Medicine and Health Sciences Commons^™

What's In A Message? The Impact Of Patient-Clinician Email Message Content On Patient Health Outcomes And Healthcare Utilization, Dawn M. Heisey-Grove

Theses and Dissertations

Introduction

In the upcoming chapters, we present our study findings as three papers ready for submission to peer-reviewed journals. The first paper describes the associations between taxa and the characteristics of the patients and clinic staff who exchange those messages. The second paper explores the associations between those taxa and patients’ healthcare utilization. The third paper presents associations between taxa and patient health outcomes for diabetes and hypertension. We conclude with how the three papers are related and highlight the importance of this research.

Across the three papers, we reference a theory-based taxonomy we developed specifically for secure messaging. A …

Relationship Between Patient-Health Coach Interactions And Changes In Markers Of Glucose Homeostasis, Jason P. Nagy

Theses and Dissertations

Diabetes and insulin resistance are on the rise in the United States. Early detection and deployment of therapies has allowed for the reversal of pancreatic beta cell damage. Unfortunately, not all providers can offer the support to facilitating the required life style modifications. The introduction of clinical health consultants (CHC) as supplemental care has improved patient health for a variety of chronic diseases. Missing in the literature are studies investigating the correlation between the number of CHC interactions and improvement in biomarkers.

The study utilized a non-experimental, retrospective study design to evaluate the relationship between the use between the use …

Determining The Effect Of Knocking Out Microrna-21 On Subsarcolemmal And Interfibrillar Mitochondria, Madhur Batra

Theses and Dissertations

Type 2 diabetes mellitus is a growing problem across the world and has significant pathological changes associated with it, including diabetic cardiomyopathy, wherein cardiac function is reduced. MicroRNA-21 has been shown to play a role in both the heart and diabetes so it was thought that knocking out miR-21 could have a protective effect on oxidative phosphorylation function in diabetic mice. Subsarcolemmal and interfibrillar mitochondria were isolated from adult male WT, miR-21 KO, db/db, and double knockout mice (db/db and miR-21 KO cross) and evaluated for function. Knocking out miR-21 in diabetic mice showed a restorative effect in Complex I …

Embodiment Of Empathy: Experiencing Disease Through Design, Noha Fouad

Theses and Dissertations

Today, more than 400 million individuals around the world have diabetes. This number is expected to grow to more than 600 million by 2023. However, diabetes is more than just a statistic. It is an incurable, psychologically nuanced disease, with daily battles and far-reaching complications. The lives of those afflicted undergo permanent physical and psychological changes.

Reading the stories of diabetics, or hearing them share their experience may elicit an immediate yet often fleeting sense of realization. How, then, can this brief moment of awareness be prolonged? How can a non-diabetic feel diabetes? More importantly, why should they? This research …

Supporting Practices To Adopt Registry-Based Care (Sparc): Protocol For A Randomized Controlled Trial, Rebecca S. Etz, Rosalind E. Keith, Anna M. Maternick, Karen L. Stein, Roy T. Sabo, Melissa S. Hayes, Purvi Sevak, John Holland, Jesse C. Crosson

Family Medicine and Population Health Publications

Background

Diabetes is predicted to increase in incidence by 42% from 1995 to 2025. Although most adults with diabetes seek care from primary care practices, adherence to treatment guidelines in these settings is not optimal. Many practices lack the infrastructure to monitor patient adherence to recommended treatment and are slow to implement changes critical for effective management of patients with chronic conditions. Supporting Practices to Adopt Registry-Based Care (SPARC) will evaluate effectiveness and sustainability of a low-cost intervention designed to support work process change in primary care practices and enhance focus on population-based care through implementation of a diabetes registry. …

Development Of A Collaborative Goal Setting Measure For Patients With Diabetes, Heather Morris

Theses and Dissertations

Introduction: The potential benefits of collaborative goal setting in the clinical setting have been shown. However, we have a limited understanding about what needs to have transpired between a patient and his or her clinician for them to report that they engaged in collaborative goal setting. Therefore, our ability to monitor and foster collaborative goal setting remains limited. Methods: My three-manuscript dissertation used a mixed-methods approach utilizing both qualitative and quantitative research methods. The aims of my study were to: (1) develop a conceptual model of collaborative goal setting as perceived by patients; (2) generate a list of survey items …

Healthcare Utilization Among Hispanic Immigrants With Diabetes: Investigating The Effect Of Us Documentation Status, Elizabeth K. Do, Robin K. Matsuyama

Social and Behavioral Health Publications

Previous studies have not examined whether documentation status has an effect on healthcare utilization among US Hispanic immigrants with diabetes. A secondary analysis was conducted using data from the Pew Hispanic Center and Robert Johnson Wood Foundation’s 2007 Hispanic Healthcare Survey. Hispanic immigrants diagnosed with diabetes were included in analyses. The association between documentation status and healthcare utilization was assessed using logistic regressions. Of N = 577 Hispanic immigrants with diabetes, 80 % were documented immigrants and 81 % reported having visited a healthcare provider in the last 6 months. Adjusting for confounders, those who were undocumented faced higher odds …

Public Reporting As A Communication Tool To Aid Vulnerable Consumers In Healthcare Decisions: What Do We Know?, Daniel R. Longo, Barbara A. Wright

VCU Libraries Faculty and Staff Presentations

Background/Introduction:

There is tremendous variation in quality, healthcare service utilization and disparities experienced by the poor, certain minorities, and other priority populations. Public reporting is identified as one method of bringing these differences to light and by informing consumers through documented comparison of provider performance to influence change and encourage improvement in healthcare. The federal Accountable Care Act has the stated mandate “to improve the dissemination of measures of healthcare quality and resource use, (and) to build the science of public reporting.” However, early studies on the design and use of consumer reports cite the public’s confusion and lack of …

Quantifying Polypharmacy In Diabetes Patients In The U.S., Jing Tao

Theses and Dissertations

ix Objectives: To quantify polypharmacy and assess the socio-economic predictors of medication use and expenditure in diabetics. Methods: This study analyzed adult diabetes patients using a nationally representative sample in Medical Expenditure Panel Survey in 2006. Top ten most highly utilized drug classes were identified. Descriptive statistics were used to portray the patients’ medication utilization and spending. Generalized linear models were conducted to assess the socio-economic variants in drug use and spending. Results: On average, a diabetes patient had 45 prescriptions in 2006, for total annual spending of $3,161. A diabetes patient used drugs from 3.43 classes within top ten …

Chronic Care Management To Improve Adherence: A Comparison Of Approaches In The Care Of Diabetes, Mary Ellen Gervais

Theses and Dissertations

Managing chronic conditions is seen as the public health challenge of the 21st century. The number of Americans with chronic conditions is expected to rise to 157 million by 2020. Diabetes prevalence and costs contribute to the growing problem. Diabetes was the seventh leading cause of death in 2006. Nationally, the cost of diabetes is expected to be $138 billion in 2020. Diabetes leads to multiple and significant complications. The desired outcomes of management of chronic conditions are improvement in clinical status, avoidance of complications, prevention of co-morbid conditions and avoidance of the costs associated with complications. In the 1990s, …

Association Between Obesity And Depression And Anxiety Disorders: Results From The 2008 National Health Interview Survey, Monica Gaidhane

Theses and Dissertations

Introduction: Obesity is one of the most important medical problems in the U.S. and is considered to be an epidemic with over 30% of the population being obese. Obesity is associated with increased risk of hypertension, diabetes, cardiovascular diseases, certain cancers and a shorter life expectancy. Recent studies have shown that higher BMI levels are also significantly associated with several lifetime mental disorders such as major depressive disorder, anxiety disorders as well as panic attacks and panic disorders. Purpose: The purpose of this study was to quantify the extent to which higher BMI increased the likelihood of Depression, Anxiety Disorder …

The Prevalence Of Comorbid Chronic Disease In Virginia's Adult Patient Population During The Years 2001 And 2004, Joseph D. Schwartz

Theses and Dissertations

Objective: Chronic disease comorbidities, on the rise in the U.S. and Virginia, represent a new challenge to the way medicine is practiced and prescribed. This descriptive study uses Virginia hospital discharge data to describe the prevalence and trends of chronic disease comorbidities present in the state's over-45 population during the years 2001 and 2004.Methods: Data collected by Virginia Health Information was utilized. Adults over the age of 45 years and who selected for race and location were included in this analysis, with an aggregate sample size of 813,336 (N=458,593 [2001]; N=364,743 [2004]). Pearson chi-square analyses determined significant sample population differences …

Obesity And Health Status Among Urban Vs. Suburban Elderly In Philadelphia And Surrounding Counties, Ockidde Dufayne Harris

Theses and Dissertations

Obesity is a dangerous health condition affecting approximately 30% of all Americans and can be attributed to 300,000 deaths a year. Obesity has been found to disproportionately affect Blacks, Latinos, and those with lower SES. Although obesity is a problem for all age groups, its prevalence is highest among those 60-74 years of age. Studies have shown that there is an association between obesity and chronic conditions such as cardiovascular disease, arthritis, cancers, and type-2 diabetes. According to the Centers for Disease Control, chronic health conditions affect 80% of all elderly persons, many times limiting function and decreasing quality of …

Introduction, H. St. George Tucker

MCV/Q, Medical College of Virginia Quarterly

A Symposium on Diabetes was presented at the Medical College of Virginia on September 23, 1976, sponsored jointly by the Division of Endocrinology and Metabolism of the Department of Medicine, and by the Department of Continuing Education. The symposium was also sponsored in part by a grant-in-aid for continuing medical education from the Upjohn Company.