Public Health Commons^™

The Impact Of Electronic Health Records Meaningful Use On Patient Safety And Satisfaction, Paulette Brown

Walden Dissertations and Doctoral Studies

AbstractThe widespread adoption of electronic health records (EHRs) is encouraged because of their potential to improve the quality of care provided. It was unknown to what extent the meaningful use of EHRs would impact patient safety and satisfaction in general and specialty hospitals. The researcher’s purpose for this quantitative correlational research was to examine the impact of meaningful EHR use of EHRs on patient safety and satisfaction outcomes in general and specialty hospitals in Philadelphia (PA). The constructs of the institutional theory guided the study. The hypotheses that guided the study included (a) Meaningful EHR use positively influences patient satisfaction …

Experiences Of Individuals With Opioid Use Disorder In Medication Assisted Treatment Programs, Lynda M. Maxfield

Walden Dissertations and Doctoral Studies

AbstractOpioid use accounts for many deaths each day in the United States. Although research has shown that retention in medication assisted treatment (MAT) programs increases quality of life for those individuals with opioid use disorder (OUD) and decreases premature death, there has been limited research on the perspectives of individuals with OUD in MAT programs and why they remained in or left the programs. The purpose of this qualitative phenomenological study, guided by Merleau-Ponty’s theory of perception, was to explore the lived experiences of those with OUD treated in a MAT program. An algorithm type interview was conducted to ask …

Nursing Staff Education On The Use Of The American Diabetes Association Guidelines, Terrie Hattie Allen

Walden Dissertations and Doctoral Studies

AbstractDiabetes mellitus is a complex chronic condition that requires continuous care and management. Approximately 34 million Americans are diagnosed with diabetes and around 90%–95% suffer from Type 2 diabetes. The problem identified in this project was the need to follow the American Diabetes Association guidelines in place at the study site clinic but are not adhered to by the staff. Framed within the analysis, design, development, implementation, and evaluation model of instructional design, the purpose of this project was to plan, implement, and evaluate a nursing staff education program on the use of the American Diabetes Association Guidelines for diabetes. …

Guidelines For Managing Dysautonomia Dysfunction, Angela Coleman Webb

Walden Dissertations and Doctoral Studies

Dysautonomia dysfunction (DD) is a disorder of the autonomic nervous system. Over 70 million people suffer from some type of DD, and the average length of time from symptoms to diagnosis is 6 years. Most facilities and providers choose not to treat DD due to the number of symptoms and the difficulty of being able to diagnose correctly. The purpose of this project study was to create guidelines for the diagnosis, treatment, and management of DD. The research question addressed the effectiveness of these guidelines to help nurses and providers caring for patients with DD provide better care. Watson’s theory …

Experiences Of Spanish-Speaking Patients Using Interpreter Services With Their Physicians, Rafael Raul Caycho

Walden Dissertations and Doctoral Studies

In the United States, many patients cannot speak English well enough to communicate with their medical providers. Many of these patients use professional interpreter services offered by their medical organizations to help with communication, which can lead to miscommunication due to the translation process between patients, interpreters, and physicians, and to incorrect diagnosis and poor health outcomes for the patient. The purpose of this study was to explore the experiences of Spanish-speaking patients who used interpreter services with their physicians. The transmission model was the theoretical framework used to explore the experiences and outcomes for the participants. In this study, …

The Combined Impact Of Race And Education On Obesity Among U.S. Adults By Fidelis Okoye, Fidelis Chidi Okoye

Walden Dissertations and Doctoral Studies

Walden University

College of Health Professions

This is to certify that the doctoral dissertation by

Fidelis Okoye

has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made.

Review Committee Dr. Vasileios Margaritis, Committee Chairperson, Public Health Faculty Dr. Srikanta Banerjee, Committee Member, Public Health Faculty Dr. James Rohrer, University Reviewer, Public Health Faculty

Chief Academic Officer and ProvostSue Subocz, Ph.D.

Walden University2021

AbstractThe Combined Impact of Race and Education on Obesity Among U.S. Adults by Fidelis Okoye

MA, Walden University, 2009BS, Marygrove College, 2001

Dissertation …

The Lived Experience Of African American Young Adult Men With Hiv And Self-Care Collaborative Management, Barbara A. Moore

Walden Dissertations and Doctoral Studies

AbstractAfrican American young adult (AAYA) men living with HIV often lack interventions that address the influence that HIV has on their quality of life, especially their relationships. Self-care collaborative management (SCCM) concerns related to disclosure and stigmatization complicate social, psychological, and SCCM behaviors. Intervention programs addressing these concerns should be based on relevant, accurate information, but this information is lacking for AAYAs. The purpose of this research was to explore and describe the lived experiences of male AAYAs with HIV and their use of SCCM. The study method was qualitative; Husserl’s transcendental phenomenology was the design. The individual family self-management …

Health Care Provider Program On The Management Of Obesity, Erlinda P. Bhat

Walden Dissertations and Doctoral Studies

Research has shown that educational programs have led to developing the professional skills and behaviors of front-line health care providers who care for overweight or at-risk obese patients. The purpose of this project was to provide an educational program on best practices for weight management to health care providers at a large military clinic. The project question was developed to assess whether the educational program increased the knowledge and confidence of health care providers in the management of obesity. Utilizing Pender's health promotion model, a quasi-experimental study was conducted in which 15 health care providers, including licensed and unlicensed personnel …

Current Effects Of U.S. Preventive Care Quality Narratives On Preventive Health Services, James Fisher

Walden Dissertations and Doctoral Studies

In the interest of improving patient outcomes, significant investments in operationalized quality of care within the Medicare space have promulgated a low-resolution narrative predicated on conflation of higher quality scores with improved population health. Concomitant financial incentivization of Medicare Advantage plans through aligned Star Measures places contracts as the fundamental unit of most care quality analyses, but no studies have considered how present incentivization schema have impacted physician use and associated quality scores over time for breast cancer screening (BCS), colorectal cancer screening (CCS), and annual flu vaccination (AFV) at a county level. Guided by the Evidence Based Model framework, …

Factors That Determine The Place Of Childbirth In Lagos State, Nigeria, Ohiemi Emmanuel Adegbe

Walden Dissertations and Doctoral Studies

AbstractNigeria is among the 10 countries in the world with the worst maternal mortality. Though most of these deaths can be prevented using antenatal care (ANC) and having institutional deliveries, in Nigeria, ANC attendance and institutional delivery are suboptimal. Research is lacking on the reasons for the disparity between the use of antenatal services compared to deliveries at health centers. The aim of this study was to determine the associations between sociodemographic, obstetric, and health service factors and the place of delivery used by pregnant women in predominantly urban, cosmopolitan Lagos, Nigeria. Because both service delivery and demand factor categories …

Evidence-Based Strategies For Improving Medication Adherence Among Psychiatric Patients: A Systematic Review, Omah S. Tsikada

Walden Dissertations and Doctoral Studies

Nonadherence to psychotropic medications among patients with serious and persistent psychiatric disorders, including bipolar disorder and schizophrenia, is approximately 70%. Nonadherence is a common barrier to the treatment of individuals with mental health disorders. However, there is limited awareness of evidence-based interventions and strategies to address this problem. Therefore, the question for this project asks whether a systematic review can identify strategies to improve adherence of psychotropic medications among individuals with serious and persistent mental illness. The purpose of this systematic review was to explore the evidence-based strategies that can aid in increasing medication adherence in patients with mental health …

Advanced Practice Registered Nurses And Their Knowledge Regarding The Hindrance Of Obesity, Crystal Rainey

Walden Dissertations and Doctoral Studies

Advanced Practice Registered Nurses and Their Knowledge

Regarding the Hindrance of Obesity

by

Crystal N. Rainey

MSN, Walden University, 2014

BSN, University of Arkansas in Little Rock, 2011

AASN, Southeast Arkansas College, 2009

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2020

Quality Of Life For Persons With Chronic Disease Utilizing Mobile Integrated Healthcare, Dr John Robert Ash

Walden Dissertations and Doctoral Studies

The use of mobile integrated healthcare-community paramedicine (MIH-CP) has the potential to be integrated into existing chronic disease management initiatives as a means of reducing unnecessary hospitalizations and costs as well as improving quality of life (QOL). The purpose of this study was to analyze the relationships between demographics, noncommunicable disease type (NCD), and changes in self-perceived, self-reported QOL for those who have participated in an MIH-CP program. The research design for this study was a pretest/posttest design using secondary data that were obtained from a research partner using the MIH-CP intervention and collecting QOL data using the Euroqol QOL …

Pharmacy Manager Strategies For Reducing Financial Losses From Adverse Drug Events By Polypharmacy Patients, Francis Rudden

Walden Dissertations and Doctoral Studies

Every year over 100,000 deaths occur in the U.S. from adverse drug events derived from medication errors. Medication errors account for an annual cost of $100 to $200 billion. Healthcare pharmacists lack strategies to reduce adverse drug events and medication errors from taking place. Grounded in complex adaptive system theory, the purpose of this qualitative multiple case study was to explore strategies to reduce advere drug events and medication errors. The participants were 5 pharmacist managers in a county in central Florida. These pharmacists were from different community pharmacies, and each had a minimum of 5 years’ experience in the …

Changes In Operating Performance In Rural Hospitals From 2012 To 2019, Oluwaseyi Tami Young-Harry

Walden Dissertations and Doctoral Studies

Rural hospitals treat patients while dealing with the challenges of an inadequate workforce, limited financial resources, and an isolated geographic location, leading to difficulties in achieving financial viability. The purpose of this quantitative study was to analyze the operating performance of rural, general, medical and surgical hospitals in the United States and to determine if performance had changed from 2012 to 2019. Guided by x-efficiency theory, this study addressed whether hospital ownership explained variation in performance and if performance had changed from 2012 to 2019. A random sample of 394 rural hospitals was used, with data drawn from the American …

Staff Education On Type 2 Diabetes Mellitus, Joan P. Williams

Walden Dissertations and Doctoral Studies

Diabetes mellitus is a major health concern that affects the physical and financial facets of communities. During the past 4 years, a multidisciplinary health care clinic in a northern state reported an increase in the number of type 2 diabetes (T2D) patients. Forty-three percent (43%) of adults with T2D had an elevated glycated hemoglobin A1c of 7.5% or higher. Yet, the staff at the clinic lacked current knowledge of T2D, quality of care, and prevention strategies for patients with T2D. This resulted in increased serious health care issues, associated costs, and increased complications of the patients with T2D. The purpose …

Primary Care Physicians’ Knowledge And Perception Of The Impact Of Health Literacy On Patient Care, Lutrisha S. King

Walden Dissertations and Doctoral Studies

Until recently, many health literacy studies were completed from the patient and nurse perspective, while few focused on the physician perspective, specifically the primary care physician. The purpose of this study was to provide insight into the health literacy knowledge and education of primary care physicians and determine the association, if any, between physicians’ perceptions of patients’ limited health literacy and physicians’ use of health literacy communication techniques. The knowledge, attitudes, and practice (KAP) framework directed this study. This framework posits that knowledge informs or influences attitudes, which leads to practices. The KAP framework was employed to answer the research …

Impact Of Medicare Utilization On Mortality And Readmission Rates Of Heart Failure Patients 65 Years And Over, Joanna Alexander

Walden Dissertations and Doctoral Studies

Roughly 25% of individuals 65 years and over hospitalized with heart failure are readmitted within 30 days after discharge. Elderly individuals identified with heart failure possess a 5-year mortality approaching 50%. The purpose of this study was to determine if there is a relationship between Medicare-covered services for care, mortality rates, and readmission rates for beneficiaries 65 years and over with heart failure. To address this topic, the chosen approach was retrospective and quantitative. The theoretical foundation was the Chronic Care Model. The research questions sought to determine if there is a relationship between the Medicare-covered services for care and …

Guidelines For Chronic Back Pain: An Education Module For Health Providers, Ron Pascual

Walden Dissertations and Doctoral Studies

Effective chronic back pain management and patient self-care guidelines are necessary for healthcare providers treating patients with complaints of low back pain (LBP). The purpose of this doctoral project was to provide an evidence-based educational program aimed at improving the knowledge and skills of healthcare professionals regarding the Center for Disease Control (CDC) and American Chronic Pain Association (ACPA) guidelines, emphasizing alternative pain management treatments. The staff education project was supported by the biomedical pain model and chronic care model. A panel of 3 experts including the clinic’s board-certified anesthesiologist and pain management specialist, clinical manager, and leading medical director …

Antibiotic Stewardship And The Quality Of Life For Residents Over 65 Years, Reshma Beharry-Guest

Walden Dissertations and Doctoral Studies

Antibiotics were often over-prescribed in long term care facilities (LTCFs) and antibiotic stewardship guidelines, established by the CDC were not followed. The nursing home administrator was responsible for the quality of care for the residents and ensured that the facility met and/or exceeded the CMS antibiotic stewardship standard of care. The purpose of this quantitative study was to analyze operational secondary data collected from a Texas LTCF regarding antibiotic utilization for male and female residents over 65 years. The theoretical framework of the social cognitive theory was applicable for quality improvement in the LTCF setting. The data analysis showed that …

Racial Differences In Hospital Readmission And Reimbursement Rates For Patients With Congestive Heart Failure, Catherine Talongwa

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is associated with a significant economic burden that includes frequent emergency department visits, hospitalizations, and readmissions. The purpose of this study was to examine the differences, if any, between hospital readmission rates and insurance reimbursement rates for non-Hispanic Black and White CHF patients in California. The theoretical framework was Bandura's social cognitive theory. Secondary data for this quantitative study were obtained from the Office of Statewide Health Planning and Development and State Inpatient Databases from Healthcare Cost and Utilization for calendar year 2014-2016. A t-test and Levene's test for equality of variance were conducted on a …

Use Of Managerial Epidemiology By Healthcare Leaders In Ambulatory Settings, Chantelle Schenning

Walden Dissertations and Doctoral Studies

Despite many health reforms, the United States continues to struggle with limited healthcare access, exponential healthcare costs, and poor quality of care. Overcoming these challenges requires healthcare leaders’ effective navigation of industry transformation towards population health and a shift in patient volume to ambulatory healthcare settings. Research has demonstrated that the use of managerial epidemiology, an application of epidemiology tools and principles to management decision-making within healthcare organizations, can better serve the health of the population and could improve the triple aim of inadequate access, high costs, and poor quality. However, the adoption of this practice is weak and its …

Telehealth Efforts To Reduce Hospital Readmissions Of Congestive Heart Failure Patients, Sirfornia L. Deasfernandes

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is a chronic condition that affects millions of individuals in the United States. There is no cure for CHF, but medical interventions can help treat the symptoms and improve health outcomes. The purpose of this quantitative study was to determine if telehealth services help to reduce the readmission status of patients diagnosed with CHF. The theoretical framework used in this study was the individual and family self-management theory to help focus on self-management behaviors that contribute to improving the patients' health outcomes. The research questions were focused on addressing CHF patients receiving telehealth services and whether …

Cancer Treatment Decision Making In Aging Minorities, Patrice Kemp

Walden Dissertations and Doctoral Studies

Cancer incidence is high for aging minority and underserved populations, yet research is limited about patient-provider communications with aging racial and ethnic minority populations. Achieving high-quality cancer care is crucial to reducing health disparities for this population. However, potential shortages in professional health personnel, the cost to treat cancer, a strained health care system, and large aging populations contribute to the problem. The purpose of this qualitative study was to understand the personal experiences of aging minorities during cancer treatment decision making when communicating with their cancer care providers. Purposive sampling methods were used to recruit 10 minority women and …

Reducing Cost Of Healthcare Facilities By Decreasing Nursing Turnover, Valour Akia Richardson

Walden Dissertations and Doctoral Studies

Registered Nurse (RN) turnover is costly for hospitals and healthcare facilities. The problem that healthcare administrators face today is their inability to retain nurses for long periods of time and the detrimental effects that come from the lack of retention. The purpose of this quantitative secondary data analysis is to explore the relationship between the retention of RNs and the geographic regions in which they work. The theoretical framework for this study was Barney's concept of viewing people as resources. Deidentified secondary data of RNs was utilized from the Healthforce Center at the University of California San Francisco to probe …

Exploring The Mechanisms Of Racial Disparity In Infant Mortality: A Grounded Theory Approach, Barry Chukwugekwu Eneh

Walden Dissertations and Doctoral Studies

Infant mortality (IM) is a critical health-disparity problem in the United States. Of the 23000 infants who die each year, the highest number occurs among African Americans. Previous studies implicated a mix of health determinants and risk factors, but no study has explored the mechanisms by which IM predictably persists among African Americans. This study uncovers the complex network of risk factors that underlies racial death disparities in infants. Two theoretical lenses chosen for this study were social systems theory (SST) and critical race theory (CRT). SST explains human behavior as an intersection of interrelated systems. CRT interrogates inherent social …

Veteran Administration Disease Model To An Interdisciplinary Healthcare Model, Bertha J. Harris

Walden Dissertations and Doctoral Studies

There is a growing need for healthcare teams within the Veterans Administration (VA) healthcare system to effectively collaborate and communicate to improve patient outcomes. The need to improve patient care in the Patient Aligned Care Team (PACT) has been well established. The scholarly literature does not provide evidence whether using the primary care PACT model on communication and teamwork by an interdisciplinary medical team ameliorates these communication breakdowns. Bronstein's design for interdisciplinary collaboration provided the overarching framework for this study. The purpose of this qualitative case study was to investigate the use of the PACT model on communication and teamwork …

The Association Between Leapfrog's Healthcare Organizational Grades And 30-Day Mortality Rates, Steven Michael Armstrong

Walden Dissertations and Doctoral Studies

U.S. healthcare consumers have access to various provider ratings from several organizations that are meant to assist in selecting their healthcare providers. Leapfrog Hospital Safety Grades is one such rating system that professes to allow consumers the ability to select the best hospital for their care. However, since consumers ranking mortality risk as their most important concern, it is essential to determine if Leapfrog grades align with consumer expectations. Andersen's Phase-4 behavioral model of healthcare utilization was used as the foundation for understanding healthcare consumer preferences. This study was designed to determine if Leapfrog grades are predictive of CMS 30-day …

Involving Patient/Family Advisors And Advisory Councils With Patient And Family Engagement, Cortney D. Forward

Walden Dissertations and Doctoral Studies

Health care consumers are under-represented in literature when defining patient and family engagement. The proportion of people living longer is rapidly growing. Future research is needed to evaluate which strategies of patient and family engagement are most useful in real-world health care settings for patient and families. The purpose of this study was to describe the lived experiences of patient/family advisors working within patient family advisory councils at an academic medical center in the Midwestern United States. The conceptual framework is based on Greenleaf's servant leadership and Bass's transformational leadership. The research questions examined how patient/family advisors describe patient and …

Noncompliance With Follow-Up Visits In Primary Care, Amanda Michelle Northern

Walden Dissertations and Doctoral Studies

No-show appointments, also referred to as missed appointments, occur 23% to 34% annually in general practice care settings. Missed appointments can lead to reduction in appointment availability, decrease in provider/staff productivity, patient/provider discordance, disruption in continuity of care, and reduced quality of care. There is a gap in the nursing literature regarding effective interventions to reduce missed appointments. The purpose of this quality improvement, secondary analysis project was to determine whether implementation of an evidence-based no-show, nurse-led intervention would reduce missed appointment rates in a family medicine practice. The health belief model and the plan, do, study, act model guided …