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Articles 31 - 60 of 219
Full-Text Articles in Medicine and Health Sciences
Knowledge Integration: The Iaims Experience At Lvh., Donald L. Levick Md, Linda M. Schwartz Mde, Ahip, Cm, Bryan G. Kane Md
Knowledge Integration: The Iaims Experience At Lvh., Donald L. Levick Md, Linda M. Schwartz Mde, Ahip, Cm, Bryan G. Kane Md
Bryan G Kane MD
No abstract provided.
An American Epidemic: Burnout Syndrome In Hospital Nurses, David P. Paul Iii, Lama Bakhamis, Harlan Smith, Alberto Coustasse
An American Epidemic: Burnout Syndrome In Hospital Nurses, David P. Paul Iii, Lama Bakhamis, Harlan Smith, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
The number of Registered Nurses (RNs) in the United States (U.S.) is roughly three times that of physicians and surgeons, making RNs a critically important component of the U.S. healthcare system. RN Burnout – defined as the feeling of exhaustion from working long hours without rest – is a real concern, having been reported in many hospitals. The purpose of this research is to examine the causes and consequences of Burnout Syndrome among RNs in U.S. hospitals, in order to identify solutions to this problem. The methodology involves a review of the literature and semi-structured interviews. Seven primary databases, two …
Ransomware In Healthcare Facilities: The Future Is Now, Nikki Spence, David P. Paul Iii, Alberto Coustasse
Ransomware In Healthcare Facilities: The Future Is Now, Nikki Spence, David P. Paul Iii, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Cybercriminals have begun to target the healthcare industry with a type of malware called ransomware, malware that encrypts an infected device and any attached devices or network drives. After encryption, cybercriminals demand a sum of money, also known as a “ransom,” to release the devices from encryption. Without adequate disaster recovery and backup plans, many businesses are forced to pay the ransom. The purpose of this study was to determine the extent of recent ransomware infections in healthcare settings, the risk liabilities and cost associated with such infections, and to determine possible risk mitigation tactics. Financial costs associated with business …
Accountable Care Organizations And Transaction Cost Economics, Stephen S. Farnsworth Mick, Patrick D. Shay
Accountable Care Organizations And Transaction Cost Economics, Stephen S. Farnsworth Mick, Patrick D. Shay
Patrick Shay
Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of …
Superbugs Versus Outsourced Cleaners: Employment Arrangements And The Spread Of Health Care-Associated Infections, Adam Seth Litwin, Ariel C. Avgar, Edmund R. Becker
Superbugs Versus Outsourced Cleaners: Employment Arrangements And The Spread Of Health Care-Associated Infections, Adam Seth Litwin, Ariel C. Avgar, Edmund R. Becker
Adam Seth Litwin
On any given day, about one in 25 hospital patients in the United States has a health care–associated infection (HAI) that the patient contracts as a direct result of his or her treatment. Fortunately, the spread of most HAIs can be halted through proper disinfection of surfaces and equipment. Consequently, cleaners—“environmental services” (EVS) in hospital parlance—must take on the important task of defending hospital patients (as well as staff and the broader community) from the spread of HAIs. Despite the importance of this task, hospitals frequently outsource this function, increasing the likelihood that these workers are under-rewarded, undertrained, and detached …
Ct Scanning Is Sufficient To Clear The Cervical Spine Of Elderly Falls Less Than 5 Feet., Douglas Lehman Md, Rovinder S. Sandhu Md, Leslie Baga Bsn, Farheen Hussain Ms, John J. Hong Md
Ct Scanning Is Sufficient To Clear The Cervical Spine Of Elderly Falls Less Than 5 Feet., Douglas Lehman Md, Rovinder S. Sandhu Md, Leslie Baga Bsn, Farheen Hussain Ms, John J. Hong Md
John J. Hong, M.D.
No abstract provided.
Can Scribes Boost Fps' Efficiency And Job Satisfaction, Stephen T. Earls, Judith A. Savageau, Susan Begley, Barry G. Saver, Kate Sullivan, Alan Chuman
Can Scribes Boost Fps' Efficiency And Job Satisfaction, Stephen T. Earls, Judith A. Savageau, Susan Begley, Barry G. Saver, Kate Sullivan, Alan Chuman
Barry G. Saver
Purpose: Research in other medical specialties has shown that the addition of medical scribes to the clinical team enhances physicians' practice experience and increases productivity. To date, literature on the implementation of scribes in primary care is limited. To determine the feasibility and benefits of implementing scribes in family medicine, we undertook a pilot mixed- method quality improvement (QI) study.
Methods: In 2014, we incorporated 4 part-time scribes into an academic family medicine practice consisting of 7 physicians. We then measured, via survey and time-tracking data, the impact the scribes had on physician office hours and productivity, time spent on …
Can Scribes Boost Fps' Efficiency And Job Satisfaction, Stephen T. Earls, Judith A. Savageau, Susan Begley, Barry G. Saver, Kate Sullivan, Alan Chuman
Can Scribes Boost Fps' Efficiency And Job Satisfaction, Stephen T. Earls, Judith A. Savageau, Susan Begley, Barry G. Saver, Kate Sullivan, Alan Chuman
Barry G. Saver
Purpose: Research in other medical specialties has shown that the addition of medical scribes to the clinical team enhances physicians' practice experience and increases productivity. To date, literature on the implementation of scribes in primary care is limited. To determine the feasibility and benefits of implementing scribes in family medicine, we undertook a pilot mixed- method quality improvement (QI) study.
Methods: In 2014, we incorporated 4 part-time scribes into an academic family medicine practice consisting of 7 physicians. We then measured, via survey and time-tracking data, the impact the scribes had on physician office hours and productivity, time spent on …
Can Scribes Boost Fps' Efficiency And Job Satisfaction, Stephen T. Earls, Judith A. Savageau, Susan Begley, Barry G. Saver, Kate Sullivan, Alan Chuman
Can Scribes Boost Fps' Efficiency And Job Satisfaction, Stephen T. Earls, Judith A. Savageau, Susan Begley, Barry G. Saver, Kate Sullivan, Alan Chuman
Judith A. Savageau
Purpose: Research in other medical specialties has shown that the addition of medical scribes to the clinical team enhances physicians' practice experience and increases productivity. To date, literature on the implementation of scribes in primary care is limited. To determine the feasibility and benefits of implementing scribes in family medicine, we undertook a pilot mixed- method quality improvement (QI) study.
Methods: In 2014, we incorporated 4 part-time scribes into an academic family medicine practice consisting of 7 physicians. We then measured, via survey and time-tracking data, the impact the scribes had on physician office hours and productivity, time spent on …
The Relationship Between Quality Improvement And Health Information Technology Use In Local Health Departments, Kendra Johnson, Kim K. Nguyen, Shimin Zheng, Robin P. Pendley
The Relationship Between Quality Improvement And Health Information Technology Use In Local Health Departments, Kendra Johnson, Kim K. Nguyen, Shimin Zheng, Robin P. Pendley
Shimin Zheng
This research examined if there is a relationship between engagement in quality improvement (QI) and health information technology (HIT) for local health departments (LHDs) controlling for workforce, finance, population, and governance structure. This was a cross-sectional study that analyzed data obtained from the Core questions and Module 1 in the NACCHO 2010 Profile of LHDs. Descriptive statistics, bivariate analyses, and logistic regression analyses were conducted. Findings suggest that LHD engagement in QI has a relationship with utilization of HIT including electronic health records, practice management systems, and electronic syndromic surveillance systems. This study provides baseline information about the HIT use …
How Safe Is Healthcare? Perceptions Within The Healthcare Community And The General Public., Rodhan A. Khthir, Shahed Elhamdani, Ibrahim Hatab, Felyn Espina, Gerry Asuncion, Sutoidem Akpanudo
How Safe Is Healthcare? Perceptions Within The Healthcare Community And The General Public., Rodhan A. Khthir, Shahed Elhamdani, Ibrahim Hatab, Felyn Espina, Gerry Asuncion, Sutoidem Akpanudo
Rodhan Khthir
Objectives: Complexity of health care is progressively increasing and with that the number of medical errors and adverse events are increasing to an alarming level. The purpose of this study is to assess the perception of healthcare safety within the healthcare community and the general public and examine the association between the perception regarding healthcare safety and the prior exposure to medical errors.
Methods: The study is a cross-sectional online survey. The online survey included basic demographics and a series of questions related to the knowledge and perception about healthcare safety and personal healthcare experience.
Results: 504 respondent …
Icd-10 Implementation: Is The Workforce Ready?, David P. Paul Iii, D.D.S., M.B.A., Ph.D, Patricia A. Sacconi, Pamela Ann Glover, Robert Marriot, Alberto Coustasse Dr. Ph, Md, Mba
Icd-10 Implementation: Is The Workforce Ready?, David P. Paul Iii, D.D.S., M.B.A., Ph.D, Patricia A. Sacconi, Pamela Ann Glover, Robert Marriot, Alberto Coustasse Dr. Ph, Md, Mba
Alberto Coustasse, DrPH, MD, MBA, MPH
After many delays, the U.S. finally implemented ICD-10-CM/PCS on October 1, 2015, bringing the U.S. into line with other industrialized nations, most of which have been using ICD-10 for many years. We outline the benefits and challenges to the preparatory activities of the ICD-10-CM/PCS implementation for the U.S. healthcare industry. To ease the transition, CMS allowed healthcare facilities to submit test claims prior to the implementation date, and delivered feedback on the acceptability of those claims. Early results indicated a relatively smooth transition, although some questions regarding the available data remain. Additional data, especially data concerning outcomes, is required.
Big Data: Harnessing The Beast!!, Rebecca Hovemeyer, Debra Stinson, Beteseb Gebremariam, Alberto Coustasse Dr. Ph, Md, Mba
Big Data: Harnessing The Beast!!, Rebecca Hovemeyer, Debra Stinson, Beteseb Gebremariam, Alberto Coustasse Dr. Ph, Md, Mba
Alberto Coustasse, DrPH, MD, MBA, MPH
The healthcare industry’s growing use of health information technology has contributed to the enormous accumulation of health care data, leading to active use of the term big data. Although there has been large amounts and varieties of complex data captured during patient care, this data has remained vastly underutilized. The purpose of this study was to assess the variety of benefits and barriers of obtaining meaningful information from big data in healthcare. The methodology utilized was a qualitative literature review that referenced 17 sources published between 2005 and 2016.Findings suggest that applied big data analytics within the healthcare arena can …
Provider Reimbursement Following The Affordable Care Act, Brandon Bowling, David Newman, Craig White, Ashley Wood, Alberto Coustasse Dr. Ph, Md, Mba
Provider Reimbursement Following The Affordable Care Act, Brandon Bowling, David Newman, Craig White, Ashley Wood, Alberto Coustasse Dr. Ph, Md, Mba
Alberto Coustasse, DrPH, MD, MBA, MPH
Decreasing healthcare expenditure has been one of the main objectives of the Affordable Care Act (ACA). To achieve this goal, the Centers for Medicare and Medicaid Services (CMS) has been tasked with experimenting with provider reimbursement methods in an attempt to increase quality, while decreasing costs. The purpose of this research was to study the effects of the ACA on physician reimbursement rates from CMS to determine the most cost effective method of delivering healthcare services. CMS has experimented with payment methods in an attempt to increase cost effectiveness. Medicare has offered shared cost savings incentives to reward quality care …
The Trends In Dtca And Effects Of Dtca By Pharmaceutical Firms In The United States, Sathorn Preechavuthinant, William K. Willis Drph, Alberto Coustasse Drph, Md, Mba
The Trends In Dtca And Effects Of Dtca By Pharmaceutical Firms In The United States, Sathorn Preechavuthinant, William K. Willis Drph, Alberto Coustasse Drph, Md, Mba
Alberto Coustasse, DrPH, MD, MBA, MPH
The Direct-to-Consumer Advertising (DTCA) of pharmaceutical firms has been defined as an attempt of pharmaceutical companies to advertise products directly to patients (comsumers). Pharmaceutical DTCA has been criticized due to its inappropriateness and some urged the need to strengthen regulations. The DTCA has an impact on the public from both a benefit and harm concern. The purpose of this study is to investigate the current trend of pharmaceutical DTCA in the US and its effect on patients, physicians, and drug utilization. The methodology used in the research is literature review and semi-structured interview. The pharmaceutical DTCA showed reduction in total …
Why Physicians Switch Electronic Health Record Vendors, Pete Andresen, Michelle Shussler, Kyle Sowards, Alberto Coustasse Dr.Ph. Md
Why Physicians Switch Electronic Health Record Vendors, Pete Andresen, Michelle Shussler, Kyle Sowards, Alberto Coustasse Dr.Ph. Md
Alberto Coustasse, DrPH, MD, MBA, MPH
There are many factors involved when a physician chooses to switch Electronic Health Record [EHR.] vendors including system functionality, cost, poor customer service, company reputation, platform of software, meaningful use certification, and various others. The purpose of this research study was to locate the various reasons that lead to switching vendors and the barriers and benefits associated with doing so. System functionality and cost were the two largest deciding factors in switching vendors. Shifting regulatory standards require additional functionality to fulfill quality reporting measures including the Meaningful Use and Physician Quality Reporting Systems standards and many physicians and health systems …
Medicare Fraud, Waste And Abuse, Jamie Bush, Leslie Sandridge, Cierra Treadway, Kimberly Vance, Alberto Coustasse Dr. Ph, Md, Mba
Medicare Fraud, Waste And Abuse, Jamie Bush, Leslie Sandridge, Cierra Treadway, Kimberly Vance, Alberto Coustasse Dr. Ph, Md, Mba
Alberto Coustasse, DrPH, MD, MBA, MPH
In 2014, the U.S. spent approximately $3 trillion on health care. Medicare accounted for $554 billion of these costs and around $60 billion were squandered due to incorrect billing methods, abuse, and fraud. Types of fraud included: kickbacks, up coding, and organized fraudulent crimes. To reduce the financial burden associated with these activities, the U.S. has created various fraud prevention programs. The purpose of this study was to identify methods of Medicare fraud, examine the various programs implemented by the U.S. government to combat fraud and abuse, and determine the effectiveness of these programs. While fraud prevention strategies have proven …
Continuing Development Of An All Payer Health Care System In Maryland, David P. Paul Iii, Taeko Matsumoto, Alberto Coustasse, Lama Mohammed Bakhamis, Mary Lynn Harshbarger
Continuing Development Of An All Payer Health Care System In Maryland, David P. Paul Iii, Taeko Matsumoto, Alberto Coustasse, Lama Mohammed Bakhamis, Mary Lynn Harshbarger
Alberto Coustasse, DrPH, MD, MBA, MPH
The state of Maryland, in collaboration with the Centers for Medicare and Medicaid, developed the first all-payer system model in the U.S. in 1971, and some 35 years later in response to financial pressures, modernized this program. The focus of the modernized program was to improve overall per capita expenditure, quality of care, and the outcome of Marylanders’ health. This study showed positive change in moving its healthcare delivery model from volume-driven care to value-driven coordinated care. Maryland hospitals have changed their mindsets to achieve the Triple Aim of cost reduction, health improvement, and quality of care improvement for the …
Mobile Health Interventions For Adult Obesity In The United States: Analysis Of Effectiveness And Efficacy, David P. Paul Iii, Keerthi Gochipathala, Alberto Coustasse, Bezawit Wodajo, Niharika Bhardwaj
Mobile Health Interventions For Adult Obesity In The United States: Analysis Of Effectiveness And Efficacy, David P. Paul Iii, Keerthi Gochipathala, Alberto Coustasse, Bezawit Wodajo, Niharika Bhardwaj
Alberto Coustasse, DrPH, MD, MBA, MPH
The Unites States continues to struggle with the negative health effects associated with increasing population obesity, a problem which has been historically difficult, if not impossible, to solve. Mobile health applications represent a potential partial solution to this problem. We examine the existing literature on the effects of mobile health applications on body weight, waist circumference, BMI, and lifestyle, examining both physical findings as well as adherence, satisfaction and cost effectiveness. The use of mobile for weight reduction looks promising, but evidence is mixed, which is not surprising given the rapidly evolving nature of the mobile application field.
Benefit Of Report Card Feedback After Point-Of-Care Assessment Of Communication Quality Indicators, Michael H. Farrell, Clair R. Sprenger, Shelbie L. Sullivan, Bree A. Trisler, Jessica J F Kram, Erin K. Ruppel
Benefit Of Report Card Feedback After Point-Of-Care Assessment Of Communication Quality Indicators, Michael H. Farrell, Clair R. Sprenger, Shelbie L. Sullivan, Bree A. Trisler, Jessica J F Kram, Erin K. Ruppel
Mike Farrell, MD
Purpose
Communication is crucial for patient experience and biomedical outcomes. Training programs improve communication but are too resource-intensive for sustained use across an entire health care organization. This study demonstrates in a heterogeneous set of encounters the efficacy of quantitative feedback on two groups of physician communication behaviors: 1) jargon explanation, and 2) assessment of patient understanding.
Methods
We used a secure Internet application to audio-record conversations between primary care physicians and 54 patients. Transcripts were quantitatively abstracted using explicit-criteria definitions for assessments of understanding and jargon explanations. These data were conveyed to physicians using a previously tested report card. …
Drawing Comparisons Across Community Health Agents (Acs), Nurses And Physicians In Brazil’S Unified Health System (Uhs), Rahbel Rahman
Drawing Comparisons Across Community Health Agents (Acs), Nurses And Physicians In Brazil’S Unified Health System (Uhs), Rahbel Rahman
Rahbel Rahman
Recent WHO guidelines emphasize on empowering communities to take ownership of their healthcare needs. Brazil’s UHS is a model for delivering community-based care through Family Health Strategy (FHS) interdisciplinary teams - ACS, nurses, and physicians. Our study compares nurses, physicians and ACS on their perceptions of work environment, professional skills, cognitive capacities and job context. Global health administrators and policy makers can leverage on comparisons across providers to develop interprofessional training and implement system-level interventions.
Strategic Management Practices Help Hospitals Get The Most From Volunteers, Sean Rogers Ph.D.
Strategic Management Practices Help Hospitals Get The Most From Volunteers, Sean Rogers Ph.D.
Sean Edmund Rogers
Hospital administrators are facing twin challenges with regard to their volunteers—a generational change that may mean fewer volunteer hours in the future, and the need to set strategies to manage and recognize the value of current volunteers. This report, based on a survey conducted with a group of more than 100 hospital officials, identifies a specific set of 23 management practices to improve the volunteer experience, grouped into four categories: job design; recruitment and selection; orientation, training, and development; and performance management and supervision. The report also highlights the importance of making a complete accounting of the volunteer contribution, by …
Complexity And Chaos In Surgical Start Times, Dennis J. Baumgardner
Complexity And Chaos In Surgical Start Times, Dennis J. Baumgardner
Dennis J. Baumgardner, MD
In discussing an article investigating the causes for delay of first-case operating room start times included in this issue of the Journal of Patient-Centered Research and Reviews, the editor uses elements of complexity science and chaos theory to explain that such stubborn problems rarely stem from one of a few isolated causes. Taking a whole systems approach that utilizes flexibility, cross training, enhanced communication, common sense and perhaps mathematical models is suggested to effect positive change.
Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse
Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of HEAT …
Why Should Busy Clinicians Take Time To Participate In Clinical Research?, Todd H. Davies, Phd
Why Should Busy Clinicians Take Time To Participate In Clinical Research?, Todd H. Davies, Phd
Todd H. Davies
No abstract provided.
Patient Satisfaction With The Annual Wellness Visit, Maria Espiridion, Raghavendra Mulinti, Md, Suzanne E. Kemper, Mph, Lynne J. Goebel, Md
Patient Satisfaction With The Annual Wellness Visit, Maria Espiridion, Raghavendra Mulinti, Md, Suzanne E. Kemper, Mph, Lynne J. Goebel, Md
Lynne J. Goebel
OBJECTIVES - To determine patient satisfaction with the Annual Wellness Visit (AWV) DESIGN – Survey SETTING- Charleston Area Medical Center and Marshall Health PARTICIPANTS – 66 volunteers, average age 74 years MEASUREMENTS – Patient satisfaction was assessed with a 13 item survey. RESULTS - Of 1,537 eligible patients, 211 (14%) of these agreed to schedule their AWV. From 66 patients surveyed, 87% of patients said the visit “met expectations,” “would recommend to friends,” and “would do it again.” Only 5 (8%) were disappointed that new problems were not addressed and 2 (3%) were dissatisfied that physical exams and blood tests …
A Qualitative Review Of Differential Diagnosis Generators, William Bond Md, Ms, Linda M. Schwartz Mde, Ahip, Cm, Kevin R. Weaver Do, Donald Levick Md, Mba, Michael Guliano Md, Med, Mhpe, Mark L. Graber Md
A Qualitative Review Of Differential Diagnosis Generators, William Bond Md, Ms, Linda M. Schwartz Mde, Ahip, Cm, Kevin R. Weaver Do, Donald Levick Md, Mba, Michael Guliano Md, Med, Mhpe, Mark L. Graber Md
Kevin Weaver, D.O., FACOEP
No abstract provided.
Double The Outcomes: Employing Sensory Based Approaches To Improve The Quality Of Care And Reduce The Use Of Restraints On Inpatient Behavioral Health Units, Mary Ellen O'Connell Rn, Bsn, Msn, Mba, Jennifer P. Maloney Ms, Otr/L, Stephanie Lenhart Mba, Cphq
Double The Outcomes: Employing Sensory Based Approaches To Improve The Quality Of Care And Reduce The Use Of Restraints On Inpatient Behavioral Health Units, Mary Ellen O'Connell Rn, Bsn, Msn, Mba, Jennifer P. Maloney Ms, Otr/L, Stephanie Lenhart Mba, Cphq
Mary Ellen O'Connell
No abstract provided.
The Promises And Realities Of Evidence-Based Practices: Perceptions From Assessment Personnel, Jessica A. Rueter, Cynthia G. Simpson
The Promises And Realities Of Evidence-Based Practices: Perceptions From Assessment Personnel, Jessica A. Rueter, Cynthia G. Simpson
Jessica Rueter
Assessment personnel are those individuals who work in the capacity of evaluation of students with disabilities, including, but not limited to, educational diagnosticians, educational examiners, psychometrists, and instructional specialists. These professionals are responsible for identifying strengths and weaknesses and for providing teachers with evidence-based recommendations that can be implemented in the classroom to improve performance of students with learning deficits. This qualitative study examines 19 educational diagnosticians’ perceptions related to the barriers and supports that impacted their ability to provide evidence-based recommendations for students who are learning disabled. Three categories of barriers to issuing successful evidence-based recommendations emerged as a …
Costs, Staffing, And Services Of Assisted Living In The United States: A Literature Review, Amy Kisling, David P. Paul Iii, Alberto Coustasse
Costs, Staffing, And Services Of Assisted Living In The United States: A Literature Review, Amy Kisling, David P. Paul Iii, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Assisted Living Facilities (ALFs), which provide a community for residents who require assistance throughout their day, is an important part of the long-term care system in the US. The costs of ALFs are paid either out of pocket, by Medicaid or by Long-Term Care Insurance (LTCI). Monthly costs of ALFs have increased over the past five years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the US to determine the impact healthcare on costs. The methodology for this study was a literature review and a total of 32 sources …