Medicine and Health Sciences Commons^™

Sepsis: Do The Clinical Criteria Support The Medical Coding?, April M. Insco

Theses and Dissertations (ETD)

Background: Sepsis is a condition that can be very costly and very deadly. Diagnosing sepsis can be challenging as there is not one specific test that will identify whether a patient has sepsis and there are varying opinions as to the true definition of sepsis. The definition of sepsis used for this research is a combination of System Inflammatory Response Syndrome (SIRS) with an identified infection. Medical Coders must review the documentation provided in a medical record to accurately assign an ICD-10-CM code. Administrative data is then used to provide statistical information for research purposes. When coded data is not …

The Relationship Of Child Health And Parenting Stress To Child Neurocognitive Development, Nancy Alise Farrell

Theses and Dissertations (ETD)

Problem. Although the United States rates high in economic resources, the neurocognitive development (NCD) of children falls behind many other developed nations. Levels of parenting stress may be linked to sociodemographic factors such as the high incidence of poverty in children or health disparities in children, which in turn may affect NCD in children. Using the data from an observational, longitudinal cohort study of a diverse population could provide information related to parenting stress, child health, and related factors to guide and support interventions with families and policies to improve child NCD. Aims. The overall aim of this study was …

Responding To The Pandemic: A Multicountry Study On Social-Political Factors And Health Outcomes Of Covid-19, Lan Yao

Theses and Dissertations (ETD)

Introduction. Coronavirus Disease 2019 (COVID-19) poses a major global threat to human beings, which has caused devastating consequences of population health, political, and economic crises in many countries. This dissertation was composed of three research activities to study the following aims: (1) review the existing literature focusing on political factors and health outcomes of COVID-19; (2) assess the relationship between democracy and case fatality rate of COVID-19 by controlling for the effect of age, comorbidity, health expenditure, healthcare workforce, and population density; and (3) identify the trajectory pattern cases peak days, deaths peak days, and peak periods.

Methods. We accessed …

Feasibility And Acceptability Of Using Mobile Health Apps In Underserved Patients With Diabetes, Jieyu Luo

Theses and Dissertations (ETD)

Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. …

Renal And Cardiovascular Outcomes Associated With Cannabis Use In Veterans With Advanced Chronic Kidney Disease Transitioning To Dialysis, Praveen Kumar Potukuchi

Theses and Dissertations (ETD)

Background: Legalization of cannabis and its constituents may lead to increased exposure of a higher number of consumers to cannabis use, including those with chronic kidney disease (CKD). We expect increase in cannabis use, especially, in patients with compromised kidney function. However, there is sparse literature on the effects of cannabis use on cardiorenal and mortality outcomes among patients with advanced CKD. Objectives: The main goal of the current study was to examine the effect of cannabis use on renal and cerebrovascular outcomes as well as mortality in patients with advanced CKD. Using a nationwide cohort of US veterans with …

Medication Nonadherence, Health Care Utilization, And Safemed Care Transitions Model Impact In Super-Utilizers, Satya Surbhi

Theses and Dissertations (ETD)

BACKGROUND: Super-utilizers are individuals with disproportionately high inpatient and emergency department (ED) use, and mostly have multiple chronic conditions and use multiple concurrent medications. They place a substantial burden on the U.S. healthcare system and have become the focus of policy initiatives aimed at reducing their disproportionate inpatient and ED use. Medication management is critical for these patients since nonadherence to essential chronic medications is associated with poor health outcomes, and higher health care utilization and costs. OBJECTIVES: This dissertation employed a three empirical research papers approach to study the following aims: (1) the prevalence and patterns of medication nonadherence …

Super-Utilization: The New Perfect Storm Of Health Reform, Jill Diane Nault

Theses and Dissertations (ETD)

This three-essay dissertation was focused on geographic variation of super-utilization, or the disproportionately high healthcare utilization and costs attributed to a small sub-set of the inpatient population. For purposes of this research, super-utilization was operationalized as high repeat utilization (HRU) and referred to inpatient utilization and inpatient readmission expenditures attributed to beneficiaries with four or more 30-day readmissions per year. The overall purpose of the research was to identify geographic areas at increased risk for HRU. These areas corresponded to where beneficiaries live and were aligned with the geographically-bound healthcare delivery systems. Each essay employed an observational study design using …

Medicaid Discontinuity Among Adults With Cardiovascular Disease Or High Risk Conditions: Associations With Medication Adherence And Health Care Utilization, Kiraat Divyang Munshi

Theses and Dissertations (ETD)

BACKGROUND: Medicaid coverage among adults is often characterized by discontinuity – loss of Medicaid coverage, and churning, or entering and exiting Medicaid – over short durations. Little is known about the impact of having discontinuous Medicaid coverage on access to care, preventive care, pharmacotherapy, primary care, and hospitalizations, among non-elderly adults with cardiovascular disease (CVD) or high-risk conditions.

OBJECTIVES: This dissertation employed a three empirical research papers approach to pursue the following aims: (1) characterize the adult subpopulations with CVD or conditions placing them at high risk for CVD who lack continuous Medicaid coverage, and examine the characteristics associated with …

An Examination Of Factors That Influence Health Behaviors Among Low Income African American Women With Type 2 Diabetes In Memphis, Tn: A Qualitative Inquiry Using Mixed Methods, Adole Muruako

Theses and Dissertations (ETD)

Obesity and type 2 diabetes are increasing health concerns in the United States, particularly among women and minorities. Generally, research has highlighted the health disparities that exist among African American women, especially as these disparities relate to obesity and type 2 diabetes. In Memphis, TN, the ZIP codes of 38106 and 38109 have the highest rates of diabetes hospitalizations in the city. Further, African American women in Memphis, TN have been identified as being most vulnerable to experiencing a potentially avoidable hospitalization due to chronic disease. The purpose of study was to identify factors that may impact African American overweight/obese …

Analysis Of Out-Of-Pocket Expenditures Of Oral Oncologics For Tennessee Recipients Of Medicare Part D, Eve Carolyn Elias

Theses and Dissertations (ETD)

Background: There are few studies that examine patients' costs of oral oncology drugs from Medicare Part D plan providers. These drugs can impose a financial burden to beneficiaries, and, due to their cost, place beneficiaries in the coverage gap in a short period of time. In addition to examining costs, there is little published concerning the potential impact of drug utilization management techniques on access to these drugs in Medicare Part D plans. This study examined the roles of prior authorization, step-therapy, and placement of drugs in higher formulary tiers on patients' out-of-pocket costs, and access to therapy.

Methods …

The Influence Of Patient-Reported Provider Availability Factors On Nonurgent Emergency Department Use, Cheryl Anne Dewood

Theses and Dissertations (ETD)

Purpose. The purpose of this study was to examine the influence of patient‑perceived provider availability on nonurgent emergency department use (NUEDU). The study population consisted of a nationally‑representative population of non‑elderly adults who were continuously privately insured (CPI) for at least a year before an emergency department visit that was determined to be nonurgent, and who reported having a regular source of care (RSC).

Methods. Data were obtained from a nationally‑representative longitudinal survey, the Medical Expenditure Panel Survey (MEPS). The classification of ED visits as nonurgent was based on patient report using a method developed for this study. Patient­‑perceived provider …

The Development And Psychometric Testing Of A Hypertension Knowledge Instrument In A Vulnerable Population, Crescent Elayne Rowell

Theses and Dissertations (ETD)

The primary objective of the study was to assess the psychometric properties of a hypertension knowledge instrument in a vulnerable population. The secondary objective was to determine the association between hypertension knowledge and outcomes such as systolic and diastolic blood pressure and hemoglobin A1c.

A cross-sectional study was conducted using a convenience sample of 196 adults aged 18 years and older with hypertension. Item analysis was conducted to determine the reliability of the instrument. The factor structure was determined and confirmed using exploratory factor analysis and confirmatory factor analysis, respectively. Logistic regression analysis was used to determine the association between …

Assessing The Sensitivity Of The Canadian Adverse Event Following Immunization Surveillance System ( Caefiss), Mina Tadrous

Theses and Dissertations (ETD)

Background: Vaccines are important to public health, but because of the way they are manufactured, their mechanism of action, and their indicated population, careful monitoring of their adverse events is necessary. Canada has a national surveillance system that collects reports on adverse events that may be associated with vaccine administration. Sensitivity is one of the tools used with surveillance systems to study the extent and characteristics of reporting of a surveillance system. To date, the sensitivity of the Canadian system has not been assessed.

Purpose: To assess the sensitivity of the Canadian Adverse Event Following Immunization Surveillance System …

Evaluating The Impact Of The Guatemalan Nursing Program On Staff, Organizational, And Clinical Outcomes, Sara Williamson Day

Theses and Dissertations (ETD)

There is great disparity between the outcome of childhood cancer in developed and developing countries. Nurses, who comprise the largest group of health care professionals globally, are essential to successful treatment. Pediatric oncology education is generally unavailable for nurses in developing countries. This lack of education is likely to contribute to the disparity in survival rates, as undereducated nurses are unable to meet the demands of pediatric cancer care. A second critical problem in developing countries is the workload of the nurse, with a patient nurse ratio reported as high as 30 patients per one nurse.

In 2006, the quality …

Pain Management In Nursing Home Residents With Cancer And Dementia With And Without Hospice Services, Todd Bryant Monroe

Theses and Dissertations (ETD)

Aims: We sought to identify differences in pain management between two groups; nursing home residents with malignant cancer and dementia with and without hospice services.

Methods: Decedent records from 2003-2009 were assessed for diagnosis of dementia and cause of death as cancer. Ten malignant cancer diagnoses were determined a priori from the CDC 2004 data on the top 10 malignant cancers for all races and genders. Fifty-five decedents from 10 nursing homes were included in the final sample. Four instruments were used: Minimum Data Set (MDS) a standardized assessment tool required of most U.S. nursing homes. A large …

Impact Of Parent’S Hiv Status On Their Uninfected Child—A Comparative Analysis Of The Child’S Healthcare Utilization, Access And Health Outcomes, Arijit Ganguli

Theses and Dissertations (ETD)

With the advent of effective antiretroviral medication and increased expectancy of life span among HIV-infected individuals has lead to an increase in the at-risk population of uninfected children living with their HIV-infected parent(s). The purpose of this study was to investigate the impact of parent’s HIV status on their child’s access to healthcare resources, healthcare utilization and health outcomes.

This was a cross-sectional study in which the information on the children of HIV seropositive parent(s) was collected through a face-to-face interview of the HIV-infected parents having children currently residing with them. The comparative group comprising of children of HIV seronegative …

Self-Efficacy, Physical Activity, And Aerobic Fitness In Middle School Children: Examination Of A Pedometer Intervention Program, Dana M. Manley

Theses and Dissertations (ETD)

The purpose of this study was to examine the relationships among self-efficacy levels, physical activity, aerobic fitness, and body composition (relative body mass index; RBMI) and to determine whether a school-based pedometer intervention program would improve those variables and prevent weight gain in sixth and seventh graders in rural mid-South middle schools. Bandura’s Social Cognitive Theory served as the theoretical basis for the study.Methods: A quasi-experimental pre-test, post-test design was used. The sample, recruited from two rural middle schools in Kentucky, consisted of 116 sixth and seventh grade students (98% Caucasian, 51% male, age=11.65±0.71). Anthropometric assessment of height, weight, …

Women’S-Perceived Quality In Postpartum Care, Maryland A. Hunter

Theses and Dissertations (ETD)

Increased competition among healthcare organizations for the obstetric consumer market has led to increased interest in women’s perceptions of their obstetric experience. This study explored women’s perceptions of quality and women’s perceptions of benefits for women who received family-centered postpartum care (FCPPC) and women who received traditional postpartum care (TPPC). The study also assessed the relationship between women’s-perceived quality (WPQ) and women’s-perceived benefit (WPB) for those receiving FCPPC and those receiving TPPC. Quality and beneficence are the two concepts of Larrabee’s (1992) model of quality operationalized in this study. The sample consisted of 60 postpartum women, 30 receiving care on …

Patient Perceptions Of Quality: The Influence Of Value And Beneficence, Rebecca H. Waldon

Theses and Dissertations (ETD)

The influence of patient values and patient perception of benefits on patient perceptions of quality have not been extensively investigated, even though patient and provider perceptions of quality have been widely studied. Refocusing quality assessment and improvement to include factors that influence patient perceptions of quality is necessary for humanitarian and economic reasons. The health care patient has certain expectations of health care. These expectations are based on the value the patient places on the services. Value is a predictor of patient-perception of quality. The relative worth of patient goals may also be related to patient perceptions of quality. If …

Pain And Hospital Patients Perception Of Quality, Kathy L. Beck

Theses and Dissertations (ETD)

Each year pain disables approximately 50 million Americans. These patients seekhealth care for the relief of pain and its underlying cause. Many of those seeking relief from pain are hospitalized and others experience pain during their hospitalization. All of these patients have the right to relief of their pain and none should suffer pain needlessly. Yet, often nurses fail to accurately assess and adequately manage patients' pain.

Adequate pain management may increase patient perception of nursing care quality. The purpose of this study is to determine the relationships between pain relief and patients' and nurses' perceptions of quality. The relationship …

Hospital Patients' And Nurses' Perceptions Of Quality, June Hansen Larrabee

Theses and Dissertations (ETD)

Hospital quality assurance programs have been provider-oriented, focusing on structure and process elements of care rather than outcomes specific to patient needs and values. This study tested the relationship between quality and value, proposed in Larrabee's model of quality, by developing prediction indices for patient and nurse quality and value.

The sample consisted of 199 adult patients. Patient quality was measured by a 100 mm visual analog scale (VAS) (PQUALG) and a modified version of an existing instrument (PQUALT). Patient value was measured as patient goal achievement (PGOAL), the average of three VAS scores for patient defined goals …