Health and Medical Administration Commons^™

Changes In Fundamental Frequency Of Voice In A Group Of Transwomen Following Voice Modification Therapy, Emily Marquez

Open Access Theses & Dissertations

The term transgender refers to an individual that identifies with a gender that is different to the one given at birth. Individuals that are transgender experience conflict between the gender the individual identifies with and the sex they are born with. Individuals that are transgender may elect to go through a transition process so that their outward appearance is congruent with their gender identity. Part of the transition process may include voice modification therapy. Transgender individuals may seek voice modification therapy so that the outward appearance matches the voice. However, there is limited information regarding the efficacy of traditional voice …

Perspectives Of Primary Care Physicians On Adopting Electronic Medical Records In The Atlanta, Georgia Area, Chris U. Okoro

Walden Dissertations and Doctoral Studies

Slow adoption of electronic medical records (EMR) by primary care physicians in medical office practices has not facilitated the EMR adoption process. The problem is the slow pace of EMR adoption by primary care physicians in the Atlanta, Georgia area has become a public health concern. Research regarding the lived experiences of these physicians with EMR implementation and utilization may identify reasons for the slow adoption. The purpose of this phenomenological study was to explore the lived experiences of primary care physicians, who practice in the Atlanta area, regarding their perception, successes, barriers, and urgency of adoption of EMR in …

A Causal Layered Analysis Of Assistive Technology For The Cognitively Impaired Elderly, Dariusz J. Ropiak

Walden Dissertations and Doctoral Studies

Assistive technology may delay cognitively impaired elders' need for long-term institutionalization, and the promote independence. Its use is on the rise, yet the gap between the needs of the cognitive impaired elderly and what developers of the assistive technologies design, manufacture, and implement, remains to be filled. Using Inayatullah's 6-pillar approach, as the guide to the future of assistive technology, the purpose of this qualitative study was to explore how assistive technologies may fulfill the daily functional needs of the cognitively impaired elderly with Alzheimer's or other dementia by 2037. Data were collected from a focus group of 10 seniors …

Strategies For Shipping Temperature-Sensitive Medical Devices Using Cognitive Mapping, Eric C. Guynes

Walden Dissertations and Doctoral Studies

Supply chain management (SCM) practitioners who ship temperature-sensitive diagnostic medical devices (DMDs) to clinicians must use effective cold chain management (CCM) strategies to avoid temperature excursions that contribute to medical device errors. Such errors have caused patient harm and death, which costs the U.S. health care system billions of dollars per year. The purpose of this qualitative multiple case study was to explore strategies for selecting and managing cold chain shipping solutions (CCSSs) requiring SCM executives to trade cost for regulatory compliance and predictability when mitigating temperature variations that occur during shipping. The conceptual framework for the study was the …

Examining The Relationship Between Organizational Climate And Organizational Citizenship Behaviors Within Hospitals, Michelle Christine Maus

Walden Dissertations and Doctoral Studies

Members of the healthcare industry have not fully understood organizational climate factors that enhance organizational citizenship behaviors (OCBs). This lack of understanding can result in negative patient outcomes. The purpose of this cross-sectional quantitative study was to examine the relationships between organizational climate factors and OCBs of employees at hospitals via person-organization fit theory. More, specifically, the purpose of this research was to explore (a) the relationships between organizational climate variables (i.e., welfare, autonomy, involvement, effort, training, integration, and supervisory support) and OCBs (n = 218), (b) differences in OCB scores between hospital leaders (n = 72) and followers (n …

Reducing Sepsis Mortality: A Cloud-Based Alert Approach, Janet A. Zink

Theses and Dissertations

The aim of this study is to examine the impact of a cloud-based CDS alerting system for SIRS, a precursor to sepsis, and sepsis itself, on adult patient and process outcomes at VCU Health System. The two main hypotheses are: 1) the implementation of cloud-based SIRS and sepsis alerts will lead to lower sepsis-related mortality and lower average length of stay, and 2) the implementation of cloud-based SIRS and sepsis alerts will lead to more frequent ordering of the Sepsis PowerPlan and more recording of sepsis diagnoses. To measure these outcomes, a pre-post study was conducted. A pre-implementation group diagnosed …

A Comparison Of Quality Indicators Between Medicare Accountable Care Organizations And Health Maintenance Organizations Using Publicly Available Data, William W. Campbell Iii

Theses and Dissertations

The purpose of this study is to explore differences in quality between Medicare Accountable Care Organizations (ACO) and Health Maintenance Organizations (HMO). Three outcomes measures reported by these plans use different methodologies but possess enough alignment to permit comparison: percent of diabetic patients with last HbA1c > 9.0%, colon cancer screening rate and ER visits per 1,000. These outcomes are the dependent variables (DV). A secondary purpose is to explore differences in quality based on the size of the beneficiary population served, using the same measures.

As the Medicare program faces threats to its solvency in coming decades, with 10,000 baby …

Advanced Practice Nurse Intervention And Heart Failure Readmissions, Tanesha Kemble

Walden Dissertations and Doctoral Studies

Heart failure (HF) is one of the main reasons for hospitalizations and readmissions. A local hospital collaborated with a skilled nursing facility (SNF) in 2012 with the goal of reducing systolic HF readmissions. This collaboration consisted of having an Advanced Practice Nurse (APN) who specializes in cardiac care follow up with all patients discharged from the hospital to the SNF with a diagnosis of systolic HF. The practice-focused question for this project addressed whether early follow-up and continuity of care by a cardiac APN would decrease hospital readmission within 30 days in patients with systolic HF who are discharged to …

Hospital Executive Succession Planning Strategies, Janet Tingling

Walden Dissertations and Doctoral Studies

Approximately 50% of New York City hospitals lack succession planning as baby boomers transition out of the workforce into retirement. The potential loss of knowledge capital could affect leadership development and corporate stability. Guided by the transformational leadership theory, the purpose of this single site case study was to explore successful strategies executive-level leaders used to facilitate succession planning within their hospital. Three hospital executive-level leaders from a single site location participated in a semistructured face-to-face interview and provided data that assisted the analysis. Four themes emerged from the data analysis through a word cloud format that showed the most …

Increasing The Value Of Medicare Annual Wellness Visits For Patients And Providers, Stephanie Hope Turner

Walden Dissertations and Doctoral Studies

The Medicare Annual Wellness Visit (AWV) has been available to Medicare beneficiaries since 2005; however, most eligible individuals have not taken advantage of this benefit. The literature supports that patients are willing to schedule and complete an AWV if urged to do so by their primary care provider; however, providers are reluctant to advise patients to pursue the AWV due to the lack of perceived value and overall health benefit. The integrative theory of health behavior change was used as the theoretical framework for the project. By increasing patient self-management skills through education, engagement, and support, the project was designed …

Nigerian Hospital-Based Interprofessional Collaborative Patterns And Organizational Implications, Osaeloka Christiandolus Ekwueme

Walden Dissertations and Doctoral Studies

Interprofessional collaboration is recognized as the innovative, evidence-based strategy that strengthens health systems and improves performance and health outcomes. While resource-rich countries have benefited much from the implementation of this initiative, literature is scarce regarding sub-Sahara Africa. This quantitative cross-sectional descriptive study described the extent of interprofessional collaborative practice at the tertiary care level in Nigeria and its implications on patient health outcomes, professionals' performance, satisfaction, and healthy practice environment. The relational coordination theory (RCT) provided the conceptual framework for the study. Key research questions were on the association between the extents of interprofessional practice and each of the outcome …

Reducing Clabsi Rate Among Icu Patients, Rita L. Walker

Walden Dissertations and Doctoral Studies

Approximately 55% of intensive care unit (ICU) patients require the use of a central venous catheter (CVC). CVCs are often an essential component of care; however, CVCs can create avenues for pathogens to enter the bloodstream and cause a central line-associated bloodstream infections (CLABSI), which can lead to increased mortality and morbidity, prolonged length of stay, increased cost of care, decreased patient satisfaction, and increased workload. In 2017, the CLABSI rate at the project site was 4.3 per 1,000 catheter days as compared to the national rate of 0.8 per 1,000 catheter days. Based on Piaget's theory of constructivism, a …

Exploring Student-Led Interprofessional Education Through A Community Service Project, Lindsay Ann Doerschuk

EWU Masters Thesis Collection

Purpose: The purpose of this research was to explore the effectiveness of a student-led interprofessional education (IPE) workshop in improving student attitudes and perceptions toward IPE. Students from four health science programs including Dental Hygiene, Communication Sciences and Disorders/Speech and Hearing, Health Services Administration and Occupational Therapy participated in a community service event. Students provided screenings to veteran patients including a health history intake, hearing test, and sleep screening while other students observed.

Methods: Students were asked to attend an orientation, the Vets Day IPE workshop, and a debrief session. This mixed methods approach study utilized the Readiness for Interprofessional …

Implementation Of A Diabetic Resource Toolkit In A Veterans Administration Emergency Department, Caroline Hairston

Walden Dissertations and Doctoral Studies

Diabetes is the 7th leading cause of death in the United States. Uncontrolled diabetes and lack of self-care knowledge leads to increased emergency department (ED) visits, utilizing limited health care resources. The practice-focused question asked whether a patient-focused diabetic self-care toolkit could decrease the number of diabetes-related ED visits. The purpose of this project was to reduce the number of diabetes-related ED visits and was supported by the social cognitive theory. The sources of evidence included the facility's ED Information System (EDIS) data and a patient survey developed by the project lead. There were 149 participants (135 males and 14 …

Catheter-Associated Urinary Tract Infection In New York And North Carolina, Kehinde O. Abiodun

Walden Dissertations and Doctoral Studies

In the United States, many hospitalized patients with indwelling urinary catheters acquire catheter-associated urinary tract infections (CAUTI) during their hospital stay. CAUTI negatively affects peoples' health and quality of life and causes a financial burden to individuals and the nation. The purpose of this quantitative cross-sectional study was to explore the relationship between gender, age, and hospital types and CAUTI incidence in New York and North Carolina over a 3-year period. The theoretical framework of choice was the Donabedian model. Simple logistic regression and hierarchical multivariable logistic regression analysis were performed on archival data that was requested from Healthcare Cost …

Strategies To Prevent And Reduce Medical Identity Theft Resulting In Medical Fraud, Junior V. Clement

Walden Dissertations and Doctoral Studies

Medical identity fraud is a byproduct of identity theft; it enables imposters to procure medical treatment, thus defrauding patients, insurers, and government programs through forged prescriptions, falsified medical records, and misuse of victim's health insurance. In 2014, for example, the United States Government lost $14.1 billion in improper payments. The purpose of this multiple case study, grounded by the Health Insurance Portability and Accountability Act as the conceptual framework, was to explore the strategies 5 healthcare leaders used to prevent identity theft and medical identity fraud and thus improve business performance in the state of New York. Data were collected …

Chronic Care Management Services At A Clinical Medical Group, Sharon Guccione

Walden Dissertations and Doctoral Studies

The purpose of this project was to design a chronic care plan using the chronic care management (CCM) framework to improve health services at lower healthcare costs. The practice-focused question explored whether the operationalization of the CCM model would impact progress toward the management of chronic illness for the target population of Medicare beneficiaries with 2 or more chronic illnesses in an urban acute care agency located in the western United States. The middle-range theory, logic rational plan model, Lewin’s change theory, and the CCM’s coordination care and collaborative care concepts were used to guide the project. Data were collected …

Financial Strategies And Initiatives For Preventing Rural Hospital Closure, Chinue Uecker

Walden Dissertations and Doctoral Studies

In the United States, rural hospital closures increased 34% since 2015 due to financial reasons, affecting access to healthcare services in rural communities. For rural hospital leaders, improving the hospital's financial performance is a valuable strategic goal. This multiple case study was designed to explore strategies that rural hospital leaders implement to improve their hospital's financial performance in Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, and the United States Virgin Islands. The strategic decision-making framework supported the study because top leaders make decisions that affect the organization's health and survival. Fifteen rural hospital leaders who maintain their hospital's financial stability provided hospital …

Impact Of Empowerment And Autonomy On The Nursing Director's Intent To Stay, Tiffany Bergquist

Walden Dissertations and Doctoral Studies

Retention of nursing directors is important to the viability and success of the healthcare industry because they have a large impact on nursing job satisfaction, overall retention of nurses in an institution, productivity, and patient outcomes. Factors that retain nurse directors, such as autonomy and empowerment, appear to be important to job satisfaction, but there is little in the current research to corroborate these findings. The purpose of this quantitative study was to determine what factors impact nursing directors' intent to stay in their current role and what effect role autonomy and empowerment have on their intent to stay as …

Development Of A Staff Education Module On Adolescent Obesity, Deborah Ann Stallworth

Walden Dissertations and Doctoral Studies

Adolescent obesity is a growing health concern in the United States due to its increasing prevalence and comorbidities that can reduce longevity and increase morbidity. Advanced practice nurses (APNs) providing care in school-based health centers (SBHC) located in marginalized communities are uniquely positioned to work with adolescent students challenged with obesity. The management of adolescent obesity requires advanced skills and knowledge to promote healthy lifestyles, prevent obesity, and to directly address the many factors that contribute to the condition. The purpose of this project was to develop an education program for APNs to prepare them to work with students in …

The Survival Of Healthcare In Rural Texas, Destin Cook

Walden Dissertations and Doctoral Studies

Over 80 rural hospitals have closed in the United States since 2010, representing about half of all hospital closures during this period, and another 600-700 rural hospitals are at risk of closing shortly. The purpose of this qualitative exploratory multiple case study, which was based on transformational leadership and diffusion of innovation theories, was to gain a common understanding of financial problems and operational inefficiencies that may be impacting rural hospital leaders in the state of Texas. Data collection involved semi-structured interviews with 4 senior healthcare leaders from 3 separate regions in Texas. Data analysis included compiling, sorting, fragmenting, and …

Evaluation Of The Effectiveness Of An Established Glycemic Monitoring Program In A High School Setting For Adolescents With Type I And Type Ii Diabetes Mellitus, Tabatha Lee Obeda

Walden Dissertations and Doctoral Studies

Adolescents with Type I and Type II diabetes need to monitor blood glucose and food intake, administer insulin, and participate in activities including physical education during school hours to maintain glycemic control. Glycemic management programs (GMPs) exist for the improvement of diabetes management during school hours. The purpose of this project was to evaluate a GMP in a school system in a rural area in the Southeastern United States. The goal was to determine if the existing GMP met objectives and to make recommendations for continuation, revision, or discontinuation of the GMP. The logic model provided the basic framework for …

Strategies For Sustaining Small Businesses In The U.S. Health Care Sector, James Utobunwa Nwachukwu

Walden Dissertations and Doctoral Studies

In the United States, many small businesses fail within the first 5 years due to poor implementation of sustainability strategies. Researchers and business practitioners have indicated that small business owners face challenges on how to maintain their businesses beyond 5 years due to lack of sustainability strategies. The purpose of this qualitative multiple case study was to explore the strategies that health care small business owners and managers in New York State use to maintain their businesses beyond 5 years. Sustainability development theory was used for the study's conceptual framework. Semistructured face-to-face interviews were conducted with 6 purposively-selected participants who …

Strategies For Developing And Implementing Information Technology Systems For Ehrs, Priscilla Riddley

Walden Dissertations and Doctoral Studies

Some hospital leaders lack the technical expertise to implement electronic health records (EHRs) even though the healthcare industry has a government mandate. The purpose of this single case study was to explore strategies healthcare executives use to develop and implement information technology systems for processing EHRs. The target population consisted of healthcare leaders and managers successful in implementing EHR systems in a healthcare organization. Lewin's 3-step change theory was used as the conceptual framework for this study with data collected from observations (5), semistructured interviews (5), and organizational documents. Descriptive coding was used to identify 3 themes that emerged from …

Strategies For Improving Healthcare Efficiency While Reducing Costs, Jean Calvin Tchatchoua

Walden Dissertations and Doctoral Studies

In comparison to the European healthcare system, the U.S. healthcare system has lower quality care, higher costs, and covers a smaller percentage of the population. Despite the high costs, the U.S. healthcare system remains dysfunctional. The purpose of this exploratory single case study was to identify the strategies that some healthcare managers in a hospital setting in the midwestern region of the United States use to improve efficiency while decreasing healthcare costs. Complex adaptive systems theory was used to frame this study that included face-to-face interviews with 6 highly experienced healthcare managers. Data were collected from audio recorded interviews and …

Low-Income Uninsured Perceptions, Beliefs, And Level Of Knowledge Concerning Primary Care Services, Pamela Ann Brown

Walden Dissertations and Doctoral Studies

In the United States, there is an issue with low-income uninsured patients using emergency services for nonurgent conditions instead of using primary care services. Primary care services are more beneficial than emergency services for such patients, in that they can receive continual or follow-up care through primary care and thus achieve better health outcomes over the long term. Though information is available concerning factors in (or the rationale for) low-income uninsured patients choosing the emergency department (ED) instead of primary services for nonurgent conditions, research focusing on low-income uninsured patients' perspectives, beliefs, and level of knowledge about this matter is …

Determining Perceived Barriers Affecting Physicians' Readiness To Disclose Major Medical Errors, Jean-Pierre K. Folligah

Walden Dissertations and Doctoral Studies

Medical errors have been detrimental in the field of medicine. They have impacted both patients and doctors. While physicians recognized that error disclosure was an ethical and professional obligation, most remained silent when mistakes happened for different reasons. Guided by the theory of planned behavior and Kant's deontological theory, the purpose of this quantitative study was to investigate the perceived barriers affecting physicians' willingness to report major medical errors. An association was tested between the independent variables physician fear of disclosure of errors, organizational culture toward patient safety, physician apology, professional ethics and transparency, physician education, and the dependent variable …

Family Relational Experiences During Major Transitions With A Chronic Illness, Juanita Sibayan

Walden Dissertations and Doctoral Studies

Although health care transitions have received some attention in the literature, few researchers have emphasized family relational experiences and communication during major changes while living with a chronic illness. The purpose of this phenomenological study was to understand the lived experience of parents and their adult children while transitioning from pediatric to adult care of a chronic illness. The bio-psychosocial theory, family systems theory, and attachment theory established the context for this study. A criterion-based sampling technique and snowball sampling were used to recruit 7 parents and 6 of their adult children aged 18 to 30 years who were diagnosed …

The Impact Of Diabetes And Obesity In The African American Population, Andrea Lynette Swails

Walden Dissertations and Doctoral Studies

Within the 21st century, Type II diabetes has emerged as a public health crisis. African Americans and Hispanic Americans have the highest rates of Type II diabetes and obesity compared to European Americans. The purpose of this DNP project was to teach medical assistants (MA) to provide self-management of diabetes and obesity for the African American population in the local clinical setting. An educational tool kit for health providers was developed to guide the educational project. The chronic care model was used to guide the development of the educational toolkit. A pretest posttest design was incorporated into the educational program. …

Public Health Strategies For Strengthening Prehospital Injury Responses In St. Lucia, Delwin Oliver Ferguson

Walden Dissertations and Doctoral Studies

Traumatic injuries have steadily increased during the last two decades, affecting over 5.8 million persons annually and have become a global public health issue. Since 2008, 80% of all deaths from noncommunicable diseases and trauma, approximately 29 million occurred in developing countries. Sixteen thousand young adults worldwide have died due to traumatic injuries. Additionally, injuries account for over 15% of the global burden of diseases, with approximately 90% of these injuries occurring in developing countries like St. Lucia. The purpose of this qualitative descriptive study was to examine policy gaps in prehospital traumatic injury responses and explore implementing Essential Public …