Medicine and Health Sciences Commons^™

Association Of Diabetes Prevalence With Labor Force Participation Rates In Kentucky Counties, Ryan Montgomery

MPA/MPP/MPFM Capstone Projects

Compared to other states in the USA, Kentucky has one of the highest rates of diagnosed diabetes and one of the lowest levels of labor force participation. This project employs a multivariable linear regression model to estimate the correlation between county-level diabetes prevalence and county-level labor force participation rates in Kentucky counties from 2015-2019, using publicly available data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey (ACS). Labor force participation rates serve as the dependent variable and diabetes prevalence rates serve as the primary independent variable, alongside nine …

Everybody’S Working (But The Weakened): An Assessment Of Medicaid Work Requirements And Their Administrative Burdens, Samuel Misleh

MPA/MPP/MPFM Capstone Projects

Although Medicaid work requirements are currently halted in both Arkansas and Kentucky, this analysis utilizes the data available to make an assessment and estimate of what Kentucky’s Medicaid enrollment will look like if work requirements similar to those Arkansas had are ever implemented. The relative severity of the administrative burden of such requirements provide a tool for comparison, and a difference-in-differences analysis of the change in Medicaid enrollment between Arkansas and West Virginia, a state that has not implemented and currently has no plans to implement Medicaid work requirements, provide the bases for this estimate. After coding the work requirements …

Evaluating Ways To Reduce Errors In Medication Reconciliations Performed By Nurses In A Rural Hospital Setting, Kalen T. Freeman

MPA/MPP/MPFM Capstone Projects

Medication reconciliation, also known as “med recs”, are an important part of a patient’s care during their hospitalization. A med rec is when hospital personnel generate a list of the medications the patient takes at home. Med recs are vital in the hospital admission process because home medications need to be restarted at appropriate times to fully care for the patient. Also, mistakes in a home medication list can lead to serious consequences in the patient’s health. This study focuses on med recs being performed at Marcum and Wallace Hospital in Irvine, Kentucky. More specifically, the study explores the different …

Evaluating The Impact Of Fine Particulate Matter Pollution Standards On Mortality Rates In The Southeastern United States, Lauren Wice

MPA/MPP/MPFM Capstone Projects

The Environmental Protection Agency (EPA) continuously monitors six criteria pollutants that are known to have impacts on public health and welfare. One of these pollutants, fine particulate matter, or PM_2.5 (which includes particles that are smaller than 2.5 micrometers in diameter), is easily inhalable and can enter the lining of the lungs and the bloodstream, posing a great risk to human health. Standards for allowable concentrations of PM_2.5 were amended in 1997, 2006, and again in 2012, becoming increasingly stringent each time. According to the EPA, health organizations, and other research studies, these particles can specifically contribute to …

Evaluation Of A Palliative Care Initiative On The African Continent: Responsibly Improving Access To Pain Treatment, J. Spencer Hirschi

MPA/MPP/MPFM Capstone Projects

The African continent today faces a crisis of inadequate palliative care, in spite of the growing level of suffering of its citizens who are faced with debilitating diseases and injuries. Much of this problem stems from deeply ingrained attitudes towards opioids: while the American continent grapples with the effects of opioid overprescribing, physicians trained in Africa are taught that opioids are inappropriate for virtually all scenarios, and therefore they come to fear and avoid their use or simply remain untrained on them altogether. Patients fail to advocate for themselves out of submission to the doctor’s authority, governments remain apathetic to …

Efforts To Reduce Concomitant Opioid And Benzodiazepine Prescribing At The Lexington Veterans Affairs Medical Center, Kaitlyn A. Staton

MPA/MPP/MPFM Capstone Projects

The United States is in the throes of an opioid epidemic. Any person who uses an opioid medication may experience an intentional or unintentional overdose. An overdose is more likely to occur when an individual ingests an opioid in combination with certain classes of medications, such as benzodiazepines or nonbenzodiazepines (Z-drugs). These medications are more likely to cause sedation and respiratory depression when taken together. Veterans, due to their unique mental and physical health challenges, are more likely to experience an overdose when they receive a combination of opioid therapy with benzodiazepine or Z-drug therapy as opposed to a single …

Comparative Storage And Utilization Analysis Of Insulin Across Inpatient Hospital Settings, Tristan A. Moorman

MPA/MPP/MPFM Capstone Projects

Insulin is the primary medication used by health systems across the nation to provide glucose control to those patients who need it. As this medication is generally available in a multi-dose vial, proper administration techniques should be used to minimize waste and optimize the cost effectiveness of the drug. Even though dosing guidelines for hospital use of insulin exist each institution has the opportunity to choose their administration technique. In this paper I will to identify administration characteristics utilized by four different hospitals in the central Kentucky area, compare and contrast those techniques through data collection, and analyze the findings …

Determinants Of An Individual's Suicide Intention In South Korea, Nam Keun Choi

MPA/MPP/MPFM Capstone Projects

This study has examined a variety of variables that influence an individual’ s suicide intention, and analyzed the impact of these variables. The data are from the 2014 wave of the Korea Welfare Panel Survey (KoWePS). I analyze data on 13,687 out of 17,134 survey participants.

The dependent variable of my study is suicide intention such as suicidal thoughts and behaviors. The independent variables are classified into three categories: socio-demographic, psychological and mental health. Socio-demographic variables are gender, age, education, marital status, and income. Psychological variables are self-esteem, satisfaction with life, and religion. Mental health variables are depression, alcohol use, …

Across The States: Do Long Term Services & Supports Policies Affect The Number Of Nursing Home Residents With Low-Care Needs?, Mary Otis

MPA/MPP/MPFM Capstone Projects

Long term care for the elderly has been steadily gaining salience in the public policy realm for many years. The federal government has been vigorously studying and exploring solutions, including the Centers for Medicare and Medicaid Services’ (CMS) efforts to expand access to home and community-based services (HCBS) in order to reduce dependence on institutional care. These federal efforts include various incentive programs and policies recently offered under the Affordable Care Act. However, data on the strength of each state’s long term services and supports system has not been easily accessible until recently. The report “Raising Expectations: A State Scorecard …

Do Air Pollutant Emissions Lead To An Increase In Total Personal Health Care Costs By State?, Dana Jespersen

MPA/MPP/MPFM Capstone Projects

Total personal health care costs are increasing in the United States every year. Currently personal health care costs are predicted to increase at a national average rate of 6.5 percent. This is on track with the historical data. The increase has returned to the 6.0 percent mark after falling down to an increase of 3.7 percent in 2013. Recovering from the recession and the implementation of the Affordable Care Act has contributed to the steady increase back up to the average 6 percent increase per year. When looking at individual states, all averaged around the 6 to 8 percent increase …

Study On Private Health Insurance Coverage For Adults Under 65: 34 States From 2003 To 2010, Weisheng Gu

MPA/MPP/MPFM Capstone Projects

Objectives: The analysis in this paper is designed to find out what factors contributed to the change of uninsured rate of people aged between 18 and 65 from 2003 to 2010.

Method: A fixed-effect analysis with panel data is conducted. The analysis unit is state. The main independent variable is the private health insurance cost per enrollee per year. The private insurance cost data covered 34 states sampled in Medical Expenditure Panel Survey from 2003 to 2010.

Key finding: The private insurance cost per enrolled adult below 65, private insurance cost per enrolled adult below 65 as a proportion of …

Psychotropic Medication Utilization In Care Home Residents Age 65 Or Older Compared With The Equivalent General Population In Scotland, Tyler P. Stewart

MPA/MPP/MPFM Capstone Projects

Purpose: In Scotland, care homes provide assisted living and medical services. Psychotropic medications (antipsychotics, anxiolytics, and hypnotics) may be over utilized in these facilities. This study compared psychotropic medication utilization in elderly care home residents to the equivalent population of non-care home residents. It is hypothesized that patients in care homes utilize psychotropic medications more than non-care home residents.

Methods: Demographic and prescription information for all patients aged 65 years and older on January 1, 2011 who received at least one prescription for a psychotropic medication during 2011 was retrieved from the national Prescribing Information System (PIS). Patients were grouped …

Relationship Between Clandestine Methamphetamine Laboratory Seizures And Burns In Kentucky, David A. Wittmer

MPA/MPP/MPFM Capstone Projects

Methamphetamine is a highly addictive stimulant that is synthetically produced using equipment and chemicals available in the community. Its burden to society may be determined through a number of mechanisms, including the imposed strain on healthcare systems. The evolution of methamphetamine use and production methods has led to reports of increased methamphetamine related burn admissions among hospital burn units[1-3] . Current literature identifies an increase in injury severity, comorbid complications, and cost of care associated with methamphetamine related burn injuries[1-5]. The intent of this study is to identify burn injuries in Kentucky and assess whether a statistically significant association exists …

Veterinary Specialty Certification: Analyzing The Value Of Certification Through The American Board Of Veterinary Practitioners, Jeff Allen

MPA/MPP/MPFM Capstone Projects

When it comes to professional certification a number of potential benefits can be cited by the organizations that offer them. Self-improvement, recognition by peers, public benefit and enhanced career opportunities are just a few of the frequently mentioned values associated with certification programs. This study was conducted to identify the primary benefits of certification for the American Board of Veterinary Practitioners (ABVP) by recording and analyzing the perceived value of ABVP certification within the veterinary community. An online survey was developed to collect data from ABVP certified and non-certified veterinarians, relying heavily on the Perceived Value of Certification Tool (PVCT). …

Kentucky Pharmacist Opinions Of The Potential Reclassification Of Pseudophedrine As A Legend Drug, Kathleen E. Monson

MPA/MPP/MPFM Capstone Projects

Methamphetamine is a drug of abuse, which is often produced in clandestine laboratories. Recent efforts to curb methamphetamine abuse are aimed at controlling access to precursors, including pseudoephedrine (PSE), used in illicit methamphetamine production. Currently, access to PSE is controlled in Kentucky by placement behind pharmacy counters, retail quantity limitations and electronic tracking. Recent legislation proposed in Kentucky to change PSE from non-prescription to a legend medication was unsuccessful and highly controversial. The objective of this project is to collect and analyze pharmacists’ opinions on the effectiveness of current precursor controls, proposed legislation to make PSE a legend drug and …

Influence Of Prescription Drug Monitoring Programs On Acetaminophen-Related Liver Toxicity, Aaron Barcelo

MPA/MPP/MPFM Capstone Projects

No executive summary.

Influence Of Medical Marijuana Programs On Controlled Substance Utilization, James A. Farley Ii

MPA/MPP/MPFM Capstone Projects

Currently there are no studies examining the impact of medical cannabis programs on controlled substance prescribing. The intent of this study is to conduct a preliminary investigation into whether cannabis substitution for prescription drugs results in lower rates of controlled substance use. The hypothesis is that controlled substance use (in this project, defined by controlled substance supply) will decline in states after the introduction of medical cannabis programs.

State and year–specific per capita retail distributions of the seven most commonly prescribed opioid drugs (fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, and oxycodone) were obtained from the Automation of Reports and Consolidated …

Should Pseudoephedrine (Pse) Be Moved From Behind The Counter To Prescription-Only? An Analysis Of Pse As An Otc Medication And A Precursor For Methamphetamine Production, Jerry Dillon

MPA/MPP/MPFM Capstone Projects

Kentucky State Senator Tom Jensen recently sponsored Senate Bill 45, which would change pseudoephedrine (PSE) from an over-the-counter to a schedule V prescription-only drug. The bill failed, but the debate continues as to whether Kentucky should make PSE, a precursor required to manufacture illicit methamphetamine, a controlled drug that is available by prescription only.

Methamphetamine abuse has been increasing in Kentucky as well as in the rest of the country, despite efforts to control the sale of PSE through federal and state legislation. The Combat Methamphetamine Epidemic Act (CMEA) of 2006 and Kentucky’s initiative to electronically monitor the sales of …

Dental Service Utilization In An Academic Setting: An Analysis For Improved Oral Health, Paula R. Sandford

MPA/MPP/MPFM Capstone Projects

The National Oral Health Surveillance System (NOHSS) is the result of a collaborative effort between the Centers for Disease Control and Prevention and the Association of State and Territorial Dental Directors which is designed to monitor aspects of oral health and disease on both a national and state level. The NOHSS ranks Kentucky at or near the bottom in most oral health indicators. The primary message of the Surgeon General’s May 2000 report on Oral Health in America was to emphasize the link between oral health and overall health including the effect on day‐to‐day activities such as work and school …

The Incidence Of Hip Fracture Associated With Proton Pump Inhibitor (Ppi) And/Or H2 Receptor Antagonist (H2ra) Use In The Kentucky Medicaid Population, Timothy C. Umeh

MPA/MPP/MPFM Capstone Projects

No executive summary.

The Cost Of Medication Errors In The Emergency Department: Implications For Clinical Pharmacy Practice, Benjamin Bowman

MPA/MPP/MPFM Capstone Projects

Introduction

The main purpose of this capstone project is to provide an objective analysis of the cost of a medication error in the emergency department. The secondary objective of this analysis is to estimate the cost avoidance impact of providing clinical pharmacy services in the emergency department (ED).

Literature review

Previous literature has described the scope of clinical pharmacy services in the ED and has, to some extent, presented economic outcomes analyses of the impact of these services (Cohen et al., 2009; Lada and Delgado, 2007). According to Cohen et al., the current literature is still lacking a formal pharmacoeconomic …

Impact Of Levalbuterol Versus Albuterol In Kentucky Medicaid Patients, Velma Henry

MPA/MPP/MPFM Capstone Projects

Problem:

Asthma is a chronic pulmonary disease that occurs in approximately 10 percent of the population worldwide and is associated with a significant increase in direct medical expenditures. Levalbuterol and racemic albuterol are two short-acting β2-agonists (SABA) prescribed for the treatment of asthma. Racemic albuterol has been used for more than 40 years but is associated with several side effects including tremor. When levalbuterol was approved in 2005 its manufacturer and several studies suggested that using levalbuterol results in better respiratory parameters, fewer hospitalizations, less adverse effects and therefore, lower overall treatment costs and hence less need for β-adrenergic agonist …

The Relationship Between Obesity And Skin And Soft Tissue Infections, Juliana Swiney

MPA/MPP/MPFM Capstone Projects

The Problem:

It is well known that our country is experiencing an obesity epidemic: 33.9% of all adults are obese (BMI>30) and 67% of adults are either overweight or obese (BMI>25). Obesity is a risk factor for several serious disease states such as, diabetes, stroke, hypertension, heart disease and some types of cancer. It also has a less well defined relationship with skin and soft tissue infections.

Although it is known that excessive weight increases the opportunity for harmful skin conditions, this relationship has not been as well studied. Some of the mechanisms that predispose obese people to …

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 Implementation Of The Kentucky Transitions: A Money Follows The Person Demonstration Grant Program, Amie Goodin

MPA/MPP/MPFM Capstone Projects

Kentucky Transitions is a Kentucky Medicaid program that is funded primarily by a grant from the Centers for Medicare and Medicaid Services. The purpose of this program is to transition individuals residing in long-term care facilities back into the community, where they will continue to receive health, social, and other benefits but do so in an approved residential setting. Individuals living in the community may experience higher quality of life and the increased ability to choose how and when they receive services, while Medicaid reaps the projected financial benefit of providing less-expensive community alternatives for care.

Though Kentucky Transitions operates …

Medication Therapy Management: Is It Worth Medicare’S Time?, Jennifer White

MPA/MPP/MPFM Capstone Projects

Problem:

Medication Therapy Management (MTM) is a service that a pharmacist can provide to any of their patients, but mostly to those who are either high risk patients for adverse events or those who are new to chronic medication therapy. As Medicare Part D has begun to cover MTM services, more and more pharmacists and other clinicians are becoming providers of MTM.

The intent of MTM is to decrease adverse events and healthcare costs to both the patient and the third party payer. In realizing the benefits of MTM, it is important to assess these outcomes to see if clinical, …

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 …

Evaluating The Healthy States Initiative Policy Forums, Jessica Harmon

MPA/MPP/MPFM Capstone Projects

Since 2005, The Council of State Governments (CSG) has participated in a cooperative agreement funded by the Centers for Disease Control and Prevention (CDC) called the Healthy States Initiative. The initiative promotes public health by providing information resources to state legislators through publications and public health forums. CSG is interested in information about the impact of the public health forums on state legislators. More specifically, they would like to know if the forums have encouraged the participants to produce public health legislation, to support funding for public health projects, and to work closely with colleagues and various groups to improve …

The Influence Of Veterinary Schools On The Veterinary Labor Market, Kyle Bosh

MPA/MPP/MPFM Capstone Projects

Problem Statement:

Does the presence of a veterinary school in a state influence the supply of veterinarians practicing in that state? Citizens and animals in states without a veterinary school are at a disadvantage if the presence of a veterinary school significantly improves public health and access to medical services in those states that have a veterinary school.

Research Strategy:

The unit of analysis in this study is 50 states and the District of Columbia. The study is designed as a cross-sectional analysis of 2006 pet, 2002 livestock, 2006 human, labor, and economic data. The study uses simultaneous equations to …