Location Evaluation of Childcare Facilities Focusing on Transportation in Japanese Urban Areas

In recent Japan, as there has been an increase of dual-income households and the demand for childcare facilities has especially increased especially in urban areas, childcare facilities and workers are lacking and it leads to the serious issue of children on waiting lists. Based on the background mentioned above, using statistical method, geographical information system (GIS) and public open data, scenario analysis to select transportation, the present study aimed to propose a method to quantitatively evaluate the current location of childcare facilities in Japanese urban areas. In the present study, the model of the p-median problem used to obtain the optimal location of facilities was modified, and a method to evaluate the current situation concerning the shortage or overage of childcare facilities by district was proposed. As evaluations are conducted using quantitative data such as the specialization coefficient of person trip for transportation and the distance between childcare facilities and districts, the evaluation results are also quantitative, making it an effective indicator for evaluating the locations of childcare facilities. Additionally, the specialization coefficient of person trip for transportation and the distance between childcare facilities and districts were calculated based on public open data. Therefore, the evaluation method in the present study has a high temporal reproducibility as well as spatial reproducibility

N.C. Medicaid Reform: A Bipartisan Path Forward

The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race. The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers. This report is submitted to North Carolina’s policymakers and citizens. It assesses the current Medicaid landscape in North Carolina, and it offers recommendations to North Carolina policymakers concerning: (1) the construction of Medicaid Managed Care markets, (2) the potential and dangers of instituting consumer-driven financial incentives in Medicaid benefits, (3) special hotspotting strategies to address the needs and escalating costs of Medicaid\u27s high-utilizers and dual-eligibles, (4) the emerging benefits of pursuing telemedicine and associated reforms to reimbursement, regulation, and Graduate Medical Education programs that could fuel telemedicine solutions to improve access and delivery. The NC Medicaid Reform Advisory Team includes: Deanna Befus, Duke School of Nursing, PhD ‘17Madhulika Vulimiri, Duke Sanford School of Public Policy, MPP ‘18Patrick O’Shea, UNC School of Medicine/Fuqua School of Business, MD/MBA \u2717Shanna Rifkin, Duke Law School, JD ‘17Trey Sinyard, Duke School of Medicine/Fuqua School of Business, MD/MBA \u2717Brandon Yan, Duke Public Policy, BA \u2718Brooke Bekoff, UNC Political Science, BA \u2719Graeme Peterson, Duke Public Policy, BA ‘17Haley Hedrick, Duke Psychology, BS ‘19Jackie Lin, Duke Biology, BS \u2718Kushal Kadakia, Duke Biology and Public Policy, BS ‘19Leah Yao, Duke Psychology, BS ‘19Shivani Shah, Duke Biology and Public Policy, BS ‘18Sonia Hernandez, Duke Economics, BS \u2719Riley Herrmann, Duke Public Policy, BA \u271

Report of Data Analyses to the Georgia Commission on the Efficacy of the CON Program

A highlight of presentations and discussions during the Philanthropic Symposium on School Health held October 16, 2000 in Atlanta, GA.Community and Public Healt

Formal and Informal Care: An Empirical Bayesian Analysis Using the Two-Part Model

Informal care provided to the elderly by their children is proposed as a less expensive alternative to institutional long-term care. This paper explores how the elderly\u27s consumption of medical care changes in response to changes in the informal care they receive from their children. Many earlier studies have ignored both the endogeneity of informal care and the complicated nature of health care utilization data. This paper develops a two-part model with informal care treated as an endogenous regressor and imposes exclusion restrictions on the selection process. The model is fitted using the Bayesian Markov Chain Monte Carlo (MCMC) methods, in particular the Gibbs sampler and the Metropolis-Hasting algorithm. The average treatment effects and the distributions of the treatment effects are obtained via posterior simulation. The results indicate that informal care provides a substitute for nursing home care and hospital inpatient care, but it does not affect paid home health care on average. The treatment effects are heterogeneous. The largest substitution effects occur for nursing home and hospital inpatient care at the intensive margin. The policy analysis suggests that informal care policies targeting the group that incurs the largest substitution effect may help to reduce government spending on Medicaid and Medicare

公共交通における安全性と交通手段の選択を最適化するための影響因子の探索－スリランカ・コロンボ都市圏におけるフィールド調査研究

国立大学法人長岡技術科学大

Determining Care Delivery Model Feasibility Using Discrete-Event-Simulation

Background: The need for inpatient pediatric psychiatric services to address the growing issue of pediatric mental health in a multi-state integrated hospital enterprise is straining the system’s capacity to provide timely mental health care. Local Problem: Lack of access to specialty pediatric psychiatric treatment for dual diagnosis medi-psychiatric care management is a patient quality and safety issue. Insufficient capacity contributes to longer emergency room boarding times and inpatient length of stay for patients who have a mental illness. Methods: Use of digital simulation methodology to analyze the behavior of a dynamic event-driven care delivery workflow and to optimize quality patient outcomes by implementing a hub and spoke model of care. Interventions: A discrete event simulation model was built using retrospective data to evaluate existing resources and “what if” scenarios based on patient movement through a hub-and-spoke regional patient transfer structure. Results: Simulation of the patient flow determined that a decentralized hub-and-spoke model for management of pediatric dual diagnosis patient volume was unnecessary. Simulation modeling results revealed an average daily census of five indicating an ability to centralize all pediatric dual diagnosis volume into one hub hospital instead of three. Conclusions: Simulation was a cost effective, predictive, and innovative approach to evaluating alternative care models at the nurse executive level. The project demonstrated that prudent strategy for use of capital project resources can be enhanced at the beginning of the design phase in project management and clarity of scope realized at the macro, meso, and micro levels every project, every time

Associations Between Healthcare Facility Types and Healthcare-Associated Infections

Healthcare-Associated Infections (HAIs) continue to be an epidemiological issue burdening patients and public health systems worldwide. The purpose of this study was to determine if specific healthcare facility types (Acute Care Hospitals, Long Term Acute Care Hospitals, and Inpatient Rehabilitation Facilities) were associated with particular categories of HAIs: Ventilator-Associated Pneumonias (VAPs), Central Line-Associated Bloodstream Infections (CLABSIs), and Catheter-Associated Urinary Tract Infections (CAUTIs). The theoretical framework for this study was the environmental determinants of infectious disease framework. A single research question focused on whether an association existed among the specified health care facility types and HAIs. Three independent categorical variables were used, including Acute Care Hospitals, Long Term Acute Care Hospitals, and Inpatient Rehabilitation Facilities, and 3 dependent variables were used, comprising of VAPs, CAUTIs, and CLABSIs. A quantitative design engaged the chi-square test of association, using a 2012 population-level report of archival data collected by the Centers for Disease Control and Prevention\u27s National Healthcare Safety Network. Seven groups of HAIs and facility types were tested, and the results revealed that 6 groups had statistically significant differences. This study may contribute to positive social change by helping to identify whether healthcare facility types are associated with HAIs and to supply evidence to stakeholders to support standardization of best practices across all facility types, thus contributing to the reduction of HAIs in the United States

Morehead State University 2000 Self-Study Report

2000 self-study of Morehead State University prepared for the Southern Association of Colleges and Schools.https://scholarworks.moreheadstate.edu/college_histories/1182/thumbnail.jp

Provision of Hospital-based Palliative Care and the Impact on Organizational and Patient Outcomes

Hospital-based palliative care services aim to streamline medical care for patients with chronic and potentially life-limiting illnesses by focusing on individual patient needs, efficient use of hospital resources, and providing guidance for patients, patients’ families and clinical providers toward making optimal decisions concerning a patient’s care. This study examined the nature of palliative care provision in U.S. hospitals and its impact on selected organizational and patient outcomes, including hospital costs, length of stay, in-hospital mortality, and transfer to hospice. Hospital costs and length of stay are viewed as important economic indicators. Specifically, lower hospital costs may increase a hospital’s profit margin and shorter lengths of stay can enable patient turnover and efficiency of care. Higher rates of hospice transfers and lower in-hospital mortality may be considered positive outcomes from a patient perspective, as the majority of patients prefer to die at home or outside of the hospital setting. Several data sources were utilized to obtain information about patient, hospital, and county characteristics; patterns of hospitals’ palliative care provision; and patients’ hospital costs, length of stay, in-hospital mortality, and transfer to hospice (if a patient survived hospitalization). The study sample consisted of 3,763,339 patients; 348 urban, general, short-term, acute care, non-federal hospitals; and 111 counties located in six states over a 5-year study (2007-2011). Hospital-based palliative care provision was measured by the presence of three palliative care services, including inpatient palliative care consultation services (PAL), inpatient palliative care units (IPAL), and hospice programs (HOSPC). Derived from Institutional Theory, Resource Dependence Theory, and Donabedian’s Structure Process-Outcome framework, 13 hypotheses were tested using a hierarchical (generalized) linear modeling approach. The study findings suggested that hospital size was associated with a higher probability of hospital-based palliative care provision. Conversely, the presence of palliative care services through a hospital’s health system, network, or joint venture was associated with a lower probability of hospital-based palliative care provision. The study findings also indicated that hospitals with an IPAL or HOSPC incurred lower hospital costs, whereas hospitals with PAL incurred higher hospital costs. The presence of PAL, IPAL, and HOSPC was generally associated with a lower probability of in-hospital mortality and transfer to hospice. Finally, the effects of hospital-based palliative care services on length of stay were mixed, and further research is needed to understand this relationship

ASSESSMENT OF ASEPTIC TECHNIQUE AMONG NURSES IN MANAGEMENT OF BURNS PATIENTS AT KENYATTA NATIONAL HOSPITAL

Background: Nurses are at greater risk of acquiring and transmitting Health Care Acquired Infections (HCAI) in the course of delivering nursing care; measures to prevent the transmissions are therefore a significant core nursing care. Aseptic Technique among nurses in infection control during management of burns plays a vital role in reducing their morbidity and mortality and hence cost of burn wound management at individual and national level. Therefore, HCAI is the most serious complication of burns with sepsis being the main cause of death. Adherence to the standard operating procedures on burns management put in place by KNH on aseptic techniques assist in preventing infection spread. The aim of this study was to assess aseptic technique among nurses in management of burns patients at KNH. Methods: A cross sectional descriptive study design was employed to obtain a sample size of 59 nurses working in the burns wards, Kenyatta National Hospital. A self administered questionnaire and structured observational checklist was used to collect data. Data was coded and analyzed using SPSS version 21, descriptive statistics such as median, mean and frequency distribution were applied and categorical data was analyzed using chi-square. Measurements of association between the independent variables with key dependent variable were ascertained through logistical regression modeling. Results: 42.9% of the participants did not wash their hands properly before, during and after the dressing procedure while 88.1% had good knowledge on aseptic technique , however 14.6% of the participants maintained the aseptic technique practice throughout the procedure while 85.4% did not. Statistical significance was found between barriers to aseptic technique and adequate water supply in the taps and soap at P=0.038(OR=4.5).70.7% of the rooms lacked standard operating procedures on infection prevention. Presences of segregation posters were present at 31.6 % of the rooms. Barriers to aseptic technique implementation were noted by 54.8% of the nurse’s in hindering application of knowledge to practice. RECOMENDATION: This results suggest that nurses in the specialized wards need to be re -trained on aseptic technique procedures by the institution and institutional policies be availed to the respective ward departments, in addition to adequate logistics on supplies and equipments Infection prevention surveillance needs to be improved from the managerial to the ward level to maintain the Standard Operating Procedure