This Study uses Organizational Theory, Social Movement Theory, and Critical Theory to analyze s local long term care ombudsman program (LTCOP) effectiveness in and ability to conduct systems advocacy. A case study methodology was used to conduct telephone survey interviews with local LTCOP coordinators in Georgia to examine more closely systems advocacy within their local LTCOPs and factors that influence effectiveness in conducting systems advocacy. Influencing factors measured include resources, program autonomy, and inter-organizational relationships. Georgia interview and National Ombudsman Reporting System (NORS) data were collected from 2006 - 2007. Data from similar projects in New York and California are then used evaluate both within and across-state differences in factors influencing local LTCOP effectiveness in and ability to conduct systems advocacy. Findings show that while all factors were found to impact local LTCOP effectiveness in and ability to conduct systems advocacy in each state, the results were variable within as well as across states. Organizational Theory, Social Movement Theory, and Critical Theory inform a discussion about potential explanations for the differential impact of resources, autonomy, and inter-organizational relationships on local LTCOP within and across states. Knowledge and understanding concerning barriers to effective program operation and successful programmatic approaches are essential to enhance the safety and well-being of those residing in LTC facilities, to strengthen local LTCOPs, and to develop meaningful public policy.

While the rates of smoking in the general population have declined substantially over the last several decades, the prevalence of smoking among people with mental illness remains alarmingly high. For example, various estimates suggest that 50-90% of people with serious mental illness smoke, and nearly half of tobacco-related deaths each year occur among people with mental illness. Moreover, 70% or more of people with mental illness want to quit smoking, yet there often exist considerable barriers to access for cessation support. This research project is an attempt to understand the development and emergence of initiatives based on collaborative efforts between the mental health community and the smoking cessation field to raise awareness about and address the high rates of smoking among people with mental illness and the resulting health disparities that exist for this population. Research methods included: (1) individual in-person and telephone interviews with 26 national leaders in smoking cessation and mental health, (2) focus group interviews with 26 mental health consumers of various smoking statuses in California, (3) participant observation and fieldwork, and (4) a frames analysis of articles on this topic published in the last 10 years from six leading U.S. newspapers. Data were collected and analyzed using grounded theory methods. Overall, this research describes how collaborative efforts between the mental health and smoking cessation fields have resulted in the recognition of the high rates of smoking among people with mental illnesses as a social problem. This awareness has come from a shift in the social construction of tobacco use to one in which cessation is considered integral to overall wellness. The effort to address the disproportionate use of tobacco in the mental health community has allowed for the collective mobilization of the mental health and smoking cessation arenas, fields that have long been divided. This dissertation explores the enactment of and the possibilities for messages and actions to effectively and sensitively lower the rates of smoking among people with mental illness to reduce tobacco-related diseases, increase quality of life and life expectancy, and expand possibilities for recovery.

Electronic health records (EHRs) are described as one strategy to: 1) improve health care quality; 2) prevent medical errors; 3) reduce health care costs; 4) increase administrative efficiencies; 5) decrease paperwork; 6) expand access to affordable care; and 7) bring public health benefits through tracking and early detection of disease (Health and Human Services, n.d.). This dissertation uses sociological inquiry to address most of these perceived benefits.

Objective: To better understand the impact EHRs have on the structures, institutions, and practice of primary care as it relates to cost, quality of care, workflow, time, and provider-patient interactions using a grounded approach from both theoretical and practical standpoints. The human factor of this nonhuman technology is explored as is relates to the practice of health care, specifically as it relates to cost and quality and efficiency.

Research Methods: Ethnographic analysis of 11 Case studies of early-adopter solo and small group primary care practices using an EHR (including ethnographic observations, semi-structured interviews, surveys, and review of practice financial and productivity records) funded by the Commonwealth Foundation and unfunded 5 supplemental in-depth interviews of primary care providers using an EHR in various practice settings.

Findings: The macro-level findings are, when using an EHR: 1) the biomedical paradigm is reproduced and formalized; 2) provider power and autonomy are reproduced and formalized; and 3) the reimbursement structure is exploited. The mezzo-level findings are, when using an EHR: 1) health care providers' work remains relatively unchanged in type and content; 2) how the EHR is used is more important than that it is used; 3) all members of a practice are critical in the use of the EHR; 4) the EHR is used primarily for profit; 5) the EHR is secondarily used for efficiency; 5) quality-oriented features are often unused. The micro-level findings are, when using an EHR: 1) using the computer during an encounter strains interaction with patients; 2) management of information is the basic use of the EHR; 3) workflow patterns change; and 4) there are increased stages of the medical encounter. Policy implications are discussed.