Health and Medical Administration Commons^™

Implicit Racial Bias In Physicians: Racial Disparity In Opioid Prescriptions In United States Emergency Departments, Anjali Ta

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Over the past 30 years, a documented racial disparity in opioid prescriptions in U.S. emergency care departments has persisted despite overall prescription trends fluctuating throughout the rise and fall of the early 2000’s opioid epidemic. Consistently, Blacks and other minorities receive lower levels of opioid analgesics when presenting with conditions or characterizing pain levels similar to white patients. This study focuses on identifying the mechanisms of implicit racial bias, quantified by scores on the Implicit Bias Association Test (IAT), that influences physicians’ abilities to equitably assess and treat pain of racially diverse patient populations. Research has shown that physicians with …

Systemic Risk Management Plan For Electronic Medical Records (Emr): Why And How?, Ziniya Zahedi, Faisal Mahmud, Cesar Pinto

Engineering Management & Systems Engineering Faculty Publications

Electronic patient data use and handling are critical issues in terms of privacy, confidentiality, security, and the Health Insurance Portability and Accountability Act (HIPAA) regulations. The risks associated with electronic patient data are not limited to identity theft but rather include a person’s social, economic, and psychological well-being. However, there have not been many studies that have focused on the associated risk factors that could lead to these situations. This paper identifies those risks related to electronic patient data breaches by means of a grounded theory approach and develops a systemic risk management plan that enables engineering managers and risk …

Cost Savings And Patient Satisfaction Following Implementation Of An Online Blockchain-Based Healthcare Payment Portal, Zubin Hussain, Meghan Gannon, Phd, Constantine Daskalakis, Scd

Phase 1

Introduction. Although most patients prefer e-billing, many providers use paper. On average, over three paper bills are sent before payment is received. This means wasted time, money, energy, and decreased patient satisfaction. Could the implementation of an online, blockchain-based healthcare payment portal increase cost savings and patient satisfaction while maintaining confidentiality?

Methods. Transaction data was collected by MAPay through their portal system from about 100 providers in 50 locations in the NYC area, all through IntegraConnect. This study analyzes trends in how patients pay their medical bills and how much they pay.

Results. From March through September, all electronic methods …

Impact Of Servant Leadership Style On Customer Service And Patient Satisfaction, Chibunna E. Nwaobia

Walden Dissertations and Doctoral Studies

Patient satisfaction presents an emerging area of research for healthcare providers because major healthcare providers like Medicare/Medicaid control the finances of healthcare institutions as based on their patient and customer satisfaction. The purpose of this study was to examine the impact of servant leadership on customer service, and patient satisfaction, in the Inland Empire Region of Southern California. The theoretical framework applied to this study was the servant leadership theory. Participants consisted of 82 managerial staff within the University Health System, which is comprised of a teaching hospital, 5 behavioral health centers, 10 federally qualified health centers, and a public …

Association Between Breastfeeding And Child Stunting In Mexico, Ana Paola Campos, Mireya Vilar-Compte, Summer Sherburne Hawkins

Department of Public Health Scholarship and Creative Works

Background: Globally, the prevalence of child stunting has been decreasing over the past decades. How-ever, in low-and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting. Objective: To examine the association between breastfeeding (defined as never breastfed, any breast-feeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under –2 standard deviations of the World Health Organization child growth standards’ median) in Mexico. Methods: Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6–35 months with information on previously identified risk and protective factors for stunting. We conducted fixed-and mixed-effects logistic regression models sequentially controlling for each level of factors. Findings: Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breast-feeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models. Conclusions: According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.

Assessing Attitudes And Knowledge Regarding Voice Modification In Transgender People Among Practicing Speech Language Pathologists (Slps) In Texas, Iliana Renee Lopez

Open Access Theses & Dissertations

The purpose of this cross-sectional study is to examine the attitudes and knowledge of voice modification in TG persons among practicing SLPs in the state of Texas. Thirty-nine individuals completed the 10-minute survey with 38 questions. SLPs in Texas who responded are professionally and personally comfortable working with transgender individuals. Most respondents did not know what was targeted in voice modification services, however are willing to learn. Respondents' attitudes, knowledge and comfort were impacted most by personal values, graduate school education and personal relationships. The results from this study support the need for education and clinical training on cultural competence …

Impact Of Performance-Based Budgeting On Quality Outcomes In U.S. Military Healthcare Facilities, Kimberly L. Decker Virginia Commonwealth University

Theses and Dissertations

Performance-based budgeting (PBB) is a variation of pay for performance that is applicable to government programs. It works by increasing or decreasing funding based on pre-established performance thresholds, which incentivizes organizations to improve performance. In late 2006, the U.S. Army implemented a PBB program in all of its healthcare facilities due to rising concerns over costs and quality in its facilities. The U.S. Army’s PBB program tied hospital-level funding decisions to performance on key cost and quality-related metrics. This study examined the impact of this program and a subsequent PBB program on quality improvement in U.S. Army healthcare facilities. Drawing …

Innovative Framework For Academic And Public Health Departments' Partnership On Preparing Future Practitioners- Preliminary Data, Michele Kekeh, Muge Akpinar-Elci, Myngoc Nguyen, Nancy Welch

Community & Environmental Health Faculty Publications

This article presents a model to respond to current public health challenges and transform knowledge into preventive strategies. It also presents an innovative way for academic institutes and public health departments to focus on public health workforce development. Academic institutes partnership with public health departments have started fostering service-learning opportunities to engage students in public health with an emphasis on the specific public health outcomes. However, the benefit of service–learning projects on the health departments and the populations served is largely unknown. Recently, these service-learning opportunities are becoming less sustainable due to the inability of preceptors to provide the necessary …

Risk Factors For Workplace Encounters With Weapons By Hospital Employees, James Blando, Chalsie Paul, Mariana Szklo-Coxe

Community & Environmental Health Faculty Publications

Objective:The specific aim of this study was to determine which risk factors were associated with frequent weapons confiscation in a healthcare facility. This study investigated the hypothesis that hospital-related factors impact the frequency of weapons confiscation.

Study design:Cross-sectional.

Methods:A cross-sectional survey was administered on-line to hospital security directors and assessed the associations of organizational factors with the frequency of weapons confiscation.

Results:It was found that hospitals with metal detectors were more than 5 times as likely to frequently confiscate weapons, suggesting this intervention is effective. It was also found that hospitals with psychiatric units were more likely to have frequent …

A Hybrid System Dynamics, Discrete Event Simulation And Data Envelopment Analysis To Investigate Boarding Patients In Acute Hospitals, Leila Keshtkar, Wael Rashwan, Waleed Abo Hamad, Amr Arisha

Articles

Timely access to health services has become increasingly difficult due to demographic change and aging people growth. These create new heterogeneous challenges for society and healthcare systems. Congestion at acute hospitals has reached unprecedented levels due to the unavailability of acute beds. As a consequence, patients in need of treatment endure prolonged waiting times as a decision whether to admit, transfer, or send them home is made. These long waiting times often result in boarding patients in different places in the hospital. This threatens patient safety and diminishes the service quality while increasing treatment costs. It is argued in the …

Telehealth: Advances In Alternative Payment Models, Mei Zhao, Hanadi Hamadi, D Rob Haley, Jing Xu, Cynthia White-Williams, Sinyoung Park

Department of Health Administration Faculty Publications

Introduction

Previous studies indicated that telehealth services may improve hospital performance. However, the extent to which these telehealth provisions would improve hospital total performance score under the hospital value-based purchasing (HVBP) programme is not clear. The aim of this study is to examine the association between telehealth provision and hospital performance.

Methods

We performed a retrospective analysis of the association between the provision of telehealth services and 2699 hospital’s total performance score (TPS) on the 2018 HVBP programme and its four domains. Multivariate regression models were used to analyse TPS and hospital performance on each domain. Telehealth services offered by …

Racial Differences In Hospital Readmission And Reimbursement Rates For Patients With Congestive Heart Failure, Catherine Talongwa

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is associated with a significant economic burden that includes frequent emergency department visits, hospitalizations, and readmissions. The purpose of this study was to examine the differences, if any, between hospital readmission rates and insurance reimbursement rates for non-Hispanic Black and White CHF patients in California. The theoretical framework was Bandura's social cognitive theory. Secondary data for this quantitative study were obtained from the Office of Statewide Health Planning and Development and State Inpatient Databases from Healthcare Cost and Utilization for calendar year 2014-2016. A t-test and Levene's test for equality of variance were conducted on a …

Quality Of Life For Persons With Chronic Disease Utilizing Mobile Integrated Healthcare, Dr John Robert Ash

Walden Dissertations and Doctoral Studies

The use of mobile integrated healthcare-community paramedicine (MIH-CP) has the potential to be integrated into existing chronic disease management initiatives as a means of reducing unnecessary hospitalizations and costs as well as improving quality of life (QOL). The purpose of this study was to analyze the relationships between demographics, noncommunicable disease type (NCD), and changes in self-perceived, self-reported QOL for those who have participated in an MIH-CP program. The research design for this study was a pretest/posttest design using secondary data that were obtained from a research partner using the MIH-CP intervention and collecting QOL data using the Euroqol QOL …

Evaluating The Impact Of An Early Alert Team Implementation On Sepsis Mortality Rates, Shelley Ann Hyndman

Walden Dissertations and Doctoral Studies

Sepsis is ranked as one of the leading causes of death among hospitalized patients in the United States. Early identification and treatment of sepsis according to time-sensitive evidence-based protocols is essential to improve outcomes. Existing sepsis research focused on fostering consensus on sepsis definitions and evidence-based treatment protocols; yet, the literature lacks prescriptive evidence regarding organizational structures that reduce patient mortality. The purpose of this quantitative study was to understand how a change in organizational infrastructure could influence the delivery of sepsis-focused care. Using Donabedian’s theoretical framework, the research questions for this study focused on an implementation of an Early …

Impact Of Advanced Access Scheduling On Missed Appointment Rates In Primary Care, Helen Yvonne Krippel

Walden Dissertations and Doctoral Studies

A major problem encountered within outpatient physician offices are missed appointments. Missed appointment research revealed how no-show rates remain a focus for healthcare administrators as decreasing no-show rates may reverse harmful health consequences. The purpose of this study, which also addressed the research gap, was to determine if there was an association between advanced access scheduling and no-show rates for patients scheduled with preferred primary care physicians versus nonpreferred primary care physicians. The health belief model was the conceptual framework as missing a prescheduled appointment is a health behavior. The 1st and 2nd research questions examined whether there was a …

Advanced Practice Registered Nurses And Their Knowledge Regarding The Hindrance Of Obesity, Crystal Rainey

Walden Dissertations and Doctoral Studies

Advanced Practice Registered Nurses and Their Knowledge

Regarding the Hindrance of Obesity

by

Crystal N. Rainey

MSN, Walden University, 2014

BSN, University of Arkansas in Little Rock, 2011

AASN, Southeast Arkansas College, 2009

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2020

Pharmacy Manager Strategies For Reducing Financial Losses From Adverse Drug Events By Polypharmacy Patients, Francis Rudden

Walden Dissertations and Doctoral Studies

Every year over 100,000 deaths occur in the U.S. from adverse drug events derived from medication errors. Medication errors account for an annual cost of $100 to $200 billion. Healthcare pharmacists lack strategies to reduce adverse drug events and medication errors from taking place. Grounded in complex adaptive system theory, the purpose of this qualitative multiple case study was to explore strategies to reduce advere drug events and medication errors. The participants were 5 pharmacist managers in a county in central Florida. These pharmacists were from different community pharmacies, and each had a minimum of 5 years’ experience in the …

Human Resource Strategies Used To Retain Millennials In Hospitals, Thomas F. Turner

Walden Dissertations and Doctoral Studies

Lead hospital human resource managers (HRMs) experience new recruitment, retention, and training costs for Millennial employees to close the skill gaps and address challenges from Baby Boomer employees retiring. The median turnover rate of 3 years for Millennial workers in hospitals is more than 3 times higher than older workers at hospitals. The purpose of this qualitative multiple case study was to identify retention strategies hospital HRMs use to address the retention of millennial generational employees beyond 3 years. Transformational leadership theory was the conceptual framework for the study. The data collection process included semistructured interviews and a review of …

Evaluation Of The Tuberculosis Management Program In Ghana, Boampong Akese

Walden Dissertations and Doctoral Studies

Tuberculosis (TB) is a major health issue estimated to be affecting about 1/3 of the world’s population. TB is a major health problem in Ghana primarily because of weak health infrastructure and poor TB case detection and management practices. Measuring and evaluating the performance of health programs is an important aspect of health care services in any country. The purpose of this quantitative study was to evaluate the TB management program in Ghana. A cross-sectional research design was used to answer the research questions. Secondary data were obtained from the Ghana District Health Information Management System database. The theoretical foundation …

Antibiotic Stewardship And The Quality Of Life For Residents Over 65 Years, Reshma Beharry-Guest

Walden Dissertations and Doctoral Studies

Antibiotics were often over-prescribed in long term care facilities (LTCFs) and antibiotic stewardship guidelines, established by the CDC were not followed. The nursing home administrator was responsible for the quality of care for the residents and ensured that the facility met and/or exceeded the CMS antibiotic stewardship standard of care. The purpose of this quantitative study was to analyze operational secondary data collected from a Texas LTCF regarding antibiotic utilization for male and female residents over 65 years. The theoretical framework of the social cognitive theory was applicable for quality improvement in the LTCF setting. The data analysis showed that …

Comparison Of Diagnosis And Hospital Referral Rates Between Physician And Non-Physician Practitioners, Joshua Alan Fisher

Walden Dissertations and Doctoral Studies

Physician extenders as support in healthcare facilities has been increasing in the United States and has the potential to help in currently under served communities. This study evaluated the quality of care provided by physician extenders through the examination of average diagnosis and referral rates that may inform healthcare leaders and policymakers in future decisions. The literature review pointed to a gap in the research related to the quality of care based on patient diagnosis and referral rates by physicians and physician extenders. The conclusions were based on a quantitative analysis of secondary data from the National Ambulatory Medical Care …

Congestive Heart Failure And Strategies To Improve Quality Of Life, Esther Akunna Okorie

Walden Dissertations and Doctoral Studies

Congestive heart failure is a global, chronic, progressive, and debilitating disease affecting mostly older adults. The multiple complications associated with the health issue led to readmissions and markedly reduced ability of heart failure (HF) patients to perform the self-care management of the problem. Nurses are responsible for providing a standardized quality education for patients; however, nurses at the project site lacked adequate skills and knowledge to bridge the gap in HF self-care management education. The project was guided by health belief model and self-care deficit with the goal of boosting the staff knowledge and confidence with providing patient HF self-care …

Respiratory Therapists' Roles In Reducing 30-Day Readmission Rates For Patients With Copd, Soumaya M. Osen

Walden Dissertations and Doctoral Studies

Since 2014, hospital administrators initiated several measures to reduce the 30-day readmission rates for patients with chronic obstructive pulmonary disease (COPD). The research problem was that the respiratory therapists (RTs) were excluded from the discharge planning teams in many hospitals while 20% of patients with COPD continue to be readmitted within 30-day post discharge. The purpose of this qualitative study was to seek understanding of the care managers’ perceptions regarding the potential role of the respiratory therapists in the discharge planning for patients with COPD. The theoretical framework for this study was the systems theory in management. The research questions …

Strategies To Reduce Costs Associated With Hospital Readmissions, Almunzer Zakaria

Walden Dissertations and Doctoral Studies

Hospital administrators struggle to reduce hospital readmissions to improve hospital performance. Reducing costs of readmissions is important to hospital administrators because it may lead to an inability to meet budget requirements. Grounded by complex adaptive systems and business process quality management principles, the purpose of this qualitative single case study was to explore strategies nonprofit hospital administrators use to reduce costs associated with hospital readmissions. Participants included 4 successful hospital administrators at 1 hospital in Doha, Qatar, who have responsibility for overseeing readmissions. Data were collected using semistructured face-to-face interviews and organizational documents. Traditional text analysis was used to identify …

Healthcare Organizational Design Strategies To Improve Performance, Katherine Madonna Chubbs

Walden Dissertations and Doctoral Studies

Business leaders are exploring ways to improve organizational performance through organizational design, including reviewing the structures of their organization. Grounded in McKinsey’s 7S framework, the purpose of this qualitative single case study was to explore organizational design strategies healthcare leaders used to improve organization performance. Participants were 6 leaders within a healthcare organization in Alberta, Canada, who successfully developed and implemented organizational design strategies to improve organizational performance. The data collection techniques included a review of internal and external documents, a reflective journal, and semistructured interviews. I used methodological triangulation and thematic analysis to complete the data analysis. The data …

Hypertensive Self Care: An Educational Tool For Advanced Practice Nurses, Kelisia Burks Mckay

Walden Dissertations and Doctoral Studies

Poorly controlled hypertension is a serious public health problem. Persons with high blood pressure are required to perform a variety of self-care behaviors. Advance practice nurses can improve health outcomes for hypertensive patients when they provide self-care education along with prescribing appropriate medications needed to treat high blood pressure. The purpose of this study was to educate rural advance practice nurses about hypertension medication and self-care management using the Hypertension Self-Care Activity Level Effects (H-SCALE) and the 8th National Joint Committee (JNC- 8) hypertensive guidelines. Twelve primary care advanced practices nurses (APN's) participated in an educational presentation that included pre …

Strategies Health Care Leaders Use To Implement Strategic Change Initiatives Successfully, Sophia F. Brown

Walden Dissertations and Doctoral Studies

Health care organizations lose a significant competitive edge when leaders fail to align strategic change initiatives with necessary operational activities. Health care leaders who struggle to maintain a competitive edge are at high risk for failure. Pettigrew and Whipp's content, process, and context strategic change management and Hoshin Kanri (HK) program deployment models constituted the composite conceptual framework for this study. The purpose of this qualitative multiple case study was to explore strategies health care leaders use to implement strategic change initiatives successfully. The participants comprised of 4 strategic change leaders from 2 health care organizations in Manhattan, New York, …

Strategies Used In Ehealth Systems Adoption, Joshua Adams

Walden Dissertations and Doctoral Studies

Failure to adopt an interoperable eHealth system limits the accurate communication exchange of pertinent health-care-related data for diagnosis and treatment. Patient data are located in disparate health information systems, and the adoption of an interoperable eHealth system is complex and requires strategic planning by senior health care IT leaders. Grounded in DeLone and McLean’s information system success model, the purpose of this qualitative case study was to explore strategies used by some senior information technology (IT) health care leaders in the successful adoption of an eHealth system. The participants were 8 senior health care IT leaders in the eastern United …

Leadership Strategies To Achieve Organizational Excellence, Cherron Lakisha Blakely

Walden Dissertations and Doctoral Studies

Inadequate quality management tools and processes can lead to inefficient hospital operations and poor organizational performance. Community hospital leaders who fail to improve operations and organizational performance risk negatively impacting patient care and profitability. Grounded in the theory of high-performance work systems (HPWS), the purpose of this qualitative single case study was to explore strategies community healthcare leaders use to effectively employ quality management approaches to improve operations and achieve organizational excellence. The participants comprised 5 community healthcare leaders in the northeast United States who effectively used quality management approaches to improve operations and achieve organizational excellence. Data were collected …

Care Management And Readmission Among Elderly African American Patients With Chronic Illnesses, Vivien Lyn Salmon

Walden Dissertations and Doctoral Studies

More than 70 million Americans aged 50 years and older suffer from at least 1 or more chronic condition and use the emergency department frequently. By 2025, chronic illness will affect an estimated 164 million Americans or nearly 49% of the population. The rapid rise in chronic illness is due to a combination of an aging population, longer life expectancies, and poor lifestyle choices. This quantitative study provided a statistical analysis on the impact of care management on readmissions among African Americans between the ages of 65 and 80, with diabetes, hypertension, asthma, or multiple chronic conditions. Logistic regression was …