The Enhanced Primary Care Package aimed to improve health and quality of life through enhancing primary health care for those over 75 years, Aboriginal and Torres Strait Islanders over 55 years and those with chronic conditions and multidisciplinary needs. A multi-level approach was implemented to promote the package. West Vic Division of General Practice conducted the General Practice Education Support and Community Linkages implementation program for the package in Western Victoria and focused on health assessments for those over 75 years. This research investigated what factors affected change in rural general practitioner practice through surveying general practitioners and collecting Health Insurance Commission data prior to and following the program. Patients were also interviewed to determine acceptance of health assessments and nurse involvement. The program increased awareness, but had little effect on increasing uptake, as only 53% of general practitioners began undertaking health assessments. However the general practitioners indicated an increased frequency of health assessment prescription. Health Insurance Commission data suggested an immediate increase in the use of the assessments, however the rate fluctuated and then declined. Lack of sustained uptake of the program was not associated with remuneration, as 77% of general practitioners did not regard finance as a barrier. Respondents’ major barrier was time (40% pre-education, 73% post-education). This data reflected a rural environment where general practitioners face competing priorities, time constraints, workforce shortage and long consultation lists. A notable change did however occur from practice nurse employment as the involvement of a practice nurse generally resulted in patient satisfaction with the assessment. It was apparent that a complex multifaceted and longer-term view is needed to address factors which limit rural general practitioners’ ability to change. This needs to be addressed at the Commonwealth level and not in isolation in order to produce an integrated framework to enhance and promote, rather than demand change. / Master of Applied Science

Report-in-lieu-of-Thesis (M.P.H.)--University of North Texas Health Science Center at Fort Worth, 2008. / Title from title page display. Bibliography: p. 48-52.

Thesis (M.H.P.A.)--Washington State University, May 2009. / Title from PDF title page (viewed on Apr. 13, 2010). "Department of Health Policy and Administration." Includes bibliographical references (p. 37-46).

Thesis (M.S. in Management)--Naval Postgraduate School, December 1990. / Thesis Advisor(s): Doyle, Richard. Second Reader: Gates, William R. "December 1990." Description based on title screen as viewed on March 30, 2010. DTIC Identifier(s): Cost Analysis, Medical Services, RBRVS(Resource Based Relative Value Scales Theses), CHAMPUS, Physicians, Medicare. Author(s) subject terms: RBVS, CHAMPUS, RBVS and CHAMPUS. Includes bibliographical references (p. 64). Also available in print.

Thesis (Ph. D.)--Case Western Reserve University, 2005. / [School of Medicine] Department of Epidemiology and Biostatistics. Includes bibliographical references. Available online via OhioLINK's ETD Center.

Thesis (M.H.P.A.)--Washington State University, May 2010. / Title from PDF title page (viewed on July 20, 2010). "Department of Health Policy and Administration." Includes bibliographical references (p. 30-35).

Thesis (M.H.P.A.)--Washington State University, May 2010. / Title from PDF title page (viewed on July 22, 2010). "Department of Health Policy and Administration." Includes bibliographical references (p. 42-51).

A mere 16 percent of the population enjoys the benefits of private healthcare; medical schemes however remain an important contributor to the South African economy with an annual contribution flow of close to R85 billion per annum. Similar to the international scenario, South African healthcare inflation surpassed consumer price inflation. In addition, the medical schemes industry remains riddled with fraud, this coupled with escalating private healthcare costs remain subsequent threats to the sustainability of the industry. It is reported that service provider fraud has surpassed fraud committed by scheme members. Most medical schemes appear to have policies in place to manage and combat fraud, however transparency in terms of information sharing remains elusive. Of greater concern have been the investigation and management ethicality and endgame of medical schemes in terms of fraud risk management amongst medical practitioners. The research problem states that there is currently no standard fraud investigation and management protocol available for the ethical investigation and management of medical schemes fraud committed by medical practitioners. The literature review demonstrated that there has been a paradigm shift regarding the expectations that society has of the modern corporation and emphasised the inclusive stakeholder model theory in favour of the traditional shareholder dictum: pursuit of profit maximisation at any cost. The research design was done by providing a survey questionnaire to private medical practitioners. The literature review and survey findings highlighted the need for medical schemes to pay greater heed to their ethicality and stakeholder issue management practices. Focus areas for the development of an industry standard fraud investigation and management protocol was recommended.

The transition from hospital to home or alternate care setting is a time of vulnerability for all patients and particularly for our elders. If not handled appropriately there is a risk to our elders for readmission to the hospital environment that may decrease their overall quality of life and further compromise their health status. in addition to the individual risks associated with patient readmissions, there are societal impacts that reach far beyond our current generation of elders 65 and older. This impact may have dire implications for the future fiscal health of the next generation. a review of the current and past literature shows that there are a limited number of resources available for hospitals to use in order to comply with the new Value Based Purchasing initiatives that are being implemented by CMS regarding the reduction in readmission rates. the problem of hospital readmissions is confounded by the many processes that are available for study, from pre-hospitalization conditions and care through hospitalization, discharge, and finally to post discharge processes. While most research and literature reviews have focused on individual disease causes, there is a need to provide hospitals with a resource that outlines the available options and interventions that have been shown to be effective in reducing hospital readmissions. the purpose of this study is to review relevant literature related to the problem of hospital readmissions for our elder population. This study is designed to look at interventions, both disease based and non-disease based, that have been previously implemented and have shown effective reductions in readmission rates. This analysis and synthesis can provide an important contribution to our understanding of the factors and variables that influence the readmission rates of our elder population. This review has the potential to assist and direct hospital administrators and to discharge planners, social workers, and other health professions to implement intervention strategies that promote the continuing health status of our elder population while reducing their overall rates of readmissions.

This study evaluated the effect of community-based case management (CM) intervention on patient outcomes in Medicare beneficiaries with chronic illness in a rural Midwest region from 2002 to 2004. The relationships between 252 patients' access and clinical outcomes (the number of hospitalizations, length of stay (LOS), and emergency department (ED) visits) and CM were investigated. CM services were provided as four types: high home, high clinic, high telephone, and mixed-care services by nurse case managers. A descriptive, repeated-measurement design was used, and a secondary analysis of a data set containing longitudinal community-based CM data was conducted. The transitional care model and transition theory served as the theoretical background for the study. Descriptive statistics and frequency analysis, t-test, and a repeated-measure ANOVA analysis were used to analyze the data. Characteristic profiles of the patients were analyzed with their self-care Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores. The patients in this study were relatively healthy on their self-care functional status at the beginning of the study. The four types of CM services were compared with patient-reported clinical outcomes (the self-care ADL, IADL, symptom control, quality-of-life, and personal well-being scores) in each year. Analyses showed that patients' clinical outcomes were similar regardless of the type of CM services in each year. Two years of longitudinal CM intervention greatly affected patient's clinical outcomes and access outcomes. The study found that CM significantly reduced the number of hospital days and influenced patients' quality of life and symptom control. The impact of CM on LOS and ED visits was indeterminate. Further research is needed-including the effect of type and dosage of CM services and outcomes and the development of a comprehensive CM model-to guarantee CM as a core intervention in health care reconfiguration.