Medicine and Health Sciences Commons^™

Redefining Trauma: Utilizing Restorative Justice To Repair Care Systems, Emebet Aklilu

Master's Projects and Capstones

This project examined the ways in which restorative justice programming can improve trauma informed care among the African American population in Oakland, CA. With 23% of African American men and women living at or below the poverty line in the United States, this project assesses gaps in current trauma informed care practices as evident in the literature. Following a rigorous document review the author coded and organized key programming components following six factors detailed by Rowher, Schoones, and Young (2014). Further examination of these program components was conducted using Bloom’s taxonomy levels to assess program outcomes associated with specific modules …

How Does Access To Healthcare Affect Life Expectancy?, Yara Mahmoud

Senior Honors Projects, 2010-2019

Access to health care is a pressing issue in the United States, whether it be the cost of care or not having enough of it. To emphasize the importance of this topic, this paper assesses the impact of access to health services on life expectancy. A comparison is made between the universal health systems in France and Spain and the mixed system in the United States. Even though the United States spends the most on health care in the world, its statistics fall below those of other developed countries. After addressing other risk factors, it was found that individuals under …

Is Sabr Cost-Effective In Oligometastatic Cancer? An Economic Analysis Of Sabr-Comet Randomized Trial, Yujie Chen

Electronic Thesis and Dissertation Repository

The phase II randomized study SABR-COMET demonstrated that in cancer patients with 1-5 oligometastatic lesions, stereotactic ablative radiotherapy (SABR) was associated with an improvement in both progression-free survival and overall survival compared to standard of care (SoC). SABR, however, is associated with higher costs and treatment-related toxicity. The objective of this study was to assess the cost-effectiveness of SABR versus SoC in patients with oligometastatic disease.

A time-dependent Markov model with five health states was constructed from the Canadian health care system perspective. Utility values and transition probabilities were derived from the SABR-COMET trial. Costs were obtained from the published …

Extracting Patterns In Medical Claims Data For Predicting Opioid Overdose, Ryan Sanders

Graduate Theses and Dissertations

The goal of this project is to develop an efficient methodology for extracting features from time-dependent variables in transaction data. Transaction data is collected at varying time intervals making feature extraction more difficult. Unsupervised representational learning techniques are investigated, and the results compared with those from other feature engineering techniques. A successful methodology provides features that improve the accuracy of any machine learning technique. This methodology is then applied to insurance claims data in order to find features to predict whether a patient is at risk of overdosing on opioids. This data covers prescription, inpatient, and outpatient transactions. Features created …

Examining Racial & Ethnic Disparities In The Reach Of The Medicare Shared Savings Program, Lindsey Arneson

Capstone Experience

It is important to understand the quality of health care for racial and ethnic minorities covered under the largest U.S. government-run insurance program, Medicare, because the demographics of the U.S. are becoming older and more diverse. A new value-based program under Medicare is the Shared Savings Program (MSSP), which creates incentives to improve care quality and health outcomes for Medicare beneficiaries with a specific focus on increasing the provision of preventive care services. This capstone project aims to understand the representation of racial/ethnic minority Medicare beneficiaries, namely African Americans/Blacks and Hispanics/Latinxs, that receive care from providers or facilities (i.e., Accountable …

Organizational Culture Change In The United States Government And Its Application In State And Local Public Health Agencies: A Literature Review, Katherine Barrow

Capstone Experience

State and local health agencies play a critical role in the assessment and assurance of public health in the United States. Their authority to shape the structure and delivery of health services makes organizational culture change imperative for the improvement of government services and ultimately, the health of the public. A systematic literature review using SCOPUS, PsycINFO, Business Source, and Academic Search Premier was conducted to 1) analyze organizational culture change efforts in United States federal, state, and local government settings and 2) make recommendations on how to implement organizational culture change initiatives in state and local health agencies. Of …

Collection Of Analyzed Data From Health And Human Services Professionals: Stressors And Self-Care Practices, Yesenia Alcala

Capstone Projects and Master's Theses

Alliance on Aging is a nonprofit agency in Salinas, California. It was established in 1970, and they help serve the needs of the senior citizen community by offering multiple services. Working professionals experience high levels of stress in the workplace. Although there are many contributing factors for high stress in the workplace, the main factors at play are the lack of self-care and lack of support Zastrow (pg. 332, 2015). Because working professionally in the human services field experience high stress the consequences they may face are burnout, high turnover rates, and poor overall health. The capstone project will assess …

Blueprint For Shared Safety Strategic Plan, Reann Ramos

Capstone Projects and Master's Theses

The Blueprint for Shared Safety strategic plan will be adopted by Santa Cruz County Community Corrections Partnership as a framework of principles and practices that community leaders can use to lead shared safety strategies. By shifting the focus from the traditional criminal justice system to investments that can truly make our communities safer, the Blueprint aims to re-envision public safety together. The Community Corrections Partnership Community Education and Engagement Workgroup (CCP CEEW) has conducted data analysis to identify the key assets and gaps in Santa Cruz County. After identifying the key assets and gaps there were recommendation review sessions that …

Diabetes And Effectiveness Of Gym Usage, Roberto Moore

Capstone Projects and Master's Theses

The Central Coast YMCA’s Diabetes Prevention Program (DPP) exists to support community members who are diagnosed as pre-diabetic. DPP participants are provided a free membership to the YMCA’s gym, but are under utilizing this resource. Some reasons that participants may not be utilizing the gym are lack of time, work schedules, the language barrier in utilizing the equipment and childcare concerns. If participants are not utilizing the gym they may not complete the program and may be at risk of contracting diabetes and possibly losing a limb. In order to understand the specific barriers for this group in utilizing this …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

Construction Of Prediction Models For The Health Utility Index Mark 3 In Ontario And Its Application, Yue Niu

Electronic Thesis and Dissertation Repository

The government of Ontario initiated primary care reform in the early 2000s, leading to a shift away from the traditional fee-for-service (FFS) physician remuneration to incentive-based blended remuneration models. Research on the association between change in physician remuneration and patients' health status is unknown. The objectives of this thesis are to (i) construct a statistical model to predict the Health Utility Index 3 (HUI3) values for all non-institutionalized Ontario residents, and (ii) study the association between the change in physician remuneration models and patients' health status measured by HUI3. The data came from the Canadian Community Health Survey (CCHS) 2000-2001 …

Understanding Young Adult Survivors Of Childhood Cancers’ Participation In Late Effects Screening: A Mixed Methods Approach, Kristen Trost Mantlo

Health Services Research Dissertations

Significant advancements in the treatment of childhood cancers have helped to increase the 5-year survival rate from 56% in the early 1970s to approximately 80-85% in the early 2000s (Greenlee, Murray, Bolden, & Wingo, 2000; Hampton, 2005). Treatment modalities such as chemotherapy and radiation have led to many serious long-term side effects, known as late effects. Between 60% and 90% of survivors develop some form of long-term chronic condition due to their treatment and up to 40% of those conditions will be life-threatening (Howlader, N. et al., 2013). While the majority of young adult survivors of childhood cancer are at …

Exploring Healthcare Consumer Involvement In Clinical Practice Guideline Development, Adam Jordan

Electronic Thesis and Dissertation Repository

Involving healthcare consumers (HCCs) in clinical practice guideline (CPG) development can lead to identification of topics that guidelines should consider. To evaluate the strategies being used to involve HCCs in CPG development, a description of these strategies is needed. This study utilized qualitative description to analyze CPGs and related documents. Professionals involved in CPG development were also interviewed. Patients, family members, and informal caregivers have been involved in the formulation of recommendations, CPG reviewing and editing, and through use of patient resources. According to the results, involving HCCs is done to incorporate patient preferences and values into CPGs, and to …

Wellness For One, Healthy Community For All: Improving A Multidimensional University Wellness Programlth, Shea Gaier

Master's Projects and Capstones

Background: Evidence suggests that college students are often unaware of the seven

dimensions of wellness (Social, emotional, environmental, financial, physical, intellectual, and spiritual). According to interviews, most students think of physical wellness only when it comes to wellness. Besides the dimensions of wellness, students have shown to gain substantial benefits from increasing their knowledge of school resources regarding personal health.

Methods: This was a quality improvement project for the Wellness Matters Program that encompassed a Plan, Do, Study, Act cycle. The goal was to improve the program by adding a comprehensive educational workshop and optimizing the one-on-one sessions. Pilot tests …

Paging Dr. Strong: A Call To Action Towards Addressing Occupational Stress And Burnout Among Primary Care Health Professionals, Carmen Olmedo

Master's Projects and Capstones

Purpose: Within a rapidly evolving industry, occupational stress and burnout among healthcare clinicians and staff is becoming a pervasive public health crisis across all subspecialties. The purpose of this project was to use the Compassion Satisfaction-Compassion Fatigue (CS-CF) Theory as a method to assess burnout among primary care health professionals, in addition to developing recommendations to assist the promotion of a staff wellness initiative at an urban community clinic.
Methods: A needs assessment was conducted at a Community Health Center (CHC) in San Francisco. Data collection consisted of anonymous distribution of the Professional Quality of Life (ProQOL) Survey and semi-structured …

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 …

Uptake Of Colorectal Cancer Screening Tests By Ontario Physicians., Owen Litwin

Electronic Thesis and Dissertation Repository

This population-based study used administrative healthcare data to examine the uptake of tests recommended for colorectal cancer screening by eligible Ontario physicians and non-physicians, and to examine if testing of primary care physicians is associated with greater testing in their patients. Physicians (n=11,434) were matched 1:4 to non-physicians (n=45,736) on age, sex, and geographic location as of April 21, 2016. Uptake of colorectal tests was similar in physicians (67.9%, 95% CI, 67.0–68.7%) and non-physicians (66.6%, 95% CI, 66.2–67.1%). Physicians were more likely than non-physicians to undergo colonoscopy and less likely to undergo fecal occult blood testing. Uptake of colorectal tests …

Depression Among Expectant And New Mothers: A Multi-Study Investigation Of Rates, Correlates, And Training For Healthcare Providers, Molly M. Long

Health Services Research Dissertations

Perinatal depression (PD) is a common concern among women. PD has been shown to have negative effects on the mother, child, and mother-child relationship. Screening for PD is inconsistent and low among healthcare providers. However, several governing organizations (e.g., The American College of Obstetricians and Gynecologists, The American Academy of Pediatrics) have provided guidelines for screening and treating PD, indicating the importance and utility of screening and treating PD by a variety of healthcare providers. Few studies, with low methodological rigor, have attempted to improve PD screening, treatment, and referral practices. Therefore, it is important to implement and assess additional …

Working With Youth As Stakeholders In Mental Health System Transformation: An Institutional Ethnography Of A Service Organization In Access Open Minds, Eugenia Canas

Electronic Thesis and Dissertation Repository

As national system- and research-agendas invest heavily in the improvement of youth mental health services delivery, the discursive and policy impetus for the inclusion of youth as advisors has increased. However, we know little about the work of youth engagement (YE) in the everyday realities of a care-delivery organization. Does the engagement of youth advisors ultimately inform care?

This dissertation addresses the knowledge concerns of YE with a detailed account of the experiences of youth advisors, service providers, and an organization in the process of services reform. I used institutional ethnography to (1) reveal the day-to-day work of engaging young …

Measuring Quality Of Life In Patients With Rotator Cuff Disorders, Rochelle Furtado

Electronic Thesis and Dissertation Repository

Rotator cuff disorders (RCDs) are a common musculoskeletal problem with a higher prevalence in women and after the age of 60. Due to the increasing need for patient-centered care, researchers have been directed towards the use of patient reported outcomes (PROs) to evaluate the progress of patient recovery, as the experience varies across individuals.

Recently, the Western Ontario Rotator Cuff Index was reduced in items to create the shortened version of the Western Ontario Rotator Cuff Index (Short-WORC). However, the Short-WORC’s psychometrics have yet to be evaluated. Therefore, this mixed-methods thesis aimed to evaluate the psychometric properties of the Short-WORC …

Comorbidities And Medication Adherence Among Older Individuals Living With Hiv In The United States, Amanda M. Kong

Dissertations and Theses

The number of people living with HIV (PLWH) ≥65 years old is increasing in the United States (US) as PLWH live longer. In 2015, there were nearly 1 million people living with diagnosed HIV in the US and under 10% were age ≥65. By 2035, the proportion of PLWH in this age group is projected to be 27%. Like the general population of elderly individuals, as they age, PLWH face age-related comorbidities, many of which require routine medical care and daily medications, in addition to daily antiretroviral therapy (ART) for treatment of HIV. Previous research has found that PLWH develop …

Examining The Effects Of Approaches On Reducing Hospital Utilization: The Patient-Centered Medical Home, Continuity Of Care, And The Inpatient Palliative Consultation At The End-Of-Life, Xiaoting Sun

Theses & Dissertations

Background: It has become a national priority to reduce the high health care expenditure in the United States while improving the quality of care. Hospital care is taking up one-third of the healthcare spending, and services offered in hospitals are costly compared to others. Only one-twentieth of the patients with high-needs account for about half of the health care spending. They consuming a high level of hospital services if their conditions are not well-managed in the outpatient settings. Therefore, it is important to examine the effectiveness of the approaches that have the potentials to reduce costly care utilization through improvements …

God, I Hope This Part Of My Life Is Over: A Focused Ethnography Of A Correctional Youth Facility’S Therapeutic Climate, Eric Meyer

Theses & Dissertations

Although all prisons have the same goal of isolating offenders from society, the precise strategies used vary from one jurisdiction to the next. Some prisons use means of punishment to gain inmate compliance. Other prisons concentrate their limited resources on rehabilitation. Contained within the following pages are details of a focused ethnography that was completed in a state correctional youth facility that housed males between the ages of 15 and 21 years, all of whom were convicted of violent crimes. This study had the objective of exploring the climate of therapy in this correctional youth facility where rehabilitative programs were …

Impact Of Healthcare Delivery And Policies On Children's Outcomes After The Affordable Care Act Of 2010, Shreya Roy

Theses & Dissertations

The Patient Protection and Affordable Care Act (ACA) of 2010 introduced programs to promote integrated pediatric healthcare delivery and to expand public health insurance (Medicaid) eligibility for adults from low-income families in the United States. This dissertation examined whether progress was made towards integration of healthcare delivery for children with developmental disabilities after the implementation of ACA, and also whether expansion of Medicaid for adults impacted the preventive care utilization and school absenteeism of children from low-income families. A cross-sectional study design was used to examine whether integration of pediatric healthcare delivery was accomplished and a quasi-experimental difference-in-differences approach was …

Barriers And Facilitating Factors To The Integration Of The First Uk-Trained Physician Associates Onto Secondary Care Services In The British National Health Service, Tamara S. Ritsema

Theses & Dissertations

Introduction: The Physician Associate (PA) profession was brought from the United States (where it is called the "Physician Assistant" profession) to the United Kingdom (UK) approximately 15 years ago. Universities have begun to train PAs and these graduates are now starting work in the British National Health Service (NHS) in both primary and secondary care. The number of PAs graduating from PA programs and beginning to work in secondary care will increase substantially over the next few years. No research has been conducted on barriers and facilitators to the integration of a UK-trained PA onto a secondary service.

Methods: A …

Factors Influencing Unmet Medical Need Among U.S. Adults: Disparities In Access To Health Services, Ahmad Khanijahani

Electronic Theses and Dissertations

Inequities in access to health services has negative consequences on individual well-being, and imposes financial and emotional burden on patients, families, health care systems, and the public. Inequities engendered from differences in socioeconomic status, health insurance coverage, race, and other characteristics can engender disparities. This study aimed to identify the potential predictors of unmet medical need among the civilian noninstitutionalized U.S. adults. Inability to receive needed medical care or receiving medical care after a delay, due to the associated costs, constructed unmet medical need. This study used a four-year (2014-2017) National Health Interview Survey (NHIS) data (sample size: 296,301 adults) …

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 …

Increasing Low-Income Residents’ Access To Fresh Produce Through A Local Mobile Pantry, Laura Wasson

Human Nutrition and Hospitality Management Undergraduate Honors Theses

Seeds that Feed (STF) is a mobile food pantry located in Fayetteville, Arkansas. STF receives produce from local farmers to distribute to residents in low-income housing sites throughout Northwest Arkansas. According to Feeding America, food insecurity affected 14.3% Washington County, Arkansas’ population in 2016. The purpose of this study was to determine if STF’s model is an effective way to increase individuals’ access to fresh fruits and vegetables and increase their potential to meet the United States Department of Agriculture’s Food Patterns (USDA-FP) for to fruit and vegetable consumption. Twenty-three participants from three sites completed the study. A survey was …

A Framework For Learning During An Honors Internship: Embold Health Inc., Haley Haldeman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Embold Health Inc. is a health care analytics start-up company that identifies top performing providers using large data sets and clinically nuanced measurement. A comprehensive assessment of quality, appropriateness, and cost is what Embold Health delivers. Embold allows payers more control in choosing providers within their region. Being able to identify top provider behaviors through rigorous data driven measurement is significant both clinically and commercially; it provides the opportunity to increase value of care, decrease waste, and drive down cost.

Over the past year as an intern, I’ve had a first-hand look into the complexity that surrounds data driven health …

Transition In Occupations Of Refugees During Resettlement, Jacqueline-Elizabeth Cantrell, Kimberley K. Banuelos, Adam Chan, Jennifer H. Daine

Occupational Therapy | Graduate Capstone Projects

Purpose: In 2016, there were 22.5 million refugees worldwide (UNHCR, 2017). California resettled just over 5,000 of those 85,000 (Igielnik & Krogstad, 2017). Limited research has been conducted in the United States (U.S.) focusing on the refugee experience; furthermore, there is a significant gap in research regarding the impact of the refugee experience on the occupations of refugees as they transition to living in the U.S. Smith (2012) explored the adaptation of cultural weaving among Karen refugees to maintain their previous occupations and the impact of daily weaving on their lives within Western culture; however, the study focused only …