Browsing by Subject "Health care"
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Item Attitudes towards immigrants & support for government spending on health care(2010-05) Shannon, Melissa Maura; Osborne, Cynthia Anne, 1969-A steady increase of new immigrants to the United States has sparked a great debate on the financial impact the foreign born population has on public services. While the United States government has an extensive history on exclusions for potential public charges, the impact of negative attitudes towards immigrants has caused substantial changes in eligibility criteria for legal permanent residents and ultimately immigration policy at large. This report uses group threat theory, which predicts a punitive response from a dominant group when these individuals perceive a threat to their group interests to explain shifts in attitudes and corresponding changes in eligibility criteria for public benefit programs for immigrants. Additionally, this study examines how U.S. citizens’ misinformed perceptions of immigrants’ utilization of public programs may negatively influence public support for increased government spending on public health care programs. To quantify the implications of public attitudes, the study uses repeat crosssectional data on attitudes towards immigration from the General Social Survey (GSS) from 1994 (N=578), prior to Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. The responses are compared to a similar survey conducted by GSS in 2004 (N=365) an era of steep economic growth and substantially higher health care costs.Item Corporate responsibility as a strategic goal : open source healthcare appliances in developing countries(2010-12) Rosales, Antonio A., 1981-; Ambler, Tony; Duvic, Robert Conrad, 1947-Despite the trillions of dollars spent over the past decades on foreign aid 80% of humanity still lives on less than $10 dollars a day. There is an alarming need to deliver quality healthcare services and products to developing countries. The healthcare industry for developing countries is estimated to be $202 million and growing exponentially. However, intrinsic obstacles have prevented companies from fully deploying solutions in these countries. With the emergence of Citizen-Sector Organizations companies now have an alley to create High Value Chains enabling companies to deliver solutions to developing countries. Thereby, increasing shareholder value and increasing the living conditions of global citizens. As citizens of developing countries have better health care they are better equipped to succeed economically and consume other services and products the company has to offer. This paper discusses how an engineering manager can increase shareholder value by aligning corporate responsibility with the company’s strategic goals by leveraging High Value Chains. Specifically this paper discusses how open source methodologies can be utilized to improve healthcare in developing countries while increasing shareholder value.Item Group Facilitation Software Perceptions in a Practice Management Setting(2011-08) Conover, Pat; Crooks, Steven M.; Maushak, Nancy; Inan, Fethi A.Healthcare is a complex industry with a diverse workforce and a wide array of business issues that often require the formation of groups to solve problems. Group facilitation software, such as Microsoft’s SharePoint, has the promise to provide workgroups with the ability to solve complex problems. The study involved 141 health care employees of a large Southwestern academic health center who responded to survey items concerning the perceived usefulness and the ease of use of SharePoint. The survey also contained items designed to measure employees need for affiliation and computer self efficacy. Results revealed different demographic profiles between respondents that had a high acceptance of SharePoint and those that reported a low acceptance of SharePoint. The respondents that had a lower acceptance of SharePoint reported lower computer self efficacy scores than the respondents that reported a high acceptance of SharePoint. The respondents that are required to use SharePoint were less likely to report that SharePoint is useful and easy to use. The respondents that are not required to use SharePoint had significantly higher TAM scores than those required to use SharePoint. This finding suggests that the acceptance of group facilitation software differs for those employees that are required to use SharePoint from employees that are not required to use this technology. Other findings revealed that TAM was positively correlated to both the need for affiliation and computer self efficacy. TAM was found to be inversely related to the frequency of use of the SharePoint features of upload a document and download a document. Computer self efficacy was found to be inversely related to the frequency of use of the SharePoint features of upload a document, download a document, search, and automated notifications. The two components of TAM, perceived ease of use and perceived usefulness, were found to be positively correlated. Perceived ease of use was found to be inversely related to the SharePoint features of comment, upload, download, announce, and alert. Further research is recommended to provide a more rigorous examination of these relationships.Item Health care for homeless individuals : implications of the patient protection and Affordable Care Act(2011-05) Rolle, Mary Joy; Thompson, Sanna J.; Angel, Jacqueline LoweThis professional report explores the unique health needs of homeless individuals, how homeless individuals access medical and mental health services, and the impact that the Patient Protection and Affordable Care Act (ACA) may have on medical services for homeless individuals. Homeless individuals are more likely to experience physical and mental health problems and earlier mortality rates than the general population. Common access points for homeless medical services include clinics, such as Community Health Centers, and emergency care centers, such as hospital emergency rooms. Homeless individuals often face barriers of access to medical services, including competing priorities to sustain life, strained relationships with medical providers, and an inability to pay for high health care costs. Through the expansion of Medicaid and the Community Health Center network, the ACA has the potential to increase access to medical services for homeless individuals. This report concludes by offering recommendations to ensure that homeless individuals benefit from health care reform through the ACA.Item Health care reform in Sandinista Nicaragua, 1979-1990(2014-08) Anderson, Kristin Cheasty; Garrard-Burnett, Virginia, 1957-This dissertation explores the health care system built by the Sandinista government in Nicaragua between the years 1979-1990. Prior to the 1979 victory of the Sandinista revolution, Nicaragua had a limited, balkanized health care system that afforded access to care to only a small percentage of the Nicaraguan population. The Sandinistas sought to build a nationwide health care system that provided free and equal access to health care. This project is a study of how the Sandinistas did that, and an analysis of what success they had. This project relies upon new sources as well as established archival ones. Former Minister of Health Dora María Tellez (1985-1990) recently donated her personal collection of Actas Ministeriales (Ministerial Executive Orders) to the Universidad de Centroamérica's Instituto de Historia de Nicaragua y Centroamérica (IHNCA), a cache that substantially increases the documentary record of the latter half of the 1980s, and thus expands our understanding of the issues at hand and the solutions the Ministry implemented. Also, this dissertation relies heavily upon oral history. Seventy-five interviews with Ministry leaders, health workers, and Nicaraguan citizens create a more personal history of health in Sandinista Nicaragua, and explain how this nationwide effort actually functioned in communities, both urban and rural. The five chapters of this dissertation explore these central questions through multiple lenses. The first chapter provides both a history of foreign intervention and of history of health care in Nicaragua. The second and third chapters explore the historical trajectory of the Ministry of Health during the eleven years of Sandinista rule, first at a national level, and then with a focus on the northern zones of Nicaragua. In the final two chapters the dissertation explores the international angle of this history. The fourth chapter looks at the important role Cuban foreign aid played in helping the Sandinista government build, supply, and maintain their health care system. The fifth and final chapter interrogates the presence of long-term volunteer health care workers from the United States in light of the fact that the U.S. was leading efforts to overthrow the Sandinista government throughout the 1980s.Item Mobilizing medicine: a design response to the accessibility and cost issues in health care(2014-05) Kahler, Ashleigh Joy; Garrison, MichaelNationally, there is increasing concern over the accessibility, cost, and quality of the American health care system. While the quality of the care given is generally out of the control of designers, it has received increased attention in recent years, as is evidenced in the trends of healing gardens, private patient rooms, and improved social settings. As beneficial as these trends are to the patients they serve, they often have a negative effect on overall accessibility and cost of care due to the constant construction and renovations needed and their largely urban presence. While quality health care is very important and should not suffer as a result, how can designers address nonenvironmental sustainability issues of cost and access in the American healthcare system? Due to the trend in increasing cases of chronic illness, as opposed to more pathogenic ailments of the past, the necessity for all healthcare settings to be highly controlled and sterile environments should be reevaluated. While less popular and not as fully developed as the typical facilities most Americans are familiar with, an increase in mobilized health care units could be a solution to the lack of economic and social access and sustainability in the current healthcare model while still providing safe, quality care. By examining current instances of mobile clinics, I will explore the design requirements necessary to make mobile clinics accessible and cost effective. In addition, I will look for facilitators and barriers to these systems, such as improvements in mobile communication technologies and lack of stakeholder support.Item The Paradox of Physician Privacy(2012-05) Jennings, Paige Megginson; Sage, William M.; Warner, David C.This Report examines the “paradox” of physician privacy: while physician privacy has been explicitly or implicitly invoked over the last century to defend physicians against greater transparency, proposals that might cause them economic harm, or interference by government or corporate entities, there has been little comprehensive work done to examine the substance and source of any privacy rights physicians may actually enjoy. This Report attempts to make three primary contributions with respect to physician privacy. First, the Report examines the current state of physician privacy and the legal framework that governs it. Second, the Report argues that physician “privacy” is not, and should not be considered, a unitary concept encompassing a singular meaning. Rather it is a broad umbrella term that encompasses not only a variety of legal protections for privacy, but guards against a variety of very different perceived harms. As a result, this Report argues that in evaluating policy initiatives, discussions about “privacy” implications can be counterproductive because the term obscures the real values, concerns, and policy judgments at play. To address this, the Report’s third aim is the proposal of an analytical framework that policymakers and others may use to consider the impact of various initiatives on the values and concerns that physician “privacy” actually protects: professional autonomy; economic considerations; personal dignity; and practical difficulties.Item Planning and Scheduling Surgeries under Stochastic Environment(2012-08-15) Choi, Sangdo 1971-This dissertation presents an integrated approach to planning and scheduling surgeries in operating-rooms (ORs) at strategic, tactical and operational levels. We deal with uncertainties of surgery demand and durations to reflect a reality in OR management. The strategic part of the dissertation studies capacity decisions that allocate surgical specialties to OR days with the objective of minimizing total expected costs due to penalties for any patients who are not accommodated and for under- (i.e., idleness) and over- (i.e., overtime) usage of OR capacity. It presents a prototypical non-linear, stochastic programming model to structure the problem and four adaptations, along with associated solution approaches, with the goal of facilitating solution by overcoming the computational disadvantages of the prototype. Each of these models offers advantages but is also attended by disadvantages. Computational tests compare the four models and solution approaches with respect to solution quality and run time. The tactical part of the dissertation prescribes an approach to optimize a master surgical schedule (MSS), which adheres to the block scheduling policy, using a new type of newsvendor-based model. Our newsvendor approach prescribes the optimal duration of each block and the best permutation, obtained by solving the sequential newsvendor problem, determines the optimal block sequence. We obtain closed-form solutions for the case in which surgery durations follow the normal distribution. Furthermore, we give a closed-form solution for optimal block duration with no-shows. We conduct numerical tests for surgery durations that follow normal, lognormal and gamma distributions. Results show that the closed-form solutions associated with the normal distribution gives close approximations to solutions associated with log-normal and gamma distributions. The operational part of the dissertation prescribes an optimal rule to sequence two or three surgeries in a block. The smallest-variance-first-rule (SV) is generally accepted as the optimal policy for sequencing two surgeries, although it has been proven formally only for several restricted cases. We extend prior work, studying three distributions as models of surgery duration (the lognormal, gamma, and normal) and including overtime in a total-cost objective function comprising surgeon-and-patient- waiting-, operating-room-idle-, and staff over-times. We specify expected waiting- and idle- time as functions of the parameters of surgery duration to identify the best rule to sequence two surgeries. We compare the relative values of expected waiting- and idle- times numerically with that of expected overtime. Results recommend that the SV rule be used to minimize total expected cost of waiting-, idle- and over-time. We find that gamma and normal distributions with the same mean and variance as the lognormal give nearly the same expected waiting- and idle- times, observing that the lognormal in combination with either the gamma or normal gives a similar result. Lastly, the dissertation investigates an appointment system with deterministic arrival times (D) and non-identical exponential service times (M). For two customers, we show that both the smallest-mean-first-rule and the SV minimize the sum of expected waiting- and idle-times. We prove that neither is optimal for three customers, but verifies that the first customer in the sequence should be the one with the smallest variance (mean).Item Privately run health care in prisons : an industry and health impacts analysis(2014-08) Larsen, Rebecca Ann; Warner, David C.; Rountree, Michele A.The following report is an assessment of the privatization of health care in prisons. It attempts to better understand the industry, the leading companies, and to determine whether they are providing adequate and constitutionally mandated levels of care. The report begins with an overview of prison health care in the United States, covering its history and its current state. It then examines the private correctional health care industry by looking at industry structure, market share, and leading companies. In an attempt to analyze the impact this industry has on people behind bars, several research approaches were utilized, including a literature review, a review of government reports and court documents, a review of case studies, a narrative report of one individual's experiences, and an assessment of mortality rates. Research findings suggest that the current privatization model incentivizes limiting services rather than improving oversight and access to care. Mortality rates were found to be the highest in privately run care facilities. Case study findings further suggest that private correctional care is routinely inadequate and exposes prisoners to harm and risk of harm, including inhibited access to care, severe medical conditions, amputations, suicide, and death. The propensity of this harm compared to publicly run care remains inconclusive. Increased independent oversight and population reduction over privatization are recommended.Item Race and health care : problems with using race to classify, assess, and treat patients(2010-05) Nitibhon, Atalie; Warner, David C.; Dorn, EdwinThough racial classifications may serve as a mechanism for identifying and correcting disparities among various groups, using such classifications in a clinical setting to detect and treat patient needs can be problematic. This report explores how medical professionals and researchers use race in health care for purposes of data collection, risk assessment, and diagnosis and treatment options. Using mixed race individuals as an example, it then discusses some of the problems associated with using race to group individuals, assess risk, and inform patient care. Finally, it discusses how certain components of personalized medicine, such as genetic testing, Electronic Health Records, and Rapid Learning Systems could help address some of the concerns that arise from the application of race in a health care setting.Item Simulation and Optimization Models for Scheduling Multi-step Sequential Procedures in Nuclear Medicine(2011-08-08) Perez Roman, EduardoThe rise in demand for specialized medical services in the U.S has been recognized as one of the contributors to increased health care costs. Nuclear medicine is a specialized service that uses relatively new technologies and radiopharmaceuticals with a short half-life for diagnosis and treatment of patients. Nuclear medicine procedures are multi-step and have to be performed under restrictive time constraints. Consequently, managing patients in nuclear medicine clinics is a challenging problem with little research attention. In this work we present simulation and optimization models for improving patient and resource scheduling in health care specialty clinics such as nuclear medicine departments. We rst derive a discrete event system speci cation (DEVS) simulation model for nuclear medicine patient service management that considers both patient and management perspectives. DEVS is a formal modeling and simulation framework based on dynamical systems theory and provides well de ned concepts for coupling components, hierarchical and modular model construction, and an object-oriented substrate supporting repository reuse. Secondly, we derive algorithms for scheduling nuclear medicine patients and resources and validate our algorithms using the simulation model. We obtain computational results that provide useful insights into patient service management in nuclear medicine. For example, the number of patients seen at the clinic during a year increases when a group of stations are reserved to serve procedures with higher demand. Finally, we derive a stochastic online scheduling (SOS) algorithm for patient and resource management in nuclear medicine clinics. The algorithm performs scheduling decisions by taking into account stochastic information about patient future arrivals. We compare the results obtained using the SOS algorithm with the algorithms that do not take into consideration stochastic information. The SOS algorithm provides a balanced utilization of resources and a 10% improvement in the number of patients served.Item Texas primary care and the Affordable Care Act : implications for the primary care physician workforce(2012-05) Lavelle, Tanya Josée Holland; Angel, Jacqueline Lowe; Warner, David C.Primary care physicians are the first point of contact for patients entering the formal health care system. A shortage of primary care physicians in the United States has left approximately 60 million people without adequate access to a physician, resulting in lowered health care outcomes and excess stress on the health care safety net. Texas has one of the most severe shortages of primary care physicians with more than 5.7 million people living in rural and urban areas considered to be underserved. The state’s rapid population growth, as well as the wide geographic distribution of its residents, makes it particularly vulnerable to health care disparities. Although there is a decisive need, factors like high medical school debt and low anticipated salaries are leading more students to specialize instead of pursue a primary care career. A variety of solutions have been proposed to address this problem including: rethinking the physician reimbursement structure; expanding graduate medical education opportunities for primary care students; and incentivizing primary care with loan repayment. In 2014, the new insurance exchanges created by the Patient Protection and Affordable Care Act will begin operating, giving millions more Texans access to health insurance. The current Texas primary care physician workforce shortage will be exacerbated once the major components of the Patient Protection and Affordable Care Act are fully enacted; therefore, state policymakers must take steps to increase Texas’ primary care physician workforce by making primary care a more attractive and accessible career path for medical students.