Kruger, EstieMcGeachie, JohnTennant, MarcAlabbasi, Khalid Hishmet Abdul Moin2023-12-182023-12-182022https://hdl.handle.net/20.500.14154/70273Chapter 1 has been published in the Saudi Journal of Health System Research, and Chapter 2 has been published in Geriatrics journal. Chapter 3 has been published in the Saudi Journal of Emergency Medicine and Chapter 4 has been published in the Clinics and Practice. Finally, Chapter 5 has been submitted to the BMC Health Service Research. However, these chapters have been formatted to the same layout of the thesis. In addition, the references for these chapters are incorporated in the bibliography; published versions have been included in appendices I, II, III, IV & V. Paper 1: Evaluation of Emergency Health-Care Initiatives to Reduce Overcrowding in a Referral Medical Complex, Jeddah, Saudi Arabia Paper 2: Long Term Implications of Home Healthcare Management on Mortality in Older Adults with Functional Difficulties in the Saudi Community Paper 3: Bed Management Systems: Do They Help Tackle Inpatient Bed-Availability Challenges in a Public Medical Complex in the Kingdom of Saudi Arabia? Paper 4: Strengthening Saudi Arabia's Primary Health Care Through an E-referral System: A Case Study Paper 5: Evaluating population-based geographic access to primary healthcare services in second cluster jeddah-saudi ArabiaModel of Care has been designed in Saudi Arabia to improve health outcomes for the population alongside the rationale of allocating financial resources. This Model of Care based on six “systems” of care (keep me well, planned care, maternity care, chronic care, urgent care, and end of life care) and delivers 42 integrated interventions that cut across all systems of care. Thus, the key aims of this thesis are to comprehensively evaluate the impact of reform efforts on different models of health care delivery in Saudi Arabia, using a comprehensive hospital database from one site (King Abdullah Medical Complex in Jeddah city, Saudi Arabia) that implemented the Model of Care. The obtained data were analysed to assess whether King Abdullah Medical Complex was able to: 1) reduce the emergency department visits; 2) improve health outcomes in patients receiving home healthcare services; 3) reduce the average length of stay in hospital; and 4) improve the health referral system. An additional set of data on the population distribution and the primary healthcare centre’s locations of Jeddah Second Cluster–Jeddah city were obtained from open-access web-based sources to investigate the spatial accessibility of the existing primary healthcare. Data analyses revealed that the number of cases attending the emergency department significantly decreased following the introduction of the urgency transfer policy. In Home Healthcare, three significant explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] were identified. In addition, the findings suggested that the number of patients admitted to the hospital were far greater after the bed management initiative began than before it was implemented. Introducing e-referral systems has improved scheduling,decreased variation among clinics and improved patient access and would likely improve the closing rates of the referral loop. However, the capacity of primary healthcare centers does not appear to be enough to satisfy the demands of the population. In Jeddah’s Second Cluster–Jeddah city, the population density varies significantly between districts, with services concentrated in some highly populated areas. It is anticipated that the findings of this single site implementing the Model of Care will be explored further at other hospital complexes within Saudi Arabia, to enhance Model of Care refinement and success.198enBOR Bed Occupancy Rate BTR Bed Turnover Rate CAD Coronary Artery Disease CI Confident Interval COVID-19 Coronavirus Disease CTAS Canadian Triage and Acuity Scale CVD Cerebrovascular Diseases DM Diabetes Melitius ED Emergency department ER Emergency Room HHC Home Healthcare ICD International Classification of Diseases IQR Interquartile Range J1 Jeddah First Cluster J2 Jeddah Second Cluster J2-J Jeddah Second Cluster – Jeddah CityThesis