UMD Theses and Dissertations
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New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.
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Item The Impact of International Accreditation on The Quality of Health Services at King Fahd University Hospital, Saudi Arabia: A Mixed Methods Approach(2019) AL Shawan, Deema Saad; Franzini, Luisa; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The Joint Commission International Accreditation (JCIA) is perceived worldwide as the symbol of exceptional quality of care. Despite the popularity of international accreditation, evidence of its effectiveness on improving health care quality is inconclusive. This dissertation research utilized a Convergent parallel mixed method framework to evaluate the impact of the JCIA process on quality and to identify the factors that influence the effectiveness of this process at King Fahd Hospital of the University in Khobar, Saudi Arabia. An interrupted time series analysis was conducted to assess the changes in a total of 12 quality outcomes pre and post accreditation. Furthermore, a qualitative approach was used to investigate the attitudes and perceptions of 31 health providers towards this process and the factors that influence its success. The quantitative results suggested that the JCIA had a positive impact on 9 out of 12 outcomes. The improved quality outcomes included: the average length of stay, the percentage of hand hygiene compliance, the rate of nosocomial infections, the percentage of radiology reporting outliers, the rate of pressure ulcers, the percentage of the correct identification of patients prior to medication administration, the percentage of critical lab reporting within 30 minutes, and the bed occupancy rate. The outcomes that did not improve were the rate of patients leaving the ER without being seen, the percentage of OR cancelations on the day of the or and the rate of patient falls. The qualitative analysis suggested that the JCIA was perceived positively by all participants. Some of the perceived advantages of international accreditation included the transformation of the organizational culture to a culture that promotes continuous quality improvement, standardization, and the reduced paperwork in some departments. The participants’ responses also indicated that there were many factors that influence the success of the process. Examples of the factors identified in the study include the increased workload and the providers’ resistance to participate in the JCIA process. In conclusion, international accreditation seemed to have a positive impact on quality outcomes and was received positively by providers. Nevertheless, the factors that hindered the JCIA process need to be addressed by the hospital’s leadership to ensure more efficient quality improvement efforts during future accreditation cycles.Item ESSAYS ON PREFERENTIAL TRADE AGREEMENTS(2019) Laget, Edith; Limão, Nuno; Economics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Preferential Trade Agreements (PTAs) are a prominent feature of current globalization. Over the last decades, country participation in PTAs has become widespread, with each member of the World Trade Organization having signed an average of 10 PTAs, up from 3 PTAs in 1990. Most importantly, the proliferation of PTAs was accompanied by a significant deepening of their scope. Their content now spans diverse behind-the-border disciplines, such as investment, technical barriers to trade (TBT), sanitary and phytosanitary (SPS) measures , intellectual property rights, visa and asylum, labor market laws and environmental regulations. In order to quantify the impacts of the provisions included in PTAs on various outcomes of interest, such as gross trade, foreign direct investment (FDI), global value chains, quality, and so on, trade economists face several empirical obstacles to model Non-Tariff Measures (NTMs). While it is straightforward to model provision, such as an import quota or an export tax with an ad-valorem tariff equivalent, this technique is not suitable for other provisions that do not purely deal with market access. Many NTMs are implemented to address behind-the-border issues rather than to discriminate against foreign businesses. Therefore, it would be misleading to restrict the effect of certain trade policies to their market access dimension only. The objective of this dissertation is two-fold: it is, first, to understand the impacts of the overall content of PTAs on economic outcomes and, second, to shed light on the relationships of specific disciplines included in PTAs with those outcomes. In the first chapter, I review the recent evolution of trade and investment integration and how the content of PTAs has been reshaped over the years. The second and third chapters are dedicated to the analysis of two of the most frequent provisions in PTAs — TBT and SPS provisions. In the theoretical part, I augment the structure of the traditional Melitz model to assess the impact on quality of such provisions. I model TBT/SPS measures as domestic regulations ensuring minimum quality of goods. By integrating these regulations, PTAs change the economic struc- ture of the model (with respect to minimum quality enforcement) from segmented to joint markets. I highlight two potential channels to explain the change in quality of exported goods following the enforcement of a PTA with TBT/SPS provisions. The first channel for quality improvement is driven by the increase in market size. With larger markets to export to, firms have the incentive to differentiate vertically their products in order to capture bigger shares. The second channel depends on the type of provisions implemented. I consider two cases, mutual recognition ver- sus harmonization of TBT/SPS measures. The ultimate impact on quality of this regulatory channel depends on the new reference for minimum quality once a PTA is signed. Then, I empirically test the importance of these two channels using new data on the content of PTAs and estimates of the quality of imported goods. I find that mutual recognition positively impacts quality relatively more than harmoniza- tion. This result is driven by PTAs between developed and developing countries. The effect is heterogenous across sectors, with bigger impact of deep PTAs on goods that have a wider scope for quality differentiation. Finally, I study the impact of PTAs on FDI and find that deep PTAs promote foreign investments. The impact is bigger for projects related to service activities, as well as North-South investment relationships.Item Self-regulation, productivity, and nonlinear pricing. Three essays on quality production in agricultural markets(2006-05-16) Zago, Angelo; Chambers, Robert G.; Agricultural and Resource Economics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In this dissertation I analyze the quality choices of a group of producers. In the first essay I use mechanism design to study the interaction of asymmetric information and the democratic process in the quality choices of a group of heterogeneous producers facing an opportunity to gain from establishing a reputation for their quality products. I find an asymmetry in the possible equilibria between the high and the low quality majorities. The quality level provided by the group with a low quality majority is lower than the first best, and the minority producers get rents. With high quality majority, if demand and group conditions are favourable, the quality level provided by the group is higher than the first best and the minority's type left with rents. Otherwise, the quality level provided by the group is first best and no rents are left to the low-quality producers in the minority. The second essay proposes a methodology to measure the characteristics of intermediate products when quality is multidimensional. It uses a general representation of the multioutput technology via directional distance functions and constructs quality indicators based on differences. The quality indicators may be used to evaluate firms' output taking into account the whole set of quality attributes. I explore the relationships among the different quality attributes and the yields by a systematic investigation of the disposability properties of the technology. In addition, I show how aggregate quality may vary with the production level. The third essay designs an optimal payment system for a group of producers implementing it empirically. In the essay I show how to implement the first best through higher prices for better quality commodities, deriving the optimal pricing schedule. I take into account producers' heterogeneity by modelling inefficiency and illustrating how technical efficiency interacts with producers' ability to produce output for a given level of inputs and hence affects revenues. The technology and the technical efficiency of producers are then estimated with a stochastic production function model. The estimation results are then used to simulate the pricing scheme.