Public Health Commons^™

Residential Mobility And Enrollment Churn In A Medicaid Population, John E. Stewart

Theses and Dissertations

Previous investigations show high rates of enrollment discontinuity, or churn, among Medicaid participants. Discontinuity of coverage can limit appropriate use of health care, increase emergency department utilization and in-patient hospitalization, negatively affect self-reported health, increase health care spending, and compound Medicaid administrative costs. Efforts to more fully understand and ultimately reduce enrollment churn thus are vital to Medicaid agencies and beneficiaries. Residential moves are life transitions, often marking other significant life events (e.g., changes in employment or family structure) that can alter eligibility for Medicaid benefits. Few studies have examined residential moves among Medicaid members, or considered residential mobility as …

How Do Health System Employees With Established Musculoskeletal Complaints Decide On Their Treatment Pathway? A Qualitative Approach, Noor Alshareef

Theses and Dissertations

Purpose: Non-pharmacologic treatment such as physical therapy (PT) are advocated for musculoskeletal pain for decreasing opioid use. Early access to PT has been shown to decrease costs and improve outcomes through direct access via self-referral. Although self-referral to PT is permitted in the majority of U.S states, health insurance coverage has been identified as a barrier preventing some patients with musculoskeletal complaints from using it. There are few studies examining patient factors related to early access to physical therapy via self-referral. The purpose of this study was to identify the factors outside of insurance that influence the choice to access …

Introduction Of Innovative Medical Practices In Mayo Clinic: Effect Of The Interventions On Patient Outcomes, Duaa I. Aljabri

Theses and Dissertations

Purpose: Assessment of health technologies in medical practice is an ongoing process to provide clinicians and policymakers with information on the value of those applications. This dissertation aims to add to the existing body of literature and fill the gaps in prior studies by assessing two health technologies in Mayo Clinic Florida (MCF). The first paper provides an assessment of patient portal adoption and activity during hospitalization among cancer patients, and determines whether a portal application is associated with selected indices of patient safety, utilization and satisfaction. The second paper provides an assessment of a new approach in pain …

Association Of Insurance And Provider Type With Patients’ Perceived Cost And Ease Of Access To Healthcare Services Among Medicare Beneficiaries Diagnosed With Diabetes, Metria Harris

Theses and Dissertations

Medicare beneficiaries diagnosed with diabetes are likely to have health complications or episodes associated with diabetes, resulting in higher health care utilization and costs. Andersen’s Health Care Utilization Behavior Model (HCBM) includes predisposing, enabling, and need factors, but it excludes perception. Ajzen’s Theory of Planned Behavior (TPB) shows that perception influences health service use. This study was performed using a real-world model integrating Andersen’s HCBM and Ajzen’s TPB to determine whether there was an association between insurance type (Medicare Part D versus non-Part D) and perceived ease of access or cost among Medicare beneficiaries with diabetes. The second objective was …

Layperson Perceptions And Attitudes Towards A National Electronic Health Record Introduction In Saudi Arabia, Jwaher Abdullah Almulhem

Theses and Dissertations

Introduction: Since patients and the general public may interact with a national electronic health record (EHR), including them during implementation of an EHR is important. Such acceptance has been documented as one of the critical areas in the development of a national EHR. However, only a few studies have considered public perceptions and attitudes regarding use of their health information in a universal EHR. This is the first study that concentrated on Saudi patients and citizens’ attitudes regarding a national EHR. . Objectives: The purpose of this quantitative study was to understand perceptions and attitudes regarding the introduction of a …

Internet Speed And The Effect On Health Information Technology Adoption, Matthew W. Yuen

Theses and Dissertations

Background. The Internet has become pervasive in everyday life; the Pew Research Center reported over 84% of Americans use the Internet either on their phone or a computer. However, due to the methods by which the Internet was created, an Internet digital divide was created. The Internet digital divide is the disparity in access and speed of Internet of certain populations. This study looked into the disparity between urban and rural populations and their Internet access in two forms: e-prescriptions adoptions and Internet health information seeking behavior (HISB) through their mobile devices.

Methods. This study used 4 datasets, …

The Association Between Clinical Recognition Of Depression And Unplanned Hospital Readmission Among Older Adults, Karen M. Jones

Theses and Dissertations

Purpose

The likelihood of a depression diagnosis may differ based on whether the patient was seen in an inpatient or outpatient setting. Depression has been associated with an increased risk of a 30-day readmission. The purpose of this study was to determine the level of agreement (concordance) between depression diagnosis as identified by inpatient and outpatient records and examine the relationship between depression diagnostic concordance and 30-day readmission.

Methods

Using universal administrative claims data from South Carolina, we examined inpatient and outpatient records. The analysis was restricted to Medicaid recipients aged 55 years and older with a primary admitting diagnosis …

Racism Across The American South: The Association Between Racism On Twitter, Rurality, & Black Mortality, Jarrod Bullard

Theses and Dissertations

Racism can be understood as a system of dominance and power designed to uphold the racially privileged of society. One can be exposed to racism through various mechanisms including the Internet and social media. Evidence indicates that exposure to racism is associated with poor mental and physical health outcomes as well as unhealthy behaviors. Current literature studying the effects of racism focus primarily on experienced or perceived racism. Furthermore, the geographic influence of racism on health at the county level and across levels of rurality is currently unknown. The purpose of this study was twofold; 1.) To explore the geographic …

Association Of Freestanding Dialysis Facility Size, Quality Incentive Program Scores And Patient Survival, Fozia Ajmal

Theses and Dissertations

Background

In 2011, The Centers for Medicare and Medicaid Services (CMS) has introduced a bundled payment reform along with a Quality Incentive Program (QIP) to bring efficiency in End stage renal disease (ESRD) care. The QIP rates facilities using clinical and reporting criteria, but misses out on patient outcomes. It penalizes facilities not achieving a target score by 0-2% of payments. The small facilities are expected to be impacted more by a reduction in payments. We determined the association between ESRD facility size and QIP scores and the association between QIP scores and patient survival.

Methods

We used the Medicare …

The Influences Of Family Supportive Supervisor Behaviors On The Relationships Among Work-Family Conflict, Stress, And Turnover Intention In Saudi Arabian Registered Nurses, Sitah S. Alshutwi

Theses and Dissertations

Many countries around the world are struggling to maintain adequate number of nurses. Inadequate nurse staffing could compromise the quality of patient care. Among many factors that contribute to RN turnover, the influence of work–family conflict (WFC) has gained little attention. In Saudi Arabia, the turnover rate among Saudi nurses reached 50 % of the total employed nurses. Work-family conflict was found to be a reason that influence Saudi nurses to leave their workplace. In addition, WFC was found to be significantly association with increased turnover intention (TI) among employees. Furthermore, WFC has been linked to a number of negative …

Survey Of Assessing Pain In Clinical Practice And Applicability Of A New Assessment, Michelle Rose Konz

Theses and Dissertations

ABSTRACT

SURVEY OF ASSESSING PAIN IN CLINICAL PRACTICE AND APPLICABILITY OF A

NEW ASSESSMENT

by

Michelle Konz

The University of Wisconsin-Milwaukee, 2016

Under the Supervision of Professor Joyce Engel, PhD

Aims The purpose of this study is to identify pain assessments that are being used to measure an individual’s pain experience and to discover how occupational therapists are currently assessing pain in youths who have complex communication needs with a developmental disability (DD). Methods Phase 1: A literature review was conducted through the use of electronic databases to research 17 different methods of pain assessment to create descriptive charts to …

Frequency Of Colonoscopy Surveillance In Average-Risk Adults Relative To Guideline Recommendations, Meng-Han Tsai

Theses and Dissertations

Colorectal cancer (CRC) is the third leading cancer in the United States with an estimated 132,700 new cases and 49,700 deaths in 2015. Well-performed screening colonoscopies prevent cancer by allowing visualization of the entire colon and removal of precancerous polyps (adenomas). Persons with high-risk polyps at screening are therefore advised to undergo periodic surveillance colonoscopy. Screening and surveillance colonoscopy guidelines were updated by the U.S. Multi-society Task Force (USMSTF) in 2006, which emphasized risk stratification by polyp features at screening colonoscopy.

This is a retrospective cohort study of patients with screening colonoscopy at an endoscopy center in South Carolina between …

Job Satisfaction And Intent To Quit Outcomes Among Home Health Aides In Home Health Care Industry Of The United States: A Multilevel Study, Seokwon Yoon

Theses and Dissertations

Backgrounds: Home health aides’ job satisfaction and intent to quit have been attributed to organizational and community level factors. The objective is to determine the effects of individual-, organizational-, and community-level factors on job satisfaction or intent to quit among home health aides.

Methods: This research used data from two subsets of the 2007 National Home and Hospice Care Survey and the 2007 National Home Health Aides Survey, sampling six eligible workers across the agencies in the Unites States. As another data source, the present study uses Area Health Resource File. The author used hierarchical linear modeling technique for handling …

Essays On Two Implications Of The Affordable Care Act (Aca), Esmaeil Salem

Theses and Dissertations

ESSAYS ON TWO IMPLICATIONS

OF THE AFFORDABLE CARE ACT (ACA)

by

Esmaeil Salem

The University of Wisconsin-Milwaukee, 2016

Under the Supervision of Professor Scott J. Adams

The main objective of my dissertation is to investigate some of the causal effects of the Affordable Care Act (ACA) on U.S. healthcare system. After an overview about some of the new provisions enacted by the ACA and their components and timelines, effects of the ACA on immunization coverage for children under age of three and its impact on retention of the insureds receiving newly established rebates would be assessed.

Chapter 2 evaluates changes …

Rn Perceptions Of Coworker Incivility And Collective Efficacy As Influential To Hospital Structures And Outcomes, Jessica Grace Smith

Theses and Dissertations

Background: An aging population and retiring workforce might affect United States health delivery care and could threaten the quality of care in hospitals. Nurses, as the largest profession in healthcare, can buffer these effects if supported in a safe nurse work environment. The purpose of this dissertation was to understand how peer-to-peer registered nurse workplace incivility as a mediator, and collective efficacy as a moderator, influence relationships among hospital structures (i.e. nurse manager leadership and staffing) and hospital outcomes (i.e. missed nursing care and patient safety cultures).

Methods: Donabedian’s (1980) structure-process-outcomes conceptual framework was the theoretical basis for this study. …

Healthcare Utilization And Expenditure Patterns Among Older Adults With Functional And Medical Decline, Ashley Shields Robertson

Theses and Dissertations

Purpose. As the aged population of this country grows, the U.S. healthcare system will face increased pressure to provide long-term care services and supports to increasing numbers of elderly Medicare beneficiaries. Studies have indicated that unmet long-term care need can lead to increased, unnecessary utilization of the healthcare system, thus further taxing the Medicare system. Little is known about how type of long-term care, as well as how long-term care policies—specifically payment policies—affect health care utilization. The objective of this original dissertation research was to examine the effects of place of residence (community versus residential long-term care facility) and …

Demand And Supply Factors Affecting Maternal Healthcare Utilization Pattern In Nigeria, Dumbiri Joy Powell

Theses and Dissertations

Given poor maternal services utilization and associated high maternal mortality risk in Nigeria, we document policy-amenable supply and demand factors impacting women’ use of skilled ANC and institutional delivery services. Using a cross-sectional design, we analyzed data from the Nigeria State Health Investment Project health facility and household surveys on 418 health facilities and 3,726 women with a pregnancy within 24 months prior to survey living in 241 geographic wards of two states. Logistic regression was used to study associations of women’s use of each maternal service with ward facilities’ ANC outpatient satisfaction, healthcare staff job satisfaction, surveyorverified facility infrastructure, …

Examining The Relationship Among Patient-Centered Communication, Patient Engagement, And Patient’S Perception Of Quality Of Care In The General U.S. Adult Population, Jumee Wang

Theses and Dissertations

Introduction: Patient-centered care is a major focus of healthcare organizations, policy makers, and researchers. Patient-centered communication by the provider and patient engagement are important components of patient-centered care. Despite increasing attention to these topics, we do not fully understand how patient-centered communication and patient engagement relate to perceived quality of care as reported by patients. This study takes some initial steps in exploring these relationships. The study also identifies patient-related factors such as sociodemographic, health-related, and health system factors that are associated with patient-centered communication, patient engagement, and perceived quality of care.

Method: This study used survey data …

Dental Insurance As A Mitigating Factor In Reducing The Risk Of Mortality Among Working-Age Adults With Dental Caries And Periodontitis, Naveed Sadiq

Theses and Dissertations

Background Poor oral health had been associated with increased risk of having systemic diseases and thus mortality. The purpose of this research was to find if dental coverage with health insurance could mitigate the risk of death due to untreated dental caries and periodontitis among working age U.S. adults. Methods Data were drawn from NHANES III (1988-1994) and linked to mortality updated till Dec. 31st, 2011. It was restricted to those in the age range of 20-64 years adults. Furthermore, it was restricted to those who had complete data collection on all measures. Unweighted propensity scores were calculated to control …

From Data To Decision: An Implementation Model For The Use Of Evidence-Based Medicine, Data Analytics, And Education In Transfusion Medicine Practice, Nazanin Tabesh

Theses and Dissertations

Healthcare in the United States is underperforming despite record increases in spending. The causes are as myriad and complex as the suggested solutions. It is increasingly important to carefully assess the appropriateness and cost-effectiveness of treatments especially the most resource-consuming clinical interventions. Healthcare reimbursement models are evolving from fee-for-service to outcome-based payment. The Patient Protection and Affordable Care Act has added new incentives to address some of the cost, quality, and access issues related to healthcare, making the use of healthcare data and evidence-based decision-making essential strategies. However, despite the great promise of these strategies, the transition to data-driven, evidence-based …

The Lived Experiences Of An Injured Athlete And Members Of A Performance Management Team During Injury Rehabilitation: An Interpretative Phenomenological Analysis, Courtney Wynne Hess

Theses and Dissertations

In response to an ever growing understanding of the biopsychosocial nature of health and well-being, multidisciplinary and interdisciplinary approaches to rehabilitation have grown in acceptance over the past decade. Studies that have explored the effect of these two approaches have found them to be effective in improving rehabilitation outcomes (McAlister et al., 2001; Tur et al., 2003). Although they have been shown to be objectively effective, the impact that these approaches have on the lived experiences of the team employing them, and the athlete or patient they serve, is not well understood. As such, the purpose of the current study …

Three Essays On Enhancing Clinical Trial Subject Recruitment Using Natural Language Processing And Text Mining, Euisung Jung

Theses and Dissertations

Patient recruitment and enrollment are critical factors for a successful clinical trial; however, recruitment tends to be the most common problem in most clinical trials. The success of a clinical trial depends on efficiently recruiting suitable patients to conduct the trial. Every clinical trial research has a protocol, which describes what will be done in the study and how it will be conducted. Also, the protocol ensures the safety of the trial subjects and the integrity of the data collected. The eligibility criteria section of clinical trial protocols is important because it specifies the necessary conditions that participants have to …

Spatial Analysis And Correlates Of Waterpipe Tobacco Smoking Among College Students In The United States, Frederick Richard Kates

Theses and Dissertations

Introduction: In the United States, young adults have the highest prevalence of waterpipe tobacco smoking (WTS) according to National Adult Tobacco Surveys (NATS) published by the Center for Disease Control (CDC). Experimentation of different tobacco products is highest among 18-24 year olds. Most recently, WTS has surged in popularity among this demographic group. The rapid diffusion of WTS among this population has been accelerated by marketing efforts on the Internet. There are misperceptions that WTS is less harmful than smoking cigarettes and there is a proliferation of WTS establishments due to tobacco retail exemptions. Presently, WTS establishments are almost completely …

Association Between Electronic Prescribing Among Ambulatory Care Providers And Adverse Drug Event Hospitalizations In Older Adults, Grishma Patel Bhavsar

Theses and Dissertations

Purpose.

This dissertation research sought to determine whether the proportion of physicians using electronic prescribing (e-prescribing) was associated with the hospitalization rate for adverse drug events (ADEs) among patients aged 65 and older in 2011. Additionally, we sought to determine whether increases in the proportion of e-prescribing physicians in a county were associated with decreases in the hospitalization rate for ADE among older adults.

Methods.

Two study designs were used, a cross-sectional study using 2011 data and a pre-post- study using 2008 and 2011 data. Data from the 2008 and 2011 State Inpatient Databases, the Office of the National …

Longitudinal Study Of The Effectiveness Of The South Carolina Medicaid Policy For The Application Of Fluoride Varnish For Children Age Three And Under, Christine N. Veschusio

Theses and Dissertations

In South Carolina, the burden of dental decay disproportionately affects disadvantaged children enrolled in Medicaid (Dye et al., 2012; Martin et al., 2012; Ayers et al., 2013). To address this oral health disparity, South Carolina’s Medicaid Program initiated payment to physicians for the delivery of fluoride varnish (FV), an evidence-based preventive dental service at the well-child visit, to children up to thirty-six months of age. Fluoride varnish has been found to reduce dental decay by thirty-seven percent when applied two to four times a year (Weyant et al., 2013; Marinho et al., 2013).

Two retrospective cohort studies were undertaken to …

Examination Of The Association Of Receipt Of Opioid Therapy And Lung Cancer Patient Survival Rates Among South Carolina Medicaid Recipients, Jametta Sade Magwood

Theses and Dissertations

Introduction: Lung cancer is a high pain cancer that can require the attention of clinical specialists. Already vulnerable populations, like those that inhabit rural areas, when dealing with chronic diseases, like lung cancer, need and deserve adequate medical attention. However, rural communities often lack clinical specialists and are left without the needed care. It is necessary to investigate the current availability of treatment options (medications) available to cancer patients in rural communities. Gaining this knowledge can result in economic savings and improvement of the quality of life for rural populations.

Methods: Medicaid data from 1996-2010 was used to …

Patient And Provider Characteristics And Practice Patterns Of Primary Care Physicians Of Weight-Related Counseling, Kolby T. Redd

Theses and Dissertations

Background: The United States Preventive Services Task Force (USPSTF) recommends three types of health education counseling for use in primary care practices for adult, obese patients. While these recommendations are well known, a low percentage of physicians provide this counseling to their patients on a consistent basis. There are inconsistencies in past studies in regards to what aspects of the health encounter influence the likelihood of receiving health education counseling during a primary care visit. The objective of this study was to (1) investigate the patterns of these three types of counseling occurring within primary care practices and to …

Mental Disorders, Mental Health Problems, And Treatment Among Army Recruiters And Recruiting Candidates, 2011-2013: An Examination Of Current Rates In The Recruiting Population, Chadwick Karl Knight

Theses and Dissertations

Purpose: This study sought to determine the prevalence and severity of mental health disorders (MHDs) and/or mental health problems (MHPs) and types of treatments received among soldiers who have or will serve as recruiters. Research Design and Methods: Data were collected between October 2011 to July 2013 from active duty soldiers (N=2,783) attending courses on Fort Jackson at the U.S. Army’s Recruiting and Retention School (RRS). Students consisted of regular active duty soldiers and activated Guard/Reservist that were either recruiters or recruiting candidates. The medical records of participating recruiters and recruiting candidates were reviewed for the prevalence of MHDs and …

The Role Of Interactive And Critical Health Literacy In Appointment Cancellations: A Quality Assurance Survey, Amanda Nielsen

Theses and Dissertations

Objective: An agency located in the Midwest identified a 30 percent cancellation rate in their federally funded Part C early intervention (EI) program. Parents and caregivers of children with developmental delays tend to access and utilize the health care system and programs aimed at improving developmental outcomes more frequently. These children will likely benefit from caregivers who have ample health literacy to navigate the complicated systems of care. Although the role of functional health literacy (i.e., reading and numeracy skills) on health and developmental outcomes is well documented in the literature, limited research exists on the importance of interactive and …

Assessing The Impact Of An Incentivized Employee Wellness Program On Participation And Weight, Jennifer T. Fink

Theses and Dissertations

ABSTRACT

ASSESSING THE IMPACT OF AN INCENTIVIZED EMPLOYEE WELLNESS PROGRAM ON PARTICIPATION AND WEIGHT

by

Jennifer Fink

The University of Wisconsin-Milwaukee, 2014

Under the Supervision of Dr. Doug Ihrke

Introduction: Employers are increasingly adopting workplace wellness programs designed to improve employee health and decrease employer costs associated with health insurance and job absenteeism. This dissertation examines the outcomes of 6,375 obese health care workers who were offered financial incentives for participating in an employee wellness program (EWP) as they relate to participation and potential change in body mass index (BMI). This study aims to contribute to three distinct literatures, including …