Health Services Research Commons^™

Geographic Disparities Associated With Stroke And Myocardial Infarction In East Tennessee, Ashley Pedigo Golden

Doctoral Dissertations

Stroke and myocardial infarction (MI) are serious conditions whose burdens vary by socio-demographic and geographic factors. Although several studies have investigated and identified disparities in burdens of these conditions at the county and state levels, little is known regarding their geographic epidemiology at the neighborhood level. Both conditions require emergency treatments and therefore timely geographic accessibility to appropriate care is critical. Investigation of disparities in geographic accessibility to stroke and MI care and the role of Emergency Medical Services (EMS) in reducing treatment delays are vital in improving health outcomes. Therefore, the objectives of this work were to: (i) classify …

An Evaluation Of A Peer Led Bystander Intervention Program To Reduce Sexual Assault Violence Among College Students, Elizabeth Madeline Childers

Graduate Theses and Dissertations

It has been reported that sexual victimization among college women is three times higher than the general population. Because of these alarming rates, sexual violence prevention has become a main concern on college campuses. Sexual violence prevention programs have been implemented and evaluated throughout the years in order to decrease the incidence of sexual violence, but very few have explored the bystander intervention component. The current study developed and evaluated a program that promoted proSocial bystander behavior through a one-time educational program utilizing peer educators. Data for this study were collected with a pre/posttest design from a Division 1 university …

Analysis Of The Morbidity And Mortality Of Severe Influenza Infection In Clark County, Nevada For The 2010--2011 Influenza Season, Kindra Maureen St. Jacques

UNLV Theses, Dissertations, Professional Papers, and Capstones

Influenza circulates in the community in a fairly predictable manner each year; however, throughout the duration of any influenza season, influenza strains have the ability to evolve through antigenic mutations, viral reassortment, development of anti-viral resistance, and alterations in virulence. These changes are likely to cause illness among the unimmunized and can result in severe illness or death. Therefore, it is especially important to closely monitor severe influenza-associated hospitalizations and deaths. The University of Nevada, Las Vegas in collaboration with the Southern Nevada Health District (SNHD), Office of Epidemiology (OOE) analyzed data from the severe hospitalized influenza morbidity and mortality …

An Empirical Investigation Of Supply Chain Excellence In Healthcare, Brian Keith Smith

Graduate Theses and Dissertations

This research is motivated by opportunities to improve the cost and quality of healthcare delivery through improved supply chain processes. This research assesses the quality of the healthcare supply chain and identifies factors that are driving supply chain excellence among organizations in the healthcare industry. The first objective of this research is to assess the state of quality measurement in the healthcare supply chain. The achievement of this first objective is presented in Chapter 3 of this dissertation in the form of a manuscript accepted for publication in The Quality Management Journal. The second research objective is to develop …

Individual And Combined Effects Of Dehydration, Hyperthermia, And Fatigue On Movement Patterns And Cognition, Rachel M. Karslo

Master's Theses

Individual and Combined Effects of Dehydration, Hyperthermia, and Fatigue on Movement Patterns and Cognition

Rachel M. Karslo, University of Connecticut

Purpose: The purpose of the study was to examine the individual and combined of effects of dehydration, hyperthermia, and fatigue on movement patterns and cognition. Secondly, we wanted to see if the effects of dehydration, hyperthermia, and fatigue lead to a combined increase in injury risk.

Methods: 12 males completed a within-subject repeated measures design to study the effects of hyperthermia, dehydration and fatigue on movement and cognition. Subjects completed 4 randomized test sessions in different conditions: hydrated normothermic, dehydrated …

The Influence Of Patient-Reported Provider Availability Factors On Nonurgent Emergency Department Use, Cheryl Anne Dewood

Theses and Dissertations (ETD)

Purpose. The purpose of this study was to examine the influence of patient‑perceived provider availability on nonurgent emergency department use (NUEDU). The study population consisted of a nationally‑representative population of non‑elderly adults who were continuously privately insured (CPI) for at least a year before an emergency department visit that was determined to be nonurgent, and who reported having a regular source of care (RSC).

Methods. Data were obtained from a nationally‑representative longitudinal survey, the Medical Expenditure Panel Survey (MEPS). The classification of ED visits as nonurgent was based on patient report using a method developed for this study. Patient­‑perceived provider …

Analysis Of Out-Of-Pocket Expenditures Of Oral Oncologics For Tennessee Recipients Of Medicare Part D, Eve Carolyn Elias

Theses and Dissertations (ETD)

Background: There are few studies that examine patients' costs of oral oncology drugs from Medicare Part D plan providers. These drugs can impose a financial burden to beneficiaries, and, due to their cost, place beneficiaries in the coverage gap in a short period of time. In addition to examining costs, there is little published concerning the potential impact of drug utilization management techniques on access to these drugs in Medicare Part D plans. This study examined the roles of prior authorization, step-therapy, and placement of drugs in higher formulary tiers on patients' out-of-pocket costs, and access to therapy.

Methods …

Effects Of Environment On Children's Motor Scores, Eligibility Status, And Administration Times, Derrick Mittelstadt, Abigail Parker, Kirsten Pickett, Heather Temkin

UNLV Theses, Dissertations, Professional Papers, and Capstones

Best practices for assessing developmental skills in young children focus on naturalistic observation in everyday settings, but the effects of environment on test scores, eligibility status and administration time have not been explored. The Peabody Developmental Motor Scales-Second Edition (PDMS-2) was administered to 34 children aged 18 to 59 months in natural and pull-out settings. PDMS-2 total, gross, and fine motor quotient (TMQ, GMQ, and FMQ) scores were significantly lower in the natural environment (p’s≤.014). Based on our results, more children would qualify for services when tested in natural environments using TMQ and GMQ scores. It also took significantly longer …

Playing With Fire Or Arson? Identifying Predictors Of Juvenile Firesetting Behavior, Mary Ellen Britt

UNLV Theses, Dissertations, Professional Papers, and Capstones

Firesetting is a complex behavior that spans a wide range of developmental stages in childhood and adolescence and involves varying motivations and intents. A better understanding of this destructive behavior is critical to developing strategies to control its devastating effects. The purpose of this research project was to identify potential predictors of juvenile firesetting behavior by studying youth who were enrolled in a regional firesetting intervention program. Data collected from firesetting assessment instruments completed by parents or guardians of program participants were examined. In the analyses, special emphasis was placed on evaluating associations between juvenile firesetting behavior and the socioeconomic …

Adoption Of Electronic Health Records By Admitting Physicians: A Heuristic Model, John Sharon Hudson

Health Services Research Dissertations

Background: Although hospital electronic health records (EHRs) are generally perceived to improve care, physician resistance may hinder EHR adoption.

Purpose: This study uses constructs from diffusion of innovations and resource dependence theories to predict adoption and rate of adoption of an EHR by admitting physicians from three of ten hospitals in a highly integrated health system in Virginia. Functions evaluated: computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS). The study tested hypotheses that adoption would be associated with: working at larger, academic hospitals; financial alignment; larger physician groups; office EHR; youth; males; medical …

The Characteristics Of Successful Evidence Retrieval By Nephrologists And The Impact Of Pubmed Search Filters, Salimah Shariff

Electronic Thesis and Dissertation Repository

Background: Clinicians frequently search PubMed to guide patient care. This study investigated the factors that impact successful searching and the utility of PubMed search filters.

Methods: A random sample of nephrologists was surveyed between 2008 and 2010; 160 valid responses were received (72% response rate). One group of 60 respondents was presented with the same two clinical questions, while the other 100 were each presented with a unique clinical question. The clinical questions were based on recently published systematic reviews. Respondents provided the search terms they would type into PubMed to address their clinical question(s). All physician-provided searches …

Local Public Health System Partnerships: A Mixed Methods Multi-State Study, Priscilla A. Barnes

Dissertations

The purpose of this three-paper dissertation was to conduct a mixed methods multi-state examination of specific partnership-related activities among local public health systems (LPHSs) as well as to explore perceptions of LPHS practitioners regarding partnership practices.

In the first paper, secondary data analysis of questions from the National Public Health Performance Standards Program (NPHPSP, n = 110) was used to determine the frequency that partnership activities were conducted optimally (> 75% of the time) and whether any associations existed between three different partnership capacities. Activities were matched with relational, organizational, and programmatic capacities from the Collaborative Capacity Framework. Overall, 86% …