The effect of increased part-charges on the health-seeking behaviours of Group 3 workers and their families : a thesis presented in partial fulfilment of the requirements for the degree of Master in Arts (social policy) at Massey University

This thesis is about health, change and user charges. In 1991 New Zealand embarked in a new direction for the funding of health services, including extensive use of a targeting regime in which 'those that can afford' social services were paying more so that those who could not were paying less. For the 'high-income' families classified as Group 3, this meant that part charges at point of service were increased at all levels of health services. Concerns immediately arose that the income levels had been set too low and would create financial barriers for some 'high-income' families, particularly those on the margin. This thesis explores the demand response of 129 families in Group 3 to the new charges imposed by the Interim Targeting Regime. The survey population is characterised by high incomes and insurance coverage across income levels. Through a nonrandom survey methodology based on the opinions and perceptions of the user community (Group 3 workers and their families), over one-quarter of the survey families reported health services demand being diverted from allopathic medical services. However, even though 25% reported demand diversion, only 11% of families reporting lowered health status. The study also looked at diversion from conventional medicine to alternatives including self-treatment, seeking advice from a chemist, complementary therapies or changing lifestyle habits. The data did not suggest diversion to alternatives equal to the reduction of conventional medical services. Through the use of nonparametric statistical techniques, characteristics of the survey population were analysed in an attempt to begin untangling a complex web of factors affecting the survey population's health services demand when faced with increases in price. Factors included in this study were income level, insurance coverage, health status, gender, family size and composition . Various subsamples of the survey population reported different effects and different magnitudes of demand diversion. The differences between insured and uninsured families were particularly marked. Evidence provided by the user community implicates a high degree of moral hazard within the insured subsample. The study suggests further research on the influence on moral hazard in meeting the stated goals of the reforms. Because the study is nonrandom and exploratory, any claim of representativeness would be unwarranted. However, the study suggests that the attributes of high incomes and insurance coverage may be inherent to Group 3. To more accurately assess the representativeness of any research on the effects of the increase in part charges on Group 3, the study proposes a further clarification of the specific attributes of the families belonging in the Group 3 category is necessary. Finally, the study questions the adequacy of the targeting regime and the increase in part charges for meeting the objectives set out by the health reformers, particularly in respect to the objectives of cost containment and individuals becoming more responsible for their own health

The American Academy of Ambulatory Care Nursing\u27s Invitational Summit on Care Coordination and Transition Management: An Overview

The American Academy of Ambulatory Care Nursing convened an Invitational Summit of national leaders to assist with strategic planning for promulgation of the care coordination and transition management (CCTM™) model. The conference was devoted to CCTM and the roles of registered nurses (RNs) across the care continuum to ensure safety and quality health care. The specific emphasis was on embedding the CCTM RN in healthcare policy and payment reform, as well as integration into academic and ongoing education across all care settings and specialties

Developing the Value Proposition for Registered Nurse Care Coordination and Transition Management Role in Ambulatory Care Settings

The Patient Protection and Affordable Care Act (2010) established clear provisions for Patient-Centered Medical Homes and Accountable Care Organizations. In both, care coordination and transition management are methods to provide safe, high-quality care to at-risk populations such as patients with multiple chronic conditions. The emphasis on care coordination and transition management offers opportunities for nurses to work at their full potential as an integral part of the interprofessional team. Development of a model for the registered nurse in care coordination and transition manage- ment provides nurses the opportunity to develop the knowledge, skills, and attitudes to be a resource to the team and to patients, and to con- tribute to high-quality patient and organization outcomes

Developing the Value Proposition For the Role of the Registered Nurse In Care Coordination and Transition Management in Ambulatory Care Settings

The Patient Protection and Affordable Care Act (2010) established clear provisions for Patient-Centered Medical Homes and Accountable Care Organizations. In both, care coordination and transition management are methods to provide safe, high quality care to at-risk populations such as patients with multiple chronic conditions. The emphasis on care coordination and transition management offers opportunities for nurses to work at their full potential as an integral part of the interprofessional team. Development of a model for the registered nurse in care coordination and transition management provides nurses the opportunity to develop the knowledge, skills, and attitudes to be a resource to the team and to patients, and to contribute to high-quality patient and organization outcomes

The Effects of Partial Body Weight Support for Gait for Patients with Neurological Dysfunction: A Case Study Approach

The purpose of this study was to determine the effects of partial body weight support during gait for individuals with neurological dysfunction. Body weight support (BWS) training provides a safe environment in which the individual can perform and practice mechanics of normal gait at a variety of speeds with or without body weight support, depending on the level of function. The subjects who participated in this study were community ambulators older than 20 years of age with a neurological diagnosis. Each subject was tested initially and at the conclusion of the study to compare data using a battery of balance and gait tests. Each subject participated in body weight support treadmill gait training using the LiteGaitTM three times a week for up to six weeks. Each subject was to begin with 40% body weight support (BWS) and a treadmill speed of .5 mph, progress to 20% BWS and a speed of .7 mph, and finally to 0% BWS and a speed of 1.0 mph. All three subjects made improvements when comparing initial to final testing results. Many factors may have limited the results of our study including the tester, sensitivity of the tests performed, or sudden changes in medical status

Developing Ambulatory Care Registered Nurse Competencies for Care Coordination and Transition Management

The need for care coordination and management of transitions between Patient-Centered Medical Home providers, outpatient and community settings, including the Accountable Care Organization is often overlooked, episodic, and accountability for coordinating care and managing transitions between providers and services is lacking

Care Coordination: Roles of Registered Nurses Across the Care Continuum

Lack of coordination leads to health care that is fragmented, inconsistent, and poorly planned. Conversely, effective care coordination supports achieving the Quadruple Aim. Care coordination, roles of RNs in care coordination, and implications for healthcare delivery are explored

Mapping, Tracking and Modeling the Movements of Single Membrane-Bound Transcription Activator Proteins in Live Vibrio cholerae.

Cholera has been known since ancient times, yet there is still no cure. Vibrio cholerae bacteria cause cholera by producing cholera toxin. Cholera toxin production is regulated by the protein ToxT, which itself is regulated by two membrane-bound proteins, TcpP and ToxR, that work together to bind DNA and activate transcription of toxT. The molecular-scale details of this unusual membrane-bound transcription activation mechanism are unclear and cannot be observed using traditional light microscopy due to the diffraction limit of light. In this thesis, we use single-molecule tracking and super-resolution localization microscopy to overcome the diffraction limit and directly observe the motions and interactions of TcpP labeled with the fluorescent proteins Dendra2, mCherry and PAmCherry in live V. cholerae cells. We describe methods developed–and obstacles encountered–in the course of our studies of these protein fusions, and find, of the three fluorescent proteins examined, PAmCherry is the best choice for tracking TcpP motion. By using mean squared displacement and cumulative probability distribution analyses of single-molecule trajectories, we compare TcpP-PAmCherry motions across three V. cholerae strains. In each strain, the native copy of TcpP is removed and replaced with TcpP-PAmCherry expressed ectopically. We find TcpP motion can be categorized into three populations: fast, slow and immobile; and TcpP-PAmCherry moves faster when both binding partners (ToxR and the toxT promoter) are present than when either is lacking. Our findings support a mechanism for TcpP--ToxR--toxT promoter interaction in which ToxR recruits TcpP to the toxT promoter. Although PAmCherry is adequate for our single-molecule microscopy experiments, it is not an ideal fluorophore. A brighter fluorescent label that resists photobleaching would enable faster imaging and longer measured trajectories. We present a protocol for enhancing PAmCherry fluorescence by coupling TcpP-PAmCherry in the membrane of live V. cholerae cells to extracellular gold nanoisland films and nanotriangle arrays to achieve plasmon-enhanced fluorescence. We can detect single-molecule fluorescence above background scatter on both nanostructured gold surfaces, which is promising for further live cell studies. Greater understanding of the ToxR regulon may lead to novel therapeutics to combat cholera, and enhanced fluorescence will help us observe such interactions with greater detail.PHDChemistryUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/109021/1/leveret_1.pd

Optimizing Strategies for Care Coordination and Transition Management: Recommendations for Nursing Education

The purpose of this descriptive qualitative study was to explore nurse and healthcare leaders\u27 experiences and perceptions of care coordination and transition management (CCTM®). Four barriers emerged that added insight into the lack of adopting and integrating CCTM knowledge, skills, and attitudes in nursing education in the following categories: curriculum redesign, silos of care settings and care providers, knowledge gap, and faculty development/resistance. Recommendations and implications for education, for both nursing students and practicing nurses, are described