Medicine and Health Sciences Commons^™

Promoting Mammography Screenings In African American Women: Media, Church, And Health Providers, Lasonya Little, Debra C. Wallace, K.Jay Poole

Journal of Health Disparities Research and Practice

Due to the underutilization of screening mammography, African American women (AAW) are more likely to experience negative health outcomes after receiving a late-stage breast cancer diagnosis than White Women (WW). The purpose of this article is to examine the roles of the media, health community and the African American church and pastor and their potential impact in AAW screening decisions. Fifteen AAW, ages 45 and older, were invited to participate in a semi-structured interview. Most women agreed the African American pastor and church as well as the health community, and media are an integral part of their lives. Therefore, specific …

Enhanced Iot-Based Electrocardiogram Monitoring System With Deep Learning, Jian Ni

UNLV Theses, Dissertations, Professional Papers, and Capstones

Due to the rapid development of computing and sensing technologies, Internet of Things (IoT)-based cardiac monitoring plays a crucial role in providing patients with cost-efficient solutions for long-term, continuous, and pervasive electrocardiogram (ECG) monitoring outside a hospital setting. In a typical IoT-based ECG monitoring system, ECG signals are picked up by sensors located on the edge, and then uploaded to the remote cloud servers. ECG interpretation is performed for the collected ECGs in the cloud servers and the analysis results can be made instantly available to the patients as well as their healthcare providers.In this dissertation, we first examine the …

New-R Intervention For Clients With Severe Mental Illness And Obesity: Grant Writing For Implementation Funds Supporting Occupational Therapy Interventions, Kaitlyn Hoffman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Increasing numbers of people suffer from obesity and severe mental illness co-morbidly. If these conditions remain untreated, they can harm an individual's health and well-being. Unfortunately, there are very few programs currently available that target both management and improvement of these conditions simultaneously. Even so, despite the lack of programming options, it must be noted that the NEW-R program strives to reach those goals, although there hasn't been an abundance of literature supporting the effectiveness of this program. This poses a concern for occupational therapy practitioners who hope to assist their clients in managing these conditions as occupational therapy treatments …

Advancing Health Equity In The Us Military, James D. Mancuso, John Young, Jennifer Rusiecki, Shauna Stahlman, Natasha Schvey, Toya Randolph, Candy Wilson, Catherine Witkop, Patrick Hyde, Althea Green, Patcho Santiago, Donald Shell, Tracy Sbrocco

Journal of Health Disparities Research and Practice

Eliminating health disparities and achieving health equity are central to US national health objectives and the Military Health System’s “quadruple aim,” which has readiness as its core aim. Because military service members enjoy universal eligibility for health care, it is sometimes assumed that health disparities do not exist in the Department of Defense (DoD). However, while some studies have shown that disparities have been attenuated or eliminated in the DoD, others suggest that significant disparities remain. Reasons these disparities may remain include that universal eligibility for care does not necessarily result in equal to access to care, and that equal …

Self-Reported Covid-19 Diagnosis And Severity And Its Association With Utilization Of And Delays In Needed Medical Care, Mohammad Hesam Alavi

UNLV Theses, Dissertations, Professional Papers, and Capstones

Covid-19, caused by the virus SARS-CoV-2, was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. The pandemic-related disruptions and the pursuant lockdowns have adversely impacted every aspect of people’s lives including access to medical care, cancer care, preventive medicine, mental health, and dental care in an already imperfect healthcare system in the US. This study utilized the 2020 self-reported data from quarters 3 and 4 of the National Health Interview Survey, a cross-sectional interview survey by the Centers for Disease Control and Prevention, to determine the possible association of self-reported COVID diagnosis, test positivity, and …

Predictor Of Hospital Closure In The United States, Haniyeh Shariatmadari

UNLV Theses, Dissertations, Professional Papers, and Capstones

Hospital closures have recently been more common and a crucial concern in the United States since they can influence many aspects of patients' health conditions. This situation has led many scholars to investigate the adverse effect of hospitals closure. Previous research has well documented the effects of a hospital closure. However, there is a lack of studies on the predictor of a hospital closure. To fill this gap, the objective of this longitudinal study is to explore organizational and market factors associated with hospital closure. We used Data from the American Hospital Association (AHA), the Centers for Medicare and Medicaid …

Quality Of Care: A Business Case For Us Hospitals, Iwimbong Kum Ghabowen

UNLV Theses, Dissertations, Professional Papers, and Capstones

The Patient Protection and Affordable Care Act present some threats and opportunities to many hospitals across the USA. Under the Value-Based Purchasing Program, acute care hospitals' rewards are tied to incentive payments for the quality of care provided in the inpatient hospital. In the last 20 years, growing research has examined the effects of the quality of care on the financial performance of hospitals. There is a gap in the literature, particularly exploring the relationship between quality and hospital financial performance using national samples. This dissertation investigates the association between patients' experience of care, 30-day readmission rates, and case-mix-index (CMI) …

The Nursing Leader’S Role In Decreasing Implicit Rationing By Improving The Nursing Work Environment, Allison Mchugh

UNLV Theses, Dissertations, Professional Papers, and Capstones

Despite all the literature about missed care and its contributing factors, it is prevalent in most hospitals worldwide. Missed care is the result of care that is implicitly rationed. For this paper, implicit rationing is defined as how nurses decide what care is delivered based on the present work environment. Many factors influence implicit rationing. One such factor is the work environment. The association between the nursing work environment and implicit rationing is well described in the literature. The nursing leader is in a formal position responsible for patient outcomes and the nursing practice environment. Therefore, it is important to …

Profit Or Purpose: What Increases Medical Doctors’ Job Satisfaction?, Young Kyun Chang, Won-Yong Oh, Sanghee Han

Management, Entrepreneurship and Technology Faculty Publications

This study integrates two competing views to examine whether medical doctors are satisfied with their jobs when they perceive their hospitals as being oriented toward profit (i.e., rational choice theory) or purpose (i.e., public service motivation). Using a sample of 127 doctors from 70 hospitals, this study tests these competing views. The results show that doctors who perceive their hospitals as purpose-driven are likely to experience job satisfaction, and this pattern still holds even if they also perceive their hospitals to be emphasizing profits. However, only the purpose-driven orientation results in job satisfaction via a sense of meaningfulness. Thus, this …

New Nurse Reality Shock & Early Burnout: Can Role Transition Education Received During New Nurse Residency Positively Affect Satisfaction?, Bonnie L. Stolzman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Newly licensed nurses are at incredibly high risk for reality shock leading to early burnout which results in many of them resigning their positions or leaving nursing altogether. Common feelings leading to reality shock often involve exhaustion, cynicism, depersonalization, decreased self-efficacy, and decreased job satisfaction. The result of early burnout presents significant financial strain and quality concerns for our already struggling healthcare systems. In the 1960s and early 1970s, Marlene Kramer brought her research regarding newly licensed nurses and their experience of “reality shock” to publication. Kramer felt strongly that reality shock was a key factor that led newly licensed …

Factors That Determine Comprehensive Categorical Classification Of Ehr Implementation Levels, Soumya Upadhyay, William Opoku-Agyeman

Healthcare Administration & Policy Faculty Publications

Electronic Health Records (EHRs) have the potential to alleviate patient safety mistakes. Of the various levels of EHR, advanced or higher-level functionalities of EHR are designed to improve patient safety. Certain organizational and environmental factors may pose as barriers toward implementing all of the functionalities, leaving certain hospitals intermediate between basic and comprehensive levels of implementation. This study identifies a comprehensive categorical classification that includes hospitals that have functionalities between basic and comprehensive levels of EHR and determines the organizational and environmental factors that may influence hospitals to implement one or more combinations of these categories. A longitudinal panel design …

Developing Strategic Partnerships To Impact Population Health: A Professional Development Module, Andra S. Scano

UNLV Theses, Dissertations, Professional Papers, and Capstones

Massive organizational changes occurring in our health care delivery system have provided opportunities for nurse leaders who think in terms of population health, to develop new skills needed to impact the populations they serve. Aspects of these changes include a focus on the delivery of primary and community-based care and the development of partnerships, alliances, and other linkages across settings to build integrated systems (Williams, 2020, p. 17). Turner (2020) asserts that population-focused nurse leaders are charged with creating a new future for healthier communities which often involves strategic partnership development. However, strategic partnership development is a complex task that …

An Evaluation Of Care Coordination In Reducing Depression Symptoms And Emergency Room Visits, Stacy Sumpter

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Individuals living with multiple chronic conditions (MCC) account for 26% of the population; however, they consume 84% of healthcare resources, are three times more likely to have depression than healthy individuals, and have increase emergency room (ER) visits and healthcare resource use. This population requires coordinated health care to reduce unnecessary spending and the misappropriation of healthcare resources. The purpose of this project was to evaluate the efficacy of care coordination (CC) and the support system it provides in lowering depression symptoms and ER visit frequency as a viable measure to reduce overall healthcare costs.

Methods: The healthcare providers, …

Variations In Schedule Iii Prescription Patterns In A Medicaid Population Pre- And Post-Policy, Radhakrishnan Nagarajan, Jeffery Talbert, Craig S. Miller, Jeffrey Ebersole

Dental Medicine Faculty Publications

The present study investigated variations in patient movement patterns between prescribers before and after House Bill 1 (HB1) implementation in Kentucky using network abstractions (PPN: prescriber-prescriber networks) from a one-month cross-sectional Schedule III prescription data in a Medicaid population. Network characteristics such as degree centrality distribution of PPN was positively skewed and revealed Dental Practitioners to be the highly connected specialty with opioid analgesic hydrocodone-acetaminophen to be the most commonly prescribed drug. Taxonomy enrichment of the prescriber specialties in PPN using chi-square test revealed a reduction in the enriched taxonomies Post-HB1 compared to Pre-HB1 with Dental practitioners being constitutively enriched …

Gender Disparity In Composition And Compensation Among Maryland Hospital Executives, Gilberto O. Lobaton, Majd Marrache Md, Varun Puvanesarajah Md, Dawn M. Laporte Md, Amit Jain Md, Shruti Aggarwal Md

Journal of Health Disparities Research and Practice

Introduction: Senior executive positions in hospitals have traditionally been held by men, and do not reflect the gender, racial, ethnic, and cultural diversities of the communities they serve. Despite sex parity in medical school graduates, women remain underrepresented in hospital executive leadership positions. In this study, the authors examined differences in gender composition and compensation of Maryland hospital executives.

Methods: The authors examined 47 Maryland hospitals’ publicly available tax forms from 2013-2018. Data collected included hospital revenue and executive positions’ count, salary, and gender. Executive positions included President and/or Chief Executive Officer (P/CEO), Chief Financial Officer (CFO), Chief Medical Officer …

Management Of Atrial Fibrillation With Smartphone Technology, Teresa Praus

UNLV Theses, Dissertations, Professional Papers, and Capstones

Atrial fibrillation is the most common arrhythmia affecting over six million people; it is predicted to increase two-fold by the year 2050. This arrhythmia results in a lack of

atrial/ventricular communication, accompanied by ineffective atrial contraction, suboptimal ventricular filling, and thrombus formation. This may lead to stroke, and ultimately heart failure. The current economic burden related to the complications of atrial fibrillation is estimated to be greater than $6 billion annually with potentially catastrophic events, further increasing expenditure.

When patients experience symptoms related to atrial fibrillation, it is common for them to present to a hospital emergency department. These visits, …

The Effect Of Language Barriers On Variation And Receipt Of Early Stage Breast Cancer Treatment, Abigail R. Madans Do, Richard T. Zera Md, Phd, Rachel M. Nygaard Phd

Journal of Health Disparities Research and Practice

Background: Arriving at and implementing an appropriate patient centered treatment plan for early stage breast cancer requires significant dialogue between healthcare providers and patients. How language barriers affect this process has not been thoroughly explored in the literature. The aim of this paper is to examine the effect of language barrier on variation and receipt of early stage breast cancer treatment.

Methods: Rates of lumpectomy, mastectomy, and contralateral prophylactic mastectomy (CPM) with or without reconstruction were compared between English speaking and Low English Proficiency (LEP) cohorts. Patients with recurrent or bilateral breast cancer, male patients, and/or known genetic mutations …

Effect Of Bundled Payments As A Care Improvement Initiative On Hospital Care Of Total Joint And Sepsis: A Perspective On Organizational Effectiveness, Pearl Kim

UNLV Theses, Dissertations, Professional Papers, and Capstones

This study investigates the potential impact of the Bundled Payments for Care Improvement (BPCI) initiative from Center for Medicare and Medicaid Services on hospital performance and behavior related to effectiveness and efficiency. The BPCI is under the Affordable Care Act and provides hospitals with a fixed amount of reimbursement for a total episode of care. Building on the agency theory, I argue that the BPCI initiative has the potential to enhance the effectiveness and efficiency of hospital care. This quasi-experimental study examines the changes in hospital care outcomes of patients with replacement of the lower extremity or sepsis in BPCIparticipating …

Readmission Rates And Their Impact On Hospital Financial Performance: A Study Of Washington Hospitals, Soumya Upadhyay, Amber L. Stephenson, Dean G. Smith

Public Health Faculty Publications

This longitudinal study examines whether readmission rates, made transparent through Hospital Compare, affect hospital financial performance by examining 98 hospitals in the State of Washington from 2012 to 2014. Readmission rates for acute myocardial infarction (AMI), pneumonia (PN), and heart failure (HF) were examined against operating revenues per patient, operating expenses per patient, and operating margin. Using hospital-level fixed effects regression on 276 hospital year observations, the analysis indicated that a reduction in AMI readmission rates is related with increased operating revenues as expenses associated with costly treatments related with unnecessary readmissions are avoided. Additionally, reducing readmission rates is related …

Leadership Development In Nursing: Planning From The Bedside To The Executive Suite, Janet C. Wright

UNLV Theses, Dissertations, Professional Papers, and Capstones

Nurses comprise the largest portion of the healthcare sector workforce over 4 million professional nurses licensed in the United States (National Council of State Boards of Nursing, 2019). Leading within a vast workforce such as nursing requires the nurse leader to have the expertise of the nursing profession along with leadership and business skills to maintain competitiveness in the complex healthcare industry. Consequences of effective leadership include improved patient outcomes, decreased staff turnover, and decreased costs to the organization related to patient outcomes and turnover costs. These results suggest the importance for organizations to ensure their leaders are properly trained …

Evidence-Based Practice Guide And Workflows: Improving Hospital Throughput And Reducing Emergency Department Overcrowding, Maulah Halley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Hospitals in the United States are experiencing disruptions to patient throughput. These disruptions create barriers to patients who seek emergent care in the Emergency Department (ED) and who must be moved to hospital inpatient beds after the decision to admit has been made. As a result, patients requiring hospital admission via the ED may have long wait times, which, in turn, contribute to ED crowding and overcrowding. The root causes of ED overcrowding are inefficiencies within the system and the inability of hospitals to meet demand. Although bed capacity on any given unit may not be altered, ED patient’s arrival …

Emergency Department Use Among Asian Adults Living In The United States: Results From The National Health Interview Survey (2006 – 2013), Kathleen M. Sullivan, James Davis, Angela Sy

Asian/Pacific Island Nursing Journal

This paper presents secondary analyses of the National Health Interview Survey data focused on emergency department (ED) utilization among Asian adults residing in the United States. National Health Interview Survey data provided from survey years 2006-2013 was pooled and disaggregated by single-race Asian ethnic subgroups (Filipino, Chinese, Asian Indian, other Asian). We explored trends in reports of an ED visit over the survey years for the purpose of determining whether reports of an ED visit increased or decreased over survey years. We also explored background/biologic, environment, access to care, and behavior factors and their associations with having an ED visit. …

Association Between Alcohol Screening And Brief Intervention During Routine Check-Ups And Alcohol Consumption Among Adults Living In California, Gene Kilian Wells

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: Alcohol consumption accounts for 1 in 10 deaths among U.S. adults, and has cost upwards of $200 billion in a single year due to lost productivity. Alcohol Screening and Brief Intervention (ASBI) was developed as a treatment approach for use in primary care to identify and reduce hazardous and harmful substance use behaviors among the general population. Although ASBI has proven to be successful, implementation rates remain low. Few studies have been conducted in Nevada to encourage or improve ASBI implementation in primary care. In order to better support Nevada policy decisions, this study investigates the proportion of ASBI …

A Qualitative Study Of Job Competencies For Healthcare Social Work Administrators: An Application Of The Short Competency Model Process Used To Identify The Behaviors And Personal Characteristics Of Exemplary Performers, Lashonda Jones-Moore

UNLV Theses, Dissertations, Professional Papers, and Capstones

Job competencies are central to every organization’ s human resource management system. Competencies can be used to help organizations create high performance cultures, select and hire a workforce, develop leaders, and establish a foundation for training strategies. Social work, as a profession, has developed competency models for many specialized fields of social work. Health is the second most common practice area reported by social workers with a master’ s degree in social work, the predominant social work degree for licensed social workers. In highly structured, rapidly evolving, and complex organizations such as healthcare systems, leaders and managers require distinctively different …

Athletes’ Perceptions Of Athletic Trainers Quality Of Care, Chadley Foster

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to explore student athletes’ perceived satisfaction of care from certified and licensed athletic trainers (ATC) and satisfaction of care between full time and graduate student ATCs at University of Nevada, Las Vegas (n=61). Studies identify satisfaction as a method to measure quality of care and its influence on many aspects of athletes’ success including health outcomes. This is the first study that evaluated multiple aspects of care including type and length of sport participation, academic class status, number of ATCs seen, primary ATC (graduate or full time), number of interactions with primary ATC, injury, …

Improving Transitions Of Care In The Perioperative Setting, Brian Wayne Selig

UNLV Theses, Dissertations, Professional Papers, and Capstones

It is estimated that nearly 200,000 Americans die each year due to preventable medical mistakes (Gupta, 2012), and nearly 80% of all medical errors involve some form of miscommunication between healthcare providers (Joint Commission Center for the Transformation of Healthcare, 2013). Handoffs, or the transitioning of patient care from one provider to another, occur multiple times each day in the hospital setting and done incorrectly can lead to significant mistakes in patient care.

The purpose of this project was to improve the quality of handoffs that occurred between perioperative and inpatient nurses at an urban, tertiary medical center. A shared …

Patient Service Quality And Health Maintenance Organizations: Not An Oxymoron, Jessica Mcbeath

UNLV Theses, Dissertations, Professional Papers, and Capstones

Today’s quality movement in health care has driven the importance of patient satisfaction and experience across the industry. While the subject is of huge interest to researchers and health care companies, many struggle to identify a unified list of attributes that are applicable globally. Due to the industry’s uniqueness, it becomes necessary to understand the population and specific attributes for each. In review of previous service quality research, this study presents many dimensions and attributes for application. Using existing service quality framework 5Qs, this study provides unique findings correlated to existing literature and presents actionable items.

Purpose: The purpose of …

Understanding The Experience Of Medicare Advantage Patients In A Health Maintenance Organization, Curtis E. Boldman

UNLV Theses, Dissertations, Professional Papers, and Capstones

This study was conducted using a single Health Maintenance Organization in Las Vegas, NV to determine the key drivers and attributes of quality in the patient experience for Medicare Advantage holders. The purpose of this study was to investigate these perceptions of quality to assist the provider in identifying the areas in their treatment process which could be refined in order to better serve their customer base. With the recent changes in healthcare laws, patient satisfaction is now a key determinant in the financial compensation providers receive for services performed.

Data was collected by doing patient intercepts outside of the …

Family Nurse Practitioner Mentoring Relationships' Impact On Organizational Commitment, Patricia Bartley-Daniele

UNLV Theses, Dissertations, Professional Papers, and Capstones

Family nurse practitioners (FNPs) are vital primary care providers who are responding to increased primary health care needs in the United States. Organizational commitment is reflective of workplace relationships that foster professional development, innovation, and outcome achievement. An organizationally committed FNP workforce is essential to achieving primary health care goals.

Mentorship has been proposed as a strategy to foster FNP organizational commitment. Mentoring has been characterized as a teaching-learning relationship. The mentor can serve as a guide to foster graduate FNP practitioner transition into primary care practice. Types of mentoring relationships occur in formal workplace settings or develop as informal …

Socio-Economic And Cultural Determinants Of Health Care Services Utilization In Ghana, Vickita Akosua Antwiwaa Harvey

UNLV Theses, Dissertations, Professional Papers, and Capstones

The study examines the relationship between socio-economic and cultural determinants of health care service utilization in Ghana using Ghana Demographic and Health Survey (GDHS) 2008 data collected by Ghana Statistical Service (GSS) in which a two-stage sample design was used. The first stage involved a systematic sampling, with probability proportional to size, of 412 clusters using the 2000 Ghana Population and Housing Census as the sampling frame. At the second stage, systematic samples of 30 households from each cluster were selected, making a total of 12,360 sampled households. According to the GSS, data were not collected in some of the …