Digital Commons Network^™

Navigating Post-Covid A Guide For Young Adults Recovering From Mild To Moderate Cases Of Covid-19, Chesley Ferris

Muskie School Capstones and Dissertations

COVID-19 is a new strain of the Human Coronavirus. There are many types of Human Coronavirus, with COVID-19, or the Coronavirus Disease, being discovered in December 2019. COVID-19 is classified as a mild to severe upper respiratory illness. It can affect people differently, with some being asymptomatic, or having no symptoms, and others having mild, to moderate or severe symptoms. Symptoms can also present differently in each person. One person may not have the same symptoms as another.The virus is easily transmittable, meaning it can travel from person to person quickly and easily. This is why it is important to …

Substance Use Prevention: Communication And Strategies To Reduce Alcohol, Marijuana, And E-Cigarette Use Among College Students, Emily Bauer

Muskie School Capstones and Dissertations

Substance use among college students impacts universities, communities and student outcomes across the United States. Based on the Monitoring the Future study (MTF), college students have a higher prevalence of past 30-day alcohol use at 63% than their non-college peers (59%) (2016). Nearly one-third of college students (32%) have had five or more drinks in a row in the past two weeks (2016). Monthly marijuana use for college students has remained steady at 22% (2016). Electronic cigarette (e-cigarette) use is 6.9%, which is gaining in popularity but still lower than traditional cigarettes (8.9%) (2016). There are many prevention communication strategies …

For Our Health: Partnerships In Maine, Joanna Morrissey

Muskie School Capstones and Dissertations

The Maine Shared Community Health Needs Assessment (Maine Shared CHNA) has created a mature network of local collaborations that come together every three years to conduct a statewide needs assessment. This capstone looks into whether there have been successful partnerships that continue collaborating on health improvement planning and implementation post CHNA. Key questions included, “Where there were successful collaborations, what was it that made them successful? What are the challenges to forming and maintaining a collaboration and how have groups overcome those challenges?” A comparative case study approach was used in order to compare and contrast two sites, each demonstrating …

Recommendations For Creating A Certification System For Community Health Workers In Maine, Lyvia Gaewsky

Muskie School Capstones and Dissertations

Executive Summary

The following report was developed to inform the Maine Community Health Worker Initiative (MECHWI) on the processes used by five other states to create a Community Health Worker (CHW) certification system. An assessment of the current situation in Maine as it pertains to certification development was also conducted and a set of recommendations to guide the MECWHI in furthering CHW certification efforts is provided. In summary, the processes used to develop a CHW certification system in Massachusetts, Oregon, Texas, Rhode Island and Indiana tended to involve the following activities: outreach to CHWs and CHW employers, engagement of key …

A Comparative Analysis Of Primary Care Practice Payment Models: Practice And System Level Implications, Travis Masood

Muskie School Capstones and Dissertations

EXECUTIVE SUMMARY

The purpose of this capstone was to (1) assess the likely effects of various primary care practice reimbursement models on quality of care and costs, (2) assess each reimbursement model’s applicability relative to practice size, and (3) analyze each model’s practice and system level implications. This was done through the conduction of a comparative analysis of current practice reimbursement models. The questions addressed in this analysis include:

• What are the primary, practice reimbursement models currently being used?
• What are the implications of these models on quality and costs?
• Are these reimbursement models applicable in all practice types (e.g. …

Identifying Challenges Different Provider Group Encounter In Managing Opioid Use Disorder, Chinonye Anumaka

Muskie School Capstones and Dissertations

The Centers for Disease and Control (CDC) describes opioid use disorder (OUD) also known as opioid addiction as the problematic pattern of opioid use leading to clinically significant impairment or distress. In 2016, about 2.1 million people were diagnosed of OUD in the US. In Maine, York County has the third highest drug overdose response and had 166 deaths occurring between 2012-2016. York County is a designated medically underserved area and has a shortage of provider workforce and limited treatment infrastructure. To further understand the challenges providers in York County encounter in managing patients with OUD, 6 focus groups was …

Early Data From The Maine Ombudsman’S Hospital Advocacy Program: A Deeper Look At Difficult To Place Patients, Joseph Zamboni

Muskie School Capstones and Dissertations

There is little data available on the complex cause and effect of delayed hospital discharge; however, some evidence suggests that long-stay patients tend to be complex, older, and sicker. In Maine, a 2014 Maine Health Association report found complex hospital patients were waiting weeks, months and sometimes over a year in Maine Hospitals before accessing long-term services and supports. In response to these concerns around delayed discharge from hospitals, the First Regular Session of the 127th Maine Legislature created the Commission to study Difficult to Place Patients. The Commission ultimately passed Legislation that gave the Maine Long- Term Care Ombudsman …

Hepatitis C In Injection Drug Users: A Study Of A Detoxification Program In Maine, Meghan Rousselle

Muskie School Capstones and Dissertations

The opiate epidemic has had an impact on the lives of millions of people in this county. As we explore ways to address this issue, it is important to consider the long-term consequences that the epidemic will have. One long-term consequence is the spread of the hepatitis C virus (or HCV). Approximately 3.2 million people in the United States are chronically infected with this virus. Without consideration about ways to treat this virus and prevent its transmission, there will be large numbers of people who will die from complications of HCV in the future. These losses will contribute to the …

Direct Care Nursing Aide Turnover In Long-Term Care Facility, Qilian Luo

Muskie School Capstones and Dissertations

This capstone project, Direct Care Nursing Aide Retention in a Long-Term Care Facility, will uses both qualitative and quantitative analyses to identify the possible contributors to high nursing aide turnover rates in Maine. The quantitative analyses of this project are based on the staffing payroll data of one Maine assisted living facility. The final product of this capstone project will be shared with the study facility, in the hope that they may find uses for its content.

Lung Cancer Screening Provider Survey, Lindsay Mcfarren

Muskie School Capstones and Dissertations

The purpose of this capstone project is to evaluate provider knowledge, attitudes, and behaviors around lung cancer screening in Maine. To evaluate these elements, a survey will be developed and administered to primary care physicians in Maine through three physician specialty societies. The survey will be developed keeping existing literature and previous studies of a similar nature in mind. This survey is being developed in collaboration with the Center for Outcomes Research and Evaluation (CORE), a branch of Maine Medical Center Research Institute. The Evidence- Based Public Health Framework will be used to outline and ground this capstone project.

A Qualitative Assessment Of New Graduate Nurse Practitioners First Year Of Practice, Alex Beggs Rn, Msn

Muskie School Capstones and Dissertations

This project serves as a Capstone and final requirement for the Master of Public Health Degree at the University of Southern Maine Muskie School for Public Service. The project is a qualitative inquiry into the experience of new graduate nurse practitioners’ in their first year of practice, and their transition from the registered nurse (RN) into the nurse practitioner (NP) role. Using the theoretical constructs of Benner’s “From Novice to Expert” and the Burch’s “Conscious Competence model” new graduate nurse practitioners’ experiences will be analyzed. Risk and protective factors for role confidence will be identified through the use of qualitative …

Palliative Players: Project Development And Initial Implementation, Eliza Eager

Muskie School Capstones and Dissertations

The Palliative Players are screened and trained hospice volunteers who provide a low-cost, sustainable, role-playing resource for use teaching communication skills to healthcare workers who discuss serious illness with patients and their families. The Palliative Players project was conceived and developed in early 2017 by Dr. Lauren Michalakes, Medical Director of Palliative Care at Coastal Healthcare Alliance (CHA); Sarah Dwelley, RN; Flic Shooter, Director of Hospice Volunteers of Waldo County (HVOWC); and Eliza Eager, Project Coordinator; to provide believable, emotive simulated patients (SPs) for role-play in workshops teaching healthcare workers communication tools and skills for use in conversations with patients …

New Outpatient Experience Survey Design: A Quality Improvement Case Study, Nathan Paluso

Muskie School Capstones and Dissertations

The purpose of this capstone project is to evaluate the implementation process for a new survey methodology introduced by Maine Medical Partners (MMP), by following the Plan-Do-Study-Act (PDSA) quality improvement cycle framework. This new survey has been implemented to collect data on patients’ experiences in the MMP outpatient facilities, and is offered to the patients via iPad at check-out after their appointment. Through observation at MMP practices and MMP staff interviews, strengths and weaknesses of the implementation process have been identified. Evidence-based solutions pertaining to the identified weaknesses have been selected through a literature review and are incorporated in recommendations …

A Guide For Assessing Older Adults’ Needs On Maine Islands, Beatrice Byrne

Muskie School Capstones and Dissertations

This template may help Maine island communities identify older adults’ needs and island resources, in order to allow older adults to age in the island communities.

Three interviews with island health leaders, one community conversation with older islanders, and one pilot test provided information about what to include in the template.

The template includes a demographic survey, guides for conducting semi-structured interviews and group conversations with older adults and caregivers, a guide and worksheet for analyzing the data, a guide for assessing community resources, a guide for dissemination, and a list of additional resources.

Assessment Of The Use Of Overdose Education And Naloxone Distribution By Maine Buprenorphine/Naloxone Prescribers, Stephen Kirsch

Muskie School Capstones and Dissertations

Background: Overdose deaths, specifically related to opioids, have been identified as a public health problem both nationally and in the state of Maine. Overdose Education and Naloxone Distribution (OEND) is an innovative model of patient education that has been shown to be effective in increasing knowledge of overdose risk and has the potential to help reduce opiate related overdose deaths.

Methods: A 28-item web-based survey examining clinician attitudes, OEND practices and characteristics was distributed to 196 Maine based physicians with a Drug Enforcement Agency waiver to prescribe burprenorphine/naloxone. Facilitators and barriers to the provision of OEND were also assessed. Surveys …

Urine Cotinine In Children And Parental Behavior Modification: A Pilot Study, Teresa Lachance

Muskie School Capstones and Dissertations

“Urine Cotinine in Children and Parental Behavior Modification” was designed by Dr. Deirdre Burns, a pediatrician at the Barbara Bush Children’s Hospital (BBCH). It was implemented as a pilot study to determine whether urine cotinine testing in children who are admitted to the hospital for respiratory illness and tracking parental smoking behaviors over time was feasible. Parents were given a brief survey to assess their current smoking behaviors and to understand their readiness to quit smoking. They received smoking cessation materials provided by the Breathe Easy Coalition of Maine. These materials outline information about second-hand and third-hand smoke, and encourage …

Development Of Health Education Materials To Prevent Sexually Transmitted Infections Among University Of Southern Maine Students, Lily Parenteau

Muskie School Capstones and Dissertations

The purpose of this project was to develop health education materials that can be used to educate college students about the risks, symptoms, and prevention measures associated with chlamydia and gonorrhea infections, as well as provide information about current disease information in the state of Maine.

Evaluation Of Childhood Exposure To Lead In Community Water Systems In Maine, Nicholas Flavin

Muskie School Capstones and Dissertations

The concentration of lead in Maine’s public drinking water was evaluated from 4,700 first-draw water samples collected from 358 Maine Community Water systems. Samples collected from 2012-2015 were obtained by request from the Maine Center for Disease Control and Prevention’s (MeCDC)’s Drinking Water Program.

Exposure and physiological uptake of lead can be mathematically modelled or predicted based on the amount of lead in “background” sources of contaminated media such as soil, dust, water, air or dietary items; the better the characterization of lead in these media, the better the exposure predictions. To assess childhood lead exposure, EPA recommends using the …

A Secondary Analysis In Support Of The Community Health Needs Assessment For Oasis Free Clinics, Jillian Wheeler

Muskie School Capstones and Dissertations

Oasis Free Clinics offer free medical and dental services to uninsured, low income adults living in Sagadahoc County, Maine (with the exception of the town of Richmond) and the towns of Brunswick, Freeport, and Harpswell in Cumberland County and Durham in Androscoggin County. Oasis has filled a critical need in providing affordable health care to the working poor with the absence of Medicaid expansion in the state of Maine. The clinic offers wellness checks, women's wellness, prenatal care, chronic disease management, limited mental health counseling, a prescription assistance program and dental care.

Oasis Free Clinics will conduct a Community Health …

Analysis Of The Efforts Of Urban And Rural Health Systems To Achieve Accountable Care Organization Target Goals For Dilated Eye Exams In Individuals With Diabetes, Michele Gilliam

Muskie School Capstones and Dissertations

This capstone project was designed to understand and analyze the completion rates for diabetic dilated eye exams within four different health systems participating in the MaineHealth Accountable Care Organizations (ACO). This research is valuable within the current US health care climate as health care providers have sought to evaluate the cost of care in terms of their value to payers. Moreover, many providers have elected to join the ACO in order to demonstrate better outcomes, improve the cost of care and to share programmatic content and tools to standardized care. Within this capstone, system level workflows and processes were evaluated …

Population Health Improvement Through Coordination Of Care, Trevey Davis

Muskie School Capstones and Dissertations

The objective of this Capstone Project is to work with the Mercy Gap in Care Coordinators (GCCs) to document the value of the care coordination at Mercy Health System. A key element of this project was to develop a workflow diagram alongside the GCC in order to track patient outcomes. Additionally, the team developed a system for documenting patient outcomes that is crucial to measuring the impact of care coordination. From the data collected there are a number of outcomes that can be measured. The number of patients who are contacted for screening is measurement of patient experience. Following initial …

Implementing A Good Catch Program In Nursing Homes, Leigh Raposo

Muskie School Capstones and Dissertations

Rationale and processes for reporting near misses and evidence-based tools were collected by a literature search, seminal works by Sidney Dekker and James Reason, and websites for the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and the Centers for Medicare and Medicaid Services (CMS). Tools, information, and strategies found in this research were evaluated for implementation in Maine nursing homes. The tools provide a communication vehicle for nursing home staff to safely report to management near misses, or mistakes that do not harm residents. To emphasize a positive approach, the project replaces the term …

Grant Writing In Higher Education, Amos Bean

Muskie School Capstones and Dissertations

The primary aim of this capstone was to elicit feedback from public health and grant writing practitioners and funders in order to gather data that can be used to supplement teachings and readings for a course in the Muskie School of Public Service Masters in Public Health (MPH) graduate program. Two overarching questions served as the basis for this endeavor. The primary question for public health and grant writing practitioners was, “What are the most important lessons you have learned that you think graduate students who are writing their first proposals should know?” The primary question for funders was, “What …

An Analysis Of Women’S Access To Acute Opioid Detoxification Services In Maine: Identifying The Barriers To Treatment, Karen E. Conley

Muskie School Capstones and Dissertations

The lack of treatment facilities and services for opioid use disorder in Maine, combined with an increased prevalence of addiction, creates a potential for health inequity between men and women that may be intensified by barriers in access to care. This capstone study utilized detoxification screening inquiry forms and data obtained from the Milestone Foundation’s acute opioid detoxification program to assess and categorize barriers to access by gender. A barriers model was developed based on existing literature and was to identify potential associations among and between the known barriers to accessing treatment. Barriers were described as internally or externally based, …

Access To Oral Health For Children On Mainecare In The Lakes Region Towns Of Bridgton, Casco, Sebago, And Naples, Carissa L. Parent

Muskie School Capstones and Dissertations

Although we know that children covered by Medicaid often do not receive needed dental services, the extent of the problem in Maine is not fully understood. In particular, rural communities in Maine may face challenges for families to access dental services for their children given low reimbursement rates and fewer available providers. This project addresses these gaps in knowledge by examining MaineCare- funded utilization and dental care access for children with MaineCare in four rural Maine towns in the Lakes Region.

Expanding Access To Naloxone In Maine: Opportunities And Barriers, Kate E. Richardson

Muskie School Capstones and Dissertations

The Centers for Disease Control and Prevention have declared prescription drug abuse a national epidemic (Office of National Drug Control Policy, 2014). In addition to strategies designed to prevent opioid abuse and misuse, many public health officials, policy makers, healthcare providers and harm reduction task forces seek to increase access to naloxone, a prescription drug known to reverse the effects of an opioid overdose. This report provides an overview of the barriers and opportunities for the state of Maine to expand access to the opioid antagonist, naloxone, in an effort to reduce fatal opioid drug overdose rates.

Policy Options For Recruiting And Retaining Rural Primary Care Physicians In Maine, Casey Lancaster

Muskie School Capstones and Dissertations

Maine faces a challenge providing primary care services to over half of its residents, as they live in rural areas – even though Maine has enough primary care physicians practicing in the state to service the needs of the population. Maine has a primary care physician distribution problem. Androscoggin, Oxford, Sagadahoc, Somerset, Waldo, Washington, and York Counties, all fall well below the national average of primary care physicians per 100,000 residents. Maine has no true financial incentive program to help rural area’s recruit and retain primary care physicians, though Maine does have two programs that attempt to get primary care …

Policy Considerations For Community Health Workers In An Era Of Health Reform, Sara Kahn-Troster

Muskie School Capstones and Dissertations

In order to better understand how CHWs are being integrated in state health reform initiatives, including facilitating care coordination, enhancing access to community-based services, and addressing social determinants of health, the author, working in collaboration with the National Academy for State Health Policy (NASHP), developed a nation-wide scan of CHW policy activity, published online as State Community Health Worker Models in February, 2015. The CHW chart gives a comprehensive look at how states are utilizing CHWs as part of quality improvement, health care reform, and expanded models of public health.

Evaluation Of Patient To Provider Oriented Telemedicine In Hospitals And Physician Practices, Macklin G. Gaynor

Muskie School Capstones and Dissertations

This project explores barriers to telemedicine adoption and meaningful integration with contemporary healthcare delivery systems.

Conception To Implementation: Quality Improvement In Behavioral Health Home Organizations, Elizabeth A. Miller

Muskie School Capstones and Dissertations

This capstone project developed quality improvement tools to be used by community mental health agencies participating in the Maine Behavioral Health Homes Initiative. Providing technical assistance, analysis of feedback, and developing recommendations were the foundation of this project with a central tenet to enhance the existing Quality Improvement Project Template created by MaineCare, Maine’s Medicaid Office. These recommendations suggest the Quality Improvement Project Template may be improved by providing an additional fillable quality improvement process outline, providing a list of example projects and focus areas for quality improvement projects, and providing tools to assist in implementation of quality improvement projects. …