Digital Commons Network^™

Does Physician-Hospital Vertical Integration Affect Hospital Output?, Soumya Upadhyay, Neeraj Bhandari

Healthcare Administration and Policy Faculty Research

Background: Physician-hospital vertical integration is gaining steam but it is unclear how they affect hospital output.

Objective: To examine the direct impact of vertical integration on hospital output.

Design: A pooled design with 6-year data using linear regressions was used. Then, panel data design with hospital fixed effects was used.

Methods: We linked American Hospital Association data (2016-2021) with AHRQ Comparative Health System Performance Initiative’s Compendium (2018, 2020, 2021; 34 987 hospital-year observations) to develop new measures of vertical integration and assess its relationship with several measures of hospital output including annualized total admissions, total number of inpatients days, …

The Living Document: Medical Records As A Malleable Presence, Camilla Lyckblad

Proceedings from the Document Academy

Understanding why individuals might safeguard information or keep secrets in working documents such as medical records is essential for the development of good quality care, fostering an environment where both patients and staff feel secure to part with sensitive information, encouraging more honest and open communication as well as improved quality of care. This ongoing research aims to deepen comprehension of information behavior in clinical contexts, where the contemporary medical record, with its increasing properties such as open record access for patients, can be viewed as an entity that both listens and influences. This examination sheds light on the complex …

Infant Mortality Data: Missing Pieces To Prevention In Lesotho, Jacinda Croissant

Master's Projects and Capstones

Lower-middle-income countries (LMICs) like Lesotho lack complete and quality infant mortality data. Without infant mortality data, it can be challenging to develop public health education, programming, and policies to address preventative infant deaths in specific populations (Rao et al., 2004). A literature review identified strategies to improve infant mortality data in LMICs. Through a community engagement model and digital storytelling, community members can gain awareness, begin an ongoing conversation about local public health issues, and participate in an improved data collection system. Infant mortality is often used as an indicator of health for a population; improved infant mortality data can …

Improving Health Equity: Integrating Mental Health Services Into Mobile Health Clinics For Unhoused And Low-Income Populations In The United States, Tiffany Lynn Wong

Master's Projects and Capstones

Mental health disparities among homeless and low-income populations in the United States highlight significant challenges in access and quality of care. This literature review explores the integration of mental health services into Mobile Health Clinics (MHCs) as a promising recommendation to address these disparities. I used various search engines, extracting 10 articles published from 2013 to 2023 focused on the U.S. MHCs show its effectiveness in improving healthcare access and quality of care, covering different services like mammography, reproductive health, COVID-19 testing, and diabetes care. Building on these successful models, this paper proposes extending MHCs to include mental health screenings, …

The Impact Of Adverse Childhood Experiences And Allostatic Load On Premature Birth Rates: A Literature Review, Roxane J. Scherek

Master's Projects and Capstones

This paper examines the relationship between Adverse Childhood Experiences (ACEs), allostatic load, and the likelihood of women giving birth prematurely in the United States and Canada. I searched multiple databases exploring this association, identifying nineteen articles published between 2004 and 2024. The literature highlights that racism and discrimination are a cause of chronic stress, and that this stress, and implicit bias, are both implicated in preterm birth. While ACEs scores have been found to be associated with preterm birth, the results for allostatic load are mixed. The results suggest that more attention should be paid to mitigating the stress associated …

Food Security And Its Impact On Hypertension In Urban Communities, Lauren M. Nobriga

Master's Projects and Capstones

The Quality Improvement Team proposed an intervention to increase enrollment in the Food Security Program, a six-month initiative that provides vouchers redeemable for fruits and vegetables. Long-term impacts of this Program include an improved food economy and enhanced patient disease management autonomy. This project aimed to increase the percentage of eligible adult medicine clinic patients enrolled in the Food Security Program by 25%, or 11 patients per month, based on the mean enrollment for the first four months of the Program (May to August) of nine patients. The intervention was based on bi-monthly performance reports, making the goal include enrolling …

The Evidence Is In: Breast Implants Are Making People Sick Increasingly Women Find When They Have Their Implants Removed, Their Symptoms Improve—Or Disappear., Pamela J. Appea

Capstones

Over the years, breast implants have been associated with a wide range of health issues, including cancer and autoimmune diseases, but surprisingly these issues are not well known to the public. In 1992, health concerns led the FDA to halt the use of silicone gel breast implants for cosmetic surgeries, although implants containing saline remained available (it was during this period that the Oprah segment that Gmitro remembered ran on TV). In 2006, after more research, which some experts believe was insufficient, the FDA re-approved the use of silicone implants. In 2019, a novel “textured” breast implant manufactured …

Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta

Master's Projects and Capstones

Diet and lifestyle changes have been proven to reduce blood pressure in patients with hypertension, and a key dietary approach aligned with this recommendation is the DASH diet, which includes consuming fruits and vegetables. Food insecurity, defined as lacking enough safe, nutritious food to maintain an active and healthy life, is a growing crisis in the United States, affecting 13.5% of U.S. households in 2023. This is especially significant for those whose chronic disease management depends on the accessibility of healthy food. An urban community clinic implemented a Food Security Program to decrease food insecurity and reduce hypertension among their …

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …

Chronic Disease Screening And Detection In Vulnerable Populations, Courtney J. Seman, Hussein Hadid, Tania Jaimes, Robert Walls

Master's Projects and Capstones

This quality improvement project aims to address gaps in chronic disease screening by implementing standardized protocols for diabetes, hypertension, vision impairment, and scoliosis within the University of San Francisco (USF) Nurse-Led Clinic in Orange County. Problem: The clinic identified a lack of screening practices, which limited early detection and intervention for two specific vulnerable populations. Context: The clinic serves two high-risk groups: older adults, including formerly homeless individuals, and children in two local grade schools. These populations face significant healthcare disparities, making early detection of chronic conditions critical. Interventions: Guided by Kotter’s Change Theory, the project developed and implemented evidence-based …

Interventions In Treating Ptsd As A Result Of Birth Trauma, Christine Marie Samatra-Montalvo

Master's Projects and Capstones

This paper explores the prevalence, causes, and consequences of PTSD resulting from childbirth, highlighting the need for effective intervention strategies. A systematic review of 25 studies encompassing cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), pharmacotherapy, and support groups was conducted to evaluate their effectiveness. Findings indicate that CBT and EMDR are the most promising treatments, with pharmacotherapy and support groups also providing substantial benefits. However, access to these interventions remains a challenge for certain populations. This paper underscores the importance of tailored, trauma-informed care and suggests that comprehensive maternal mental health programs can significantly improve outcomes for mothers …

Msw Portfolio, Andrea E. Anderson

Graduate Student Portfolios, Professional Papers, and Capstone Projects

The portfolio narrative includes a brief introduction to my academic journey including field related work. The ten social work competencies are used as a guide while I reflect on the required appendices, theoretical frameworks and orientation to practice throughout the narrative.

¿Qué Futuro Les Espera A Los Trabajadores Latinos? El Calor Extremo, Las Promesas Vacías Y La Incertidumbre Política, Yunior Rivas Garcia

Capstones

Este artículo explora las condiciones mortales que enfrentan los trabajadores latinos en Estados Unidos debido al estrés por calor, un riesgo creciente en sectores esenciales como la construcción, la agricultura y el almacenamiento. A pesar de representar una proporción significativa de las muertes laborales, las protecciones contra el calor son insuficientes, y la falta de regulación federal agrava la vulnerabilidad de estos trabajadores, muchos de los cuales son indocumentados. A través de casos específicos, como la muerte de Esvin Cruz Mateo, y un análisis de las políticas laborales actuales, el texto examina las fallas estructurales que perpetúan la inseguridad laboral …

Determinants Of Pediatric Tuberculosis In Dki Jakarta During The Covid-19 Pandemic, Chandrayani Simanjorang, Rana Zahra Raniyah Wangsawinangun, Ulya Qoulan Karima, Fajaria Nurcandra

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

The COVID-19 pandemic has affected the diagnosis and treatment of pediatric tuberculosis (TB), which can pose a public health burden if not properly treated. This study aims to find out the risk factors for pediatric TB. The design of this study was cross-sectional, using TB surveillance data extracted from maintenance cards of individuals who underwent TB screening in 2020–2022 at health facilities in DKI Jakarta. The independent variables in this study are age, gender, contact history, BCG immunization, and nutritional status. Logistic regression analysis was performed to identify factors associated with childhood TB after bivariate analysis using chi-square to determine …

A Supervised Machine Learning Statistical Design Of Experiment Approach To Modeling The Barriers To Effective Snakebite Treatment In Ghana, Eric Nyarko, Edmund F. Agyemang, Ebenezer Kwesi Ameho, Louis Agyekum, José María Gutiérrez, Eduardo Alberto Fernandez

School of Mathematical & Statistical Sciences Faculty Publications

Background

Snakebite envenoming is a serious condition that affects 2.5 million people and causes 81,000–138,000 deaths every year, particularly in tropical and subtropical regions. The World Health Organization has set a goal to halve the deaths and disabilities related to snakebite envenoming by 2030. However, significant challenges in achieving this goal include a lack of robust research evidence related to snakebite incidence and treatment, particularly in sub-Saharan Africa. This study aimed to combine established methodologies with the latest tools in Artificial Intelligence to assess the barriers to effective snakebite treatment in Ghana.

Method

We used a MaxDiff statistical experiment design …

Assessing The Reach Of Health Access Resources In Indianapolis For Populations With Low Income, Kyler A. Casbon, Kai J. Gatting, Simran Nadig, Isabella K. Peckinpaugh, Alexandre A. Sauquet, Kourtney A. D. Byrd, Megan E. Conklin, Gicella Garcia, Mitchell L. Struewing, Omolola A. Adeoye-Olatunde

Purdue Journal of Service-Learning and International Engagement

Two public health crises that the United States are contending with are diabetes and the prevalence of opioid overdoses, both of which have a significant impact on communities nationwide. Inequities in social conditions contribute to health disparities amidst these diabetes and opioid overdose public health crises nationally and locally. To address these health inequities in Indianapolis, Indiana, the the Purdue University Center for Health Excellence, Quality and Innovation (CHEQI) shaped relationships through their CHAMP (Community Health Access Model Partnerships) services with local food pantries and homeless shelters, providing Indianapolis residents pre-diabetes screening and resources and convenient access to and education …

Jovial Family Farm Facilitates Intergenerational Learning Opportunities Through Urban Farming, Maera Williams

Purdue Journal of Service-Learning and International Engagement

Maera Williams is a sophomore in Environmental and Ecological Engineering at Purdue University. She joined the Engineering Projects in Community Service (EPICS) Urban Farming team as a freshman and now serves as project manager of ten undergraduate students collaborating with Jovial Family Farm to design and develop three indoor hydroponics systems for a laboratory space on their property in Broad Ripple, IN. Jovial Family Farm is a nonprofit organization founded by Drs. Bobbie and Brian Jellison with the mission to provide senior citizens, their families, and their communities with meaningful engagement opportunities on an intergenerational scale through urban agricultural activities. …

Elevated Ambient Temperature Associated With Reduced Infectious Disease Test Positivity Rates: Retrospective Observational Analysis Of Statewide Covid-19 Testing And Weather Across California Counties., Nicholas Wing-Ping Kwok, Joshua Pevnick, Keith Feldman

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: From medication usage to the time of day, a number of external factors are known to alter human body temperature (BT), even in the absence of underlying pathology. In select cases, clinical guidance already suggests the consideration of clinical and demographic factors when interpreting BT, such as a decreased threshold for fever as age increases. Recent work has indicated factors impacting BT extend to environmental conditions including ambient temperature. However, the effect sizes of these relationships are often small, and it remains unclear if such relationships result in a meaningful impact on real-world health care practices.

OBJECTIVE: Temperature remains …

Take Charge Of Your Health: Start With Your Smile, Jordan L. Lacey, Brizette O. Owusu, Sophia Gardner, Madeline Whitehead, Haeun Park, May Ligno

Nursing Leadership in Community Engagement Projects

Take Charge of Your Health: Start with Your Smile

Oral health is a fundamental component of overall health, yet it is often neglected-particularly among vulnerable populations like houseless individuals (Freitas et al., 2019). Houseless individuals face numerous barriers to accessing healthcare, with dental services being limited. This lack of access contributes to a higher prevalence of oral diseases, which if left untreated, can lead to severe complications. Poor oral health doesn’t just affect the mouth; it negatively impacts one’s overall systemic health, psychosocial well-being, and quality of life (Csikar et al., 2019).

As nursing students engaged in a Community Health …

The Impact Of Adverse Childhood Experiences On The Eating Behaviors Of Black American Women, Teshia Stovall Dula

Doctoral Dissertations and Projects

This dissertation explores the impact of behaviorism on understanding adverse childhood experiences (ACEs) and their effects on eating behaviors, particularly emotional overeating, and satiety responsiveness, in Black women. It highlights the importance of addressing ACEs to promote holistic well-being, especially given racial health disparities. The study investigates various factors shaping the behavior of Black women, including individual traits, environments, and behavioral patterns, focusing on an under-researched area. It calls for standardized definitions in this context and advocates for more extensive and diverse sample sizes for future research. Ultimately, the research aims to empower Black women by translating insights into effective …

Mexican Health And Aging Study Biomarker And Genetic Data Profile, Rafael Samper-Ternent, Jesús Daniel Zazueta-Borboa, Alejandra Michaels-Obregon, Dolly Reyes-Dumeyer, Sandra Barral, Giuseppe Tosto, Rebeca Wong

Faculty, Staff and Student Publications

The Mexican Health and Aging Study (MHAS) is one of the largest ongoing longitudinal studies of aging in Latin America, with six waves over 20 years. MHAS includes sociodemographic, economic, and health data from a nationally representative sample of adults 50 years and older in urban and rural Mexico. MHAS is designed to study the impact of diseases on adults' health, function, and mortality. As Mexico is experiencing rapid population aging, providing adequate information to study this phenomenon is vital for designing and implementing public policies. The availability of biomarker and genetic data and longitudinal survey data elevates opportunities for …

The Work-Life Balance Of Higher Education Faculty In Light Of Constant Access To Technology: A Case Study, Giordana Morales-Spier

Doctoral Dissertations and Projects

The purpose of this instrumental case study was to explore the perception of constant access to technology for faculty members in the university setting. Constant access to technology was defined as the majority of work tasks taking place in front of the computer, the expectation of quick email responses, and the pressure for continual student interaction, particularly outside of regular business hours. Burnout theory guided this study, which provided views of faculty’s efficiency, stress levels, and personal time. The central research question that guided the study was: How do higher education faculty at CVU guard against burnout while experiencing constant …

Review Of Epidemiology, Prevention And Management Of Blood-Borne Viruses Experienced By Aboriginal And Torres Strait Islander Peoples, Katiska Davis, Eliza Lock, Laura Thum, Gemma Crawford, Roanna Lobo, Odette Aung Thein, Shane Kavanagh, Jonathan Hallett

Journal of the Australian Indigenous HealthInfoNet

This review examines the epidemiology, prevention, and management of blood-borne viruses (BBVs) experienced by Aboriginal and Torres Strait Islander peoples in Australia with a focus on hepatitis B, hepatitis C, and HIV. The review highlights the disproportionate burden of BBVs among Aboriginal and Torres Strait Islander peoples in Australia, influenced by historical, social, and cultural factors stemming from colonisation. Key findings include higher prevalence rates of hepatitis B and C compared to non-Indigenous Australians, with some progress in reducing new infections through vaccination and treatment programs. However, significant gaps remain in screening, linkage to care, and treatment uptake. The review …

Self-Perceived Well-Being Among Doctor Of Physical Therapy Students In The United States In 2022 Compared To 2021, David Kietrys, Ellen Zambo Anderson, James S. Parrott, Suchismita Ray

Journal of Wellness

Introduction: The purpose of this study was to explore well-being in a cohort of Doctor of Physical Therapy (DPT) students in 2022, and compare factors related to well-being to a cohort of DPT students from 2021.

Methods: This cross-sectional observational study combined data from a self-administered survey of participants who had participated in a well-being survey in 2021 (and agreed to be contacted for follow-up one year later) with survey data from first year DPT students during the fall of 2022. The survey included the WHO-5 Well-being Index, the Perceived Stress Scale-10, the Brief Resiliency Scale, and an array of …

Impact Of Pathogenic E. Coli In Drinking Water On The Well-Being Of Children, Aysha Khatoon

CBER Conference

Despite global advancements, unsafe drinking water is a major cause of illness, ranked as the eighth highest worldwide (Forouzanfar et al., 2015). Studies indicate that even improved water sources, can harbour faecal contamination (Shaheed et al., 2014; Bain et al., 2014b). Globally, 1.8 billion people rely on drinking water contaminated with faecal matter (Bain et al., 2014a), with pathogenic E. coli being a primary concern. In Pakistan, the situation is dire. About 25 million people, particularly children, suffer due to open defecation, leading to 53,000 child deaths annually from diarrhoea (UNICEF, 2021). Pathogenic E. coli is a significant contributor to …

An Exploration Of Telemedicine Application Service Quality And Its Relevance With Patient Satisfaction, Victoria Olguin

Honors Program Theses and Research Projects

When the world experienced a pandemic due to the SARS-CoV-virus (COVID-19) in 2019, a lockdown quickly took place and travel restrictions were applied, placing a barrier to in- person healthcare access. This made the healthcare settings practice alternate ways in delivering healthcare that did not necessarily have to be in-person. The evolvement of a remote setting took place, and the development and usage of telemedicine quickly accelerated. This form of healthcare has transformed the way care is delivered to patients, with many key elements shaping their experience and outcomes. Now that the COVID-19 pandemic has ended, the practice of telemedicine …

Examining The Effects Of Language Barriers For Non-Native English Speakers In The Healthcare System In Northwest Ohio, Sarah Witt

Honors Projects

Hundreds of thousands of people in the state of Ohio speak a language other than English, and communication in a predominantly English-speaking state can prove not only cumbersome, but dangerous as well. Patients who have difficulties communicating with their healthcare providers experience higher rates of medical error, adverse medical reactions because of improper drug use, longer hospital stays, and more hospital readmissions than the general population. Additionally, they experience high rates of anxiety and frustration when receiving medical care, which causes resentment and mistrust of the healthcare system. This study investigated language barriers in healthcare systems across Northwest Ohio by …

Factors Associated With Receipt Of Tobacco Treatment Integrated With Nurse Navigation In A Centralized Lung Cancer Screening Program At An Urban Academic Medical Center, Christine S. Shusted, Sarah Mukhtar, James Lee, Brooke Ruane, Emily Muse, Lawrence Emeigh-Mcbride, Eboni Gatson-Anderson, Gregory C. Kane, Kuang-Yi Wen, Hee-Soon Juon, Julie A. Barta

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

PURPOSE: Optimal approaches for tobacco treatment counseling among individuals who currently smoke and are undergoing shared decision-making (SDM) and lung cancer screening (LCS) are unknown. The objective of this cross-sectional study was to determine the rate of reported interest in tobacco treatment counseling and pharmacotherapy among individuals who currently smoke and are receiving integrated nurse navigation for LCS and tobacco treatment in a centralized LCS Program.

METHODS: We identified individuals undergoing SDM through our centralized LCS Program between March 2021 and March 2022. The LCS Program tobacco treatment protocol includes counseling both in-person and via telephone during SDM, LCS results …

Disparities In The Pregnancy Experience: A Multi-Case Analysis, Tiffany C. Thomas, Lindsay Gietzen

Pacific Journal of Health

Racial disparities in maternal healthcare continue to be a significant issue, with Black women experiencing worse outcomes compared to White women. Despite improvements in healthcare, Black women are still 2.5 times more likely to die from pregnancy-related causes, and they face higher rates of preterm births, low birth weight, and insufficient prenatal care. This paper examines the experiences of three African American women from high socioeconomic backgrounds, focusing on where these negative experiences are most common throughout pregnancy, childbirth, and postnatal care. The study uses the Pregnancy and Maternity Care Patients' Experiences Questionnaire (PreMaPEQ) to explore different stages of care, …

Understanding Provider Competency In Gender Affirming Care, Vanessa Castle, Lindsay Gietzen

Pacific Journal of Health

Lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual plus (LGBTQ+) individuals, especially transgender patients, face many healthcare disparities. It is extremely important for them to have access to high-quality healthcare, particularly Gender Affirming Care (GAC), to support their well-being and mental health. However, many healthcare providers, including clinical social workers, NPs, PAs, and MDs lack proper training to offer GAC. The current training opportunities available are often basic and lack comprehensive, detailed information. To reduce healthcare barriers for the transgender and gender-diverse community, we must have comprehensive training on GAC available for providers so they can treat their patients with …