Medicine and Health Sciences Commons^™

Operating Room First Start Efficiency Throughout A Large Urban Hospital System, Callie Cox Bauer, Kiley A. Bernhard, Danielle M. Greer, Scott Kamelle

Aurora Ob/Gyn Faculty

Background: Operating room delays decrease health care system efficiency and increase hospital costs. Data on delays in a multihospital system are sparse.

Purpose: In an effort to improve our operating room efficiency, we investigated operating room delays, the causes and the impending financial impact.

Methods: A retrospective analysis on first case-of-the-day surgeries at three hospitals during 2013 was conducted. Delays were defined as in-room time being after scheduled surgery start time. Length of delay and causes were recorded. Patient demographics, body mass index, hospital facility, total number of procedures, provider specialty and time of patient arrival were incorporated into a …

Potential Savings From Consumer-Driven Health Plans, Jessica Mcnair, Brittany White, Christopher Miller, William Ferguson, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Consumer Driven Health Plans (CDHPs) have been identified as a high-deductible insurance option that has increased consumer responsibility while health care expenditures have decreased. Anticipated savings through the use of CDHPs have drawn increased interest of employers and policymakers. The increased need to control healthcare costs as well as healthcare utilization have also fostered the development of increased use of CDHPs. As the use of CDHPs have expanded, educated consumers have become more engaged in their healthcare services and have increased demands for transparency of healthcare costs. Healthcare costs, utilization, and moral hazard of this study are further discussed.

Implications Of Upcoding On Medicare, Katrina Cremeans, Samantha Marcum, Carli Followay, Jessica Oldaker, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The complexity of and amount of funds involved in Medicare has led to a significant increase in the incidence of Medicare fraud. A type of Medicare fraud, upcoding, has contributed to excessive and unnecessary health care spending. Upcoding has been an illegal strategy that some providers have used to increase their Medicare reimbursement for certain conditions. This is accomplished by coding a provided service as a more expensive service than what was actually performed. With the proliferation of upcoding, there has been an astonishing $12.5 billion in fraudulent Medicare charges since 2007. The fraudulent strategy of upcoding to increase Medicare …

Utilization Of Acupuncture Services In The Emergency Department Setting: A Quality Improvement Study, John R. Burns, Jessica J. F. Kram, Vashir Xiong, Jeanne M. Stark Casadont, Tiffany A. Mullen, Nancy Conway, Dennis J. Baumgardner

Jessica Kram, MPH

Purpose: Patients often present to the emergency department (ED) for pain. As opioid fatalities rise, alternative treatments are warranted for pain management. Acupuncture, a nonpharmacological treatment involving the insertion of needles into skin or tissue at specific points within the body, may help to decrease acute pain. Our study aimed to assess the utilization and impact of acupuncture in the ED for acute pain management.

Methods: We conducted a retrospective analysis of purposefully collected quality improvement data. Patients who were ≥18 years old and who presented to the ED at an urban medical center in Wisconsin during 2017 were offered …

Predicting Adverse Outcomes In End Stage Renal Disease: Machine Learning Applied To The United States Renal Data System, Zeid Khitan, Alexis D. Jacob, Courtney Balentine, Adam N. Jacob, Juan R. Sanabria, Joseph I. Shapiro

Joseph I Shapiro MD

We examined machine learning methods to predict death within six months using data derived from the United States Renal Data System (USRDS). We specifically evaluated a generalized linear model, a support vector machine, a decision tree and a random forest evaluated within the context of K-10 fold validation using the CARET package available within the open source architecture R program. We compared these models with the feed forward neural network strategy that we previously reported on with this data set.

Predicting Adverse Outcomes In End Stage Renal Disease: Machine Learning Applied To The United States Renal Data System, Zeid Khitan, Alexis D. Jacob, Courtney Balentine, Adam N. Jacob, Juan R. Sanabria, Joseph I. Shapiro

Joseph I Shapiro MD

We examined machine learning methods to predict death within six months using data derived from the United States Renal Data System (USRDS). We specifically evaluated a generalized linear model, a support vector machine, a decision tree and a random forest evaluated within the context of K-10 fold validation using the CARET package available within the open source architecture R program. We compared these models with the feed forward neural network strategy that we previously reported on with this data set.

At-Risk Ems Employees- A Model Of Assessment And Intervention.Pdf, Ron J. Hammond, Kate Miller

Ron J. Hammond

Predicting Adverse Outcomes In End Stage Renal Disease: Machine Learning Applied To The United States Renal Data System, Zeid Khitan, Alexis D. Jacob, Courtney Balentine, Adam N. Jacob, Juan R. Sanabria, Joseph I. Shapiro

Juan R. Sanabria

We examined machine learning methods to predict death within six months using data derived from the United States Renal Data System (USRDS). We specifically evaluated a generalized linear model, a support vector machine, a decision tree and a random forest evaluated within the context of K-10 fold validation using the CARET package available within the open source architecture R program. We compared these models with the feed forward neural network strategy that we previously reported on with this data set.

The Opioid Epidemic In West Virginia, Nicholas Bowden, Rachel Merino, Sruthi Katamneni, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The rate of overdose-related to the use of licit and illicit opioids has drastically increased over the last decade in the U.S. The epicenter being West Virginia the highest rates of overdoses accounting for 41.5 deaths for 100,000 people among the 33,091 deaths in 2015. The number of people injecting drugs has increased from 36% in 2005 to 54% in 2015. The total U.S cost of prescription opioid abuse in 2011 has been estimated at $25 billion, and criminal-justice-system costs to $5.1 billion. The reasons for this opioid epidemic incidence in WV have been a combination of sociocultural factors, a …

The Continuing Epidemic Of Hepatitis C In The United States: The Case Of West Virginia, David P. Paul Iii, Neha Botre, Maggie Phillips, Jumana Abboud, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Hepatitis C virus (HCV) is one of the most significant public health problems currently facing the U.S. If it is left untreated, the likelihood of sustaining a treatment response decreases. While early identification has been identified as a critical focus in trying to obtain better health outcomes, new drug treatments appear quite promising.

Macra And Rural Hospitals, Erica Kelley, Rhea Lipscomb, Jennifer Valdez, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The purpose of this research was to study MACRA (Medicare Access & CHIP Reauthorization Act) and to determine how its implementation would financially impact rural hospitals. Although the long-term effects of MACRA have not been able to be studied, MACRA has the prospective to negatively impact rural hospitals financially. MACRA has potential risks and benefits for physicians associated with its two reimbursement payment methods. The estimated negative reimbursements and set reductions to hospital reimbursement have supported the idea that physicians and all healthcare organizations need to be aware and prepared for MACRA.

Hospital Nurse Burnout: A Continuing Problem, David P. Paul Iii, Lama Bakhamis, Harlan M. Smith Ii, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

RNs are a critically important component of the U.S. healthcare system. RN burnout – the feeling of exhaustion from working long hours without rest – is a real concern, having been reported in many hospitals. We examine the background, causes and consequences of burnout among RNs in U.S. hospitals, in order to identify solutions to this problem. Findings indicate that Burnout Syndrome in RNs can be analyzed in terms of four clusters of characteristics: individual, management, organizational, and work. The consequences of burnout include increased RN turnover rates, poor job performance, and threats to patient safety. RN burnout in hospitals …

Organizational Culture Change In A Texas Hospital, Alberto Coustasse-Hencke M.D., M.B.A., M.P.H.

Alberto Coustasse, DrPH, MD, MBA, MPH

Coustasse-Hencke, Alberto, MD, MBA, MPH, Organizational Culture Change in a Texas Hospital. Doctor of Public Health (Health Behavior), June 2004, 329 pp., 11 tables, 8 illustrations, bibliography, 198 titles. The purpose of this research was to analyze a Balanced Scorecard (BSC) approach in a Texas hospital with a main focus in Patient Satisfaction (PS), and to measure organizational change and its impact on PS. This dissertation also applied a "Shared Vision" of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. The development of …

Hospital Mergers And Public Accountability: Tennessee And Virginia Employ A Certificate Of Public Advantage, Erin C. Fuse Brown

Erin C. Fuse Brown

No abstract provided.

Trends And Effects Of Pharmaceutical Dtca, Alberto Coustasse, P. Sathorn, William K. Willis

Alberto Coustasse, DrPH, MD, MBA, MPH

Purpose – The purpose of the review is to investigate the current trend of pharmaceutical Direct-to-Consumer Advertising (DTCA) in the US and its effect on patients, physicians, and drug utilization. DTCA by pharmaceutical firms may be defined as an attempt by pharmaceutical companies to advertise products directly to patients.

Design/methodology/approach – Methodology for this paper is a literature review approach.

Findings – Pharmaceutical DTCA demonstrated a reduction in total spending, while the online channel media experienced growth. DTCA has influenced the physician-patient relationship and patient satisfaction. Patients who received medication associated with DTCA showed higher satisfaction. DTCA of second-line drugs …

The 340b Program: Benefits And Limitations, Craig Kimble Pharmd, Mba, Ms, Bcacp, Alberto Coustasse Dr.Ph. Md, Mba, Mph

Craig Kimble, PharmD, MBA, MS, BCACP

This in progress study reviews challenges and successes associated with implementing a 340B program at Marshall Health and Cabell Huntington Hospital (CHH) in Huntington, West Virginia. CHH qualified as a participant in the 340B program because it has met qualification as a disproportionate share hospital (DSH). The site has also been able to open two outpatient pharmacies to serve the targeted patient population. The pharmacies have also been able to use savings from the program to embed clinical pharmacists into the physician care areas to provide medication therapy management services including discharge counselling, disease state management services, patient financial assistance …

Burnout Syndrome And Nurse-To-Patient Ratio In The Workplace, Ekaterina Gutsan Msha, Jami Patton, William K. Willis, Alberto Coustasse Dr.Ph. Md, Mba, Mph

William K Willis

Introduction: Burnout among Registered Nurses has been a great concern within the U.S. healthcare system and has been reported in many hospitals. Nurse Burnout has been defined as a chronic response to work-related stress comprising three components or dimensions: emotional exhaustion, depersonalization, and personal accomplishment. The purpose of this research was to analyze the nurse-to-patient ratio to determine how it affects the psychological, mental, emotional health and the nurse overall productivity in the workplace.

Methodology: The methodology was a review of literatures and a semi-structured interview. There were four primary databases and one website used in this research, and 31 …

The 340b Program: Benefits And Limitations, Craig Kimble Pharmd, Mba, Ms, Bcacp, Alberto Coustasse Dr.Ph. Md, Mba, Mph

Alberto Coustasse, DrPH, MD, MBA, MPH

This in progress study reviews challenges and successes associated with implementing a 340B program at Marshall Health and Cabell Huntington Hospital (CHH) in Huntington, West Virginia. CHH qualified as a participant in the 340B program because it has met qualification as a disproportionate share hospital (DSH). The site has also been able to open two outpatient pharmacies to serve the targeted patient population. The pharmacies have also been able to use savings from the program to embed clinical pharmacists into the physician care areas to provide medication therapy management services including discharge counselling, disease state management services, patient financial assistance …

Healthcare Facilities: Another Target For Ransomware Attacks, David P. Paul Iii, Nikki Spence, Niharika Bhardwa, Alberto Coustasse Dr.Ph, Md, Mba, Mph

Alberto Coustasse, DrPH, MD, MBA, MPH

Ransomware is a type of malware used by cyber criminals who encrypt files and then extort money in return for unlocking those files. Without adequate disaster recovery and backup plans, many businesses are forced to pay the ransom. We examine recent ransomware infections in healthcare settings, the liabilities and cost associated with such infections, and discuss possible risk mitigation tactics. Risks associated with ransomware attacks on healthcare facilities include financial, future business loss and damage to reputation. Healthcare facilities should have a disaster plan with adequate data backups and educate employees who are the usual sources of ransomware attacks.

The Emerging Issue Of Hepatitis C Virus In The United States And In West Virginia, Alberto Coustasse Dr.Ph. Md,Mba, Mph, Maggie Phillips Rn, Bsn, Mha, Jumana Abboud Mha, Neha Botre Mha, David P. Paul Iii

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction:

Hepatitis C virus (HCV) is one of the most significant public health problems currently facing the U.S., Especially in West Virginia. If it is undetected and left untreated, the likelihood of sustaining a treatment response decreases. While early identification has been identified as a critical focus in trying to obtain better health outcomes, new drug treatments appear promising, although somewhat expensive. West Virginia, a predominantly rural state, is beginning to face a mounting financial crisis due to HCV.

Purpose of the Study:

The purpose of this study was to examine the effects of early identification and treatment for patients …

Burnout Syndrome And Nurse-To-Patient Ratio In The Workplace, Ekaterina Gutsan Msha, Jami Patton, William K. Willis, Alberto Coustasse Dr.Ph. Md, Mba, Mph

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: Burnout among Registered Nurses has been a great concern within the U.S. healthcare system and has been reported in many hospitals. Nurse Burnout has been defined as a chronic response to work-related stress comprising three components or dimensions: emotional exhaustion, depersonalization, and personal accomplishment. The purpose of this research was to analyze the nurse-to-patient ratio to determine how it affects the psychological, mental, emotional health and the nurse overall productivity in the workplace.

Methodology: The methodology was a review of literatures and a semi-structured interview. There were four primary databases and one website used in this research, and 31 …

Family Practice Resident Expectations By Year From Faculty And Resident Perspectives: A Quality Improvement Initiative, Alyssa Krueger, Devin Lee, Jessica J.F. Kram, Will Lehmann, Dennis J. Baumgardner

Will Lehmann, MD

Background: The transition from student to physician requires substantial commitment and work from residents as well as guidance from program faculty. The Accreditation Council for Graduate Medical Education (ACGME) has standardized certain academic requirements for U.S. residency programs; however, faculty expectations of residents according to year in the program are less formal and more a hidden curriculum. Setting expectations for residents to consult could better help residents navigate their graduate medical education experience and achieve the level of excellence expected by ACGME.

Purpose: Our quality improvement study aimed to: 1) determine what the expectations of family practice residents were based …

Medicare And The Affordable Care Act: Fraud Control Efforts And Results, Sarah Clemente, Ronald Mcgrady, Rob Repass, David P. Paul Iii, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of HEAT …

Maryland's All-Payer Health Care System: A Light At The End Of A Tunnel, Lama Bakhamis, Taeko Matsumoto, Mary Tran, David P. Paul Iii, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The state of Maryland, in collaboration with the Centers for Medicare & Medicaid Services, developed the first all-payer system model in the Unites States in 1971 and 35 years later in response to financial pressures undertook to modernize this program. The focus of the modernized program was to improve overall per-capita expenditure, quality of care, and the outcome of Marylanders' health. The financial status of Maryland hospitals was declining because of the rate setting of the Health Services Cost Review Commission while hospital admission rates and spending were increasing. This study showed positive change in moving Maryland health care delivery …

Personal Health Records: Beneficial Or Burdensome For Patients And Healthcare Providers?, Melissa Lester, Samuel Boateng, Jane Stanley, Alberto Coustasse

Melissa Lester, DO

Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to analyze the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 articles. PHRs are powerful tools for patients and healthcare providers. Better healthcare results and correction of medical records have been shown to be positive outcomes of the use of PHRs. PHRs have also been …

Push For Progress Inspired Improved Outcomes, Jacob L. Bidwell

Jacob Bidwell, MD

The author and issue editor describes the changing faces of health care as well as movements undertaken by U.S. health systems over the last two decades to improve the treatment and documented outcomes of minority or impoverished patients and to understand the impact of cultural differences on patient care. While much progress has been made, achieving health equity will require the continued efforts of many working toward this goal.

Challenges Of Refugee Health Care: Perspectives Of Medical Interpreters, Case Managers, And Pharmacists, Fabiana Kotovicz, Anne Getzin, Thy Vo

Fabiana Kotovicz, MD

Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin. Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. …

Family Practice Resident Expectations By Year From Faculty And Resident Perspectives: A Quality Improvement Initiative, Alyssa Krueger, Devin Lee, Jessica J.F. Kram, Will Lehmann, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Background: The transition from student to physician requires substantial commitment and work from residents as well as guidance from program faculty. The Accreditation Council for Graduate Medical Education (ACGME) has standardized certain academic requirements for U.S. residency programs; however, faculty expectations of residents according to year in the program are less formal and more a hidden curriculum. Setting expectations for residents to consult could better help residents navigate their graduate medical education experience and achieve the level of excellence expected by ACGME.

Purpose: Our quality improvement study aimed to: 1) determine what the expectations of family practice residents were based …

Burnout Syndrome In Hospital's Nurses: Causes And Consequences, Lama Bakhamis, Harlan M. Smith Ii, Alberto Coustasse, David P. Paul Iii

Harlan M. Smith

PURPOSE: The purpose of this research was to examine the causes and consequences of Burnout Syndrome among RNs in U.S. hospitals to identify solutions to this problem.

METHODS: The methodology was the review of the literature and a semi-structured interview. There were seven primary databases and two websites used in this research, and 35 articles were used for this literature review.

RESULTS: Causes and risk factors of burnout syndrome among RNs have been categorized into four major areas: individual, management, organizational, and work characteristics. Burnout syndrome rate among RNs with age under 30 years was 43.6% higher …

Burnout Syndrome In Hospital's Nurses: Causes And Consequences, Lama Bakhamis, Harlan M. Smith Ii, Alberto Coustasse, David P. Paul Iii

Alberto Coustasse, DrPH, MD, MBA, MPH

PURPOSE: The purpose of this research was to examine the causes and consequences of Burnout Syndrome among RNs in U.S. hospitals to identify solutions to this problem. METHODS: The methodology was the review of the literature and a semi-structured interview. There were seven primary databases and two websites used in this research, and 35 articles were used for this literature review. RESULTS: Causes and risk factors of burnout syndrome among RNs have been categorized into four major areas: individual, management, organizational, and work characteristics. Burnout syndrome rate among RNs with age under 30 years was 43.6% higher than RNs over …