Medicine and Health Sciences Commons^™

When It Hits The Fan, Does Network Management Matter? : A Study On Policy Shocks And The Production And Delivery Of Public Goods And Services By Service Delivery Networks, Jennie Rhodes Law

Legacy Theses & Dissertations (2009 - 2024)

EXECUTIVE SUMMARYFor decades public administration and management scholars have conceptualized organizational networks as solutions to failures of markets and hierarchies (see, for example, Goldsmith and Eggers 2005; Osborne and Gaebler 1992). Relationships among organizations or actors within a network are framed positively as channels through which human, financial, and knowledge resources flow to address complex or “wicked” social problems (see, for example, Rittel and Weber, 1973). However, recent scholarship has sought to pull the curtain back and identify the pitfalls of networked arrangements for public service delivery (see, for example, O’Toole & Meier, 2006; O’Toole & Meier, 2004). Such studies …

Using Machine Learning To Predict Super-Utilizers Of Healthcare Services, Kevin Paul Buchan Jr.

Legacy Theses & Dissertations (2009 - 2024)

In this dissertation, I aim to forecast high utilizers of emergency care and inpatient Medicare services (i.e., healthcare visits). Through a literature review, I demonstrate that accurate and reliable prediction of these future high utilizers will not only reduce healthcare costs but will also improve the overall quality of healthcare for patients. By identifying this population at risk before manifestation, I propose that there is still time to reverse undesirable healthcare trajectories (i.e., individuals whose clinical risk increases an excessive healthcare and treatment burden) through timely attention and proper care coordination. My dissertation culminates in the delivery of state-of-the-art predictive …

Presence And Characteristics Of Axial Skeleton Fractures Experienced By Cheerleaders And Gymnasts From 2010-2019, Jordan Trimm

Honors Theses

Context: Cheerleading and gymnastics are sports containing dangerous skills that place athletes at risk of severe injuries, such as axial skeleton fractures. In addition, cheerleaders and gymnasts frequently have less access to on-site healthcare, such as athletic training services, which requires increased utilization of emergency departments. Objective: To compare national estimates of axial skeleton fractures in cheerleading and gymnastics by injury characteristics over a 10-year period. Design: Descriptive Epidemiological. Setting: United States Emergency Department via the National Electronic Injury Surveillance System Database. Participants: Cheerleaders and gymnasts presenting to a sample of US hospitals. Interventions: Independent variables included body region fractured. …

The Future Of American Primary Care, Julianne M. Johnsonwall

Classical Conversations

Historically, primary care has been delivered by physicians in private practices. However, pre-medical and medical students considering primary care should consider that market trends and physician preferences are changing the delivery methods of primary care. This thesis aims to predict the future delivery methods of primary care in America. By analyzing current studies, articles, and physician polls, it asserts that private practices are not a financially viable practice model and that medical systems will dominate primary care. Firstly, it identifies low insurance reimbursement rates, increasing quality documentation requirements, and an unhealthy work-life balance as the primary obstacles to private practice …

Resources To Access Health Care For Low Socioeconomic Status Youth Athletes, Stephanie Walsh

Electronic Theses and Dissertations

Background: Approximately 60 million youth participate in organized sports, with 13.5 million receiving care for sports related injuries each year. Most youth sports organizations do not have readily accessible health care resources; relying on parents and guardians to manage injuries. However, a majority of parents and guardians are untrained in appropriate management of injuries, therefore there is a need for understanding the availability of health care resources within the community. Resources necessary to access health care include health services, health insurance, transportation, and communication. Barriers to these resources may affect lower socioeconomic status family’s accessibility to care. Purpose: Investigate the …

The Effect Of Paid Sick Leave On Physician Office-Based Visits, Korvin Vicente

Theses and Dissertations

This paper uses a balanced sample of workers from cross-sections of the National Health Interview Survey to estimate the causal effects of paid sick leave on the medical care seeking behavior of individuals, as measured by physician office-based visits.

Socioeconomic Determinants Of Health Disparities By Race And Ethnicity: The Mediating Role Of Social, Psychological And Behavioral Factors, Amanuel Zimam Melekin

Dissertations and Theses

Socioeconomic status (SES) is inversely related to health status. Disparities in health status among races and ethnic groups are partly attributable to differences in SES, but the indirect pathways by which SES may influence health status are not widely studied.

Using the Health and Retirement Study (HRS) data, this dissertation examined the pathways by which SES, via social, psychological, and behavioral factors predicted physical impairment and overnight hospitalization, and asked whether these indirect relationships differed by race/ethnicity. The HRS is a nationally representative multistage area probability sample administered biennially to respondents over the age of 51 and their spouses. Data …

Effects Of Therapeutic Music On Pain In Spinal Surgery Recovery, Michael Poulsen

Evidence-Based Practice Project Reports

Pain is one of the most common experienced symptoms reported by more than 80% of postoperative patients. Approximately 77-98% of postoperative patients report pain following their procedure with 40- 80% having moderate to severe pain. Pain is shown to elevate stress levels manifesting in increased heart rates, blood pressures, and oxygen demand. Inadequate pain control can develop into surgical complications causing surgical failure, blood clots, pneumonia, and chronic pain. Complimentary and alternative medicine such as music can be used in combination with opioid medication help improve pain control leading to successful surgical outcomes. The purpose of this evidence-based practice project …

Pharmacy Interventions In Transitions Of Care From Hospital Discharge (Pitch) Pilot Program For Medicare Part D Patients At High-Risk For Readmission, Muirisha Nicole Lavender

Doctor of Pharmacy Honors Theses

Background: Pharmacist implemented transitions-of-care (TOC) programs focus on identifying adherence issues, developing care plans, investigating medication-related insurance problems, and instilling the value of medication treatment in patients frequently admitted to hospitals for manageable, chronic disease-states.

Study objective: The primary objective of this study is to determine the impact of pharmacist interventions during a TOC pilot on hospital readmission rates for patients with acute myocardial infarction (AMI), heart failure (HF), chronic obstructive pulmonary disease (COPD), or pneumonia.

Methods: This study is a retrospective review of patients receiving high intensity care to prevent readmission, including pharmacy intervention during a three-month pilot period …

Hodgkin's Lymphoma Survivors' Intentions To Follow Survivorship Care Plans, Kortni Evans

Master's Theses and Doctoral Dissertations

The purpose of this study was to determine the attitudes, perceived subjective norms, and perceived behavioral control that Hodgkin's Lymphoma (HL) survivors had towards survivorship care plans (SCPs) and how those factors impact their intentions to follow a care plan. Participants were HL survivors who had completed treatment. An online self-reporting questionnaire was used to assess demographics and questions related to HL survivor's attitudes, behavioral intention, perceived subjective norms, and perceived behavioral control. Frequency analysis and correlations were used to describe the participants and their attitudes, perceived subjective norms, and behavioral control in relation to participants' intentions to follow a …

Implementation Of An Advance Directive Protocol In A Primary Care Setting, Gloria Dillman

Evidence-Based Practice Project Reports

Despite the passage of the Patient Self-Determination Act in 1992, only 15% of the United States population has completed an advance directive (AD). This statistic will be exaggerated with the future growth of older adults in the year 2030, at which time this portion of the population is expected to double to 72.1 million people. Without an AD, patients lose their autonomy and may be subjected to costly, life prolonging treatments that they would never choose for themselves. The unnecessary costs and unwanted treatment are preventable with an AD, and primary care providers are in a prime position to initiate …

Essays On Income Inequality, Minority Health And Healthcare Spending, Rui Cheng

Legacy Theses & Dissertations (2009 - 2024)

This set of essays addresses issues related to income inequality, public healthcare supply and population health. Income inequality has been found to affect health in a number of studies. Using data from Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey of adults in the United States, the first chapter of my dissertation studies the effect of state level and county level income inequality on health status and the pathway via public health spending. By using multiple imputation method applied to BRFSS income data, it derives synthetic Gini coefficient at state level and county level for each year from 2000 …

Socio-Economic And Cultural Determinants Of Health Care Services Utilization In Ghana, Vickita Akosua Antwiwaa Harvey

UNLV Theses, Dissertations, Professional Papers, and Capstones

The study examines the relationship between socio-economic and cultural determinants of health care service utilization in Ghana using Ghana Demographic and Health Survey (GDHS) 2008 data collected by Ghana Statistical Service (GSS) in which a two-stage sample design was used. The first stage involved a systematic sampling, with probability proportional to size, of 412 clusters using the 2000 Ghana Population and Housing Census as the sampling frame. At the second stage, systematic samples of 30 households from each cluster were selected, making a total of 12,360 sampled households. According to the GSS, data were not collected in some of the …

A Qualitative Study Of The Perceived Health Care Needs Of Undocumented Latino Day Laborers Living In Las Vegas, Nevada, Siboney Zelaya

UNLV Theses, Dissertations, Professional Papers, and Capstones

Undocumented (unauthorized, illegal) immigrants seek employment on the street corners near home improvement stores offering their services and selling their labor to the employers who arrive in their cars or trucks to pick them up for a few hours of hard work. The number of undocumented immigrants in the United States continues to increase. By percentage of overall population, Nevada has one of the largest shares of undocumented immigrants in the United States, and the bulk of that percentage is Latino.

The purpose of this phenomenological qualitative research study is to gain knowledge about undocumented Latino day laborers' perceived health …

Health, Health Perceptions, Healthcare Practices, And Influencing Factors Among Korean Immigrants Living In Rural Texas, Mary Beth Winton

Nursing Theses and Dissertations

The population of Asian immigrants in the United States increased 43.3% from 2000 to 2010. During the same period, Texas experienced an increase of Korean immigrants of over 47%. Despite the increase of Korean immigrants, only a minimal number of studies explored health and healthcare needs specific to this population. Furthermore, none of the studies addressed Korean immigrants living in rural Texas. Hence, an ethnographic study was conducted to examine the health and healthcare among Korean immigrants living in rural Texas. Face-to-face interviews were conducted and transcribed. Five major themes emerged which included acculturation, health and health perceptions, healthcare, relaxation …

Between The Lines: Somali Women And Medical Interpretation Experiences, Amin Sheikh

Muskie School Capstones and Dissertations

Many studies have investigated the health care experiences of Somali women. However, there is little research that looks at Somali women’s experiences with language barriers and their language preferences. In my capstone, I explore language barriers in the health care system from the perspective of non-English speaking immigrant Somali women with children living in the Lewiston-Auburn area.

Skin Cancer - Education And Prevention: The Role Of Social Marketing, Tim Crowley

Theses

Skin cancer is the most common cancer in Ireland and worldwide. Skin cancer rates have been steadily rising in recent times. The high use of sunbeds in both Ireland and the UK is quite worrisome. Skin cancer is caused by over exposure to UV rays or through the use of sunbeds and as a result it is actually a highly preventable disease. It is estimated that 90-95% of all skin cancers are preventable. This thesis focuses on the use of social marketing in order to educate people on the dangers of skin cancer with the eventual aim of making recommendations …

The Immigrant Hispanic Population: Perceptions About Cultural Competency In The Healthcare Setting, Cheryl Swanson

Nursing Theses and Dissertations

Cultural competence has been reported as a means of impacting health disparities in minority populations. The Hispanic population has grown exponentially in the United States accounting for over fifty million people on the latest census report. Continued immigration by persons of Hispanic origin occurs for many reasons offering a challenge to nurses and other healthcare workers to provide culturally competent care. The majority of research on cultural competence and the immigrant Hispanic patient has been conducted from the viewpoint of the healthcare provider. Additionally, most research that has taken into account the perspective of the immigrant Hispanic patient focuses on …

The Lived Experiences Of Intended Parents During Surrogate Pregnancy And Transition To Parenthood In Relation To The United States Healthcare System., Kim L. Armour

Nursing Theses and Dissertations

Problem: A state of the science surrogate pregnancy manuscript revealed a dearth of research regarding intended parents of surrogate pregnancy. Not one U.S. study could be located. Intended parents are overlooked by the healthcare system during pregnancy due to the fact that that their surrogate is receiving obstetric care. Research was proposed and completed. Purpose: The aim of the research was to fill a gap by improving our understanding of intended parents lived experience during surrogate pregnancy and transition to parenthood with relation to the United States healthcare system Design: A study of phenomenology using van Manen's methodology Participants: Eleven …

Health Care Priorities And The Effects Of Double Rationing, Christine Marie Muller

Legacy Theses & Dissertations (2009 - 2024)

The purpose of my research is to investigate "double rationing" which entails rationing at two levels of the health care system. At one level, policy makers prioritize treatments that will be covered under a publicly financed health care system. At a lower level, doctors or other health care professionals prioritize patients in need of scarce medical treatments. Traditionally, research focusing on health care rationing has treated these two activities as if they were separate and unrelated events. This research considers the effects of lower level prioritization activities on the ability of policy-makers to achieve their own (and arguably, societal) health …

An Assessment Of Medical Care Provided By Nevada's High School Athletic Programs, Brooke Allen-Burnstein

UNLV Theses, Dissertations, Professional Papers, and Capstones

Even with preventative measures, injuries are inherent in sports. Almquist (2001) indicated that almost 60 percent of athletic injuries occur during practices. The American Medical Association recommends that all high schools establish an athletic medical team, but the National Athletic Trainers' Association (NATA) has estimated that only 42% of all high schools in the United States have access to a certified athletic trainer. In 2002, a NATA inter-association task force created the Appropriate Medical Care for Secondary School-Aged Athletes (AMCSSAA) Consensus Statement, which outlined the minimum standards for health care for adolescent athletes.

The purpose of this study was to …

Interventions To Improve The Management Of Medically Uninsured Adult Patients With Type 2 Diabetes Mellitus In Primary Care, Community-Based Settings, Lynn Miskovich

Evidence-Based Practice Project Reports

This project measured the effect of a clinical algorithm on the provision of care to medically uninsured adult patients with type 2 diabetes and a low socioeconomic status (SES). Primary providers often fail to implement established standards for diabetes care to their maximal benefit and do not achieve American Diabetes Association (ADA) treatment standards. Saydah, et al. (2004) reported that only 48% of patients with diabetes achieved the recommended HbA1c goal, and 33% reached blood pressure and LDL targets. Goals for all three clinical parameters were obtained by only 7% of patients. The Stetler Model of Evidence-based Practice (EBP) provided …

What Do You See In This Picture?: Bias And Reflexivity In Physician Narratives Of Disparities, Michelle Levine

Graduate Masters Theses

Disparities in healthcare stem from historical, social, institutional, and interpersonal factors--all of which can manifest at the level of the clinical encounter. A growing body of research has addressed implicit bias and, more specifically, the implicit bias involved in aversive racism as a mediator of disparate care. While recent studies have suggested links between disparate treatment and implicit bias, little direct evidence exists for how implicit bias may effect disparate care. Qualitative research on physician understanding of processes by which implicit bias translates into disparate care can help fill this gap and identify areas for further research. This study conducted …

Dependability And Accuracy Of Clinical Performance In Nursing Examination Scores, Laurie Vanessa Nagelsmith

Legacy Theses & Dissertations (2009 - 2024)

The purpose of this study is to determine the dependability and accuracy of Clinical Performance in Nursing Examination (CPNE®) scores obtained from trained raters. Intraclass correlations were calculated to estimate interrater agreement. Accuracy of scores was determined by identifying percent accuracy for each scored element. Generalizability (G) coefficients were calculated to estimate sources of variance in CPNE scores. The population for the study is adjunct faculty at Excelsior College who agreed to participate in the study and are clinical examiners trained as raters for the CPNE

Rawls And Health Care, Elizabeth H. Coogan

Honors Theses

John Rawls’s A Theory of Justice (1971), his first major work articulating his theory of justice as fairness, was immediately recognized as a fundamental contribution to political philosophy in the twentieth century. Working within the tradition established by previous philosophers such as Kant and Locke, Rawls employed the contract theory approach. Taking it to a higher order of abstraction, he sought to determine not what the structure of social organization would be, but what the principles which governed social institutions would be under a hypothetical contracting situation. Rawls uses this contract theory approach to construct a society in which the …

Other People's Country: A Memoir; And, Developing A Trustworthy Narrator: An Essay, Maureen Helen

Theses: Doctorates and Masters

This thesis comprises two interrelated sections. The first section is a substantial piece of creative writing, which l have cailed 'Other People's Country: A Memoir, in the genre of travel memoir, and an essay. The memoir borrows techniques from fiction, drama and poetry to tell a story of a middle-aged, middle-class city nurse, who travels to a remote settlement at the edge of the Western Desert of Western Australia to provide health care for a fluctuating population of around 400 people, for whom English is a third or fourth language.

Writing that includes stories about vulnerable people from another culture, …

Application Of Queuing Theory And Procedure Time Estimation In A Local Healthcare System, Galina Tsoy

Engineering Management & Systems Engineering Theses & Dissertations

People in the United States pay more for their basic healthcare needs than do people in any other nation in the world. When we consider that the United States is the wealthiest nation in the world, controlling the majority of the world's resources, it seems only reasonable to ask: Why should it be this way?

In an effort to address this problem, this thesis examines two possible methods of improving health care efficiency in hospitals. The thesis is thus in two parts: the first part examines resource allocation in medical units using Queuing Theory, and the second part examines a …

End Of Life Nursing Education Consortium Grant Implementation Project, Sheryl Ramona Terkildsen

Theses Digitization Project

This project addressed the continuing education needs of nursing staff and other health care professionals for delivering competent and compassionate palliative or end of life care. The scope of the project included, writing a grant application, training and certification by the end of life Nursing Education Consortium and implementing an education program for staff at the Loma Linda Veterans Affairs medical center.

Delays In The Emergency Department And Their Effects On The Ambulance Provider, Simon Peter Moore

Theses Digitization Project

This thesis is a case analysis of the nature of delays in emergency room admissions and the effects on ambulance dispatching and availability as it occurred in Southern California.

Nursing Home Ownership And Public Policy: An Historical Analysis, K. R. Kaffenberger

Graduate Doctoral Dissertations

In the early days of the United States, care of the disabled elderly outside the home meant the public almshouse. By the 1920s, private, nonprofit homes for the aged were prevalent. More recently, private, for-profit facilities have grown to dominate the field.

For-profit ownership has been controversial. Underlying the controversy is the concern that quality might be lowered in order to enhance profit.

This study asks why most nursing homes are privately owned and why most privately owned nursing homes are operated for profit. It does so with reference to The Nonprofit Economy, in which Burton Weisbrod describes a …