Medicine and Health Sciences Commons^™

Stepped Care For Smoking Cessation: A Cost-Effectiveness Analysis And Simulation Of Future Outcomes, Brandi E. Franklin

Theses and Dissertations (ETD)

It has been well established that smoking is the leading avoidable cause of premature morbidity and mortality in the United States and abroad. Smoking is attributable to over 400,000 annual deaths, and $193 billion in healthcare costs and lost productivity. Despite the apparent dangers and tremendous costs of tobacco use and dependence, smokers find difficulty quitting. Recently, stepped care has been proposed as a viable intensive approach for achieving long-term cessation. This research sought to evaluate cost-effectiveness of stepped care in a diverse population of smokers and analyze future health outcomes of smoking cessation.

Cost-effectiveness analysis was conducted from an …

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 …

Preferences And Willingness To Pay For Osteoarthritis Treatments Among The Medicare Population, Meghan Alexis Hufstader

Theses and Dissertations (ETD)

The design of this study is a non-random cross sectional survey to determine Medicare beneficiaries’ preferences and willingness to pay for osteoarthritis (OA) treatments. The population of interest in this study is the Medicare eligible (over age 65) population in Memphis, TN, and surrounding cities. Data were collected at Senior Centers and one internal medicine practice. The sample size was 181.

Choice-based conjoint analysis technique was utilized. The preferences and willingness to pay were determined using choice-based conjoint analysis, advanced design module with a dual-response none option. Choice-based conjoint analysis uses computer guided surveys to elicit patient preference for a …

Impact Of Cost Sharing Levels On Adherence To Controller Drugs And Consequent Outcomes Among Asthma Patients, Varun Vaidya

Theses and Dissertations (ETD)

Prescription drug cost sharing is an effective tool to reduce the excessive drug consumption. However, many times it could have a negative impact on the drug utilization especially in case of chronic conditions. Chronic conditions such as asthma require appropriate utilization of controller medication to keep the inflammation and symptoms under control. Literature on asthma drug utilization has consistently reported underuse of controller drugs among asthma patients. The present study attempted to investigate the impact of prescription drug cost sharing levels on the controller adherence among the privately insured asthma population with moderate persistent asthma. The study also analyzed the …

Cost Burden Of The ‘Presenteeism’ Health Outcome In A Diverse Nurse And Pharmacist Workforce: Practice Models And Health Policy Implications, Carol L. Warren

Theses and Dissertations (ETD)

The complex phenomenon of presenteeism is an undesirable health outcome that occurs when employees remain present on-the-job with lowered work productivity caused by personal health conditions. The cost burden of presenteeism in healthcare professionals has been under-explored and the cost burden of presenteeism across racial and ethnic minority employees has been un-explored. Aims of this research were to describe presenteeism and its cost burden among nurses and pharmacists and to determine distinctness of differences across racial/ethnic groups within these professions. In exploring presenteeism, the focus was on recognizing it, characterizing it, and measuring it. In monetizing presenteeism, its costs burden …

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 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 …

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 …

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

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 …

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 …

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 …