Medicine and Health Sciences Commons^™

The Barriers Encountered In Telemedicine Implementation By Health Care Practitioners, Olantunji Obikunle

Walden Dissertations and Doctoral Studies

Patients in rural areas in the United States do not have adequate health care facilities for illnesses and injuries not serious enough for emergency care, but telemedicine could have a positive impact both economically and medically to control rapidly rising health care costs, which is a significant percentage of the gross national product. The purpose of this case study was to explore the barriers physicians encountered in telemedicine implementation. Participants included 4 physicians who took part in face-to-face interviews in a clinical setting in Ohio to explore strategies used in implementing telemedicine. The results of these interviews, coupled with observations …

Assessing Clinical Software User Needs For Improved Clinical Decision Support Tools, Kimberly B. Denney

Walden Dissertations and Doctoral Studies

Consolidating patient and clinical data to support better-informed clinical decisions remains a primary function of electronic health records (EHRs). In the United States, nearly 6 million patients receive care from an accountable care organization (ACO). Knowledge of clinical decision support (CDS) tool design for use by physicians participating in ACOs remains limited. The purpose of this quantitative study was to examine whether a significant correlation exists between characteristics of alert content and alert timing (the independent variables) and physician perceptions of improved ACO quality measure adherence during electronic ordering (the dependent variable). Sociotechnical theory supported the theoretical framework for this …

The Influence Of On-Site Surgical Pathology Services In Rural Hospitals On Physician Satisfaction, Belinda D. Presley

Walden Dissertations and Doctoral Studies

Abstract

There is limited information regarding physician satisfaction as it relates to the presence of a surgical pathology department in rural hospitals. Physician satisfaction directly influences the quality of patient care. The theoretical frameworks that informed this study included institutional theory and population ecology. The research questions addressed differences in levels of physician satisfaction between physicians who have access to an on-site surgical pathology department and physicians who do not have such access. The research also examined differences in satisfaction between physician specialties that have or do not have access to an on-site surgical pathology department services. A quantitative, cross-sectional …

Barriers To Health Care Among Laotian Americans In Middle Tennessee, Xaiyavong Saenphansiri

DNP Projects

Background. Laotian Americans have unique heath beliefs and practices. The cultural differences between Laotian American patients and American health care providers can create challenges in achieving not only evidence-based, but also culturally sensitive care. Although the current literature addresses barriers to health care for Asian Americans, there are few studies related to the Laotian-American minority.

Aim. Describing the particular barriers to preventive and curative care in the Laotian-American population in Middle Tennessee would inform strategies for successful prevention and early treatment programs for this population. The purpose of the study is to describe the health beliefs and barriers to …

Building Comprehensive And Sustainable Health Informatics Institutions In Developing Countries: Moi University Experience, Martin C. Were, Abraham Siika, Paul O. Ayuo, Lukoye Atwoli, Fabian Esamai

Internal Medicine, East Africa

Current approaches for capacity building in Health Informatics (HI) in developing countries mostly focus on training, and often rely on support from foreign entities. In this paper, we describe a comprehensive and multidimensional capacity-building framework by Lansang & Dennis, and its application for HI capacity building as implemented in a higher-education institution in Kenya. This framework incorporates training, learning-by-doing, partnerships, and centers of excellence. At Moi University (Kenya), the training dimensions include an accredited Masters in HI Program, PhD in HI, and HI short courses. Learning-by-doing occurs through work within MOH facilities at the AMPATH care and treatment program serving …

Diffusion Of Technology In Small To Medium Medical Providers In Saudi Arabia, Ziad Hisham Arnaout

Walden Dissertations and Doctoral Studies

The Saudi ministry of health reported that government health care spending doubled from 2008 to 2011. To address increased demand, the government encouraged small to medium enterprise (SME) growth. However, SME leaders could not leverage technology as a growth enabler because they lacked strategies to address operating inefficiencies associated with technology. Only 50% of hospitals fully implemented information technology. The purpose of this phenomenological study was to explore lived experiences of SME leaders on strategies needed to accelerate technology implementation. This exploration drew on a conceptual framework developed from Wainwright and Waring's framework addressing issues of technology adoption. Data were …

Correlates Of Developmental Disabilities Direct Service Professionals' High Turnover Rate, Doreen Marie Colangelo

Walden Dissertations and Doctoral Studies

Workplace turnover is destructive to organizations both financially and operationally. The cost of selecting and replacing the wrong candidate for a position ranges from a few thousand to several million dollars. The goal for this correlational study was to assess the efficacy of an applicant test instrument for identifying key personality traits of direct service professionals (DSP) in the developmental disabilities arena which correlate with successful job tenure and decrease turnover cost. The theoretical framework that grounded this study was the poor job fit theory. The population studied consisted of DSP's hired by an organization in Glynn County, GA. Anonymous …

Differentiating Demographic Factors In Latino Patients With Type 2 Diabetes, Carol Lynne Manning

Walden Dissertations and Doctoral Studies

The American Diabetes Association (ADA) data suggest that Latinos share a greater burden of disease than do non-Latino Whites with type 2 diabetes. As a result of poor glycemic control, Latinos also suffer consequences such as blindness, kidney disease, and limb amputation more often than do other ethnic groups. The purpose of this study was to compare demographic factors of Latinos with well-controlled type 2 diabetes, as measured by a HgbA1c of 7 or less (n = 118) to Latinos not well controlled (n = 105). This cross sectional study used a secondary data set with a sample selected from …

Nonattendance Rates And Barriers To Health Care In Outpatient Clinic Settings, Susan Louise Geiger

Walden Dissertations and Doctoral Studies

Lower socioeconomic status, ethnicity, and race are associated with reduced health care use in the United States. Patients who continually miss their appointments suffer significant negative results, including a disruption in continuity of care, complications with their chronic illnesses, and an increase in hospital readmissions. The health belief model was used as the theoretical support for this project that investigated the underlying causes of no-shows at an urban hospital-based outpatient clinic in the United States. It used a quantitative, descriptive design and examined a minority, underserved, and underinsured population that was receiving care at the research site and had a …

Increasing Knowledge About Alpha-1 Antitrypsin Deficiency In The Chronic Obstructive Pulmonary Disease Population, Maureen Ann Wentink Barta

Walden Dissertations and Doctoral Studies

The purpose of the project was to increase awareness about alpha-1 antitrypsin deficiency (AATD) in chronic obstructive pulmonary disease (COPD), particularly among those with a familial history of genetic factor AATD; an additional goal was to understand its relationship to COPD. COPD is the third leading cause of death in the United States, with more than half of COPD patients experiencing significant disabilities. Major causes for COPD include smoking, air pollution, secondary smoke, upper respiratory infections, hereditary factors, occupational factors, environmental factors, and socioeconomic factors. Genetic factors, however, also play a significant role in early onset COPD and in those …

Interdisciplinary Bedside Rounding: Patient Satisfaction With Nursing Communication And Decreased Hospital Readmissions, Luanne Parks

Walden Dissertations and Doctoral Studies

There is a lack of quality communication among health care professionals and patients in the hospital setting, which can negatively impact patient satisfaction and increase hospital readmission rates. Interdisciplinary bedside rounding (IBR) is a method of rounding that uses direct communication and discussion of the patient at the bedside, and the use of IRB may improve the quality communication among health care professionals and patients. The purpose of this program outcomes evaluation project was to evaluate whether IBR increased patient satisfaction with nursing communication and if IBR decreased hospital readmission rates. The Iowa model of evidence-based practice provided a framework …

Health Literacy And Health Decision Making Attitudes In People With Human Immunodeficiency Virus, Christine Miranda

Walden Dissertations and Doctoral Studies

Health literacy has been recognized as a vital issue in the self-care management of persons living with HIV/AIDS (PLWHA). The purpose of this study was to determine the impact of functional, communicative, and critical health literacy dimensions on positive and negative attitudes toward health decision making. The transtheoretical model of health behavior change (TTM) provided the theoretical framework to explain this association. A culturally-adapted survey was used in this cross-sectional study to measure health literacy dimensions, positive and negatives attitudes toward health decision making, and other factors in 100 Puerto Ricans living with HIV/AIDS. Demographic factors and clinical and immunological …

Relevant Decision Criteria And Their Level Of Importance In Consumers' Choice Of Hospital, Jordan Brelje

Honors Program Theses

As the health care industry becomes increasingly consumer-driven, it is crucial for hospitals to understand the considerations involved in their patients’ choice of health care institution. The purpose of this study was to determine the factors which most heavily influence consumers’ choice of hospital, as well as to make recommendations to health care marketers based upon the conclusions reached. This study also hoped to provide beneficial insights to public policy makers who desire to give consumers more control in the health care decision-making process. Very little research has been performed in recent years as to consumers’ choice of hospital decision …

Third-Degree Family Health History And Perception Of Disease Risk, Liana Carrasco Romero

Walden Dissertations and Doctoral Studies

Chronic diseases are a significant cause of illness and mortality in the United States. Hereditary predisposition to chronic diseases is a useful indicator for identifying people at risk for disease development. An ideal tool for determining this predisposition is the CDC, NIH, and AAFP recommended third-degree family health history (FHH). The aim of this quantitative, cross-sectional study, based on the theoretical frameworks of social constructivism and the health belief model, was to assess the possible influence between the completed third-degree FHH and the participant's perception of disease risk. Two-hundred seventy-three participants were recruited from health care facilities and from the …

Examining The Impact Of Accreditation On A Primary Healthcare Organization In Qatar, Alia Ghareeb

Walden Dissertations and Doctoral Studies

Although a modest body of literature exists on accreditation, little research was conducted on the impact of accreditation on primary healthcare organizations in the Middle East. This study assessed the changes resulting from the integration of Accreditation Canada International's accreditation program in a primary healthcare organization in the State of Qatar. The study also investigated how accreditation helped introduce organizational changes through promoting organizational learning as well as quality improvement initiatives. Pomey's Dimension of Change framework and questionnaire was used to measure the effect of Accreditation Canada International standards on the perceived quality performance and the progress towards organizational learning. …

Measuring The Impact Of Recognized Patient-Centered Medical Homes (Pcmh), Rick Moore

Theses and Dissertations

This dissertation proposal seeks to understand if the increasingnumbers (density) of recognized PCMH practices incommunities affect avoidable hospitalizations related toambulatory care sensitive conditions (ACSC), as measured bythe AHRQ Composite Prevention Quality Indicators (PQI). Theresearch has two purposes: 1. Establish constructs and hypotheses to measurethe effect of the increasing numbers of NCQA-Recognized PCMH practices in communities(counties). 2. Using an outcomes-based measurement approach,investigate the relationship between growingdensities of NCQA-Recognized PCMH practicedoctors among all primary care doctors (PCD) ina community and the associated impact on theutilization of inpatient care, specifically related toACSCs, as measured by the AHRQ CompositePQIs.

The research is quasi-experimental in …

Navigating Independent Double Checks For Safer Care: A Nursing Perspective, Danielle D. Grant

Honors Theses and Capstones

Abstract

The purpose of this study was to explore registered nurses’ understanding and practice of “independent double-checks” prior to administration of high-alert medications. The study used a qualitative descriptive design for data collection and data analysis. It included thirteen participants from a hospital located in southern New Hampshire. Results of the study revealed a core theme of navigating independent double checks (IDC) for safer care. Two major themes stemming from the core theme were also uncovered. Navigating IDC through knowing and navigating IDC through nurse partnership both focused on the perception and practice on IDC prior to administration of high …

Toward Transforming Health Systems: A Practice Study Of Organizing And Practical Inquiry In Academic Medicine, Thomas A. Ellison

Antioch University Dissertations & Theses

Transformation of health care systems will be grounded in new professional relations and collective, cross-disciplinary actions to impact care delivery. Organizing such relations and actions involves practical inquiry rather than applying professional knowledge. This dissertation presents an exploratory, performative study of the initial organizing of the Health Systems Innovation and Research (HSIR) Program in Health Sciences at the University of Utah. The HSIR program was conceived principally to catalyze cross-disciplinary innovation and health services research and enhance care delivery changes by documenting care improvements and publishing research. This study includes a composite narrative of the organizing and practical inquiry work …

Prehospital Emergency Medical Services Treatment Protocols: Aligning With National Best Practices, Zachary Ryan Charest

Online Theses and Dissertations

Many variances in prehospital Paramedic treatment protocols exist amongst Emergency Medical Service (EMS) Providers in the State of Kentucky. These differences lead to inconsistencies in quality of patient care delivered, reduce ease of mobility of providers and result in a decreased oversight from the Kentucky Board of EMS (KBEMS). To investigate the impact of protocol variances on patient care, a mixed methods study consisting of a convenience sample of Kentucky EMS prehospital Paramedic treatment protocols was collected and compared to the Kentucky state-wide treatment protocols. A literature review of best practices regarding EMS protocols was conducted. Of all protocols 81.9% …

Changes In Malaria Prevention And Incidence Due To Political Restructuring Of Mozambique And South Africa, Nirmala K. Shivakumar

UROP Posters

The UN’s current Millennium Development Goal puts pressure on many countries to decrease malaria incidence by 2015, including Mozambique and South Africa. While Mozambique and South Africa have continually worked to decrease malaria incidence for the last five decades, neither country can claim elimination of disease by UN standards. This study analyzes the changes in political structure and the simultaneous changes in the malaria prevention programs of Mozambique and South Africa after the end of their respective civil wars in 1992 and 1994. This study analyzed public health, historical, and social science journal articles. This study examined political power distribution, …

Risk Based Optimization For Improving Emergency Medical Systems, Sandhya Saisubramanian, Pradeep Varakantham, Hoong Chuin Lau

Research Collection School Of Computing and Information Systems

In emergency medical systems, arriving at the incident location a few seconds early can save a human life. Thus, this paper is motivated by the need to reduce the response time – time taken to arrive at the incident location after receiving the emergency call – of Emergency Response Vehicles, ERVs (ex: ambulances, fire rescue vehicles) for as many requests as possible. We expect to achieve this primarily by positioning the "right" number of ERVs at the "right" places and at the "right" times. Given the exponentially large action space (with respect to number of ERVs and their placement) and …

A Case Study Of Cross-Jurisdiction Resource Sharing: The Merger Of Two Tuberculosis Clinics In East Tennessee., Anne Kershenbaum, Margaret A. Knight, Martha L. Buchanan, Janet Ridley, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Cross-jurisdiction resource sharing is considered a possible means to improve efficiency and effectiveness of public health service delivery. A merger of the Tuberculosis (TB) clinics of a rural and a metropolitan jurisdiction in East Tennessee provided an opportunity to study service provision changes in real time. A mixed methods approach was used, including quantitative data on latent TB treatment outcomes and qualitative data from staff interviews, as well as documentation of changes in staffing time in TB services. Results showed a mix of efficiency changes, indicating probable increased pressure on key service providers after the merger, in addition to expected …

What “Community Building” Activities Are Nonprofit Hospitals Reporting As Community Benefit?, Erik Bakken, David Kindig, Jo Ivey Boufford

Frontiers in Public Health Services and Systems Research

In 2008, the Internal Revenue Service (IRS) revised and standardized the reporting policy for community benefit expenses for nonprofit hospitals. These expenses are required for tax exemption. At that time, the IRS designated some categories of activities as non-eligible as a community benefit, but still mandated their reporting on hospitals’ Form 990, the annual tax filing for nonprofit organizations. One such category was community building, which encompasses a broad range of nonmedical determinants of health and an important potential source of population health revenue. This is the first study to analyze community-building dollars at any level, examining New York State’s …

What's Happening: December 29, 2014, Maine Medical Center

What's Happening

No abstract provided.

Survey Of Certified Asthma Educator (Ae-C) Pharmacists – Who Are They And How Is This Credential Being Used?, Timothy R. Hudd, Susan G. Bollmeier, Enrique Seoane-Vazquez

Pharmacy Faculty Articles and Research

Objective: A survey was developed and distributed to pharmacists who have earned the certified asthma educator credential (AE-C) to assess asthma education services provided and their perceived value of the AE-C.

Design: A 28 item survey was developed, pretested and distributed electronically.

Participants: 224 AE-C certified pharmacists practicing within the United States were invited to participate.

Main Outcome Measures: Information pertaining to the level of education, professional affiliations, and practice setting was collected along with other demographic attributes.We also inquired about the types of asthma education services provided, related clinical activities, and whether AE-C pharmacists or …

What's Happening: December 22, 2014, Maine Medical Center

What's Happening

No abstract provided.

Consumer Assessment Of Healthcare Providers And Systems (Cahps) Surveys: Assessing Patient Experience, Lisa Sprague

National Health Policy Forum

This publication provides an overview of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys, which are widely used by both public and private health plans and providers to assess the patient's experience of health care. Included is information on survey contents, how surveys are tailored to different users, and how the resulting information is collected, reported, and used to help consumers make choices and providers carry out quality improvement, as well as its role in pay-for-performance reimbursement.

What's Happening: December 15, 2014, Maine Medical Center

What's Happening

No abstract provided.

Avoiding 30-Day Readmissions Of Acute Mi Patients Utilizing Cardiac Rehabilitation, Patricia T. Forsberg

Doctor of Nursing Practice (DNP) Projects

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more …

Minimizing Avoidable Interruptions During Medication Administration, Jaleel Anne Arnado

Master's Projects and Capstones

The objective of this CNL Internship Project is to improve patient outcomes and nurse satisfaction by minimizing the avoidable interruptions that occur during medication administration. The microsystem is a pediatric and adult medical-surgical overflow unit at a large, urban teaching hospital in Northern California. A series of surveys for nurses and patients and observations of medication administrations were conducted to assess barriers during mediation administration. It was determined phone calls interrupt a nurse the most during medication administration. Interruptions leave the medication administration process vulnerable to errors because it disrupts the nurse’s workflow and thought process. Because most pediatric medication …