Should Maine Develop A More Comprehensive Approach To Invasive Species Management, Gary Fish

Muskie School Capstones and Dissertations

Currently the state of invasive species management in Maine seems to be very siloed with little interagency or organizational coordination or prioritization. To assess the current situation, a survey was created and sent to approximately 600 recipients (Appendix 1). Recipients included representatives from state, federal, non-profit and private organizations that are known actors in the invasive species community in Maine. The survey was also posted on the Maine Invasive Species Network listserv.12 There were 197 respondents which provides a significant but incomplete sample of the management efforts currently taking place in Maine. Respondents represented all potential affiliations involved in invasive …

In The Well A Social Media Communication Pilot To Engage And Educate The Public On Health Care Systems And Policies, Debra Dunlap

Muskie School Capstones and Dissertations

The purpose of this capstone project was to engage the general public to think and learn about health care systems and the policies and public opinions that influence them. The project developed a method of public engagement and education by establishing a new social media blog titled In the Well, and piloting four posts and companion recordings. A brief impact study was conducted to assess the effectiveness of this communication method, and to answer the key question: are the project’s social media posts an effective method for engaging and educating people to think about health care systems and policies?

The Association Between Chronic Diseases And Cigarettes' Smoking In Maine 2013-2017, Ishmael Thadal

Muskie School Capstones and Dissertations

Tobacco use and chronic disease have a well-established relationship. Tobacco has a direct causal link to cancer, heart disease, stroke, lung disease, and diabetes, among other chronic conditions (Centers for Disease Control and Prevention, 2020). The relationship between chronic diseases named in the Behavioral Risk Factor Surveillance System (BRFSS) and tobacco use calls for further analysis, but some studies have already defined the parameters of such relationships. In a recent meta-analysis, Rodrick et al. (2019) quantified the global prevalence of tobacco use in patients diagnosed with diabetes and found that 1 in 5 patients diagnosed with type 2 diabetes were …

Running Head: Increasing Access To Telehealth Services In Maines Healthcare System, Kaylee Leclerc

Muskie School Capstones and Dissertations

Telehealth is an effective method of communicating and visiting with your healthcare provider along with other redundant use of medical and professionals. Telehealth has become increasingly prevalent in the United States healthcare system over the past couple of years, particularly during the Coronavirus Pandemic. Defined by the Centers for Disease Control and Prevention (2019) (CDC) telehealth is “the application of electronic information and telecommunication technologies in support of and promotion of long-distance clinical healthcare and professional education in healthcare” (Coronavirus Disease 2019 (COVID-19), 2020). A key component of reforming the U.S. healthcare system is the use of telehealth to improve …

Maine Cdc Extreme Temperature Community Resilience Guidebook, Jarvis Thanex Louis

Muskie School Capstones and Dissertations

The purpose of this guidebook is to help community leaders, public health departments, municipalities, and state and local emergency planning agencies prepare for extreme temperature events in Maine. The Environmental and Occupational Health Program at the Maine Center Disease Control and Prevention (CDC) developed this Extreme Temperature Community Resilience Guidebook using existing best practices and strategies to adapt to the changing climate and to address community needs during extreme temperature events. Because extreme temperature events are becoming more frequent, local leaders must work in collaboration with private and public community partners to prepare and respond to the impact of such …

Planning And Implementing A Large-Scale Covid-19 Vaccination Clinic Recommendations, Reflections And Lessons Learned & A Guide For Maine Communities, Melissa Fochesato

Muskie School Capstones and Dissertations

In November 2020, the Maine Center for Disease Control and Prevention (Maine CDC) requested assistance from Maine hospitals to dispense COVID-19 vaccines. Mid Coast Hospital became a point of dispensing for Sagadahoc and Northern Cumberland Counties. Mid Coast Hospital became a MaineHealth member in January 2021, and benefitted from policies, procedures, and support of the larger MaineHealth system but did not adopt the Electronic Medical Record (EMR) system used by MaineHealth to schedule appointments, register patients and document vaccination until November 2021. The inability to use the EMR system required and allowed Mid Coast Hospital to make adaptations to the …

Comparing Maine Maternal Health Characteristics To The Us Average, Laciann Gilblair

Muskie School Capstones and Dissertations

Maternal health characteristics are commonly discussed topics in communities. Although some may not know exactly how in-depth data is collected on women that give birth, these characteristics are still discussed in education, healthcare, socially, and in the media. With each state collecting their own data on these characteristics, a large portion are depicted collectively, as a ‘national average’. One of the most common characteristics is mortality of both the mother and the infant. This Capstone project will dive deeper into maternal characteristics and highlighting specific data to broaden the scope of commonly discussed maternal health characteristics. It will also dive …

What Can We Learn From The Caregivers Of Adults With Dementia? A Qualitative Study, Lauren Michalakes Md

Muskie School Capstones and Dissertations

Introduction: In the US today, there are approximately 6.5 million people age 65 or older living with Alzheimer’s Disease or other dementias. This number is expected to increase to 12.7 million by 2050. Dementia imposes debility and frailty upon those effected, which is progressive and often follows an unpredictable trajectory. This places significant burdens on their informal caregivers, negatively impacting financial security, emotional and physical health, and overall quality of life. Informal caregivers are a heterogeneous group of partners, spouses, adult children, family members and others. Purpose: This qualitative study explores the experiences, worries and concerns of informal caregivers of …

Assessing Birth Outcomes Resulting From The Franklin County Model, Lane A. Simsarian

Muskie School Capstones and Dissertations

The United States’ preterm birth rate is one of the highest among high-resource countries (Fighting premature birth: The prematurity campaign 2021). Approximately 1 in 10 babies in the US is born preterm (Preterm birth 2021). There are few comprehensive community-wide interventions focused on birth outcomes and cardiovascular risk reduction. Franklin County in Maine implemented an integrated, community-level cardiovascular risk reduction program in the 1970s. This community-level intervention focused on improving the health systems (infrastructure, access, and quality), reducing risk factors (hypertension, cholesterol, and diabetes), and improving health behaviors (tobacco cessation, healthy diet, and physical activity) (Record et al., 2015). The …

An Exploratory Quantitative Analysis Of Chlamydia Rates And Female Access To Contraceptive Services In The United States, 2015, Hannah C. Durham

Muskie School Capstones and Dissertations

Purpose: Chlamydia rates have steadily increased over the past two decades in the United States. Access to contraceptives is essential for preventing transmission. This project examined the relationship between female access to contraceptive services at publicly-funded health clinics and chlamydia rates the county level in 2015. This project also examined associations between chlamydia rates and contraceptive access across rural and urban counties and by U.S. region. Methods: Data on chlamydia rates, publicly-funded clinics, and contraceptive clients in 2015 were obtained from open-access databases and published reports by the Center for Disease Control and Prevention (CDC) and the Guttmacher Institute. Simple …

Abbreviated Life Cycle Analysis Of Plastics In Medical Supplies, Emily Baker

Muskie School Capstones and Dissertations

Background

In 2015, 24 plastic production facilities in the United States produced 17.5 million metric tons of CO2 equivalent (CO2e-), which is the same as what 3.8 million cars produced that year (Hamilton 2019). The incineration (controlled burning) of this plastic in 2015 emitted approximately 5.9 million metric tons of CO2 equivalent (CO2e-) (Hamilton 2019). CO2e- is a measure for comparing greenhouse gases to carbon dioxide, by multiplying the amount produced by their global warming potential (Brander 2012). Greenhouse gases trap heat in the atmosphere and warm the planet over time, some are naturally occurring, and some are synthetic. The …

Abbreviated Life Cycle Analysis Of Medical Supplies, Emily Baker

Muskie School Capstones and Dissertations

Background In 2015, 24 plastic production facilities in the United States produced 17.5 million metric tons of CO2 equivalent (CO2e-), which is the same as what 3.8 million cars produced that year (Hamilton 2019). The incineration (controlled burning) of this plastic in 2015 emitted approximately 5.9 million metric tons of CO2 equivalent (CO2e-) (Hamilton 2019). CO2e- is a measure for comparing greenhouse gases to carbon dioxide, by multiplying the amount produced by their global warming potential (Brander 2012). Greenhouse gases trap heat in the atmosphere and warm the planet over time, some are naturally occurring, and some are synthetic. The …

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 …

Identifying Health Bright Spots In The Northeastern Region, Katharine S. F. Knight Mph

Muskie School Capstones and Dissertations

Bright Spots are counties that are experiencing better-than-expected health outcomes. There have been a limited number of analyses exploring this concept. There are two research reports that have identified Bright Spots at the county level. The Institute for Healthcare Improvement (IHI) identified 17 counties nationally as Bright Spots. The “Creating a Culture of Health in Appalachia” initiative identified 15 urban counties and 27 rural counties as Bright Spots. In this study we reviewed these findings, and applied the methods used in these reports in an analysis of the Northeast Region of the US.

The IHI published a summary report (Counties …

Assessment Of The Point Of Dispensing Just In Time Training (Jitt) Training Manual, Caitlin Hager Mph

Muskie School Capstones and Dissertations

This project assesses the utility, design, and content of a recently developed Point of Dispensing (POD) Just in Time Training (JITT) Training Manual developed and written by the Principal Investigator. The JITT Training Manual provides instructions for using the JITT Checklist, guidance for delivering JITT training, and helpful reminders. Eleven public health professionals reviewed the JITT Training Manual and provided qualitative feedback through key informant interviews. Participants found the Training Manual useful, offered suggestions for the final design, and approved of the content. Participants felt that additional training on POD operations is beneficial for public health professionals tasked with working …

Disparities In Tuberculosis Rates In New England: 2011, 2014-2018, Etienne Bobe Leta

Muskie School Capstones and Dissertations

Purpose. The purpose of this study was to assess whether decreases in tuberculosis (TB) incidence have been followed by reductions in TB disparities in New England during 2011 and from 2014 to 2018.

Background. Tuberculosis is a potentially serious infectious disease which, without treatment, can be fatal. In the United States, 8,920 new cases were temporarily reported in 2019, showing a decrease of 1.1% from 2018. Similarly, TB incidence declined to 2.7 cases per 100,000 persons, accounting for 1.6% decrease from 2018 (CDC, 2020). Although this improvement, disparities in rates of tuberculosis disease between Whites and minority groups continue to …

The Brigade Combat Team (Bct): A Revolution In Organizational Structure, Adam Davis

Muskie School Capstones and Dissertations

This paper explores the U.S. Army’s force reorganization around the Brigade Combat Team (BCT), which began in 2002. The BCT shifted how various army units interacted by changing the echelon at which different types of units report to a single commander, essentially creating self-sufficient units of about 2,500 soldiers instead of the previous self-sufficient units of about 15,000 soldiers. This paper utilizes existing organizational theories and research to better understand the implications for such a dramatic change in organizational structure. It contextualizes the army’s reorganization by applying the Rational Actor, Political, and Bureaucratic Models outlined in Essence of Decision by …

Outdoor Recreation, Greenspace, And Covid-19 In Maine, Jayne Marie Foley

Muskie School Capstones and Dissertations

In this report we are exploring the significance of outdoor recreation and usage in response to the COVID-19 pandemic. We will discuss the importance of green space and outdoor recreation as a part of sustainability and what we can do for the future to provide sustainable and safe spaces for the public. I will be looking at the response of 119 individuals from a survey collected and three interviews from stakeholders in Maine on their experiences with the outdoors during COVID-19 and comparing these results to other similar findings. We can use this information from the COVID-19 experience to better …

Future Workforce Development In Maine: The Effects Of Sudden Demographic, Socioeconomic, And Labor Market Change, Paul L. Young

Muskie School Capstones and Dissertations

The underpinnings of what is broadly called workforce development have not changed since the late 19th Century. They are still concepts primarily concerned with optimizing workers for maximal output, while attempting to instruct business owners and managers in their workplace responsibilities – responsibilities to both their organizations and their workers. Today the term ‘workforce development’ particularly addresses access and barriers to employment and necessary supports; comprising aspects of demographic shift, ethnicity, income/wealth inequality and poverty, education and training, globalization and automation, immigration, housing, social services, primary/mental healthcare and physical/mental disability, substance use, and aging. The term has come to represent …

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. …

A Framework For Cooperative Housing In Portland, Me: Lessons From 13 Existing Cooperative Houses In The U.S., Cyndi Gacosta

Muskie School Capstones and Dissertations

Cooperative housing may be a viable and financially-sound alternative for individuals and families of low to moderate income, as Portland, Maine’s downtown area becomes gentrified raising property values to unaffordable heights. Of the 13,546 family households in Portland, 8.7% earn below $25,000, which for an average family of four $24, 250¹ is considered to be in poverty, and 18.4% earn between $25,000 and $50,000. Meanwhile, 13.2% of the 16, 561 non-family households are below the poverty line, and 27.5% earn between $25,000 and $50,000 (US Census Bureau, 2014).

As it becomes increasingly difficult for low to moderate income earners …

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 …

Developing Recommendations To Prepare Individualized And Low Health Literacy Appropriate Health Education Material For Stroke Patients, Sanzida Anzuman

Muskie School Capstones and Dissertations

Stroke is the fifth leading cause of death and leading cause of long-term disability in the United States. Stroke patients often get readmitted to the hospital due to various reasons. Effective patient education is a critical part of preventing hospital readmission. Several studies revealed that patient education is more effective with individualized approach than generalized passive approach. A recent survey by the Joint Commission also recommended Central Maine Medical Center to offer stroke patients individualized education that is more appropriate and effective for patients.

Average Americans read at eighth grade level but health information is usually offered at college level. …

A Current Look At Value-Based Insurance Design (V-Bid) – What Do We Know Today About V-Bid’S Ability To Control Health Plan Costs And Improve The Quality Of Health Care, Charlotte Pease

Muskie School Capstones and Dissertations

In 2003, the University of Michigan formally conceptualized Value-Based Insurance Design (V-BID) a new approach to develop cost sharing for health plans. VBID promised improvements to health care quality and control of increasing health care costs. Using V-BID, health plans assign cost sharing according to the clinical value of health care. Health plan participants pay low or no cost sharing for high value health care and higher cost sharing for low value health care. Accordingly, varying cost sharing in this manner should encourage the usage of high value health care and discourage the usage of low value health care. To …

Count The Uncountable: The Impact Of Population Density On The Landscape Of Haiti, Jarvis Thanex Louis

Muskie School Capstones and Dissertations

An understanding of population density is essential to addressing environmental issues in Haiti. Decades of significant political, economic, environmental, and social challenges have influenced both population density and the landscape of the country. Additionally, lack of consistent and reliable census data poses great challenges to tracking population growth in Haiti. Data from the US Census Bureau and USGS Global Visualization Viewer satellite images were used to analyze the impact of population density on Haiti’s landscape. A comparison of Haiti’s population density in 2007 and 2018 using remote sensing analyses offers insight into the landscape of the country. The images illustrate …

Mobile Health Applications: Background Research And Best Practices, Piper Cassidy

Muskie School Capstones and Dissertations

This capstone was developed with the Patient Experience Department at Maine Medical Center (MMC) and an interdisciplinary MMC Tools and Technologies group. This research and analysis explores and outlines the foundations and best practices for mobile health (mHealth) applications (apps) across the spectrum of healthcare. mHealth apps used at some of the top rated hospitals in the country were selected and studied as possible templates for a similar initiative at MMC.

Accountable Care Organization Attribution Methods, Jay Knowlton

Muskie School Capstones and Dissertations

Accountable Care Organizations (ACOs) have grown rapidly in recent years as an organizational vehicle to support high quality care at a sustainable cost. ACOs function by holding providers financially accountable on measures of quality and cost for respective patient populations. Patient populations are defined via attribution methods that identify patient-provider relationships via service encounter history or attestation. There are hundreds of variations to attribution methods documented in the literature, some resulting in up to fifty percent different patient populations (for the same providers over the same time period) depending on methods. As a result, the quality and cost measure performance …