Quality Improvement Commons^™

Measuring Disability Prevalence In Healthcare: A Study Comparing Two Disability Measures, Kristen L. Milefchik, Rhonda K. Dailey, Sharon Milberger

Developmental Disabilities Network Journal

People with disabilities experience significant health disparities and interventions are needed to address them. Measuring disability prevalence is an essential aspect of designing effective, data-driven healthcare strategies. Accurately measuring disability prevalence is challenging given disability is a complex phenomenon, with biological, social, environmental, and cultural components. Previous studies have compared a variety of disability status measurements and found that measurements were incongruent with each other. This study examines the concordance between disability status using two different measures: the nationally recognized American Community Survey (ACS-6) functional difficulty questions and one disability identity question. We used data from 3,621 adult patients participating …

Addressing Substance Use Disorder In Rural Appalachia: Improving Access And Treatment Outcomes For Justice-Involved Individuals, Jessica Muldowney

Electronic Theses and Dissertations

Background: Opioid use disorder (OUD) represents a critical public health crisis disproportionately affecting justice-involved (JI) populations, with approximately 65% of incarcerated individuals having substance use disorders (James & Beatty, 2006). Rural Appalachian communities face compounded challenges due to limited healthcare access, provider shortages, and cultural stigma surrounding addiction treatment. Despite evidence demonstrating that medication-assisted treatment (MAT) reduces recidivism and overdose deaths, only 20% of correctional facilities offer these services (Klein & Seppala, 2019).

Objective: This mixed-methods study evaluated organizational readiness and infrastructure capacity for implementing evidence-based OUD interventions, specifically MAT programs across three rural counties in northwestern North Carolina.

Methods: …

Glucagon-Like Peptide-1ra As A Public Health Interventions, Briana Sepeda

Electronic Theses, Projects, and Dissertations

Glucagon-like peptide receptor agonist (GLP-1RA) medications have become a prominent topic of interest both in clinical medicine and broader societal discussions. Although the medication are relatively new and expensive, ongoing research continues to explore pharmacologic modifications aimed at improving therapeutic effectiveness and prolonged drug half-life. GLP-1RAs have gained significant traction due to their ability to lower glycosylated hemoglobin (A1c) and blood glucose levels in individuals who have been diagnosed with type 2 diabetes (T2D). In addition to glycemic control, evidence suggests its associations with appetite suppression, weight loss, reducing cardiovascular disease, improved renal dysfunction, neuroprotective effects related to neurodegenerative disease …

Improving Identification And Referral Of Xylazine‑Associated Wounds In Homeless Healthcare, Ramon A. Gambino

Doctor of Nursing Practice Scholarly Projects

Background: Xylazine-adulterated fentanyl is linked to distinctive necrotic wounds and complex care needs in unsheltered populations. This quality improvement (QI) project implemented a brief survey and referral log at Albuquerque Health Care for the Homeless (AHCH) to track suspected xylazine-associated wounds and referrals to advanced care. Methods: Final data were exported from Qualtrics, cleaned to retain finished responses, standardized categories, and de-identified. The analytic sample included 18 encounters. Results: Results showed that 55.6% (n = 10) documented suspected xylazine-associated wounds; 5.6% (n = 1) reported no suspicion; 38.9% (n = 7) were uncertain. Referrals were rarely documented overall at AHCH …

Haynes County Ems Outreach Quality Improvement, Anna Parker, Linda Haddox

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

A Quality Approach To Pneumococcal Vaccination, Nimmy Joy, Michaela Mckissack

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Digital Touchpoints: Investigating Contact Page Accessibility And Visual Authenticity Within Medical Tourism Health Websites, Alicia Mason, Elizabeth Spencer, Kristen Livingston, Treyton Meyers, Sakshi Bhati, Himika Akram

Faculty Submissions

This study examines two critical digital touchpoints on medical tourism provider (MTP) websites: (1) the accessibility of contact pages which often function as entry points for inquiries, scheduling, and pre-travel coordination, and (2) the authenticity of visual imagery used to shape expectations about care environments, personnel, and technological capacity. A sample of 105 MTPs across all six World Health Organization regions were analyzed using quantitative web accessibility testing and qualitative visual analysis. Results indicate pervasive accessibility errors on contact-page touchpoints and extensive reliance on inauthentic imagery to depict patients, providers, and medical technologies. Together, these practices may distort user expectations …

Use Of A Structured Rounding Model To Improve Interprofessional Communication And Collaboration Among Mds And Rns In A Medicine Unit – An Evidence-Based Practice Project, Jackie Raygoza,

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose/Aims

This DNP project aims to improve communication and collaboration between physicians (MDs) and registered nurses (RNs) on medical units by implementing a structured three-step communication-rounding model integrated into the daily workflow and leveraging existing communication tools. As patients’ conditions become more complex and healthcare demands increase, it is crucial to foster an environment where communication among providers and staff is clear, transparent, respectful, and collaborative. By leveraging information technology and evidence-based strategies, the project seeks to strengthen interprofessional collaboration and improve patient satisfaction and the quality of care. The project includes educational sessions for both MDs and RNs to …

Optimizing Communication In The Periprocedural Area: Implementing Sbar: A Quality Improvement Project, Autumn Chang

Loma Linda University Electronic Theses, Dissertations & Projects

The primary aim of this project is to improve standardized nurse-to-nurse communication at the electrophysiology lab of a large Los Angeles hospital. By providing nursing education on a unit-specific, structured handoff communication framework (SBAR) and incorporating a procedure-specific handoff form for electrophysiology (EP) across pre-, intra-, and post-procedure units, this project aims to improve nurses’ perceptions of the handoff process and the effectiveness of handoff education across the periprocedural units. The project further aims to assess nursing incorporation of the training four weeks post-education and changes in patient satisfaction related to nursing teamwork and communication.

Scrub Up For Success: Transforming Infection Control In Transplant Patients Through Microlearning Video And Poster – A Quality Improvement Project, Wendy Dio

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction and Background

Healthcare-associated infections (HAIs) threaten patient safety, affecting about 1 in 25 hospitalized patients. Clostridium difficile infection (CDI) is a significant contributor, impacting both high-risk groups and the general population. Proper hand hygiene is crucial for preventing CDI transmission. In the U.S., hospital-acquired CDI costs over $1.5 billion annually and causes nearly 500,000 cases and I15,000 deaths each year. California reported 3,526 CDI cases in acute care hospitals, with Loma Linda University hospitals accounting for 16 cases, or 23% of their health system's infection rate.

Methodology

Nurses in the 6A West-Transplant Unit received a PowerPoint presentation on when …

Eating Disorder Prevention And Early Intervention In U.S. Higher Education – A Comparative Benchmarking Study, Jake R. Arcement

Senior Theses

Eating disorders (EDs), including anorexia nervosa, have the highest mortality rate of any psychiatric illness, yet remain underrecognized relative to their severity and treatment burden. Because the period of peak onset aligns with the college years, institutions of higher education are uniquely positioned to play an important role in prevention, early identification, and referral to specialized care. However, limited research has examined how colleges and universities structure ED prevention and treatment resources. This thesis applies a comparative benchmarking framework to assess current institutional practices across U.S. colleges and universities. A national survey of student health and counseling centers examined staffing, …

Pedaling Through Discomfort: A Feasibility Study Of Faculty-Led Spin Classes And Their Impact On Student Engagement, Resilience, And Faculty-Student Relationships, Gabriela Baza, Elizabeth Hathaway

Pursuit - The Journal of Undergraduate Research at The University of Tennessee

This study explored the feasibility and impact of faculty-led Spin classes on college students’ engagement, well-being, and connection with faculty. Offered twice weekly at 7 AM during Fall 2024, the classes aimed to promote physical activity, resilience, and faculty-student relationships. Twenty-six students attended at least one class, with a median attendance of 4.5 sessions. Post-semester surveys (88% response rate) assessed perceived exertion, interest, enjoyment, challenge, improvement, and instructor encouragement. Students reported high levels of engagement and positive challenge (RPE = 15.3; challenge = 6.4/7). Those attending 7 or more sessions reported significantly greater perceived improvement than those attending fewer sessions …

Rural Georgia Hospital Covid-19 Virus Patient Outcomes, Susan P. Smith, Neeraj Dayama, Morgan E. House, Debra Flores, Sharon Hunt, April Dukes, Steven Gautney

Journal of the Georgia Public Health Association

Background: The Coronavirus disease 2019 (COVID-19) has led to over 1.2 million deaths in the United States. Given the staggering scale of the pandemic, rural hospitals faced heightened challenges due to limited resource availability and underlying patient characteristics.

Methods: In this context, we examined patient and hospital-related factors associated with inpatient mortality due to COVID-19. This study is a retrospective chart review of patient outcomes of patients who were hospitalized in a Southwest Georgia rural hospital with COVID-19 during the initial onset of the outbreak and over the following 23 months of the pandemic. Patient demographics, other characteristics, …

Diagnostic Trends And Service Enhancements In Deaf Mental Health: A Longitudinal Analysis, Kent Schafer, Steve Hamerdinger, Frank Wu, Rie Sakai Bizmark, Charlene Crump

JADARA

A longitudinal study investigated mental health diagnostic trends and patterns among Deaf and Hearing individuals using a comprehensive dataset from Alabama Department of Mental Health spanning 2004-2024 (Deaf=4,547; Hearing=2,056,188). Chi-square analysis revealed significant proportional differences in diagnoses between the groups. Deaf individuals showed significantly higher proportions of psychotic (12.93% vs. 8.33% Hearing), mood (20.76% vs. 18.84% Hearing), and personality (0.58% vs. 0.43% Hearing) disorders. These findings suggest that increased access to specialized and competent mental health services for individuals who are Deaf, particularly following the increase of staffing patterns for the Office of Deaf Services in 2015,contributed to more accurate …

Operational Factors Influencing Branch Revenue In Multi-Branch Child Therapy Services, Muhammad Luthfi

Jurnal Administrasi Bisnis Terapan

The management of multi-branch child therapy services requires a strong understanding of operational factors that contribute to revenue performance. This study aims to analyze the relationship between operational days, occupancy rate, service attendance, and the number of practitioners in relation to branch revenue within a child therapy service organization operating in urban areas in Indonesia. A quantitative cross-sectional design was employed using operational data collected from 24 child therapy services. This study employed a quantitative cross-sectional design using branch-level operational data collected in December 2025 from 24 child therapy service branches. Multiple linear regression analysis was conducted to examine the …

Analisis Pengaruh Patient-Perceived Hospital Service Quality Terhadap Customer Satisfaction Dan Behavioral Intention Pelayanan Rawat Inap, Launa Inayati Arlina, Dwiky Yuanasika, Mochammad Bagus Qomaruddin, Djazuly Chalidyanto

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The Bed Occupancy Rate (BOR) of inpatient rooms at Mitra Sehat Mandiri Hospital Sidoarjo during 2019-2023 has not reached the ideal standard. The BOR values were 22%, 28%, 37%, 25%, and 20%, with an average of 26.4%, remaining below the ideal range of 60-85%. One of the most influential factors contributing to the low BOR is suboptimal service quality. This study aims to analyze the relationship between Patient-Perceived Hospital Service Quality, customer satisfaction , and behavioral intention among inpatients at Mitra Sehat Mandiri Hospital Sidoarjo. This study employed a quantitative method with an analytical approach and a cross-sectional design. The …

Skin Injury (Moisture-Associated Skin Damage, Skin Tears, And Pressure Injury) Prevention Education: An Evidence-Based Practice Project, Elizabeth Lopez

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction and Aims: Skin injuries, particularly pressure injuries, pose significant challenges in hospitals, especially for critically ill patients, leading to discomfort and increased healthcare costs. Such injuries profoundly impact patient outcomes, resulting in increased morbidity and mortality rates. Furthermore, these injuries can severely affect patients' quality of life, impeding their recovery. This project at LLUMC aims to address knowledge gaps among ED nursing staff regarding skin injury prevention through targeted education, thereby enhancing nurses' knowledge and confidence in managing these injuries.

Methodology: To evaluate the effectiveness of the skin injury prevention education initiative, eight tools were utilized, including the …

Nurse-Led Interventions To Reduce Occupational Hand Injuries In Manufacturing, Patti Harter

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Occupational hand injuries cause preventable morbidity, lost productivity, and workers’ compensation costs in manufacturing. Although safety policies and personal protective equipment (PPE) are in place, inconsistent glove use, slow hazard identification, and delayed response still cause injuries. This quality improvement (QI) project evaluated an eight-week, nurse-led injury-prevention bundle at a Texas heavy-vehicle manufacturing facility. The intervention required daily glove inspections, Safety Champion participation, real-time electronic hazard reporting, and corrective action within the shift. Injury outcomes were measured using Occupational Safety and Administration (OSHA) rates per 200,000 work hours and percentage change from baseline. After implementation, hand injury rates fell from …

Sexually Transmitted Infections And Screening: An Educational, Evidence-Based, Quality Improvement Bundle, Misty D. White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: With sexually transmitted diseases on the rise in central Texas, advance practice providers were not following evidence-based practice recommendations for sexually transmitted infection screening, treatment, and follow-up. Screening for sexually transmitted diseases occurred at a rate of less than one patient every 7.75 days.

Objective: The objective of this project was to develop and implement an advanced practice provider training tool to educate the clinic providers on sexually transmitted infections, collect pre- and post-data for the educational sexually transmitted infection bundle, and collect sexually transmitted infection screening, identification, treatment, and follow-up data generated by the clinic advanced practice providers …

A Chronic Pain Self-Management Quality Improvement Bundle For Veterans, Srijana D. Baniya

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction: Veterans often face challenges accessing care services due to limited awareness of available resources for support, Self-care, and mental health (Harding et al., 2019; Patel et al., 2024). Given the high prevalence of Chronic pain and opioid use in this population, Self-management (SM) education and non-pharmacologic interventions are required to address the biological, psychological, and social effects of pain (Bair et al., 2015; Mumba et al., 2024; Nahin, 2017; Higgins et al., 2020). This Quality improvement project aims to determine whether implementing an evidence-based SM bundle for chronic pain improved Pain severity scores and increased understanding of SM strategies. …

Precision In Practice: Subject Matter Expert Integration To Support Excellence In Population-Specific Documentation, Sara Pump, Mary Hawes, Lauren Spain, Virginia Kasenic, Meagan Talent, Alivia Stewart, Carrin Shaw, Chad Gautreaux, Dori Cousin, Ponesea Allen, Jonathan Rowe

2026

This poster describes a quality improvement initiative that integrated psychiatric resource nurses as subject matter experts (SMEs) into clinical documentation workflows to improve documentation compliance for high-risk behavioral health patients. The intervention resulted in substantial improvements in charting accuracy and compliance, including an increase in emergency department documentation compliance from 28% to 95% over seven months, while enhancing staff education, collaboration, and patient safety.

No One Left Behind: Identification Of Healthcare Needs Through System-Wide Social Determinants Of Health Screenings, Rose Dela Cruz, Amanda Marquez, Madison Lemmons

2026

This poster describes a system-wide quality improvement initiative designed to increase completion rates of Social Determinants of Health (SDOH) screenings by addressing workflow barriers, educating staff, and implementing standardized processes across clinical teams. The project demonstrates how interdisciplinary collaboration, nursing engagement, and structured screening workflows can improve identification of social needs and connect pediatric patients and families with resources that support health equity and better health outcomes.

Scaling Up Health Literacy Practices Through A Champion Program, Cameron Stine, Kelli Williams, Diana Montoya, Leslie Moore, Carol Howe

2026

This poster describes the development and expansion of a Health Literacy Champion Program designed to improve the consistent use of health literacy best practices across a healthcare organization. The program successfully expanded from ambulatory nursing to 13 disciplines, using champion training, newsletters, clinical observations, and peer influence to promote plain language communication, information chunking, and teach-back techniques that support patient understanding and safety.

Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction:

Iron deficiency and iron deficiency anemia in children aged 12 to 18 months are prevalent conditions that, if not identified and treated early, are associated with adverse neurodevelopmental outcomes.

Purpose:

This quality improvement project evaluated the impact of a standardized screening and follow-up protocol on laboratory result retrieval, provider review, and caregiver follow-through in a military pediatric clinic.

Method:

A pre-post intervention design guided by the Plan-Do-Study-Act framework was implemented over 11 weeks and included staff education, standardized workflows, and caregiver outreach.

Results:

The intervention improved laboratory completion and caregiver follow-up rates; however, sustainability was limited by staffing constraints …

Leading The Way In Pediatric Oral Health Promotion, Denise C. Mckinney

Dental Hygiene Faculty Publications

[Introduction] Dental hygienists promote oral health and provide preventive services to patients throughout their lifespan. The Commission on Dental Accreditation, Dental Hygiene Standards emphasize that graduates must be competent in providing dental hygiene care for all patient populations, including children.¹ In fact, promoting pediatric oral health begins prior to birth with the expectant mother and/or caregiver. Oral health care to include education is essential during pregnancy; specifically, around the prevention and treatment of dental caries for the mother and the unborn child.² In the U.S., from 2013-2016, roughly 30% of women aged 20-44 years had untreated dental caries.³ Expectant mothers …

Transition To Home Guideline For Patients With Diabetes, Kathleen R. Burgner

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Diabetes is a leading contributor to preventable hospital readmissions. These hospital readmissions often result from fragmented discharge planning, poor care coordination, and limited post-discharge support. At a 915-bed academic medical center in Southern California, the diabetes-related readmission rate was 13.3%, compared with 11.4% among patients without diabetes. This project aimed to develop an evidence-based Transition-to-Home (TTH) guideline for hospitalized patients with diabetes and evaluate the strength of its recommendations through multidisciplinary stakeholder review.

Methods: An evidence-based guideline development project was conducted over 8 weeks. A comprehensive literature search in CINAHL, MEDLINE, PubMed, and ScienceDirect identified current evidence on transitional …

Biomedical Waste Management Practices In A Rural Health Training Centre In Southern India: A Cross-Sectional Facility Audit Using Kayakalp Guidelines, Mathivathani Palaniyappan, Kathiravan Rajendran

Digital Journal of Clinical Medicine

Background

Effective biomedical waste management (BMWM) is essential to prevent environmental contamination and health hazards in healthcare settings. In India, regulatory frameworks like the Biomedical Waste Management Rules, 2016, mandate proper handling, but compliance varies, particularly in rural facilities. This study evaluated BMWM practices at a rural health training centre using the Kayakalp assessment tool.

Methods

A cross-sectional audit was conducted from April to June 2024 at a rural health training centre affiliated with a medical college in Coimbatore, Tamil Nadu, India. The Kayakalp checklist for primary health centres was employed, encompassing 10 measurable elements with 20 checkpoints scored as …

Clinical Challenges Associated With Enhancing Hypertension Among The Underserved African American Population, Ashley Richardson

Doctor of Nursing Practice (DNP) Scholarly Projects

Background 

African Americans face a significantly higher prevalence of hypertension, tend to develop complications at younger ages, and have disproportionately higher mortality rates. Key social determinants of health (SDoH)—including food deserts, unequal access to healthcare, and geographic disparities in healthcare resources—contribute to these ongoing inequities. Addressing both systemic and individual barriers is crucial for effective hypertension management.

Objective

This study aims to assess the effectiveness of a culturally relevant, community-based intervention designed to reduce both systolic and diastolic blood pressure among Black adults with uncontrolled hypertension.

Methods 

Quality improvement (QI) initiatives typically employ multicomponent, equity-focused models. The primary components of …

Diagnosing The Discourse: How The Academy Of Breastfeeding Medicine Constructs And Constrains Treatment Of Tethered Oral Tissues, Mary E. Miller

Antioch University Dissertations & Theses

While breastfeeding is recognized as fundamental to global public health, oral restrictions that can affect infant latch, milk transfer, and feeding efficiency warrant further examination within policy frameworks. This dissertation proposes an expanded conceptualization of tethered oral tissues (TOTs) that encompasses not only anatomical frenal restrictions but also fascial tensions, neuromuscular limitations, and other conditions restricting orofacial function that may be congenital or acquired. The purpose of this study was to critically examine how this clinical guidance document shapes understandings and responses to TOTs. Using Carol Bacchi’s “What’s the Problem Represented to Be?” approach, a critical discourse analysis of the …

Association Between Neighborhood Social Determinants Of Health And Stillbirth, Tetsuya Kawakita, Misa Hayasaka, Ann M. Harper, John Brush, George Saade

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To examine the association between neighborhood-level social determinants of health and stillbirth.

METHODS:

We performed a retrospective cohort study of deliveries that occurred at a gestational age of at least 20 weeks within a five-hospital system (2012-2022). Electronic health record data mapped to the Observational Medical Outcomes Partnership Common Data Model were geocoded using addresses at the time of delivery and linked to neighborhood health indices, which included the Area Deprivation Index (ADI), Maternal Vulnerability Index (MVI), and Social Vulnerability Index (SVI) at the Census tract level. Stillbirths were adjudicated by medical record review. Modified Poisson regression generated relative …