Medicine and Health Sciences Commons^™

Correlates Of Immunization Timeliness In Three South Asian Countries: Secondary Analysis Of Demographic And Health Surveys, Tanzir Ahmed Shuvo

Theses and Dissertations

Despite the availability of effective vaccines, 1.5 million children under the age of 5 years die every year because of vaccine preventable diseases. Improvements in vaccine delivery infrastructure have resulted in relatively high coverage of vaccines, but many children are not receiving their vaccines on a timely basis. Timely administration of routine vaccines recommended by the Expanded Programme on Immunization (EPI) ensures maximum efficacy. It is vital to explore rates of vaccination timeliness and the correlates of timely vaccination among children to design targeted interventions for improving both coverage and timeliness. We conducted a secondary data analysis of the Demographic …

Gonorrhea: Core Areas And State Policies, Jessica Purser

Theses and Dissertations

This research looked at gonorrhea rates both from a community perspective and at the state level. Using hot spot analysis, means differences, and quantile regression, we found that education, specifically the percent of people over the age of 25 with less than a high school education, was the dominant factor at the state level while core areas of gonorrhea exist in the PeeDee and western Lowcountry regions of South Carolina in 2017 and 2018. Risky sexual behaviors are well-defined in the literature for individual persons, but this shows that looking at societal and community factors is important.

This is a …

Hear My Voice: Qualitative Studies To Explore What Empowers Patients To Talk With Their Doctor And Participate In Making Health Care Decisions, Alicia Marie Oostdyk

Theses and Dissertations

Patients with fibromyalgia are faced with many decisions throughout the process of seeking and obtaining health care. For patients to feel empowered to take action, it is essential they feel as if they can play a role in making decisions up to their desired level of participation. However, it is unclear what constitutes empowerment in shared decision making between patients and providers. For patients with fibromyalgia, who deal with complex symptomology and individualized treatment choice, it is important to know what makes them feel empowered to participate in care. The objective of this dissertation is to create a patient-centered definition …

A Cost Effectiveness Analysis Of The Nutritious Eating With Soul Study, Mary Jones Wilson

Theses and Dissertations

PURPOSE Historically, African Americans (AA) have been underrepresented in nutritionrelated behavioral research despite their disproportionate higher risk of cardiovascular disease (CVD). The Nutritious Eating with Soul (NEW Soul) Study is one of the first of its kind to recruit an AA only study group to examine CVD prevention via a clinical trial to examine changes in CVD risk factors across two cohorts who are randomly assigned to a plant-based, soul food vegan diet or low-fat omnivorous (omni) diet. The purpose of cost effectiveness analysis (CEA) is to inform clinical and policy decisions and the costs of interventions that society is …

Examining The Cost And Quality Relationship In Medicare, Alexandria Fleming Delage

Theses and Dissertations

Purpose.

The purpose of this study is to evaluate the cost and quality of care dynamic among physicians billing under Medicare Fee for Service in 2018 to examine the relationship between quality and total cost of care at the physician level. Examining this relationship will advance scientific knowledge regarding the impact of increasing high value service use on healthcare costs and will provide insight in terms of expected cost outcomes of quality programs for healthcare policymakers (Salmond and Echevarria 2017; Williams, Brown, and Healy 2018).

Methods.

The study used publicly available data sets provided by the Center for Medicare and …

Maternal Preventive Dental Services Utilization: The Role Of Preconception Oral Health Counseling In And The Association With Birth Outcomes: Evidence From South Carolina Prams, Monique Johnette Williams

Theses and Dissertations

ABSTRACTThe purpose of this study is to examine maternal preventive dental services utilization by analyzing the role of preconception oral health counseling in utilization of dental cleaning services before or during pregnancy and the association of utilization with preterm birth (<37 weeks) and small for gestational age (SGA) (same sex newborns having birth weight for gestational age below the 10th percentile of the reference population as defined by the World Health Organization (WHO)). Studies suggest that unfavorable maternal oral conditions have significance in birth outcomes, specifically periodontal disease (periodontitis), an oral inflammatory condition which is shown to be a risk factor for preterm birth and low birth weight (Dortbudak et al., 2005; Guimarães et al., 2012; Tejada et al., 2012). Dental cleaning before and during pregnancy is effective in the prevention of oral disease including gingivitis and periodontitis (Johnson et al., 2006; Kurien et al., 2013; Steinberg et al., 2013).

Cross-sectional 2012-2015 data from the South Carolina Pregnancy Risk Assessment Monitoring System (SC PRAMS) survey, a population-based surveillance system on prenatal, perinatal and postpartum experiences of resident mothers who recently delivered a live-born infant, were analyzed using weighted analyses in SAS. Analyses included demographic univariate analyses, Rao-Scott Chi-squared tests of significance to study differences between groups, and multivariate logistic …

Examining Parental Perceptions And Decisions To Uptake Child Influenza Immunizations: Assessing Pandemic And Policy Impacts On Vaccination Rates Following The H1n1 Pandemic, And The Acip Laiv Preferential Recommendation Revocation, Amir H. Mehrabi

Theses and Dissertations

Introduction

2009 H1N1 Pandemic: The historical 2009 H1N1 Influenza pandemic, which had a CDC estimated accrued disease burden of 100.5 million illnesses, 936,000 hospitalizations, and 75,000 deaths from 2009 to 2018, resulted in a declared state of emergency nationally, with ensuing diminished vaccine confidence and amplified fears of infection, prompting some to pursue flu vaccination, and others to forego. Although the Centers for Disease Control and Prevention (CDC), and its Advisory Committee on Immunization Practices (ACIP) recommend an annual flu vaccine for individuals 6 months of age and older as the “first and best” defense against influenza, a low percentage …

Effect Of Lifestyle, Medical School Culture And Income On Medical Students' Decision To Pursue A Primary Care Career In Saudi Arabia, Ahmed Abdullah Alhussain

Theses and Dissertations

This study aims to examine the relationship of medical school students who select primary care as their career specialty. Based on extensive literature review, we focused on the three main factors that influence students to consider career specialty: lifestyle, income, and medical school culture. With a paper questionnaire of a cross-sectional study survey at ten medical schools, we were able to collect 1,006 participants from fourth and fifth year students. The clear majority of students considered lifestyle characteristics to be a significant influence in their career decision (PP<.05). Also, we found there was a significant relationship between students’ specialty choices and income variables. The result showed us that medical school culture played a notable role in terms of forming the students’ decisions in different ways. First, specialty characteristics were strongly correlated with career consideration. Second, having advising and mentoring within the medical school enhanced the probability of choosing primary care specialty. Finally, the effect of the primary care course was significant and closely related to the choice of the primary care specialty. In conclusion, the study demonstrated the impact of lifestyle, income, and medical school culture on student career selection. These results are in parallel with previous studies conducted in many countries around the world.

Effectiveness And Experience Of An Integrated Maternal Mental Healthcare Intervention In Private Clinics And Public Health Facilities In Pakistan, Syeda Somyyah Owais

Theses and Dissertations

Maternal depression is often undetected or undertreated at the primary care level. Despite the growing high prevalence of depression among women of childbearing age, the usual primary care practice in Pakistan does not include depression screening. Two facility-based cluster randomized control trials, including a maternal depression intervention component, were conducted within two healthcare settings, private and public primary care facilities in Rawalpindi and Lahore. This study aimed to estimate the effectiveness of each trial in reducing maternal depression among mothers in the intervention arm compared to the control by analyzing the change in PHQ-9 (Patient Health Questionnaire-9) scores from baseline …

Correlates Of Maternal Health Service Use And Women’S Experiences Using Antenatal Care In Ghana: A Mixed-Methods Study, Anna Cofie

Theses and Dissertations

The pace of improvements in maternal mortality has been slow in Ghana. While Ghana’s maternal mortality ratio (MMR) decreased from 635 per 100,000 live births to 319 per 100,000 live births between 1990 and 2015, the country failed to meet the 75% reduction target set by Millennium Development Goal (MDG) goal 5A, to reduce maternal mortality ratio by 75% between 1990 and 2015. Antenatal care (ANC) is critical to improving maternal morbidity and mortality and child deaths. In 2003, Ghana introduced the National Health Insurance Scheme to ensure that all pregnant women have access to free maternal care, and in …

Aging With Hiv In The United States: Trends And Impact Of Hospital Stays On Inpatient Resource Utilization, And Costs Of Care, 2003-2015, Khairul Alam Siddiqi

Theses and Dissertations

Background:

Due to advances in Antiretroviral Therapy (ART), people living with HIV (PLWH) live longer in the United States. Aging prolongs exposure to HIV and antiretroviral drugs, which could lead to an elevated risk of developing multiple age-related comorbidities [HIV Associated Non-AIDS (HANA) conditions], earlier for PLWH. Higher comorbidity burdens among older PLWH may require greater use of inpatient care, i.e., higher hospitalization, inpatient resource utilization, and costs. This study examined the trends and characteristics of comorbidities, resource utilization, and costs of hospital stays with HIV (HSWH) compared to hospital stays without HIV (HSWOH). We also assessed trends for resource …

Effectiveness Among Community Health Center Governing Boards: An Assessment Of The Different Governing Board Members’ Perspectives, Brandi L. Wright

Theses and Dissertations

Governing boards of Community Health Centers were created with the anticipation that majority of its members be patients (users) of the Community Health Center they served. This study assessed South Carolina Community Health Center governing board members’ perception and understanding of what they believe their roles and responsibilities are, and their perceived overall effectiveness. It provides a framework for understanding the governance structure of Community Health Centers, based on examining three characteristic areas (Board Function, Board Performance and Board Development) of Community Health Centers located in South Carolina.

This study invited 234 governing board members to obtain members perceptions. Key …

The Impact Of Financial Incentives On Urban-Rural Disparities In Dental Supply: Evidence From Thailand, Rakchanok Noochpoung

Theses and Dissertations

Financial incentive is one of the common strategies used to attract healthcare workers in rural and remote areas. Both high-income and low-income countries extensively use financial strategy to tackle the disparity distribution of healthcare workers. However, most studies were conducted in developed countries and assessed positive incentives programs. Previous studies showed the effectiveness of financial incentives on recruitment and retention of healthcare workers. Current studies show that most of the financial incentives supported for education such as scholarships and loan repayment programs are effective. A few studies assessed the effectiveness of direct payment incentive programs, especially in low-middle income countries. …

Magnet Recognition (Mr) And Hospital Quality Outcomes In The U.S.A– Analysis Based On 2017 Hospital Data, Abdulmalik Alhammad

Theses and Dissertations

The American Nurse Credentialing Center (ANCC) introduced Magnet Recognition (MR) in the U.S.A in 1994. Magnet Recognition was adopted based on the findings of a comprehensive study (conducted in 1983) that tried to identify factors explaining high rates of nurses’ retention in 41 hospitals in the U.S.A.

The objective is to compare MHs with the hospitals not recognized as “Magnet” (non-MHs) in terms of important outcomes of the health system and to examine whether the MHs themselves vary significantly in terms of the outcomes.

All the general specialty of MHs (367 hospitals) and their matched of non-MHs (380 hospitals) in …

The Association Of Hospital Practices To Breastfeeding Behaviors In South Carolina: Analysis Of 2013-2015 Pregnancy Risk Assessment Monitoring System (Prams) Data, Larisa Donnette Bruner

Theses and Dissertations

Objective: The purpose of this study was to determine whether hospital practices are associated with breastfeeding initiation and breastfeeding duration for ≥10 weeks.

Methods: We analyzed the 2013-2015 South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) data. The population of interest was mothers who delivered a single live birth in the hospital. The infant was alive and living with the mother at the time of the survey. Chi-square and logistic regression were used to examine breastfeeding initiation and duration among all women who delivered in a hospital and those who stated that they initiated breastfeeding while in the …

Introduction Of Innovative Medical Practices In Mayo Clinic: Effect Of The Interventions On Patient Outcomes, Duaa I. Aljabri

Theses and Dissertations

Purpose: Assessment of health technologies in medical practice is an ongoing process to provide clinicians and policymakers with information on the value of those applications. This dissertation aims to add to the existing body of literature and fill the gaps in prior studies by assessing two health technologies in Mayo Clinic Florida (MCF). The first paper provides an assessment of patient portal adoption and activity during hospitalization among cancer patients, and determines whether a portal application is associated with selected indices of patient safety, utilization and satisfaction. The second paper provides an assessment of a new approach in pain …

Residential Mobility And Enrollment Churn In A Medicaid Population, John E. Stewart

Theses and Dissertations

Previous investigations show high rates of enrollment discontinuity, or churn, among Medicaid participants. Discontinuity of coverage can limit appropriate use of health care, increase emergency department utilization and in-patient hospitalization, negatively affect self-reported health, increase health care spending, and compound Medicaid administrative costs. Efforts to more fully understand and ultimately reduce enrollment churn thus are vital to Medicaid agencies and beneficiaries. Residential moves are life transitions, often marking other significant life events (e.g., changes in employment or family structure) that can alter eligibility for Medicaid benefits. Few studies have examined residential moves among Medicaid members, or considered residential mobility as …

Association Of Insurance And Provider Type With Patients’ Perceived Cost And Ease Of Access To Healthcare Services Among Medicare Beneficiaries Diagnosed With Diabetes, Metria Harris

Theses and Dissertations

Medicare beneficiaries diagnosed with diabetes are likely to have health complications or episodes associated with diabetes, resulting in higher health care utilization and costs. Andersen’s Health Care Utilization Behavior Model (HCBM) includes predisposing, enabling, and need factors, but it excludes perception. Ajzen’s Theory of Planned Behavior (TPB) shows that perception influences health service use. This study was performed using a real-world model integrating Andersen’s HCBM and Ajzen’s TPB to determine whether there was an association between insurance type (Medicare Part D versus non-Part D) and perceived ease of access or cost among Medicare beneficiaries with diabetes. The second objective was …

How Do Health System Employees With Established Musculoskeletal Complaints Decide On Their Treatment Pathway? A Qualitative Approach, Noor Alshareef

Theses and Dissertations

Purpose: Non-pharmacologic treatment such as physical therapy (PT) are advocated for musculoskeletal pain for decreasing opioid use. Early access to PT has been shown to decrease costs and improve outcomes through direct access via self-referral. Although self-referral to PT is permitted in the majority of U.S states, health insurance coverage has been identified as a barrier preventing some patients with musculoskeletal complaints from using it. There are few studies examining patient factors related to early access to physical therapy via self-referral. The purpose of this study was to identify the factors outside of insurance that influence the choice to access …

Association Of Freestanding Dialysis Facility Size, Quality Incentive Program Scores And Patient Survival, Fozia Ajmal

Theses and Dissertations

Background

In 2011, The Centers for Medicare and Medicaid Services (CMS) has introduced a bundled payment reform along with a Quality Incentive Program (QIP) to bring efficiency in End stage renal disease (ESRD) care. The QIP rates facilities using clinical and reporting criteria, but misses out on patient outcomes. It penalizes facilities not achieving a target score by 0-2% of payments. The small facilities are expected to be impacted more by a reduction in payments. We determined the association between ESRD facility size and QIP scores and the association between QIP scores and patient survival.

Methods

We used the Medicare …

Internet Speed And The Effect On Health Information Technology Adoption, Matthew W. Yuen

Theses and Dissertations

Background. The Internet has become pervasive in everyday life; the Pew Research Center reported over 84% of Americans use the Internet either on their phone or a computer. However, due to the methods by which the Internet was created, an Internet digital divide was created. The Internet digital divide is the disparity in access and speed of Internet of certain populations. This study looked into the disparity between urban and rural populations and their Internet access in two forms: e-prescriptions adoptions and Internet health information seeking behavior (HISB) through their mobile devices.

Methods. This study used 4 datasets, …

Racism Across The American South: The Association Between Racism On Twitter, Rurality, & Black Mortality, Jarrod Bullard

Theses and Dissertations

Racism can be understood as a system of dominance and power designed to uphold the racially privileged of society. One can be exposed to racism through various mechanisms including the Internet and social media. Evidence indicates that exposure to racism is associated with poor mental and physical health outcomes as well as unhealthy behaviors. Current literature studying the effects of racism focus primarily on experienced or perceived racism. Furthermore, the geographic influence of racism on health at the county level and across levels of rurality is currently unknown. The purpose of this study was twofold; 1.) To explore the geographic …

The Association Between Clinical Recognition Of Depression And Unplanned Hospital Readmission Among Older Adults, Karen M. Jones

Theses and Dissertations

Purpose

The likelihood of a depression diagnosis may differ based on whether the patient was seen in an inpatient or outpatient setting. Depression has been associated with an increased risk of a 30-day readmission. The purpose of this study was to determine the level of agreement (concordance) between depression diagnosis as identified by inpatient and outpatient records and examine the relationship between depression diagnostic concordance and 30-day readmission.

Methods

Using universal administrative claims data from South Carolina, we examined inpatient and outpatient records. The analysis was restricted to Medicaid recipients aged 55 years and older with a primary admitting diagnosis …

Frequency Of Colonoscopy Surveillance In Average-Risk Adults Relative To Guideline Recommendations, Meng-Han Tsai

Theses and Dissertations

Colorectal cancer (CRC) is the third leading cancer in the United States with an estimated 132,700 new cases and 49,700 deaths in 2015. Well-performed screening colonoscopies prevent cancer by allowing visualization of the entire colon and removal of precancerous polyps (adenomas). Persons with high-risk polyps at screening are therefore advised to undergo periodic surveillance colonoscopy. Screening and surveillance colonoscopy guidelines were updated by the U.S. Multi-society Task Force (USMSTF) in 2006, which emphasized risk stratification by polyp features at screening colonoscopy.

This is a retrospective cohort study of patients with screening colonoscopy at an endoscopy center in South Carolina between …

Job Satisfaction And Intent To Quit Outcomes Among Home Health Aides In Home Health Care Industry Of The United States: A Multilevel Study, Seokwon Yoon

Theses and Dissertations

Backgrounds: Home health aides’ job satisfaction and intent to quit have been attributed to organizational and community level factors. The objective is to determine the effects of individual-, organizational-, and community-level factors on job satisfaction or intent to quit among home health aides.

Methods: This research used data from two subsets of the 2007 National Home and Hospice Care Survey and the 2007 National Home Health Aides Survey, sampling six eligible workers across the agencies in the Unites States. As another data source, the present study uses Area Health Resource File. The author used hierarchical linear modeling technique for handling …

Demand And Supply Factors Affecting Maternal Healthcare Utilization Pattern In Nigeria, Dumbiri Joy Powell

Theses and Dissertations

Given poor maternal services utilization and associated high maternal mortality risk in Nigeria, we document policy-amenable supply and demand factors impacting women’ use of skilled ANC and institutional delivery services. Using a cross-sectional design, we analyzed data from the Nigeria State Health Investment Project health facility and household surveys on 418 health facilities and 3,726 women with a pregnancy within 24 months prior to survey living in 241 geographic wards of two states. Logistic regression was used to study associations of women’s use of each maternal service with ward facilities’ ANC outpatient satisfaction, healthcare staff job satisfaction, surveyorverified facility infrastructure, …

Examining The Relationship Among Patient-Centered Communication, Patient Engagement, And Patient’S Perception Of Quality Of Care In The General U.S. Adult Population, Jumee Wang

Theses and Dissertations

Introduction: Patient-centered care is a major focus of healthcare organizations, policy makers, and researchers. Patient-centered communication by the provider and patient engagement are important components of patient-centered care. Despite increasing attention to these topics, we do not fully understand how patient-centered communication and patient engagement relate to perceived quality of care as reported by patients. This study takes some initial steps in exploring these relationships. The study also identifies patient-related factors such as sociodemographic, health-related, and health system factors that are associated with patient-centered communication, patient engagement, and perceived quality of care.

Method: This study used survey data …

Healthcare Utilization And Expenditure Patterns Among Older Adults With Functional And Medical Decline, Ashley Shields Robertson

Theses and Dissertations

Purpose. As the aged population of this country grows, the U.S. healthcare system will face increased pressure to provide long-term care services and supports to increasing numbers of elderly Medicare beneficiaries. Studies have indicated that unmet long-term care need can lead to increased, unnecessary utilization of the healthcare system, thus further taxing the Medicare system. Little is known about how type of long-term care, as well as how long-term care policies—specifically payment policies—affect health care utilization. The objective of this original dissertation research was to examine the effects of place of residence (community versus residential long-term care facility) and …

Dental Insurance As A Mitigating Factor In Reducing The Risk Of Mortality Among Working-Age Adults With Dental Caries And Periodontitis, Naveed Sadiq

Theses and Dissertations

Background Poor oral health had been associated with increased risk of having systemic diseases and thus mortality. The purpose of this research was to find if dental coverage with health insurance could mitigate the risk of death due to untreated dental caries and periodontitis among working age U.S. adults. Methods Data were drawn from NHANES III (1988-1994) and linked to mortality updated till Dec. 31st, 2011. It was restricted to those in the age range of 20-64 years adults. Furthermore, it was restricted to those who had complete data collection on all measures. Unweighted propensity scores were calculated to control …

Spatial Analysis And Correlates Of Waterpipe Tobacco Smoking Among College Students In The United States, Frederick Richard Kates

Theses and Dissertations

Introduction: In the United States, young adults have the highest prevalence of waterpipe tobacco smoking (WTS) according to National Adult Tobacco Surveys (NATS) published by the Center for Disease Control (CDC). Experimentation of different tobacco products is highest among 18-24 year olds. Most recently, WTS has surged in popularity among this demographic group. The rapid diffusion of WTS among this population has been accelerated by marketing efforts on the Internet. There are misperceptions that WTS is less harmful than smoking cigarettes and there is a proliferation of WTS establishments due to tobacco retail exemptions. Presently, WTS establishments are almost completely …