Quality Improvement Commons^™

Utility Of Student-Run Free Clinics For Underserved Individuals During Covid-19 Michigan Shelter-In-Place Order, Sara Saymuah, Hailey Heil, Janki Vaghasia, Marla Rojas Thaureaux, Victoria Badia, Paige Baal

Medical Student Research Symposium

Introduction: Cass Clinic, a student-run free clinic (SRFC) affiliated with Wayne State University School of Medicine in Detroit, Michigan, provides free healthcare to predominantly underprivileged populations. Cass Clinic remained open during Governor Whitmer’s shelter-in-place order from March 24, 2020 through June 12, 2020 and throughout the COVID-19 pandemic. The purpose of this study was to assess SRFC’s utility in meeting patient needs during the COVID-19 pandemic.

Methods: A mixed, open and closed-ended quality improvement survey was administered to patients who utilized Cass Clinic between the dates of May 2, 2020 and June 6, 2020. Qualitative analysis included descriptive statistics, while …

Impact Of Covid-19 On The Italian And American Healthcare Systems : A Comparative Assessment, Bita Pejam, Jennifer Lam

All Reports

This report aims to examine and assess the impact of the COVID-19 global pandemic on the healthcare systems of the United States of America and Italy; two of the most heavily affected nations. Using data from December 2019 to January 2021, several consultations, and policy reviews, we identify risks and notable areas of issue in each nations’ approach to combating the virus. We focus our report particularly on the health policies and the governmental structures in place that contributed to each nations’ initial method of alleviating the impact of COVID-19. Our report compares the two healthcare systems and proposes a …

The Impact Of The Hospital Value-Based Purchasing Program On Healthy Days, Health Inequity, And Hospital Community Benefit Spending, Samhita Kadiyala

Scripps Senior Theses

The Hospital Value-Based Purchasing Program (HVBP) is a Centers for Medicare and Medicaid Services (CMS) program implemented in 2012 to reward acute-care hospitals with incentive payments for the quality of care provided to Medicare patients in inpatient settings. Under this policy, payment adjustments are made based on a variety of factors including clinical quality, patient experience, and cost reductions. This paper uses state-level variation in the implementation of HVBP to ascertain whether the policy led to improvements in Healthy Days (a CDC-designed composite measure of individuals’ self-reported number of physically and mentally “healthy” days per month), health disparities, and community …

Covid-10, Healthcare Interior Design + Provider Experience - How Does Your Space Work For You?, Ruth E.P. Deibler

Graduate Research Posters

The lack of research on healthcare staff experience and interior design of the spaces they work in is evident. A focus on staff perspective is needed, particularly staff who navigated the COVID-19 pandemic. This research seeks to capture those stories to develop further research in order to improve staff experience. The initial phase of this mixed-methods approach is a survey. Hypothetically, by placing providers at the center of qualitative research related to healthcare interior design, we can better understand existing healthcare spaces. Ideally, we can develop additional evidence-based, human-centered solutions to transform interior environments in healthcare.

The 20-year Women’s Health …

Another Step In Diagnostics Consultation Model© Actualization: Examining The Impact Of Consultation Workflow Processes On Providers' Clinical Decision Making, Elizabeth K. Leibach

Theses and Dissertations

Background
Communication errors in health services delivery significantly compromise quality in clinical decision making (CDM). Diagnostic information generated by clinical laboratories (CL) accounts for as much as 93% of objective data in the clinical record and therefore is foundational in CDM. This work describes the Diagnostics Consultation Model© (DCM©), a CL communications portal, which supports CDM within interprofessional teams, providers, and institutions. Specific aims were to develop and validate a workflow prediction index (the complexity index, CI) to assign resolution of consultation requests based on an algorithm comprised of characteristics available at the point of consultation initiation. The CI functions …

Effect Of An Electronic Order Set On Newborn Hepatitis B Immunization Rates, Daniel Pedersen, Angelina Rodriguez, Olu Oyesanmi, Heather Schramm, Michael King

HCA Healthcare Journal of Medicine

Objective

Hepatitis B is an infectious deoxyribonucleic acid virus which can cause significant morbidity and mortality. There is no current definitive treatment, however in the United States immunization is widely available. A paper published by the Advisory Committee on Immunization Practices/Centers for Disease Control (ACIP/CDC) in 2018 made updated recommendations regarding vaccination practices in the United States. The most notable change made was that all healthy newborns weighing ≥2000 g with a negative hepatitis B-status mother should receive hepatitis B immunization within 24 hours of birth. This quality improvement project studied the effect of the electronic medical record newborn admission …

Right To Health In Gats: Can The Public Health Exception Pave The Way For Complementarity?, Swati Gola

Pace International Law Review

This paper demonstrates how a right to health approach in the interpretation of the public health exception outlined in GATS Article XIV(b) can bring about a harmonious application of international human rights and international trade law regimes. Focusing on the interpretive value of the right to health for the public health exception in GATS, it examines whether a WTO Member, who has committed itself under GATS to fully liberalize all service sectors that have implications for health (e.g., hospital and other healthcare services), still retains the regulatory space to undertake measures to fulfill their right to health obligations and can …

Reviewing Patient Satisfaction Of Lifecare Alliance Services Provided To The Columbus Community, Sean Ruffner

Masters Theses/Capstone Projects

Two separate patient satisfaction surveys were sent out to LifeCare Alliance’s customers. Each patient was asked a set of five questions that generalized the encounters as a whole experience. The first survey is for patients that were seen by nurses for footcare, general wellness and more (1A - PowerPoint). The other survey was sent to clients who received the flu vaccine (1B - PowerPoint). To conclude, data was then collected and analyzed using an excel spreadsheet (1C – PowerPoint).

Health Insurance And The Undocumented Immigrant, Anja Diercks

Honors Theses

The purpose of this thesis is to perform a comparative analysis on how seven different countries (USA, South Africa, Germany, England, Canada, France and Singapore) organize their healthcare system to cope with the issue of undocumented immigrants and whether or not these systems in place were “fair.” The thesis will also explore the possible ways the United States could change to be more inclusive and fairer in the world of healthcare and health insurance for the undocumented immigrant. A study on what fairness means both in ethical and economical terms is done to suggest a new basis of a fair …

Creation Of A Covid-19 Community Testing Team For Home Health And Hospice, Lilah Raja

Master's Projects and Capstones

The novel SARS-CoV-2 strain (COVID-19) was identified in Wuhan, China in December 2019 (Eddy et. al, 2020). The resulting US outbreak has affected the Kaiser Permanente (KP) Oakland health care system. With the threat of COVID-19 highest among immunosuppressed and elderly clients, KP Oakland home health and hospice (HH/HO) department is rapidly mobilizing to provide community and in-home testing for eligible clients. A project was created to build a COVID-19 testing team workflow to provide diagnostic and preventative testing. This project focuses on team-based interventions that will change the pre-existing practice of requiring HH/HO clients to travel to remote testing …

Bystanders’ Perspectives On The Provision Of Informal, Hospital-Based Care To Bedridden Patients With Cancer In Sri Lanka, B. Sunil S. De Silva

Nursing ETDs

Due to the nursing shortage in Sri Lanka, patients need informal caregivers, known as bystanders, to help provide patient care. This study described bystanders’ perspectives on informal, hospital-based care to bedridden patients with cancer in Sri Lanka. In this qualitative descriptive study, 17 bystanders at Apeksa/Cancer Hospital, Sri Lanka, were recruited using snowballing sampling. Data were collected through telephone interviews and analyzed using content and thematic analyses. Findings showed that paid and unpaid bystanders cover all caregiving tasks with minimum interaction with nurses. Unpaid bystanders described the need for same-sex bystanders and additional help with patients’ mobilization and specialized care. …

Improving Colorectal Cancer Screening And Testing In A Primary Care Clinic, Leslie Michelle Dubois

Doctor of Nursing Practice

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related deaths worldwide (World Health Organization, 2019a). In the United States, CRC was the fourth most common cancer in 2016 (Centers for Disease Control and Prevention, 2019a). The American Cancer Society (2020a) estimated that there will be 147,950 estimated new cases and 53,200 estimated deaths of CRC in the U.S. in 2020. The purpose of the project was to improve CRC screening completion rates and follow up referrals from 27.5% to 35% for adult patients, 50-75 years of age, within a family medicine clinic …

Disparities In Oral Health: Socioeconomic Status And Policies To Increase Access To Primary Dental Care, Mckenzie Nutter

Theses/Capstones/Creative Projects

Primary dental care is a patient-centered service consisting of routine dental checkups. The oral cavity is the first point of entrance to the body for many harmful pathogens. Therefore, primary dental care is essential to not only prevent and treat conditions in the mouth, but to also reduce the number of systemic diseases in the rest of the body. However, people with higher incomes or wealth have increased access to primary dental care. People with low socioeconomic status have decreased access to primary dental care, at least in part due to difficulties in paying for separate dental insurance. Disparities in …

Understanding The Significance Of Virtual Support During Global Pandemic In Young Adults Diagnosed With Hepatitis C, Veronika Arkhipova

Master's Projects and Capstones

Hepatitis C is a viral infection that attacks the liver and leads to inflammation. In recent years, the prevalence of hepatitis C infections among 20 and 30 years of age has increased by 300 percent, and between 30 and 39 years by 400 percent. Due to the global coronavirus pandemic, people diagnosed with Hepatitis C have lost access to mental health services and resources, including in-person meetings with support groups. Since most states enforced stay-at-home order, many community centers, non-profit organizations that work with Hepatitis C patients and the affected population provide limited to no access to support group meetings …

Evaluating The Effect Of Care Around Labor And Delivery Practices On Early Neonatal Mortality In The Global Network's Maternal And Newborn Health Registry, Archana B. Patel, Elizabeth M. Simmon, Sowmya R. Rao, Janet Moore, Tracy L. Nolen, Robert L. Goldenberg, Shivaprasad S. Goudar, Manjunath S. Somannavar, Sarah Saleem, Farnaz Naqvi

Community Health Sciences

Background: Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation's (UN's) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization's Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness.
Methods: Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD's Global Network's (GN) Maternal Newborn …

Looking Beyond The Numbers: Quality Assurance Procedures In The Global Network For Women's And Children's Health Research Maternal Newborn Health Registry, Ana Garces, Emily Macguire, Holly L. Franklin, Norma Alfaro, Gustavo Arroyo, Lester Figueroa, Shivaprasad S. Goudar, Sarah Saleem, Fabian Esama, Archana Patel

Community Health Sciences

Background: Quality assurance (QA) is a process that should be an integral part of research to protect the rights and safety of study participants and to reduce the likelihood that the results are affected by bias in data collection. Most QA plans include processes related to study preparation and regulatory compliance, data collection, data analysis and publication of study results. However, little detailed information is available on the specific procedures associated with QA processes to ensure high-quality data in multi-site studies.
Methods: The Global Network for Women's and Children's Health Maternal Newborn Health Registy (MNHR) is a prospective population-based registry …

Decreasing Readmissions In Medically Complex Children, Colleen Bartlett

Student Scholarly Projects

Practice Problem: There was a report of an existing practice problem of increased 30-day readmission rates in medically complex children at an outpatient clinic within an extensive hospital system. Hospital readmissions can cause clinical, social, and financial burdens to the patients and their families and thus reflected a need for interventions to reduce readmissions.

PICOT: The PICOT question that guided this change project: In medically complex pediatric patients ages 0-17, what is the effect of a discharge intervention bundle in reducing all-cause 30-day hospital readmissions compared to current practice within an 8-week timeframe?

Evidence: The literature revealed 18 …

Measuring Service Quality And Assessing Its Relationship To Contraceptive Discontinuation: A Prospective Cohort Study In Pakistan And Uganda, Karen T. Chang, Nirali M. Chakraborty, Amanda M. Kalamar, Waqas Hameed, Ben Bellows, Karen A. Grépin, Agha Xaher Gul, Sarah E K. Bradley, Lynn M. Atuyambe, Dominic Montagu

Community Health Sciences

Background: The quality of contraceptive counseling that women receive from their provider can influence their future contraceptive continuation. We examined (1) whether the quality of contraceptive service provision could be measured in a consistent way by using existing tools from 2 large-scale social franchises, and (2) whether facility quality measures based on these tools were consistently associated with contraceptive discontinuation.
Methods: We linked existing, routinely collected facility audit data from social franchise clinics in Pakistan and Uganda with client data. Clients were women aged 15-49 who initiated a modern, reversible contraceptive method from a sampled clinic. Consented participants completed an …

Survey Of Workplace Violence Perception, Prevention, Strategies, And Prevalence Of Weapons In Healthcare Facilities, James D. Blando, Marilyn Lou Ridenour, Daniel Hartley

Community & Environmental Health Faculty Publications

No abstract provided.

Death By Contamination, Syeda Sana Batool

MSJ Capstone Projects

This research was conducted by Centre for Excellence in Journalism, IBA, Karachi during 2019 as a capstone project for Master of Science in Journalism. The data and information regarding water contamination was obtained and compiled through a thorough reporting, researched articles and documents provided by concerned organization.

The water which is used for the drinking purpose in Karachi is the most polluted and contaminated one as compare to the other cities of Pakistan. The reason behind this water contamination is the industries disposition of waste, which has ruined the environment by polluting the water bodies with its toxic effluent.

The …

Realizing Improved Patient Care Through Human-Centered Design In The Operating Room, Volume 2, Clemson Center For Health Facilities Design & Testing

Center for Health Facilities Design and Testing

This 4-year grant from the Agency for Healthcare Research and Quality supports the development of a learning lab focused on designing a safer, more ergonomic operating room. Sponsor: Agency for Healthcare Research Quality Project period: 9/1/15 to 8/31/19 Project Description: The overarching goal of the learning lab titled, “Realizing Improved Patient Care through Human-Centered Design in the Operating Room (RIPCHD.OR) is to develop an evidence-based framework and methodology for the design and operation of operating rooms such that it impacts improved perioperative outcomes including surgical site infections, surgical errors and staff injuries.

Hypertension Patient Compliance, Taylor Myers

University Honors Program

Hypertension is a prevalent condition in the United States that often has many comorbidities. It is usually asymptomatic, so patients are less likely to comply with treatment if they feel healthy. This is a growing concern due to the complications that can arise from hypertension. Hypertension can be associated with a lower quality of life in patients that have symptoms. However, in patients that do not show symptoms they may feel that they have a higher quality of life by not changing their preexisting habits. The reasons for patient noncompliance will be studied as well as interventions to increase compliance, …

Microbiological Contamination Of Mobile Phones Of Clinicians In Intensive Care Units And Neonatal Care Units In Public Hospitals In Kuwait, Mohammed Heyba, Mohammad Ismaiel, Abdulrahman Alotaibi, Mohamed Mahmoud, Hussain Baqer, Ali Safar, Noura Al-Sweih, Abdullah Al-Taiar

Community & Environmental Health Faculty Publications

Background: The objective of this study was to explore the prevalence of microbiological contamination of mobile phones that belong to clinicians in intensive care units (ICUs), pediatric intensive care units (PICUs), and neonatal care units (NCUs) in all public secondary care hospitals in Kuwait. The study also aimed to describe mobile phones disinfection practices as well as factors associated with mobile phone contamination.

Methods: This is a cross-sectional study that included all clinicians with mobile phones in ICUs, PICUs, and NCUs in all secondary care hospitals in Kuwait. Samples for culture were collected from mobile phones and transported for microbiological …

Patient Safety Culture And High Reliability Organizations, Jared D. Padgett

Walden Dissertations and Doctoral Studies

A 1999 evaluation of case studies performed by staff from the Institute of Medicine found that between 40,000 and 98,000 patients died from preventable errors, while 43,598 individuals died in car accidents that year. A 2011 report increased that estimate nearly 10 times. Widespread preventable patient harm still occurs despite an increase in healthcare regulations. High-reliability organization theory has contributed to improved safety and may potentially reverse this trend. This explorative single case study explored how the perceptions and experiences of nursing and respiratory staff affected the successful transition of a healthcare organization into a reliability-seeking organization. Fourteen participants from …

Shea/Apic Guideline: Infection Prevention And Control In The Long-Term Care Facility, Philip W. Smith, Gail Bennett, Suzanne Bradley, Paul Drinka, Ebbing Lautenbach, James Marx, Lona Mody, Lindsay Nicolle, Kurt Stevenson

United States Department of Veterans Affairs: Publications

Long-term care facilities (LTCFs) may be defined as institutions that provide health care to people who are unable to manage independently in the community.¹ This care may be chronic care management or short-term rehabilitative services. The term nursing home is defined as a facility licensed with an organized professional staff and inpatient beds that provides continuous nursing and other services to patients who are not in the acute phase of an illness. There is considerable overlap between the 2 terms.

More than 1.5 million residents reside in United States (US) nursing homes. In recent years, the acuity of illness …

Patient Satisfaction And Disease Specific Quality Of Life After Uterine Artery Embolization, Wendy J. Smith, Elizabeth Upton, Elizabeth J. Shuster, Arnold J. Klein, Martin L. Schwartz

Faculty Publications - College of Medical Science

Objectives: This study was undertaken to evaluate changes in fibroid specific symptom severity and health-related quality of life (HRQOL) after uterine artery embolization (UAE) and to consider the impact of these changes on satisfaction with the procedure.

Study design: A validated, fibroid specific, symptom, and HRQOL questionnaire was mailed to 80 women who had undergone UAE from 1998 through 2002. Pre- and postprocedure symptom severity and HRQOL scores were obtained. The primary outcome measure was change in fibroid symptoms and HRQOL after UAE. Secondary outcomes included objective measures of patient satisfaction, and the decrease in uterine volume after UAE.

Pérou: Les Gestionnaires Doivent Régulièrement Veiller Á La Qualité Des Soins, Frontiers In Reproductive Health

Reproductive Health

No abstract provided.

Peru: Managers Must Monitor Quality Of Care Regularly, Frontiers In Reproductive Health

Reproductive Health

In the late 1980s, Peru’s National Family Planning Program within the Ministry of Health (MOH) assigned method-specific targets to clusters of health facilities. In 1998, the MOH changed its policies to ensure that services responded to individual reproductive health needs and wishes. It eliminated method quotas, ended voluntary surgical contraception campaigns, and issued norms to ensure quality of care and informed choice. In 1999, the Population Council collaborated with the MOH to determine whether providers were complying with the new guidelines and, secondarily, to develop a monitoring system to assess compliance over time. As concluded in this brief, family planning …

Perú: Los Administradores Deben Supervisar Rutinariamente La Calidad De La Atención, Frontiers In Reproductive Health

Reproductive Health

No abstract provided.

Estimating Costs Of Post-Abortion Services. General Hospital Aurelia Valdivieso, Oaxaca, Mexico, Population Council

Reproductive Health

Health care systems around the world are facing problems providing quality care with increasingly constrained resources. While modern practices and diagnostic tests have made pregnancy a much less risky event than in the past, not all pregnancies have a favorable outcome. Spontaneous abortion occurs in 15–45% of all known pregnancies, and studies show that 25% of all obstetric/gynecology hospital admissions are for incomplete abortion. Given the high level of resources devoted to treating this condition, it is imperative to develop cost-effective methodologies to provide quality care. Unsafe abortion performed by untrained and inexperienced providers is the fourth leading cause of …