Health Services Administration Commons^™

Assessing The Impact Of Employee Wellness Programs On Healthcare Employee’S Weight, Reja F. Basyyoni

Theses and Dissertations

Introduction: Over 32% of employees in healthcare are clinically overweight with a BMI over 30. This level of obesity is more significant in healthcare than in other professions. (Aldana, 2021). The growing prevalence of diseases among employees in healthcare settings has increased the concern about their health, well-being, and productivity. (Aldana, 2021). Notably, the reduction of obesity rates holds the potential to avert 40 million instances of chronic diseases, encompassing hypertension, diabetes, and cardiovascular ailments. (Milken Institute Study, 2022) Therefore, maintaining a healthy body weight or shedding excess pounds is crucial to reduce the risk of developing these. As a …

An Analysis Of The Special Focus Facility Program And Nursing Home Quality, Annie S. Rhodes

Theses and Dissertations

The Special Focus Facility Program is an intensive program meant to rapidly support 88 of the lowest quality nursing homes in the United States, as determined by the Five-Star Quality Ranking system. There are also 435 facility candidates which are similarly low performing but not enrolled in the program. Academic literature has largely ignored this program, and the existing grey literature is more than a decade old and does not include COVID-19 data. Applying a political economy of aging framework and using a case matching methodology, Special Focus Facilities (SFF), Special Focus Facility Candidate (SFFc) nursing homes, and 5-star nursing …

Hear My Voice: Qualitative Studies To Explore What Empowers Patients To Talk With Their Doctor And Participate In Making Health Care Decisions, Alicia Marie Oostdyk

Theses and Dissertations

Patients with fibromyalgia are faced with many decisions throughout the process of seeking and obtaining health care. For patients to feel empowered to take action, it is essential they feel as if they can play a role in making decisions up to their desired level of participation. However, it is unclear what constitutes empowerment in shared decision making between patients and providers. For patients with fibromyalgia, who deal with complex symptomology and individualized treatment choice, it is important to know what makes them feel empowered to participate in care. The objective of this dissertation is to create a patient-centered definition …

Examining The Cost And Quality Relationship In Medicare, Alexandria Fleming Delage

Theses and Dissertations

Purpose.

The purpose of this study is to evaluate the cost and quality of care dynamic among physicians billing under Medicare Fee for Service in 2018 to examine the relationship between quality and total cost of care at the physician level. Examining this relationship will advance scientific knowledge regarding the impact of increasing high value service use on healthcare costs and will provide insight in terms of expected cost outcomes of quality programs for healthcare policymakers (Salmond and Echevarria 2017; Williams, Brown, and Healy 2018).

Methods.

The study used publicly available data sets provided by the Center for Medicare and …

A Cost Effectiveness Analysis Of The Nutritious Eating With Soul Study, Mary Jones Wilson

Theses and Dissertations

PURPOSE Historically, African Americans (AA) have been underrepresented in nutritionrelated behavioral research despite their disproportionate higher risk of cardiovascular disease (CVD). The Nutritious Eating with Soul (NEW Soul) Study is one of the first of its kind to recruit an AA only study group to examine CVD prevention via a clinical trial to examine changes in CVD risk factors across two cohorts who are randomly assigned to a plant-based, soul food vegan diet or low-fat omnivorous (omni) diet. The purpose of cost effectiveness analysis (CEA) is to inform clinical and policy decisions and the costs of interventions that society is …

Two Essays On Leveraging Analytics To Improve Healthcare, Deepika Gopukumar

Theses and Dissertations

The healthcare cost has continued to increase over the past few years despite various policies, efforts, and initiatives taken by the government. It is still projected to grow over the next few years by the Centers for Medicare and Medicaid Services (CMS). Readmissions have been a major contributor to the increase in costs and have always been a contributing factor. To get a perspective, considering the fact that at least 9% of individuals who had COVID-19 were likely to get readmitted shortly, according to a study by the Centers for Disease Control and Prevention (CDC) COVID-19 response team, along with …

Another Step In Diagnostics Consultation Model© Actualization: Examining The Impact Of Consultation Workflow Processes On Providers' Clinical Decision Making, Elizabeth K. Leibach

Theses and Dissertations

Background
Communication errors in health services delivery significantly compromise quality in clinical decision making (CDM). Diagnostic information generated by clinical laboratories (CL) accounts for as much as 93% of objective data in the clinical record and therefore is foundational in CDM. This work describes the Diagnostics Consultation Model© (DCM©), a CL communications portal, which supports CDM within interprofessional teams, providers, and institutions. Specific aims were to develop and validate a workflow prediction index (the complexity index, CI) to assign resolution of consultation requests based on an algorithm comprised of characteristics available at the point of consultation initiation. The CI functions …

Effect Of Lifestyle, Medical School Culture And Income On Medical Students' Decision To Pursue A Primary Care Career In Saudi Arabia, Ahmed Abdullah Alhussain

Theses and Dissertations

This study aims to examine the relationship of medical school students who select primary care as their career specialty. Based on extensive literature review, we focused on the three main factors that influence students to consider career specialty: lifestyle, income, and medical school culture. With a paper questionnaire of a cross-sectional study survey at ten medical schools, we were able to collect 1,006 participants from fourth and fifth year students. The clear majority of students considered lifestyle characteristics to be a significant influence in their career decision (PP<.05). Also, we found there was a significant relationship between students’ specialty choices and income variables. The result showed us that medical school culture played a notable role in terms of forming the students’ decisions in different ways. First, specialty characteristics were strongly correlated with career consideration. Second, having advising and mentoring within the medical school enhanced the probability of choosing primary care specialty. Finally, the effect of the primary care course was significant and closely related to the choice of the primary care specialty. In conclusion, the study demonstrated the impact of lifestyle, income, and medical school culture on student career selection. These results are in parallel with previous studies conducted in many countries around the world.

Maternal Preventive Dental Services Utilization: The Role Of Preconception Oral Health Counseling In And The Association With Birth Outcomes: Evidence From South Carolina Prams, Monique Johnette Williams

Theses and Dissertations

ABSTRACTThe purpose of this study is to examine maternal preventive dental services utilization by analyzing the role of preconception oral health counseling in utilization of dental cleaning services before or during pregnancy and the association of utilization with preterm birth (<37 weeks) and small for gestational age (SGA) (same sex newborns having birth weight for gestational age below the 10th percentile of the reference population as defined by the World Health Organization (WHO)). Studies suggest that unfavorable maternal oral conditions have significance in birth outcomes, specifically periodontal disease (periodontitis), an oral inflammatory condition which is shown to be a risk factor for preterm birth and low birth weight (Dortbudak et al., 2005; Guimarães et al., 2012; Tejada et al., 2012). Dental cleaning before and during pregnancy is effective in the prevention of oral disease including gingivitis and periodontitis (Johnson et al., 2006; Kurien et al., 2013; Steinberg et al., 2013).

Cross-sectional 2012-2015 data from the South Carolina Pregnancy Risk Assessment Monitoring System (SC PRAMS) survey, a population-based surveillance system on prenatal, perinatal and postpartum experiences of resident mothers who recently delivered a live-born infant, were analyzed using weighted analyses in SAS. Analyses included demographic univariate analyses, Rao-Scott Chi-squared tests of significance to study differences between groups, and multivariate logistic …

Examining Parental Perceptions And Decisions To Uptake Child Influenza Immunizations: Assessing Pandemic And Policy Impacts On Vaccination Rates Following The H1n1 Pandemic, And The Acip Laiv Preferential Recommendation Revocation, Amir H. Mehrabi

Theses and Dissertations

Introduction

2009 H1N1 Pandemic: The historical 2009 H1N1 Influenza pandemic, which had a CDC estimated accrued disease burden of 100.5 million illnesses, 936,000 hospitalizations, and 75,000 deaths from 2009 to 2018, resulted in a declared state of emergency nationally, with ensuing diminished vaccine confidence and amplified fears of infection, prompting some to pursue flu vaccination, and others to forego. Although the Centers for Disease Control and Prevention (CDC), and its Advisory Committee on Immunization Practices (ACIP) recommend an annual flu vaccine for individuals 6 months of age and older as the “first and best” defense against influenza, a low percentage …

Machine-Learning-Based Prediction Of Sepsis Events From Vertical Clinical Trial Data: A Naïve Approach, Tyler Michael Gaddis

Theses and Dissertations

Sepsis is a potentially life-threatening condition characterized by a dysregulated, disproportionate immune response to infection by which the afflicted body attacks its own tissues, sometimes to the point of organ failure, and in the worst cases, death. According to the Centers for Disease Control and Prevention (CDC) Sepsis is reported to kill upwards of 270,000 Americans annually, though this figure may be greater given certain ambiguities in the current accepted diagnostic framework of the disease.

This study attempted to first establish an understanding of past definitions of sepsis, and to then recommend use of machine learning as integral in an …

Effectiveness And Experience Of An Integrated Maternal Mental Healthcare Intervention In Private Clinics And Public Health Facilities In Pakistan, Syeda Somyyah Owais

Theses and Dissertations

Maternal depression is often undetected or undertreated at the primary care level. Despite the growing high prevalence of depression among women of childbearing age, the usual primary care practice in Pakistan does not include depression screening. Two facility-based cluster randomized control trials, including a maternal depression intervention component, were conducted within two healthcare settings, private and public primary care facilities in Rawalpindi and Lahore. This study aimed to estimate the effectiveness of each trial in reducing maternal depression among mothers in the intervention arm compared to the control by analyzing the change in PHQ-9 (Patient Health Questionnaire-9) scores from baseline …

Aging With Hiv In The United States: Trends And Impact Of Hospital Stays On Inpatient Resource Utilization, And Costs Of Care, 2003-2015, Khairul Alam Siddiqi

Theses and Dissertations

Background:

Due to advances in Antiretroviral Therapy (ART), people living with HIV (PLWH) live longer in the United States. Aging prolongs exposure to HIV and antiretroviral drugs, which could lead to an elevated risk of developing multiple age-related comorbidities [HIV Associated Non-AIDS (HANA) conditions], earlier for PLWH. Higher comorbidity burdens among older PLWH may require greater use of inpatient care, i.e., higher hospitalization, inpatient resource utilization, and costs. This study examined the trends and characteristics of comorbidities, resource utilization, and costs of hospital stays with HIV (HSWH) compared to hospital stays without HIV (HSWOH). We also assessed trends for resource …

Correlates Of Maternal Health Service Use And Women’S Experiences Using Antenatal Care In Ghana: A Mixed-Methods Study, Anna Cofie

Theses and Dissertations

The pace of improvements in maternal mortality has been slow in Ghana. While Ghana’s maternal mortality ratio (MMR) decreased from 635 per 100,000 live births to 319 per 100,000 live births between 1990 and 2015, the country failed to meet the 75% reduction target set by Millennium Development Goal (MDG) goal 5A, to reduce maternal mortality ratio by 75% between 1990 and 2015. Antenatal care (ANC) is critical to improving maternal morbidity and mortality and child deaths. In 2003, Ghana introduced the National Health Insurance Scheme to ensure that all pregnant women have access to free maternal care, and in …

Effectiveness Among Community Health Center Governing Boards: An Assessment Of The Different Governing Board Members’ Perspectives, Brandi L. Wright

Theses and Dissertations

Governing boards of Community Health Centers were created with the anticipation that majority of its members be patients (users) of the Community Health Center they served. This study assessed South Carolina Community Health Center governing board members’ perception and understanding of what they believe their roles and responsibilities are, and their perceived overall effectiveness. It provides a framework for understanding the governance structure of Community Health Centers, based on examining three characteristic areas (Board Function, Board Performance and Board Development) of Community Health Centers located in South Carolina.

This study invited 234 governing board members to obtain members perceptions. Key …

The Impact Of Financial Incentives On Urban-Rural Disparities In Dental Supply: Evidence From Thailand, Rakchanok Noochpoung

Theses and Dissertations

Financial incentive is one of the common strategies used to attract healthcare workers in rural and remote areas. Both high-income and low-income countries extensively use financial strategy to tackle the disparity distribution of healthcare workers. However, most studies were conducted in developed countries and assessed positive incentives programs. Previous studies showed the effectiveness of financial incentives on recruitment and retention of healthcare workers. Current studies show that most of the financial incentives supported for education such as scholarships and loan repayment programs are effective. A few studies assessed the effectiveness of direct payment incentive programs, especially in low-middle income countries. …

Magnet Recognition (Mr) And Hospital Quality Outcomes In The U.S.A– Analysis Based On 2017 Hospital Data, Abdulmalik Alhammad

Theses and Dissertations

The American Nurse Credentialing Center (ANCC) introduced Magnet Recognition (MR) in the U.S.A in 1994. Magnet Recognition was adopted based on the findings of a comprehensive study (conducted in 1983) that tried to identify factors explaining high rates of nurses’ retention in 41 hospitals in the U.S.A.

The objective is to compare MHs with the hospitals not recognized as “Magnet” (non-MHs) in terms of important outcomes of the health system and to examine whether the MHs themselves vary significantly in terms of the outcomes.

All the general specialty of MHs (367 hospitals) and their matched of non-MHs (380 hospitals) in …

The Relationships Among External Environments, Organizational Structures, And Performance In Pursuit Of The Clinical And Academic Missions At Academic Health Centers, Eric J. Strucko

Theses and Dissertations

Clinical and academic missions place Academic Health Centers (AHCs) at the center of the American health care system, and the future viability of these institutions requires successful performance in competitive environments. AHCs are organizations involving hospitals, physician group practices, and medical schools, and treat patients with complex conditions, conduct bio-medical and health science research, and educate future physicians and health professionals. AHCs account for 20% or $540 billion of national health care expenditures, conduct over 80% of all heart, liver, and lung transplants, utilize over $27 billion in annual sponsored research funding, and graduate approximately 17,300 medical doctors annually. Financial …

Engaging Hmong Americans Long-Term Use Of Healthcare Technology Using Culturally Revised Social Cognitive Theory Model, Peggy Xiong

Theses and Dissertations

Purpose: Information technology benefits the world, and it’s required for health care system, such as electronic medical records (EMR). User acceptance model is to systematically study how users come to accept and use a technology. For example, the cultural values of a society restrict use of technology in which an individual can be less incline to accept it. There is a significant amount of Hmong population in great Milwaukee area. Spirits are a central part of Hmong religious beliefs where the spirit is tied to health. Chronic disease is believed to be caused by bad actions done by the individual’s …

Engaging Hmong Americans Long-Term Use Of Healthcare Technology Using Culturally Revised Social Cognitive Theory Model, Peggy Xiong

Theses and Dissertations

Purpose: Information technology benefits the world, and it’s required for health care system, such as electronic medical records (EMR). User acceptance model is to systematically study how users come to accept and use a technology. For example, the cultural values of a society restrict use of technology in which an individual can be less incline to accept it. There is a significant amount of Hmong population in great Milwaukee area. Spirits are a central part of Hmong religious beliefs where the spirit is tied to health. Chronic disease is believed to be caused by bad actions done by the individual’s …

Medication Self-Management Behaviors Of Community-Dwelling Adults With Chronic Disease, Michelle Yvonne Williams

Theses and Dissertations

MEDICATION SELF-MANAGEMENT BEHAVIORS OF COMMUNITY- DWELLING

ADULTS WITH CHRONIC DISEASE

by

Michelle Y. Williams, PhD, MSN, RN

The University of Wisconsin-Milwaukee, 2019

Under the Supervision of Professor Rachel Schiffman, PhD, RN, FAAN

Chronic conditions threaten public health, individuals, and families and affect all areas of a person’s life and require significant self-management from the individual with the disease, care from the healthcare provider and team, and support from the individual’s family. The relationship of selected risk and protective factors and communication with healthcare providers to medication self-management behaviors and quality of life was examined in 616 adults with chronic disease …

Information Overload: Auditing The Clinical Utility Of Smart Pump Reporting Tools, Elizabeth Rodman

Theses and Dissertations

Purpose: Smart pump technology provides detailed information about each infused drug and fluid that can be used to examine trends and assist in data set optimization. When smart pumps interface with the electronic health record through interoperability, additional data are available.

Methods: The primary outcomes of this study were to identify the top 10 drugs implicated in smart pump near miss events and to reduce the number of near miss events related to smart pump programming. Interoperability data from April 2017 to October 2017 were assessed for near miss trends. Potential interventions for the top 10 drugs were compared using …

Patient-Centered Medical Homes And Hospital Value-Based Purchasing: Investigating Provider Responses To Incentives, Lauryn Walker

Theses and Dissertations

Provider incentives are a commonly used policy tool to mold provider behaviors.¹ However, while we frequently measure the change in patient outcomes, failure to consistently produce changes in outcomes does not mean that providers are not changing their behavior. This paper focuses on two programs with null or inconsistent quality outcomes to try to identify why such inconsistency occurs. The two programs, both ratified in the Affordable Care Act, are 1) patient-centered medical homes (PCMHs), and 2) the Medicare Hospital Value-Based Purchasing (HVBP) program.

Chapter 1: Using data from the Medical Expenditure Panel survey (MEPS), I match provider characteristic …

Critical Illness Survivors’ Perceptions Of Their Recovery: An Interpretive Phenomenological Inquiry, Kelly Calkins

Theses and Dissertations

Surviving critical illness with its physical, cognitive, and psychosocial morbidities is a growing clinical and research challenge and an important public health concern. Currently, there are few interventions for survivors of critical illness after hospital discharge. Potential interventions include rehabilitation services, Intensive Care Unit (ICU) diaries and ICU follow-up clinics, however, most survivors do not have access to these post-hospital interventions.

The purpose of this study is to gain a better understanding of how critical illness survivors experience their recovery, interventions they use, and what they perceive as facilitators and barriers to their recovery. A better understanding of these factors, …

The Association Of Hospital Practices To Breastfeeding Behaviors In South Carolina: Analysis Of 2013-2015 Pregnancy Risk Assessment Monitoring System (Prams) Data, Larisa Donnette Bruner

Theses and Dissertations

Objective: The purpose of this study was to determine whether hospital practices are associated with breastfeeding initiation and breastfeeding duration for ≥10 weeks.

Methods: We analyzed the 2013-2015 South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) data. The population of interest was mothers who delivered a single live birth in the hospital. The infant was alive and living with the mother at the time of the survey. Chi-square and logistic regression were used to examine breastfeeding initiation and duration among all women who delivered in a hospital and those who stated that they initiated breastfeeding while in the …

How Do Health System Employees With Established Musculoskeletal Complaints Decide On Their Treatment Pathway? A Qualitative Approach, Noor Alshareef

Theses and Dissertations

Purpose: Non-pharmacologic treatment such as physical therapy (PT) are advocated for musculoskeletal pain for decreasing opioid use. Early access to PT has been shown to decrease costs and improve outcomes through direct access via self-referral. Although self-referral to PT is permitted in the majority of U.S states, health insurance coverage has been identified as a barrier preventing some patients with musculoskeletal complaints from using it. There are few studies examining patient factors related to early access to physical therapy via self-referral. The purpose of this study was to identify the factors outside of insurance that influence the choice to access …

Association Of Insurance And Provider Type With Patients’ Perceived Cost And Ease Of Access To Healthcare Services Among Medicare Beneficiaries Diagnosed With Diabetes, Metria Harris

Theses and Dissertations

Medicare beneficiaries diagnosed with diabetes are likely to have health complications or episodes associated with diabetes, resulting in higher health care utilization and costs. Andersen’s Health Care Utilization Behavior Model (HCBM) includes predisposing, enabling, and need factors, but it excludes perception. Ajzen’s Theory of Planned Behavior (TPB) shows that perception influences health service use. This study was performed using a real-world model integrating Andersen’s HCBM and Ajzen’s TPB to determine whether there was an association between insurance type (Medicare Part D versus non-Part D) and perceived ease of access or cost among Medicare beneficiaries with diabetes. The second objective was …

Introduction Of Innovative Medical Practices In Mayo Clinic: Effect Of The Interventions On Patient Outcomes, Duaa I. Aljabri

Theses and Dissertations

Purpose: Assessment of health technologies in medical practice is an ongoing process to provide clinicians and policymakers with information on the value of those applications. This dissertation aims to add to the existing body of literature and fill the gaps in prior studies by assessing two health technologies in Mayo Clinic Florida (MCF). The first paper provides an assessment of patient portal adoption and activity during hospitalization among cancer patients, and determines whether a portal application is associated with selected indices of patient safety, utilization and satisfaction. The second paper provides an assessment of a new approach in pain …

Residential Mobility And Enrollment Churn In A Medicaid Population, John E. Stewart

Theses and Dissertations

Previous investigations show high rates of enrollment discontinuity, or churn, among Medicaid participants. Discontinuity of coverage can limit appropriate use of health care, increase emergency department utilization and in-patient hospitalization, negatively affect self-reported health, increase health care spending, and compound Medicaid administrative costs. Efforts to more fully understand and ultimately reduce enrollment churn thus are vital to Medicaid agencies and beneficiaries. Residential moves are life transitions, often marking other significant life events (e.g., changes in employment or family structure) that can alter eligibility for Medicaid benefits. Few studies have examined residential moves among Medicaid members, or considered residential mobility as …

Layperson Perceptions And Attitudes Towards A National Electronic Health Record Introduction In Saudi Arabia, Jwaher Abdullah Almulhem

Theses and Dissertations

Introduction: Since patients and the general public may interact with a national electronic health record (EHR), including them during implementation of an EHR is important. Such acceptance has been documented as one of the critical areas in the development of a national EHR. However, only a few studies have considered public perceptions and attitudes regarding use of their health information in a universal EHR. This is the first study that concentrated on Saudi patients and citizens’ attitudes regarding a national EHR. . Objectives: The purpose of this quantitative study was to understand perceptions and attitudes regarding the introduction of a …