Medicine and Health Sciences Commons^™

Impact Of Advanced Access Scheduling On Missed Appointment Rates In Primary Care, Helen Yvonne Krippel

Walden Dissertations and Doctoral Studies

A major problem encountered within outpatient physician offices are missed appointments. Missed appointment research revealed how no-show rates remain a focus for healthcare administrators as decreasing no-show rates may reverse harmful health consequences. The purpose of this study, which also addressed the research gap, was to determine if there was an association between advanced access scheduling and no-show rates for patients scheduled with preferred primary care physicians versus nonpreferred primary care physicians. The health belief model was the conceptual framework as missing a prescheduled appointment is a health behavior. The 1st and 2nd research questions examined whether there was a …

Advanced Practice Registered Nurses And Their Knowledge Regarding The Hindrance Of Obesity, Crystal Rainey

Walden Dissertations and Doctoral Studies

Advanced Practice Registered Nurses and Their Knowledge

Regarding the Hindrance of Obesity

by

Crystal N. Rainey

MSN, Walden University, 2014

BSN, University of Arkansas in Little Rock, 2011

AASN, Southeast Arkansas College, 2009

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2020

Human Resource Strategies Used To Retain Millennials In Hospitals, Thomas F. Turner

Walden Dissertations and Doctoral Studies

Lead hospital human resource managers (HRMs) experience new recruitment, retention, and training costs for Millennial employees to close the skill gaps and address challenges from Baby Boomer employees retiring. The median turnover rate of 3 years for Millennial workers in hospitals is more than 3 times higher than older workers at hospitals. The purpose of this qualitative multiple case study was to identify retention strategies hospital HRMs use to address the retention of millennial generational employees beyond 3 years. Transformational leadership theory was the conceptual framework for the study. The data collection process included semistructured interviews and a review of …

The Impact Of Digital Self-Scheduling On No-Show Event Rates In Outpatient Clinics, Karen M. Marhefka

Walden Dissertations and Doctoral Studies

The failure of patients to keep scheduled appointments results in significant loss of revenue due to decreased administrative efficiency, expensive clinical resource time, disruptive continuity of care between the patient and the provider, and reduced quality of care. The purpose of this quantitative study was to explore the use of digital self-scheduling as an emerging alternative to traditional office-assisted scheduling methods and determine if its use has an impact on reducing the occurrence of no-show events. The theoretical framework used for the study was the Consumer Behavior Theory. Three years of de-identified secondary data were collected from a large, adult …

Newly Licensed Registered Nurse Generation Cohorts And Retention In First Registered Nurse Positions, Elizabeth S. Gizenski

Walden Dissertations and Doctoral Studies

The purpose of this quantitative study was to evaluate the association between newly licensed registered nurses (NLRN) generational cohorts and NLRN who plan to leave or have left their first nursing position. The research problem focused on the generational cohorts of NLRN and retention. The research questions addressed different generations of NLRN, their intent to stay in their first job, and whether poor orientation was a factor for those who already left their first nursing position. The theoretical foundation was Strauss–Howe’s generational theory explaining how each generation views the world based on what they experienced in their lifetime. Data retrieved …

Inpatient Stays Involving Mental Illness And Substance Use Disorders, Latonya Smith

Walden Dissertations and Doctoral Studies

Nearly one-third of Americans suffer from a mental illness. Twenty-three million people are affected by substance use or a dependency issue and the length of stay for patients enrolled in treatment services is rising. Mental health issues and substance use are rising within the United States and are associated with increased healthcare costs and the need for healthcare services. The purpose of this quantitative study was to determine the association between inpatient services, residential, outpatient, age, and payer source on substance use and mental health services using the 2017 Substance Abuse and National Mental Health Services Administration survey. The Donadebian …

Successful Retention Strategies By Perfusion Managers To Reduce Perfusionist Attrition, Krysta Lynne Gleeson

Walden Dissertations and Doctoral Studies

Perfusion managers who lack strategies to mitigate perfusionist attrition place a strain on their remaining employees and incur replacement costs for their organization. Grounded in Vroom’s expectancy model, the purpose of this multiple case study was to explore strategies perfusion managers use to mitigate perfusionists attrition within open-heart centers in a northeast U.S. city. Data were collected through digital semistructured interviews with 5 licensed perfusionists who demonstrated successful staff retention. Perfusionist job listings were used as a secondary data source. Data were analyzed using Yin’s 5 step process. Four significant themes emerged: job satisfaction, work-life balance, surveys, and compensation. Perfusion …

An Examination Of Virginia Wic Staff’S Attitudes And Knowledge Towards The Brush, Book, Bed Oral Health Program, Tia Jackson, Tegwyn H. Brickhouse, Lizbeth Snead, Natalie Pennywell

Graduate Research Posters

Introduction: Families who are low income and have low oral health literacy tend to have poor oral health. The Brush, Book, Bed (BBB) program helps caregivers establish a consistent night routine for their children that includes brushing teeth, reading, and an age-appropriate bedtime. BBB has been shown to increase oral hygiene behaviors and therefore oral health outcomes. Studies have shown that children who participate in Women, Infants, and Children, (WIC) programs are more likely to access dental services. This study examined local Richmond, Virginia (VA) WIC staff on their current oral health knowledge and views on implementing BBB.

Methods: A …

10-13-2020 Hsc Committee Meeting Minutes, Hsc Committee

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.

An Exploration Of The Gross National Happiness Approach To Assure Patient Safety And Healthcare Quality In Bhutan, Rinchen Pelzang, Alison M. Hutchinson

Journal of Sustainable Social Impact

Although the principles of Gross National Happiness (GNH) are currently being used as the overall framework for Bhutan’s development programs (including healthcare services), little is known about how Bhutanese healthcare professionals perceive the relationship between GNH and patient safety or how the GNH principles could help in improving patient safety in Bhutan’s healthcare system. The aim of this study was to explore how Bhutanese healthcare professionals, educators, managers, and policy makers perceive the relationship between GNH and patient safety and what they believe should be done to improve patient safety in Bhutan. A qualitative exploratory descriptive study using in-depth interviews …

12-01-2020 Hsc Committee Meeting Minutes, Hsc Committee

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.

Association Between Breastfeeding And Child Stunting In Mexico, Ana Paola Campos, Mireya Vilar-Compte, Summer Sherburne Hawkins

Department of Public Health Scholarship and Creative Works

Background: Globally, the prevalence of child stunting has been decreasing over the past decades. How-ever, in low-and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting. Objective: To examine the association between breastfeeding (defined as never breastfed, any breast-feeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under –2 standard deviations of the World Health Organization child growth standards’ median) in Mexico. Methods: Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6–35 months with information on previously identified risk and protective factors for stunting. We conducted fixed-and mixed-effects logistic regression models sequentially controlling for each level of factors. Findings: Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breast-feeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models. Conclusions: According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.

Was That In An Email? An Electronic Tool To Improve Nursing Communication Satisfaction, Jennifer A. Morgan

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Nursing communication satisfaction impacts engagement and turnover as well as patient care which affects organizational profits. Although direct care nurses report dissatisfaction with nurse manager communication methods, organizations and nurse managers do not utilize best practice strategies. In addition, there is a lack of high-quality implementation studies of best practice communication methods, specifically on obstetrics units, to assist managers in improving communication methods. Methods: An electronic communication tool was implemented on an inpatient obstetrics unit at a large tertiary hospital in the Upper Midwest. The tool was accessible on all unit computers on the SharePoint site. The project leader …

Implementation Of Sbar Tool In A Rural Hospital, Molly M. Tschetter

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Introduction: Patient handovers between healthcare providers during shift change or unit and interfacility transfers are a vulnerable time for inadequate communication. To ensure a handover is concise, healthcare organizations must implement and educate their staff on evidence-based communication tools.
Methods: SBAR is a communication tool commonly used during a handover. SBAR allows for a steady flow of report and a reduction of information missed. When nurses use SBAR, the efficiency of their report improves and handover time is decreased. By decreasing interfacility handover time, patients may be transferred to higher levels of care faster. By receiving more advanced care faster, …

Impact Of Performance-Based Budgeting On Quality Outcomes In U.S. Military Healthcare Facilities, Kimberly L. Decker Virginia Commonwealth University

Theses and Dissertations

Performance-based budgeting (PBB) is a variation of pay for performance that is applicable to government programs. It works by increasing or decreasing funding based on pre-established performance thresholds, which incentivizes organizations to improve performance. In late 2006, the U.S. Army implemented a PBB program in all of its healthcare facilities due to rising concerns over costs and quality in its facilities. The U.S. Army’s PBB program tied hospital-level funding decisions to performance on key cost and quality-related metrics. This study examined the impact of this program and a subsequent PBB program on quality improvement in U.S. Army healthcare facilities. Drawing …

Hospital Investment In Urgent Care: Impacts On Emergent, Outpatient, And Ambulatory Surgery Volumes, Hillary A. Linhart

Theses and Dissertations

As the popularity of urgent care centers (UCCs) has grown, hospitals have increasingly chosen to invest in this care model. Hospital interest in UCCs is largely driven by two key factors. First, hospitals aim to use UCCs to generate referrals, which generate additional patient volume for downstream hospital services. Secondly, hospital UCC investment presents an opportunity to ease the demand for non-urgent care in the emergency department (ED) by diverting low-acuity ED patients to the more appropriate UCC setting. No study to date has evaluated the impact of hospital UCC investment on referrals or downstream service volumes. A few studies …

An Exploration In Accountable Care Organization Structure, Contingency And Performance, 2015-2017, Siriporn P. Satjapot

Theses and Dissertations

The Patient Protection and Affordable Care Act of 2010 enacted one of the most significant reforms seen in the United States healthcare landscape. The Center for Medicare and Medicaid (CMS) led transformation efforts in regulatory reform and coverage expansion across the U.S. population. Since 2010, care delivery systems have been shifting from episodic, decentralized and fee-for-service models to value-based population health models, like accountable care organizations (ACO). ACOs have been specifically primed for local response to improve the health of their communities. ACO research has traditionally focused on performance measures like mortality, readmissions, quality outcomes and savings. ACO organizational characteristics …

Innovative Framework For Academic And Public Health Departments' Partnership On Preparing Future Practitioners- Preliminary Data, Michele Kekeh, Muge Akpinar-Elci, Myngoc Nguyen, Nancy Welch

Community & Environmental Health Faculty Publications

This article presents a model to respond to current public health challenges and transform knowledge into preventive strategies. It also presents an innovative way for academic institutes and public health departments to focus on public health workforce development. Academic institutes partnership with public health departments have started fostering service-learning opportunities to engage students in public health with an emphasis on the specific public health outcomes. However, the benefit of service–learning projects on the health departments and the populations served is largely unknown. Recently, these service-learning opportunities are becoming less sustainable due to the inability of preceptors to provide the necessary …

Risk Factors For Workplace Encounters With Weapons By Hospital Employees, James Blando, Chalsie Paul, Mariana Szklo-Coxe

Community & Environmental Health Faculty Publications

Objective:The specific aim of this study was to determine which risk factors were associated with frequent weapons confiscation in a healthcare facility. This study investigated the hypothesis that hospital-related factors impact the frequency of weapons confiscation.

Study design:Cross-sectional.

Methods:A cross-sectional survey was administered on-line to hospital security directors and assessed the associations of organizational factors with the frequency of weapons confiscation.

Results:It was found that hospitals with metal detectors were more than 5 times as likely to frequently confiscate weapons, suggesting this intervention is effective. It was also found that hospitals with psychiatric units were more likely to have frequent …

Treatment Plans For Diabetes Management During Hurricane Maria In Puerto Rico, Joel De La Cruz Oller

Walden Dissertations and Doctoral Studies

The purpose of this study was to evaluate the health outcomes of diabetic patients in Puerto Rico, before, during, and after Hurricane Maria, in 2017. The Department of Health in Puerto Rico provided the secondary data for the variables low-density lipoproteins (LDL) cholesterol, hemoglobin A1C (HbA1c), mortality, and consumer price index (CPI). The inclusion criteria were participants for whom electronic data were available before, during, and after Hurricane Maria; the sample size was 450. The theoretical framework for this investigation was the health outcomes and impact assessment. The data were analyzed by univariate and analysis of variance (ANOVA) to compare …

A Hybrid System Dynamics, Discrete Event Simulation And Data Envelopment Analysis To Investigate Boarding Patients In Acute Hospitals, Leila Keshtkar, Wael Rashwan, Waleed Abo Hamad, Amr Arisha

Articles

Timely access to health services has become increasingly difficult due to demographic change and aging people growth. These create new heterogeneous challenges for society and healthcare systems. Congestion at acute hospitals has reached unprecedented levels due to the unavailability of acute beds. As a consequence, patients in need of treatment endure prolonged waiting times as a decision whether to admit, transfer, or send them home is made. These long waiting times often result in boarding patients in different places in the hospital. This threatens patient safety and diminishes the service quality while increasing treatment costs. It is argued in the …

Care Management And Readmission Among Elderly African American Patients With Chronic Illnesses, Vivien Lyn Salmon

Walden Dissertations and Doctoral Studies

More than 70 million Americans aged 50 years and older suffer from at least 1 or more chronic condition and use the emergency department frequently. By 2025, chronic illness will affect an estimated 164 million Americans or nearly 49% of the population. The rapid rise in chronic illness is due to a combination of an aging population, longer life expectancies, and poor lifestyle choices. This quantitative study provided a statistical analysis on the impact of care management on readmissions among African Americans between the ages of 65 and 80, with diabetes, hypertension, asthma, or multiple chronic conditions. Logistic regression was …

Guidelines For Chronic Back Pain: An Education Module For Health Providers, Ron Pascual

Walden Dissertations and Doctoral Studies

Effective chronic back pain management and patient self-care guidelines are necessary for healthcare providers treating patients with complaints of low back pain (LBP). The purpose of this doctoral project was to provide an evidence-based educational program aimed at improving the knowledge and skills of healthcare professionals regarding the Center for Disease Control (CDC) and American Chronic Pain Association (ACPA) guidelines, emphasizing alternative pain management treatments. The staff education project was supported by the biomedical pain model and chronic care model. A panel of 3 experts including the clinic’s board-certified anesthesiologist and pain management specialist, clinical manager, and leading medical director …

Use Of Managerial Epidemiology By Healthcare Leaders In Ambulatory Settings, Chantelle Schenning

Walden Dissertations and Doctoral Studies

Despite many health reforms, the United States continues to struggle with limited healthcare access, exponential healthcare costs, and poor quality of care. Overcoming these challenges requires healthcare leaders’ effective navigation of industry transformation towards population health and a shift in patient volume to ambulatory healthcare settings. Research has demonstrated that the use of managerial epidemiology, an application of epidemiology tools and principles to management decision-making within healthcare organizations, can better serve the health of the population and could improve the triple aim of inadequate access, high costs, and poor quality. However, the adoption of this practice is weak and its …

Measuring Knowledge Of Chronic Kidney Disease (Ckd) Among Community College Students, Jacquelyn Caldwell Moore

Walden Dissertations and Doctoral Studies

Chronic Kidney Disease (CKD) once detected is easily treated; however, it has become a major health problem associated with increased morbidity and mortality rates, creating an economic burden worldwide. While approximately 24 million Americans over the age of 20 suffer from CKD, there is a lack of awareness among the general population. Using a pre/post assessment, this quantitative study measured the impact of a 75-minute workshop on 126 community college students' knowledge of kidney disease, perception of its severity, and perceived susceptibility. The theoretical framework for the study was the health belief model, which suggests that individuals will make positive …

Telehealth: Advances In Alternative Payment Models, Mei Zhao, Hanadi Hamadi, D Rob Haley, Jing Xu, Cynthia White-Williams, Sinyoung Park

Department of Health Administration Faculty Publications

Introduction

Previous studies indicated that telehealth services may improve hospital performance. However, the extent to which these telehealth provisions would improve hospital total performance score under the hospital value-based purchasing (HVBP) programme is not clear. The aim of this study is to examine the association between telehealth provision and hospital performance.

Methods

We performed a retrospective analysis of the association between the provision of telehealth services and 2699 hospital’s total performance score (TPS) on the 2018 HVBP programme and its four domains. Multivariate regression models were used to analyse TPS and hospital performance on each domain. Telehealth services offered by …

Quality Of Life For Persons With Chronic Disease Utilizing Mobile Integrated Healthcare, Dr John Robert Ash

Walden Dissertations and Doctoral Studies

The use of mobile integrated healthcare-community paramedicine (MIH-CP) has the potential to be integrated into existing chronic disease management initiatives as a means of reducing unnecessary hospitalizations and costs as well as improving quality of life (QOL). The purpose of this study was to analyze the relationships between demographics, noncommunicable disease type (NCD), and changes in self-perceived, self-reported QOL for those who have participated in an MIH-CP program. The research design for this study was a pretest/posttest design using secondary data that were obtained from a research partner using the MIH-CP intervention and collecting QOL data using the Euroqol QOL …

Sustainable Building Certification In Healthcare And Patient Satisfaction, Brian Jay Goehner

Walden Dissertations and Doctoral Studies

Eco-friendly healthcare delivery concepts are becoming more accepted as hospital leaders seek to control energy costs, mitigate contributions to climate change, and preserve scarce resources. Leadership in Energy and Environmental Design (LEED) offers healthcare leaders a framework for designing and constructing sustainable facilities that meet efficiency goals. The purpose of this quantitative cross-sectional study was to build an understanding of whether LEED certification influences Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. Using complex systems theory as the framework, the research questions were focused on exploring if higher levels of LEED certification led to greater HCAHPS overall hospital …

Leadership Strategies To Maintain Hospital Business Office Productivity During A Merger, Scott Alan Hughes

Walden Dissertations and Doctoral Studies

In 2017, healthcare system mergers in the United States set a record with 115 deals made and 11 involved sellers with net revenue of at least $1 billion; however, it is common for hospital business office productivity to suffer during a merger. Grounded in the theory of business process re-engineering, the purpose of this qualitative single case study was to explore strategies hospital leaders in the southeastern United States used to maintain business office productivity as they completed a merger. A review of documentation from archival records supplemented in-depth interviews with 7 purposively selected hospital leaders. Yin’s 5-step analysis guided …

Strategies To Implement A Material Management Information System For Medical Device Recalls, Paul Leo Lafrance

Walden Dissertations and Doctoral Studies

Health care business executives lack strategies to implement material management information systems (MMIS) related to medical device recalls. Lacking sufficient MMIS, health care business executives face insufficient product tracking related to medical devices affecting operational efficiency. Grounded in the conceptual frameworks of the technology acceptance model and diffusion of innovation, the purpose of this qualitative single case study was to explore health care business executives’ strategies for implementing an MMIS related to medical device recalls. The participants were 6 health care executives who implemented an MMIS in an urban hospital in the northeast region of the United States. Data were …