Medical Humanities Commons^™

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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). …

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

All ETDs from UAB

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 …

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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

All ETDs from UAB

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 …

Fixed And Variable Costs At Critical Access Hospitals, Jeremy J. Lyman

All ETDs from UAB

Cost structures (the ratio of fixed to variable costs) vary across and within indus-tries. Hospital managers and policymakers can make better decisions when they under-stand cost structures, including marginal costs (the change in the total cost that arises when the quantity produced is increased by one unit). Although some studies have inves-tigated hospital cost structures, the results have been mixed and less than definitive, and very little attention has been given to critical access hospitals and marginal costs specifi-cally. Rural hospitals, including critical access hospitals, have increasingly experienced financial distress. Between 2005 and 2019, 159 rural hospitals closed across the …

Impact Of Ncqa Pcmh-Level On Low Income Diabetics In Louisiana, Michael G. Griffin

All ETDs from UAB

While past studies have examined the relationship between safety-net provider sites that are certified as Patient Centered Medical Homes (PCMH) and quality health care outcomes, no previous studies have evaluated the relationship between NCQA PCMH certification levels at primary care sites and quality health care outcomes. NCQA is the largest national certification program for PCMH, and for 10 years was the only national program that offered a tiered level of certification based on provider level of patient engagement and deployed resources. The Donabedian Model, which focuses on structure, process, and outcomes, was used to develop the theoretical framework to address …

Impact Of Registered Nurse Staffing Ratio On Nursing Home Operating Margins And Quality Measure Star Ratings, Douglas R. Whitman

All ETDs from UAB

Today’s nursing homes are under immense pressure from government regulators to improve quality while the government simultaneously tightens reimbursement rates. These two forces squeeze operating margins. The question facing nursing home operators is how to improve quality without breaking the bank. This study looks at the association of more registered nurses (RN) with quality and margins in U.S. nursing homes. This research project fills literature gaps which previously found improved nursing home quality correlates with more RNs. However, prior studies used self-reported data and typically considered only two or three quality measures. This study uses recently released electronic payroll data …

Examining The Impact Of Baldrige On Hospital Performance, Jennifer O. Strahan

All ETDs from UAB

The national Baldrige program has supported performance excellence within healthcare for over twenty years, yet it has seen recent declines in the number of applications despite Baldrige award recipients claiming noteworthy improvements across operational, clinical, and financial outcomes. Previous studies have compared Baldrige hospital recipients to non-recipients, but no studies have empirically investigated the value of pursuing the Baldrige award, regardless of award recognition or not. Furthermore, it is unclear if specific categories of the Baldrige Excellence Framework (BEF) are associated with standardized industry performance outcomes. This study used propensity score matching with linear and quantile regression techniques to understand …

The Relationship Between Asthma And Electronic Cigarette Use Among Youth And Young Adults: Mediation And Moderation Approaches, Abdullah M M Alanazi

All ETDs from UAB

Asthma is associated with a higher likelihood of electronic cigarette (e-cigarette) use, which may increase the risk of pulmonary complications. Therefore, we sought to identify factors that influence e-cigarette use that may inform future behavior interventions targeting e-cigarette use prevention. In this dissertation, we used mediation and moderation to model the relationship of health beliefs, psychosocial and behavioral factors that may affect the relationship between e-cigarette use and asthma. We used national samples from public datasets, and a clinical sample recruited from healthcare facilities in Alabama. The results of this study are reported in three different papers. In the first …

Restless Legs Syndrome And Multiple Sclerosis: The Possible Role Of Physical Activity For Managing Symptoms, Katie Cederberg

All ETDs from UAB

Restless legs syndrome (RLS) is an idiopathic neurological disorder characterized by unpleasant sensations in the legs that affects 26% of persons with multiple sclerosis (MS). The current pharmacological treatments for RLS are associated with a number of side effects, including the worsening of symptoms (i.e., augmentation). Physical activity represents a promising, behavioral approach for managing symptoms of RLS in MS. To date, physical activity has demonstrated tremendous benefits for managing many consequences of MS, but there is no evidence on its efficacy for managing RLS in MS. This dissertation described the current literature regarding physical activity and RLS in adults …