The average length of stay and hospital location were examined. Crude and age-adjusted odds ratios with 95% confidence intervals and chi-square tests were used to compare rates with southern rural women as the reference group. Oneway analysis of variance was used to compare the average length of stay for obstetric episodes among study groups.<p> The rate of obstetric episodes per 100 pregnancies were only 5 to 18% higher for northern women and southern registered Indian women. Northern and registered Indian women had higher rates for deliveries per 1,000 women, for ectopic pregnancies per 1,000 pregnancies, and for antenatal episodes with diabetes or abnormal glucose or with urinary tract infections per 100 pregnancies and lower rates of deliveries with cesarean sections, instrument use and episiotomy. Northern women had higher rates for deliveries with fetal and placental problems and for vaginal birth after cesarean section per 100 deliveries, and lower rates of antenatal episodes with hyperemesis per 100 pregnancies. All registered Indian women had lower rates of labour and delivery complications per 100 pregnancies. The average length of stay for obstetric episodes was similar for all study groups. Over 35% of northern women delivered in northern hospitals.<p> The results support continued northern obstetric practice and provide a baseline for evaluation of health transfer and renewal for northern tribal councils and health districts. The high fertility rates among northern and registered Indian women warrant a high priority on obstetric services, hospital facilities, prenatal care and postnatal care that are age and culture sensitive.<p>

Background The demand of long-term care facilities has increased because of the geriatric population growing up rapidly. How to reduce the frequency of the nursing home residents¡¦ being hospitalized is one of the most important indicators for the quality of long-term care. Objective To understand the characteristics of facilities and nursing home residents. To test the effect of the characteristics on the probability of hospitalization of nursing home residents and to analyze the predictors of readmission in order to improve the quality of nursing care and the life quality of their residents. Methods We collected 329 residents of a hospital-based nursing home in southern Taiwan before March 31, 2011 and who stayed more than 90 days at the facility. The medical records were reviewed retrospectively. Data were analyzed using descriptive statistics (correlation and one way ANOVA) to test the effect of the resident¡¦s and facility¡¦s characteristics on the probability of hospitalization. Multiple linear regression was used to study the risk factors and the predictors of readmission frequency. Results Of the 29 residents, 141(42.9%) were male. The average age was 78.06. 33.7% of the residents died in the facility. The total individual admissions were from 0 to 18. The hospitalized frequency was 0.42 in each 90-day period. Infectious disease was the majority diagnosis of admission. The three leading causes of admission were pneumonia(45.5%), urinary tract infection (20.0%) and upper gastrointestinal bleeding(10.3%). Correlation analysis showed the age had a positive correlation with the frequency of readmission. The hemoglobin level, serum albumin level, serum cholesterol level, body mass index, mini-nutritional assessment score and mini-mental status evaluation score disclosed a negative correlation with the frequency of readmission. Multiple linear regression showed the male gender, age, lung diseases, complete bed-ridden and mini-nutritional assessment score were significant predictors of readmission frequency. Conclusion The evaluation of the risk factors and predictors might help to identify the nursing home residents who are likely to be readmitted. It is hoped that the hospitalizations from nursing home may be prevented and the results of this study might contribute to the quality of long-term care facilities.

Chronic illness impacts numerous families in the United States. Children are increasingly among those affected by a chronic illness. The families undergo trials and experiences that tax their coping skills and require extensive coping strategies. This research project explored how families cope with chronic illness in one of the children in the family. The objective of the research project was to use the method of case study to examine the everyday lives, perceptions, and coping strategies of the family members as they deal with the realities of the effects of a child’s illness on a daily basis. Three families were studied using the case study format. Through interviews, observations, and investigation of data, the researcher gathered pertinent information about the participants’ lives and experiences. Emergent themes were identified from the facts gathered. These themes included information and suggestions that various participants offered. Included among the emergent themes were the following titles: alarming environment, redefined realities, relational requests, valuable individual, coping concoctions, as well as awareness and advocacy. The study’s emergent themes were divided into numerous subcategories. The multiple realities that the family members face is evidenced in the number of issues and themes that emerged from the study. This research project gives additional insight into the reality of the lives of families experiencing chronic illness in one of the children. Suggestions and observations by the participants could be useful for family, friends, medical professionals, educational systems, and support groups that interact with families facing similar trials. The descriptive style of the study lends itself to the vicarious interaction of the reader to the circumstances of the participants. This format allows the reader to transfer knowledge to his or her own experiences. The study could further be useful by offering detail to the existing knowledge base, in addition to aiding in the development of theory.

Thesis (Ph. D.)--University of Chicago, School of Social Service Administration, June 2001. / Includes bibliographical references. Also available on the Internet.

The hospitalization of childbirth and maternal care in Sweden is from an international perspective quite unique. It was implemented already in the beginning of the 20th century and fully mainstreamed by the 1960’s. This essay examines the professional discussions of midwives and doctors as depicted in their union’s membership papers, during the hospitalization period. The hospitalization of childbirths presented a shift in responsibility and power from the midwives to the doctors, which has lead previous research to analyse this development as a clear conflict of professional interest. I will argue however that the professional frictions came later, as the midwife profession grew stronger as a collective, and were not so much present in the actual making. This essay investigates why, and touches upon class and gender divergences as explanatory factors. My findings are in part that the overtaking was more elaborate from the doctor’s point of view than the midwives. Through undermining the midwives professional competence, denying them necessary resources and advocating their superiority in the midwives internal debates, the doctor’s managed to steer the development of hospitalization and establish the hierarchy that followed. Today’s lively and sometimes infectious debate on the organization of childbirth and maternal care highlights the necessity for a deeper historical understanding and background to the indeed different positions midwives and doctors take in this regard.

Thesis (Ph. D.)--University of Washington, 1989. Vita. / Includes bibliographical references (leaves [116]-130).

Thesis (D.P.H.)--University of Michigan, 1996.

Thesis (M.S.)--University of Michigan, 1980.

Thesis (M.S.)--University of Michigan, 1980.