Medicine and Health Sciences Commons^™

Multimorbidity In Diverse Populations: Stratified Analysis Of Race/Ethnicity, Age, Obesity, And Healthcare Costs, Manal Alshakhs

Theses and Dissertations (ETD)

This research aims to fill an essential gap in understanding how Body Mass Index (BMI) cutoffs relate to multimorbidity across races in the United States (US). Given the significant and growing rates of obesity and multimorbidity, as well as the known differences in healthy fat distribution among different races, this is an important area of research. BMI is a widely used but imperfect measure of obesity, as it does not account for differences in body composition. However, it is still used as a diagnostic tool. It is vital to ensure that the cutoffs used to define obesity are appropriate for …

Crna Decision-Making Within The Anesthesia Care Team, Cindi L. Dabney

Theses and Dissertations (ETD)

This research focused on Certified Registered Nurse Anesthesiologists’ (CRNAs’) perspectives on the value placed on their decision-making skills within the Anesthesia Care Team (ACT). The emphasis of the study was to examine CRNA’s perspectives on the strengths, challenges, conflict resolutions, and any other information they were willing to divulge when working with physician anesthesiologists in the ACT model. An electronic survey questionnaire was sent to practicing CRNAs, primarily in the southeast region of the United States, with 171 informants completing the questionnaire. Data analysis included demographic information of the convenience sample that included age, gender, initial educational preparation as a …

The Uncertainty And Psychological Health Of Family Caregivers Of Patients With Delirium In Intensive Care Units, Amal Shokri Haji Assa

Theses and Dissertations (ETD)

Each year, more than 5 million patients are admitted to an intensive care unit (ICU) in the United States, and up to 80 % of these patients develop delirium. Delirium is a common indicator of acute brain dysfunction in the ICU and a predictor of mortality, longer ICU/hospital stay, and long-term cognitive impairment. Family caregivers are a valuable resource in preventing, detecting, and managing delirium in the ICU. However, witnessing delirium episodes can generate adverse psychological symptoms in family caregivers that may compromise their health and well-being. Research in this area has demonstrated a gap in the literature regarding how …

Nursing Perspectives And Opinions On Early Or Delayed Sepsis Treatment: A Mixed Methods Approach, Pamela L. Harris

Theses and Dissertations (ETD)

Purpose. Each year at least 1.7 million adults in America develop sepsis. Sepsis can lead to life threatening organ dysfunction, severe hypotension, and death when severe sepsis or septic shock is involved. Sepsis is responsible for 50% of acute kidney injury (AKI), which is the most common form of organ dysfunction seen in critical care. Sepsis associated AKI results in loss of, or decreased renal function, is associated with adverse long-term outcomes, and carries a higher mortality rate than non-septic AKI, sepsis without AKI, or septic shock without AKI. Surviving sepsis guidelines suggests a 1-hour window from the time of …

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 …

Predictors Of Hyperkalemia And Outcomes Of Dyskalemia In Us Veterans With Advanced Chronic Kidney Disease Transitioning To Dialysis, Ankur Dashputre

Theses and Dissertations (ETD)

Background: The kidneys play a crucial role in maintaining homeostasis of serum potassium levels (K+). Patients with advanced chronic kidney disease (CKD) are at a higher risk of experiencing dyskalemia events (i.e. hyper- and hypokalemia; especially the former) and thus future adverse outcomes. Currently, there is a dearth of literature on prediction models for hyperkalemia and the effects of dyskalemia on outcomes such as incidence of ischemic stroke and short-term hospital/emergency room (ER) utilization in an advanced CKD population transitioning to dialysis. Objectives: Using a nationally representative sample of US veterans with advanced CKD transitioning to dialysis, in the pre-dialysis …

The Relationship Of Child Health And Parenting Stress To Child Neurocognitive Development, Nancy Alise Farrell

Theses and Dissertations (ETD)

Problem. Although the United States rates high in economic resources, the neurocognitive development (NCD) of children falls behind many other developed nations. Levels of parenting stress may be linked to sociodemographic factors such as the high incidence of poverty in children or health disparities in children, which in turn may affect NCD in children. Using the data from an observational, longitudinal cohort study of a diverse population could provide information related to parenting stress, child health, and related factors to guide and support interventions with families and policies to improve child NCD. Aims. The overall aim of this study was …

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. …

Renal And Cardiovascular Outcomes Associated With Cannabis Use In Veterans With Advanced Chronic Kidney Disease Transitioning To Dialysis, Praveen Kumar Potukuchi

Theses and Dissertations (ETD)

Background: Legalization of cannabis and its constituents may lead to increased exposure of a higher number of consumers to cannabis use, including those with chronic kidney disease (CKD). We expect increase in cannabis use, especially, in patients with compromised kidney function. However, there is sparse literature on the effects of cannabis use on cardiorenal and mortality outcomes among patients with advanced CKD. Objectives: The main goal of the current study was to examine the effect of cannabis use on renal and cerebrovascular outcomes as well as mortality in patients with advanced CKD. Using a nationwide cohort of US veterans with …

Forecasting The Essential Chemotherapy Needed For Treatment Of Children With Acute Lymphoblastic Leukemia In Low- And Middle-Income Countries, Brian T. Lewis

Theses and Dissertations (ETD)

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, with contemporary therapy resulting in a 90% survival in high-income countries (HIC). However, an estimated 89% of the world’s children live in low- and middle-income countries (LMIC) where survival is much lower. Lack of access to essential chemotherapy contributes significantly to the decreased survival rates for LMIC, and inaccurate forecasting of chemotherapy needed may lead to stockouts or oversupply. This chapter describes a simple forecasting system with population and patient-based multipliers for each drug used in the treatment of pediatric ALL, thus estimating the essential chemotherapy quantities needed for a …

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 …

The Value Of Online Medication Rating Systems To Older Adults And Their Association With Self-Reported Outcomes, Yazed Sulaiman Alruthia

Theses and Dissertations (ETD)

The Internet is a powerful and very popular vehicle for distributing judgment-free health information to patients. Multiple studies have examined the role of online health information as well as physician-rating websites in health care. Studies have examined the value of online drug information for patients and the value of the online drug information for patients. However, no study has examined the usefulness or value of online medication rating websites in facilitating physician-patient communication or participant-reported outcomes. In this study, the value of online medication rating websites to older adults in facilitating communication with their physicians using a newly developed tool …

Racial Disparities In Adherence To Cardiovascular Medications Among The Elderly In Medicare: Three Empirical Essays, Mustafa Hussein Muhammad Hussein

Theses and Dissertations (ETD)

This dissertation sought to explore the relatively understudied area of racial disparities in adherence to cardiovascular medication regimens among the elderly. Black and Hispanic seniors are well documented to have lower rates of adherence to their prescribed cardiovascular medications, relative to their white counterparts. This disproportionately lower adherence places these minority groups at higher risk for worse cardiovascular prognosis and premature cardiovascular death. The Medicare Program, which covers healthcare predominantly for elderly Americans, offers an interesting laboratory to study these disparities and their response to policy changes. Using nationally representative data from the Medical Expenditure Panel Survey on white, black, …

Predictors And Mediators Of Long-Term Functional Limitations In The Older Adult Population, Teresa Maria Bell

Theses and Dissertations (ETD)

With nearly 40 million Americans being treated for nonfatal injuries in emergency departments annually, the burden of nonfatal injury in the United States is extensive. The longterm functional consequences of these injuries can be enduring and far-reaching, especially for older adults. Although studies have reported that persistent functional deficits exist after injury, less information is known about long-term recovery patterns and the factors that influence functional outcomes.

The primary aims of this study are to (1) classify differences in long-term, longitudinal changes in functional limitations within the injured population, (2) identify individual characteristics that predict recovery after injury and (3) …

Cost Of Illness Study Of Anxiety Disorders For The Ambulatory Adult Population Of The United States, Elaheh Shirneshan

Theses and Dissertations (ETD)

Background: Anxiety disorders are the most common psychiatric illness in the United States. However, economic burdens of this category of mental illnesses have not been well studied yet. The objective of this study was to estimate the societal cost of anxiety disorders for the ambulatory adult population of the U.S.

Data and Method: Data was collected from the 2009 and 2010 Medical Expenditure Panel Survey (MEPS), Bureau of Labor Statistics (BLS), and National Vital Statistics System (NVSS). Cost components included in the analyses were direct medical costs (i.e. cost for inpatient visits, outpatient visits, emergency room visits, office-based visits, prescription …

The Influence Of Patient-Reported Provider Availability Factors On Nonurgent Emergency Department Use, Cheryl Anne Dewood

Theses and Dissertations (ETD)

Purpose. The purpose of this study was to examine the influence of patient‑perceived provider availability on nonurgent emergency department use (NUEDU). The study population consisted of a nationally‑representative population of non‑elderly adults who were continuously privately insured (CPI) for at least a year before an emergency department visit that was determined to be nonurgent, and who reported having a regular source of care (RSC).

Methods. Data were obtained from a nationally‑representative longitudinal survey, the Medical Expenditure Panel Survey (MEPS). The classification of ED visits as nonurgent was based on patient report using a method developed for this study. Patient­‑perceived provider …

Analysis Of Out-Of-Pocket Expenditures Of Oral Oncologics For Tennessee Recipients Of Medicare Part D, Eve Carolyn Elias

Theses and Dissertations (ETD)

Background: There are few studies that examine patients' costs of oral oncology drugs from Medicare Part D plan providers. These drugs can impose a financial burden to beneficiaries, and, due to their cost, place beneficiaries in the coverage gap in a short period of time. In addition to examining costs, there is little published concerning the potential impact of drug utilization management techniques on access to these drugs in Medicare Part D plans. This study examined the roles of prior authorization, step-therapy, and placement of drugs in higher formulary tiers on patients' out-of-pocket costs, and access to therapy.

Methods …

Evaluating Consumer Preferences For Medicare Part D Using Conjoint Analysis, La'marcus Wingate

Theses and Dissertations (ETD)

The establishment of an outpatient prescription drug benefit in Medicare, Medicare Part D, was one of the more significant events in United States healthcare reform history. Many seniors have chosen to enroll in the plan as the program has an enrollment of over 27 million. One central premise of Medicare Part D was that the plan would be administered entirely through private insurance plans. Because many plans would be competing against one another for potential beneficiaries, it was expected that companies would offer seniors plans with high quality benefits at lower costs that would presumably be attractive to seniors. However, …

Emergency Physicians' Perspectives On The Usability Of Health Information Exchange, Shirley A. Thorn

Theses and Dissertations (ETD)

Emergency physicians are key users of health information exchanges (HIE). Understanding their perspectives on the usability of HIE is important if the full potential of the HIE is to be achieved. The literature identified that emergency physician experiences with HIEs are unexplored areas requiring further studies. The purpose of this study using grounded theory methods was to understand the perspectives of emergency physicians concerning the usability of HIEs. The fundamental question was how do emergency physicians use the HIE in making clinical decisions?

Rich and thick data were collected from 15 emergency physicians in four urban hospitals in the mid-south …

The Multilevel, Multicultural, And Multi-Temporal Ecosocial Framework Of Population Health : How Neighborhoods, Culture, And History Impact Health Outcomes And Produce Health Disparities, Lawrence Tarves Brown

Theses and Dissertations (ETD)

According to findings in the field of genetics, it has now been established that the impact of race on health is mostly a function of a people's lived experience, not their genetic make-up. Due to this, the role of race in the study of health outcomes and health disparities has traditionally been specified improperly in statistical models due to confounding with ethnicity. Additionally, the role of geography or the impact of neighborhoods on health is often not specified properly.

Thus, the author proposes a multilevel, multicultural, and multi-temporal ecosocial framework that explains the impact of neighborhoods on health and the …

Stepped Care For Smoking Cessation: A Cost-Effectiveness Analysis And Simulation Of Future Outcomes, Brandi E. Franklin

Theses and Dissertations (ETD)

It has been well established that smoking is the leading avoidable cause of premature morbidity and mortality in the United States and abroad. Smoking is attributable to over 400,000 annual deaths, and $193 billion in healthcare costs and lost productivity. Despite the apparent dangers and tremendous costs of tobacco use and dependence, smokers find difficulty quitting. Recently, stepped care has been proposed as a viable intensive approach for achieving long-term cessation. This research sought to evaluate cost-effectiveness of stepped care in a diverse population of smokers and analyze future health outcomes of smoking cessation.

Cost-effectiveness analysis was conducted from an …

Impact Of Parent’S Hiv Status On Their Uninfected Child—A Comparative Analysis Of The Child’S Healthcare Utilization, Access And Health Outcomes, Arijit Ganguli

Theses and Dissertations (ETD)

With the advent of effective antiretroviral medication and increased expectancy of life span among HIV-infected individuals has lead to an increase in the at-risk population of uninfected children living with their HIV-infected parent(s). The purpose of this study was to investigate the impact of parent’s HIV status on their child’s access to healthcare resources, healthcare utilization and health outcomes.

This was a cross-sectional study in which the information on the children of HIV seropositive parent(s) was collected through a face-to-face interview of the HIV-infected parents having children currently residing with them. The comparative group comprising of children of HIV seronegative …

Preferences And Willingness To Pay For Osteoarthritis Treatments Among The Medicare Population, Meghan Alexis Hufstader

Theses and Dissertations (ETD)

The design of this study is a non-random cross sectional survey to determine Medicare beneficiaries’ preferences and willingness to pay for osteoarthritis (OA) treatments. The population of interest in this study is the Medicare eligible (over age 65) population in Memphis, TN, and surrounding cities. Data were collected at Senior Centers and one internal medicine practice. The sample size was 181.

Choice-based conjoint analysis technique was utilized. The preferences and willingness to pay were determined using choice-based conjoint analysis, advanced design module with a dual-response none option. Choice-based conjoint analysis uses computer guided surveys to elicit patient preference for a …

Impact Of Cost Sharing Levels On Adherence To Controller Drugs And Consequent Outcomes Among Asthma Patients, Varun Vaidya

Theses and Dissertations (ETD)

Prescription drug cost sharing is an effective tool to reduce the excessive drug consumption. However, many times it could have a negative impact on the drug utilization especially in case of chronic conditions. Chronic conditions such as asthma require appropriate utilization of controller medication to keep the inflammation and symptoms under control. Literature on asthma drug utilization has consistently reported underuse of controller drugs among asthma patients. The present study attempted to investigate the impact of prescription drug cost sharing levels on the controller adherence among the privately insured asthma population with moderate persistent asthma. The study also analyzed the …

Cost Burden Of The ‘Presenteeism’ Health Outcome In A Diverse Nurse And Pharmacist Workforce: Practice Models And Health Policy Implications, Carol L. Warren

Theses and Dissertations (ETD)

The complex phenomenon of presenteeism is an undesirable health outcome that occurs when employees remain present on-the-job with lowered work productivity caused by personal health conditions. The cost burden of presenteeism in healthcare professionals has been under-explored and the cost burden of presenteeism across racial and ethnic minority employees has been un-explored. Aims of this research were to describe presenteeism and its cost burden among nurses and pharmacists and to determine distinctness of differences across racial/ethnic groups within these professions. In exploring presenteeism, the focus was on recognizing it, characterizing it, and measuring it. In monetizing presenteeism, its costs burden …

Factors Affecting Long-Term Outcomes Following Intensive In-Home Services, Sarah Hurley

Theses and Dissertations (ETD)

Intensive in-home services (IIHS) work with families toward building skills and resources to better manage their children with behavioral difficulties. Factors that impact long-term outcomes following IIHS are not well understood. This study examined the relative importance of youth demographic and clinical characteristics, family history variables, characteristics of program participation, and organizational-level factors in explaining placement stability, educational progress, and contact with legal authorities one year following discharge from IIHS.

The sample included all youth who received IIHS, were discharged between January 1, 2001 and December 31, 2006, and completed a follow up at one-year post-discharge (n = 2,649) from …