Eunique Noel October 13, 2011 PHC 4720-310 U29748885 Peer-Reviewed Example Paper Case Study Moreira, T. (2011).

Health care rationing in an age of uncertainty: A conceptual model. Social Science & Medicine, 72(8), 1333-1341. doi:10.1016/j.socscimed.2011.02.026 Original Abstract: Explicit health care rationing or priority-setting is the use of institutional procedures for the systematic allocation of resources within health care systems. With the establishment of priority setting systems in various countries in the past two decades, research has been conducted on their principles, methods and institutional aspects. This paper draws on the sociology of science and technology to propose an uncertainty-focused conceptual model of the relationship between knowledge practices and political processes in health care rationing. Taking a case-study approach, the paper explores the public controversy about whether dementia drugs should be available on the UK National Health Service. It shows how three aspects of the controversyloose institutional framing, open membership and hybrid knowledgeworked together to enable the use of a pragmatic balance between rules and cases. Placing this outcome within the space of possibilities suggested by the model, the paper suggests that accepting and fostering the exploration of uncertainty at the core of health care priority setting systems should provide those systems with increased social robustness. Abstract Rewrite: Other countries have found a health care solution that involves the rationing of services and the systematic allocation of resources. By examining a case-study in the UK the question whether or not dementia drugs should be available through resource allocation. Drawing a line between political goals and that of the health care systems is the biggest challenge in this study. There are many aspects that lead to controversy of this approach, but there is some belief that investigation of the ambiguity of health care can resolve issues and help to supply health care systems with an increase in social perception.

Literature Review Brady, A., Redmond, R., Curtis, E., Fleming, S., Keenan, P., Malone, A., & Sheerin, F. (2009). Adverse events in health care: A literature review. Journal of Nursing Management, 17(2), 155-164. doi:10.1111/j.1365-2834.2008.00887.x Original Abstract: Aim: This paper aims to develop understanding of the nature, costs and strategies to reduce or prevent a range of adverse events experienced by people within the

healthcare system. Background: Care interventions are not always based on safe practice and adverse events can and do occur that cause or place at risk patients lives and well-being. The nature of adverse events is diverse and can be attributed to a multitude of individual and system contributory factors and causes. Evaluation: A review of the literature was undertaken in 2006 and 2007 using the following databases: Pubmed, CINAHL, Biomed Ovid, Synergy and the British Nursing Index. This paper evaluates the literature that pertains to adverse events and seeks understanding of this complex issue. Key issues: Published statistics confirm that globally, professional errors in clinical practice and care delivery occur at an unacceptably high level and result in considerable human and financial consequences. Conclusion: Reaching understanding of the multiple factors that contribute to unsafe clinical practice situations requires a cultural shift in organizations. Implication for Nursing Management: Reasons for adverse events are complex and require healthcare managers to evaluate the system issues which impact on the delivery and organization of care. Abstract Rewrite: It is important to understand that adverse health events may occur under the care of a health professional. A change is needed in the system because the majority of adverse events that occur can be prevented by the change and development of more effective clinical practices and the delivery of care. It is the responsibility of healthcare managers to reevaluate their system a make a change that directly reduces the number of issues. The goal is to positively impact the organization of healthcare in a way which reduces adverse event, along with the cost to both patient and healthcare provider.

Empirical Study Forbat, L., Cayless, S., Knighting, K., Cornwell, J., & Kearney, N. (2009). Engaging patients in health care: An empirical study of the role of engagement on attitudes and action. Patient Education and Counseling, 74(1), 84-90. doi:10.1016/j.pec.2008.07.055 Original Abstract: Objective: Identify the role of engaging people affected by cancer in service development in influencing healthcare professionals and service-users attitudes toward, and enactment of, engagement. Methods: Focus group discussions with healthcare professionals and people affected by lung cancer, prior to and following an intervention where lung cancer teams were supported to engage with patients and family members. Results: Staff and people affected by cancer who participated displayed more positive attitudes toward involvement than those who did not participate. Conclusion: Progressing the involvement agenda requires the use of supported, small scale, projects where staff and patients/family members can develop their skills and knowledge of involvement. Practice implications: Doing patient engagement work is a vital step toward changing attitudes and actions toward the involvement agenda. Abstract Rewrite: The objective was to measure the affects of actively engaging patients in their healthcare. By exposing patients to positive attitudes and group discussion with healthcare professionals, patients were likely to include themselves and their family in the treatment. Those who chose to engage showed more positive attitudes when compared to those who did not

engage. It is important to help patients by providing a supportive environment where patients engage and find it easy to approach healthcare. This outcome can be used on larger scales, the involvement of staff and family members are critical to changing attitudes about receiving health care. Theoretical Article Fennell, M. L., & Adams, C. M. (2011). U.S. health-care organizations: Complexity, turbulence, and multilevel change. Annual Review of Sociology, 37205-219. doi:10.1146/annurev.soc.012809.102612 Original Abstract: The focus of this review is macro-level organizational change in U.S. healthcare organizations, with a special emphasis on turbulent changes in the environments of healthcare organizations. We examine several contemporary theories used to study health-care organizations (institutional theory, complexity theory, and multilevel approaches). These and other theories may be helpful in framing investigations that emphasize key environmental changes of the 1990s and the first decade of the twenty-first century, which in turn have led to changes in healthcare systems and macro-level structures. Those key changes include advances in health-care technologies, changes in the systems of care, and of course, changes in health-care policy. Abstract Rewrite: The aim is to provide an explanation of the difference in health-care organizations at a more precise level. By examining several theories used to observe healthcare organizations and the services they provide, a suggestion can be made about the predicted change of current health-care systems and organizations. The progression of time is a factor in the advancement of theories. The change from the 90s into the current century leads to the analysis of new technologies, the change in health care policy due to the change in administration, and changes in the way in which we execute the system of care.

Methodological Article Marconi, K. M., & Rudzinski, K. A. (1995). A formative model to evaluate health services research. Evaluation Review, 10(5), 501-510. doi:10.1177/0193841X9501900501 Original Abstract: Proposes a model for conducting formative evaluations of health services research grant programs, based on a typology that classifies such research in terms of purpose, methodology, and level of analysis. The purposes of health services research projects are defined in terms of substantive outcomes (i.e., access to health care, costs, and quality of care). Methodological intent identifies the study's analytical foci (i.e., descriptive, data development, theory building, policy analysis, or dissemination). Level of analysis may include individual knowledge or behaviors, and the perceptions of patients, health professionals, or the public; organizations; and community or state systems.

Abstract Rewrite: The goal is to recommend a model that would assess health services and the grant programs that fund the research being developed. By developing a methodology that appraises what health services comprise, researchers and evaluate whether or not current grant programs are successful in nature or need modification based on the definition provided. Researchers will examine health practices and theories of health practices by analyzing patient opinion, the practice of health professionals, and public organizations to name a few. The preferred outcome would to have a model of health care and services that is applicable to more than one situation.