Medicine and Health Sciences Commons^™

Over-Utilization Of Advanced Imaging In The Hospital Setting: An Educational Approach To Reduce Unnecessary Inpatient Studies, Guillermo Madero, J. Platnick, L. Voutsinas, R. Wetz, S. Buchbinder

Internal Medicine

By several measures, health care spending continues to rise, forcing businesses and families to cut back on operations and household expenses. In 2008, health care spending in the United States reached $2.4 trillion dollars, and is projected to reach $3.1 trillion in 2012.During the past decades, there has been a steady increase in the utilization of expensive inpatient imaging studies, with an overall increase in health care costs. In particular, advanced imaging includes CT, MRI and Nuclear Medicine, used for the diagnosis and management of hospitalized patients. The reasons for unnecessary imaging examinations include indirect financial benefit to physicians, medico-legal …

What's Happening: April, 2009, Maine Medical Center

What's Happening

No abstract provided.

Prevention Of Mother-To-Child Transmission (Pmtct) Of Hiv In The Sub-Saharan Africa Region With A Focus On Uganda, Emily K. Franks

Senior Honors Theses

With the rise of the HIV/AIDS epidemic in the past thirty years, people of all ages, infants to elderly alike, all over the world, suffer from its adverse effects. Even an unborn baby in-utero can contract this virulent infection by means of mother-to-child transmission (MTCT) (Sweeney, 2005). Infants and children diseased in this way comprise 90% of the estimated 800,000 new cases of HIV in children seen each year, but the region hit hardest, however, is Sub-Saharan Africa, with the country of Uganda historically having the highest incident rate for a time (Stringer, E.M., et al. 2008). Therefore, the purpose …

Health Care-Associated Infections: Is There An End In Sight?, Lisa Sprague

National Health Policy Forum

Health care–associated infections (HAIs) have emerged as a significant concern in policy as well as clinical circles. An HAI is an infection acquired during treatment for another condition. Some of the HAI-causing bacteria have become drug-resistant; methicillin-resistant Staphylococcus aureus, or MRSA, is a familiar example. Tied to perhaps 100,000 deaths and $20 billion in health care costs each year, HAIs have given rise to state laws, legislative proposals at the federal level, public-private initiatives, and work at the hospital system and individual hospital level. However, much remains to be done. This issue brief reviews the prevalence of HAIs and the …

Or Practice—Efficient Short-Term Allocation And Reallocation Of Patients To Floors Of A Hospital During Demand Surges, Steven M. Thompson, Manuel Nunez, Robert Garfinkel, Matthew D. Dean

Management Faculty Publications

Many hospitals face the problem of insufficient capacity to meet demand for inpatient beds, especially during demand surges. This results in quality degradation of patient care due to large delays from admission time to the hospital until arrival at a floor. In addition, there is loss of revenue because of the inability to provide service to potential patients. A solution to the problem is to proactively transfer patients between floors in anticipation of a demand surge. Optimal reallocation poses an extraordinarily complex problem that can be modeled as a finite-horizon Markov decision process. Based on the optimization model, a decision-support …

What's Happening: March, 2009, Maine Medical Center

What's Happening

No abstract provided.

Healthcare Could Your Organization Save Money With Complementary And Alternative Medicine?, William Martin, Hugh Long

Publications – Dreihaus College of Business

Some evidence suggests complementary and alternative medicine could reduce costs and improve efficiency while increasing patient satisfaction.

Initial Research And Evaluation Concepts For Public Health Pbrns, Glen Mays

Glen Mays

Initial research and evaluation activities of the Public Health PBRN Program are intended to provide a descriptive characterization of networks during their early stages of development. This descriptive ‘network analysis’ will provide a baseline for tracking changes in network structure and function over time. The information generated through these activities is intended to be useful for a variety of audiences, including current grantees and others interested in developing or expanding public health PBRNs, as well as policy and practice stakeholders interested in using the evidence and insight to be produced through PBRNs.

What's Happening: February, 2009, Maine Medical Center

What's Happening

No abstract provided.

Healthcare Could Your Organization Save Money With Complementary And Alternative Medicine?, William Martin, Hugh Long

William Marty Martin

Some evidence suggests complementary and alternative medicine could reduce costs and improve efficiency while increasing patient satisfaction.

Reauthorizing Schip: A Summary Of Selected Issues, Jennifer Ryan, Cynthia Shirk

National Health Policy Forum

This document provides a brief overview of some of the policy and programmatic issues that were addressed in legislation to reau¬thorize the State Children’s Health Insurance Program (Title XXI of the Social Security Act) during the summer and fall of 2007. This overview provides a background for understanding the elements for a second round of reauthorization that will likely be debated in the early days of the 111th Congress. The paper reviews several of the key issues under discussion and summarizes some of the related provisions in the reauthorization bills that were considered in 2007.

Uncompensated Care Cost: A Pilot Study Using Hospitals In A Texas County, Alberto Coustasse, Andrea L. Lorden, Vishal Nemarugommula, Karan P. Singh

Management Faculty Research

The financial ramifications of uncompensated care cost (UCC) on the healthcare industry have been difficult to quantify. With the lack of a standardized definition of uncompensated care and the need to account for the uninsured, indigent, and immigrant populations, the authors identified $190 million of UCC from Southwestern border hospitals for emergency room treatment of undocumented immigrants and $934 million of uncompensated care charges for 23 hospitals in a Texas county, which translated to $353 million of UCC. Although lawmakers passed the Medicare Prescription Drug Improvement and Modernization Act (2003) to address the growing imbalance, the shortfall of funds highlights …

A Generic Approach To Computer-Based Clinical Practice Guideling Management Using The Eca Rule Paradigm And Active Databases, Bing Wu, Kudakwashe Dube

Articles

The increasing demand for reduced cost and improved quality of service in healthcare has prompted the call for better management of medical knowledge. The main emphasis has been on knowledge that is acquired through experience and medical research and then formalised into Clinical Practice Guidelines (CPGs). This paper presents a generic approach to CPG information and knowledge management that uses the Event-Condition-Action (ECA) rule paradigm and active databases within a unified management framework. The paper focuses on an approach for facilitating the use and management of CPGs by clinicians through delivering the CPGs at the point-of-care by a computerised mechanism.

Children's Mercy Hospital Annual Report 2008, Children's Mercy Hospital

Children's Mercy Annual Reports

Annual report for The Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Start-Up Activities For Public Health Pbrns, Glen Mays

Glen Mays

Launching a successful public health practice-based research network requires a planned approach to developing the necessary infrastructure, relationships, and scientific direction.

Policy Issues Affecting Maine’S Hospitals, John A. Gale Ms, Jennifer D. Lenardson Mhs

Rural Hospitals (Flex Program)

Legislators and other policymakers will be continually challenged to balance the needs of hospitals for appropriate reimbursement and oversight with supporting their provision of important services to local communities.

A Participant Model: Predictive Medical And Behavioral Factors Of Prostate Cancer Screening Attendees At Markey, Shana L. Steinbach

MPA/MPP/MPFM Capstone Projects

Problem Statement

The Prostate Cancer Screening Program at the Markey Cancer Center co-sponsors prostate cancer screenings with the Prostate Cancer Education Council. All participation, including African-American attendance, has decreased 38% from years 2006 to 2008 and program managers are seeking insight to improve program participation by acquiring knowledge of behavioral and medical characteristics that may influence screening attendance. Because of the higher incidence of prostate cancer in African-American men (ACS, 2008), a specific program goal is also to increase screening attendance for this minority population.

Research Strategy

Questions that assess participant behavior, personal, and family medical history are analyzed to …

The Effect Of Moral Distress On Nursing Retention In The Acute Care Setting, Cynthia L. Cummings

UNF Graduate Theses and Dissertations

This descriptive study explored the relationship between moral distress, professional stress and intent to stay in the hospital setting. The study involved 234 nursing participants and was conducted via an online survey over a 90 day period. The survey tool consisted of 51 items taken from known moral distress, professional stress and intent to stay tools. The items were divided into frequency and intensity of occurrence. Various statistical measures were utilized to conclude that moral distress and professional stress factors were significant (p

What's Happening: January, 2009, Maine Medical Center

What's Happening

No abstract provided.

Perceptions About The Impact Of Global Medical Travel On Poorer Populations In India, Blair Gifford, Sinyoung Park, Sharmila Anand

Department of Health Administration Faculty Publications

There is anecdotal evidence that the increasing focus on global medical travel health services for foreigners in India is likely to exacerbate the different levels of access to health services between India’s wealthy and poor populations. However, surveyed physicians (n=177) at three hospitals in New Delhi indicated positive attitudes to global medical travel, especially in regards to global medical travel’s effects on poorer populations. Overall, these results appear to be the result of respondents’ support of the economic development, new medical technologies, and increased medical training that comes from the health infrastructure investments needed to attract foreign patients.

Cultural Determinants Affect Implementation Of Good Clinical Practice (Gcp) In Human Research Studies In Malawi, Africa, Joann Jeanne Schmidt

Master's Theses and Doctoral Dissertations

Clinical research conduct and Good Clinical Practice (GCP) implementation are influenced by local culture. This study examines the experiences of 26 clinical research personnel in Malawi, Africa, in order to define relevant issues, identify solutions, and give voice to local investigators. Qualitative, semi-structured interviews were conducted, audio-recorded, transcribed, and analyzed. Six themes, related to cultural determinants, emerged: 1) communitybased decision-making, 2) illiteracy, 3) patient identifiers, 4) local myths and misconceptions, 5) poverty and disease, and 6) barriers to teamwork. Findings revealed that: 1) Malawians are best at identifying local solutions, 2) operations research is needed 3) greater networking and communication …

Intuitive Decisions As A Means Of Preventing Medical Errors, Lynette M. Savage

Walden Dissertations and Doctoral Studies

Medical errors occur despite precautionary measures. Limited research has focused on intuition in preventing medical errors. The problem addressed in this study explored the role of intuition by health care team members in preventing medical errors from reaching hospitalized patients. The research questions focused on the differences in response to medical errors by health care team members from 3 West Coast hospitals. The theoretical framework included human error, personality typing, skill acquisition, and a model of intuition. In this exploratory mixed method study 1,836 unusual occurrence reports submitted over 6 months were analyzed. Of the 710 health care team members …

A Case Study Of Factors Influencing Health Benefit Offerings By Small Businesses, Richard J. Dahlkemper

Walden Dissertations and Doctoral Studies

If the United States is turning to consumer-driven health plans to control costs and improve access, research is needed regarding the perception of such plans among small businesses. Nearly half of Americans are employed by small businesses where access to health insurance has declined most rapidly. Reviews of the literature revealed solid theoretical bases for high expectations regarding the diffusion of consumer-driven health plans among small businesses, but relatively little information was found regarding the attitudes of small businesses toward emerging health plan models. Qualitative case studies of 6 small employers in the Ogden, Utah, area were conducted to address …

Test Of A Multidisciplinary Health Behavior Model Of Medicare Elders' Antihypertensive Acquisitions, Ann Marie Kopitzke

Health Services Research Dissertations

This study examined the relative utility of the enhanced Health Belief Model as compared to the proposed Pharmaceutical Acquisition Model for Medicare Elders (PAMME) in describing antihypertensive acquisition with usage intentions for Medicare elders (65 years or older) in Southeastern Virginia. Data collection included record reviews to identify hypertensive Medicare elders. Consenting Medicare elders were randomly selected for invitation, with consenting Medicare elders contacted by telephone or in-person interviews. The survey instrument utilized open and closed ended questions. The target population for this study is Southeastern Virginia Medicare elders enrolled in a Part D plan and prescribed at least one …

Medical Conditions In Children With Down Syndrome: A Literature Review ; Changes Over Time In Medical Conditions And Service Use By Children With Down Syndrome, Kelly Thomas

Theses : Honours

Background: Children with Down syndrome experience an array of medical conditions and health care problems. Although there have been vast improvements in the medical management of these conditions, they still significantly impact on quality of life for families and children with Down syndrome. However, despite the magnitude of this problem limited literature has described the overall health status of children with Down syndrome. Aim: The purpose of this review was to describe the medical conditions commonly experienced by children with Down syndrome and to consider the clinical implications of this knowledge. Methods: Databases Medline, CINHAL and PsychINFO were electronically searched …

Physician Recruitment At Highlands Regional Medical Center: What Works?, Sarabeth Blankenship

MPA/MPP/MPFM Capstone Projects

There is a physician shortage in eastern Kentucky because older physicians are retiring, and younger physicians are choosing to practice in more urban, affluent areas. Eastern Kentucky is plagued with persistent poverty and lacks cultural amenities. These facts put together myths regarding rural practice create a shortage.

My research consisted of interviewing twenty physicians currently practicing at Highlands Regional Medical Center in Prestonsburg, Kentucky. I created a survey instrument that asked questions of physicians regarding demographics characteristics, medical school attended, and what motivated them to practice at Highlands. I chose Highlands because I was able to get interviews scheduled with …

Employability After Substance Abuse Treatment In Kentucky: An Analysis Of The Kentucky Treatment Outcome Study, Steven Scrivner

MPA/MPP/MPFM Capstone Projects

Public funding of substance abuse treatment (SAT) in Kentucky dates back to the 1950s when legislators sought to curb the problem of alcoholism through legislative acts. The definition of substance abuse expanded through the years to include other substances such as cocaine, marijuana and opiates.

Employment after SAT is a critically important outcome for policymakers to consider when allocating funds because it assists in social re-integration, helps to prevent relapse and promotes economic self-sufficiency. Because of this, employment is an important factor to consider when assessing the impact SAT has on its clients (participants).

The Kentucky Alcohol and Other Drug …

Determinants Of Nursing Home Performance: Examining The Relationship Between Quality And Efficiency, Nailya Delellis

Theses and Dissertations

Determinants of nursing home performance: examining the relationship between quality and efficiency By Nailya O. DeLellis, MPH, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2010 Director: Dr. Yasar Ozcan, Professor, Department of Health Administration To assess the relationship between quality of care and efficiency of nursing homes this study used 10% random sample of non-hospital based nursing homes of size 20-360 beds and occupancy rate of 5-100% in OSCAR database 2008 (n=1430). Data Envelopment Analysis was used to calculate efficiency score and Structural …

A Longitudinal Examination Of How Hospital Provision Of Home Health Services Changed After The Implementation Of The Balanced Budget Act Of 1997: Does Ownership Matter?, Tiang-Hong Chou

Theses and Dissertations

By using a natural experiment approach and longitudinal national hospital data, this study sheds light on the objective functions of hospitals with different ownership forms by comparing their relative reductions in HH provision after the implementation of the BBA. The empirical findings reveal that for-profit hospitals behave differently as compared to public and private nonprofit hospitals, due to their different operational objectives. While the response of for-profit hospitals is consistent with the profit-maximizer model, both public and private nonprofit ownership types behave consistently in accordance with the model of two-good producers whose objective is to maximize market outputs for meeting …

Contextual Leadership: The Social Construction Of Leadership In A Comprehensive Healthcare System, Mark J. Moir

Antioch University Full-Text Dissertations & Theses

Healthcare is a complex and dynamic environment containing a plurality of social forces and perspectives that shape the organizational culture and the nature of the leadership. As leadership is a social phenomenon, it is important to understand the complex social processes that mediate our perceptions and that in turn influence processes of leader attribution. The central purpose of this study has been to illuminate the nature of culturally specific processes that emerge within a specific organizational setting and that fuel leader attribution and the social construction of leadership. Accordingly, this qualitative study has developed a Grounded Theory utilizing Situational Analysis …