Health and Medical Administration Commons^™

Association Of Maternity Care Deserts With Maternal And Pregnancy-Related Mortality, Rula Atwani, Lindsay Robbins, George Saade

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To evaluate the association between the level of maternity care access and maternal and pregnancy-related mortality.

METHODS:

This was a cross-sectional analysis of county-level data in the United States from January 2018 to December 2021. Using the level of maternity care access, we categorized counties into desert, low access, moderate access, and full access. The primary outcome of interest was maternal mortality rate per 100,000 live births. A secondary outcome was pregnancy-related mortality rate per 100,000 live births. Absolute risk differences and adjusted incidence rate ratios were calculated for maternal mortality and pregnancy-related mortality with multivariable negative binomial mixed-effects …

Generating Real-World Evidence In Early Alzheimer's Disease: Considerations For Applying The Target Trial Emulation Framework To Study The Safety Of Anti-Amyloid Therapies, Xiaojuan Li, Sonal Singh, Bahareh Rasouli, Jennifer Lyons, Noelle M. Cocoros, Richard Platt, Ivan Abi-Elias, Jerry H. Gurwitz

Department of Medicine Faculty Publications

Anti-amyloid beta monoclonal antibodies (anti-Aβ mAbs) have received approval from the US Food and Drug Administration for the treatment of patients with mild cognitive impairment or mild dementia due to Alzheimer's disease (collectively known as early AD) based on evidence from clinical trials. However, whether findings from these trials are generalizable to the real world is uncertain. We need reliable evidence on the real-world safety of these treatments to inform decision making for clinicians, patients, and caregivers. Using lecanemab as an exemplar, we outline the key considerations in designing and implementing an observational study on safety and utilization outcomes using …

Exploring The Perception Of Learning Environment Among Undergraduate Medical Students In South India – A Cross-Sectional Study, Suba A, Suma S, Shobana R, Abeetha S, Chitra M, Shruthy K M

Health Professions Education

Purpose: The term "learning environment" refers to the combined social, physical, and psychological context in which the students learn. While a dismissive environment can lead to stress and burnout, a supportive environment enhances professionalism and academic success. Students' perceptions of the medical school learning environment might vary significantly depending on their age, gender, kind of institution and based on their academic year. Comprehending the disparities in perceptions towards the educational setting related to the above said variations may aid in devising interventions that promote favourable experiences for medical students. This study aimed to assess perception of learning environment by South …

Forecasting Covid-19 Cases, Hospital Admissions, And Deaths Based On Wastewater Sars-Cov-2 Surveillance Using Gaussian Copula Time Series Marginal Regression Model, Hueiwang Anna Jeng, Norou Diawara, Cynthia Jackson, Rekha Singh, Kyle Curtis, Raul Gonzalez, David Jurgens, Sasanka Adikari

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Modeling efforts are needed to predict trends in COVID-19 cases and related health outcomes, aiding in the development of management strategies and adaptation measures. This study was conducted to assess whether the SARS-CoV-2 viral load in wastewater could serve as a predictor for forecasting COVID-19 cases, hospitalizations, and deaths using copula-based time series modeling. SARS-CoV-2 RNA load in wastewater in Chesapeake, VA, was measured using the RT-qPCR method. A Gaussian copula time series (CTS) marginal regression model, incorporating an autoregressive moving average model and Gaussian copula function, was used as a forecasting model. Wastewater SARS-CoV-2 viral loads were correlated with …

Organizational Accounting In Value-Based Care: How Are You Really Doing?, Stephanie Fischer Mba, Jennifer Stephens Do

Administration & Leadership

No abstract provided.

Icu-Length Of Stay Prediction On Electronic Health Records Using Graph Neural Networks And Homogeneous Similarity Graphs, Ahmad F. Al Musawi, Pratip Rana, Sibtanu Raha, Joshua Braunstein, William C. Sleeman Iv, Rishabh Kapoor, Preetam Ghosh

Computer Science Faculty Publications

Predicting the length of stay (LoS) is important for hospital administration, as it helps allocate proper resources, such as bed management and hospital staffing. Patients' Electronic Health Records (EHRs) contain highly relevant data for LoS prediction; however, their integration and effective use in predictive modeling for accurately estimating LoS remain challenging. To address this, we propose a homogeneous Graph Neural Network (GNN)-based framework for predicting LoS. This method employs a comprehensive data fusion strategy based on the hospital Visit-based Similarity Graph (VSG), which integrates diverse multi-modal clinical features into a coherent, homogeneous graph representation. Next, this VSG is fed into …

Increasing Special Pathogen Preparedness At A Frontline Hospital: A Quality Improvement Project, Mckenna Freed, Christa Arguinchona, Barbara Bennett-Wolcott

Articles, Abstracts, and Reports

No abstract provided.

A Worker's Struggle, Sakan Binte Imran, Shadman Mahmood Khan Pathan

Electrical & Computer Engineering Faculty Publications

[Introduction] The casualty department at Sir Salimullah Medical College Mitford Hospital was crowded, as it always was. The air smelled of antiseptics, and hurried footsteps echoed through the narrow corridors. It was another day of internship, and I had just finished checking on a patient when a nurse called me over.

“There’s a new case in Trauma. Factory worker. Severe hand injury.”

I hurried over and found a man sitting on the examination table. His face was pale, and his forehead was glistening with sweat. His right hand was wrapped in a blood-soaked cloth. His left hand trembled as he …

Satisfaction Of Excellent Service Training Participants With The Kirkpatrick Model At Alia Hospital Depok, Nur Fadilah Dewi

Jurnal Vokasi Indonesia

The study aims to improve the quality of human resources and services at Alia Hospital Depok through evaluation of training programs. The approach used is the Donald Kirkpatrick model evaluation which is a common method used in evaluating the effectiveness of training. The main problem faced by Alia Hospital Depok is the lack of evaluation conducted on the training programs that have been held. Therefore, training evaluation needs to be considered to improve the quality of human resources and services provided. The research method used is a survey by distributing questionnaires to service excellent training participants to evaluate their reactions …

Gender Disparities And Burnout Among Emergency Physicians: A Systematic Review By The World Academic Council Of Emergency Medicine-Female Leadership Academy For Medical Excellence., Suman Thakur, Vivek Chauhan, Sagar Galwankar, Fatimah Lateef, Pia Daniel, Zeynep Cakir, Katia M. Lugo, Samjhana Basnet, Busra Bildik, Siham Azahaf, Sevilay Vural, Busra H. Difyeli, Lisa Moreno-Walton

School of Medicine Faculty Publications

Background: The Female Leadership Academy for Medical Excellence, members of the World Academic Council of Emergency Medicine, conducted this systematic review, which explores gender disparities in burnout among emergency physicians (EP) using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Burnout is a critical issue in healthcare, particularly in emergency medicine where high stress and demanding work environments prevail. Methods: Following PRISMA guidelines, we searched PubMed and Epistemonikos for studies using MBI-HSS to measure burnout in EPs. Inclusion criteria encompassed peer-reviewed, English-language articles reporting burnout by sex. Data extraction focused on proportions of burnout and its subcomponents, mean scores, and odds …

Analisis Klaim Pending, Verifikasi Dan Audit Pascaklaim Jaminan Kesehatan Nasional, Anugrah Aulia Ulil Amri, Atik Nurwahyuni

Jurnal Ekonomi Kesehatan Indonesia

The implementation of Indonesia’s National Health Insurance (JKN) poses new challenges for hospitals as service providers. Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, the program’s administrator, now routinely conducts post-claim verifications and audits after claims have been paid. This often results in claim adjustments or even full reversals of previously reimbursed amounts. This case study examines JKN claim management at a Type D General Hospital in 2022, focusing on pending claims, verification, and post-claim audits, using a systems theory framework. Key issues in pending claims include incomplete medical records (29%), insufficient supporting documents (24%), and coding errors (21%). Post-claim problems primarily …

The Role Of Social Health Insurance In Achieving Universal Health Coverage In Asia: A Systematic Review, Afaf Jauhar, Mardiati Nadjib

Jurnal Ekonomi Kesehatan Indonesia

Universal Health Coverage (UHC) aims to ensure that all individuals have access to essential health services without financial hardship. Social Health Insurance (SHI) is critical in achieving this goal, especially in low- and middle-income countries. This systematic review explores the role of SHI systems in advancing UHC across 14 Asian countries, focusing on healthcare access, financial protection, and equity. A comprehensive search across PubMed, Scopus, and ScienceDirect identified 768 articles, and 37 studies were selected after screening, following the PRISMA guidelines. The chosen studies cover countries with varying SHI models across Asia. The findings reveal that high-income countries such as …

Letter To "Early Do-Not-Attempt Resuscitation Orders And Neurological Outcomes In Older Out-Of-Hospital Cardiac Arrest Patient: A Multicenter Observational Study", Benjamin Tangkamolsuk, Quang La, David F Lo

Rowan-Virtua School of Osteopathic Medicine Departmental Research

We enjoyed reading the article by Kohri et al., titled “Early do‐not‐attempt resuscitation orders and neurological outcomes in older out‐of‐hospital cardiac arrest patients: A multicenter observational study” and would like to offer additional commentary on the article. We hope these perspectives may provide insight into areas that may require further research and improvement.

Ethical Aspects Of Utilising Artificial Intelligence In Clinical Settings, Jeffrey Byrnes, Michael Robinson

Philosophy Faculty Articles and Research

In response to recent proposals to utilize artificial intelligence (AI) to automate ethics consultations in healthcare, we raise two main problems for the prospect of having healthcare professionals rely on AI-driven programs to provide ethical guidance in clinical matters. The first cause for concern is that, because these programs would effectively function like black boxes, this approach seems to preclude the kind of transparency that would allow clinical staff to explain and justify treatment decisions to patients, fellow caregivers, and those tasked with providing oversight. The other main problem is that the kind of authority that would need to be …

Transparency And Authority Concerns With Using Ai To Make Ethical Recommendations In Clinical Settings, Jeffrey Byrnes, Michael Robinson

Philosophy Faculty Articles and Research

In response to recent proposals to utilize artificial intelligence (AI) to automate ethics consultations in healthcare, we raise two main problems for the prospect of having healthcare professionals rely on AI-driven programs to provide ethical guidance in clinical matters. The first cause for concern is that, because these programs would effectively function like black boxes, this approach seems to preclude the kind of transparency that would allow clinical staff to explain and justify treatment decisions to patients, fellow caregivers, and those tasked with providing oversight. The other main problem is that the kind of authority that would need to be …

Priorities To Care Within The Military Health System: A Mixed Methods Study On Military Spouse Access To Care During Covid-19 On Okinawa, Elayne L. Wilson

Theses & Dissertations

Military spouses in Okinawa experienced denial of care at military treatment facilities and off base Japanese healthcare facilities during the COVID-19 pandemic. Over two years of travel restrictions further contributed to difficulties accessing healthcare while stationed on the island with their active-duty spouse. This study examined the implications of a priority-based access system through the TRICARE program implemented due to limited resources during COVID-19 and its impact on military spouses in a scarce medical resource environment. This concurrent mixed-methods research used a survey tool developed by Community First Hawaii to quantify access to healthcare and in-depth interviews to further explore …

Analysis Of Public Opinion Polls About Covid-19 Vaccines: Theoretical And Policy Implications For Vaccine Communication And Campaigns To Address Vaccine Hesitancy, Muhammad Ittefaq, Hong Tien Vu, Ali Zain, Tayyeb Ramazan, Gary L. Kreps

School of Communication Studies - Faculty Scholarship

This study analyzed 1432 questions asked in 19 surveys (N = 43,014) on COVID-19 vaccines between January 2020 and August 2022 using dimensions including (1) information sources about COVID-19 vaccine, (2) information about the access, effectiveness, and side effects of COVID-19 vaccine, (3) COVID-19 vaccine hesitancy (i.e. false perception, skepticism, and vaccine refusal), (4) motivations to get the COVID-19 vaccine (i.e. to perform routine activities, convenience, incentives, influences, and travel requirement), (5) false perceptions caused vaccine refusal, and (6) intentions to get vaccinated. Our results show that vaccine refusal was rampant throughout the pandemic and mostly attributed to the …

Does Physician-Hospital Vertical Integration Affect Hospital Output?, Soumya Upadhyay, Neeraj Bhandari

Healthcare Administration and Policy Faculty Research

Background: Physician-hospital vertical integration is gaining steam but it is unclear how they affect hospital output.

Objective: To examine the direct impact of vertical integration on hospital output.

Design: A pooled design with 6-year data using linear regressions was used. Then, panel data design with hospital fixed effects was used.

Methods: We linked American Hospital Association data (2016-2021) with AHRQ Comparative Health System Performance Initiative’s Compendium (2018, 2020, 2021; 34 987 hospital-year observations) to develop new measures of vertical integration and assess its relationship with several measures of hospital output including annualized total admissions, total number of inpatients days, …

Advanced Practice Clinician Outcomes: Pre/Post Implementation Of An Advanced Practice Clinician Council, Jeannine M. Moss

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Improving access to quality, affordable, and timely healthcare is a national priority. Health systems across the United States are utilizing Advanced Practice Clinicians (APCs) to fill the void in healthcare delivery. As provider shortages continue and the demand for APCs increases, organizations must develop robust structures to support APC engagement, retention, job satisfaction, and professional growth. Currently, 44% of the provider workforce within a large urban health system are APCs, yet despite substantial APC provider labor pool representation, the organization had little infrastructure to support APC professional growth and no mechanism for organizational involvement. This quality improvement (QI) project aimed …

Reducing No-Shows In A Behavioral Health Setting: A Program Evaluation, Meagan Evans

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Mental healthcare in America faces many significant challenges; this is especially true in rural regions like Southwest Virginia. When patients miss their scheduled appointments, it represents a lost opportunity to deliver the critical mental health services that other individuals in need could have benefited from. A significant access issue presents itself when patients are not able to get the mental health support they need. The lack of outpatient access leads to patients utilizing emergency rooms inappropriately for what could have been routine care visits. A multitude of factors can contribute to patients failing to attend their scheduled appointments, including transportation …

The Living Document: Medical Records As A Malleable Presence, Camilla Lyckblad

Proceedings from the Document Academy

Understanding why individuals might safeguard information or keep secrets in working documents such as medical records is essential for the development of good quality care, fostering an environment where both patients and staff feel secure to part with sensitive information, encouraging more honest and open communication as well as improved quality of care. This ongoing research aims to deepen comprehension of information behavior in clinical contexts, where the contemporary medical record, with its increasing properties such as open record access for patients, can be viewed as an entity that both listens and influences. This examination sheds light on the complex …

Optimizing Fall Prevention: A Quality Improvement Initiative To Enhance Documentation And Intervention Accuracy Using The Hester Davis Scale In Medical-Surgical Units, Kiana Conn, Brooklin Hunter-Johnson, Jashan Kahlon, Adrian Paz

Master's Projects and Capstones

Falls among hospitalized patients remain a critical safety concern, particularly in medical-surgical units caring for geriatric and oncology patients. This quality improvement project aimed to evaluate and address gaps in adherence to fall prevention protocols by utilizing the Hester Davis Scale (HDS) in two medical-surgical units at a large metropolitan hospital in Southern California. The project focused on auditing current practices to identify inconsistencies in documentation and intervention implementation, emphasizing areas such as bed alarm activation, fall risk signage placement, and armband use. Weekly audits were conducted from October 3 to October 29, 2024, to establish baseline data and inform …

Improving Anesthesia Technician Workflow: Implementation Of A Standardized Checklist And Formal Handoff Communication Tool To Enhance Management Of The Pediatric Portable Anesthesia Lockers Recommendation, Megan Shayna Sosnick Msel, Rn

Master's Projects and Capstones

Objective: The surgical department of a well-known Bay Area medical center faces substantial challenges in supply management. These challenges include inconsistent stocking, disorganized storage, and an inefficient ordering process. These logistical issues impact patient care negatively, increase supply costs, and weaken team morale and communication. U.S. hospitals spend $83 billion annually on medical supplies, with $25.4 billion wasted on preventable material expenses (Balkhi et al., 2022). Aim and Methods: This quality improvement project aims to train 80% of anesthesia technicians in proper stocking procedures for portable pediatric anesthesia lockers within three months. Interventions include the implementation of a standardized …

Reducing The Incidence Of Nosocomial Aspiration Pneumonia In The Adult Oncology Population Through Improved Compliance With Oral Hygiene Protocols, Kenneth R. Brown

Master's Projects and Capstones

Objective

Oncology patients receiving chemotherapy are at risk of complications such as mucosal barrier injuries (MBI) and aspiration pneumonia, and aspiration pneumonia rates are higher than desired. Improved oral hygiene protocols and compliance in this population reduces the incidence of these complications.

Context and Background

The microsystem assessed includes six oncology units at Hospital A, a large California academic hospital. Aspiration pneumonia, commonly associated with MBI, is a life-threatening challenge that increases costs and complications in oncological treatment settings. An aspiration pneumonia task force focused on six oncology acute care units is committed to reducing the incidence of hospital acquired …

Transforming Care: Elevating Oral Hygiene Compliance To Combat Nosocomial Aspiration Pneumonia In Adult Oncology Patients, Karina Larrea

Master's Projects and Capstones

Objective Aspiration pneumonia is a preventable, yet common complication in oncology patients undergoing chemotherapy, steered by suboptimal compliance with oral hygiene protocols and elevated susceptibility due to mucosal barrier injuries. Despite its major impact on healthcare costs and morbidity, compliance with evidence-based practices remains inadequate. Aim This project aimed to decrease nosocomial aspiration pneumonia rates from 1.5% to 1.3% by enhancing oral hygiene compliance from 41% to 70% over a 12-week period. Methods Proposed interventions included implementing paired oral hygiene order sets into electronic medical records, once-per-shift cues, staggered patient education sessions, and staff education on standardized protocols. Pre-intervention data …

Implementing Donna Wright’S Competency Model For Enhancing Nursing Professional Development In Pediatric Perioperative Units, Justin C. Chu

Master's Projects and Capstones

Background Hundreds of thousands of deaths occur in hospitals annually due to preventable adverse events. As literature shows nurse competency is positively associated with improved patient outcomes, it is the mission of any healthcare organization to continually improve staff competency. Bay Area Children’s Hospital X is looking to adopt the Donna Wright Competency Model (DWCM) to change the way they approach this process, transitioning from traditional methods of manager-selected competencies to a collaborative, shared governance approach. Objectives Utilizing the DWCM, the project goal is to enhance competencies among 90 nurses in pediatric perioperative units. The ultimate goal is to create …

Food Security And Its Impact On Hypertension In Urban Communities, Lauren M. Nobriga

Master's Projects and Capstones

The Quality Improvement Team proposed an intervention to increase enrollment in the Food Security Program, a six-month initiative that provides vouchers redeemable for fruits and vegetables. Long-term impacts of this Program include an improved food economy and enhanced patient disease management autonomy. This project aimed to increase the percentage of eligible adult medicine clinic patients enrolled in the Food Security Program by 25%, or 11 patients per month, based on the mean enrollment for the first four months of the Program (May to August) of nine patients. The intervention was based on bi-monthly performance reports, making the goal include enrolling …

Venous Thromboembolism Prophylaxis In Orthopedic Surgery: A Narrative Review, Jacob Lahti, Sarah Gallitto, Thomas C. Varkey

Annual Research Symposium

This poster highlights current and updated guidelines for chemical and mechanical prophylaxis for venous thromboembolism in patients undergoing major and minor orthopedic surgery. Existing and new potential therapies were reviewed, as well as an analysis into the lack of high-quality risk-prediction score calculators to improve personalization of prophylaxis regimens. Alongside a summary of existing and potential new prophylaxis protocols, a call to action to improve validity of said risk score calculators so as to improve patient outcomes and personalized medicine is made.

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …

Practicing Responses To Acute Clinical Troubles: Initiative Through Clinical Education (P.R.A.C.T.I.C.E.) To Improve Medical Emergency Response Increasing Nurse Confidence And Preparedness Through Low-Stakes Clinical Education, Lauren Castelblanco Rn, Viviana Lopez Rn, Nosa Odiase Rn, Everly Pompa Rn

Master's Projects and Capstones

A newly established pediatric outpatient infusion center in Los Angeles does not have immediate access to a Code Blue Team or a Rapid Response Team, and instead relies on the Staff Assist protocol to manage medical emergencies. Via direct interviews, registered nurses at the infusion center report feeling underprepared and lacking confidence to respond to medical emergencies that must be escalated to code blue. Microsystem assessment tools determined the root cause to be limited clinical exposure and limited opportunities for skills development. To address the nurses' concerns, Practicing Responses to Acute Clinical Troubles: Initiative through Clinical Education (P.R.A.C.T.I.C.E.) was implemented …