Health and Medical Administration Commons^™

Healthcare Of The Uninsured Population In West Virginia And The United States, Leslie Salyers, Mounica Mummaneni, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: The uninsured population in the United States has increased dramatically over the past few years. Hospitals and physicians bear the financial burden of the uninsured by compensating for the billions of dollars in bad debt or uncompensated care they incur each year. Emergency rooms and other healthcare facilities are left with billions in uncompensated care due to 47 million uninsured Americans. Uncompensated care in 2006 was $31.2 billion. Majority of individuals accounting for uncompensated care are those living at or below the federal poverty level and those individuals who can afford health coverage but freely choose to forgo purchasing …

Utilization Of 340b Program In A Rural Hospital, Heath Ashford, Lauren Valli, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: The 340B is a federal program that provides eligible rural hospitals, providers, and clinics the capability to purchase medications at reduced prices for outpatient use. Enrollment in the 340B program requires drug manufacturers to supply covered healthcare entities and eligible healthcare organizations medications at substantially reduced prices and has allowed covered entities to extend federal resources by offering more comprehensive services and reaching more of the vulnerable populations. The purpose of this research study was to examine utilization of 340B program within provider based clinics of a university medical school affiliated with a rural hospital to assess the benefits …

A Business Case For Tele-Intensive Care Units, Alberto Coustasse, Stacie Deslich, Deanna Bailey, Alesia Hairston, David Paul

Alberto Coustasse, DrPH, MD, MBA, MPH

Objectives: A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes. Methods: This literature review examined a large number of studies of implementa­tion of tele-ICU systems in hospitals. Results: The evidence supporting cost savings was mixed. Implementation of a tele- ICU system was associated with cost savings, shorter lengths of stay, …

Use Of Smartphones In Hospitals, N. A. Thomairy, M. Mummaneni, S. Alsalamah, N. Moussa, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Mobile technology has begun to change the landscape of the medical profession with more than two-thirds of physicians regularly using smart phones. Smartphones have allowed healthcare professionals and the general public to communicate more efficiently, collect data and facilitate the clinical decision making. The methodology for this study was a qualitative literature review following a systematic approach of the smartphone usage among physicians in hospitals. Fifty-one articles were selected for this study based on inclusion criteria. The findings were classified and described into seven categories: use of smartphone in obstetrics, pediatrics, surgery, internal medicine, radiology, and dermatology which were chosen …

Is The Nationwide Health Information Network Feasible?, Tyler Godby, Christian Gomes, Jazmine Valle, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Nationwide Health Information Network (NHIN) use in healthcare facilities was examined for utilization and efficacy, although the advantages are abundant, healthcare facilities have been reluctant to adopt it due to associated costs. The purpose of this study was to analyze the feasibility of a U.S NHIN by exploring and determining the benefits of and assessing the barriers to its implementation. The results of this study suggest that implementation and utilization of NHIN by healthcare industry stakeholders leads to an increased quality of patient care, increased patient-provider communication, and cost savings opportunities. Increased quality of care is achieved by reducing adverse …

Evaluation Of Glucose Monitoring Technologies For Cost Effective And Quality Control/Management Of Diabetes, David P. Paul Iii, Stacy Ashworth, Leslie Salyers, Sarah Saldanha, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The diabetes epidemic in the United States (U.S.) has become a burden in regards to treatment, disease management, and associated costs. Key advancements in medical technology have been developed in efforts to mitigate this issue. We compare several types of glucose monitoring systems with respect to quality of care, management, and cost-effectiveness for type 1 and type 2 diabetics.

Big Data Management In United States Hospitals: Benefits And Barriers, Chad Schaeffer, Ariful Haque, Lawrence Booton, Jamey Halleck, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Big Data has been considered as an effective tool to reduce healthcare costs by eliminating adverse events and reducing readmissions in hospitals. The purpose of this study was to examine the emergence of Big Data in the United Sates healthcare industry, to evaluate hospital’s ability to effectively make use of complex information, and to predict the potential benefits hospitals might realize if they are successful. The findings of the research suggest that there were a number of benefits expected by hospitals when using Big Data analytics, including cost savings and business intelligence. In addition, hospitals have recognized that there have …

The Qualitative And Quantitative Effects Of Patient Centered Medical Home In The Veterans Health Administration, Samuel N. Lovejoy, Eric Stalnaker, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Since the 1990’s, the Veteran’s Health Administration (VHA) has implemented a system of primary care that has been considered some of the best care that can be offered (Klein, 2011). The Patient Center Medical Home (PCMH) Model, also called “Patient Aligned Care Team” (PACT) in the VHA, has been coordinating and integrating services which ensure optimal health outcomes at an acceptable value (Bidassie, Davies, Stark, & Boushon, 2014).

PACT was created in 2010, building on 20 years of the VHA transforming from a loosely based system of inpatient services to a provider of outpatient primary care for veterans. From 2010 …

Quality Of Care And Profitability In Not-For-Profit Versus For-Profit Nursing Homes, David P. Paul Iii, Tyler Godby, Sarah Saldanha, Jazmine Valle, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Nursing home residents across the Unites States rely on quality care and effective services. Nursing homes provide skilled nurses and nursing aides who can provide services 24 hours a day for individuals that could not perform these tasks for themselves. Not-for-Profit (NFP) versus For-Profit (FP) nursing homes have been examined for utilization and efficacy, however, it has been shown that NFP nursing homes generally offer higher quality care and greater profit margins compared to FP nursing homes. The purpose of this research was to determine if NFP nursing homes provide enhanced quality care and a larger profit margin compared to …

Telestroke: An Approach To The Shortage Of Neurologists In Rural Areas, Sarah Mcsweeney, Jean Pritt, Angie Swearingen, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Telestroke has provided swift, lifesaving treatment and has afforded patients the ability to be treated in an efficient manner in rural areas where neurologists may not always be available. It has been reported that Telestroke in rural areas has increased the ability to treat patients by being able to access a neurologist for assistance in evaluating the patient to determine if administering lifesaving in treatments were needed. The utilization of Telestroke has been shown to increase the use of IV Tissue Plasminogen Activator (tPA) which improves outcomes such as better quality of life, lower disability and improved rehabilitation. Employment of …

Burnout Syndrome In Hospital Nurses, Priscilla Holdren, David P. Paul Iii, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Burnout is a state of mental, physical and emotional stress resulting in a chronic state of pressure or stress at work and is associated with individuals who do “people work” (Aiken and Sloane, 1997), a category into which nurses obviously fall. The number of nurses suffering from burnout has increased over the years, possibly causing negative effects on patient care, working environments and staffing shortages. Hospitals should focus on creating a healthy work environment in which nurses feel supported by their coworkers and management. Hospitals should also make available stress management programs that address symptoms of burnout and assure safe …

Latino Access To Health Care: The Role Of Insurance, Managed Care, And Institutional Barriers, J. Emilio Carrillo, Fernando M. Trevino, Joseph R. Betancourt, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The health care system in the United States is the most expensive and yet arguably among the least cost effective in the developed world (Anderson, 1998). Despite the highest per person health care spending among the Organization for Economic Cooperation and Development (OECD) nations, the United States still ranks below many along a variety of health indicators (Woolhandler & Himmelstein, 1991). In a complicated health care system where the rules are many and economic forces drive both structure and function, the needs of vulnerable populations inevitably suffer. This chapter explores the consequences of these market forces on a vulnerable population--Latinos …

Tweeting And Treating: How Hospitals Use Twitter To Improve Care, Christian Gomes, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: Hospitals that have adopted Twitter primarily use it to share organizational news, provide general healthcare information, advertise upcoming community events, and foster networking. The purpose of this study was to explore the benefits that Twitter utilization has had in improving quality of care, access to care, patient satisfaction, and community footprint while assessing the barriers to its implementation. Methodology: The methodology used in this study was a qualitative study with a semi structure interview combined with a literature review which followed the basic principles of a systematic review. Results: The utilization of Twitter by hospitals suggest that it leads …

Benefits And Barriers Of Implementation And Utilization Of Radio-Frequency Identification (Rfid) Systems In Transfusion Medicine, Alberto Coustasse, Brian Cunningham, Stacie Deslich, Eric Wison, Pamela Meadows

Alberto Coustasse, DrPH, MD, MBA, MPH

Radio-frequency identification (RFID) technology is used by hospital supply chains to track medical products and monitor inventories. Hospitals have also begun incorporating RFID technology as part of their transfusion processes. The purpose of this review was to analyze how healthcare organization supply chains can benefit from the utilization of RFID systems in transfusion service departments. The methodology for this study was a literature review following the steps of a systematic review with a total of 52 sources referenced. RFID technology is used to manage and track blood products from the initial donor phlebotomy to final disposition or product transfusion. RFID-enabled …

Medical Tourism: Comparing Coronary Bypass Surgery In The U.S. And Abroad, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Rising health care costs have employers searching for remedies to the increasing rates they pay for employee health insurance. The development of U.S. health insurance policies, with the option of utilizing medical tourism as a low cost care provider for treatment of cardiac coronary bypass surgery provides a method for receiving treatment. The medical tourism approach to providing treatment for bypass surgery has prompted hospitals in India, Thailand, and Singapore to seek U.S. patients. A comparison of costs for bypass treatment between the U.S. and these countries illustrates some of the issues and concerns that arise when making such comparisons. …

The American Epidemic: The U.S. Nursing Shortage And Turnover Problem, Patrick Cox, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: Nursing shortages have been on the rise throughout the country which has continued to become a problem due to an aging baby-boomer population causing increased turnover through the United States (U.S.). With this need for nurses expected to rise, determining the root causes of this problem are essential for health care providers as costs continue to grow. Methods: The methodology for the qualitative study was a literature research review of case studies as well as a semi-structured interview. Five electronic databases were minded. Thirty-six articles were utilized in this study. Results: Through the use of a conceptual framework the …

Early Mobilization In Icu Patients, Alex Hunter, Leslie Johnson, William Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: Bed rest or immobilization is frequently part of treatment for patients in the intensive care unit with critical illness. The average intensive care unit length of stay was 3.3 days and for every day spent in an intensive care unit bed, the average patient spent an additional 1.5 days in a non-intensive care unit bed. Daily costs have increased more than 30% from 2000-2005 with an average daily cost of $3518. Weaning from mechanical ventilation has been correlated with increased intensive care unit and hospital length of stay. Mechanical ventilation has been correlated with the development of intensive care …

Racial/Ethnic Differences In Exposure To Environmental Volatile Organic Compounds In The U.S. General Population: The National Health And Nutrition Examination Survey 1999–2000, Y. S. Lin, Alberto Coustasse, W. H. Ho, K. Singh, A. Arif

Alberto Coustasse, DrPH, MD, MBA, MPH

Background: Exposure to volatile organic compounds (VOCs) has been associated with many health disorders. A better understanding of unequal health risk from exposure to environmental VOCs is critical to the elimination of health disparities. Objective: The goal of this study was to investigate racial/ethnic differentials in exposure to airborne VOCs within a national sample of the U.S. population and assessed socio-demographic determinants that may contribute to these racial differences. Methods: We used data from a stratified sample of 576 participants (aged 20–59 years) who provided personal air samples for VOC measurements in the National Health and Nutrition Examination Survey (NHANES) …

Financial Advantages Of Hospitals’ Relationships With Accountable Care Organizations, David P. Paul Iii, Rodrigo Carmago, Thaisa Carmago, Stacie Deslich, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Accountable care organizations are groups of providers who agree to accept the responsibility for elevating the health status of a defined group of patients, with the goal of enabling people to take charge of their health and enroll in shared decision-making with providers. The large initial investment required (estimated at $1.8 million) to develop an ACO implies that the participation of large health care organizations, especially hospitals and health systems, is required for success. Findings of the study suggest that ACOs based in a larger hospital organizations are more likely to meet CMS criteria for formation because of financial and …

Assisted Living: Trends In Cost And Staffing, Amy Kisling, David P. Paul, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Assisted living communities (ALFs), which provide a community for residents who require assistance throughout their day, is an important part of the long-term care system in the US. Trained individuals assist residents with activities known as Activities of Daily Living (ADL). The costs of ALFs are paid either out of pocket, by Medicaid or by Long-Term Care Insurance (LTCI). Medicare does not pay for ALFs. Monthly costs of ALFs have increased over the past five years on an average of 4.1%. The major reason for this cost increase is probably the increased healthcare needs of the baby boomers generation, but …

Does Computerized Physician Order Entry Reduce Medical Errors?, Krista Charles, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: Computerized Physician Order Entry (CPOE) is a system that allows physicians to electronically order patient services. The services that can be ordered, but are not limited to include: prescriptions, labs, x-rays, and referrals. Adopting CPOE will eliminate the use of paper orders with illegible hand writing. The purpose of this research project was to examine the cause of medical errors and to determine if adopting a CPOE system would be an effective solution to this problem. Results: The results of this study show that CPOE can reduce medical errors and adverse drug events significantly. CPOE coupled with other systems …

Management Of Rfid Systems In Hospital Transfusion Services, Alberto Coustasse, Brian Cunningham, Stacie Deslich, Eric Wilson, Pamela Meadows

Alberto Coustasse, DrPH, MD, MBA, MPH

Radio Frequency Identification Devices (RFID) technology is used by hospital supply chains to track various medical products and monitor inventories. To improve overall operations, hospitals have implemented RFID as part of their supply chain processes. Hospitals have also have begun incorporating RFID technology as part of their transfusion services processes. The purpose of this review was to analyze how healthcare organization supply chains can benefit from the utilization of RFID systems in transfusion services departments. The methodology for this study was a literature review following the steps of a systematic review with a total of 51 sources referenced. RFID technology …

Medical Education, Pdas And Smartphones: Welcome To The 21st Century, David P. Paul, Nicole Moussa, Sara Asad, Brad Pershing, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

PDAs and Smartphones allow medical professionals to access medical information more easily than ever before. This literature review examines use of these devices and associated “apps” in medical education, finding widespread use by medical students, residents, and faculty. Surprisingly, little generational bias was noted.

The Business Case For The Efficiency And Effectiveness Of Tele-Intensive Care Units, David P. Paul, Deanna Bailey, Alesia Hairston, Stacie Deslich, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

A tele-Intensive Care Unit (tele-ICU) is the use of telemedicine in an Intensive Care Unit (ICU) setting, using technology to provide care to critically ill patients by off-site clinical resources. This literature review examined a large number of studies of the implementation of tele-ICU systems in hospitals. Generally, implementation of a tele-ICU system was associated with cost savings, shorter lengths of stay, and decreased mortality. Implementation of tele-ICUs is initially relatively expensive but result in cost savings and better clinical outcomes. Intensivists working these systems are used more effective providing better clinical outcomes for patients at lower costs for hospitals.

Electronic Prescribing And Its Implementation In The United States, Kate Englebert, Amber Porterfield, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: Electronic prescribing (e-prescribing) is an important part of the nation’s push to create an electronically accessible national health system. E-prescribing allows providers to send prescriptions electronically to the pharmacy and can be stand-alone systems or part of an integrated electronic health record system. Methodology: The methodology for this study was a literature review. Electronic databases accessed include EBSCOhost, PubMED, and Google Scholar. Additionally, government websites and a semi-structured interview were used. A total of 39 sources were referenced for the review. Results: The results of the literature review demonstrated that e-prescribing reduces prescribing errors, increases efficiency, and helps save …

Benefits And Barriers For Adoption Of Personal Health Records, Brittany Vance, Brent Tomblin, Jena Studney, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

A Personal Health Record (PHR) is an electronic, universally available, lifelong resource of health information maintained by individuals. There are numerous potential benefits to PHRs, including improved patient-provider relationships, increased patient empowerment, and enhanced care safety, efficiency, coordination, and quality. However, privacy, security, cost, and adoption issues have been significant barriers to implementation. The purpose of this research was to determine how the use of PHRs affects patient outcomes, as well as to analyze benefits and barriers of adoption of PHRs. The methodology for the examination of the benefits and barriers to PHR implementation was conducted following the basic principles …

Managed Care And Accountable Care Organizations, David P. Paul, Diego Arroyo, Bethany Daniel, Heather Graves, Krisitn Neal, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Managed care generally, and more specifically, accountable care organizations (ACOs) have attempted to provide coordination of patient care in order to eliminate or reduce unnecessary procedures and or test redundancy. The purpose of this research was to study the effects of managed care in accountable care organizations by decreasing health care costs by increasing efficiency in health care.

Personal Health Records: Is Rapid Adpoption Hindering Interoperability?, Jana Studeny, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The establishment of Meaningful Use criteria has created a critical need for robust interoperability. A universal definition for a Personal Health Records (PHRs) has not been agreed upon. Standardized code sets have been built for specific entities but integration between them has not been supported. The purpose of this research study was to explore the hindrance and promotion of interoperability standards in relationship to PHRs to describe interoperability progress in this area. The methodology for this study was conducted following the basic principles of a systematic review, with 61 articles used for this research study. Lagging interoperability has been stemmed …

Assessment Of Obesity As A Cardiovascular Disease Risk Factor In A Geriatric Rural Texas Community - A Six Month Follow-Up, Alberto Coustasse Md, Mba

Alberto Coustasse, DrPH, MD, MBA, MPH

Coustasse, Alberto, Assessment of Obesity as a Cardiovascular Disease Risk Factor in a Geriatric Rural Texas Community – A Six Month Follow-up. Master of Public Health Track, Public Health Administration, December 1999, 22 pp., 9 tables, 9 illustrations, bibliography, 7 titles. The health fair approach was used as a method to establish individual and population health status baselines and to provide a mechanism to follow-up with an elderly population in a rural Texas community. A controlled trial sample of forty-four seniors was initially screened in a primary care clinic in August 1998. Patients were reevaluated at six months and results …

Medicare Fraud In The United States: Can It Ever Be Stopped?, Chelsea Hill, Alex Hunter, Leslie Johnson, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The majority of the United States health care fraud has been focused on the major public program, Medicare. The yearly financial loss from Medicare fraud has been estimated at about $54 billion. The purpose of this research study was to explore the current state of Medicare fraud in the United States, identify current policies and laws that foster Medicare fraud, and determine the financial impact of Medicare fraud. The methodology for this study was a literature review. Research was conducted using a scholarly online database search and government Web sites. The number of individuals charged with criminal fraud increased from …