Medicine and Health Sciences Commons^™

Improving Breastfeeding Rates In A Rural And Medically Underserved Community, Kaylie D. Waters

Culminating Experience Projects

Background: The Centers for Disease Control and Prevention reports national breastfeeding rates that are inconsistent with the recommendation of exclusive breastfeeding for the first six months of life (CDC, 2020). The rate of infants receiving any breastmilk by six months of age in a rural Midwest County is only 16% in contrast to 55% nationally (CDC, 2020; XXXXX, 2021). This discrepancy was addressed by evaluating breastfeeding status in that Midwest community followed by strategies to improve breastfeeding rates.

Methods: A multi-intervention quality improvement project was implemented using the SEIPS framework. The project evaluated the effectiveness of documenting breastfeeding status in …

Comparing The Health Care Resource Utilization And Medication Adherence Of People With Epilepsy And People With Diabetes By Insurance Status, Nikole Hoffman, Gerald Shoultz, Sarah Nechuta

Culminating Experience Projects

Background: Epilepsy is one of the most common neurological diseases worldwide; diabetes is a chronic metabolic disease that affects how the body produces and uses insulin. Prescribed medications are vital for controlling these and other chronic diseases by minimizing severe health issues, which can be affected by insurance type and status. Consequences of non-adherence include uncontrolled blood glucose in people with diabetes and uncontrolled seizures in people with epilepsy. We aimed to compare the healthcare resource utilization and medication adherence of people with epilepsy and people with diabetes by insurance status. Methods: Data was from the 2021 National …

The Use Of Occupational Therapy Services In Outpatient Mental Health, Kelsey A. Wasik, Matt T. Valois, Kaylee M. Essenberg, Kelcie P. Beck

Masters Theses

The purpose of this study is aimed to explore the structure and utilization details of occupational therapy in outpatient behavioral health settings. Two occupational therapists participated in qualitative phenomenological interviews which were transcribed and analyzed using the thematic approach. A total of two themes emerged: billing and coverage, and education and advocacy. Participants identified there are necessary factors for reimbursement of services, in addition to the need for education and advocacy for occupational therapists to practice in outpatient behavioral health settings. Future research should be aimed at recruiting more participants, occupational therapists, and from other roles in these clinics such …

Evaluating The Caprini Risk Assessment In An Inpatient Rehabilitation Facility, Alissa Payne, Kelsey Boersma, Sarah Nechuta

Culminating Experience Projects

Deep vein thrombosis (DVT) is an often underdiagnosed disease that can be life threatening for individuals. Currently, the best practice approach to assess the risk of venous thromboembolism (VTE) in patients within a rehabilitation hospital is unknown. We examined how well the Caprini risk assessment (CRA) score predicts VTE events (deep vein thrombosis (DVT), pulmonary embolism (PE)) within an inpatient rehabilitation hospital. Between January 2015 and October 2020, VTE events, the CRA Score, and risk factors were collected from a chart review conducted at Mary Free Bed Rehabilitation Hospital (MFB) among 3,091 patients. Results from the unadjusted logistic regression model …

Occupation-Based Learning Modules In Preparation For Parole: A Program Evaluation, Alisha Cheyne, Gabrielle Martino, Elizabeth Vander Wall, Natalie Wallace

Community Based

A qualitative research study was conducted that examined occupational therapy students’ fieldwork rotation at Muskegon Correctional Facility, where they implemented a 15-week pre-parole program. One focus group with three participants was conducted. Transcription, coding, and theming followed, providing five themes; restriction, OT perceptions, learning styles, future needs, and relationships. Results showed areas of needs within this population, ways occupational therapy can address this need, and general improvements that can be made to pre-release programs.

A Collaborative Approach To Incentivizing Healthy Food Choices Among Uncontrolled Diabetic Patients At A Local Federally Qualified Health Center To Improve Health Outcomes, Briauna J. Taylor

Doctoral Projects

Background: The rate of uncontrolled diabetes among patients at a local Federally Qualified Health Center (FQHC) is higher than the nation standard, a phenomenon believed to be caused by the effects of social determinants of health (SDOH). SDOH, specifically food insecurity, play a significant role in health outcomes of diabetic patients. Increasing access to healthy foods, thereby reducing food insecurity, has the potential to improve glycemic control and reduce diet related chronic disease.

Objectives: The project aims to determine if partnership with a membership based incentivized grocery store has the potential to positively impact health outcomes among vulnerable patients with …

A Policy Analysis Of Adult Lead Exposure Screening In Michigan, Omoyemi A. Idowu

Doctoral Projects

A growing body of scientific literature suggests that even at low levels, lead is an important, but often overlooked risk factor for cardiovascular disease mortality in adults. Through an initial literature review and organizational assessment, the DNP student was able to identify a potential gap between current research and policy guidelines related to adult lead exposure screening in the state of Michigan. The purpose of this policy analysis project was to examine current literature and policy guidelines related to lead exposure screening in the adult population in order to identify and analyze a potential gap that may be amenable to …

Exploring Neighborhood Level Variation In Incidence And Secondary Transmission Of Seasonal Influenza, Melissa Freeland

Masters Theses

Influenza epidemics in the United States, are major causes of morbidity and mortality, and cause serious economic disruption on an annual basis. Evidence has begun to accumulate linking neighborhood-level socioeconomic disadvantage to higher rates of hospitalization and mortality related to influenza (Cordoba & Aiello, 2016; Jung, Lin, & Viswanath, 2013). Some studies suggest that this may be due to lower rates of vaccination, higher rates of comorbidities in socioeconomically disadvantaged communities (Cordoba & Aiello, 2016; Jung, Lin, & Viswanath, 2013; Ross & Mirowsky, 2001). However, few studies have evaluated the effects of neighborhood level socioeconomic disadvantage and structural features on …

Occupational Therapy In Prisons, Amber Carmean, Amanda Boman, Katie Kowalski, Joselyn Walsworth

Community Based

This study investigates the needs of incarcerated individuals upon reintegration into the community. In this article, we use thematic analysis to dissect two prison documentaries in order to best assess the needs of these individuals to inform occupational therapy intervention. Occupational therapy seeks to empower individuals while analyzing needs and how the individuals can be best supported. Our analysis shows that there are many needs that go unaddressed prior to community reintegration leading to a higher chance of recidivism recurring. Through better understanding the needs of individuals, occupational therapy can become better informed on how intervention can benefit this specific …

Advocacy-Related Occupations Among People With Disabilities: Assessing Program Outcomes Of An Advocacy Workshop, Audrey Tarbutton, Stefanie Austin, Rachel Bendewald, Hayley Monforte

Community Based

An emerging area of occupational therapy (OT) practice includes program development for persons with disabilities (PWD). These programs are designed to train PWD how to identify issues and advocate for inclusion and accessibility (Umeda et al., 2017). Among the available literature on community-based advocacy programs, results show positive social outcomes including increased self-advocacy knowledge and related behaviors (i.e. Kramer, 2015; Mishna et al., 2011). Regarding the present study, an advocacy training program titled “Community Organizing Advocacy Skills Training” (COAST) was developed using the Midwest Academy Training Manual for the Advocate. The purpose of this study was to pilot a tool …

Global Occupational Therapists’ Health And Wellness Interventions With Community-Dwelling Older Adults, Catherine Keegin, Lyndsey Lehman, Hannah Meier, Megan Weinberg

Older Adult

Rationale: The profession of occupational therapy (OT) has an opportunity to positively impact health and wellness for community-dwelling older adults with the approaching global increase of the aging population (He, Goodkind, & Kowal, 2016). Objective: The purpose of this study was to explore occupational therapists’ use of health promotion and wellness approaches to facilitate healthy aging with community-dwelling older adults in a global context. Results: Four qualitative themes were uncovered: perceptions of older adults, safety, the role of OT, and preventive versus reactive care. Participants with 10 or more years of experience addressed spirituality in practice more often than those …

Implementation Of Evidence-Based Chronic Non-Malignant Pain Management Protocol For Primary Care, Jenny E. Kipp

Doctoral Projects

Chronic pain is the most prevalent health condition in the United States and is the most common reason people seek healthcare (Chang, Daubresse, Kruszewski & Alexander, 2014). In 2012, health care providers wrote 259 million prescriptions for opioid pain medications despite little change in self-reported pain prevalence (Centers for Disease Control and Prevention (CDC) 2016; Chang et al., 2014). Initiatives to prevent the under treatment of pain have resulted in overreliance on opioids to treat pain. As a consequence of opioid centric prescribing, an opioid epidemic has evolved with devastating consequences such as dependence, addiction and overdose deaths related to …

Interprofessional Collaboration During Discharge Planning For A Large Midwestern Hospital, Sarah Shepler

Doctoral Projects

Introduction: Interprofessional collaboration (IPC) improves the quality of healthcare delivery. IPC enhances communication during discharge planning, through use of structured daily rounds to reduce readmissions, length of stay (LOS), cost, and mortality. A $240 billion reduction in cost could be achieved with IPC. The Joint Commission, Institute of Medicine, and World Health Organization emphasize use of IPC to reduce errors, improve patient outcomes, and refine transitions of care for patients.

Objectives: The goal of this project was to determine how IPC within structured daily rounds during discharge planning impacts patient LOS and staff satisfaction.

Methods: This quality improvement project was …

Increasing Screening And Education For Human Trafficking In The Obstetric Department, Chibwe Caroline Powell

Doctoral Projects

Background: Human Trafficking, is a human rights violation with global public health implications. HT is associated with multiple health problems. Healthcare providers working in obstetrics departments are in a unique position to interact with trafficked persons. Lack of specific HT screening tools, training and education have been identified as barriers to recognizing HT victims.

Objectives: The purpose of this quality improvement project was to increase victim identification and referrals by improving screening through implementation of an interdisciplinary screening tool into the EHR workflow and providing HT education.

Methods: This project examined the impact of implementing a HT screening tool and …

Factors Associated With Rapid Repeat Pregnancy Among Women In A Healthy Start Program In Kent County, Michigan, Sarah Jane Schmidt

Masters Theses

Strong Beginnings (SB) is a federal Healthy Start Program aiming to improve the health and well-being of black and Hispanic families by promoting racial equity and eliminating racial disparities in birth outcomes, including rapid repeat pregnancy (secondary pregnancy within 18 months of index birth). To better prevent the occurrence of rapid repeat pregnancy (RRP), this study explores individual, social, and environmental factors associated with RRP. De-identified data for this study included information from SB, the Maternal Infant Health Program, Medicaid claims, and birth certificates. The sample includes women enrolled in SB with an index birth between 2013 and 2015. Chi-square …

An Implementation Toolkit For Increasing Breastfeeding Sustainability, Regina Kirwin

Doctoral Projects

Introduction: African American women have the lowest rates of breastfeeding in the United States compared to other racial and ethnic groups (DHHS, 2016). Peer support increases breastfeeding rates (Shakya, 2017). An evidence-based implementation toolkit will provide key stakeholders the information and skill development needed to successfully implement and sustain peer support programs geared toward increasing breastfeeding rates for African American women in West Michigan. The purpose of this paper is to disseminate the quality improvement process used to develop an evidence-based toolkit guided by a secondary data analysis from research data collected in a previously implemented peer mentor program.

Objective: …

Evaluation Of Processes And Procedures For Care Of The Opioid Recipient Patient In The Primary Care Setting, Anne Sproat

Doctoral Projects

Introduction: Chronic non-cancer pain is far reaching, affecting over 100 million Americans (Zgierska et al., 2018). Opioids are commonly prescribed for chronic pain, with approximately 20% of patients presenting to primary care offices with symptoms of pain or pain-related diagnoses (Dowell, Haegerich, & Chou, 2016). As a result, opioid prescribing rates are increasing at a faster rate for primary care practice compared with other specialties (Dowell et al., 2016). Within the United States population, it is estimated that three percent to four percent of the adult population are prescribed long-term opioids for the treatment of chronic non-cancer pain (Dowell et …

Incidence, Clinical Manifestations And Risk Factors Of Acute Rheumatic Fever: A Systematic Review And Meta-Analysis Of The Global Perspective, Jessica Fritzler

Masters Theses

Acute Rheumatic Fever (ARF) is a system-wide disease in which chronic, wide spread inflammatory changes occur in response to a group A streptococcal (GAS) infection that most often affects children and adolescents and those from developing countries. The aim of this study is to calculate the global incidence of ARF and identify the frequencies of major and clinical manifestations and risk factors globally to provide a better indication of the burden of disease and additional information on the dispersion of manifestations and risk factors. A meta-analysis was conducted by pooling cross-sectional and cohort studies, and Morbidity and Mortality Weekly Reports …

Influence Of Socioeconomic Status On Event-Free Survival In Children Diagnosed With Acute Lymphoblastic Leukemia, Jordan L. Chester

Masters Theses

Acute lymphoblastic leukemia (ALL) is the most common type of cancer diagnosed in children. However, little is known about how socioeconomic status (SES) influences the outcomes of children diagnosed with ALL. The goal of the research study was to understand how SES impacted the outcomes of children diagnosed with ALL, with a particular interest in children living in West Michigan. Children ages 0-14 years who received treatment for ALL at Spectrum Health’s Helen DeVos Children’s Hospital’s Pediatric Hematology and Oncology program between the years 2002-2011 were considered for this study. Eligible participant’s zip codes and dates of relapse/death were obtained …

Assessing The Potential Benefits Of Recreational Therapy On Functioning Outcomes, Samantha R. Lamkin

Masters Theses

Background: The aim of recreational therapy, like all rehabilitation therapies, is to promote the functionality and well-being of a person with disability. However, unlike other forms of therapy, recreational therapy utilizes a unique approach to rehabilitation by incorporating meaningful daily life activities into the patient’s individualized rehabilitation plan. Gains in functionality can be quantified using a Likert scale measurement Functional Independence Measures (FIM®). Previously conducted research shows a positive association between recreational therapy services and functionality gains in specific populations of persons with disability with stroke, traumatic brain injury, and spinal cord injury being most heavily represented. Problem: Research gaps …

Midwives For Haiti: Process Evaluation, Denielle M. Riley

Masters Theses

The reduction of maternal mortality is a long-time international objective. One often underemphasized component of addressing complex and context-driven health problems, such as maternal mortality, is the importance of program evaluation. Program evaluation has been identified as particularly scarce among safe motherhood initiatives, which seek to reduce maternal deaths and improve the health outcomes of mothers (Freedman et al., 2007). Useful program evaluation starts with process evaluation. This study is a case study process evaluation of postpartum data collection, which utilizes interviews, observations, and document review. The purpose of this study was to evaluate, describe, and compare the intended and …

Effect Of Michigan State-Funded Child And Adolescent Health Center (Cahc) In Directing The Health And Wellness Of West Michigan's Oakridge School District, Amber M. Bytwerk

Masters Theses

School-based health centers are an integrated and proactive resource to promote health and wellness of students, as well as the surrounding community. Literature shows that the number of school-based health centers are steadily increasing across America, with few looking at their integration into the population. Within West Michigan, only two such clinics are operational. Applying data from the Michigan Profile for Healthy Youth (MiPHY) and primary data collected from school staff and administrators, an evaluation was conducted on the interconnectedness and behavioral effects of a community branching from the school-based health center. This project is based on review of: the …

Sexual Health Education Among The Intellectually And Developmentally Delayed Populations: An Examination Of Medical Providers Perspective, Sarah E. Nota

Masters Theses

Sexuality is a recognized human right as it influences mental, social and emotional wellbeing. Despite this, individuals with intellectual or developmentally delays (ID/DD) rarely receive the necessary sexual education. ID/DD persons are also at an increased risk for sexual abuse, further demonstrating the strong need for education. A natural setting in which to receive unbiased and informative sexual health information is through their medical provider. The purpose of this research was to examine current clinic standards, education, and perceptions of medical providers in regards to sexual education for ID/DD adolescents. Medical providers and students within West Michigan were surveyed with …

Sociodemographic Characteristics Of Heart Failure Associated Hospital Readmissions In Michigan Medicare Patients, Kelsey A. Peterson

Masters Theses

Repeated hospital admissions constitute a large proportion of healthcare expenses, but are incurred by a small minority of chronically ill patients. Rising healthcare expenditures and the link between readmissions and quality of care make readmission rates a high priority for clinicians as well as insurance payers. Though hospital readmissions have many components, one of the relationships which is still inconclusive is that between socioeconomic status and hospital readmission rates.

Investigating the conditions which have a substantial impact on the rate of hospital readmissions, heart failure stands out as it is the leading cause of death in the United States. This …

Perceived Stress And Health-Promoting Behaviors In Nursing Students Using Pender's Health Promotion Model, Gail E. Dunham

Masters Theses

The purpose of this descriptive, correlational study was to add support to the literature that there is a relationship between the perceived stress (Student Stress Inventory) that nursing students report and their practice of health-promoting behaviors (Health Promoting Lifestyle Inventory). A convenience sample of 36 first-year associate degree nursing students was obtained. The conceptual framework used was Pender's Health Promotion Model. No relationships were found between demographic variables and perceived stress. Results indicated that subjects reported they engaged in health-promoting behaviors more than sometimes and they perceived themselves overall as slightly stressed. A negative correlation between perceived stress and health-promoting …

Effectiveness Of An Interdisciplinary Chronic Low Back Pain Program Based On Return To Work Outcome, John R. Bromfield, Deborah A. Knowles, Stacie M. Schoenberg

Masters Theses

The purpose of this study was to determine the effectiveness of a Midwestern Hospital's Interdisciplinary Outpatient Chronic Low Back Pain program. Rate of return to work was selected as the outcome measure for effectiveness. For purposes of discussion, the percentage of patients who were compliant with home exercise, who were involved in a vocational rehabilitation program, and who consulted a physician since discharge were analyzed. There were 118 male and female subjects, average age of 43; who successfully completed the 8 week chronic low back pain program between 1992 and 1994. Subjects were then sent questionnaires at 1, 3, 6, …