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Planning Implementation Success Of Syncope Clinical Practice Guidelines In The Emergency Department Using Cfir Framework, Jing Li, Susan S. Smyth, Jessica M. Clouser, Colleen A. McMullen, Vedant A. Gupta, Mark V. Williams 2021 University of Kentucky

Planning Implementation Success Of Syncope Clinical Practice Guidelines In The Emergency Department Using Cfir Framework, Jing Li, Susan S. Smyth, Jessica M. Clouser, Colleen A. Mcmullen, Vedant A. Gupta, Mark V. Williams

Center for Health Services Research Faculty Publications

Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, research indicates that current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guidelines (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators ...


Identifying Causes Of Readmission At Unm Hospital, Jewel Meyer-Hagen MS3, Justine Yang MS3, Christopher Bartlett MD, Avanika Mahajan MS3, Susie Pham MS3, Ishan Shah DO, Harsh Sharma MD, Jessie Rogers MD, Brianna Muller MD, Julia Howard DO, Radha Denmark NP, Gabriel Palley MD, Anthony Worsham MD 2021 University of New Mexico

Identifying Causes Of Readmission At Unm Hospital, Jewel Meyer-Hagen Ms3, Justine Yang Ms3, Christopher Bartlett Md, Avanika Mahajan Ms3, Susie Pham Ms3, Ishan Shah Do, Harsh Sharma Md, Jessie Rogers Md, Brianna Muller Md, Julia Howard Do, Radha Denmark Np, Gabriel Palley Md, Anthony Worsham Md

Quality Improvement/Patient Safety Symposium

Background/Introduction:

Inadequate coordination of care and poor transition of care quality are known contributors to hospital readmission. Patient readmission is a known risk factor for poor patient outcomes. Department of Internal Medicine (DOIM) readmission rate was 13.18% during fiscal year (FY) 2020, and is 13.58% to date during FY21. The objective of this study is to identify system-based drivers of readmission, understand why the readmission rate has increased from FY20 to FY21, and design interventions to address identified gaps.

Methods:

Developed a survey using RedCap. Retrospective chart review of 104 randomly selected patients discharged from UNMH during ...


The Role Of A Monoclonal Gammopathy Of Undetermined Significance Diagnosis In Healthcare Utilization, Maira A. Castaneda-Avila 2021 University of Massachusetts Medical School

The Role Of A Monoclonal Gammopathy Of Undetermined Significance Diagnosis In Healthcare Utilization, Maira A. Castaneda-Avila

GSBS Dissertations and Theses

Background

Monoclonal Gammopathy of Undetermined Significance (MGUS) is an understudied precursor of multiple myeloma (MM), the second most prevalent hematologic malignancy in the United States. This dissertation was designed to: (1) Describe the trajectories of serum biomarkers over time in patients with an MGUS diagnosis, (2) Determine if an MGUS diagnosis is associated with changes in healthcare service utilization, and (3) explore the patient- and provider-level drivers of healthcare utilization in patients with MGUS.

Methods

Data sources include health claims and electronic health records from a community-based population of patients seeking care in central Massachusetts and primary qualitative data collected ...


Effects Of Social Determinants Of Health In Progression To Type 2 Diabetes, Folabi I. Ariganjoye 2021 University of Tennessee Health Science Center

Effects Of Social Determinants Of Health In Progression To Type 2 Diabetes, Folabi I. Ariganjoye

Applied Research Projects

The prevalence of prediabetes and diabetes in the United States and around the world has increased faster than expected in the last 30 years. The economic burden this costs a nation can be astronomic both in terms of expense and loss in productivity. One-third of U.S. adults, 86 million people, have prediabetes. Effective management is needed that can reach these 86 million, and others at high risk, to reduce their progression to diagnosed Type 2 diabetes. After the literature review, there was not enough literature to support how these led to the progression to diabetes. The abundant literature is ...


Measuring The Impact Of The Affordable Care Act Medicaid Expansion On Access To Primary Care Using An Interrupted Time Series Approach, Elizabeth A. Brown, Brandi M. White, Walter J. Jones, Mulugeta Gebregziabher, Kit N. Simpson 2021 Medical University of South Carolina

Measuring The Impact Of The Affordable Care Act Medicaid Expansion On Access To Primary Care Using An Interrupted Time Series Approach, Elizabeth A. Brown, Brandi M. White, Walter J. Jones, Mulugeta Gebregziabher, Kit N. Simpson

Health and Clinical Sciences Faculty Publications

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.

METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to ...


Loss Of Obstetric Services In Rural Appalachia: A Qualitative Study Of Community Perceptions, Caroline R. Efird, David Dry, Rachel F. Seidman 2021 University of North Carolina at Chapel Hill

Loss Of Obstetric Services In Rural Appalachia: A Qualitative Study Of Community Perceptions, Caroline R. Efird, David Dry, Rachel F. Seidman

Journal of Appalachian Health

Background: As rural hospitals across the United States increasingly downsize or close, the availability of inpatient obstetric services continues to decline in rural areas. In rural Appalachia, the termination of obstetric services threatens to exacerbate the existing risk of adverse birth outcomes for women and infants, yet less is known about how the cessation of these services affects the broader community.

Purpose: The purpose of this paper is to explain how the loss of local obstetric services affects perceptions of healthcare among multi-generational residents of a remote, rural Appalachian community in western North Carolina.

Methods: An interdisciplinary team of researchers ...


Rurality As A Moderator Of Perception Of Need For Medical Care And Patient Satisfaction, Kyndal Grammer 2021 East Tennessee State University

Rurality As A Moderator Of Perception Of Need For Medical Care And Patient Satisfaction, Kyndal Grammer

Electronic Theses and Dissertations

Many individuals experience barriers to accessing medical care, especially in rural areas. Some barriers are attitudinal and represent perceptions of quality care. Patient satisfaction and perceived need for medical care are two such attitudinal barriers related to health care utilization, yet the relationship between these variables has not been explored. Using data from an online survey, the current study examined the association between these variables, and further, whether rurality status moderated this association. Results indicated a significant correlation between patient satisfaction and perception of need. Although the overall moderation model was significant, perception of need was not significantly associated with ...


Access To Healthcare For The Hispanic/Latino Population, Rebecca Loritz 2021 University of Arkansas, Fayetteville

Access To Healthcare For The Hispanic/Latino Population, Rebecca Loritz

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: The U.S. Hispanic/Latino population faces significant barriers to accessing healthcare. The most common barriers Latinos face are language barriers, cost barriers, immigration statuses, insurance coverage barriers, transportation barriers, health literacy and education barriers, as well as lack of access to healthcare providers. These barriers impact not only their ability to access healthcare but also the quality of healthcare they receive.

Purpose: To synthesize the existing literature evaluating that identifies barriers to healthcare.

Methods: CINAHL and PubMed were systematically searched, along with a manual internet search for journal articles that studied access to care issues for the Latino ...


Medicare-Paid Naloxone: Trends In Non-Metropolitan And Metropolitan Areas, Chris Delcher, Yue Cheng, Minji Sohn, Jeffery C. Talbert, Patricia R. Freeman 2021 University of Kentucky

Medicare-Paid Naloxone: Trends In Non-Metropolitan And Metropolitan Areas, Chris Delcher, Yue Cheng, Minji Sohn, Jeffery C. Talbert, Patricia R. Freeman

Rural & Underserved Health Research Center Publications

Overview of Key Findings

  • Medicare pays for the largest share (> 30%) of naloxone dispensed from retail pharmacies in non-metropolitan areas.
  • Medicare-paid dispensing has grown since 2013, but from 2017-2018 dispensing growth in non-metropolitan areas slowed considerably compared to metropolitan areas (42% v 121%, respectively).
  • As of 2018, the rate of naloxone dispensing to Medicare enrollees in metropolitan areas was approximately double that in non-metropolitan areas (4.9 v 2.9 per 1,000 enrollees, respectively).


An Intersectional Analysis Of Lgbtq+ Healthcare In The United States, Nicole Niles 2021 University of Rhode Island

An Intersectional Analysis Of Lgbtq+ Healthcare In The United States, Nicole Niles

Senior Honors Projects

LGBTQ+ healthcare has made some significant progress in the last few decades, yet countless studies have shown that the American healthcare system still lags behind in equitable healthcare. My project sought to identify the issues that prevent the LGBTQ+ community from receiving quality healthcare, which involved the curation of over twenty academic journal articles for an annotated bibliography, along with a paper discussing these articles.

One of the most important concepts to gender studies is intersectionality. Coined by legal theorist Kimberlé Crenshaw in 1989, intersectionality describes the concept of how one’s individual characteristics, including race, class, and gender, intersect ...


Social Justice Attitudes And Health: A Cross Sectional Study, Edward Donovan 2021 University of Rhode Island

Social Justice Attitudes And Health: A Cross Sectional Study, Edward Donovan

Senior Honors Projects

Background: Increasingly, social justice is being considered as a key factor associated with health outcome. In addition, there is growing interest in exploring perception of discrimination in healthcare settings. This study explored perceptions of social justice, health care discrimination, health care status and utilization of healthcare resources. The investigators predict a significant association between the level of social justice awareness and healthcare utilization based on the hypothesis that those who are cognizant of social inequities are more likely to be informed self-advocates in healthcare settings.

Methods: First, a survey was created based on a review of existing literature. The survey ...


Nebraska Public Guardianship Of Unbefriended Patients: A Preliminary Review Of Health Outcomes And Cost Savings, Emily N. Berzonsky 2021 University of Nebraska Medical Center

Nebraska Public Guardianship Of Unbefriended Patients: A Preliminary Review Of Health Outcomes And Cost Savings, Emily N. Berzonsky

Capstone Experience

Unbefriended patients often experience an extended length of stay in the hospital while their medical providers await legal appointment of a public guardian to make their medical decisions. The medically unnecessary days the unbefriended patient spends in the hospital equates to high costs for the hospital, but more importantly, negative health outcomes for the patient. The purpose of this study is to provide literature and data to support recommendations for possible changes in Nebraska’s public guardianship appointment process. A literature review seeks to answer: (1) What is the median hospital length of stay for an unbefriended patient without a ...


Agreement Success Plan, Miranda Holtz 2021 California State University, Monterey Bay

Agreement Success Plan, Miranda Holtz

Capstone Projects and Master's Theses

Monterey County Health Department’s Administration Bureau works with contracts and agreements for the Public Health Bureau, which detail what services programs will complete so that they can receive funding or maintain a partnership with the County. The problem was that a large portion of the management analyst’s time was dedicated towards technical support for agreements. The Agreement Success Pan is aimed to increase efficiency by aiding program staff with agreements through a Prezi, which is similar to a self-paced webinar. The project had three phases; interviews of program supervisors or managers, gathering supporting documents, and final launch. Afterward ...


Exposure To Weight Management Counseling Among Students At 8 U.S. Medical Schools, Karen M. Ashe, Alan C. Geller, Jyothi A. Pendharkar, Lori Pbert, Sybil L. Crawford, Melissa A. Clark, Christine F. Frisard, Cassie A. Eno, Jamie Faro, Judith K. Ockene 2021 University of Massachusetts Medical School

Exposure To Weight Management Counseling Among Students At 8 U.S. Medical Schools, Karen M. Ashe, Alan C. Geller, Jyothi A. Pendharkar, Lori Pbert, Sybil L. Crawford, Melissa A. Clark, Christine F. Frisard, Cassie A. Eno, Jamie Faro, Judith K. Ockene

University of Massachusetts Medical School Faculty Publications

INTRODUCTION: Clinical guidelines support physician intervention consistent with the Ask, Advise, Assess, Assist, Arrange framework for adults who have obesity. However, weight management counseling curricula vary across medical schools. It is unknown how frequently students receive experiences in weight management counseling, such as instruction, observation, and direct experience.

METHODS: A cross-sectional survey, conducted in 2017, of 730 third-year medical students in 8 U.S. medical schools assessed the frequency of direct patient, observational, and instructional weight management counseling experiences that were reported as summed scores with a range of 018. Analysis was completed in 2017.

RESULTS: Students reported the least ...


Testing Of Patients First In A Real-World Setting, As A Patient Experience Accreditation Tool For Hospitals And Clinics, Carlos Bezos, Rosa M. Salazar, María Caballero 2021 Instituto paraa la Experiencia del Paciente

Testing Of Patients First In A Real-World Setting, As A Patient Experience Accreditation Tool For Hospitals And Clinics, Carlos Bezos, Rosa M. Salazar, María Caballero

Patient Experience Journal

Many healthcare providers are developing patient experience strategies and investing in this area. Yet, patients have no means to know if a hospital is following proper patient experience standards. For this reason, it is important to certify that hospitals and clinics follow own a patient experience policy and apply patient experience standards. This is the reason why the accreditation Patients First was developed. The goal of this study is to test the accreditations’ feasibility in a real-life environment. The accreditation was tested at the Guadarrama Hospital, nearby Madrid in Spain. A mixed team between Guadarrama staff and the Institute for ...


Patient And Provider Perspectives Regarding Criteria For Patient Prioritization In Two Specialized Rehabilitation Programs, Julien Déry, Angel Ruiz, François Routhier, Marie-Pierre Gagnon, André Côté, Daoud Ait-Kadi, Valérie Bélanger, Marie-Eve Lamontagne 2021 Université Laval

Patient And Provider Perspectives Regarding Criteria For Patient Prioritization In Two Specialized Rehabilitation Programs, Julien Déry, Angel Ruiz, François Routhier, Marie-Pierre Gagnon, André Côté, Daoud Ait-Kadi, Valérie Bélanger, Marie-Eve Lamontagne

Patient Experience Journal

To increase fairness and equity in access to rehabilitation services, a strategy emerging from the literature is patient prioritization. Selecting explicit prioritization criteria is a complex task because it is important to simultaneously consider the objectives of all stakeholders. The of this study was to compare service users’ and service providers’ perspectives regarding patient prioritization criteria in two rehabilitation programs. We conducted a multiple case study in two rehabilitation programs, i.e., a driving evaluation program and a compression garment manufacturing program. We sent a web-based survey asking two groups (patients and providers) to individually produce a set of criteria ...


Exploring Mental Health Experience In Individuals Living With Temporomandibular Disorders, Wafaa Safour, Richard Hovey 2021 Mcgill University / Sebha University

Exploring Mental Health Experience In Individuals Living With Temporomandibular Disorders, Wafaa Safour, Richard Hovey

Patient Experience Journal

Despite the evidence supporting deteriorating mental health because of temporomandibular disorders (TMDs) conditions, there is limited evidence of TMD patients' experience regarding how their mental health is affected by the disorders. As a sequence of these conditions, TMD patients suffer from physical and mental complications, not to mention the loss of food enjoyment. In this study, we aim to explore TMD patients' lived experiences who had changed their dietary habits concerning their mental health. Six participants were interviewed to answer open-ended questions during semi-structured interviews regarding their mental health experiences with TMD-related food routine changes. These interviews were held face-to-face ...


Co-Production Of The Quality Of Patient-Centered Outcomes Research Partnerships Instrument For People With Mental Health Conditions, Karen L. Fortuna, Amanda Myers, Jessica Brooks, Caroline Collins-Pisano, Skyla Marceau, Sarah Pratt, Kathy Lyons, Robert Walker, Shavon Thompson, Kaycie Greene, Willie Pringle, Katina Carter 2021 Dartmouth College

Co-Production Of The Quality Of Patient-Centered Outcomes Research Partnerships Instrument For People With Mental Health Conditions, Karen L. Fortuna, Amanda Myers, Jessica Brooks, Caroline Collins-Pisano, Skyla Marceau, Sarah Pratt, Kathy Lyons, Robert Walker, Shavon Thompson, Kaycie Greene, Willie Pringle, Katina Carter

Patient Experience Journal

Mounting scientific evidence over the past decades in the field of psychiatry has shown community engagement in research produces more relevant research, increased uptake of research findings, and better clinical outcomes. Despite the need for the integration of community engagement methodologies into the scientific method, doctoral and master's level competencies in the field of psychiatry commonly do not include dedicated training or coursework on community engagement methodologies. Without appropriate training or research experience, attempts to facilitate community engagement are often ineffective and burdensome and leave stakeholders feeling disenfranchised. The goal of this study was to co-produce an instrument designed ...


Partnering With Patients To Design A Prehabilitation Program For Optimizing The Patient Experience Through General Surgery, Jacqueline Francis-Coad, Dale Edgar, Caroline E. Bulsara, Alix Barrett-Lennard, Kristine Owen, David Fletcher, Fiona Wood, Anne-Marie Hill 2021 Curtin University, Bentley WA

Partnering With Patients To Design A Prehabilitation Program For Optimizing The Patient Experience Through General Surgery, Jacqueline Francis-Coad, Dale Edgar, Caroline E. Bulsara, Alix Barrett-Lennard, Kristine Owen, David Fletcher, Fiona Wood, Anne-Marie Hill

Patient Experience Journal

The objective of this study was to explore patients’ experiences when preparing for and undergoing general surgery at a large tertiary hospital. Findings aimed to inform the development of a prehabilitation program to empower patients to optimize their recovery and enhance their experience of general surgery. A qualitative exploratory research approach was utilized. Patients (>18 years) attending for elective general surgery between May and July 2018 were invited to participate. Four focus groups (n=18) and an interview were conducted to reach saturation. Deductive content analysis was used to map responses against theoretical determinants of health behavior change. Patients described ...


The Experiences Of Rural British Columbians Accessing Surgical And Obstetrical Care, Aria Jazdarehee, Anshu Parajulee, Jude Kornelsen 2021 University of British Columbia Faculty of Medicine

The Experiences Of Rural British Columbians Accessing Surgical And Obstetrical Care, Aria Jazdarehee, Anshu Parajulee, Jude Kornelsen

Patient Experience Journal

The attrition of small volume surgical and maternity services in rural Canada over the past three decades has made access to these services especially challenging for rural citizens. While many of these closures have occurred as consequences of regionalization, a strategy to regionally centralize healthcare services, many studies investigating outcomes of regionalization have focused on costs and medical endpoints rather than the direct experiences of the rural patients affected. In this study, we aimed to understand and document the experiences of rural residents accessing procedural and maternity care both locally and away from home. This study is part of a ...


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