Health and Medical Administration Commons^™

Improving Pediatric Emergency Department Lethal Means Safety Documentation Rates For Adolescents With Mental Health Concerns, Cassandra L. Stegall, Ana-Maria Mcgill, John Fanton, Paul C. Mullan

Department Psychiatry & Behavioral Science Faculty Publications

Introduction:

Lethal means safety counseling (LMSC) is recommended for children presenting to the emergency department (ED) for a mental health (MH) evaluation. Currently, no gold-standard guidelines exist for documenting LMSC in the ED.

Methods:

This quality improvement project was conducted in the ED of a tertiary children's hospital. Baseline data were analyzed for access to any LMSC documentation (ALD) for "firearms/guns," "sharps," or "medication," and for complete LMSC documentation (CLD) if access to all 3 types was documented. The first intervention period added open-ended screening questions about access to lethal means to the MH-licensed clinical social worker note template. Intervention …

Exploring Management Strategies To Reduce Workplace Violence: Perceptions Of Illinois Healthcare Professionals, Mary Mack

All Student Theses and Dissertations

This qualitative study examined how managers of nonprofit healthcare facilities in the Chicago metropolitan area implement strategies to reduce workplace violence, what these strategies are and how they are carried out, and what organizational factors facilitate or impede their implementation. Semi-structured interviews were conducted with seven healthcare professionals in management or safety-oriented roles across seven facilities, purposefully sampled through the researcher's professional network. Findings revealed four recurring patterns across the sample. Prevention infrastructure was installed reactively, following specific triggering incidents rather than anticipating documented risk. Facilities consistently favored lower-cost mitigation measures over more resource-intensive prevention strategies. Reliance on short-tenure contract …

Criterion Validity Of The Functional Status And Pain Assessment Scale Versus Pain And Length Of Stay In Hospitalized Adults With Scd, Wally R. Smith, Daniel M. Sop, Yue May Zhang, Margaret S. Guy, Rehan Qayyum

Department of Medicine Faculty Publications

Objectives

In prior research we demonstrated face, construct, discriminant, and preliminary convergent validity of the newly developed, 10-item Functional Status Pain Assessment (FSPA) scale (0-50) in adult SCD patients hospitalized with VOC. We aimed in this study to further demonstrate criterion validity of the FSPA.

Methods

This was a prospective observational study of 561 daily functional and pain assessments from 91 hospitalized adults with SCD from January 2018 to June of 2019. Principal Component Analysis (PCA) Partial Least Squares (PLS) models determined the relationship between LOS, pain intensity, and FSPA. A Generalized Linear Model (GLM) to quantified the impact of …

Diagnosing The Discourse: How The Academy Of Breastfeeding Medicine Constructs And Constrains Treatment Of Tethered Oral Tissues, Mary E. Miller

Antioch University Dissertations & Theses

While breastfeeding is recognized as fundamental to global public health, oral restrictions that can affect infant latch, milk transfer, and feeding efficiency warrant further examination within policy frameworks. This dissertation proposes an expanded conceptualization of tethered oral tissues (TOTs) that encompasses not only anatomical frenal restrictions but also fascial tensions, neuromuscular limitations, and other conditions restricting orofacial function that may be congenital or acquired. The purpose of this study was to critically examine how this clinical guidance document shapes understandings and responses to TOTs. Using Carol Bacchi’s “What’s the Problem Represented to Be?” approach, a critical discourse analysis of the …

Navigating An Uncharted Path: Chief Diversity Officer Challenges In Creating And Implementing A Dei Strategy Plan Within Major Hospital Systems, Diane Shines Mcdaniel

Antioch University Dissertations & Theses

This qualitative phenomenological study investigated the major challenges Chief Diversity Officers (CDOs) face when creating and implementing DEI strategy plans within major hospital systems in the United States. The study was guided by one research question: What are the major challenges that Chief Diversity Officers face in creating and implementing a DEI strategy plan within major U.S. hospital systems? A phenomenological design was used to examine the challenges of six Chief Diversity Officers serving in major U.S. hospitals as they led DEI strategy planning and implementation. Data were generated through semi-structured interviews consisting of eight open-ended questions designed to elicit …

Contextualizing The Aspe Standards Of Best Practice: Reflecting On The Past, Present, And Future Of Sp Methodology, Amelia M. Wallace, Cory Krebsbach, Janice Radway, Lou Clark

EVMS School of Health Professions Faculty Publications

As we celebrate the publication of the Association of SP Educators Standards of Best Practice (ASPE SOBP) for Physical Exam Teaching Associates (PETAs) and corresponding literature review, we, elected leaders of ASPE, offer reflections on SP methodology history, current practices, and future opportunities. Our aim is to contextualize this addition to what is now the third SOBP publication [1, 2] that guides the global simulation community on best practices of simulated participant (SP) methodology.

Thank you to the ASPE members and SP Educators who made time to share their expertise as authors on these new standards- in addition to their …

Enhancing Military Health System Organizational Efficiency And Quality Of Care Through A Social-Ecological Framework, Eric L. Peipelman

College of Graduate Studies: Theses & Dissertations

Timely and fair adjudication of incivility-related actions within the Department of Defense (DoD) and Military Health System (MHS) is increasingly crucial for maintaining accountability, mission readiness, and quality of care. Ongoing delays in resolving workplace complaints and inefficiencies in resource-heavy adjudications highlight the need to shift from reactive complaint handling toward proactive civility promotion and transparent decision-making. This Integrated Learning Experience (ILE) introduces the Peipelman Civility Discussion and Assessment Toolkit (PCDAT)—a comprehensive, evidence-based framework designed to improve civility, optimize resources, and enhance communication, even in the MHS. Based on the Social-Ecological Model (SEM) and adapted from the Workplace Power and …

Association Between Neighborhood Social Determinants Of Health And Stillbirth, Tetsuya Kawakita, Misa Hayasaka, Ann M. Harper, John Brush, George Saade

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To examine the association between neighborhood-level social determinants of health and stillbirth.

METHODS:

We performed a retrospective cohort study of deliveries that occurred at a gestational age of at least 20 weeks within a five-hospital system (2012-2022). Electronic health record data mapped to the Observational Medical Outcomes Partnership Common Data Model were geocoded using addresses at the time of delivery and linked to neighborhood health indices, which included the Area Deprivation Index (ADI), Maternal Vulnerability Index (MVI), and Social Vulnerability Index (SVI) at the Census tract level. Stillbirths were adjudicated by medical record review. Modified Poisson regression generated relative …

Visit Complexity Differs Between Scarring And Nonscarring Alopecia: A 5-Year Dataderm Analysis, Ian Noel Encarnacion, Noelle Desir, Nicholas Schell, Apoorva Mehta, Temitayo Ogunleye, Susan Taylor

Department of Medicine Faculty Publications

[Introduction] Accurate coding is a critical component of dermatologic practice, influencing reimbursement and documentation of clinical complexity. Although alopecia has significant psychosocial and financial burdens, Current Procedural Terminology (CPT) coding patterns in alopecia management remain largely understudied. Our population-level study using the American Academy of Dermatology's DataDerm clinical registry¹ evaluates alopecia CPT coding trends, pre-2021 and post-2021 evaluation and management (E/M) CPT coding updates,² aiming to inform coding practices and visit complexity, which have significant reimbursement implications.

Determinants Of Patient Satisfaction In An Academic Primary Care Setting: A Cross-Sectional Study Of The Postpandemic Era, Alvin Maliakal, Rajita Kanapareddy, Zooha Altaf, Janani Anbazhagan, Kristin Olson, Cynthia Avila, Rehan Qayyum

Department of Medicine Faculty Publications

Background

Patient satisfaction, a key indicator of healthcare quality, is associated with improved adherence, continuity, and outcomes. However, limited evidence describes determinants of patient satisfaction in contemporary primary care settings reflecting the postpandemic era, when care delivery models and patient expectations have evolved substantially.

Objective

To evaluate the sociodemographic and clinical factors associated with patient satisfaction in an academic primary care setting following the postpandemic era.

Methods

We conducted a cross-sectional survey of adult patients (≥18 years) attending a primary care clinic. Participants completed a self-administered questionnaire including the Visit-Specific Satisfaction Questionnaire (VSQ-9) and measures of sociodemographic and clinical characteristics. …

The Effect Of The Affordable Care Act Medicaid Expansion On The Risk Of Hospital Closure And Adolescent Hpv Immunization In Rural Counties, Juliette Des Rosiers

Scripps Senior Theses

From 2005 to 2025, over 200 rural hospitals shut their doors, often citing increased operational costs, staffing shortages, low patient volume, regulatory barriers, financial challenges exacerbated by the COVID-19 pandemic, and uncompensated care as common contributors to the closures. Rural patients are often referred by their primary care physician to a hospital for regular immunizations, since smaller clinics have less capacity to provide immunizations due to a shortage of pediatricians and limited vaccine stock. A crucial vaccine that is not required by schools and underutilized in rural areas is that against human papillomavirus (HPV), a virus that infects cutaneous and …

Clinical Pathway Sebagai Solusi Keberlanjutan Jkn Di Indonesia: Systematic Review, Septiana Septiana, Siti Soekiswati, Burhannudin Ichsan

Jurnal Ekonomi Kesehatan Indonesia

The National Health Insurance (JKN) program is threatened with a deficit and potential default in 2026 due to inefficiency and the risk of fraud in healthcare facilities. In the context of JKN, which uses a package system (INA-CBG), Clinical Pathway (CP) is a strategic instrument within the JKN system that has dual benefits for both Payers (BPJS Kesehatan) and Providers (Hospitals). For BPJS Kesehatan, CP primarily functions to ensure service quality and prevent undertreatment fraud, the practice of reducing services to benefit hospitals. This prevention ultimately achieves cost efficiency in the JKN program by avoiding payment of complication claims and …

Documenting Death: Maternal Mortality And The Ethics Of Care In Tanzania (Adrienne E. Strong 2020), Luluk Oktavia, Megawati Sukarno

Paradigma: Jurnal Kajian Budaya

In recent decades, global efforts to reduce maternal mortality have become a primary focus in health development agendas. However, challenges in providing quality healthcare remain complex, especially in resource-limited countries. Adrienne E. Strong’s book, Documenting Death: Maternal Mortality and the Ethics of Care in Tanzania, offers an ethnographic perspective on the relationship between bureaucratic structures, resource constraints, and healthcare practices in Tanzania. This review examines Strong’s key concepts, such as good enough care, documented care, and fierce care, which highlight the ethical dilemmas faced by healthcare workers in delivering care under administrative pressures and limited facilities. The critique of the …

Moving Toward Healthy Ageing: The Role Of Physical Activity In Cognitive Function And Self-Esteem Among Older Adults In Türkiye, Canan Birimoglu Okuyan, Müjde Kerkez

Makara Journal of Health Research

Background: This study aimed to evaluate the relationship between religious attitudes and breastfeeding attitudes and the effect of this relationship on breastfeeding practices.

Methods: A cross-sectional study was conducted with 251 older adults. Data were collected using the International Physical Activity Questionnaire, the Standardized Mini-Mental State Examination, and the Rosenberg Self-Esteem Scale. Spearman’s correlation and chi-square tests were employed for statistical analysis.

Results: Physical activity levels were positively correlated with both cognitive function (r = 0.546, p < 0.001) and self-esteem (r = 0.168, p < 0.05). No significant association was observed between cognitive function and self-esteem. Physical inactivity, cognitive decline, and low self-esteem were more prevalent among women, participants with lower educational attainment, those with chronic diseases, and individuals engaged in polypharmacy.

Conclusions: The findings emphasize the importance of integrating physical activity promotion into national healthy ageing policies, particularly in Mediterranean contexts such …

Disaster Risk Reduction In Rural Indonesia: Evaluation Of The Japan Red Cross Program In Pujiharjo Village, Meyralda Dara Adisa, Pujo Widodo, Anwar Kurniadi, Wilopo Wilopo

Preventia: The Indonesian Journal of Public Health

Pujiharjo Village in Malang Regency, Indonesia, is highly vulnerable to natural disasters. In 2021, the Indonesian Red Cross (PMI) partnered with the Japanese Red Cross Society (JRCS) to implement a community-based disaster preparedness program. This study evaluates the program's effectiveness in terms of community participation, institutional support, and alignment with the Sendai Framework for Disaster Risk Reduction 2015–2030. Using a qualitative case study, data were collected through document analysis of Vulnerability and Capacity Assessments (VCA), Community Action Plans (CAP), and local SOPs. Thematic analysis explored disaster risk perception, governance, mitigation investment, and emergency preparedness. The program successfully improved risk awareness, …

Pxj Volume 12 – Key Theme Summary And Article Index, Patient Experience Journal

Patient Experience Journal

Volume 12 of the Patient Experience Journal showcases a global dedication to advancing human experience in healthcare, illuminating both existing challenges and crucial emerging practices. The content, spanning three issues, emphasizes that improving the human experience is not a temporary initiative but rather the essential foundation for building trust, ensuring safety, facilitating healing, and sustaining organizational resilience. The overarching message of Volume 12 is that human experience is the heart of healthcare. It is actively shaped through shared purpose, design, empathy, communication, and partnership. The journal calls for a future where every voice is heard, every story matters, every …

Compensation Transparency In The U.S. Healthcare Workforce, Brandon Perkins

Honors Projects

This study investigates how perceptions of pay transparency among U.S. healthcare workers relate to work engagement, burnout levels, and intentions to stay with their current institution. A quantitative survey was conducted of 200 clinical and non-clinical employees across academic, nonprofit, for-profit, and government healthcare organizations. Self-reported views of transparency were evaluated in relation to validated measures of work engagement, burnout, stay intentions, and pay secrecy. The results showed that increased perceived compensation transparency was highly connected with greater work engagement and lower levels of burnout. Both engagement and burnout appeared as major indicators of the employees' intentions to stay with …

Enhancing End-Of-Life Quality In Hospice Care, Gerson Orellana Prudencio

Capstone Projects and Master's Theses

The‍‌‍‍‌ increasing demand for hospice care in Monterey County is a clear indicator of the rapid growth in the need for end-of-life services driven by the aging population. The project was developed at the Department of Hospice of the Central Coast, which is under the Montage Health Foundation, a non-profit organization. The community served consists of elderly people receiving hospice and end-of-life care, as well as volunteers who provide administrative and indirect support. The Volunteer Handbook aims to create a comprehensive procedural manual for hospice volunteers to improve administrative efficiency and ensure the quality of care. Interviews were conducted with …

Schema, Stigma, And The “We-Them” Divide: Perspectives On Ageism From Everyday Life To Healthcare, Temple D. West

English Theses & Dissertations

Ageism remains a pervasive and often underexamined form of discrimination, affecting older adults across both everyday and clinical contexts. This paper explores how cognitive schemas—mental frameworks that shape perception and experience—and stigma interact to reinforce a “we–them” divide between and older patients and healthcare providers, as well as between older and younger individuals in broader society. Through focus groups and listening to the voices of older patients, this study examines how assumptions of age-based decline are embedded in society and inform schemas of ageism. It considers how those schemas shape the spoiled identity of older people as a stigmatized group, …

Co-Designing A Patient-Facing Version Of A Mental Healthcare Pathway For People Receiving Dialysis, Alexandra Albers, Charlotte Berendonk, Julie Robison, Richard Sawatzky, Loretta Lee, Monika Bolin, Jeff Costley, Sandy Johnstone, Kevin Kemp, Justin Leroux, May Tourangeau, Sabiha Zaman, Kara Schick-Makaroff

Patient Experience Journal

A Community Advisory Committee comprised of nine members with lived experience of kidney failure, identified the need for a patient-facing version of a mental healthcare pathway for people receiving dialysis in Alberta, Canada. Recognizing that healthcare tools to support person-centred care practices should be available in lay language, our team (comprised of Community Advisors and healthcare clinicians and researchers) co-designed a patient-facing pathway: “Your Journey: Coping with and Adjusting to Dialysis.” The Provincial Pathways Unit provided a template for the pathway, and the content was adapted through multiple online and in-person meetings with the Community Advisors. Adaptations were informed by …

Leading Through Partnership: Development Of A Hospital-Wide Family-Centered Care Collaborative, Jessica T. Fry, Naomi Shapiro, Barbara Lawlor Burke, Kalee Ryan, Kerri Z. Machut

Patient Experience Journal

Though it has been widely recognized that systematic patient and family engagement plays a critical role in strengthening the provision of family-centered pediatric healthcare, significant gaps in knowledge remain regarding how to develop and build a successful model of engagement. As a group of pediatric health care professionals invested in improving the patient and family-centered care provided by our children’s medical center, we saw the opportunity for family and organizational collaboration as a needed “first step” in model development. In this case study, we describe our institutional journey to build connections and resources though the development of a Family Centered …

Virtual Nurse Discharge: Improving Patient And Nurse Experience, Dina Flihan, Christine Odell, Stacey Davis, Carolyn Oates, Fay Wright

Patient Experience Journal

This case study reviews the virtual discharge nurse (VDN) process and its impact on patient experience and nursing workflow as an exemplar of an effective telehealth innovation at a community hospital 23-bed Short Stay Unit (SSU). At the SSU, the daily turnover rate of more than 50% of the unit census challenged the nurses’ ability to provide comprehensive individualized discharge education. SSU patient experience scores measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) reflected opportunities to improve the discharge process. Therefore, the direct care nurses on SSU suggested a trial innovation of a VDN to improve …

Triad: A Novel Team Structure Pilot And Its Impact On Patient Experience In The Pediatric Emergency Department, Walter Palmer Md, Joseph R. Mijares Iii, Md, Sephora Morrison Mbbs, Msci, Mba

Patient Experience Journal

Introduction: Patient experience is inextricably tied to effective communication between the care team and patient. Published trials designed to improve communication and therefore patient experience in the pediatric emergency department setting are lacking. Methods: This is a novel care team reorganization in a single tertiary care pediatric emergency department. A Triad team consisted of a nurse, emergency technician (Tech), and physician or advanced practice practitioner (APP). The team was designed and trained with an emphasis on closed loop communication with the team and patient to test whether improving effective communication can subsequently improve the patient experience. Using a real-time survey, …

Empowering Frontline Staff In Service Recovery, Sarah E. Duncan, Brianna Camera, Iva Ervin-Stanberry, Heather L. Pezzullo

Patient Experience Journal

Objective: This study aimed to develop and implement a standardized service recovery training program within the VA healthcare system to enhance patient experiences and address grievances effectively. The purpose of the training was to equip VA employees with the necessary skills and knowledge to resolve service issues promptly and empathetically, adhering to the principles of the VA’s SALUTE model for service recovery. Method: The training program was designed based on feedback from anonymous pre-surveys to identify knowledge gaps and incorporate industry best practices. The VA’s SALUTE model, which emphasizes six key actions—saying hello, apologizing, listening, understanding, taking action, …

A Case Report On Meeting The Spiritual Need Of Intubated Conscious Patient, Mahuya Karmakar, Santhna Letchmi Panduragan, Faridah Mohd Said

Patient Experience Journal

Nurses are showing more interest in including spiritual health to prevent and treat illnesses. For patients who can speak may ask for their spiritual need to the health care provider. But for intubated patients it.s difficult to express such needs. Most of the time caregivers focus on the physical parameters only for intubated patients. Apart from physical symptoms these patients also experience a variety of bio-psycho-socio-spiritual sensations. Research has shown that spiritual therapies can reduce distress, assist in preparing the patient for end-of life care, and enhance overall wellbeing along with improving their quality of life. The purpose of this …

A Systematic Review Of The Literature On The Validity, Reliability, And Utility Of The Nhs Friends And Family Test As A Method For Gathering Feedback On And Improving The Experiences Of Patients, Miss Jenny King, Catherine Davidson, Miss Hannah Wade, Chris Graham

Patient Experience Journal

The NHS Friends and Family Test (FFT) is widely used across the National Health Service to collect patient feedback on care experiences. Given its scale and cost, there is strong public and organisational interest in the validity, reliability, and utility of the FFT. This study aimed to systematically review the literature on the validity, reliability, and utility of the FFT as a method for gathering feedback on and improving patient experiences. PubMed and ProQuest databases were searched in September 2024. Studies were included if they met the inclusion criteria. Information extracted included study information (e.g., title, authors, publication year, research …

Reliability And Validity Of A Modified Version Of The Consumer Assessment Of Healthcare Providers And Systems (Cahps®) Clinician And Group Visit Survey 4.0 (Beta) For Ambulatory Behavioral Health Care, Jessica K. Jeffrey, Ron D. Hays, Randi Hissom, Mark Grossman, Samuel A. Skootsky

Patient Experience Journal

Patient experience is a fundamental indicator of healthcare quality. A patient experience survey that assesses telemedicine and in-person ambulatory behavioral health care is needed. This study aims to adapt the CAHPS Clinician and Group Visit Survey 4.0 (beta) to assess adult patient experience with ambulatory behavioral health services and its reliability and validity. Seven behavioral health subject matter experts (psychiatrists, therapists with master’s degrees, and primary care physicians) at an integrated delivery system aligned with an academic institution provided input to select a subset of items and make minor wording adjustments to the CAHPS survey. The adapted survey was administered …

Assessing Patient Satisfaction With The Services Provided Under The National Health Insurance Scheme At The Outpatient Department Of The Levy Mwanawasa University Teaching Hospital In Lusaka, Zambia, Wesley Kapaya Mwambazi, Mubanga Mpundu

Patient Experience Journal

The National Health Insurance Scheme (NHIS), introduced in Zambia in 2019 to enhance healthcare financing and service delivery, still faces challenges impacting patient satisfaction. This study assesses and investigates the factors influencing patient satisfaction with NHIS-provided services at a third-level tertiary public hospital. The study was conducted at the outpatient department (OPD) of Levy Mwanawasa University Teaching Hospital (LMUTH) in Lusaka, Zambia, deliberately chosen as one of the largest publicly financed tertiary referral hospitals and among the first NHIS-accredited facilities. A cross-sectional survey was conducted with 270 respondents using a modified SERVQUAL 5-point Likert scale questionnaire, whose reliability was assessed …

Using Patient Experience Data With Impact: A Framework For Healthcare Improvement, Corey Adams, Ramesh Walpola, Reema Harrison

Patient Experience Journal

Background: Despite major investment in patient experience measurement, healthcare organizations often struggle to translate patient feedback into lasting improvements. Existing knowledge translation frameworks provide useful concepts, but often lack the practical detail or contextual relevance needed to improve patient experiences. Objective: To develop and present the IMPACT Framework, an evidence-informed approach designed to bridge the gap between patient experience measurement and meaningful improvement in healthcare. Methods: This framework was informed by a systematic review of patient experience measurement and analysis of barriers to feedback use. Findings from contemporary patient experience research were combined with key principles of knowledge translation, change …

Enhancing System-Level Quality Improvement Through Patient-Inclusive Teamwork: A Review, Shaik Mohiuddin

Patient Experience Journal

Engaging patients in quality improvement (QI) initiatives offers significant advantages, including increased patient satisfaction, improved outcomes, and the integration of creative insights from patient perspectives. This review synthesizes findings from 14 peer-reviewed articles retrieved from PubMed and Google Scholar, focusing on patient-inclusive teamwork in healthcare settings. Despite the recognized benefits, patient involvement remains limited due to cultural and professional barriers, logistical challenges, and the need for structured training programs. The review contrasts conventional provider-centered approaches with patient-centered models, emphasizing the importance of policy reform, organizational culture change, and supportive training to enhance patient engagement. Traditional QI strategies often overlook patient …