Medicine and Health Sciences Commons^™

Effectiveness Of Antibiotic Stewardship For Healthcare Providers At Urgent Care Clinics, Helen T. Adewole

Electronic Theses and Dissertations

Antibiotics have revolutionized modern medicine; however, the overuse in urgent care and primary care significantly contributes to the global burden of infections resistant to available antimicrobial medicines. Approximately 30% of the antimicrobials prescribed in acute care settings are unnecessary. Patient demand for antibiotics has seemingly skyrocketed following the recent COVID-19 pandemic. Practitioners must be knowledgeable about antibiotic stewardship initiatives, such as the wait-and-see approach, to reduce antibiotic overuse and improve the trajectory of antibiotic resistance and patient health outcomes. The gap in practice was the limited awareness of scientific evidence-based tools to partner with patients and improve antibiotic prescription patterns. …

Examining The Impact And Implementation Of Protected Administrative Time On Provider Well-Being And Service Delivery Indicators Within A Multi-State Network Of Primary Care Medical Practices, Lauren Junge-Maughan

Electronic Theses and Dissertations

Background:

Primary care is integral to achieving high-quality health outcomes for the population and decreasing healthcare costs. However, primary care clinicians suffer from conflicting demands, impossible expectations, and burdensome processes. With burnout and mental fatigue increasing, leadership must find innovative programs to implement in their organizations. This mixed-methods research study assessed the impact of one such intervention, protected administrative time (PRAT), on improving provider well-being.

Purpose:

The first aim was to evaluate the association of PRAT on the service delivery indicators of primary care clinicians’ productivity, average appointments per day, patient satisfaction (likelihood to recommend), clinician time to the next …

Organizational Change In Saudi Healthcare Settings: Evaluating Organizational And Individual Readiness For Change, And The Mediating Role Of Readiness For Change Between Management Support And Commitment To Change., Sultan Alsaif

Electronic Theses and Dissertations

BACKGROUND: To respond to the constantly changing environment and developments of healthcare, leaders of healthcare organizations have been trying to introduce and implement transformations that allow their organizations to be able to operate effectively and efficiently to meet the shifts in healthcare demand and to deal with new patterns of health issues, comply with the new policies, and to enhance their present in the market. Thus, it is important for managers to determine the level of readiness for implementing organizational changes from to perspectives. These perspectives include organizational readiness for change and individual readiness for change. METHOD: This first manuscript …

A Case Study Of The Political Determinant Of Health On The Public Health Crisis Of Malaria In Nigeria, Bisola M. Olumegbon

Electronic Theses and Dissertations

Abstract

Globally, there were about 229 million cases of malaria in 2022. The sub-Saharan African region accounted for 92% of the reported cases and 94% of deaths. Nigeria had the highest number of malaria cases and deaths, representing 27% of global cases. This scholarly project was a case study guided by the political determinants of health. Triangulation of data using thematic analysis was used to identify the political determinants of malaria in Nigeria and to understand how the concept of interaction contributes to the persistence of the disease. The analysis involved a deductive and inductive approach based on the literature …

An Analysis Of The Effects Of Certified Electronic Health Records On Organizations And Patients., Picandra Elzie

Electronic Theses and Dissertations

The growing technological advancement of electronic health records can become an issue with quality and electronic patient information exchange if hospitals do not adhere to federal guidelines. It is recommended that hospitals utilize certified electronic health records (EHRs) to receive financial incentives. This certification is supposedly also associated with the quality of the EHR itself. The certification process is criticized for allowing EHR vendors to meet a set of limited functions known in advance. EHRs can affect healthcare quality and electronic health information exchange. This dissertation explored what is known about the effects of certified EHRs on length of stay …

Profitable, Alternative Income Generation And Improved Quality Of Life Among Global Beekeepers, Chris Honeycutt

Electronic Theses and Dissertations

Interventions that promote alternative income generation (AIG) to address social determinants of health are associated with increased household income and improved health outcomes. Organizations have used beekeeping to address poverty and other development goals with mixed outcomes. Beekeeping presents a viable option to promote AIG. Organizations increase their risk of failing to achieve positive outcomes when beekeeping interventions are inadequate. This project aims to develop an organizational assessment tool that measures organizational position in relation to evidence-based factors for income generation and improved quality of life among global beekeepers. The assessment is organized into seven domains that correspond with PRECEDE-PROCEED …

The Correlation Between Transformational Leadership And Mental Health Clinician Burnout, Rebekah E. Shutter

Electronic Theses and Dissertations

Mental health clinicians working in a hospital setting are at a high risk of experiencing burnout due to the stressful demands of their caseloads, compassion fatigue, limited resources, and unsupportive leadership. While there is ample research regarding the cause and effect of burnout on clinicians there is a gap in the literature when it comes to the impact leadership has on mental heath clinician burnout. The purpose of this quantitative, correlational study is to determine if and to what extent there is a correlation between Transformational Leadership and mental health clinician burnout. Participants for this study consisted of 200 mental …

Emergency Care For Youth Who Experience Suicidality And Identify As Lesbian Gay Bisexual Transgender Queer/Questioning (Lgbtq+): An Interpretive Phenomenology, Theresa Schultz

Electronic Theses and Dissertations

Purpose: Suicide is a leading cause of death in children; youth who identify as LGBTQ+ are at an exponentially higher risk of suicide. The purpose of this study was to explore the lived experiences of young adults who identify as LGBTQ+ and sought emergency care for suicidality when they were adolescents.

Methods: Heideggerian hermeneutics phenomenology is the research method used in this study. Youth, ages 18-25 years, who identify as LGBTQ+ and sought emergency treatment for suicidality when they were adolescents (13-17 years) were recruited to participate;fifteen youth enrolled. Individuals ranged in age from 20 to 25 years. Participants described …

Overview Of Transition Care Clinics And Patient No-Shows, Manul Awasthi

Electronic Theses and Dissertations

Introduction

Transition care clinics (TCCs) have proven to be effective in meeting the time-sensitive needs of patients in the post-discharge period and ensuring smooth transitions of patients from hospital to home. These clinics have led to lower readmissions, lower emergency department visits, cost savings, and lower rates of other adverse events following discharge. However, TCCs, including the East Tennessee State University Family Medicine (ETSU-FM) TCC have been facing high rates of patient no-shows.

Aim

The aim of this dissertation is to identify the different components and outcomes of TCC based on the literature. We further aim to analyze the TCC …

Self-Measured Blood Pressure Monitoring In Hypertension Control: The Role Of Social Determinants Of Health, Current State In The United States, And Future Directions, Adekunle Oke

Electronic Theses and Dissertations

Hypertension, a medical condition, predisposes to other cardiovascular diseases, and can be impacted by the social determinants of health (SDOH). Self-measured blood pressure monitoring (SMBP) is an evidence-based approach to hypertension control, but not much is known about the influence of SDOH on SMBP. This dissertation aims to: 1) highlight the SDOH factors whose relationship with SMBP have been explored in research studies; 2) examine the relationship between SDOH and SMBP among United States (U.S.) adults with high blood pressure; and 3) examine the current state of SMBP in the U.S., highlight policy implications from the empirical study and provide …

The Association Of Demographic Characteristics And Social Vulnerability With Covid-19 Outcomes, Gloria D. Boone

Electronic Theses and Dissertations

The Association of Demographic Characteristics and Social Vulnerability With COVID-19 Outcomes

by

Gloria Boone

(Under the Direction of Gulzar Shah)

ABSTRACT

This research explored 102 Illinois counties' COVID-19 data to determine whether demographic characteristics and social vulnerability are associated with increased vulnerability to COVID-19 infections and deaths. COVID-19 is disproportionately impacting vulnerable groups and has been deadlier for African American and Hispanic people. The findings of this research will contribute to the knowledge base regarding social vulnerability and assist public health officials in targeting resources and designing interventions. This study used a retrospective cross-sectional design to assess demographic characteristics of …

Preventable Hospitalization Among Type 2 Diabetes Patients In Kentucky Before And After Medicaid Expansion 2010-2017., Turky Jamil Arbaein

Electronic Theses and Dissertations

Objectives: 1) Analyze county level variation in T2DM-PH rates in Kentucky before ACA (2010-2013) and after the ACA (2014-2017). 2) Analyze the relationship between county level socioeconomic factors (income per capita, percentage of uninsured people, percent of urban population, primary care and general preventive offices, population aged 65 and above, median age, household income, percentage in poverty, and unemployment rate ) and county level T2DM-PH rates before (2010-2013) and after (2014-2017) ACA implementation in Kentucky. Method: This research was conducted in two phases: Phase one of this study estimated the county-level PH variation among T2DM patients across eight years (2010-2017), …

Managing Stress In A Constantly-Changing Workforce, Lorri Burch-Hubbard

Electronic Theses and Dissertations

When staffing reductions occur in the workplace, staff left behind may face increased stress, may not be given the support they need to manage the feelings caused by the reduction. This study was conducted to evaluate the impact of stress caused by staffing reductions has on medical technologists (MT), medical technicians (MLT) and respiratory therapists (RT), and to identify any common methods of stress management used by those staff who remain in the organization.

Literature research showed the negative impact stress can have on individuals when it is not addressed, such as decreased work performance, health issues, and even the …

Converting Threats Into Opportunities Predicting Medical Error Reporting Behavior., Whitney Thomas Rogers

Electronic Theses and Dissertations

Medical errors are a public health epidemic and a major threat to patient safety. Estimates suggest they may be responsible for 210,000 - 440,000 preventable deaths per year. This would make medical errors the third leading cause of death in the United States. The societal burden of medical errors is steep, with the economic impact near $1 trillion. The purpose of this study was to use a theory-driven approach to better understand the reporting behavior of healthcare professional. Increased error reporting leads to heightened awareness of the precursors or conditions generating errors, which can then be corrected. In its most …

Oral Health-Related Quality Of Life In Us Adults With Type 2 Diabetes., Giang Truong Vu

Electronic Theses and Dissertations

This dissertation focused on the relationship between type 2 diabetes (T2DM) and oral health-related quality of life (OHRQoL) and the factors associated with this relationship in the US. The objectives of the dissertation research were a three-part process: (1) to understand the relationships of T2DM with poor OHRQoL, clarify risk and preventive factors that affect this association, and identify research gaps in the literature, (2) to analyze risk factors associated with poor OHRQoL in US adults with T2DM using a nationally representative random probability cluster sample, and (3) to apply structural equation modeling (SEM) to a simplified Andersen’s Behavioral Model …

Heat Waves And Heat-Related Mortality In East Tennessee, Taiwo Adesoba

Electronic Theses and Dissertations

Heat waves represent a public health challenge that requires multiple responses and warnings to protect vulnerable populations. Although studies have reported an increasing trend of heat wave occurrence in many areas of the world, no clear trend exists in East Tennessee. Using data from Parameter-elevated Relationships on Independent Slope Models (PRISM), CDC WONDER and the United States Census Bureau, the relationship between mortality rates and year was estimated during heat wave events between 1999 and 2010. Five heat wave definitions were tested. Overall, 2007 and 2010 stand out as the years with the highest number of heat wave days in …

Adverse Childhood Experiences, Homeless Chronicity, And Age At Onset Of Homelessness, Joseph T. Tucciarone Jr.

Electronic Theses and Dissertations

Childhood adversity is associated with numerous negative outcomes across multiple domains, including mental and physical health, interrelationships, and social functioning. Notably, research suggests that childhood adversity has a dose-response relationship with these outcomes; that is, greater numbers of adverse experiences in childhood are associated with worse outcomes. These outcomes overlap with many risk factors of homelessness. This study sought to address two questions: 1) Does a dose-response relationship exist between childhood adversity and chronic homelessness? 2) Does childhood adversity negatively predict the age at which homelessness first occurs? Adults experiencing homeless who are accessing homeless services in the Tri-Cities area …

Predictors Of Hospital Quality And Efficiency, Hoda Fotovvat

Electronic Theses and Dissertations

American hospitals have made serious efforts to implement and expand their health information technology capabilities and to integrate different specialized care or high-tech services in order to maximize the efficiency and quality of care. In providing a variety of HIT-related services, these hospitals expanded their national reputation in line with integrated care goals. As a result, hospitals are encouraged to establish effective communication channels to facilitate patient-physician sharing of the patient care experience, to enhance effective pain management, and to transform patient-centered care modalities to solidify the adequacy of patient care processes. By analyzing national data sets publicly available, this …

Let Me Upgrade You: Common Measures In Public Health Accreditation Action Plans, Gurleen K. Roberts

Electronic Theses and Dissertations

Objectives: The purpose of this study is to understand the success rates for health departments pursuing and achieving accreditation in version 1.0 and 1.5 of the Public Health Accreditation Board (PHAB) standards and measures. During the accreditation process, health departments that present performance gaps are asked to complete an Action Plan to specify how they plan to improve to meet the desired conformity. This study will highlight specific measures that are often included in Action Plans so that health departments pursuing accreditation can be better prepared to address these common pitfalls.

Methods: This study is a non-experimental, secondary …

Public Health Workforce Perceived Impact Of Emerging Issues In Public Health, Kristie C. Waterfield

Electronic Theses and Dissertations

Background: In an era where public health has been viewed as a global, multi-disciplinary field, the public health workforce has remained united to unfailingly holding fast to the mission of protecting, promoting, and improving the health of the public. However, the practice of public health is consistently evolving, and the workforce is continually facing a mirage of challenges. In order to overcome these challenges, practitioners need to be up-to-date on the necessary knowledge and skills to effectively deliver the core public health services.

Purpose: The purpose of this research was to explore the perceived impact of emerging trends in public …

Association Of Health Departments’ Completion Of A Community Health Assessment, Community Health Improvement Plan, And Strategic Plan With Better Population Health Outcomes, Kelora T. Cofer

Electronic Theses and Dissertations

Promoting health and well-being requires a strong public health infrastructure. This study examined the association of engagement of local health departments (LHDs) in accreditation and its pre-requisites with health outcomes in LHD jurisdictions such as the prevalence of premature death and tobacco use in the counties they serve. Two data sets, The 2016 National Profile of Local Health Departments and 2018 Community Health Rankings were linked using deterministic linkage approach, based on county FIPS codes as a unique identifier. Descriptive and multinomial logistic regression analyses were performed using SPSS Version 25. The results showed that having recently completed a community …

Generalized Spatiotemporal Modeling And Causal Inference For Assessing Treatment Effects For Multiple Groups For Ordinal Outcome., Soutik Ghosal

Electronic Theses and Dissertations

This dissertation consists of three projects and can be categorized in two broad research areas: generalized spatiotemporal modeling and causal inference based on observational data. In the first project, I introduce a Bayesian hierarchical mixed effect hurdle model with a nested random effect structure to model the count for primary care providers and understand their spatial and temporal variation. This study further enables us to identify the health professional shortage areas and the possible impacting factors. In the second project, I have unified popular parametric and nonparametric propensity score-based methods to assess the treatment effect of multiple groups for ordinal …

An Exploration Of Barriers To Health Care Access Among Uninsured Patients: Using The Moderating Effect Of Patients’ Enablement, Enedelia L. Jessup

Electronic Theses and Dissertations

ABSTRACT On March 23, 2010, Congress passed the Patient Protection and Affordable Care Act (ACA) to increase value of care, improve clinical outcomes, decrease health care costs, and increase affordability in health care access. The purpose of the study attempts to examine the moderating effects of patient enablement impacting barriers, low socio economic status, and unmet basic needs, toward health care access in uninsured populations post ACA. Only certain aspects of patient enablement in self-management of an individual’s health care goals have been conducted with uninsured populations with barriers toward health care access. The research design was a quantitative, exploratory, …

Work And Family Conflict: A Comparative Analysis Among Staff Nurses, Nurse Managers, And Nurse Executives, Amanda Raffenaud

Electronic Theses and Dissertations

The nursing workforce increasingly faces issues that affect clinical and managerial practice. One such issue is work-family conflict (WFC) and family-work conflict (FWC). Nurses face role strain as they confront the pressures from often competing work-and-family roles. This study assessed WFC/FWC among varying nurse roles: staff nurses, managerial nurses, and nurse executives. A random sample of 5,000 nurses, generated from registered nurses practicing in the state of Florida, was surveyed for this research study. Nurses were surveyed on demographics, perceptions regarding the work environment, and perceptions of WFC/FWC. Descriptively, nurses experienced more work-family conflict than family-work conflict. Regression analyses and …

Risk In Privacy Breach Determination: The Application Of Prospect Theory To Healthcare Privacy Officers, Amanda Walden

Electronic Theses and Dissertations

A significant concern in healthcare is that of patient privacy and how organizations protect against unauthorized access to protected health information. The federal government has responded by instituting policies and guidelines on requirements for protection. However, the policy language leaves areas open to interpretation by those following the guidelines. Reporting to the Office for Civil Rights and/or the patient can open an organization to risk of financial and possible criminal penalties. There is a risk of harm to their reputation which could impact patient visits and market share. Therefore, Privacy Officers might view risk in different ways and therefore handle …

Interaction Between Income, Health Insurance, And Self-Rated Health: A Path Analysis., Atalie Ashley West

Electronic Theses and Dissertations

The political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of health, with income being the most consistent predictor. As a result, this study investigated whether earned income is related …

Association Between Local Health Departments’ Engagement In Phab Accreditation And Budget Cuts Prevention, Ghadeer M. Albashir

Electronic Theses and Dissertations

Objectives: The primary purpose of this study is to examine whether engagement in Public Health Accreditation Board (PHAB) accreditation process and its requirements are associated with budget cuts prevention for local health departments (LHDs). Methods: For this study, we performed multinomial logistic regression using the 2016 National Profile of Local Health Departments Survey conducted by the National Association of County and City Health Officials. Results: While budget did not change for a majority of LHDs in comparison with previous year (48.6%), there were 28.7% that reported budget increase, and almost a quarter of LHDs had reduced budget (23%). The multinomial …

Merging Cultures: Organizational Behavior, Leadership, And Differentiation In A Health System Merger, Colin G. Chesley

Electronic Theses and Dissertations

Health system mergers and acquisitions (M&As) have increased exponentially in recent years as a result of the Affordable Care Act (Brown, Werling, Walker, Burgdorfer & Shields, 2012). M&As are consummated as a way to control for interdependencies within the market, control costs and leverage debt, and negotiate better rates among health insurers (Bolman & Deal, 2013; Cooper & Finkelstein, 2010; Mirc, 2013). Regardless of the impetus for a merger, the largest predictor of the success or failure of a M&A lies within the organizational culture (Brown, et al., 2012; Cooper & Finkelstein, 2010; Kastor, 2010; Ovseiko, Melham, Fowler & Buchan, …

Burden Of Illness And Pharmacoeconomic Evaluation Of Lumacaftor/Ivacaftor In Cystic Fibrosis, Pratyusha Vadagam

Electronic Theses and Dissertations

Objectives: (1) To estimate the burden of illness in cystic fibrosis (CF) using 2010-2014 Medical Expenditure Panel Survey (MEPS) data, and (2) to conduct a pharmacoeconomic evaluation of lumacaftor/ivacaftor in the treatment of CF.

Methods: The study was conducted in two parts. Part 1 involved a retrospective analysis using individuals in MEPS database with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 277.00 for a principal diagnosis of CF. Dependent variables were cumulative and out-of-pocket (OOP) expenditures and independent variables included patient demographics and clinical characteristics. Unweighted and weighted estimates of expenditure in CF group, …

Tobacco Use, Cessation, And Locus Of Control Among College Students, Bernard Ambe

Electronic Theses and Dissertations

ABSTRACT

The purpose of this study was to (a) determine the locus of control among American college students (b) determine if tobacco use or cessation correlate with any demographic variables to better understand the efficacy of tobacco interventions and help design an intervention most effective in the prominent LOC of college students.

The Global Adult Tobacco Survey (GATS) was modified for the purposes of this study and used to determine demographic factors and tobacco usage status. The modified GATS survey also included the LOC questionnaire which yielded the data. Seventy-four responses were recorded. The mean locus of control scores were …