Health and Medical Administration Commons^™

Building The Foundation For Equitable Diabetes Education: Examining Trust And Digital Access In Rural And Unreserved Population, Niasia Hazelton Smalls

MUSC Theses and Dissertations

Disparities in patient portal use undermine equitable chronic disease management, particularly for adults with diabetes in rural and historically underserved communities. This explanatory sequential mixed-methods study examined the associations among trust in the healthcare system and patient portal use among U.S. adults, using nationally representative data from the Health Information National Trends Survey (HINTS) 2023 (N = 3,711), supplemented by semi-structured interviews with frontline healthcare providers. Bivariate analyses revealed that adults with diabetes reported lower trust (83% vs. 86%, p = 0.003) and lower portal use (62% vs. 66%, p = 0.014) compared to those without a diagnosis. Multivariate logistic …

Facilitators And Barriers To Mobile Health Unit Implementation: A Qualitative-Dominant Mixed Methods Study Exploring Staff Perspectives And Service Outreach, Kelsey Hardin

MUSC Theses and Dissertations

Background: Health disparities are linked to rising healthcare costs in the United States, particularly related to healthcare accessibility. Mobile Health Units (MHUs) have proven to be an effective intervention in reducing barriers to healthcare services, for example, providing early access to prenatal care, thus reducing infant mortality rates. This study focused on the facilitators and barriers to implementing an MHU program, based on staff perspectives and service outreach, to improve maternal and infant health outcomes.

Methods: This study employed a qualitative-dominant mixed-methods research design. Data was collected through interviews to assess staff perspectives. Secondary data analysis of quantitative data was …

Strategic Planning Time Horizons And Hospital Performance Outcomes, David Meyer

MUSC Theses and Dissertations

Background: Despite widespread adoption of strategic planning in healthcare, empirical evidence linking strategic planning time horizons to hospital financial and quality performance outcomes remains limited. Healthcare executives invest substantial resources in strategic planning processes, yet lack evidence-based guidance on whether longer or shorter planning horizons yield enhanced financial and quality-related results.

Methods: This study employed an exploratory sequential mixed-methods design combining executive survey data with archival performance data. A REDCap survey was administered to 22 hospital CEOs, CFOs, and other C-suite executives between January and February 2026. Survey responses were matched to publicly available financial and quality performance data from …

Redesigning Outpatient Chemotherapy Scheduling: A Management Approach To Site-Integrated Operations, Dominick J. Morrone

MUSC Theses and Dissertations

Outpatient infusion centers face persistent scheduling complexity driven by variable treatment durations, coordination between clinics, pharmacy lead times, and constrained staffing. This doctoral project develops and reviews a comprehensive framework for infusion scheduling transformation that integrates workforce role redesign, site‑level communication pathways, and data‑informed workqueue governance. Using a multi‑phase case at a large cancer center as an anchor, the framework specifies responsibilities across central schedulers, on‑site teams, medical coordinators, and nursing; details communication and escalation design (secure messaging and in‑basket use); and outlines training and proficiency tiers. The project synthesizes evidence from scheduling science and time-driven activity-based costing principles to …

A Scenario Analysis Of The Impact Of H.R.1 2025 Medicaid Coverage Loss And Payment Reductions On U.S. Hospital Operating Margins, Tangee Pruitt

MUSC Theses and Dissertations

The “Big Beautiful Bill” is expected to affect the financial health of U.S. hospitals. We performed a scenario analysis using five case studies combined with national data on payer mix information to illustrate potential impact in 2027. The scenarios explored the following question: What is the expected healthcare access and economic impact of H.R.1 under three sets of assumptions: 1) loss of Medicaid coverage for 10% or more of an institution’s current patients who will then become uninsured; 2) decrease in Medicaid payments by 10% or more; 3) loss of Medicaid coverage and decrease in Medicaid payments simultaneously. We defined …

Risk Management Practices In The Healthcare Supply Chain: A Cross-Sectional Survey Of Professionals In Saudi Arabia, Maha Ghamedi

MUSC Theses and Dissertations

Healthcare supply chain disruptions threaten the quality of patient care, and can increase costs, particularly in systems reliant on global suppliers. This study examined the risk management practices of healthcare supply chain professionals in Saudi Arabia. A cross-sectional survey of 72 professionals from hospitals, regulatory agencies, and other healthcare organizations revealed that 72.2% experienced supply shortages in the past year, most often involving general medical supplies, specialty medicines, and essential medicines. The most frequently reported risks were supplier shortages, reliance on single-source suppliers, and logistics disruptions, while cybersecurity threats were rarely cited. Although 76.4% of organizations reported having formal risk …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

The Incidence Of Hospital-Acquired Pressure Injuries In The Setting Of The Changing Nursing Workforce Throughout The Covid-19 Pandemic, Jacqueline H. Jacobs

MUSC Theses and Dissertations

Background: This study examines how the experience level of Registered Nurses (RNs) has declined while the incidence of hospital-acquired pressure injuries (HAPIs) has increased from 2018 to 2022. Purpose: To evaluate the association between nurses’ experience level and patient outcomes, specifically HAPIs, on a state-by-state basis. Methods: Retrospective, observational study of Medicare patients hospitalized in 41 states using the Medicare 5% Limited Dataset. Nurse experience was measured by the date of first licensure using the Nursing Sample Survey of Registered Nurses (NSSRN). Outcomes include a comparison of the percent increase in HAPIs and change in RN experience level by state. …

The Self-Sustainability Of Federally Qualified Health Centers, Javier Vallejo

MUSC Theses and Dissertations

This exploratory data analysis examines the self-sustainability of Federally Qualified Health Centers (FQHCs) using the 2023 Uniform Data Systems (UDS) dataset, focusing on health centers' reliance on government grants as a revenue source. FQHCs provide high-quality healthcare services to medically underserved populations; today, nearly 1 out of every 11 Americans receives some form of care at an FQHC. There is widespread variability in the delivery of care amongst FQHCs. Additionally, funding and reimbursement methodologies vary across states and geographic regions. FQHCs face challenges maintaining operational efficiency amid federal funding shortfalls, shifting reimbursement methodologies, and the lingering impact of the COVID-19 …

Exploring How The Affordable Housing Market In Charleston County, South Carolina Impacts The Retention And Recruitment Of Healthcare Workers, Roger Aaron Williams

MUSC Theses and Dissertations

This dissertation explores the impact of the affordable housing market in Charleston County, South Carolina, on the retention and recruitment of healthcare workers. The study addresses the critical shortage of affordable housing and its implications for healthcare institutions, focusing on support staff such as medical assistants, certified nursing assistants, and other essential roles. Through a comprehensive survey of healthcare workers, the research identifies the extent of housing challenges, including financial strain, long commutes, and job dissatisfaction. The findings highlight the significant correlation between housing affordability and workforce stability, emphasizing the urgent need for targeted housing solutions. The dissertation reviews current …

Primary Care Physicians' Perspectives On Clinical Integration And Performance Metrics In A Medically Underserved Area., Kern Kumar

MUSC Theses and Dissertations

With the national movement toward improving population health and helping combat the rising costs in healthcare, there are still assumed challenges and barriers concerning performance among healthcare organizations that impact costs and health outcomes. The Physician Hospital Organization (PHO) site within this study has been plagued with poor performance with assumed challenges and barriers for years. In this mixed-methods study leveraging the qualitative approach to support existing data, all primary care physicians within the PHO under study were interviewed, and by following the inductive approach and thematic analysis, valuable themes arose. It was found that due to patient education lacking …

Perceptions Of Artificial Intelligence In Healthcare: A Qualitative Study Among Physicians And Nurses In Florida, Aaron Miri

MUSC Theses and Dissertations

This investigation will leverage participant focus group interviews with 32 clinicians (16 nurses / 16 physicians) to study what, if anything, is inhibiting AI adoption across the hospital. Specific physicians will be sourced across the key service lines of primary care, oncology, cardiology, behavioral health, and emergency department medicine, as these tend to be patient volume driven and thus have the maximum amount of potential for positive impact leveraging AI. Nurses in these same departments will be assessed to analyze if there is a similarity or difference between the nursing and physician AI adoption barriers.

Quantifying Trends In Hospital Administrative Costs: Examining Urban-Rural Disparities, Barriers, And Opportunities For Cost Reduction In Healthcare, Lauree Handlon

MUSC Theses and Dissertations

Administrative and general (A&G) expenses in U.S. hospitals represent a growing financial burden, accounting for 15%–30% of healthcare expenditures. Despite this impact, A&G trends remain underexamined, particularly between rural and urban hospitals. This study used Medicare Cost Report data from over 4,400 short-term acute care hospitals from 2011 to 2022, combined with qualitative interviews with hospital executives, to assess rural-urban differences in A&G expenses. Using an explanatory sequential mixed-methods design, rural hospitals were found to consistently spend a higher proportion of total expenses on A&G salaries—18% more than urban hospitals, even after adjusting for hospital and financial characteristics. Although salary-related …

Ob/Gyn Physician Perspectives On Maintenance Of Certification (Moc), Brent Bost

MUSC Theses and Dissertations

Abstract

Objective: To evaluate physician perspectives of the current maintenance of certification(MOC) activities utilized by the American Board of Obstetrics and Gynecology (ABOG).

Methods: We performed a convergent mixed methods study, using parallel quantitative and qualitative data collected via the internet plus paper surveys of a nationwide sample of Obstetrics and Gynecology (Ob/Gyn) physicians from November 12 to December 13, 2024. The questionnaire included 23 items about various aspects of maintenance of certification, physician burnout and demographics. Three open-ended questions regarding the pros and cons of MOC and recommendations for improvement were also included.

Results: Of the 5,083 requests sent, …

Healthcare Key Performance Indicators; A Dha Study In Perception And Importance By Clinical And Non-Clinical Healthcare Professionals At A Large Healthcare System, Jennifer Burchill

MUSC Theses and Dissertations

Healthcare systems in the United States are unique structures where compassion for the care of others meets the science of medicine. It is a business, but it is a business with passionate professionals who care about the health of its customers, or patients. While most businesses have one structured financial system, health care contains finance for both the business and the patient.

KPIs or Key Performance Indicators, reported by finance are usually created for revenue driven initiatives with little contact and communication with the clinical teams. KPIs are a prominent driver utilized by health systems and reimbursement agencies to measure …

The Impact Of Health Insurance Coverage On Short-Term And Long-Term Readmissions To The Emergency Department For Pediatric Patients With Asthma: A Retrospective Regression Analysis, Micheline Plantada

MUSC Theses and Dissertations

Inadequate health insurance coverage may hinder the management of asthma in children in recurrent emergency department (ED) visits in comparison to children with health care insurance. Children with asthma who do not have health insurance are at risk of not having access to primary care physicians. They may live in poorer communities, where they are more likely to encounter higher concentrations of asthma-inducing agents or factors contributing to increased healthcare utilization, resulting in increased expenditures and reduced patient outcomes.

The Impact Of Covid-19 On The Utilization Of Early Magnetic Resonance Imaging (Emri) In The Assessment Of Acute Uncomplicated Low Back Pain (Lbp) And The Subsequent Effect On Health Care Service Utilization And Patient Outcomes, Kimberly F. Radcliffe

MUSC Theses and Dissertations

OBJECTIVES: To examine changes in MRI rates between Pre-COVID-19 period (Feb-April 2019) and COVID-19 period (Feb-April 2020) among commercially insured patients aged 18-60 with a diagnosis of acute LBP, and to analyze differences in patient characteristics and outcomes between the time periods. Additionally, to examine the impact of eMRI on patient outcomes and health care costs for patients in the COVID-19 period.

DESIGN/METHODS: Using IBM® MarketScan® Commercial Database (MarketScan) we performed a quantitative pre-post comparative retrospective observational study of 117,150 total patients to examine adjusted differences in patient characteristics and rates of MRIs between time periods. We analyzed 49,020 patients …

Readmission Rates Of Mothers Experiencing Preeclampsia Or Complications After Delivery In Underserved Populations, Sadia M. Robinson

MUSC Theses and Dissertations

Hospital readmissions during pregnancy nationwide impacts maternal health outcomes elevating the risk of maternal deaths after discharge. The accessibility and affordability of necessary prenatal care is integral to the field of health across the lifespan. Socioeconomic barriers within rural locations place expecting mothers at an adverse risk of developing conditions including preeclampsia and other complications that may result in hospital readmission. Economic barriers including hospital closures, shortages of specialty healthcare providers, unstable internet access and, ease of care access on further contribute to this disparity among rural women.

A retrospective analysis was conducted using data from Health Care Cost and …

Assessing The Types Of Juvenile Detention Medical Issues: A Focus On Florida, De’Angelo L. Dean

MUSC Theses and Dissertations

The justice system for young people in the United States has been a source of worry as more people acknowledge the possible adverse outcomes of involvement in the justice system during adolescence. Involvement with law enforcement can lead to various difficulties for young people, such as heightened susceptibility to psychological problems, interruptions in their education, and reduced prospects for achievement in the future. Hence, it is crucial to understand the interplays between the health care for juveniles referred by courts or law enforcement for hospital care to identify opportunities for process and outcome improvements. The interaction between juveniles and the …

Characteristics And Patterns Of Diagnoses For Patients Admitted From And Discharged To Court Or Law Enforcement In The State Of Florida, Christopher Bridgeman

MUSC Theses and Dissertations

OBJECTIVE: The role of prison healthcare is to provide safe, high-quality, and timely healthcare for prisoners. This study examines the characteristics of patients discharged from healthcare in the nation’s third-largest prison system, the state of Florida.

METHODS: This was a study of adults (18-64) admitted from or discharged to law enforcement agencies in Florida in 2018 for healthcare in Florida hospitals. Patients were divided among distinguishable characteristics of gender, zip code, income quartile, rural/urban locality, and insurance type. Data was collected within the Office of Data Collection & Quality Assurance (DCQA) within the Florida Agency for Health Care Administration (Florida …

A Comparative Analysis Of Costs Associated With Assisted Reproductive Technology; Invitro Fertilization Of Singleton, Twin, And Multiple Gestations Compared To Non-Invitro Fertilization Singleton Gestations, Ruth Arthur-Asmah

MUSC Theses and Dissertations

This study examines IVF and non-IVF costs associated with prenatal, delivery, and postpartum care using claims data from Merative MarketScan Commercial and Encounter data from 2018-2020 to understand the costs associated with respective IVF singleton, twin, and multiple gestations, as compared to non-IVF singleton gestations. These patients identified as females at birth, were continuously enrolled in private insurance, and have not experienced termination of pregnancy. The Student T-test was performed on continuous variables, and logistic regression was performed on binary variables with the overall outcome variables being cost, IVF, and non-IVF, controlling for age. The cost data was gamma log …

Hospital Characteristics Impact On Left Without Being Seen, Anthony Roberts

MUSC Theses and Dissertations

Emergency Department (ED) care is provided to patients for urgent and life-threatening emergencies. Inefficiency and overcrowding of ED continues to be a problem for the U.S. Health systems threaten the ability to provide care for the most vulnerable patients. The inefficiency of ED and hospital throughput creates challenges in being able to provide timely and effective care for ED patients. Prolonged ED wait times can be related to the availability of ED and hospital beds, inefficiencies in the emergency department, staffing, and other factors. Timely and effective care is important to providing high-quality care and decreases the risk of serious …

Developing A Blueprint For Health Equity Programs And Investigating Interventions And Metrics, Belita Strudwick

MUSC Theses and Dissertations

Racial and ethnic minority groups and rural and low-income populations are examples of populations who continue to experience health disparities despite policy mandates to eliminate them. This doctoral project will provide a foundational blueprint to aid health plans in addressing and improving health equity internally and with external stakeholders. The blueprint will be based on research comparing the robust health equity initiatives of four states to the NCQA national guidelines. The barriers to achieving and recommendations for advancing the field of health equity by implementing and analyzing policies and data that target health disparities through improved access to quality care …

Healthcare Employees’ Perceptions On The Effects Of Internal Audits, Jeremy Mason

MUSC Theses and Dissertations

With limited research on the perceptions of internal audits, this study was

able to add more literature to the subject. The study’s aim was to survey

employee perceptions of the effects of internal audits. This study will provide organizations with results pertaining to how employees perceive the usefulness of internal audits. The study team conducted a single-site study and invited the healthcare organization's employee population to participate in the study. The survey captured 40 responses from 361 invitees (11%). The survey explored the perceptions on six categories of internal audits: Efficiency, Ethical Behavior, Effectiveness, Auidotr-Auditee Relationship Exchange, Learning from Audit, …

Virtual Visits In Routine Prenatal Care, Katrina K. Wu

MUSC Theses and Dissertations

Problem

One million pregnant persons in the United States do not receive early prenatal care or the recommended number of prenatal visits each year, and this gap in care access disproportionately affects people of color, those with lower incomes, and those living in rural communities. Telemedicine was widely utilized in prenatal care during the COVID-19 pandemic, and optimizing prenatal telemedicine has the potential to improve prenatal care access beyond the pandemic.

Purpose

This dissertation focused on examining the integration of virtual visits in routine prenatal care during the COVID-19 pandemic. The purpose of this dissertation was to:

Aim 1. Explore …

The Impact Of County Level Characteristics On Type 2 Diabetes Related Ed Utilization, Jessica Wilson

MUSC Theses and Dissertations

Approximately 90-95% of the more than 37 million American adults who are living with diabetes have type 2 diabetes. Additionally, those living in rural areas face poor health outcomes related to chronic diseases such as diabetes. The impact of factors related to social determinants of health such as the role of rurality and social vulnerability were described by examining county diabetes related Emergency Department (ED) visit rates for adults aged 18-25 living in North Carolina. No difference in county level diabetes related ED visits were observed between rural counties vs. nonrural counties in the state. However, patterns did emerge in …

A Quality Improvement Initiative To Improve Follow-Up Time And Reduce Readmissions And Emergency Department Utilization For Oncology Patients, Delaney Serfling

MUSC Theses and Dissertations

Hospitals across the nation are facing extreme challenges with overcrowding. Unplanned readmissions and emergency department use are two significant contributors to this urgent issue. Historically, oncology patients are high utilizers of emergency department services, and have elevated numbers of unplanned readmissions. This is especially true of gastrointestinal medical oncology patients. In an effort to move the needle in the right direction, an operational quality improvement initiative to decrease emergency department utilization and unplanned readmissions was conducted. This pilot project took place over a three-month period, and consisted of protecting time for advanced practice providers (APPs) and updating inefficient workflows. The …

Improving Scheduling For Diagnostic Imaging And The Effect On Hospital Revenue: An Ex Post Facto Study, Stephen Liebowitz

MUSC Theses and Dissertations

Background and Need: Outpatient diagnostic radiology can be a substantial driver for revenue growth in health systems but without proper processes in place, health systems may not be optimizing patient access within their radiology departments health systems who are having difficulty getting patients to obtain care at their departments/centers and retain loyalty (Lu et.al 2011). To evaluate radiology patient access, patient retention, and market analysis, in 2018, Berkeley Research Group, LLC (BRG) engaged with a six-hospital faith-based health system in New York State to evaluate, create, and implement a variety of different performance improvement (PI) initiatives with the goal of …

The Association Of Foreign Phi On Ame & Death, Larry Norman

MUSC Theses and Dissertations

Background: Recent data shows at least 1.5 million people are affected by adverse medication events (AME) every year. The purpose of this study is to see if increased use of FPHI is associated with lower instances of AME’s and lower mortality rates for hospitals.

Methods: Using a retrospective analysis and logistic regression, this study examines the relationship between IT use and quality. Specific metrics include AMEs and mortality rates in hospitals in the United States. Demographic data are used to control for confounders, CPT, DRG, and AHRQ questions are used as classifying variables for High IT utilization.

Results: Unadjusted rates …

Time Is Brain: How A Descriptive Analysis Of Telestroke Metrics Can Improve Program Performance, Christopher Cordero

MUSC Theses and Dissertations

In the event of an acute ischemic stroke, 1.9 million neurons are lost in the brain per minute. Since the inception of thrombolytic therapy and mechanical thrombectomy as effective tools in the treatment of acute ischemic stroke, the focal point of quality improvement in this field has become the time to treatment delivery. As rural and more interspersed environments exhibit high disability and mortality rates associated with these acute neurological conditions, inequities in timely care delivered to these patient populations persist. Limitations in access are now abated by the extension of neurologist expertise into these areas via Telestroke. This study …