Digital Commons Network^™

Veteran Administration Disease Model To An Interdisciplinary Healthcare Model, Bertha J. Harris

Walden Dissertations and Doctoral Studies

There is a growing need for healthcare teams within the Veterans Administration (VA) healthcare system to effectively collaborate and communicate to improve patient outcomes. The need to improve patient care in the Patient Aligned Care Team (PACT) has been well established. The scholarly literature does not provide evidence whether using the primary care PACT model on communication and teamwork by an interdisciplinary medical team ameliorates these communication breakdowns. Bronstein's design for interdisciplinary collaboration provided the overarching framework for this study. The purpose of this qualitative case study was to investigate the use of the PACT model on communication and teamwork …

Noncompliance With Follow-Up Visits In Primary Care, Amanda Michelle Northern

Walden Dissertations and Doctoral Studies

No-show appointments, also referred to as missed appointments, occur 23% to 34% annually in general practice care settings. Missed appointments can lead to reduction in appointment availability, decrease in provider/staff productivity, patient/provider discordance, disruption in continuity of care, and reduced quality of care. There is a gap in the nursing literature regarding effective interventions to reduce missed appointments. The purpose of this quality improvement, secondary analysis project was to determine whether implementation of an evidence-based no-show, nurse-led intervention would reduce missed appointment rates in a family medicine practice. The health belief model and the plan, do, study, act model guided …

Strategies To Reduce Employee Turnover In Clinical Logistics, Brenda Marc Simon

Walden Dissertations and Doctoral Studies

Clinical supply chain managers who do not apply effective employee turnover strategies could negatively affect team performance, employee morale, employee well-being, patient outcomes, productivity, profitability, and the sustainability of organizational activities. The purpose of this multiple case study was to explore strategies that supply chain managers used to decrease employee turnover in clinical logistics organizations. The targeted population consisted of 6 clinical logistics supply chain managers working in 6 community hospitals located in Maryland who had experience implementing successful strategies to decrease employee turnover. The servant leadership theory served as the study's framework. Data collection included semistructured interviews and a …

Decreasing Catheter-Associated Urinary Tract Infections In The Acute Care Setting, Marshanell Wright

Walden Dissertations and Doctoral Studies

The most important risk factor for developing a catheter-associated urinary tract infection (CAUTI) is the prolonged use of the urinary catheter. To address the CAUTI rate at the project site, which was higher than the national benchmark, a team of healthcare practice leaders developed an evidence-based algorithm addressing the appropriate indications for inserting or discontinuing a patient's Foley catheter. Using the plan-do-study-act model, the purpose of this quality improvement evaluation project was to evaluate the effectiveness of the evidence-based Foley algorithm for decreasing the use of Foley catheters and reducing the CAUTI rate and to explore whether using the Foley …

Improving Wound Care Using The Time Framework, Pavel Kulikov

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and purpose:Although wound care guidelines are available for primary care providers, barriers to assessment and treatment remain. This paper examines current evidence, guidelines, and discusses the need for improved training, education, and a simplified approach to wound management in primary care. The goal of the project was to increase the provider’s comfort level in assessing and initiating wound care treatment in the clinical setting. Methods:An evidence-based wound treatment framework, identified as the TIME (tissue, infection, moisture, epithelial) framework, was selected for the project. The framework was tailored by subject matter experts to provide a distinctive approach …

Mdr Matters! Improving Primary Nurse Participation In Multidisciplinary Rounds, Alma Alcantara

Master's Projects and Capstones

Abstract

Problem: The current model of multidisciplinary rounds (MDR) in a 40-bed medical-surgical unit within a Northern California community hospital has demonstrated low participation rates from primary nursing. The primary nurse attendance in MDRs is consistently at 50% participation, below the target goal of 80%. This lack of engagement leads to ineffective communication and fragmented care coordination resulting in suboptimal quality care and cost outcomes.

Context: An intervention strategy to standardize the MDR model was implemented over three months. A literature review revealed that effective and consistent MDR practices can directly influence primary nurse participation. This change management project focus …

Health Care Improvement Initiative: Outcomes And Impact Of An Academic-Practice Partnership Between A Large Integrated Health System’S Nurse Scholars Academy And The University Of San Francisco School Of Nursing And Health Professions, Ryan Fuller

Master's Projects and Capstones

By December 2018, a large integrated health system’s Nurse Scholars Academy (NSA) will have financially-sponsored 64 registered nurses to return to school through a strategic academic-practice partnership program at the University of San Francisco (USF). Referred to as ‘Nurse Scholars,' health system employees elected to return-to-school through NSA. As a five-year initiative, NSA was at risk for not receiving additional funding beyond 2020 without a thorough outcomes analysis that articulated the outcomes to executive leadership.

This health system employs more than 23,000 registered nurses in Northern California (NCAL). The NSA is a region-wide effort to accelerate academic progression, leadership development, …

Overcoming Barriers For The Implementation Of Evidence-Based Practice Through Journal Clubs, Regina Thomas

Doctor of Nursing Practice Projects

Many barriers exist at a 134-bed rural hospital in southern Illinois that hinder generation, evaluation, and implementation of evidence-based research into practice. This DNP project was completed through a phase approach utilizing a modified version of Kotter’s Model of Change, the RNcEBP Survey to self-rate individual confidence in the EBP process, and the Iowa Model of Evidence-Based Practice to facilitate implementation of journal clubs. The RNcEBP survey revealed that nurses were familiar with the concept of EBP, have positive attitudes, and are confident that EBP changes can improve patient outcomes, but lack experience in evaluating literature to support implementing evidence-based …

Essays On The Patient-Centered Medical Home In The United States Military Health System, Glen N. Gilson

Theses & Dissertations

The Patient-Centered Medical Home has been endorsed by the primary care community as the model of the future, with hopes that it will increase quality of care and the patient and provider experience while decreasing costs. Many aspects of the implementation of the Patient-Centered Medical Home model remain unexplored. This dissertation comprises three independent studies examining Patient-Centered Medical Home implementation in the Military Health System, including (1) the effects of environmental correlates on the time to implement the model, (2) the impact of differences in implementation on preventive care quality outcomes, and (3) the effect of differences in implementation on …

Resilience Training For Va Primary Care Providers, Elizabeth A. Recupero

Instructional Design Capstones Collection

Physician burnout syndrome is epidemic within the U.S. healthcare system. Burnout is defined by three main criteria: emotional exhaustion, depersonalization, and a low sense of personal accomplishment, and its prevalence is highest among primary care providers. The VA’s All Employee Survey (AES) demonstrates that more than 50% of physicians working for the VA Healthcare System exhibit at least one of these symptoms. The literature discusses that this syndrome can be improved by increasing physician resilience. This capstone project first analyzed the need for resiliency training among VA primary care providers. After the needs analysis, an online training that encompassed mindfulness …

Relationship Between Nursing Safety Culture And Patient Perception Of Safety In Inpatient Units Of An Academic Specialty Hospital, Miguel Angel Lozano Garcia

Dissertations and Theses (Open Access)

The objective of this research was to analyze the relationship between nursing safety work culture in inpatient nursing units of a specialty academic hospital and their patients’ perception of safety using quantitative and qualitative methods. The aim of the quantitative study was to quantitatively evaluate whether nursing safety culture, as measured on the Hospital Survey on Patient Safety Culture (HSOPS) safety questions of the institutional employee opinion survey, was associated with patients’ perception of safety during their inpatient care, as measured by responses on the inpatient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The aim of the …

An Evaluation Of Implementing Trauma-Informed Care Training In Healthcare Settings, Amanda Kis

Capstone Experience: Master of Public Health

Background: Trauma-informed care (TIC) has recently become a popular topic in medical science. Many patients’ health conditions have been diagnosed and treated purely as medical issues, yet emerging research indicates that trauma is sometimes the source of many physical and mental conditions. Implementing TIC education in healthcare systems may lead to preventing the onset of symptomology related to undiagnosed, chronic trauma experience.

Objectives: The primary goal of this Capstone project was to implement TIC training developed by Trauma Matters Omaha Coalition and assess preliminary evidence for changes in participants’ confidence, clinical knowledge, professional knowledge, self-awareness, and assumptions and biases regarding …

Care Of Adult Cancer Survivors, Kelsey Kloosterman

Doctoral Projects

As innovative cancer treatments emerge, more people are surviving cancer. Cancer survivors have multiple and unique healthcare needs due to their cancer and cancer treatments. Communication among those treating the cancer, primary care providers, and cancer survivors is necessary to coordinate care once treatment is finished. The development of a survivorship care plan that is reviewed with the cancer survivor is intended to facilitate communication among all stakeholders. This quality improvement project examined current practice in a survivorship clinic in a Midwestern health system cancer center that cares for a variety of types of cancer patients. By reviewing evidence in …

A Learning Community Approach To Identifying Interventions In Health Systems To Reduce Colorectal Cancer Screening Disparities., Lillian C. Man, Melissa Dicarlo, Emily Lambert, Randa Sifri, Martha Romney, Linda Fleisher, Ronald Myers

Department of Medical Oncology Faculty Papers

Although colorectal cancer (CRC) screening in the United States has been increasing, screening rates are not optimal, and there are persistent disparities in CRC screening and mortality, particularly among minority patients. As most CRC screening takes place in primary care, health systems are well-positioned to address this important population health problem. However, most health systems have not actively engaged in identifying and implementing effective evidence-based intervention strategies that can raise CRC screening rates and reduce disparities. Drawing on the Collective Impact Model and the Interactive Systems Framework for Dissemination and Implementation, our project team applied a learning community strategy to …

Improving Quiet-At-Night On A Telemetry Unit: Introducing A Holistic Sleep Menu Intervention, Christian Karl Antonio

Master's Projects and Capstones

Improving Quiet-at-Night on a Telemetry Unit:

Introducing a Holistic Sleep Menu Intervention

Abstract

Problem

A hospital in San Francisco, California has performed poorly on patient care service as evidenced by low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. The survey’s lowest score was from the “Quiet at Night” measure.

Context

A Sleep Menu initiative was implemented in the hospital’s telemetry unit. Microsystem assessment and Strengths-Weakness-Opportunities-Threats (SWOT) analysis identified practices that might impede intervention success. Findings showed that benefits and opportunities outweighed costs; cost-benefit analysis estimated an annual net benefit of $6,354. Other benefits included improved patient well-being, …

Implementation Of A Multimodal Hand Hygiene Intervention At A Rural Critical Access Hospital, Amy J. Hopp

Doctoral Projects

Healthcare acquired infections are the most common complication of hospital care in the United States, with subsequent negative implications on the healthcare system. While hand hygiene has long been considered the single most important and cost-effective way of reducing healthcareacquired infections, compliance among healthcare professionals is low, and most efforts to improve it fail. When compared to single-component hand hygiene interventions, research demonstrates that tailored multimodal interventions are an effective way to improve compliance with hand hygiene practices among healthcare professionals. This Doctor of Nursing Practice project focused on implementing a multimodal hand hygiene intervention, tailored to fit the specific …

Evaluation Of A Health System’S Community Targeted Program For Individual’S With Increased Risk For Cardiovascular Disease And Diabetes, Phallon Lovelady

Doctoral Projects

Introduction: Lack of a program evaluation plan for a community targeted primary prevention program poses a risk for undefined program effectiveness. Conducting a systemic program evaluation helps determine program effectiveness and value. The purpose of this paper is to discuss the process of implementing a program evaluation during a Doctorate of Nursing Practice (DNP) scholarly project.

Objectives: The objectives of this project were to apply a scholarly approach to program evaluation utilizing evidence-based practice tools, demonstrate DNP Essentials and health systems leader competencies, and describe the steps taken during the process.

Methods: The CDC Framework for Program Evaluation (2011) was …

Patient Barriers For Weight Management Among African American Women, Owen Bowie, Jennifer Kusch, George L. Morris Iii, Tracy Flood, Jessica Gill, Renee E. Walker, Ron A. Cisler, Jennifer T. Fink

Journal of Patient-Centered Research and Reviews

Purpose: The primary aim of this study was to assess the perceptions of local African American women who are overweight or obese using semi-structured focus groups to identify barriers to weight management and factors that support strategy success. The secondary aim of this study was to determine recommendations for patient-centered weight management interventions established specifically for African American women in the Milwaukee-area community.

Methods: Three semi-structured focus groups to explore barriers to weight management were performed among women patients. Participants (N = 41) were recruited via email, postal mail, and phone as available from an academic medical center in Milwaukee, …

Using A Reflexive Process To Investigate Organizational Change: The Use Of The Research Spider Matrix, Ardis Hanson, Allison Howard, Randall Polo, Krystal Bullers, Stephanie Tomlinson, John Orriola, Kristen Sakmar

Southern Chapter/Medical Library Association Annual Conference

The primary objective was to assess the research competencies (knowledge, experience, and skills) of librarians at an academic health sciences library using the Research Spider matrix (Smith et al., 2002). This was motivated by the shift from a traditional reference model to a research-centric paradigm.

Investigating Mpm-Iii, Sofa And Delta Sofa Scoring Systems As Predictors Of Mortality At A Tertiary Hospital In Nairobi, Kenya: A Retrospective Cohort Study, Lilian Lukoko

Master of Medicine in Anaesthesiology

Background: Despite major advances, management of critically ill patients worldwide is associated with high mortality rates. Assessment of disease severity is crucial in the analysis of ICU mortality. Although a variety of severity of illness scoring systems have been developed for this assessment and validated across Europe and the USA, few studies exist to show support of their utilization in African countries. There is conflicting evidence regarding the most reliable severity of illness scoring system suitable for resource limited countries as their mortality predictive values differ with different populations. SOFA is already in use at the AKUHN ICU and has …

State Employment First Policies #3: Investing In Training And Technical Assistance To Build Capacity In Integrated Employment, Jennifer Bose, Jean Winsor, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

For more than a decade, many states have been developing policies that prioritize integrated employment as the first choice and preferred outcome for individuals with intellectual/developmental disabilities (IDD). Collectively, these actions have been united under the framework of Employment First, a commitment by states and state IDD agencies to the propositions that all individuals with IDD (a) are capable of performing work in typical integrated employment settings, (b) should receive as a matter of state policy employment-related services and supports as a priority over other facility-based and non-work day services, and (c) should be paid at minimum or prevailing wage …

The Essential Characteristics Of Successful Organizational Transformation: Findings From A Delphi Panel Of Experts, Oliver Lyons, Jaimie Ciulla Timmons, Allison Cohen Hall, Stephanie Leblois, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

BACKGROUND: Federal legislation has called for the phasing out of sheltered workshops and the transition to integrated employment, causing providers to struggle with how to adapt their model towards providing community integration services.

Statedata: The National Report On Employment Services And Outcomes Through 2016, Jean Winsor, Jaimie Ciulla Timmons, John Butterworth, Alberto Migliore, Daria Domin, Agnes Zalewska, John Shepard, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Recent legislation and regulation governing Medicaid Home and Community-Based Services (HCBS), the Workforce Innovation and Opportunity Act of 2014 (WIOA), and settlement agreements between states and the U.S. Department of Justice are clarifying federal intent and paving the way to supporting opportunities for people with disabilities to have meaningful jobs in their communities. With an increasing emphasis on integrated employment and an Employment First philosophy, the nation is poised for transformation that could put Americans with disabilities on a path out of poverty and towards self-sufficiency. However, there remains a significant gap in employment rates between people with and without …

Evaluation Of Processes And Procedures For Care Of The Opioid Recipient Patient In The Primary Care Setting, Anne Sproat

Doctoral Projects

Introduction: Chronic non-cancer pain is far reaching, affecting over 100 million Americans (Zgierska et al., 2018). Opioids are commonly prescribed for chronic pain, with approximately 20% of patients presenting to primary care offices with symptoms of pain or pain-related diagnoses (Dowell, Haegerich, & Chou, 2016). As a result, opioid prescribing rates are increasing at a faster rate for primary care practice compared with other specialties (Dowell et al., 2016). Within the United States population, it is estimated that three percent to four percent of the adult population are prescribed long-term opioids for the treatment of chronic non-cancer pain (Dowell et …

Evaluating The Kentucky Association Of Extension 4-H Agents Annual Conference Using The Re-Aim Framework, Michael Elijah Wilson

Dissertations

The Reach, Effectiveness, Adoption, Implementation, and Maintenance (REAIM) evaluation framework, as first introduced by Glasgow, Vogt, and Boles (1999), offers a straightforward method for evaluating Extension related programs. In this study, the RE-AIM framework is used to evaluate the Kentucky Association of 4-H Extension Agents (KAE4-HA) annual conference by examining pre-existing organizational data and records that include the results from KAE4-HA post-conference surveys that had never been reviewed as part of a comprehensive program evaluation.

This dissertation is divided into five chapters. Chapter I provides an overview of the study. Chapter II reviews the history of Extension in Kentucky, program …

State Employment First Policies #2: Engaging Stakeholders In Development And Implementation, Jennifer Bose, Jean Winsor, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

This brief is the second in a series focusing on Employment First implementation as it relates to one of the seven elements within the High-Performing States in Integrated Employment model. It looks at the interagency collaboration and partnership element in depth. Interagency partnership and collaboration includes interagency agreements and relationships, provider collaboration, and outreach to stakeholders to ensure that integrated employment is a shared goal.
Case study data was collected for a sub-sample of seven states: Connecticut (CT), Delaware (DE), Kansas (KS), Minnesota (MN), Missouri (MO), Tennessee (TN), and Washington (WA). These states were selected because they represent a wide …

Building An Evidence-Based, Holistic Approach To Advancing Integrated Employment, Allison C. Hall, John Butterworth, Jean Winsor, John Kramer, Kelly Nye-Lengerman, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Since the introduction of supported employment in the Developmental Disabilities Act of 1984 and the Rehabilitation Act Amendments of 1986, there has been continued development and refinement of best practices in employment services and supports. Progress includes creative outcomes for individuals with significant support needs including customized jobs and self-employment, community rehabilitation providers that have shifted emphasis to integrated employment, and states that have made a substantial investment in Employment First policy and strategy. Despite these achievements, the promise of integrated employment remains elusive for the majority of individuals with intellectual and developmental disabilities. The number of individuals supported in …

Applying The Phenotype Approach For Rosacea To Practice And Research, J Tan, M Berg, R L Gallo, James Q. Del Rosso

College of Osteopathic Medicine (TUN) Publications and Research

BACKGROUND: Rosacea diagnosis and classification have evolved since the 2002 National Rosacea Society expert panel subtype approach. Several working groups are now aligned to a more patient-centric phenotype approach, based on an individual's presenting signs and symptoms. However, subtyping is still commonplace across the field and an integrated strategy is required to ensure widespread progression to the phenotype approach.

OBJECTIVES: To provide practical recommendations that facilitate adoption of a phenotype approach across the rosacea field.

METHODS: A review of the literature and consolidation of rosacea expert experience.

RESULTS: We identify challenges to implementing a phenotype approach in rosacea and offer …

Pubh 7090 – Public Health Practice Trends, Gulzar H. Shah

College of Public Health: Faculty Syllabi (2014-2021)

Today’s public health landscape is increasingly complex and constantly changing. This course focuses on emerging trends and challenges in public health practice that epitomize the increasing complexity and nature of challenges facing public health practitioners.

Pubh 7890 – Directed Independent Study, Jian Zhang

College of Public Health: Faculty Syllabi (2014-2021)

Provides the student with an opportunity to investigate an area of interest under the direction of a faculty mentor