Medicine and Health Sciences Commons^™

Sepsis: Do The Clinical Criteria Support The Medical Coding?, April M. Insco

Theses and Dissertations (ETD)

Background: Sepsis is a condition that can be very costly and very deadly. Diagnosing sepsis can be challenging as there is not one specific test that will identify whether a patient has sepsis and there are varying opinions as to the true definition of sepsis. The definition of sepsis used for this research is a combination of System Inflammatory Response Syndrome (SIRS) with an identified infection. Medical Coders must review the documentation provided in a medical record to accurately assign an ICD-10-CM code. Administrative data is then used to provide statistical information for research purposes. When coded data is not …

Responding To The Pandemic: A Multicountry Study On Social-Political Factors And Health Outcomes Of Covid-19, Lan Yao

Theses and Dissertations (ETD)

Introduction. Coronavirus Disease 2019 (COVID-19) poses a major global threat to human beings, which has caused devastating consequences of population health, political, and economic crises in many countries. This dissertation was composed of three research activities to study the following aims: (1) review the existing literature focusing on political factors and health outcomes of COVID-19; (2) assess the relationship between democracy and case fatality rate of COVID-19 by controlling for the effect of age, comorbidity, health expenditure, healthcare workforce, and population density; and (3) identify the trajectory pattern cases peak days, deaths peak days, and peak periods.

Methods. We accessed …

Feasibility And Acceptability Of Using Mobile Health Apps In Underserved Patients With Diabetes, Jieyu Luo

Theses and Dissertations (ETD)

Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. …

Medication Nonadherence, Health Care Utilization, And Safemed Care Transitions Model Impact In Super-Utilizers, Satya Surbhi

Theses and Dissertations (ETD)

BACKGROUND: Super-utilizers are individuals with disproportionately high inpatient and emergency department (ED) use, and mostly have multiple chronic conditions and use multiple concurrent medications. They place a substantial burden on the U.S. healthcare system and have become the focus of policy initiatives aimed at reducing their disproportionate inpatient and ED use. Medication management is critical for these patients since nonadherence to essential chronic medications is associated with poor health outcomes, and higher health care utilization and costs. OBJECTIVES: This dissertation employed a three empirical research papers approach to study the following aims: (1) the prevalence and patterns of medication nonadherence …

Assessing The Role Of Faith-Based Organizations In Health Promotion, Troylyn Braud Francis

Theses and Dissertations (ETD)

Objective: The objective of this analysis was to evaluate the relationship between organizational readiness (OR) and weight loss and physical activity outcomes among faith-based organizations (FBOs).

Methods: Data for this study were collected in two phases. Phase I data were based on a feasibility study and targeted African-American individuals (N = 55) who participated in an obesity prevention program. The intervention was accomplished in two stages, which included a 10-week core period followed by a 6-month maintenance period. Phase II data were based on key informant interviews that were conducted with community health leaders (CHLs) (N=6) from participating …

Super-Utilization: The New Perfect Storm Of Health Reform, Jill Diane Nault

Theses and Dissertations (ETD)

This three-essay dissertation was focused on geographic variation of super-utilization, or the disproportionately high healthcare utilization and costs attributed to a small sub-set of the inpatient population. For purposes of this research, super-utilization was operationalized as high repeat utilization (HRU) and referred to inpatient utilization and inpatient readmission expenditures attributed to beneficiaries with four or more 30-day readmissions per year. The overall purpose of the research was to identify geographic areas at increased risk for HRU. These areas corresponded to where beneficiaries live and were aligned with the geographically-bound healthcare delivery systems. Each essay employed an observational study design using …

Medicaid Discontinuity Among Adults With Cardiovascular Disease Or High Risk Conditions: Associations With Medication Adherence And Health Care Utilization, Kiraat Divyang Munshi

Theses and Dissertations (ETD)

BACKGROUND: Medicaid coverage among adults is often characterized by discontinuity – loss of Medicaid coverage, and churning, or entering and exiting Medicaid – over short durations. Little is known about the impact of having discontinuous Medicaid coverage on access to care, preventive care, pharmacotherapy, primary care, and hospitalizations, among non-elderly adults with cardiovascular disease (CVD) or high-risk conditions.

OBJECTIVES: This dissertation employed a three empirical research papers approach to pursue the following aims: (1) characterize the adult subpopulations with CVD or conditions placing them at high risk for CVD who lack continuous Medicaid coverage, and examine the characteristics associated with …

Women’S-Perceived Quality In Postpartum Care, Maryland A. Hunter

Theses and Dissertations (ETD)

Increased competition among healthcare organizations for the obstetric consumer market has led to increased interest in women’s perceptions of their obstetric experience. This study explored women’s perceptions of quality and women’s perceptions of benefits for women who received family-centered postpartum care (FCPPC) and women who received traditional postpartum care (TPPC). The study also assessed the relationship between women’s-perceived quality (WPQ) and women’s-perceived benefit (WPB) for those receiving FCPPC and those receiving TPPC. Quality and beneficence are the two concepts of Larrabee’s (1992) model of quality operationalized in this study. The sample consisted of 60 postpartum women, 30 receiving care on …

Patient Perceptions Of Quality: The Influence Of Value And Beneficence, Rebecca H. Waldon

Theses and Dissertations (ETD)

The influence of patient values and patient perception of benefits on patient perceptions of quality have not been extensively investigated, even though patient and provider perceptions of quality have been widely studied. Refocusing quality assessment and improvement to include factors that influence patient perceptions of quality is necessary for humanitarian and economic reasons. The health care patient has certain expectations of health care. These expectations are based on the value the patient places on the services. Value is a predictor of patient-perception of quality. The relative worth of patient goals may also be related to patient perceptions of quality. If …

Pain And Hospital Patients Perception Of Quality, Kathy L. Beck

Theses and Dissertations (ETD)

Each year pain disables approximately 50 million Americans. These patients seekhealth care for the relief of pain and its underlying cause. Many of those seeking relief from pain are hospitalized and others experience pain during their hospitalization. All of these patients have the right to relief of their pain and none should suffer pain needlessly. Yet, often nurses fail to accurately assess and adequately manage patients' pain.

Adequate pain management may increase patient perception of nursing care quality. The purpose of this study is to determine the relationships between pain relief and patients' and nurses' perceptions of quality. The relationship …

Hospital Patients' And Nurses' Perceptions Of Quality, June Hansen Larrabee

Theses and Dissertations (ETD)

Hospital quality assurance programs have been provider-oriented, focusing on structure and process elements of care rather than outcomes specific to patient needs and values. This study tested the relationship between quality and value, proposed in Larrabee's model of quality, by developing prediction indices for patient and nurse quality and value.

The sample consisted of 199 adult patients. Patient quality was measured by a 100 mm visual analog scale (VAS) (PQUALG) and a modified version of an existing instrument (PQUALT). Patient value was measured as patient goal achievement (PGOAL), the average of three VAS scores for patient defined goals …