Medicine and Health Sciences Commons^™

Evidence Based Protocol: Improving Depression Assessments In Primary Care, Katherine E. Hoffhines

Master's Projects

Depression is a destructive condition that can have a profoundly negative impact on quality of life, wellbeing, and health (Thase, Stowell, Berry, Mencia & Blum, 2014). Worldwide, depression is the leading cause of medical disability costing the health care system over $210 billion annually (World Health Organization, 2014; Greenberg, Fournier, Sisitsky, Pike & Kessler, 2015). The World Health Organization (2016) estimates depression affects 350 million people of all ages globally. One and three adults in the U.S. will experience a major depressive episode during their lifetime (Kessler, Petukhova, Sampson, Zaslavsky & Wittchen, 2012; Rubin, Ciechanowski, Egede, Lin & Lustman, 2004). …

Patient Falls: Reducing Patient Falls With Injury, Frederick Comer

Master's Projects

The occurrence of patient falls is a very important health concern facing the healthcare industry. Many patients not only experience falls, but have falls with an injury. This is a patient safety concern that can have serious effects on patient outcomes, is a leading cause of patient injuries in hospitals, and are costly adverse events (Trepanier & Hilsenbeck, 2014). It is important that healthcare professionals determine ways to prevent what has been deemed a preventable event (Bemis-Dougherty & Delaune, 2008). In 2005 The Joint Commission (TJC) included patient falls with injury as part of their National Patient Safety Goals (Bemis-Dougherty …

Postdischarge Calls In The Ed: Improving Quality And Efficiency, Megan E. Pashnik

Master's Projects

No abstract provided.

Evidence Based Protocol: Discharge Delays In The Acute Care Setting, Kylie C. Schaberg

Master's Projects

According to Batalden, Nelson, Godfrey and Lazar (2011, p, 25), the clinical microsystem is a “place where patients, families and health caregivers meet” and encompasses all interactions from the moment a patient enters the system up to and including when the patient leaves the system. In order to understand the complex and dynamic changes that occur at the microsystem level, a thorough assessment must be completed. The purpose of this chapter is to gain a greater understanding of the mechanism of the microsystem and the effects that this microsystem has on the process for discharging patients from the hospital setting …

Replicable Interprofessional Competency Outcomes From High-Volume, Inter-Institutional, Interprofessional Simulation, Deborah Bambini, Matthew Emery, Margaret De Voest, Lisa Meny, Michael J. Shoemaker

Peer Reviewed Articles

There are significant limitations among the few prior studies that have examined the development and implementation of interprofessional education (IPE) experiences to accommodate a high volume of students from several disciplines and from different institutions. The present study addressed these gaps by seeking to determine the extent to which a single, large, inter-institutional, and IPE simulation event improves student perceptions of the importance and relevance of IPE and simulation as a learning modality, whether there is a difference in students’ perceptions among disciplines, and whether the results are reproducible. A total of 290 medical, nursing, pharmacy, and physical therapy students …

Identification Of Nonalcoholic Fatty Liver Disease In Patients With Hepatitis C: Using Evidence Based Guidelines To Improve Diagnosis And Transition Of Care From Specialty Care Provider To Primary Care Provider, Debra B. Bayus

Doctoral Projects

Chronic liver disease is a process that involves progressive destruction and regeneration of the liver causing fibrosis, cirrhosis and hepatocellular carcinoma, and early death. Persons with chronic liver disease treated for hepatitis C with abnormal radiological imaging consistent with increased fat content in the liver (hepatic steatosis) should be evaluated for nonalcoholic fatty liver disease (NAFLD). However, individuals treated at a community hepatitis C treatment clinic are currently not being evaluated for NAFLD. In addition, if NAFLD is diagnosed, management of these co-occurring conditions is required to delay disease progression. Factors contributing to gaps in NAFLD care include: poor communication, …

Population Health Management Risk Assessment Tool Validation: Directing Resource Utilization, Sonya L. Christensen

Doctoral Projects

The Affordable Care Act (ACA) of 2010 is transforming health care across the nation into a value-based system that emphasizes quality and continuity with reimbursement tied to patient outcomes. The shift in emphasis is best realized through the strategy of Population Health Management, a change from traditional episodic treatment of illness to management of the health needs of populations throughout the continuum of health. The goal of care is to ensure that patients, especially the chronically ill, receive effective attention to their health needs in order to improve outcomes, decrease costs, and provide a positive patient experience. An important component …

Implementing Spirometry-Driven Evidence-Based Asthma Care In A Primary Care Practice, Douglas C. Rau

Doctoral Projects

This project was a quality improvement initiative employing an educational intervention to increase the awareness and stress the importance of utilizing spirometry in the diagnosis, treatment, and management of asthma. Clinical support staff received training on how to perform spirometry and providers received education on the interpretation and utility of spirometry results to drive care to improve outcomes for clients with asthma. Project outcomes examined the self-rated confidence to perform and interpret spirometry before and after the intervention and the subsequent utilization pattern of office-based spirometry at the primary care clinic. For clinical support staff, the self-comfort level at performing …

Implementation Of A Smart Goal Intervention For Diabetic Patients: A Practice Change In Primary Care, Mackenzie Swanson

Doctoral Projects

Self-management techniques have been shown to be useful practice tools for providers managing patients with chronic disease. One valuable aspect of self-management is goal setting, whereby the patient is directed to create highly attainable personal goals to modify a selected behavior. Through the attainment of these goals, the patient begins to experience confidence and improved self-efficacy in managing chronic diseases such as diabetes. This paper provides background on the use of SMART goals for diabetic patients, how this practice change supports Meaningful Use objectives and helps meet the requirements for future reimbursement opportunities. A thorough organizational assessment of a Midwest …

Physical Activity Assessment And Intervention Among Adult Patients At A Community Health Center, Michelle L. Vandentoorn

Doctoral Dissertations

Low levels of physical activity are associated with a number of serious health conditions in adults. These conditions include hypertension, diabetes, certain types of cancers, cardiovascular disease, and an increased risk of mortality. In spite of these serious health risks, few adults in the United States are achieving the recommended levels of physical activity. The diseases associated with low physical activity levels contribute to high healthcare costs.

Healthcare providers claim that they are not aware of available interventions and resources to increase physical activity levels in their patients. Through screening patients for physical activity levels during office visits, providers can …

Health Literacy Assessment And The Meaningful Use Incentive Of Providing Clinical Summaries In An Underserved, Hypertensive Population, Tami Pettenger

Doctoral Projects

Hypertension is a common diagnosis in the United States and can lead to health complications if not well managed. However, this condition often has few to no symptoms which may lead patients to modify, disregard, or otherwise be non-adherent to treatment plans. Also a patient’s health literacy level may directly affect his or her ability to understand and act on health information. This may be especially true in vulnerable populations such as older adults and underserved communities. In addition, the education material provided to patients, such as clinical summaries following a health visit, may not be consistent or understandable or …

Quality Improvement Initiative In Transplant Diabetes Care: Needs Assessment And Protocol Development, Dawn Korson

Doctoral Projects

Over 30,000 people receive a solid organ transplant each year, with 5-30% developing post-transplant diabetes mellitus (PTDM) (United Networking for Organ Sharing, 2015). At a Midwestern transplantation center, over 22% of patients with a history of diabetes were not consulted to endocrinology after kidney and liver transplantation. With poor glycemic control, there is an increased risk of developing PTDM leading to poor outcomes. Utilizing the Donabedian model and the Six Sigma’s Define, Measure, Analyze, Improve, and Control (DMAIC) as guides for implementation, the purpose of this project was to address the process measures of increasing appropriate consultations for evaluation and …

Screening Initiative For Non-Stroke Geriatric Inpatients, Kimberly Harper

Doctoral Projects

Current literature reveals a need for improved depression screening efforts among inpatient geriatrics. This population is at higher risk for severe depression, suicidal ideations, poorer health outcomes related to decreased compliance to healthcare regimens, and increased healthcare costs. Current best practice involves the utilization of the Geriatric Depression Scale-Short Form (GDS-SF), a 15-question yes or no answer screening tool. While not diagnostic, the tool has established validity and reliability testing. The GDS-SF should not be used on subsets of the population diagnosed with stroke, dementia or delirium.

The purpose of this project was to develop a protocol for implementation of …

Evaluating The Effectiveness Of An Exercise Program For Persons With Multiple Sclerosis, Tiffany Kuipers

Doctoral Projects

Multiple sclerosis (MS) is a chronic, degenerative condition of the central nervous system that leaves patients with a wide variety of symptoms and disability. Symptoms include decreases in energy levels, muscle strength, bone strength, vision, sensation, coordination, cognition, hearing, balance, and quality of life. Exercise has been well supported as a way to reduce symptoms and slow the disease progression of MS. Outpatient exercise programs have also been shown effective in providing patients with the necessary tools to perform appropriate exercises at home. Yet, few programs are available that are appropriate for patients with MS. This project aimed to, first, …

Use Of Culturally Tailored Media To Increase Hiv Screening Among African Americans, Leda Evans

Doctoral Projects

Over one million people in the United States have HIV with a substantial portion of these individuals being African American. Innovative approaches to improving the HIV disparity among African Americans have been encouraged by the federal government. Culturally tailored HIV risk reduction interventions have been noted as effective in several studies in reducing risk behavior. The purpose of the intervention was to determine if the use of culturally tailored HIV risk reduction media would result in an increase in HIV screening among African Americans. A one-time community based-intervention with no control group was utilized to determine impact of media. Screening …

A Standardized Palliative Care Referral Workflow And Educational In-Service At An Outpatient Congestive Heart Failure Clinic, Rachel E. Cardosa

Doctoral Projects

Cardiovascular disease is a significant health issue in the US as it is the leading cause of death and most cited reason of hospitalizations in Medicare enrollees (Centers for Disease Control, 2014; Unroe et al., 2011). The American Colleges of Cardiology and the American Heart Association Guidelines recommend palliative care for all patients with heart failure (Yancy et al., 2013). The purpose of the scholarly project was to address the gaps in current practice by creating a standardized palliative care referral process and education for clinicians in an outpatient Advanced Congestive Heart Failure (ACHF) Clinic. A referral tracking process was …

Communication Process Improvement Among Bedside Nursing Staff On A Skilled Nursing Rehabilitation Unit, Lauren Dice Smith

Doctoral Projects

Communication in healthcare is pivotal for transferring patient clinical information. Communication is important between and within disciplines and throughout the continuum of care. Poor communication has been found to be the third leading root cause of sentinel events (event which may cause death, permanent harm, or severe temporary harm) within hospitals behind human factors and leadership. Standardization of nursing handoffs using the Situation Background Assessment Recommendation (SBAR) model and conducting the handoff at the patient’s bedside have produced positive outcomes including improving patient safety, improving nursing and patient satisfaction, and increasing time efficiency for nurses. The PICO question for this …

Development Of A Toolkit To Evaluate Efficacy Of The Respecting Choices© System Of Advance Care Planning, Nicole M. Harpold

Doctoral Projects

In 1991 the United States Congress enacted the Patient Self-Determination Act which was an attempt by the government to improve completion rates of advance directives. Despite enactment of this law, completion rates of advance directives have remained relatively unchanged with only 18-36% of adult Americans having completed a document (United States Department of Health and Human Services, 2008). Nearly 90% of healthcare spending in the United States is on the management of chronic conditions (Centers for Disease Control and Prevention, 2015). As the baby boomer generation, which already has a high number of chronic conditions, ages our struggling healthcare system …

Evaluating The Use Of The Asthma Action Plan And The Asthma Control Test By Providers In A Primary Care Office After Implementation Into The Electronic Health Record, Claudia N. Turkson-Ocran

Doctoral Projects

Asthma is a life-long chronic lung disease that inflames and narrows a person’s airway. Asthma results in recurring periods of chest tightness, wheezing with inspiration and/or expiration, shortness of breath, nighttime or early morning coughing, and trouble sleeping as a result of coughing and wheezing. An asthma exacerbation occurs when asthma symptoms worsen enough to require medical intervention or self-administration of oral corticosteroids. Exacerbations can be graded in severity as mild, moderate, severe, and life threatening. An asthma action plan (AAP) is a written treatment plan developed collaboratively between the health care professional and the patient for self-management and maintenance …

Development Of A Protocol For Implementing The Medicare Annual Wellness Visit In A Primary Care Setting, Jennifer M. Ohman

Doctoral Projects

The Medicare Annual Wellness Visit (AWV) was enacted in 2011 as part of the Patient Protection and Affordable Care Act. The AWV is an opportunity to improve care delivery by encouraging use of preventive services and coordinate care for Medicare patients 65 and older who are at high risk for high usage of healthcare services. During this visit, patients are screened for common geriatric-related conditions such as depression, cognitive impairment, fall risk, and functional decline. This visit is also an opportunity to identify risk factors for chronic illness and help patients stay current on recommended screenings and vaccinations. The organization …

A Process Improvement Project: Demonstrating A Patient Portal To Increase Enrollment And Use In An Underserved Population With Chronic Illness, Jonathan Gibson

Doctoral Dissertations

High risk, high cost chronic conditions such as diabetes, asthma, and congestive heart failure are prevalent in the United States. Nearly half of all Americans have at least one chronic condition (Centers for Disease Control and Prevention, 2009). Almost four-fifths of total health care spending in the U.S. is related to high risk, chronic conditions (Baker, Johnson, Macaulay, & Birnbaum, 2011). The use of patient portals in ambulatory care may be an avenue toward improving chronic disease management. Portals can be used by patients to schedule appointments, send secure messages to their providers, request medication refills, review lab and test …

Implementation Of The Evidence-Based Cope Intervention In An Elementary Classroom To Promote Mental Health, Maria Mccormick

Doctoral Dissertations

There is a growing incidence of suicide and suicide attempts in the adolescent population. This is largely impacted by the increasing rates of mental illnesses such as anxiety and depression as well as instigating factors such as negative behaviors and stressful life events. In order to prevent these rates from continuing to rise, it is imperative that mental health promotion interventions be implemented in young children in order to facilitate positive behaviors and coping skills that can be used when stressors occur. The purpose of this scholarly project was to implement the cognitive-behavioral therapy intervention, the Creating Opportunities for Personal …

Designing, Implementing, And Evaluating A Community-Based Antenatal Education Program, Jennifer L. Zachary

Doctoral Dissertations

The United States has higher fetal and infant mortality than the majority of developed countries around the world. As of 2008, the United States was ranked 27th internationally for infant mortality among all developed countries (MacDorman, Hoyert, & Mathews, 2013). Infant morbidity and mortality is associated with numerous factors within a country; including access and quality of health care, maternal health status, public health, and socioeconomic status.

Despite recent declines in infant mortality across the country, the infant mortality rates for both Michigan and the project county remain alarmingly higher than the national averages. It is clear that innovative measures …

Acceptability Of The Interpersonal Needs Questionnaire As A Suicide Risk Screening Tool For Veterans In A Non Veterans Health Administration Primary Care Clinic, Jeffrey M. Bird

Doctoral Dissertations

Suicide among veterans is a growing concern. The Department of Veterans Affairs (VA) estimates that a veteran dies by suicide once every 60-80 minutes with 18 to 22 veterans killing themselves every day. Many veterans receive healthcare in the community (outside of the VA), but are typically not identified in these settings. Veteran-centric policies are typically absent in settings outside of the VA. Screening for suicide risk at the primary care level has been largely ineffective with some patients dying from suicide within a week of a negative screen. The Interpersonal Needs Questionnaire (INQ), which measures thwarted belongingness and perceived …

Driving In Early-Stage Alzheimer’S Disease: An Integrative Review Of The Literature, Rebecca L. Davis, Jennifer M. Ohman

Peer Reviewed Articles

One of the most difficult decisions for individuals with Alzheimer’s disease (AD) is when to stop driving. Because driving is a fundamental activity linked to socialization, independent functioning, and wellbeing, making the decision to stop driving is not easy. Cognitive decline in older adults can lead to getting lost while driving, difficulty detecting and avoiding hazards, as well as increased errors while driving due to compromised judgment and difficulty in making decisions. The purpose of the current literature review was to synthesize evidence regarding how individuals with early-stage AD, their families, and providers make determinations about driving safety, interventions to …