Digital Commons Network^™

Meta Echo: Using All-Payers Claims Data Analysis As Part Of A Multi-Layered Approach To Plan An Evaluate Echo Programs, Marcy Doyle, Erica Plante

Faculty Publications

No abstract provided.

Aligning Investments To Improve Population Health: A Statewide Strategy To Address The Social Determinants Of Health, Michael E. Swack, Sarah Boege, Kevin Barnett

The Carsey School of Public Policy at the Scholars' Repository

In this report, authors Michael Swack, Sarah Boege, and Kevin Barnett discuss the initiative to develop a statewide strategy to address the social determinants of health in New Hampshire. Launched in 2020, this project is a collaboration between the Center for Impact Finance at the Carsey School of Public Policy at UNH, the Center to Advance Community Health and Equity (CACHE) at the Public Health Institute, the Institute for Health Policy and Practice at UNH, and the New Hampshire Hospital Association/Foundation for Healthy Communities. Michael Swack, director of the Center for Impact Finance at the Carsey School, serves as the …

Improving Provider Retention Through Addressing Burnout At A Federally Qualified Health Center: A Quality Improvement Initiative, Emily Grattan

DNP Scholarly Projects

Background: Primary care providers employed by federally qualified health centers (FQHC) working with underserved populations experience high levels of burnout as patients are often medically complex, face healthcare disparities and societal stigmas. The aim of the project was to alleviate burnout and improve provider retention through introduction of organizational support measures. Participants involved were healthcare providers, as well as nurse management and senior leadership.

Methods: The quality improvement approach for this project utilized the Plan-Do-Study-Act (PDSA) cycle and a driver diagram to guide the selected interventions. Interventions were based on categories from Mayo’s Clinic’s Nine Organizational Strategies to Promote Engagement …

A Quality Improvement Initiative: Addressing Workplace Violence Toward Nurses To Promote A Culture Of Safety In An Inpatient Psychiatric Facility, Ernestina Danso

DNP Scholarly Projects

This quality improvement initiative aimed to address workplace violence against nurses in inpatient psychiatric facilities and promote a culture of safety. The QI project involved 27 participants, including inpatient psychiatric nurses and mental health counselors from Cahill 4 and 7 West units at the Cambridge Campus. The primary objective was to identify challenges that hindered the effective utilization of the Broset Violence Checklist (BVC) tool for referring patients to sensory modulation rooms.

Pre- and post-intervention surveys were conducted to assess participants' self-reported knowledge and barriers to BVC and sensory room utilization. Educational sessions covering workplace violence, debriefing techniques, and the …

A Quality Improvement Initiative To Improve Access And Patient Flow In A Non-Emergency Walk-In Care Clinic, Renee J. Broze

DNP Scholarly Projects

Background: A community-based non-emergency walk-in clinic in Southern New Hampshire experienced high volume and inefficient workflows during the pandemic, causing delays in care, long visit times, and low net promoter scores.

Purpose: Institute an evidence-based approach to improve work efficiency through innovative models of care.

Methods: A literature review on best practices for workflow redesign guided the project. The project instituted an on-demand telemedicine service and a clinic fast-track workflow. A mixed methods approach analyzed pre /post cycle times, net promoter scores, and themes from staff interviews. Pre/post cycle times analyzed 12,767 completed appointments.

Results: There was a statistically significant …

Enhancing Nurses' Self-Efficacy In Smoking Cessation Counseling To Improve Patient- Centered Care At A Federally Funded Urgent Care Center: A Quality Improvement Initiative, Adam N. Waller Ii

Master's Theses and Capstones

Background: It is well documented that there is a high prevalence of Veteran tobacco use in the United States. Additionally, providing smoking cessation counseling in an emergency setting is beneficial. The broader Veteran Affairs (VA) macrosystem has a plethora of smoking cessation resources available for Veterans. Within a VA Urgent Care Center (UCC) a quality improvement initiative was conducted that focused on increasing registered nurses (RNs) self-efficacy in providing smoking cessation counseling. Prior to this quality improvement (QI) project, smoking cessation did not occur in this UCC. If RNs have higher self-efficacy more smoking cessation counseling will occur.

Methods …

Implementation Of A Multipronged Approach To Improve Pre-Operative Efficiency And First Case On Time Start Performance, Melyssa A. Stokes

Master's Theses and Capstones

Background: Surgical services are an important source of revenue and important economic driver of hospital systems. Surgical services account for approximately 42% of a hospital’s annual revenue, however, it also constitutes 40% of facility operating costs (Gupta, et al., 2022 & Morel & Gomez, 2021). Despite the high costs associated with surgical services delays remain a significant issue across the nation. On-time starts for the first surgical cases of the day is a key performance metric tracked by surgical facilities to determine efficiency. Currently, 50 – 90% of first surgical cases are delayed throughout the United States and the most …

Engaging Nurses In Public Policy, Carlene Ferrier

DNP Scholarly Projects

Background: Nurses have been engaged in public policy since the inception of the profession. Academicians and thought leaders recognize the importance of nurses engaging in public policy to improve health and healthcare. Nurses are also the largest healthcare group and the most trusted profession for twenty years, yet they are minimally represented in the state and federal legislature. Nurses possess a skill set that is directly transferable to the policy arena such as listening and communicating effectively, leading by inspiring a shared vision, applying evidence-based research, and collaborating and building relationships to achieve a common goal. Locally, the New Hampshire …

College Of Health And Human Service Faculty’S Confidence And Inclusion Of Lgbtq+ Health Content In Curriculum, Carley S. Kanter

Honors Theses and Capstones

In the health care system, those who identify as lesbian, gay, bisexual, transgender, queer, (LGBTQ+) face discrimination and health disparities. Students who are better prepared in higher education to provide care for this population have higher levels of confidence in LGBTQ+ health content than those who have less exposure. Therefore, faculty who teach curriculum related to health and wellness have an opportunity to prepare students to provide high quality, patient centered care by teaching culturally competent care that is inclusive of LGBTQ+ populations. The aim of the study is to determine whether the degree of confidence in teaching LGBTQ+ health …

Improving Breastfeeding Establishment By Reducing The Use Of Bottles And Artificial Nipples With Medically Needed Supplementation In Full-Term Breastfed Infants: A Quality Improvement Project, Sara Fazzi Garcia

Master's Theses and Capstones

Background: Breastfeeding has long been strongly recommended by national and international organizations as a prevention of many common and chronic diseases. Baby-Friendly Hospital Initiative (BFHI) was developed to motivate hospitals to protect, promote, and support breastfeeding. This Quality Improvement (QI) project aims at supporting the continuation of the Baby-Friendly designation at the organization is being implemented, by focusing on reducing the use of bottles and artificial nipples for medically necessary supplementation for full-term breastfed newborns.

Methods: The Plan-Do-Study-Act (PDSA) framework was utilized to guide this quality improvement project.

Intervention: Educational posters on the interference of the use …

Improving Health Literacy Among Veterans Through An Educational Campaign On Urgent And Emergent Care: A Quality Improvement Project, Emily Dimarino

Master's Theses and Capstones

Background: Inappropriate use of the VAMC UCC can translate to delays in care and costly transfers. A local VAMC UCC noted that many of their veterans presented for care at the UCC rather than choose to seek care at a local emergency department. This quality improvement project focused on the impact of educational handouts in improving understanding of the VAMC UCC capabilities to overall reduce inappropriate visits and delays in patient care. Methods: Veteran participants utilizing the UCC (n = 10) completed pre-intervention surveys regarding their current health literacy using the Brief Health Literacy screening tool (BRIEF), as well as …

Integrating Yoga Into A Medication Assisted Treatment Program To Improve Retention, Linda Davidson

DNP Scholarly Projects

Background: In 2017, Health and Human Services declared the opioid epidemic a public health emergency (US Department of Health & Human Services, 2017). As a response, access to medication assisted treatment (MAT) programs was encouraged. In 2016, a community health center in Western North Carolina started a MAT program integrating buprenorphine treatment with behavioral health (BH) services. Data from May 2018 through May 2019 demonstrated retention in the MAT program ranged from 65-75% at a given time with behavioral health attendance under 50%.

Aims: The aim of this quality improvement project was to examine if integrating yoga, an …

Moving A Licensed Practical Nurse To A Registered Nurse In New Hampshire: A Health Policy Initiative, Vicki Gamez

DNP Scholarly Projects

Background: The United States is expected to experience a shortage of Registered Nurses (RN) due to a demand for more nurses to care for an aging population. Not only is there a current deficit in the number of RNs, but there is also a lack of ethnic and racial diversity among RNs. Licensed Practical Nurse (LPN) transition programs increase workforce mobility and allow LPNs to build upon their education and clinical experience as they transition to the RN roles. Therefore, the aim of this DNP project was to implement a health policy change initiative that addresses the barriers of workforce …

Evaluation Of Antimicrobial Efficacy In Shelter Cats With Upper Respiratory Infection: A Prospective Study, Jillian R. Broadhurst, Sarah E. Proctor Dvm

Student Research Projects

Feline Upper-Respiratory Infection (URI) is commonplace in most animal shelters, and its endemic presence is problematic for the animals as well as for veterinarians and other shelter personnel. Despite the fact that viruses are responsible for the majority of these infections, many cats with URI in shelters are still treated with antibiotics. Antibiotic treatment in the absence of bacterial infection and the overuse of antibiotics can lead to antibiotic resistance among feline populations. The aim of this research was to compare duration and severity of URI in shelter cats treated with and without antibiotics. Cats showing clinical symptoms were randomly …

A Pilot Of Emergency Department-Initiated Buprenorphine For Opioid Withdrawal And Opioid Use Disorder: A Quality Improvement Project, Jason Lucey

DNP Scholarly Projects

Background: Emergency department (ED) visits for opioid related visits have increased dramatically during the opioid epidemic. Buprenorphine is an evidence-based therapy for treating opioid use disorder (OUD) and withdrawal. Unfortunately, lack of access to pharmacotherapy for OUD, including buprenorphine, remains a challenge. Research supports ED-initiated buprenorphine as a practical, cost-effective strategy which engages patients in treatment better than non-pharmacologic alternatives.

Purpose: The aims of this improvement project were to 1) develop a pilot process in an ED for providing buprenorphine to patients in opioid withdrawal or for OUD; 2) recruit and train a cohort of ED staff on the process; …

Healthcare Management Primer, Students Of Health Management 721.01 (2017), University Of New Hampshire, Mark Bonica

Open Educational Resources

This primer was written by students enrolled in HMP 721.01, Management of Health Care Organizations, in the Health Management & Policy Program, College of Health and Human Services, University of New Hampshire. This course was taught by Professor Mark Bonica in Fall 2017.

Localization Of Cck(+) Neurons In The Sensory Pathways Of Mus Musculis, Zachary Ryan Tepper

Honors Theses and Capstones

With dependence upon opioids, such as codeine, morphine, and heroin, steadily increasing amongst the American public, the withdrawal symptoms associated with disuse are receiving much more attention. Our research identifies neurons that are implicated in the hyperanalgesic response to the cessation of opiate-medication after dependence has been established. These neurons are identified by the Cholecystokinin protein (CCK). The first chapter of this research focuses on localizing these neurons in regions of the central nervous system that are responsible for transducing painful signals from the periphery to the brain. Our research supports the hypothesis that neurons with high levels of CCK …

Oral Health Care Access In New Hampshire, Eleanor M. Jaffee, Joan Widmer, Lisa Speropolous

The Carsey School of Public Policy at the Scholars' Repository

In this brief, authors Eleanor M. Jaffee, Joan Widmer, and Lisa I. Speropolous provide an overview of the current state of oral health care in New Hampshire. They report that although New Hampshire is rated above the national average on most measures of pediatric oral health, performance varies substantially by county and by region. Access to adequate oral health care for both children and adults is particularly challenging for low-income families in the sparsely populated northern region of the state. Programs that address oral health care access issues by bringing services to those with the greatest need, such as school-based …

Student Health Benefits Plan Market Research And Analysis, Zachary William Doucette

Honors Theses and Capstones

The University of New Hampshire (UNH) in Durham, New Hampshire requires all full-time students to have health insurance meeting set requirements as a condition of enrollment. UNH offers its own health plan, entitled the Student Health Benefits Plan (SHBP) through its Health Services Center to students as a way to procure this insurance if they lack insurance, or if their current insurance is insufficient or does not meet the insurance requirements. Health Services at UNH is looking for market research on current attitudes, perceptions, and beliefs of both students at UNH, and the parents of students who currently have a …

Interviewing Adults With Intellectual Disabilities About Oral Health In Brisbane, Australia, Meghan Maguire

Inquiry Journal 2014

No abstract provided.

Do You Believe He Can Fly? Royce White And Reasonable Accommodations Under The Americans With Disabilities Act For Nba Players With Anxiety Disorder And Fear Of Flying, Michael Mccann

Law Faculty Scholarship

This Article examines the legal ramifications of Royce White, a basketball player with general anxiety disorder and obsessive compulsive disorder, playing in the NBA. White's conditions cause him to have a fear of flying, thus making it difficult to play in the NBA. This subject is without precedent in sports law and, because of the unique aspects of an NBA playing career, lacks clear analogy to other employment circumstances. This dispute also illuminates broader legal and policy issues in the relationship between employment and mental illness.

This Article argues that White would likely fail in a lawsuit against an NBA …

The Ideal Whole Health Family Oriented Community Center, Jessica St. Germain

Honors Theses and Capstones

This paper discusses what would make up the ideal whole health family oriented community center. It looks at the history of community centers in a general manner, and it looks at three existing community centers in New Hampshire. This paper also addresses potential problems and difficulties a whole health family oriented community center might face.

Infusing Oral Health Care Into Nursing Curriculum: Addressing Preventive Health In Aging And Disability, Joan Earle Hahn, Leah Fitzgerald, Young Kee Markham, Paul Glassman, Nancy Guenther

Nursing

Access to oral health care is essential for promoting and maintaining overall health and well-being, yet oral health disparities exist among vulnerable and underserved populations. While nurses make up the largest portion of the health care work force, educational preparation to address oral health needs of elders and persons with disabilities is limited across nursing curricula. This descriptive study reports on the interdisciplinary development, implementation, and testing of an oral health module that was included and infused into a graduate nursing curriculum in a three-phase plan. Phase 1 includes evaluation of a lecture presented to eight gerontological nurse practitioner (GNP) …

Revisiting The Regulation Debate: The Effect Of Food Marketing On Childhood Obesity, Nicole E. Hunter

The University of New Hampshire Law Review

[Excerpt] “Despite the widespread concern regarding childhood obesity, there is broad divergence of opinion regarding responsibility for the crisis. Whether the government, food industry, or parents are accountable has become the focus of much debate. Public health groups have attempted various strategies to confront childhood obesity, such as litigation, legislation, and government regulation. While many researchers and advocates agree that government should play an affirmative role with respect to childhood obesity, they are very much divided over what that role should be. For example, although none of these acts has become law, eighty-six bills have been proposed regarding obesity since …

Looking Back At Fluoridation, Allan Mazur

RISK: Health, Safety & Environment (1990-2002)

The author reviews the 50-year history of the debate over fluoridating drinking water as a public health measure.

Looking Back: Unneeded X-Rays, Allan Mazur

RISK: Health, Safety & Environment (1990-2002)

From the discovery of x-rays in 1896 to the present, Dr. Mazur explores the history of risk management of radiation exposure from x-rays and nuclear fallout.

Why Do We Worry About Trace Poisons?, Allan Mazur

RISK: Health, Safety & Environment (1990-2002)

Dr. Mazur relates how protests by the political left against nuclear tests and by the political right against fluoridation set the stage for Silent Spring to move the public toward being concerned about latent risks.

Reporting Risk: The Case Of Silicone Breast Implants, Dorothy Nelkin

RISK: Health, Safety & Environment (1990-2002)

Professor Nelkin finds journalists to be, if reluctantly, subject to influence and describes their uneasy relationship with scientists in filling a difficult role.

Amalgam Fillings: Do Dental Patients Have A Right To Informed Consent, Michael A. Royal

RISK: Health, Safety & Environment (1990-2002)

Recent animal studies have shown significant mercury absorption from dental fillings and resulted in unfavorable media attention. Yet, an FDA advisory committee has found no evidence of Risk to dental patients, and many dentists believe that patients are being unnecessarily alarmed. The paper reviews the history of amalgam fillings through the recent animal studies and concludes that the Risk, whatever it may prove to be, is sufficiently high to warrant permitting patients to choose between amalgam and alternative dental filling materials.

Mandatory Continuing Education: Does It Really Protect Society From Incompetent Health Professionals, Patricia A. Mcpartland

RISK: Health, Safety & Environment (1990-2002)

Although the focus is narrow, this article argues that, in the face of short half-lives of current knowledge, continuing education requirements are needed and suggests possible improvements in the way that continuing education is implemented. While the issue is not explicitly addressed, readers might ponder whether such requirements might be profitably extended to other disciplines.