Health and Medical Administration Commons^™

Predictors Of Hyperkalemia And Outcomes Of Dyskalemia In Us Veterans With Advanced Chronic Kidney Disease Transitioning To Dialysis, Ankur Dashputre

Theses and Dissertations (ETD)

Background: The kidneys play a crucial role in maintaining homeostasis of serum potassium levels (K+). Patients with advanced chronic kidney disease (CKD) are at a higher risk of experiencing dyskalemia events (i.e. hyper- and hypokalemia; especially the former) and thus future adverse outcomes. Currently, there is a dearth of literature on prediction models for hyperkalemia and the effects of dyskalemia on outcomes such as incidence of ischemic stroke and short-term hospital/emergency room (ER) utilization in an advanced CKD population transitioning to dialysis. Objectives: Using a nationally representative sample of US veterans with advanced CKD transitioning to dialysis, in the pre-dialysis …

The Relationship Of Child Health And Parenting Stress To Child Neurocognitive Development, Nancy Alise Farrell

Theses and Dissertations (ETD)

Problem. Although the United States rates high in economic resources, the neurocognitive development (NCD) of children falls behind many other developed nations. Levels of parenting stress may be linked to sociodemographic factors such as the high incidence of poverty in children or health disparities in children, which in turn may affect NCD in children. Using the data from an observational, longitudinal cohort study of a diverse population could provide information related to parenting stress, child health, and related factors to guide and support interventions with families and policies to improve child NCD. Aims. The overall aim of this study was …

Intermediate Anticoagulation Dosing In Covid-19 Icu Patients: Evaluation Comparing Ventilated Vs Non-Ventilated Populations, Christopher Michael D'Amico

Applied Research Projects

Surges of COVID-19 have been seen to place large numbers of patients into the ICU. Establishing standards of care is critical not only for patient care, but to also implement a baseline of therapy to build upon with future research. COVID-19 produces a hypercoagulable state resulting in higher occurrences of clotting such as deep vein thrombosis (DVT), and pulmonary embolism (PE). Anticoagulation medications thin the blood to combat this aspect of the disease from occurring but does so at the risk of increasing bleeding potential. The purpose of this study is to evaluate the risk/benefit of anticoagulation usage between ventilated …

Impact Of Central Line Bundle Care On Reduction Of Central Line Associated-Infections: A Scoping Review, Alisha James-Scott Msn, Fnp-C, Rachel Savoy Msn, Fnp-Bc, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Apn

Doctor of Nursing Practice Projects

Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use.

Methods A literature review was …

Medicated-Assisted Treatment And 12-Step Programs: Evaluating The Referral Process, Candace S. Brown, Chudney Williams, Ryan E. Stephens, Jacqueline Sharp, Bobby Bellflower, Martinus T. Zeeman

Doctor of Nursing Practice Projects

Purpose/Background Overdose deaths in the U.S. from opioids have dramatically increased since the COVID-19 pandemic. Although medicated-assisted treatment (MAT) programs are widely available for sufferers of opiate addiction, many drop out of treatment prematurely. Twelve-step programs are considered a valuable part of treatment, but few studies have examined the effect of combining these approaches. We aimed to compare abstinence rates among patients receiving MAT who were referred to 12-step programs to those only receiving MAT.

Methods In this prospective study, a cohort of participants from a MAT clinic agreeing to attend a 12-step program was compared to 15 controls selected …

Responding To The Pandemic: A Multicountry Study On Social-Political Factors And Health Outcomes Of Covid-19, Lan Yao

Theses and Dissertations (ETD)

Introduction. Coronavirus Disease 2019 (COVID-19) poses a major global threat to human beings, which has caused devastating consequences of population health, political, and economic crises in many countries. This dissertation was composed of three research activities to study the following aims: (1) review the existing literature focusing on political factors and health outcomes of COVID-19; (2) assess the relationship between democracy and case fatality rate of COVID-19 by controlling for the effect of age, comorbidity, health expenditure, healthcare workforce, and population density; and (3) identify the trajectory pattern cases peak days, deaths peak days, and peak periods.

Methods. We accessed …

The Impact Of The Health Information Technology For Economic And Clinical Health Act On Clinical Pharmacy And Computerized Provider Order Entry, Bailey Deglow

Applied Research Projects

The Health Information Technology for Clinical and Economic Health (HITECH) Act of 2009 encouraged the meaningful use of the electronic health record (EHR) by health care providers in the United States. “Meaningful use” monetary incentives were offered by the Center for Medicare and Medicaid Services (CMS) for health care providers who met standards of documenting in and using the EHR. While clinical pharmacists typically work in clinics and hospitals in the United States, they were not considered eligible professionals who could receive incentives for using the EHR. There is a great deal of literature regarding the use of the EHR …

Integrating Digital Health Technology To Alleviate Caregiver Burden, Patricia Ann Hunt

Applied Research Projects

The elder population in our country is growing at an exponential pace. Studies have shown that elders who are aged 80 years and older are projected to suffer from age related issues such as Alzheimer’s, dementia, and osteoporosis and will need assistance with Long Term Services and Support (LTSS). Additionally, many elders are also projected to suffer from more severe chronic illnesses such as diabetes, cancer, and heart related illnesses. Because many of these elders are aging in place, residing in their own homes, they will require the services of at home assistance, which high probability will be a neighbor, …

Pain Control: Opioid Vs. Nonopioid Analgesia During The Immediate Postoperative Period, Shamsie M. Lumpkin Bsn, Srna, Isaac W. Parrish Bsn, Srna, Austin S. Terrell Bsn, Srna, Dwayne S. Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to …

Feasibility And Acceptability Of Using Mobile Health Apps In Underserved Patients With Diabetes, Jieyu Luo

Theses and Dissertations (ETD)

Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. …

Effects Of Social Determinants Of Health In Progression To Type 2 Diabetes, Folabi I. Ariganjoye

Applied Research Projects

The prevalence of prediabetes and diabetes in the United States and around the world has increased faster than expected in the last 30 years. The economic burden this costs a nation can be astronomic both in terms of expense and loss in productivity. One-third of U.S. adults, 86 million people, have prediabetes. Effective management is needed that can reach these 86 million, and others at high risk, to reduce their progression to diagnosed Type 2 diabetes. After the literature review, there was not enough literature to support how these led to the progression to diabetes. The abundant literature is centered …

Effectiveness Of Ehr-Depression Screening Among Adult Diabetics In An Urban Primary Care Clinic, Filipina C. Schnabel Md, Mph, Msn, Fnp-Bc, Danielle Aldridge Msn, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR).

Methods We conducted a retrospective chart review on patients …

Assessment Of Knowledge, Attitude, Perception Of Pharmacy Students Towards Telepharmacy, Komal Patel

Applied Research Projects

Telemedicine is one of the fastest growing area in health care technology and COVID-19 pandemic has changed the way of practicing Telemedicine. Telepharmacy is a part of telemedicine where pharmacy use this technology to provide patient care services. Success of any technology depends on users’ willingness to learn and attitude towards technology. Early assessment of students’ attitude during pharmacy school is important to know in order to assess how receptive students are to accept Telepharmacy in their work setting currently or in future. That will also help to determine success of Telepharmacy implementation. This study will focus on assessing knowledge, …

The Use Of Dmaic To Improve Quality Vaccination Recommendations In Chain Community Pharmacies, Urvi Patel

Applied Research Projects

Community pharmacies provide the convenience and ease of administrating vaccinations outside traditional settings. Vaccinations are health initiatives that protect communities and improve health outcomes in all populations. Despite their accessibility and supporting clinical data, various influential factors contribute to the current suboptimal rates of vaccine administration. Given the common barriers to vaccine administration, this research narrows down to address a specific barrier and attempts to implement a method that focuses on improving vaccine rates in community pharmacies. This research is a case study that utilizes the DMAIC model of lean six sigma and aims to use this quality improvement process …

Heart Failure 30-Day Readmission Frequency, Rates, And Hf Classification, Yolanda R. Brown, Twonia M. Goyer, Margaret C. Harvey

Doctor of Nursing Practice Projects

30 Day Hospital Readmission Rates, Frequencies, and Heart Failure Classification for Patients with Heart Failure

Background Congestive heart failure (CHF) is the leading cause of mortality, morbidity, and disability worldwide among patients. Both the incidence and the prevalence of heart failure are age dependent and are relatively common in individuals 40 years of age and older. CHF is one of the leading causes of inpatient hospitalization readmission in the United States, with readmission rates remaining above the 20% goal within 30 days. The Center for Medicare and Medicaid Services imposes a 3% reimbursement penalty for excessive readmissions including those who …

Using Preliminary Data And Prospective Power Analyses For Mid-Stream Revision Of Projected Group And Subgroup Sizes In Pragmatic Patient-Centered Outcomes Research, Elizabeth A. Tolley Md, Satya Surbhi Md, James E. Bailey Md

Faculty Publications and Presentations

Pragmatic clinical trials are commonly used in patient-centered outcomes research to assess heterogeneity of treatment effects. Patient-Centered Outcomes Research Institute (PCORI) methodology standards for assessing heterogeneity of treatment effects are extremely rigorous, but their implementation in real-world settings can be difficult. Predicting recruitment effectiveness and subgroup characteristics is often challenging and may require mid-stream revision of projected group and subgroup sizes. Yet, little real-world data are available to demonstrate methodologically valid approaches to address situations where such revisions are necessary. These data were used for mid-stream revision of group and subgroup sizes in the Management of Diabetes in Everyday Life …

An Analysis Of Patient-Generated Health Data In Assisting Nurses And Physicians To Better Treat Patients With Hypertension, Diana Chaparadza

Applied Research Projects

Patient Generated Health Data (PGHD is not new but it has gained more attention these past years due to the advent of smart devices, remote monitoring devices and many applications on various smart devices. PGHD reflects medications and treatment, lifestyle choices, and health history. Unlike traditional medical visits, where clinicians collect and manage data within their offices, PGHD is collected by patients throughout the course of their day and provides an insight of how they are responding to treatments or lifestyle choices. Examples include blood glucose monitoring or blood pressure readings using home health equipment, exercise and diet tracking using …

Leveraging Health Informatics And Parental Empowerment: Perspectives From Parents And Caregivers Of Medically Complex Children, Shazia Ashraf

Applied Research Projects

This research paper focuses on the barriers that parents and caregivers of special-needs children patients face with leveraging technology and informatics as they attempt to communicate with their child’s healthcare specialists regarding specialized and critical oversight and management of complex medical conditions and the need for empowerment for this population of parents and caregivers. The literature suggests that the age and socioeconomic status of the individual has a big impact on the use of electronic applications. A review of the literature showed that the special needs population has not been represented. This study surveys a range of parents and caregivers …

Clinical And Socioeconomic Predictors Of Palliative Care Utilization, Rohan Reddy Tummala, Andrew Manuel De Jesus, Natasha Danielle Tillett, Jeffrey Scott Nelson, Christine Marie Lamey

Longitudinal Scholar's Project

INTRODUCTION: Palliative care continues to gain recognition among primary care providers, as patients suffering from chronic conditions may benefit from use of this growing service.

OBJECTIVES: This single-institution quality improvement study investigates the clinical characteristics and socioeconomic status (SES) of palliative care patients and identifies predictors of palliative care utilization.

METHODS: Retrospective chart review was used to compare clinical and SES parameters for three groups of patients: (1) palliative care patients who attended at least one visit since the inception of the University Clinical Health Palliative Care Clinic in Memphis, TN in October 2018 (n = 61), …

Computer-Assisted Coding: Post Icd-10 Implementation, Teresa C. Allen

Applied Research Projects

Computer-assisted coding (CAC) has been around since the 1950s and is projecting to reach $4.75 Billion by 2022. However, it has not been on the hospitals’ priority list until 2014 before the implementation of ICD-10 in 2015. Computer-assisted coding is a technology software that helps streamline the coding workflow, reduce backlogs by increasing productivity, and help coders navigate through more extended, more complex charts more quickly. The technology is a type of artificial intelligence. The idea of computer-assisted became more front-line with the implementation of electronic health records (EHRs) and the demands of a more restrictive reimbursement from payers. Accuracy, …

Renal And Cardiovascular Outcomes Associated With Cannabis Use In Veterans With Advanced Chronic Kidney Disease Transitioning To Dialysis, Praveen Kumar Potukuchi

Theses and Dissertations (ETD)

Background: Legalization of cannabis and its constituents may lead to increased exposure of a higher number of consumers to cannabis use, including those with chronic kidney disease (CKD). We expect increase in cannabis use, especially, in patients with compromised kidney function. However, there is sparse literature on the effects of cannabis use on cardiorenal and mortality outcomes among patients with advanced CKD. Objectives: The main goal of the current study was to examine the effect of cannabis use on renal and cerebrovascular outcomes as well as mortality in patients with advanced CKD. Using a nationwide cohort of US veterans with …

2020 County Health Rankings Tennessee Data And Updated Substance Abuse 2005-2019, Kelsey L. Grabeel, Jenny Moore

Faculty Publications

No abstract provided.

Forecasting The Essential Chemotherapy Needed For Treatment Of Children With Acute Lymphoblastic Leukemia In Low- And Middle-Income Countries, Brian T. Lewis

Theses and Dissertations (ETD)

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, with contemporary therapy resulting in a 90% survival in high-income countries (HIC). However, an estimated 89% of the world’s children live in low- and middle-income countries (LMIC) where survival is much lower. Lack of access to essential chemotherapy contributes significantly to the decreased survival rates for LMIC, and inaccurate forecasting of chemotherapy needed may lead to stockouts or oversupply. This chapter describes a simple forecasting system with population and patient-based multipliers for each drug used in the treatment of pediatric ALL, thus estimating the essential chemotherapy quantities needed for a …

Survey Of Client Perspective On The Use Of Veterinary Telemedicine For Chronic Disease Management, Nathan Jay Matlock

Applied Research Projects

Veterinary Telehealth is a rapidly growing sector of Veterinary Medicine. Technological advancements have allowed for vast changes in the way chronic disease states can be managed. There are many facets of telemedicine that must be researched to determine the productiveness of such technological advances. The first step in determination of implementation is that of community acceptance and likely utilization. This project’s scope is to determine client perspective on the use of veterinary telemedicine for chronic disease state(s) management.

Health Information Management Careers: The Importance Of Skillset And Location On Salary, Danielle Sager

Applied Research Projects

Health information management is an engaging and dynamic occupational field that employs thousands of individuals throughout the United States across the spectrum of health care providing organizations. The ability to navigate these opportunities is influenced heavily by the location of available positions and the skillsets desired by employers. Through study of workforce development data and research in health information management one is able to determine the location and skillset of positions that will help distinguish oneself in a competitive marketplace that values not only education and experience, but the ability to lead in a field that is rapidly changing and …

How One Library’S Location Change Impacted Health Information Requests: Comparing Zip Codes And Health Disparities To Inform Library Services: Data Files, David Petersen, Martha Earl, Cameron Watson, Kelsey Grabeel

Faculty Publications

No abstract provided.

Sepsis Screening Tool Increased The Usage Of Sepsis Order Set, Raweewan Liengsawangwong

Applied Research Projects

Introduction: The sepsis screening tool was launched to improve the usage of the sepsis order set.

Objectives: The purposes of this study were to determine whether the sepsis screening tool increased the usage of sepsis order set and whether the tool improved the primary outcomes. This study assessed the association between using sepsis order set and the compliance of the SEP-1 measure (represented by achieving total perfect care), and the primary outcomes. Furthermore, this study assessed association between the compliance with SEP-1 and the primary outcomes. The primary outcomes were a) time zero to antibiotics, b) inpatient length of stay, …

Health Status And Adults Willingness To Encounter A Provider By Telehealth, Jacqueline Perry

Applied Research Projects

Telehealth has proven to be a growing sector providing on-demand health services for consumers. A long history of development and refinement precede what we now know as telehealth technology. Access to telehealth technology has become widely available changing the landscape of healthcare. However, does that mean that consumers desire to use the technology? How does a factor such as health status play a role in the consumers’ willingness to encounter a provider using telehealth as the method for delivery of care? This research project aims to compare self-selected health status to consumers’ willingness to engage with telehealth services.

Barriers To Patient Electronic Portal Usage, Debbie Hoza

Applied Research Projects

This paper focuses on the barriers that patients have as to why they do not use their electronic patient portal. The literature suggests that the age and socioeconomic status of the individual has a big impact on the use of the electronic portals. A review of the literature showed that all populations have not been represented. This study surveys a broader range of patients including all ages, genders, education and socioeconomic statuses to see what barriers that this broader range of patients has to using their electronic portals.

Safeguarding Against Data Breaches, Stephanie Johnson

Applied Research Projects

Reports of data breaches have seen an increase in the past decade and compared to other businesses; these breaches are estimated to be the most expensive in healthcare and affect millions of patients. One may ask what is a data breach, what causes it, and how can it be prevented? Particularly vulnerable to breaches is Protected Health Information (PHI) collected by the healthcare provider. This information is any part of the patient’s medical record or payment history. Regularly, healthcare organizations utilize business associates and covered entities to deliver patient care. During this process, PHI is produced. This study addresses the …