Medicine and Health Sciences Commons^™

Barrier To Utilization Of Primary Healthcare Resources In Children Two Years Of Age And Under, Ruth A. Waibel

Health Services Research Dissertations

This is a retrospective longitudinal study of health service utilization using the Immunization Practice Data Set obtained from the Center for Pediatric Research, Norfolk, Virginia. Cluster sampling was used to identify a cohort of children (n = 271), aged 0 to 24 months, from the city of Norfolk, Virginia. A two-year abstraction of medical records was used to determine utilization practice patterns for three categories of health: well-baby, acute and chronic care. The purpose of this study was to identify socio-demographic, need, and health system factors associated with under-utilization of primary care services using Aday's model. The proportion of children …

A Longitudinal Study Examining The Stability Of Occupational Stressors Identified By Nursing Home Administrators, Gay Lynne Andrucci-Armstrong

Health Services Research Dissertations

As a result of the ever changing and expanding role of the nursing home administrator in conjunction with the stricter legislation governing nursing facilities over the past decade and the graying of America, a study specific to this population was warranted. The purpose of this study is to determine the relative change in the self-reported occupational stressors of nursing home administrators over a five year period (December 1994 to June 1999) secondary to the increased regulatory climate of the nursing home industry.

This study was carried out in three phases and included all practicing nursing home administrators in Virginia. Phase …

A Study Of The Factors That Impact Female Military Beneficiaries Obtaining Preventive Health Services, Cynthia Andrea Chargois

Health Services Research Dissertations

The purpose of this study was to determine what factors predict whether female military retirees or the female beneficiary of a military retiree, ages 40 to 64, will obtain preventive health services, specifically, Pap smears, mammograms, and clinical breast examinations. Based on the findings of the study, it is suggested that it may be important for the Department of Defense to broaden their scope of interest to include those areas that are most prominent in affecting female military retirees or the female beneficiary of a military retiree, particularly those 40 to 64, in obtaining preventive health services.

The study comprised …

A Health System Analysis Approach To Health Outcomes In Medicare Clients With Chronic Illnesses, Christine A. Elnitsky

Health Services Research Dissertations

Since 1863, outcomes measurement efforts have provided information to health care consumers, administrators, and policymakers in assessing concerns about access, quality and costs. With a growing population of older adults with chronic illnesses, cost-cutting strategies in health delivery systems, and federal endorsement of managed care systems, researchers have begun to evaluate the impact of different delivery system organizations on health. The current study combines two areas of health services research to provide the first published hierarchical analysis of the influence of delivery system factors, and a profile of population and community characteristics and utilization factors, on perceived health outcomes of …

Explanatory Power Of The Behavior Model Of Utilization For Pediatric Asthma Health Care In An Urban Managed Care Setting, Kathie Marie Sawyer Zimbro

Health Services Research Dissertations

The Behavior Model of Utilization played a key role in explaining health services use for pediatric members with asthma in one urban, regional managed care company. The critical role the asthma management program played in promoting the health and well-being of enrolled members was elucidated. Information gleaned from this empirical study can be used to encourage appropriate resource utilization, formulate pediatric asthma health policy, and deliver cost-effective, quality health care. More importantly, managed care company administrators and clinicians can demonstrate the value of their efforts by achieving measurable improvements in the health and well-being of children in the communities they …

The Pediatric Breathing Survey, Linda J. Galloway

Health Services Research Dissertations

To ensure culturally-sensitive assessments, the researcher designed a Pediatric Breathing Survey (PBS) to measure quality of life for African-American children. The purpose of this study was to test whether the PBS is a reliable and valid instrument. Comparisons of group differences on race, income and parent's level of education based on parent responses to the questionnaires were conducted. More specifically, differences in Health Related Quality of Life (HRQOL) between Caucasian and African-American children were examined. The researcher-designed instrument was compared to Juniper's Pediatric Asthma Quality of Life Questionnaire. The sample consisted of parents of 84 school-aged children diagnosed with asthma. …

Factors Associated With Asthma Readmissions In Children's Hospitals, Maria Acedo Kronenburg

Health Services Research Dissertations

Asthma is the most common chronic illness of childhood. Pediatric asthma hospitalization rates and costs of care have risen in recent years. Readmissions, an adverse outcome often used to monitor quality of care, may account for the increase in asthma hospitalization rates. This research examined selected hospital and patient risk factors related to asthma readmissions, using Donabedian's framework for structure, process, and outcomes to assess the quality of care for children with asthma. Outcome measures included readmission for asthma within one year of initial hospitalization, readmission within 30 days, and multiple readmissions within one year. Structure factors measured were insurance …

Factors Which Affect Post-Hospital Resource Use And Patient Health Outcomes Among Taiwanese Older Adults, Chouh-Jiaun Lin

Health Services Research Dissertations

The purpose of this study was to explore relationships among population characteristics, patient post-hospital resource use and patient health outcomes in terms of the Andersen health behavioral model. An additional purpose of this study was to examine a discharge planning screening instrument used in a large urban hospital in Taiwan to determine if it predicts resource use and patient outcomes. A longitudinal research design was adopted for this study. Data were collected from the general medicine departments of an 800-bed university teaching hospital. Out of 109 patients who were interviewed, 78 participants qualified (participation rate = 71.6%).

The majority of …

A Study Of The Knowledge And Attitudes Of Physicians Toward Victims Of Spouse Abuse, Ramani N. Garimella

Health Services Research Dissertations

The purpose of this study is to measure the knowledge and attitudes of physicians toward victims of spouse abuse. All 150 practitioners in the specialities of emergency medicine, family medicine, obstetrics-gynecology and psychiatry, in a large area general hospital are included in the sampling frame; 76 responded (RR = 51%). Knowledge and attitudes were measured using the Physician Survey on Spouse Abuse. Rosenberg's Tripartite Model of Attitude formed the theoretical basis for this study. Participants were 72% male, 90% white, 88% currently married, with a mean age of 44 years (SD = 7.99). Mean years in practice was 14.61 (SD …

Classification Of Participants Into Two Health Resource Utilization Groups By The Health Enrollment Assessment Review (Hear) Survey, Jody W. Donehoo

Health Services Research Dissertations

The study examined the ability of the Health Enrollment Assessment Review (HEAR) survey instrument to classify participants into one of two groups according to utilization of health resources anticipated in the following year. Developed by the U.S. Air Force, the HEAR survey is used worldwide by the Department of Defense for enrollees in TRICARE Prime, the military's adaptation of the HMO model of managed care. Individual HEAR reports are prepared for survey participants and their primary care providers in TRICARE Prime. Although it is currently administered worldwide to a majority of the 8.4 million health care beneficiaries of the Department …

Measurement Of Hospital Performance: Environmental And Organizational Factors Associated With Cost, Debra Kay Dierksmeier Anderson

Health Services Research Dissertations

As U.S. health care expenditures top the $1 trillion mark, there is increased interest in measuring the performance of health care providers. For bottom line oriented payors such as government and business, the focus is on measuring cost. As hospitals account for over one-third of health care expenses, hospital cost per admission is a common measure of performance.

Many environmental and organizational factors come into play in determining hospital cost per admission. This research examines several of these factors, using Raymond Zammuto's model of organizational effectiveness assessment. Using Zammuto's framework, this research looks at the relationship of social, physical, and …

A Comparison Of Factors Associated With Referrals, Service Placements And Length Of Service For African-American And Caucasian Youth With Serious Emotional And Behavioral Disturbances Served Through The Comprehensive Services Act In Virginia, Vanessa B. Sheppard

Health Services Research Dissertations

Despite the efficacy of community-based treatment, many emotionally and behaviorally disturbed youth still receive restrictive service placements. This is quite problematic for minority youth since studies have reported they are more at risk of out-of-home placements. The purpose of this study was to examine differences in referrals, out-of-home placements, residential placements and length of service for African-American and Caucasian youth. This historical cohort study was a secondary analysis of data from the Comprehensive Services Act in Virginia. The sample consisted of 2,883 youth ages 10-19. Multiple logistic regression was employed for data with dichotomous outcomes in order to adjust for …

The Effects Of A Maternal Childhood Lead-Poisoning Education Program On Knowledge, Health Beliefs, And Compliance, Sylvia Elaine Johnson

Health Services Research Dissertations

The purpose of this study is to determine the effects of two educational intervention methods on participant's knowledge, health beliefs and prevention behavior as they relate to childhood lead poisoning. The two educational methods being used in the study are personal instruction by the investigator and a 12-minute video developed by the American Academy of Pediatrics on childhood lead poisoning. Information contained in both educational tools is identical. In particular, this study seeks to determine if one educational intervention was more effective than the other. The final purpose of the study is to test the Health Belief Model by examining …

Coping Processes Used By Mothers Of Triplets, Susan Mullen Kaplan

Health Services Research Dissertations

The purpose of the study was to identify and describe the coping processes used by mothers of triplets. Using a descriptive design, interpersonal comparisons of 92 mothers of triplets attending a national meeting of families of higher order multiples were made. Variables, in addition to sociodemographic characteristics, included coping processes, levels of depression, perceived availability of social support, and current stress levels. Coping processes were measured using the Ways of Coping Questionnaire (Folkman & Lazarus, 1988), derived from their cognitive-phenomenological theory of stress and coping. Level of depression was measured using the Zung Self-rating Depression Scale (Zung, 1965). Perceived availability …

The Association Between Perceived Family Support And Psychological Well-Being In Infertile Couples, Linda Marquardt Mintle

Health Services Research Dissertations

A correlational research design utilizing a cross-sectional survey methodology was used to investigate the association between perceived family support and psychological well-being in infertile couples. Family stress theory and the construct of boundary ambiguity were conceptual frameworks applied to the developmental family life cycle. Respondents were 35 married infertile couples with primary infertility recruited from a private For-profit infertility clinic located in Virginia Beach, Virginia. Responses on the Moos and Moos (1984) Family Environment Scale and from the SCL-90-R developed by Derogatis (1977) measured perceived family support and psychological distress respectively. Major findings indicated that infertile couples rated their families …

The Influence Of National Culture On Work-Related Values And Job Satisfaction Between American And Filipino Registered Nurses, Karin Polifko-Harris

Health Services Research Dissertations

This ex post facto study explored the effects of national culture on work-related values and job satisfaction between American and Filipino registered nurses. Three questionnaires were used: Hofstede's Values Survey Module 94, the Survey of Work Values and the Minnesota Satisfaction Questionnaire. The all-female sample comprised 88 American and 56 Filipino registered nurses employed at an urban acute care facility in South Hampton Roads, Virginia.

A major finding of the study is the direction and intensity of the country scores in the Values Survey Module 94, especially in the Filipinos' scores. The masculinity value was reported as strongly feminine for …

The Effects Of Partial Hospitalization On Acute Psychiatric Hospital Readmission Days, William E. Turner Iii

Health Services Research Dissertations

Using the theoretical construct of recidivism and pathway and gatekeeper variables associated with it, this study compared the effects of a combination of partial and acute psychiatric hospitalization and only acute psychiatric hospitalization on the total number of acute hospital readmission days over a 12 month period using a causal-comparative design. Two hundred and forty cases were randomly selected from an existing database which contained information on a population of urban insurance beneficiaries who had accessed psychiatric care during a two year period. The group accessing a combination of acute care and partial care had significantly higher readmission days. Age, …

An Assessment Of The Descriptors And Determinants Of Academic Success Of Selected Allied Health Students In Virginia, Theodora Christine Gordon

Health Services Research Dissertations

This study assessed the relationship of cognitive and noncognitive variables in relationship to academic success of students from selected allied health majors: respiratory therapist (RTT), radiologic technology (RT), surgical technology (ST) and medical records technician (MRT) from hospital based and community college programs in Virginia. Student academic success was defined as academic (classroom) grade point average, clinical grade point average, cumulative grade point average and passing status. The cognitive variables were preclinical (high school) grade point average, academic, clinical and cumulative grade point averages. The noncognitive variables were character type, temperament type/preference for learning style, and the Sedlacek Noncognitive Questionnaire …

A Comparison Of The Utilization Of Health Services In The Presence Or Absence Of Prescriptive Drug Insurance In A Managed Care Environment, Martha Groblewski

Health Services Research Dissertations

This study tested if the availability of third party payment for prescriptive drugs as part of employer sponsored health insurance was associated with a change in the utilization of four types of health services in an independent practice association (IPA). The study employed the individual determinants component of the Andersen-Newman theoretical framework for health services utilization. Groups of employees in companies that offered health insurance identical in all ways except for the presence or absence of the prescriptive rider were included in the study which resulted in a population of 122 companies (89 with prescriptive rider insurance and 33 without …

Effect Of Nutrition Intervention On The Outcomes Of Pregnancy: A Rural Urban Comparison, Ranjita Misra

Health Services Research Dissertations

The present study examines the effect of nutritional intervention on two outcomes of pregnancy: birth weight of the baby and gestational age. The study further examines the difference in nutritional intervention in rural and urban areas. The research method used is ex-post facto design. Data for the study is extracted from the health records and tracking sheets of women participating in the Nutrition Intervention Project in Virginia Department of Health. Path analysis and effects analysis are used to analyze the causal and direct effect of the independent variables and each of the outcome variables. A model has been developed grounded …

Psychosocial Determinants Of Age-Appropriate Immunizations Of Infants In Norfolk, Virginia, Hoda Youssef Atta

Health Services Research Dissertations

This study represents an investigation of psychosocial factors affecting age-appropriate immunizations of infants in Norfolk, Virginia. A household survey was conducted in Norfolk, Virginia, from 4/93-8/93, to assess immunization coverage of children 12-30 months of age. This survey included a total of 389 children in the target age range. A subset of 201 mothers were randomly selected and reinterviewed to assess their knowledge and attitudes and the relationships of these factors to age-appropriate immunizations at 12 months of age. Sixty-two percent of children were not age-appropriately immunized at 12 months of age. Almost all mothers (99%) considered vaccines to be …

An Assessment Of Personal Characteristics, Job Satisfaction And Semantic Descriptors Of Virginia Acute And Tertiary Care Hospitals' Chief Executive Officers, Justin C. Matus

Health Services Research Dissertations

The purpose of the study was to identify the determinants of job satisfaction of Virginia Hospital CEO's and to identify those descriptors that best characterize the role of the hospital CEO as defined by the CEO's themselves. The study sample consisted of all hospital CEO's in Virginia as listed by the Virginia Hospital Association. The study employed a four part survey instrument that investigated four major areas: (1) personal and hospital demographics; (2) self rated performance; (3) a semantic scale measuring the concept of Hospital CEO; and (4) The Minnesota Satisfaction Questionnaire. A survey was mailed to 119 CEO's. The …

An Assessment Of Management Practices Among Virginia Acute Care Hospitals, Ogbonnia Godfrey Ochonma

Health Services Research Dissertations

The 1990's will see dramatic changes for the health care industry. At no previous time have both public and private health care institutions faced a more turbulent, confusing and threatening environment. Changes in health care arena will come from Federal, State and local governments; international as well as domestic economic and market forces; demographic shifts and life style changes; and structural evolution of the health care industry including mergers, integrations and competition.

The health care industry faces increasing financial pressures due to fundamentally new forces that affect the very viability of many health care organizations. Such pressures include prospective payment, …

Immunologic Evaluation Of Ectopic Gestation, Tawfig Amin Nasser

Health Services Research Dissertations

Ectopic gestation is an error in the implantation site of the blastocyst. Extrauterine implantation presents a unique environment since the protective features of the uterus are absent. This study is an investigation into the immunoregulatory differences that may develop as a result of a change in the feto-maternal junction.

The effects of female plasma on one-way mixed lymphocyte cultures and mitogen-stimulated cultures, anti-paternal lymphocytotoxicity, and lymphocyte phenotypes were determined on normal, ectopic and non-pregnant females. The results indicated that pregnant female plasma enhanced the response of autologous lymphocytes to spouse and male control lymphocytes. Enhancement was not seen in the …

The Effect Of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Education Program On Knowledge, Attitudes And Sexual Behavior Of Selected College Students, Arlene Jaine Jackson Montgomery

Health Services Research Dissertations

The problem studied in this investigation was whether a behaviorally focused Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) Program affects the knowledge, sexual attitudes and sexual behavior of college students.

Three hundred and six first-and third-year college students were included in the study from one university located in Southeastern Virginia. The sample was predominately female, African-American and mainly between the ages of 16-22 years of age.

Freshmen students were presently enrolled in the institution's HIV/AIDS education program, which was a part of a required course. The class sessions consisted of a pretest prior to student's completing the reading assignment …

A Multiple Case Study Of Selected Individuals Who Facilitate The Successful Adoption Of Environmental Public Policy, John H. Austin

Health Services Research Dissertations

The purpose of this study was to determine the personal and professional characteristics of successful individuals who have had a positive influence on the development of public policy concerning the environment. Additionally, which characteristics are most likely to enhance success and determine which of these characteristics might contribute to efforts toward developing public environmental policy in the future were investigated. The purpose was accomplished through the design and implementation of a multiple case study utilizing a qualitative research methodology. The sample for this study included six public servants who were identified as actively involved in affecting the development of public …

A Comparison Of The Effectiveness Of Two Types Of Clinical Instruction On Selected Variables Among Urban Baccalaureate Nursing Students, Janice Parks Hylton

Health Services Research Dissertations

The purpose of this study was to provide baseline data regarding student perceptions of bureaucratic, professional, and service values and of instructors/preceptors as role models for each model of clinical supervision, traditional versus preceptored. A non-probability, convenience sample included 113 baccalaureate nursing students from two accredited programs in an urban area. Two instruments were used to identify student perceptions of bureaucratic, professional, and service values and of instructors/preceptors as role models. The results of the questionnaires revealed no significant differences between the students' perceptions of bureaucratic and service values and perceptions of instructors/preceptors as role models, Students' perceptions of professional …

The Relationship Of Locus-Of-Control And Altruism To Prehospital Emergency Medical Care Providers Universal Precaution Practices, Joanne L. Wakeham

Health Services Research Dissertations

The purpose of this study was to determine the relationship between locus of control, altruism, occupational risk, and personal factors to the frequency of universal precautions practices of prehospital emergency medical care providers. The effects of OSHA's Occupational Exposure to Bloodborne Pathogens; Final Rule on reducing prehospital emergency medical care providers occupational exposure to bloodborne pathogens were also examined. Prehospital emergency medical care providers from municipal and private EMS agencies in the Tidewater Emergency Medical Services region participated in this study. Prehospital emergency medical care providers self-reported perceptions of locus of control, altruism, occupational risk, and universal precautions practices were …

A Comparison Of Two Theories Of Resistance To Innovation In Medical Record Administration Baccalaureate Degree Programs, Joyce Brown-Harvey

Health Services Research Dissertations

Resistance to innovation is a major obstacle to the successful implementation of planned change in colleges and universities. The purpose of this study was to compare two explanations of resistance to innovation to determine which one best explains the variance in receptivity and proposed innovations among faculty members in medical record administration programs. One explanation holds that organizational members' receptivity to change is a function of their personalities. The second explanation holds that members respond to specific innovations and that they do so in terms of whether the innovation would increase or reduce their present status.

The faculty of baccalaureate …