Health Policy Commons^™

Transplantability In Burdened Populations: A Regional Analysis Of The Robotic-Assisted Kidney Transplant Impact On Access Given Socioeconomic And Demographic Factors, Earnest James Davis Jr.

Dissertations

Introduction/Background

The social contract of health (SCOH) in America that governs healthcare interactions has listed toward provider organizations and away from the patient. End stage renal disease treatment provides an explicatory case to examine an unbalanced SCOH. The study evaluates whether the robot-assisted kidney transplantation (RAKT) technique allows for patients with higher body mass indices and of burdened socioeconomic and sociodemographic status improved access to transplant compared to traditional open kidney transplant (OKT).

Methods

The study set combined extant data for patients transplanted at Chicago from two data sets. Investigators used independent t-tests, chi-squared tests, survival analysis, analysis of frequencies, …

Rural Pregnant Women’S Experiences With Substance Use Disorder: A Qualitative Study, Cami Weber

Dissertations

Rural pregnant women with substance use disorder (SUD) are an understudied vulnerable population that often experiences poor pregnancy outcomes (Higgins et al., 2019; Jumah, 2016; Kramlich et al., 2018; Shaw et al., 2015). Despite the high prevalence and high burden associated with SUD, rural women are less likely than non-pregnant women to seek addiction treatment and complete an outpatient treatment program during pregnancy (Shaw et al., 2015). This study aimed to give voice to rural Missouri women with SUD. The research questions explored the life experiences and motivations for seeking treatment using a qualitative, descriptive research design with grounded theory …

Creating Comprehensive Wrap-Around Services For The Homeless Community: Exploring Network Activity Among Shelters And Service Organizations Within The South-Side Of Chicago, Gloria West

Dissertations

We may not all agree that the homeless community is increasing and that their essential needs to survive such as food, healthcare and housing are quality of life rights for everyone. We must adopt the compassion of the medical industry and understand the importance of how community programs and services impact their survival. The sense of urgency to address the issues of homelessness does not appear to be moving as fast as other government agendas hindering families and individual’s ability to achieve self-sufficiency. It is expected that the priorities within this population are addressed immediately, it should be understood that …

Barriers And Facilitators To Opioid Use Treatment And Recovery Services During Pregnancy, Loralie Woods

Dissertations

Purpose: To identify barriers and facilitators to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids.

Background: Over 130 Americans die daily after overdosing on opioids. Women have not been immune from opioid use disorders (OUDs), with a 4-fold increase from 1999-2010. The prevalence of opioid use among pregnant women increased from 1.5 per 1,000 hospital deliveries to 6.5. Although the annual National Surveys on Drug Use and Health (NSDUH) has provided information on risk factors for OUD related to socioeconomic and demographic factors, no studies using this data have identified barriers to opioid use …

Non-Traditional Church Involvement As A Life-Course Turning Point: Qualitative Interviews With Religious Offenders, William Hunter Holt

Dissertations

This research project conducted and then analyzed qualitative interviews from former and current addicts and criminal offenders who are voluntarily participating in the Christian faith at the same non-traditional, Protestant church. An abridged case study of this church is also provided for background and context. Life-course theory and grounded theory are utilized.

Both the offenders and this church were chosen in an attempt to better understand how the offenders’ involvement at this house of worship, along with their faith in general, have impacted them. Obtaining the perspectives of the offender is essential for three reasons. First, qualitative research conducted in …

Treatments For Cancer Given Orally: Patients' Perceptions Of Distress Due To Financial Toxicity, Ellen Carr

Dissertations

Purpose/Aims: For adult participants who have received or are receiving treatment for hematologic and solid tumor malignancies given orally, this study describes the relationship between participants’ experience of financial toxicity (FT), the participants’ perception of distress associated with FT, and participants’ self-identified adherence to prescribed treatments in the context of FT.

Background: FT has emerged as an additional source of distress for cancer patients. The costs of treatments given orally can be prohibitively expensive for patients. Therefore, these patients may experience considerable distress and may not adhere to treatments as prescribed.

Method: Descriptive cross-sectional correlational design study of a sample …

The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer

Dissertations

Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.

Methodology: This qualitative, descriptive research design identified …

Hospital Practices Related To Breastfeeding In Mississippi: A Socio-Ecological Approach, Amir Alakaam

Dissertations

Mississippi continues to have one of the lowest rates and the weakest support in respect to breastfeeding in the nation (Centers for Disease Control and Prevention, 2014a). Hospital practices supporting breastfeeding such as the Ten Steps to Successful Breastfeeding (TSSB) can dramatically increase breastfeeding rates and duration (Rosenberg, Stull, Adler, Kasehagen, & Crivelli-Kovach, 2008). The aim of this study was to explore breastfeeding practices in Mississippi hospitals based on two levels of the Socio-Ecological Model: the organizational level (phase I) examined the hospital practices based on the level of implementation of the TSSB; the individual level (phase II) examined knowledge …

National Quality Awards In Healthcare And Actual Quality In U.S. Hospitals, Beth M. Beaudin-Seiler

Dissertations

This study examined performance outcome data from the Medicare Compare Hospital database for differences in performance between national award-winning hospitals and non-national award-winning hospitals. Specific variables examined were related to clinical care and were identified in literature as well as professional medical associations and societies as being quality indicators. National award-winning hospitals were defined as those having received the Malcolm Baldrige Quality Award in Healthcare or the Healthgrades Distinguished Hospital for Clinical Excellence. The characteristics of highly reliable organizations were also used to align the indicators of excellence for Malcolm Baldrige and Healthgrades recipients. Finally, a closer examination of data …

An Evaluation Of The Primary Care Providers’ Perspective Of The Effects Of Moderate Alcohol Consumption On Health, Gisele Tchamba

Dissertations

The complexity of health benefits of moderate alcohol consumption (MAC) is well documented. From the World Health Organization recent report, impact of harm from alcohol consumption was 3.3 million deaths or 5.9 percent of all global deaths (WHO, 2014).

Yet, the benefits of MAC for better health and longer life expectancy compared with abstinence are advocated in numerous studies (Nova, Baccan, Zapatera and Marcos, 2012). However, the nature of alcohol, its role on human sufferings has generated disagreements in the scientific community. Analysis of the results of early studies advocating better health for moderate drinkers, reveal discrepancies regarding the influence …

A Study On Generic Prescription Substitution Policy As A Cost Containment Approach For Michigan’S Medicaid System, Khandaker Nayeemul Islam

Dissertations

Increasing health care costs have made management of Medicaid services to provide low-income families through Medicaid programs critical in the recent times. The number of Medicaid beneficiaries in Michigan has increased over the years mainly due to the downsizing of auto sectors. Currently, states spend almost 16% of their budget for Medicaid, making it the second largest item in the budget for most (Kaiser Foundation, 2010). Prescription drugs are a significant part of Michigan’s Medicaid costs. Higher costs caused a tremendous fiscal burden on Michigan in administering the program and providing prescription drugs for its patients. Michigan has implemented several …

A Comparative Analysis Of The Relationship Between Employee Perceptions Of An Organizational Leader's Commitment To Safety And Actual Injury Rates In A University Setting, David E. Oliver

Dissertations

The purpose of this study was to explore the correlation between employee perceptions of their supervisor’s commitment to safety (safety climate) and the actual rate of occupational injuries among the same employees. The study also aimed to examine the relationship between the employee perceptions of their supervisor’s leadership practices and the supervisor’s safety climate rating. In addition, this study examined the potential influence of employee demographic factors on their responses to survey questions. This research study sought to answer three primary questions: (1) Does a significant correlation exist between employee perceptions of his supervisor’s commitment to the health and safety …

Empirical Essays On The Impact Of Health-Aid On Health Outcomes, Elsy Thomas Kizhakethalackal

Dissertations

This dissertation consists of three essays that empirically explore the impact of multilateral health-aid on health outcomes like infant mortality rate (IMR) and incidences of an infectious disease, Tuberculosis, in developing economies. The first essay uses parametric and semiparametric mean regressions (additive and non-additive specifications) to capture the impact of education and health-aid on the IMR, after controlling for other covariates. Both specifications confirm education as an important factor in reducing IMR. However, the effect of health-aid on IMR is not significant. In our additive model, we do see a threshold level of health-aid after which the impacts of health-aid …

Degrees Of Institutionalization: Family Planning Policies And Programs In Senegal, 1980-2005, Yazmine Michelle Watts

Dissertations

Senegal's population growth rate of 2.7% is greater than double that of the world average of 1.16%. The Government of Senegal acknowledges the population problem and has made efforts to address this issue. For over the past two decades the United States Agency for International Development (USAID) has served as the predominant donor in Senegal's health sector and has been a strong supporter of Senegal's family planning program. The evolution of family planning in Senegal cannot be understood without considering the roles of culture, religion, decentralization and funding in the institutionalization process. This research addresses important questions concerning factors that …

Perceived Organizational Support And Ethical Work Climates As Predictors Of Turnover Intention Of Licensed Nurses In Skilled Nursing Facilities, Anna A. Filipova

Dissertations

The purpose of this study was twofold: (1) to replicate Victor and Cullen's (1987; 1988) studies to confirm whether ethical climates (ECs) arise in skilled nursing facilities (SNFs), and whether organizations and groups within organizations have identifiable ECs; and (2) to test a model that examines the effects of ECs and perceived organizational support (POS) on licensed nurses' turnover intention (TOI) through job satisfaction (JS) and organizational commitment (OC).

A cross-sectional survey design was implemented. Three hundred and fifty nine freestanding SNFs were selected in a midwestern state. While a total of 110 facilities (31%) agreed to participate, responses were …

Nongovernmental Program Replication And Implementation: What Can Community-Based Programs To Support The Uninsured Learn From Other Communities?, Raymond J. Higbea

Dissertations

This research study evaluated the replication and implementation of Project Access (a nongovernmental, structured program providing physician and health care services to the working-poor) in Grand Rapids, Michigan. A mixed methodological approach was used and included quantitative and qualitative methodologies. The qualitative method used was a self-administered mailed survey of all Project Access enrollees. This survey evaluated the enrollee's perceived health and lifestyle function, access to physician services, access and adherence to prescribed medication regimen, and barriers to physician services during the year pre- and post-enrollment in Project Access. The survey also evaluated the amount enrollees were able or willing …

Unintended Consequences In Public Policy: Formulation And Implementation Of Michigan’S Safe Delivery Of Newborns Law, Anne Julie Hacker

Dissertations

It is generally believed that social policy is the result of careful research and planning on the part of officials. Yet there often exists a gap between theformulation and implementation of many social policies. This gap brings with it conflict, which in turn may result in unintended consequences. Theseconsequences may be so antithetical to the formulators' original intent as to make the policy implementation paradoxical.

This qualitative research study examines the ambiguities, challenges, or boundaries that policy formulators placed on practitioners responsible for implementing Michigan's Safe Delivery of Newborns Act and that ultimately created unintended consequences indicative of a public …

Providing Uninsured Adults With Free Or Low-Cost Primary Care: Does It Influence Their Use Of Hospital Emergency Departments?, Anne G. Zahradnik

Dissertations

This study analyzes one component of the health care safety net to determine whether or not being enrolled in a free or low-cost primary care physician access program subsequently affects emergency room utilization by uninsured adults ages 18 through 64. Those individual decisions are analyzed from both public goods and rational choice schemas. Additionally, physician access programs of different formats (a low-cost physician referral program and a freewalk-in clinic) are analyzed and compared for relative effectiveness. The study is a quantitative analysis of more than 40,000 individual patient records rather than relying on qualitative patient recall or on analyzing broad …

The War On Drugs V. The War On Pain: Do Controlled Prescribing Laws Have A Role?, Susanne F. Homant

Dissertations

The illegal use of prescription drugs and the under-treatment of chronic pain are both considered serious public health issues in this country. Strong medicines classified as controlled substances by the DEA are often used to treat chronic pain conditions and are also known to be diverted to non-medical uses, thus a solution to one problem may happen at the expense o f the other. Prescription Monitoring Programs (PMPs) are public policies that are felt by many to address diversion of controlled substances, and are generally welcomed by law enforcement as an excellent tool in the war against drugs. A number …

Factors Affecting Treatment Program Development In A Mental Health Facility Serving Prisoners, Ruby Miranda Meriweather

Dissertations

There is a paucity of literature on how treatment programs for mentally ill prisoners are developed. Federal mandates require that services to mentally ill prisoners be comparable to what is offered in the community. Planners, therefore, must find ways to provide treatment programs that produce that outcome.

This research identified the most important factors that affect treatment program development and implementation to aid planners in designing treatment programs for mentally ill prisoners. This qualitative study, based on grounded theory, used a structured interview with 61 mental health staff (psychiatrists, nurses, psychologists, social workers, and activity therapists) across three categories (Administrative, …

Management Style, Organizational Climate, And Organizational Performance In A Public Mental Health Agency: An Integral Model, Pamela Sue Meserve Erbisch

Dissertations

This dissertation analyzes and estimates the interactions between domestic investment and each type of capital flow under uncertainty and capital market imperfection in 13 oil-producing countries from 1981 to 2003. First, we discuss the recent development in investment theories under uncertainty, irreversibility, and imperfect capital market. Secondly, decomposing uncertainty into permanent and transitory components--based on C-GARCH--we constructuncertainty measures of broad macroeconomic variables in addition to oil price.

Thirdly, a model of four simultaneous equations is developed to capture dynamic interactions. My contribution is twofold. First, not only do we consider the impact of uncertainty and credit market imperfection on investment, …

The Differences In Performance Between Large And Small Organizations In Mental Health Settings, Randy Parker

Dissertations

The quantitative part of this study examined the relationship between organizational size and staff performance in mental health group home settings.The data from two hundred and sixty-two group homes from small, medium, and large umbrella organizations were examined. The results of independent third party evaluations were compared across these umbrella organizations. Evaluations measured compliance and performance mandated by federal health and safety regulations.

The qualitative part of this study involved on-site interviews with group home staff from various organizations at various professional levels which scored either a low or a high number of errors. A qualitative analysis was conducted to …

The Relationship Between Locus Of Control And Nutrition Health Status Among Adult Wic Participants, Damita Jo Zweiback

Dissertations

The purpose of this study is to examine the relationship between locus of control orientation and the nutrition health status of adult WIC participants in Michigan. The locus of control variable is defined as the degree to which an individual perceives reinforcement or outcomes as contingent upon his or her own behavior. It ranges from internal to external. Internal locus of control is the individual's belief that s/he is an actor and can determine one's fate within limits. External locus of control is the person's belief that s/he is controlled by forces outside of one's self (Lefcourt, 1976; Koger, 1999). …

Demographic Factors Predictive Of Medicaid Enrollment In Michigan Counties, Dale Kennedy Howe

Dissertations

Recent changes in administration of the Medicaid program make it imperative that local agencies improve their ability to forecast demand for Medicaid services. In October of 1998 the State of Michigan redesigned the Medicaid specialty care in Michigan from a fee-for-service system to a capitated system. In a capitated healthcare system, financial risk is a result of unanticipated changes in the population size and mix. Numerous demographic factors, such as crime, population, unemployment, median age, income, and ethnicity may be used to improve the accuracy of predicted changes in enrollment for Medicaid. Using naive ordinary least squares models as the …

The Effects Of Reengineering On Hospital Performance Indicators, Linda Rutgers Albery

Dissertations

Reengineering was a management tactic designed to reduce costs and increase efficiencies in the work place. Although many hospitals reported reengineering efforts were a priority during the latter part of the 1990s, little research has been done to determine the effects of reengineering on cost and quality performance indicators.

This research studied a large regional medical center located in southwest Michigan, which implemented patient-focused care redesign. Within this medical center, ten separate and distinct patient care departments were studied over a 5-year period. These departments included critical care, medical, surgical, obstetric and pediatric areas. During the first year o f …

Developmental, Psychosocial, And Economic Predictors Of Healthy Newborns In Michigan’S Teenage Pregnancies, Cheryl Lauber

Dissertations

Teenage pregnancy is a critical health indicator. Using a risk reduction model, this study examined the relationship between the characteristics o f the teenage mother i and her newborn. The research questions were: ( I) what risk factors are associated with poor birth outcomes, (2) is addressing each factor the best way to reduce the risk, and (3) has the overall risk changed as the birth rate has declined? Developmental, psychosocial and economic risks were identified as independent variables, while age and race were mediators.

Combining the birth certificate records of women under age 20 from 1990 through 1997 resulted …

Health Care Beliefs Of Nursing Students As Predictors Of Intentions To Care For A.I.D.S. Patients, Catherine Ellen Earl

Dissertations

The purposes of this study were (a) to determine if information about AIDS taught using two different formats, lecture discussion and video discussion, results in differential retention of content about AIDS; (b) to determine if health care beliefs about AIDS change after exposure to a lecture or a video about AIDS among first year nursing students in rural community colleges; and (c) to examine whether the differences in intentions to provide care for AIDS patients are associated with health care beliefs about AIDS. In this study, both qualitative and quantitative research methods were used. The study was conducted over two …

Outcomes Related To The Quality Of Life Of Oncology Patients Aged 65 And Older Following Initial Cancer Treatment, Rosemary Clare Zivic

Dissertations

The purpose of this study was to determine whether there were changes in the quality of life of cancer patients aged 65 and older (N>488) following initial treatment for cancer. A Quality of Life conceptual model was developed. Quality of Life refers specifically to physical, social, and functional status. The study analyzed data from a larger longitudinal data set and compared data for patient’s with prostate, breast, lung, and colon cancer at three observation points: (1) three month Recall, (2) after surgery and prior to chemotherapy or radiation (Wave I), and (3) fourteen weeks following surgery, during chemotherapy or …

Crises In The Regulation Of Long-Term Care, Randall Earl Phillips

Dissertations

This study reviews the history of the legislative process that led to the passage of the Nursing Home Reform Act of 1987 and the implementation of the regulations. The analysis uses the model of Masmanian and Sabatier to identify the variables and assess their impact on the implementation process. The content of the regulations in terms of various statutory and nonstatutory variables is assessed, and an estimate is made of their effect on the program.

Three aspects of the regulations are examined. First, the relative importance of how compliance is to be determined--subjectively, objectively, or clinically. Second, the design and …

The Rise And Decline Of Mental Health Hospitals In The State Of Michigan, Gerald H. Smith

Dissertations

The State of Michigan has been partially responsible for the treatment of the mentally ill population since 1832, when Wayne County General Hospital opened its doors. The state government made a commitment to care for the afflicted, and at the same time provide an opportunity for other individuals to participate in their treatment. Eventually this commitment led to the establishment of employment for many citizens, and gradually, over the decades, a mental health bureaucracy emerged. It was necessary to hire not only professional staff, but also support staff such as food services, housekeeping, maintenance, and the like. Mental health facilities …