Health and Medical Administration Commons^™

Improving Adherence To Mental Health Treatment In A Low-Income Clinic, Janice G. Gandy

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The increasing prevalence of mental illness in the United States presents significant challenges for primary care providers in low-income settings. Integrated Behavioral Health (IBH) programs have resulted in improved general health for low-income participants; however, managing appointment adherence, in which the patient attends appointment as scheduled, is particularly challenging. The purpose of this pilot project was to implement bundled interventions at a low-income primary care clinic to improve patient adherence to behavioral health treatment. The bundle of interventions included: 1) educational interventions emphasizing the benefits of IBH care 2) warm patient handoffs between the primary care provider to a behavioral …

Mental Hell, Jesenia De Moya, Hanaa' Tameez, Maritza Villela

Capstones

Mental Hell explores how difficult it is for low-income Latinos in New York City to access mental health care. Through explanations from experts and the personal stories of three Latinas New Yorkers who have gone through the process of trying to get the care they need, the story guides the reader through the many roadblocks this demographic encounters specifically under the insurance of Medicaid.

This is an extremely important topic that affects many New Yorkers, and we believe something needs to be done to make this type of healthcare more accessible for Latinos. New York City has a very high …

Effectiveness Of An Open Access Scheduling System In A Community Mental Health Center, Callie Crockett

Doctoral Projects

Abstract

Open Access Schedule (OAS) systems are a new way to schedule patient appointment in an outpatient medical setting. In theory these systems will provide many benefits that are not seen in a traditional scheduling model, such as decreased wait times to see a provider and more provider flexibility. However, little research has been done to examine how effective these systems are once they are put into practice, particularly in the mental health setting. The purpose of this project was to examine a recently implemented open access scheduling system in a community mental health center in rural Northeast Tennessee and …

Exercise, Cognition, And The Aging Process Among Active, Competitive, And Sedentary Middle-Aged And Older Adults, Katherine Adams

Health, Human Performance and Recreation Undergraduate Honors Theses

Purpose This study aimed to compare the cognitive measures of reaction time and dual-task performance among recreationally active, master athletes, and sedentary older adults aged 50 years or older. Methods 59 late middle-aged and older adults between the ages of 50 to 88 years old participated in reaction time and dual-task tests of which consisted of multiple trials on the same day. Subjects were placed either into the recreationally active, masters athlete, or sedentary activity level group based on the Rapid Assessment of Physical Activity (RAPA) form. For the gait speed with associated dual-task component, subjects walked 10-meters at two …

Improving Service Delivery Through Provider Training: A Process Evaluation Of The Veterans Affairs Palo Alto Health Care System “Commitment To Serve” Workshop, Ismael Barrera

Master's Projects

As the customer-focused management strategies gradually advances into all of the VISNs [Veterans Integrated Service Networks], the Veterans Health Administration in Palo Alto, California implemented a customer service training program for employees to meet the diverse and complex needs of its customers. This research will analyze whether participants in this training, known as Commitment to SERVE, believe that it is achieving its goal. In other words, does the Veterans Affairs Palo Alto Health Care System (VAPAHCS) staff perceive the Commitment to SERVE workshop as a beneficial customer service training program?

Nonprofit Hospital Community Benefit Requirements: An Exploration Of National Health Policy Models, Justin P. Swearingen

Dissertations and Theses

Introduction: Nonprofit hospital organizations are public charities with complete tax immunity. Such exemptions are worth $24.6 billion and impact the health of hundreds of millions of people, yet what these charities must do to meet the current “community benefit standard” to maintain their tax-exempt status remains a policy debate. To help inform policymaking, an evaluation of four national requirement models was performed: Tax Value Requirement (at least the value of the tax exemptions must be spent on community benefit), Grassley Requirement (at least 5% of revenue must be spent on community benefit), Expense Requirement (at least 3% of expenses must …

Evaluation Of A Scientifically Developed Anesthesiology Handoff Protocol, Kristen Lise Welsh Webster

Doctoral Dissertations and Master's Theses

Communication failures have been cited as the leading cause of avoidable adverse events in healthcare. Specifically, within handoffs, these communication failures can cause error in the transfer of patient information. A multitude of factors can affect the transmission of patient information between providers including transactive memory, power distance, and conversational noise; however, literature suggests that the use of handoff protocols assist in improving communication and efficiency during handoffs. Studies regarding handoffs have typically centered on the content or delivery of the information during the handoff. To date, none have targeted the underlying mechanisms of the communication and their effects on …

Analyzing The Effectiviness Of A Prescription Drug Monitoring Program Targeting At-Risk Opioid Abuse Patients, Treadway Childs

Public Administration ETDs

The effectiveness of a prescription drug monitoring program in coordination with a prescription opioid recidivism program was examined at a semi-rural community hospital. Patients were identified by a multi-disciplinary committee to be at-risk for opioid misuse or abuse, and were denied prescription opioids. Patients were considered eligible for the program if they had over 12 emergency department visits in the previous 12 months, or 6 visits in the previous 6 months, depending on how long the hospital had records on a patient. Patients who were placed in the prescription opioid recidivism program could not receive opioids at this hospital. The …

The Role Of The Clinical Nurse Leader In Reintroducing And Sustaining A Successful Cancer Risk Assessment Program In A Community Hospital Setting, Tiffany Gishizky

Master's Projects and Capstones

Abstract

The goal of implementing a comprehensive cancer risk assessment (CRA) program prompted the evaluation of a community-based breast center microsystem and previous CRA program for feasibility and sustainability. The development of a value proposition by the Clinical Nurse Leader student highlights the role in the advancement of the nursing profession as an interdisciplinary leader. Review of current literature facilitated development of program structure and identification of downstream revenue sources. Data analysis includes historical patient volume, screening and procedural reimbursement rates, population statistics and organization market share, and program financial impacts. Data synthesis reveals a CRA program demonstrates potential revenue …

Business Intelligence Competencies: Making Healthcare Data Come Alive, Christina Bivona-Tellez

Doctor of Nursing Practice (DNP) Projects

Business Intelligence Competencies: Making Healthcare Data Come Alive While a wealth of healthcare related data exists, nurse leaders (NL) have yet to understand its implications and adopt analytical skills to lead in the transformation of care delivery. Information science is at a new frontier for nursing to embrace. It is critical for nursing leadership to advance and support business intelligence (BI) and interactive data visualization (IDV) skills across the organization and advocate for greater engagement of nurses in health system decision making. With these new tools and competencies, nursing and other health professions can innovate best practices, providing enhanced quality, …

Readiness For Improving Safe Care Delivery Through Web-Based Hospital Nurse Scheduling & Staffing Technology: A Multi-Hospital Approach, Lisa Massarweh

Doctor of Nursing Practice (DNP) Projects

Hospital scheduling and staffing practices are linked to patient safety, nurse satisfaction, and cost outcomes (Steege & Rainbow, 2017). Staffing, while complex, is ultimately central to the overall success of the hospital. Demands to eliminate events that cause death or serious harm, produce high patient satisfaction scores while maximizing workforce productivity, test any administrator’s skillset. Providing qualified staff in the right place at the right time can be challenged by restrictive union contracts, variable patient acuities, staff attendance, and mandated staffing ratios. These demands may lead to overtime utilization. There is a growing understanding of the negative effects of healthcare …

Evaluating Effective Communication Methods: Improving Internal Communication, Amber L. Suthers

Electronic Theses and Dissertations

Relaying information from a Chief Communications Officer (CIO), or centralized communications departments to hospital employees is not always efficient or effective. Employees may not be informed of important changes to department protocols or hospital policies. The purpose of the study was to determine the most efficient and effective forms of internal communications in the hospital setting.

A total of 83 surveys were mailed to communication officers working in Tennessee hospitals in and east of Nashville. Sixteen communication officers responded. This low response rate may be attributed to poor designation of communication responsibilities and an abdication of responsibilities to an off …

Comparing Total Expenditures By Source Of Long-Term Services And Supports., Maresa R. Corder

Electronic Theses and Dissertations

This study compares total expenditures between beneficiaries enrolled in traditional Long-Term Care (LTC) and beneficiaries enrolled in Home and Community Based Services (HCBS) in a Quasi-Experimental Simple Ex Post Facto study utilizing multiple linear regression with inverted propensity score weighting. The results demonstrated, during the two years of the study period, that total expenditures were on average $14,565.03 (with a p-value oflessfor the total two years of the study, for HCBS beneficiaries when compared to their LTC counterparts. There remains today a belief that expenditures of elderly, dual beneficiaries electing to age-in-place for supported self-care expend less than that of …

The Evaluation Of The Effects Of The Use Of The Palliative Care Diagnosis Code On Risk-Adjusted Mortality And Hospital Ranking In Patients With Severe Sepsis, Renee D. Donohoe

Pharmaceutical Sciences ETDs

Background: The International Classification of Diseases, Ninth-Revision-Clinical Modification (ICD-9-CM) for palliative care (V66.7) has been shown to affect risk-adjusted mortality rates. This code can increase the risk of mortality when included in billing data and incorporated into risk-adjustment models (1).

Objectives: The purpose of this study is to examine variations in coding between high-performing (low mortality indices (Observed/Expected)) and low-performing (high mortality indices) hospitals by examining the use of the ICD-9-CM code for palliative care; coding of severe sepsis; and assignment of higher-weighted Medicare-Severity Diagnosis Related Group (MS-DRG) codes.

Methods: Data were obtained from the Vizient™ Clinical Database/Resource Manager (CBD/RM) …

The Design Of A Patient-Centric Healthcare Facility Rating Website: Consumer Choice As A Tool For Reform, Christopher August Dicapua

Honors Theses

The U.S. healthcare system consistently underperforms on crucial international comparisons, thereby highlighting the need for reform. Simultaneously, there exists bipartisan and strong cultural support for patient choice; i.e. the ability of patients to assess the quality of healthcare facilities and choose amongst competing options. However, prior literature suggests that patients struggle to choose amongst competing facilities due to perceived competency barriers and insufficient information. In this two-phased thesis project, I abstracted a model for mobilizing patient choice as a tool for healthcare reform by designing a website which presents government data on healthcare facility performance. First, three types of focus …

Cancer Center Regional Benchmarks For Psychosocial Care, Desiree R. Azizoddin

Loma Linda University Electronic Theses, Dissertations & Projects

The American College of Surgeons (ACoS) Commissions on Cancer (CoC) formulated and implemented standard 3.2 for Psychosocial Distress Screening. This standard requires that all accredited cancer centers evaluate psychosocial distress and provide appropriate triage and intervention for all cancer patients. Over the past decade, Loma Linda University Medical Oncology Center (LLUMOC) administration, physicians, nurses, psychosocial care staff, and chaplaincy collaborated to implement a psychosocial screening and referral program throughout cancer patient services. This current research includes qualitative analysis assessing strengths and barriers of the psychosocial program at LLUMOC from the perspective of LLUMOC providers and two directors of Supportive Care …

Physician Orders For Life-Sustaining Treatment (Polst) Utilization In A Skilled Nursing Facility: An Educational Quality Initiative, Ryan Hazley Bsn, Rn, Dnp Student, Karl Steinberg Md, Cmd, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

According to expert reports and recent research, frequent clinician-patient conversations about individual end-of-life preferences are necessary to avoid unwanted treatment and to ensure that desired treatments are received. The ongoing diffusion of Physician Orders for Life-Sustaining Treatment (POLST) educational initiatives in skilled nursing facilities (SNFs) are vital to success of California’s POLST program, which is now recognized as only 1 of 3 mature POLST programs in the country. The purpose of this evidence-based practice project was to answer the question: Among staff in a skilled nursing facility, does implementing a formal POLST education program compared to current practice improve staff …

Process Improvement Manual: Front And Back Office, Hafsah Badar

Master's Projects and Capstones

The global aim of this project is to decrease variations and improve efficiency in the tasks assigned to the support staff at an outpatient breast clinic. The breast center has a five-person administrative team who rotate through four positions monthly. The specific aim is by May 1, 2017, 100% of the five employees will have a comprehensive knowledge of their role, and adhere to a standardized way of completing tasks. The CNL Leadership themes used were Educator, Team Leader Manager, and Outcomes Manager. Informative interviews were conducted with the staff to gauge the unique needs of the team. 100% of …

Nursing Assignments Based On Patient Acuity: The Road To Nursing Job Satisfaction, Kristina Tomic

Evidence-Based Practice Project Reports

Challenges in the healthcare industry, including nursing shortages and low nursing retention, have resulted in nurses’ job dissatisfaction. Improving work environment and workload can lead to improved and equitable nursing shift assignments, which may improve nursing job satisfaction. The purpose of this EBP project was to (a) implement a patient acuity tool in the hospital unit, (b) assess its effectiveness in appropriating nursing shift assignments, and (c) evaluate its effect on nursing job satisfaction. The Evidence Based Medicine (EBM) Model was used as a guide to facilitate the transition of the best evidence into practice. As suggested within the evidence, …

Transitional Care For Older Adults With Dementia: Variation Across Patients And Providers, Patricia Prusaczyk

Arts & Sciences Electronic Theses and Dissertations

Older adults with dementia are particularly vulnerable to negative outcomes and adverse events when they transition between healthcare settings such as being discharged from the hospital. However, little is known about how healthcare providers help patients prepare for a care transition – known as transitional care – among older adults with dementia. Therefore, this study sought to understand the transitional care currently delivered by hospital healthcare providers to older adults with dementia, how it compared to that received by older adults without dementia, and how it varied across different patient and provider characteristics. Guided by key provider/informant interviews and theory, …

The Effect Of Bundled Interventions On Prevention Of Hospital Acquired Clostridium Difficile Infection, Kaitlin Kendys

Evidence-Based Practice Project Reports

Clostridium difficile infection (CDI) rates have steadily increased in hospitalized patients due to the change in epidemiology. Approximately 13 of every 1,000 inpatients are either infected or colonized with C. difficile (CDC, 2013). CDI rates continue to rise due to the hyper-virulent strain of C. difficile and length of therapy needed to treat CDI. The average cost for a single inpatient CDI is more than $35,000, and the estimated annual cost burden for the healthcare system exceeds $3 billion (Walsh, 2012). The purpose of this evidence-based project (EBP) was to reduce hospital-acquired CDI rates over a 3-month period-oftime from November …

Combating Workplace Violence: An Evidence Based Initiative, Diana L. Giordano

Evidence-Based Practice Project Reports

Patient/visitor violence against healthcare (HC) employees is a type of workplace violence (WPV) and considered a dangerous hazard within HC occupations (Bureau of Labor Statistics, 2015). Lack of recognition of the true incidence and underreporting of WPV may contribute to a false sense of security within a HC facility (HCF). Therefore, fully addressing the problem may be met with administrative resistance, resulting in poor employee perceptions of support and commitment for a zero-violence environment. A retrospective analysis was conducted on the HCF’s online incident reports, security request calls, and data from a previously deployed WPV employee survey. The emergency department …

Text Messaging Appointment Reminders To Increase Patient Appointment Adherence Within A Prevention And Wellness Program, Janel Willingham

Graduate Theses, Dissertations, and Capstones

Abstract

Healthcare organizations want to provide quality care, decrease costs, and promote preventative services for the communities they service. Mobile health units have become an extension of many healthcare organizations and provide different types of services, such as mammography. Providing mammography and wellness exams on a mobile unit presents several challenges; appointment adherence is one of them. Mobile units typically travel to underserved areas to serve people at risk for various health conditions such as breast cancer. Breast cancer is estimated to affect over 250,000 women in the United States during 2017; women have a 1:8 lifetime risk of being …

A Meta-Analysis Of The Aftermath Of South Africa’S Apartheid On Its Health Care System, Caitlin Jaeckel

Senior Honors Projects, 2010-2019

The objective of the study was to access the possible problems of the quality of health care that whites and non-whites receive in South Africa. The research question was specific to how the residual effects of apartheid are affecting South Africa’s health care today and if citizens still feel the presence of apartheid in health care. Prior to the start of the study the researcher hypothesized that access, quality, and funding of South Africa’s health care system has not been able to recover from the effect of apartheid and South Africans still observe the effects of apartheid on an individual …

Organizational Factors Associated With Quality Perinatal Care, Lisa H. Akers

Dissertations, 2014-2019

Provisions for perinatal care are an integral part of quality healthcare and are increasingly moving to the forefront of quality care measures in the healthcare setting (Agency for Healthcare Research and Quality, 2012; National Quality Forum, 2012; & The Joint Commission, 2010). Previous literature specifically focused attention to general quality of care, but recently there has been a call for a more comprehensive approach to measuring quality in the perinatal care setting, which necessitates the need for a better understanding of what is currently being offered (Collins & Draycott, 2015). Until now the literature has remained limited on the association …

Not So Affordable Healthcare, Ashlee Charles

Honors College Theses

Rising healthcare cost in the United States has created a need to understand how a lack of healthcare coverage is decreasing women’s quality of life and leading to negative health outcomes. Though the goal of the 2010 Affordable Care Act is to give more Americans access to affordable health insurance and to reduce the growth in health care spending, it still remains unaffordable for many Americans. The purpose of this study was to identify what ecological factors impede and/or promote the quality of life for medically uninsured women. Through a focus group, participants shared information on how living without health …

Living Space : Client - Based Design For Assisted Living, Michael K. Adams

Bachelor of Architecture Theses - 5th Year

Designing an assisted living facility with the client in mind. This project aims to create a space which encourages growth and progression for its residents by focusing on community, access to nature, sunlight, open spaces, increased living space, and flex spaces.

By working with the existing community and by emphasizing a program which focuses on the physical and mental needs of the residents, this building seeks to inspire and allow the residents to pursue their passions a manner that honors who they are and what they require.

Implementation Of A Standardized Handoff During Transition Of Care From The Emergency Department To The Intensive Care Unit, Melinda Abbring

Evidence-Based Practice Project Reports

Patient safety and nursing communication are crucial to the nursing handoff during transition of care from the emergency department (ED) to the intensive care unit (ICU). The Institute of Medicine published To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm (2001) highlighting ED handoffs as a safety measure. In 2006, the Joint Commission recognized handoffs with the National Patient Safety Goal 2E. The purpose of this evidence-based practice project was to determine if implementation of a standardized handoff would improve nursing communication and patient safety during transition of care from the ED to the …

Implementation Of A Multifactorial Fall Prevention Protocol, Laura Wilkerson

Evidence-Based Practice Project Reports

According to the Joint Commission Center for Transforming Healthcare (2016), moderate to severe injuries from falls on average add 6.3 days to a hospital stay and cost approximately $14,056 per patient hospitalization. The purpose of this evidence-based practice (EBP) project was to implement a multifactorial approach to identify patients at risk for falls on admission to the orthopedic/neurosurgical unit and provide individualized interventions necessary to prevent falls. The Iowa Model of Evidence-Based Practice and Orlando’s Nursing Process Discipline facilitated the implementation of this project. A total of 45 staff members on the unit were educated on the multifactorial fall protocol …

Exploring The Association Between Patient Waiting Time, No-Shows And Overbooking Strategy To Improve Efficiency In Health Care, Cam Tu M. Nguyen

Industrial Engineering Undergraduate Honors Theses

Many primary care clinics are using overbooking as a strategy to mitigate the negative impacts on operations and performance caused by patient nonattendance of appointments, also known as “no-shows”. However, overbooking tends to increase patient waiting time and worker overtime. It is also acknowledged that patient waiting time is associated with no-show behavior, yet there is a lack of observational study to quantify the relationship. The overall goal of this research is to explore the relationships between patient waiting time, no-show behavior and overbooking strategy in terms of clinic performance. Arena® simulation software is used to create a discrete-event simulation …