Medicine and Health Sciences Commons^™

Implementation Plan For Emr And Beyond, Lori Katterhagen

Doctor of Nursing Practice (DNP) Projects

Change is never easy for anyone, but how we implement change can make the difference in how an innovation is accepted. Over the last two years, a small community hospital in California has introduced a new electronic medical record (EMR) to meet the requirements of meaningful use mandated by the Centers for Medicare and Medicaid (CMS) for all hospitals across the United States. EMRs are expected to improve quality in many areas, especially to improve outcomes, while safely reducing costs (U.S. Department of Health & Human Services, 2012). Adoption of EMR’s is not optional, if facilities want to avoid penalties …

Cost Of Illness Study Of Anxiety Disorders For The Ambulatory Adult Population Of The United States, Elaheh Shirneshan

Theses and Dissertations (ETD)

Background: Anxiety disorders are the most common psychiatric illness in the United States. However, economic burdens of this category of mental illnesses have not been well studied yet. The objective of this study was to estimate the societal cost of anxiety disorders for the ambulatory adult population of the U.S.

Data and Method: Data was collected from the 2009 and 2010 Medical Expenditure Panel Survey (MEPS), Bureau of Labor Statistics (BLS), and National Vital Statistics System (NVSS). Cost components included in the analyses were direct medical costs (i.e. cost for inpatient visits, outpatient visits, emergency room visits, office-based visits, prescription …

Dynamic Queue Management For Hospital Emergency Room Services, Kar Way Tan

Dissertations and Theses Collection (Open Access)

The emergency room (ER) – or emergency department (ED) – is often seen as a place with long waiting times and a lack of doctors to serve the patients. However, it is one of the most important departments in a hospital, and must efficiently serve patients with critical medical needs. In the existing literature, addressing the issue of long waiting times in an ED often takes the form of single-faceted queue-management strategies that are either from a demand perspective or from a supply perspective. From the demand perspective, there is work on queue design such as priority queues, or queue …

Emotional Intelligence And Community Healthcare Productivity, Christopher Jacob Fox

Dissertations

Economic crisis is threatening state budgets. The strain on state budgets effects pensions and the healthcare benefits to communities. Rising healthcare costs and lagging insurance reimbursement rates are forcing healthcare organizations to sustain programs with fewer financial resources. Research studies indicate that payment increases from Medicare and Medicaid will not keep pace with the historical trend in hospital cost inflation (Kaufman, 2011). Of the healthcare facilities affected by federal budget constraints are community mental healthcare centers. The strain on state budgets has taken its toll on community mental healthcare facilities in particular struggling under the healthcare reform initiatives (Simpson, 1995). …

Perceptions Of A Dedicated Education Unit In The Mississippi Delta, Jacquelyn Felecia Brownlow

Doctoral Projects

The highest health care disparities in the country plague the Mississippi Delta. A weakened economy, minimal access to healthcare and an outdated traditional clinical learning environment place enormous strains on nursing education in this area to provide more nurses. The office of Nursing Workforce reported a 14% to 16% nursing turnover in the Delta compared to the national average of 13.5%. As a result, the health care organization has encountered high nurse turnover, increased staffing shortages, and a decrease in nursing quality indicators. As an effort to improve clinical education and bridge gaps between education and practice, several schools in …

The Impacts Of Change In Governance On Faculty And Staff At Higher Education Institutions: A Case Study Of Ohsu, Dana L. Director

Dissertations and Theses

In the early 1990s, Oregon Health and Science University leadership examined the political and economic landscape and determined it needed a new operational model to survive and thrive. In 1995 OHSU separated from the state higher education system and became a public corporation, with goals of increased efficiency, customer-focus, ability to attract world-class researchers and physicians, and salaries commensurate with an urban academic health center.

This research examines the internal impacts when universities undergo significant change, using OHSU's governance change as a case study. Central is the question: what effect(s) did OHSU's decision to become a unique public corporation have …

The Advanced Practice Nurse And Patient-Centered Medical Home: Maintaining Patient Focus, Meeting The Institute For Healthcare Improvement Triple Aim Through The Electronic Health Record, Aileen Teresa Twomey

Seton Hall University DNP Final Projects

The Federal Government enacted the Heath Information Technology for Economic and Clinical Health Act (HITECH) in 2009, which incentivized providers to use electronic health records (EHR) for meaningful use (MU); the Patient-Centered Medical Home (PCMH) stems from the Act. Research by the National Council on Quality Assurance (NCQA) shows that primary care practices have a positive influence on the health of patients, families and communities. These positive influences are related to their ability to deliver first-contact access, and to develop long-term therapeutic relationships that focus on the person rather than the disease, improving patient health outcomes and reducing health care …

Patients' Perceptions Of Provider Communication, Provider Knowledge And Provider Competence And Associations With Potentially Inappropriate Medication Use Among Medicare Part D Beneficiaries, Engels Nnamdi Obi

Open Access Dissertations

The objectives for this study were to determine prevalence and incidence of potentially inappropriate medication (PIM) use among community-dwelling Medicare Part D beneficiaries, and to assess associations between patients' perceptions of provider communication, provider knowledge, and provider competence with PIM use. A retrospective observational analysis was conducted using data from the Medicare Current Beneficiary Survey. Individuals were included in the prevalence sample if they were aged 65 years or older in 2008, continuously enrolled in Medicare Part D from October 2007 through December 2008, and living in the community from October 2007 through December 2008. Individuals were included in the …

Evaluation Of An Educational Intervention On Perceptions Of A Patient Safety Culture Among Staff In Acute Care Nursing Units, Cynthia Ann Parkman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Patient safety has always been a central focus of nursing practice. Current research makes it increasingly clear that what occurs in the surrounding health care environment impacts patient safety. The protracted nursing shortage and nurse turnover may adversely affect patient outcomes and are exacerbated by an environment of disruptive behavior, conflict, and poor communication in the nursing workplace. The Joint Commission has identified these behaviors as key elements that jeopardize the "culture of safety" necessary to assure safe, quality patient outcomes. A culture of safety includes the attributes of teamwork, communication openness, collaboration, and a manager's positive focus on prevention …

Variables To Predict Risk Of Hospital Readmission, Julie I. Carroll

Muskie School Capstones and Dissertations

As the healthcare industry transitions toward accountable care and payment reform, creative approaches to healthcare is imperative. Poorly coordinated care and shorter hospital stays have resulted in higher rates of readmissions. This has large implications for hospitals and health systems.

Describing The Falls Prevention Program At An Acute Care Hospital In Ontario Using Leveson’S Systems Model, Mahboubeh Mehrjoo

Electronic Thesis and Dissertation Repository

Falls are the most frequent adverse event in acute care hospitals. Although a large number of studies have addressed the patients’ risk factors for falls and best practices in fall prevention, patients falls still remain a major problem. This study applied a systemic methodology (Causal Analysis based on STAMP (CAST)) to depict Ontario’s acute care hospital structure related to patient fall prevention. The system’s component behaviours and interactions were described and deficits and inappropriate control mechanisms among the system’s controllers were identified. As a result of the CAST analysis, the complexity of the health care system, lack of a consistent …

The Effect Of Electronic Medical Record Sophistication On U.S. Hospital Emergency Department Efficiency, Imran Chaudhri

Honors Theses

A key concern in emergency departments (EDs) is their overall efficiency, One proposed solution to making EDs more efficient is the use of electronic medical records (EMRs). This paper seeks to determine if varying levels of EMR sophistication have an effect on measures of emergency department efficiency. Furukawa (2011) found that EMR sophistication had varying effects on ED efficiency. Fully functional EMRs significantly improved ED efficiency in multiple measures, while basic EMR varied on its effects on efficiency. Since Furukawa’s results are somewhat inconclusive, this study aims to see if these effects are longstanding. I hypothesize that as EMR became …

Members In Mind: Outreach & Education Strategies For Co-Op Insurance Plans. Final Report, Elizabeth Rogers

Muskie School Capstones and Dissertations

As envisioned by the federal policymakers who designed the Patient Protection and Affordable Care Act of 2011 (ACA), and the state-based health leaders who are founding them, Consumer Oriented and Operated Plans (CO-OPs) are intended to be a different kind of insurer: non-profit partners in health and healthcare. While many Americans (including Mainers) should welcome this new model, CO-OPs face challenges in establishing brand recognition and capturing the hearts and minds of consumers. The purpose of this research project was to support CO-OPs, particularly Maine’s CO-OP, Maine Community Health Options (MCHO), in assessing and developing communications strategies that enable individuals …

Global-Health Diplomacy : The Social Determinants Perspective Of Health Approach And The Future Global Policy Agenda., Naseem Ansari

College of Arts & Sciences Senior Honors Theses

No abstract provided.

Evaluating Shared Governance For Nursing Excellence, Evette Michelle Wilson

UNLV Theses, Dissertations, Professional Papers, and Capstones

The national challenges of nursing shortages, decreased staffing levels, and increased patient acuities have contributed to nurse's increased workload and job dissatisfaction. Nurses have become frustrated with the professional practice environment. The inability to make decisions about issues that affect their nursing practice and the care provided to their patients results in nurses leaving the work environment in search of higher job satisfaction. Employers are becoming more creative in their strategies to improve the work environment and retain nurses within their organizations. Healthcare leaders have implemented management strategies such as shared governance models. These models focus on providing a satisfying …

Perceptions Of Hospital Patient Safety Culture In Department Of Veterans Affairs Station 593 Southern Nevada, Kimberly Falco

UNLV Theses, Dissertations, Professional Papers, and Capstones

Opportunities for error exist, adverse events occur, and challenges endure. However, patients will continue to experience preventable adverse events unless steps are taken. Efforts to improve patient safety are critical to today's healthcare environment. The Department of Veterans Affairs (VA) believes that the identification of adverse events allows for creation of system improvements to increase patient safety.

Implementing safety culture requires a proper assessment of existing barriers and potential challenges. Patient safety culture assessments start by evaluating the current patient care environment. This assists the organization in identifying barriers to patient safety and in working toward creating a culture of …

The Presence Of Methicillin Resistant Staphylococcus Aureus (Mrsa) On Environmental Surfaces In Healthcare Facilities Pre- And Post-Cleaning, Aaron Thomas Hunt

UNLV Theses, Dissertations, Professional Papers, and Capstones

The emergence of antibiotic resistant bacteria is a serious public health issue affecting millions of people. Methicillin-resistant Staphylococcus aureus(MRSA) is a leading cause of healthcare acquired infections today. Research has shown that patients infected or colonized with MRSA shed the bacteria into the environment, where the bacteria can survive for long periods of time and become potential sources of infection. Currently, infection prevention efforts focus on active surveillance, hand hygiene, personal protective equipment use and antimicrobial stewardship, with less attention given to environmental cleaning. Nevertheless, environmental cleaning is essential to remove infectious agents from environmental surfaces and prevent transmission. The …

Comparison Of Study/Article Characteristics And Methodological Quality Of International Nurse Workplace Violence Research Published Before And After The Joint Commission Sentinel Event Alert On Disruptive Behaviors, Terressa Margarette Stowell Love

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: The majority of new nurses experience workplace violence from other nurses. The purpose of this study was to compare study/research characteristics and methodological quality of international nurse workplace violence research published before and after the 2008 release of the U.S. The Joint Commission (TJC) sentinel event alert on disruptive behaviors.

Methods: Thirty-nine quantitative nurse workplace violence research articles published between 2001 and 2012 were assessed and divided into two groups: articles published (a) before the 2008 TJC sentinel event alert or the same year, i.e., 2001-2008 (BTJC) and (b) after the 2008 TJC sentinel event alert, i.e., 2009-2012 (ATJC). …

A Mathematical Model For Antibiotic Resistance In A Hospital Setting With A Varying Population, Edward H. Snyder

Electronic Theses and Dissertations

Antibiotic-resistant bacteria(ARB) is causing increased health risk and cost to society. Mathematical models have been developed to study the transmission of resistant bacteria and the efficacy of preventive measures to slow its spread within a hospital setting. The majority of these models have assumed a constant total hospital population with the admission and discharge rates being equal throughout the duration. But a typical hospital population varies from day to day and season to season. In this thesis, we apply variable admission and discharge daily rates to existing deterministic and stochastic models which examine the transmission of single and dual resistant …

The U.S. Healthcare System: The Political And Personal Perspective, Sofia Gabirelle Seckler

Honors Capstone Projects - All

A large proportion of American adults lack health insurance, due to job loss and a wide variety of other issues. With the passage of the Affordable Care Act (ACA), and the Supreme Court decision affirming its constitutional legality, the availability of healthcare is set to increase in the near future. This honors thesis addresses the fit, or lack of fit, between the ACA provisions and the needs of the currently uninsured. My study involved ten interviews with patients at a free clinic for the uninsured in Syracuse, NY, and an interview with the Commissioner of Health from Onondaga County. For …

Physician Satisfaction With Informed Consent Process In Psychiatric Research, Sushma Polavarapu

Master's Theses and Doctoral Dissertations

Informed consent process is crucial in any research. The consent is meaningful only when the subject is capable of using disclosed information in deciding whether to participate in a research study. Decision-making capacity might change in psychiatric patients during the informed consent process. Therefore, there may be some elements which are neglected during the informed consent process in psychiatric research. The purpose of this research study was to determine the perceptions of physicians about what elements of informed consent might be neglected in psychiatric research and what additional elements might be included that would improve the informed consent process for …

Health Care Crisis: Potential Solutions To The Perverse Reimbursement System And The Fragmented Care Delivery System, Britney Ryan

Senior Theses and Projects

The American health care system is in a serious crisis. We have very high health care expenditures, but receive very low quality health outcomes. It is time for America to address the problems of our health care system head on, starting with the fee-for-service reimbursement structure and the fragmented care delivery system. This paper provides a comparative analysis of the systems in place in France and Japan to draw conclusions about possible solutions for the United States. This paper also discusses successful health care institutions within America and why they work. Finally, the potential results of the Affordable Care Act …

Effects Of An Interprofessional Simulation Activity To Improve Students' Perceptions Of Other Healthcare Professions, Chase Raymond Poulsen

STEMPS Theses & Dissertations

Healthcare professionals have historically been educated and trained by members of their own profession within a curriculum that reinforces their individual discipline-specific strengths. This differentiation has contributed to students having little interaction with other professionals until after they have entered the workforce and consequently little formal education in collaboration or integration. The purpose of this mixed-method study was to evaluate the impact of an interprofessional (IP) collaborative activity on student's perceptions of the others discipline for the improvement in care of medical patients.

The sample population consisted of students from two programs, nursing (n=40) and respiratory therapy (n=33). Students were …

Urgent Aeromedical Evacuation Network Capacity Planning, Scott C. Finkbeiner

Theses and Dissertations

Aeromedical Evacuation (AE) has been steadily utilized during Operation Iraqi Freedom and Operation Enduring Freedom. AE is a global enterprise. The current structure of AE is facing changes as forces scale down from operations in Iraq and Afghanistan. AE will, however, continue to be important in its domestic use in the continental USA (CONUS). Current practice is to pull aircraft (e.g. C-17, C-130 or KC-135) from their normal operations to meet Urgent and Priority patient needs when local alternatives are infeasible. An alternative to the current system would be having a centralized "bed-down" location for AE operations that would house …

Pharmacovigilance: A Comparative Study About The Knowledge Of Adverse Drug Reaction (Adr) Reporting That Private Practitioners And Government Doctors Gained In A Random Locality In India, Shanthan B. Pingili

Master's Theses and Doctoral Dissertations

The present pilot study aims to compare the knowledge pertaining to ADR reporting systems that government doctors and private practitioners gained in a random, tier-II city in India, by conducting a questionnaire based survey. Their knowledge of ADR reporting, related guidelines and/or regulations, the frequency of ADRs they observe and diagnose, their opinion on mandatory reporting by doctors, type of ADRs they would generally report, and to whom ADRs should be reported are discussed besides evaluating the attributable reasons for underreporting, if any. A total of 47 (21.36%) responded to this random survey, of whom 27 (57.4%) were government doctors …

Rfid Technology Selection And Economic Justification For Healthcare Asset Tracking, Tyler Robert Peabody, Tali Freed

Master's Theses

Although Radio Frequency Identification (RFID) and Real-Time Location System (RTLS) technologies for inventory tracking have been growing in popularity, the healthcare industry has been reluctant to adopt these technologies. One of the primary reasons for this lack of enthusiasm has been the risk associated with electromagnetic interference between RFID/RTLS systems and medical equipment functionality. The other reason has been the substantial cost and complexity of implementing RFID/RTLS in healthcare organizations. In this study, we show that there are several ways to safely install RFID/RTLS systems to improve the inventory management processes of hospitals and clinics. We then analyze the inventory …

The Institutional Context That Supports Team-Based Care For Older Adults, Anna Foucek Tresidder

Dissertations and Theses

The aging population in the U.S. is dramatically increasing; it is predicted that not only will individuals live longer but also that they will live with multiple chronic diseases that could require high levels of medical and social resources. While the aging population increases, the number of health care providers choosing to specialize in caring for the elderly is decreasing just as dramatically. Teams are believed to be a possible response to more efficiently use the providers available, take advantage of alternative provider types, and integrate a range of health and social services to meet patient needs more effectively. Interdisciplinary …

Pharmaceutical Policy Process: Lessons From The Newly Independent States, Irina Ghazaryan

Muskie School Capstones and Dissertations

Although the pharmaceutical sector in Armenia is currently mainly established, some challenges still cause a big concern. Such facts as a lack of important policies on pharmaceuticals, an outdated legislation and a lack of regulation suggest that the pharmaceutical policy process in Armenia is not effective enough and its insufficient effectiveness is one of the most important barriers for successful implementation of pharmaceutical reforms in the country. The goal of this capstone was to analyze pharmaceutical policy process in Armenia and other Newly Independent States and to develop recommendations for Armenia. Data and information were obtained from publication searches and …

Decision Support For Reducing 30-Day Readmissions: General Medicine Patients In Community Hospitals, Ramez Labib Ayoub

Open Access Theses

Health expenditures in United States have experienced a gradual increase in spending with no indication of slowing down. Addressing this problem has been a major area of concern for policy makers, and as a result more consideration has been placed on decreasing health spending and increasing affordability. One major area recognized as being effective in decreasing these financial burdens has been inpatient thirty-day adult readmissions, currently costing $26 billion annually. Centers for Medicare & Medicaid Services (CMS) have determined readmissions to be an indicator of the quality and efficiency of patient care.

This research provides a prediction model for patients …

Weight Loss Surgery Maintenance And Psychosocial Development: A Narrative Perspective, Carrie J. L. Hickman

Walden Dissertations and Doctoral Studies

Bariatric surgery is not the panacea it was once thought to be for weight loss. Due to patient noncompliance issues, many weight loss surgery patients are relapsing and regaining the significant amounts of weight that bariatric surgery had initially helped them to lose. This failure is costly monetarily, psychologically, and medically to both the patient and to society. Using the narratives of 32 post-weight loss surgery patients, this narrative study explored: (a) whether Erikson's psychosocial stages of development occur after weight loss surgery, (b) whether successful patients (defined as those who are able to maintain their weight loss long term) …