Health and Medical Administration Commons^™

The Efficacy Of Analgesic Subdissociative Dose Ketamine In Trauma Casualties Treated By U.S. Military Special Operations Medical Professionals In A Prehospital Environment, Darin Schwartz

Theses & Dissertations

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty …

Medicare Shared Savings Performance: Three-Year Pandemic Analysis, Bryan Adams

Theses & Dissertations

The Centers for Medicare and Medicaid's (CMS) Office of Actuary predicts that U.S. national health expenditures will surpass U.S. gross domestic product per capita by 1.1% annually until 2028, totaling $6.2 trillion in healthcare spending. A significant portion of this spending, 36%, is attributed to Medicare and Medicaid. To address this issue, CMS has implemented the Medicare Shared Savings Program (MSSP) to assist Accountable Care Organizations (ACOs) in reducing healthcare costs and improving the quality of care for beneficiaries. The main objectives of this dissertation are twofold. Firstly, it aims to investigate the relationship between various factors, such as quality …

Limitations Of Telemedicine Vs. Face-To-Face Eye Examination In A Patient With New Headaches, Joseph Hallak, Od, Danielle Kalberer, Od

Optometric Clinical Practice

Background: During the emergence and rise of COVID-19, precaution directives and limitations on in-person eye examinations re-routed a significant portion of care to telemedicine and virtual modalities. While these technologies allowed for healthcare communications that otherwise could not occur during such trying times, there are major limitations to these sanctioned applications. This report will present a seemingly benign case that could have easily been re-routed from an in-person examination to a telemedicine version due to the patient’s seemingly “routine” vision complaints.

Case Report: A 50-year-old male patient contacted the eye clinic with a complaint of a minor, new, unexplained headache …

U.S. Army Physician Assistant Retention: A Latent Class Analysis, Robert Greener

Theses & Dissertations

Introduction: Retaining employees is crucial to the success of organizations. While significant effort has been made to model employee retention, models have been unable to significantly predict retention. The purpose of this quantitative, non-experimental, cross-sectional study was to develop an improved employee retention model which could be used as a practical guide to improve employee retention. Materials and Methods: The study analyzed a survey created, implemented, and collected by the Statistical Cell at the U.S. Army Center of Excellence. In September of 2020, all 864 active-duty PAs were sent a link to the survey and 290 completed the survey, …

Improving The Early Detection And Management Of Peripheral Artery Disease In Patients With Diabetes Within The Primary Care Setting, Julyssa Amanda Rodriguez

Doctor of Nursing Practice

Background. Diabetes is a significant risk factor for peripheral artery disease. Individuals with diabetes, greater than 50 years of age, having at least one other risk factor should be screened for peripheral artery disease with an ankle brachial index. Purpose. Improve detection and management of peripheral artery disease in persons with diabetes within primary care. Evidence. Individuals with diabetes and peripheral artery disease have an increased risk of adverse cardiac and limb events, impairing the patient’s quality of life and causing long-term disability (Berger & Newman, 2020). Methods. During a 10-week period, these processes were implemented: (a) screening all patients …

Pre-Admission Patient Education For A Prostatectomy Enhanced Recovery After Surgery Pathway, Vanessa C. Cotton

Doctor of Nursing Practice

Background. In the United States, prostate cancer is the most common cancer diagnosed in men and a common treatment choice is a radical prostatectomy. The Enhanced Recovery After Surgery® Society developed evidence-based guidelines to optimize treatment and improve outcomes in prostatectomy patients, yet not all hospitals are utilizing these guidelines or employing all of the elements, including pre-admission education. Purpose and Objectives. The purpose of this quality improvement project was to develop, implement, and evaluate a pre-admission patient education component for a prostate surgery pathway based on the Enhanced Recovery After Surgery guidelines. Objectives included assessing the nurse’s intention to …

Quantifying Hypertension Indicators Through Informatics, Diana Sanchez

Doctor of Nursing Practice

The purpose of this quality improvement project was to create optimal quality indicators for hypertension measures using evidence-based practice to improve metric percentages, improving hypertension management for the practice. Implementing associated interventions for the quality measures and providing the interprofessional team with fundamental knowledge of inclusion and exclusion criteria and will empower the team with knowledge, improving patient care.

An expert panel was chosen to conduct a series of three PDSA cycles for systematic measurement until desired quality indicators were achieved, within a three-month duration. The expert panel consisted of the head physician, a physician assistant, the facility administrator and …

Patient-Centered Implementation Of Statin Therapy In Patients With Type 2 Diabetes, Giovanna P. Favarato

Doctor of Nursing Practice

Heart disease is the leading cause of morbidity and mortality in Americans with type 2 diabetes mellitus. The American Diabetes Association recommends statins and lifestyle modifications for all patients with type 2 diabetes mellitus for the prevention of atherosclerotic cardiovascular events. A patient-centered approach to primary prevention is encouraged, yet there are no specific instructions regarding implementation. The Statin Choice Decision Aid is a tool designed to facilitate shared decision-making between the patient and the provider in the clinical setting. The 2018 American College of Cardiology/American Heart Association guidelines for the primary prevention of atherosclerotic cardiovascular disease for patients with …

Improving Colorectal Cancer Screening And Testing In A Primary Care Clinic, Leslie Michelle Dubois

Doctor of Nursing Practice

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related deaths worldwide (World Health Organization, 2019a). In the United States, CRC was the fourth most common cancer in 2016 (Centers for Disease Control and Prevention, 2019a). The American Cancer Society (2020a) estimated that there will be 147,950 estimated new cases and 53,200 estimated deaths of CRC in the U.S. in 2020. The purpose of the project was to improve CRC screening completion rates and follow up referrals from 27.5% to 35% for adult patients, 50-75 years of age, within a family medicine clinic …

Affordable Care Act And Preventive Care Usage: A Mixed Method Analysis Of Cardiovascular Care, Brit Peek

Theses & Dissertations

It is a commonly held belief that access to health insurance affects the level of utilization of preventive care services, and thus plays a crucial role in the effective management of avoidable chronic illnesses, decreasing levels of premature mortality, and enabling individuals to live wholesome long lives. Based on this belief, among other goals, the Affordable Care Act (ACA) was designed to increase access to health insurance and related medical services for the population of the United States. This dissertation attempts to identify whether this belief is valid or not by testing whether the usage of preventive care changed between …

Improving Transitions Of Care In Primary Care By Standardizing Discharge Summary And Medication Reconciliation Practices, Christine Virk

Doctor of Nursing Practice

Communication breakdown happens between transitions of care because healthcare disciplines function as silos. Medication and treatment plan changes are not always communicated to the next healthcare provider resulting in fractured care and preventable unnecessary cost. The purpose of this project was to create a standardized transition of care process from the acute care setting to the primary care setting in adult patients using evidence-based practice. The objectives of the project were the following: (1) to have a follow-up appointment within 14 days of discharge from an acute care setting, (2) to have a medication reconciliation performed and documented by the …

Interventions To Increase Vaccination Rates In Homeless Adults Aged 50 Years And Older In A Shelter-Based Clinic, Rubeena Smith

Doctor of Nursing Practice

Pronounced disparities in adult immunizations exist across the country. In homeless adults over 50 years of age with chronic diseases, coverage rates for influenza and pneumococcal vaccinations falls at 30% as compared to the 60% coverage rate found in the general public. Hepatitis B immunization rates are also significantly lower in the elderly homeless population. Increased prevalence of chronic diseases in the elderly homeless shelter residents’ increase their risk for severe complications following influenza, hepatitis B and meningococcal infections. To prevent disease epidemics and further disability in the homeless population, the need for appropriate and timely vaccinations is critical. Attitudes …

Implementation Of Quality Improvement Interventions To Increase Provider Adherence To Standards Of Medical Care In Diabetes, Elizabeth A. Betz

Doctor of Nursing Practice

Purpose: To improve a South Texas primary care clinic’s diabetes management system by implementation of a quality improvement intervention to help staff and medical providers increase adherence to the American Diabetes Association standards of care related to screening referrals and orders for urine microalbumin, in order to improve self-care and health outcomes for adult patients with diabetes. Background and Problem: Diabetes is the 7th leading cause of death in the United States and the cause of vision loss, amputations, and end-stage renal disease. The patients at the Wellness Center do not consistently receive routine screenings for neuropathy, retinopathy, nephropathy, microalbumin, …

Quality Improvement Programs’ Contribution To Successful Clinical Practice Changes, Erika O. Bowen

Theses & Dissertations

There is a great deal of healthcare literature on the importance of QI programs and the significant contributions they make toward patient safety and patient satisfaction; however, documentation of outcome measures and predictors of success remains challenging. This study examined the experiences of physician participants who attended a state supported South Texas medical school’s CSE course to gain an understanding of QI education, demonstrate the need for formal QI education, and determine if a change in clinical practice occurred as a result of attending a structured QI course. Kirkpatrick’s (1967) four-level evaluation model was used as a framework to guide …

Improving The Adherence Of Providers To The American Academy Of Sleep Medicine Guidelines For The Evaluation, Treatment, And Management Of Obstructive Sleep, Heather Miles

Doctor of Nursing Practice

The purpose of this project is to increase the adherence of clinic providers to the American Academy of Sleep Medicine’s Clinical Guidelines for the Evaluation, Management, and Longterm Care of Obstructive Sleep Apnea in Adults. OSA is a chronic condition that effects from 2% to 10% of the U.S. adult population. Implications of undiagnosed OSA include excessive daytime sleepiness, fatigue, irritability, difficulty controlling chronic diseases including diabetes and hypertension, heart arrhythmias, gastroesophageal reflux disease, mood disorders, attention deficit disorder, and an increased potential for dementia if left untreated. A protocol was created to align providers with the clinical guidelines. Provider …

An Initiative To Improve Primary Prevention Of Heart Disease In Adults With Type Ii Diabetes Based On The Acc/Aha (2013) And Ada (2016) Guidelines, Litzie Garza

Doctor of Nursing Practice

Heart disease is the leading cause of death in the United States and in Texas. Hyperlipidemia is a precursor to cardiovascular disease and is a highly manageable and treatable acute and chronic disease in the outpatient primary care setting. This project is designed to increase clinicians’ adherence to the American College of Cardiology/American Heart Association (2013) and American Diabetes Association (2016) clinical practice guidelines for the prevention of heart disease in 40 to 75 year old adults with type II diabetes through interactive education, an electronic alert, and quality improvement sessions on the treatment and management of cholesterol in a …

Duty Hour Limitations And Educational Outcomes: Perspectives From A Community Hospital-Based Family Medicine Residency Program, Maria Eliza Marquise

Theses & Dissertations

In 2003, the Accreditation Council for Graduate Medical Education and the American Osteopathic Association introduced new models that established limits on residents’ duty hours in training programs across the United States (Miulli & Valcore, 2010; Philibert & Taradejna, 2011); more stringent limitations were implemented in 2011. If these physician training programs decreased the time residents’ spent in a formal learning environment and utilized experiential learning as one teaching method, did the duty hour limitations affect the residents’ learning outcomes? The purpose of this ex post facto, quantitative study was to determine if there were differences in ITE (In-Training Examination) scores …

Mentoring, Job Satisfaction, Job Dissatisfaction, And Organizational Commitment Among Graduate Nurses, Abisola Adeyomibo Santos

Theses & Dissertations

Shortage of bedside nurses has been researched for a long time. Many researchers have referred to different shortage percentages, but the American Nurse Association stated that the shortage of bedside nurses would increase in the range of 29% to 36% by 2020. It is also reported that a large number of newly graduated, newly hired nurses leave within one year as compared to newly hired experienced nurses. The purpose of this correlational study was to evaluate the influence of mentoring, mediating job satisfaction, job dissatisfaction, and, therefore, organizational commitment, on nurses who completed the nurse residency program between January 2010 …

Mental Health Clinical Managers And Their Multicultural Leadership Practices, Christie Marie Melonson

Theses & Dissertations

There is a general recognition that the United States has historically failed to provide adequate mental health services to ethnic minorities. The American Counseling Association has mandated multicultural competence of counseling professionals in today’s context of dramatic demographic change. Despite numerous studies on practitioners, organizations, models, and interventions geared toward minorities, disparities in access, usage, and outcomes in still exist. Simultaneously, counseling fields have emphasized leadership development as a key factor in improving services, yet training or research on leadership remains scarce. In response to these conditions, this basic interpretive qualitative study focused on exploring clinical managers’ perceptions of their …

An Assessment Of The Relationship Between The Hospital Chief Executive Officer’S Leadership Behaviors And Hospital Success, Newton J. Courtney

Theses & Dissertations

The health care delivery system in the United States has received increased attention over the last 2 decades. Concerns of access, choice, cost, and quality have been in the forefront. This study was conducted to assess the leadership behaviors of hospitals’ chief executive officers and how they impact the performance of hospitals. Two instruments were used to collect the data for the study: the Multifactor Leadership Questionnaire (MLQ-5X; Avolio & Bass, 2004) and a demographics questionnaire. A correlational research design was used to measure the degree of association between variables related to hospital CEOs, the hospitals they represented and hospital …

Correlating Coworker Relations, Employee Involvement, And Leadership With Associate Commitment In Select Healthcare Companies Using A Mixed Sequential Explanatory Design, Kimberly Ann Lee

Theses & Dissertations

Increasing patient demands and decreasing reimbursement require better efficiency and effectiveness in health care systems and, subsequently, in health care teams. These environmental and societal factors are further complicated by the complex initiatives set forth by the Affordable Care Act (2010). In this study, the researcher sought to examine and identify the strongest variables of health care teaming and to explore resulting themes through the perception of groups of health care associates. This mixed sequential explanatory design first examined the relationships between coworker relations, employee involvement, and leadership with associate commitment and with each other. An existing database of associate …