Medical Humanities Commons^™

Exploring The Influence Of Family History Before And After Type 2 Diabetes Development Through Statistical Analysis Of Biomarkers And An Educational Intervention, Jessica Johnson Denton

All ETDs from UAB

The prevalence of type 2 diabetes is increasing at an alarming rate in both children and adults worldwide. Timely identification of those at risk for type 2 diabetes is essential to reduce morbidity and mortality and to mitigate the toll on families and the healthcare system. Family history is an effective, universal tool that can be used to identify individuals at risk for type 2 diabetes before they acquire additional risk factors. Understanding how family history contributes to biomarkers associated with diabetes in healthy individuals could facilitate the creation of early screening and prevention strategies designed for this specific at-risk …

Is There A Relationship Between Leadership Characteristics And Services Provided Among Ihs Urban Indian Health Programs?, George Grant Tribble

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IS THERE A RELATIONSHIP BETWEEN LEADERSHIP CHARACTERISTICS AND SERVICES PROVIDED AMONG IHS URBAN INDIAN HEALTH PROGRAMS?GEORGE G. TRIBBLE HEALTHCARE LEADERSHIP ABSTRACT The Native American population has faced and been impacted by a wide range of actions throughout the last few hundred years. The loss of cultural norms and way of life continues to manifest itself through various socioeconomic concerns. At the center of the Native American leadership model is a disciplined and culturally specific guidance structure. The Urban Indian Health Program (UIHP) was created by the Indian Health Service to establish a culturally appropriate health care delivery model for Native …

The Role Of Obesity, Gdm, And Lifestyle Factors On Metabolic Syndrome Scores In Mothers And Their Children 4-10 Years After Pregnancy, Makenzie Callahan

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Metabolic syndrome (MetS) is a cluster of symptoms that increase risk for heart disease and type 2 diabetes. Therefore, early detection of MetS is vital for disease prevention. Gestational diabetes (GDM) and/or obesity during pregnancy are associated with a greater risk for MetS in mothers and their children compared to mothers with no GDM. However, little is known about how much a GDM history or in utero exposure to maternal GDM contributes to MetS risk years after that pregnancy in addition to risk attributable to obesity itself. Therefore, the overall objective of this dissertation was explore how a history of …

Financial Performance Of Participating Hospitals In Accountable Care Organizations, Abdulrhman Alzhrani

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The study examines the influence of accountable care organizations ACO participation on hospital financial performance. It poses two research questions: 1) how does ACO participation influence hospital financial performance? 2) How do organizational factors- hospital size, electronic health records (EHR) utilization, and ambulatory services- moderate the relationship between hospital ACO participation and financial performance? The study used longitudinal sample of general and surgical hospitals operating in United States from 2009 to 2017. The data were obtained from several sources including American Hospital Association (AHA), AHA survey of care system and payment, hospital cost reports, AHA information technology and Area Health …

The Effect Of Medicaid Expansion On Hospitals Allowance For Bad Debt, Tara B. Dixon

All ETDs from UAB

The management of bad debt is a complex issue for hospitals, and if mismanaged, can impact the organization's current and future financial stability. The expansion of Medicaid through the Patient and Affordable Care Act (ACA) was expected to lessen the bad debt reported by hospitals by increasing the number of insured lives. Hospital managers understand that a certain percentage from the accounts receivables will end up being uncollectable; however, strategically planning for bad debt and estimating a more accurate allowance requires a specific level of strategic planning. Allowance for bad debt should not be a guessing game but should be …

Pain-Related Injustice Appraisal And Chronic Low Back Pain Among Arabs In The United States, Albatool Homoud Alnojeidi

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Pain-related injustice appraisal has emerged as a psychosocial predictor of deleterious chronic low back pain (CLBP) outcomes. The appraisal is defined as the individual’s perception regarding the magnitude and irreparability of pain-related loss and suffering, externalized blame, and unfairness. Research in diverse samples revealed racial differences in pain-related injustice appraisal, suggesting that it may reflect broader racial/ethnic, sociocultural, and socioeconomic factors. This agrees with theories recognizing the role of ethnic and cultural characteristics in ethnic minorities’ health. Despite global data showing that Arabs represent the population with the second-highest prevalence of CLBP worldwide, a reliable characterization of CLBP among Arabs …

Identifying Factors To Inform The Development Of Adaptive Interventions For Increasing Physical Activity Behavior Among People With Multiple Schlerosis, Yumi Kim

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People with multiple sclerosis (MS) can benefit from physical activity, specifically exercise, for the management of disease symptoms, including walking impairments, fatigue, and depression, and improvements in quality of life. However, people with MS do not engage in adequate amounts of physical activity for the accrual of health benefits. Researchers have focused on the delivery of exercise training and behavioral interventions to improve levels of physical activity in MS. To date, there is an emerging body of research supporting the efficacy of these interventions for increasing and potentially sustaining physical activity behavior in people with MS. Yet, people with MS …

The 340b Drug Pricing Program: Are 340b Covered Entities Providing More Services And More Uncompensated Care?, Isabell M. Pacheco

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The 340B Drug Pricing Program enacted in 1992 requires pharmaceutical manufacturers participating in the Medicaid program to provide statutorily defined discounts on "covered outpatient drugs" purchased by government-supported facilities, known as covered entities, that are expected to serve the nation's most vulnerable patient populations. The Program has been under copious scrutiny by industry stakeholders and Presidential Executive Orders that threaten its macrocosm. While previous research suggests that health systems with a mix of 340B participating and non-participating locations are not associated with expanded access to care, additional research is needed to determine if entities participating in the 340B Drug Pricing …

The Relationship Of Debt Ratio And Financial Performance For Large Nfp Health Systems, Mark Lombardi

All ETDs from UAB

This dissertation was a quasi-experimental research study exploring the relationship between long-term to debt capitalization ratio and financial performance in an environment where interest rates remained historically low and stable, while investment returns in the U.S. equity markets increased year over year. The study reviewed 142 not for profit health systems and examined total and non-operating margins along with long-term debt to capitalization ratio to determine if margins increased as long-term debt increased. Researchers have discussed the opportunity that not for profit health systems have to utilize low cost, tax-exempt debt to maintain or grow their endowments and in turn …

The Assessment Of Neuro-Mechanics Of Inspiratory Muscles During Mechanical Ventilation, Hassan Y. Abunurah

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The decline in inspiratory muscles function for patients undergoing mechanical ventilation may further extend the duration of mechanical ventilation leading to lethal complications. Thus, the assessment of neuro-mechanics of inspiratory muscles may help us understand the pathophysiology for mechanical ventilation failure to avoid its complications. In this dissertation, we assessed the characteristics of inspiratory neuromechanics under different conditions. This dissertation is reported in three different papers. In the first paper, we sought to assess the quality of the available literate that used surface EMG of extra-diaphragmatic muscles during invasive mechanical ventilation. We demonstrated that the use of sEMG of extra-diaphragmatic …

Joint Specificity Of Stretch-Shortening Cycle Potentiation, Marzouq Khalaf Almutairi

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The stretch-shortening cycle (SSC) is a well-known phenomenon to enhance an individual’s muscular performance, and it is an area of active focus of research scientists for decades. However, it is not known whether SSC potentiation is a joint-specific event and shows a joint-specific temporal behavior. It is also unclear if constraints of joint and movement specificity of SSC potentiation can be captured via isokinetic dynamometer. Therefore, the purposes of this dissertation were to examine joint specificity of SSC potentiation via isokinetic dynamometer and kinetic-kinematic analysis of jump test performance and investigate joint-specific temporal behavior of SSC potentiation. My first study …

Fqhcs, Health Center Controlled Network Affiliation And Performance, Armika Jessica Berkley

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Since the mid-1960s, Federally Qualified Health Centers (FQHCs) have been funded by the U.S. federal government to provide access to preventative and primary care for medically underserved communities. The federal government’s involvement in the funding of FQHCs was a response to extreme poverty, economic instability, and civil unrest related to the Civil Rights movement. Adoption of value-based care delivery practices to improve clinical and financial performances among FQHCs has been slow. This slow adoption has been attributable to cost, lack of expertise, and support. Since August 1994, the Department of Health Resources and Services Administration (HRSA), the funding source for …

Do Outcomes From A Behavioral Weight Loss Intervention Differ In Alabama Vs Colorado?, Julianne Clina

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There are well-established regional differences in obesity prevalence in the U.S., but relatively little is known about whether these differences impact efforts for weight loss. The objective of the study was to determine whether changes in body weight, engagement in physical activity (PA), and psychosocial factors differed in Colorado (CO) vs Alabama (AL) in response to a 16 week standardized behavioral weight management program. We hypothesized that weight loss would be greater in Colorado due to a more favorable physical and social environment.This is an ancillary study to a weight loss intervention being conducted simultaneously in AL and CO with …

Central Vestibular Integration In Concussion And Multiple Sclerosis, Graham Dean Cochrane

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Dizziness and imbalance are commonly reported by people with concussion and people with multiple sclerosis (MS). Dysfunction of the vestibular system is likely a major cause of dizziness and imbalance in both diseases, but it is not well understood whether this dysfunction typically occurs in peripheral vestibular organs and pathways or higher-level central vestibular integration pathways. As these systems are assessed and targeted with rehabilitation differently, understanding how both are affected in these diseases will improve management of dizziness and imbalance. In addition, balance has been demonstrated to correlate with self-reported fatigue in people with MS, presumably through shared dysfunction …

Race, Feeding Practices And Infant Weight Gain During The First 6 Weeks Of Life, Alysha Breanne Everett

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Background: Non-Hispanic black (NHB) infants are disproportionately affected by rapid weight gain compared to non-Hispanic white (NHW) infants, which in turn, is associated with future disparities including obesity and cardiometabolic disease. Feeding practices, such as the use of formula or bottles, differ by race and are associated with rate of weight gain. Data from the Pregnancy and Early Life in the South (PEARLS) birth-cohort study was used to test the hypotheses that change in body weight and weight-for-age z-scores (WAZ) from birth to 6 weeks would be greater for (1) NHB versus NHW infants; and (2) infants fed formula (exclusively …

Does Interdisciplinary Care Team Care Management Improve Health Quality And Demonstrate Cost Effectiveness?, F Cardwell Feagin

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The U. S. healthcare system faces unsustainable rising healthcare costs. Health care cost as a percentage of gross domestic product is expected to rise to 19.4 percent by 2027 (Wilson, 2019). This unstainable rise in healthcare costs is creating a problem for consumers of healthcare. By 2030, the average annual healthcare spending per working household, including premium and out-of-pocket expenditures, is estimated to be 33.9 percent of median compensation (Girod et al., 2016). Also, lawmakers and policymakers face funding issues of healthcare. A key finding of this study is that field-based interdisciplinary care team care management, with an algorithm selecting …

Evidence For A Bioelectrical Marker Of Insulin Resistance In Premenopausal Women: Membrane Capacitance, Valene E Garr Barry

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Insulin resistance (IR) is associated with poor metabolic and reproductive outcomes among premenopausal women. Early identification of women with IR might mitigate these outcomes. However, clinically suitable methods to identify women with IR are unavailable due to high cost, high patient burden, or limited reliability. The objective was to examine a bioimpedance-based approach to identifying women with IR using membrane capacitance (CM). CM is a measure of cell membrane health and function, which is independently associated with IR and may be a suitable predictor. We validated the association of CM with IR and established the clinical utility of CM as …

Rural And Urban Differences In Vegetable And Fruit Consumption Among Older Cancer Survivors In The Deep South: An Exploratory Cross-Sectional Study, Harleen Kaur

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Background: Rural Americans have poorer overall health and physical functioning than their urban counterparts. A varied diet, rich in vegetable and fruit (V&F) consumption may improve health; however, little is known about rural-urban differences in V&F consumption, especially in older cancer survivors. Objective: To assess differences in V&F consumption among older cancer survivors residing in urban- and rural-designated areas, and explore whether differences exist by sex, race, and cancer type. Design: This was a cross-sectional secondary analysis. Participants/setting: Screening data from the Harvest for Health trial was obtained on 731 Medicare-eligible cancer survivors across Alabama. Main outcome measures: V&F consumption …

Service Profiles In Substance Use Disorder Treatment: The Role Of Institutional And Organizational Factors, Reena Joseph Kelly

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Substance use disorders (SUDs) are a growing crisis globally and in the US, and place an enormous health, social, and financial burden on the nation. To address the complex nature of SUDs, treatment typically involves a combination of different types of services to address the medical, behavioral and social needs of the patient and care is often delivered by specialized SUD treatment facilities. Despite recommendations for a broad suite of services, individual facilities vary in the specific services that they offer. This study examined whether and why systematic differences exist between treatment facilities based on their service mix and whether …

Actual And Perceived Balance Abilities While Performing Tasks That Challenge Balance In Older Adults And Individuals With Parkinson's Disease., Jutaluk Kongsuk

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Walking is a fundamental activity for one to interact effectively with one’s environment. Walking in the community often requires both a wide range and constant modification of walking speed. Decreased walking capacity, that is the maximum speed that a person can physically achieve, results in a decline in both functional mobility and personal independence, contributing to decreased community participation among individuals whose walking is impaired. The most common test of walking speed (i.e., overground comfortable and maximum walking speed) may not reflect the full capacity of individuals to regulate gait control. Whereas walking with progressively increasing treadmill speeds allows researchers …

The Association Between Medicaid Expansion, Medicaid Disproportionate Share Payments And The Financial Performance Of Safety Net Hospitals, Jon Law

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Safety Net Hospitals (SNHs) provide necessary emergency and acute care to all individuals, regardless of their ability to pay for health care. Medicaid Expansion and Disproportionate Share (DSH) payments are two Medicaid programs that may mitigate the financial vulnerability of SNH’s. Some assert that Medicaid Expansion, as part of the Patient and Affordable Care Act (ACA), may provide financial relief for SNHs. It offers payment mechanisms for millions of uninsured individuals. DSH expenditures per capita for each state vary widely. There is some likelihood that SNHs in some states may benefit greater than others. The study was framed within the …

Value Analysis Of Electronic Health Records, Shikha Shah Modi

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The Electronic Health Record (EHR) is defined as “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting” (HIMSS, 2011). EHRs have become an important part of the current health system as a result of government regulations, technology advancements, health care challenges, and market conditions. EHRs are considered an expensive investment; however, the complexity of adopting and implementing EHRs also demands attention. Given the complexity of health information technology (HIT) systems and the hefty investment that is required in the adoption of EHRs, a return on investment is expected, and it …

Disrupting The Perioperative Opioid Gateway: Identification Of Risk Factors For New Persistent Post-Surgical Opioid Use, Gia Marie Pittet

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A large portion of the American Opioid Crisis is due to opioid naïve patients who become new persistent post-surgical opioid users, although the risk factors for the development of this addiction are not well studied. The objective of this study was to analyze multiple layers of pre-operative and procedural risk factors using an ecological perspective theoretical framework in adult patients undergoing invasive surgery. We performed a retrospective analysis of 13,970 opioid naïve adults in a mixed surgical cohort with data available at the University of California Los Angeles that was merged with narcotics data for the State of California (IRB#19-000625). …

Dietary Nitrate And The Oral Microbiome In Obesity, Health And Exercise, Christian E. Behrens

All ETDs from UAB

Obesity ranks among the top growing health concerns worldwide. The prevalence of obesity at all life stages continues to rise with nearly 40% of adults and 35% of children/adolescents being affected. Equally troublesome is the increased risk for a number of comorbidities associated with obesity including cardiovascular disease, stroke, type 2 diabetes mellitus, and certain types of cancer. The successful treatment of obesity, particularly long-term, continues to prove challenging and is often met with limited success. This highlights the importance of continued investigation into alternative strategies that may reduce the incidence and severity of obesity and associated pathophysiologies. Regular physical …

An Analysis Of The Impact Of The Long-Term Care Partnership Program On The Number Of Lives Covered By Long-Term Care Insurance And Medicaid Expenditures In Nursing Homes, Cheris Kline

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The growing number of people over the age of 65 in the U.S. will exacerbate already inadequate resources for long-term care, producing increased public health costs. The Long-Term Care Partnership Program (LTCPP) was proposed to save Medicaid expenditures by incentivizing the purchase of long-term care insurance. At this juncture, it is unclear if the partnership program saves the government money. This study draws from the expected utility theory and resource dependency theory to determine whether the LTCPP has increased the purchase of private long-term care insurance and reduced Medicaid expenditures in nursing homes in states that have adopted the partnership …

Exploring Diet Quality In Early Care And Education Centers: Measures, Policies, And Center Characteristics, Elizabeth Kroeger

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Over 65% of children ages 2-5 years attend Early Care and Education (ECE) centers where they consume most of their daily caloric intake; however, children at these centers are not meeting the Dietary Guidelines for Americans (DGA). This could suggest poor diet quality, which is a risk factor for diet-related diseases. Currently, diet quality in ECE centers is measured through the assessment of either the food/beverages listed on the lunch menu (menu), served to the children during lunch (served), or consumed by the children during lunch (consumed). However, the lunch meal may be better viewed as a process, rather than …

An Analysis Of Hospitalist Programs In Critical Access Hospitals, Robert Thomas Peterson

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AN ANALYSIS OF HOSPITALIST PROGRAMS IN CRITICAL ACCESS HOSPITALS ROBERT T. PETERSON HEALTHCARE LEADERSHIP ABSTRACT Hospitalists are physicians specially trained in the care of hospitalized patients. In critical access hospitals (CAHs), the annual cost of a physician-based hospitalist program is approximately $1M. The high cost of hospitalist programs must be offset by the hospitalists’ ability to reduce the cost of inpatient care and/or by their ability to generate additional inpatient volume and revenue. Two well-established metrics are used to measure hospitalist performance: the average inpatient length of stay (ALOS) and the average daily census (ADC). Well-performing hospitalist programs are expected …

Health Systems And Societal Level Community Benefit, Meghan Blueberry Mccarthy

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In America, the amount spent on community benefit as tax exemption justification for not-for-profit health care is approaching 100 billion dollars annually. There are multiple categories for community benefit as defined by the Internal Revenue Service (IRS). The overwhelming majority of these funds are spent on individual financial assistance rather than societal level community health investments to address social determinates of health. Societal level community benefit is defined as the total spending on community health improvement, cash & in-kind donations to community groups and community building as reported on IRS form 990 Schedule H. These three combined itemized areas of …

The Comparison Of Two Diabetes Self-Management Education Programs In The Reduction Of Patient A1c Levels, Edward Sharpless

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This dissertation was a quasi-experimental research study exploring the effectiveness of two educational teaching methods with patients with diabetes. One teaching method utilized an education framework called the Conversation Map tools, a group-based, highly interactive learning experience using colorful visual tools, activity cards and sharing of real-life experiences. The other method was a traditional, lecture-style class taught by a health educator using overhead slides and handouts.

Secondary data from a regional health system in the Western U.S. was used to test the hypothesis that participants in the Conversation Map classes would report a larger drop in A1c levels compared to …

Assessment Of Emergency Department High Utilizer Program In Public Health System Setting, Michael Malaise

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is study examined whether a case management model designed to reduce emergency department utilization among patients described as super-utilizers in a public health system could also reduce the per patient cost of those super-utilizers. The setting for this study was a large public health system in a major metropolitan area. The study focused on a low-income, urban population. Given the program’s stated desire to improve the self-efficacy of patients over time so that they could take more ownership of their own health status, this study reviewed the program within the framework of self-efficacy theory. This research predicted that the case …