The current study examines the relationship between service utilization and child outcomes, and the role fidelity to the principles of the wraparound care coordination process plays in mediating that relationship. One hundred and twenty-one participants at three separate Children’s Mental Health Services (CMHS)-funded Systems of Care national evaluation sites in three states were administered the Wraparound Fidelity Index (WFI), designed to measure adherence to the principles of wraparound; child outcomes measures, including the Child Behavior Checklist (CBCL) and the Child and Adolescent Functional Assessment Scale (CAFAS); and the Multi-Sector Service Contact Questionnaire (MSSC), designed to assess services received. Data were analyzed using hierarchical multiple regression and linear mixed models in order to examine the mediational role fidelity plays at two levels, children and wraparound facilitators, and at three different time points, baseline, six-month follow-up, and twelve-month follow-up. No statistically significant relationships were found between wraparound fidelity and child outcomes at six-month follow-up. Also, at six-month follow-up, the level of services the child and family received significantly predicted child outcomes related to externalizing symptoms but not to internalizing symptoms or functional impairment; however, this relationship was not mediated by fidelity to the wraparound process. From baseline to six-month follow-up and twelve-month follow-up, no statistically significant relationships were found between wraparound fidelity and child outcomes across wraparound facilitators. Also, no statistically significant relationships were found between the level of services the child and family received and child outcomes. A mediation model from baseline to six-month follow-up and twelve-month follow-up was not viable due to the null findings. Exploratory analyses were conducted. Implications of these findings and directions for future studies are discussed.

Thesis (Ph. D.)--University of Oklahoma, 1994. / Includes bibliographical references (leaves 110-129).

Thesis (M. Phil.)--Hong Kong University of Science and Technology, 2002. / Includes bibliographical references (leaves 106-108). Also available in electronic version. Access restricted to campus users.

Thesis (PH.D.) -- Syracuse University, 2006 / "Publication number AAT 3251478."

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 223-231).

Thesis (Hons)--BA Communication Studies. / Cover title. Prepared for the South Australian Health Commission grant no. 67/47/020. Includes bibliographical references.

Thesis (M.T.S.)--Catholic Theological Union at Chicago, 1990. / Vita. Includes bibliographical references (leaves 108-114).

Life-support treatment is regarded as the support of vital functions of respiration and circulation such as mechanical ventilation and inotropic support, and life-sustaining therapy which incorporate therapies such as artificial hydration, nutrition and haemodialysis. Life-support treatment is rendered to critically ill patients within the intensive care units. However, when treatment options are maximised, and the patient’s condition is unchanged, a decision is often made to withdraw treatment. Professional nurses are usually involved in the process of withdrawal of life-support treatment as they care for this population of patients. The study followed a qualitative, explorative, descriptive and contextual research paradigm in order to explore and describe the perceptions of professional nurses with regard to the process of withdrawing life-support treatment in a private intensive care unit. Data was collected by means of interviews, which were transcribed according to Tesch’s method of analysis. Field notes were used to supplement the data findings. Based on the data collected, it is clear that professional nurses experience difficulties when performing withdrawal of life-support treatment. There are a number of communication concerns which need to be addressed and suggestions were also made by the interview participants regarding these concerns. The study makes recommendations to assist professional nurses with the process of withdrawing life-support treatment in a private intensive care unit. The findings of the study will be disseminated to the relevant hospital and unit managers. Ethical principles were maintained throughout the study by adhering to the principles of privacy, confidentiality, anonymity and beneficence.

M.Comm. / The present study was undertaken in a bid to meet an urgent need uncovered in medical-information systems (MIS) for a formal process whereby risks posing a threat to patients in medical institutions could be identified and controlled by means of the appropriate security measures. At the time of the study, however, no such formal risk-analysis model had yet been developed specifically for application in MIS. This gave rise to the development of RAMMO, a riskanalysis model specifically aimed at the identification of risks threatening the patient in his or her capacity as an asset in a medical institution. The author, therefore, managed to achieve her object with the study, namely to initiate a riskanalysis model that could be applied to medical environments. Following, an overview of the research method used in order to achieve the objectives of the study: Firstly, background information regarding the issues and problems to be addressed was obtained, and they provided the well-founded motivation for the study. Secondly, the development and importance of MIS in medical environments came under consideration, as well as the applicability of information security in an MIS. In the third instance, general terms and concepts used in the risk-management process were defined, by means of which definitions existing risk-analysis models were investigated and critically evaluated in a bid to identify a model that could be applied to a medical environment. Fourthly, a conceptual or draft design was suggested for a risk-analysis model developed specifically for medical environments. In doing so, the first two stages of the model, namely risk identification and risk assessment, were given special emphasis. The said model was then illustrated by means of a practical application in a general hospital in South Africa. The study culminated in a summation of the results of and the conclusions reached on the strength of the research. Further problem areas were also touched upon, which could become the focus of future research projects.

A frequently cited reason for poor quality of care in the ambulatory care setting is the lack of optimally designed systems to address care for those with preventive or chronic care needs. Organizational theory suggests that culture plays an important role in the shaping of these types of programs. The purpose of this cross-sectional study is to understand through descriptive and regression analysis of secondary data, the relationship between the existence of cultural characteristics such as collegiality, quality emphasis and autonomy, and the systems employed to improve quality of care within primary care practices. The study uses an integrated theoretical framework consisting of organizational culture, social network and organizational learning theories to better understand the rationale for the relationships. The analysis is an outgrowth of a previous National Committee for Quality Assurance (NCQA) project conducted in Minnesota where 300 staff across 42 office practices were asked to answer questions on a self-report survey to assess the presence and function of clinical practice systems. To evaluate organizational culture, validated questions from the work of Kralewski and colleagues were also asked. Descriptive analysis results showed a large range in consistency of practice system use, with clinical information systems as most used and care management systems as least used. Results of the multivariate analysis showed collegiality and quality emphasis as significantly related to the use of practice systems. More specifically, both collegiality and quality emphasis were seen to positively influence the use of clinical quality evaluation and improvement systems and an emphasis of quality was seen to positively influence the use of clinician reminders and clinical information systems. A statistically significant relationship between autonomy and practice systems use was not seen. As the study shows that culture does influence the use of certain systems for care improvement, it provides an increased understanding and avenue for intervention/change in the continued quest for improved quality of care. Policymakers and practice leadership may want to focus energy on understanding primarily whether the culture of practices places an emphasis on quality and collegiality. Ultimately it may foster the use of practice systems for quality of care improvement.