Public Health Commons^™

Freestanding Emergency Departments: A Possible Solution To Rural Hospital Closure, Emily Steadman

Biology and Microbiology Graduate Students Plan B Research Projects

Freestanding emergency departments have become more and more common over the years and have started to pop up in many states across the country. A freestanding emergency department is a facility that provides healthcare in the form of emergency services separate from those at a hospital. FEDs can be seen as independent structures that are distinct from hospital-based emergency rooms and urgent facilities. Just as freestanding emergency departments have spread across the country in a bit of a frenzy, another prevalent issue has been sweeping the country, the closure of rural hospitals. Over the last decade rural hospitals have struggled …

Against The "Safety Net", Matthew B. Lawrence

Faculty Articles

Then-Representative Jack Kemp and President Ronald Reagan originated the “safety net” conception of U.S. health and welfare laws in the late 1970s and early 1980s, defending proposed cuts to New Deal and Great Society programs by asserting that such cuts would not take away the “social safety net of programs” for those with “true need.” Legal scholars have adopted their metaphor widely and uncritically. This Article deconstructs the safety net metaphor and counsels against its use in understanding health and welfare laws. The metaphor is descriptively confusing because it means different things to different audiences. Some understand the safety net …

Antiresorptive Bone Therapy Use In Advanced Lung Cancer And Associated Outcomes, Noor Naffakh

Theses and Dissertations--Pharmacy

Background/Rationale: Studies have shown antiresorptive agents decrease skeletal related events in metastatic non-small cell lung cancer. However, two prevalence studies have found low utilization rates of antiresorptive therapy in advanced lung cancer. The first study reported a rate of 14.8% during the 1995-2009 time period, while the second study reported a 33% usage rate during the time frame of 2002-2011. We believe these low utilization rates are associated with the poor prognosis of these patients. The prognosis of advanced lung cancer has improved significantly since these trials were conducted, and the utilization of denosumab has not been evaluated. We hypothesize …

Strategies For Controlling Violence Against Healthcare Workers: Application Of Fuzzy Analytical Hierarchy Process And Fuzzy Additive Ratio Assessment, Fazel Rajabi, Mehdi Jahangiri, Farnaz Bagherifard, Sean Banaee, Payam Fahadi

Community & Environmental Health Faculty Publications

Objective: The present study aimed to identify and prioritize control measures of violence against Healthcare Workers (HWs) using the Fuzzy Analytical Hierarchy Process (FAHP) and Fuzzy Additive Ratio Assessment (F-ARAS).

Background: Occupational violence is a pervasive problem in healthcare centers. Reducing violence against staff is one of the challenges for healthcare managers.

Method: At the first stage, the most common criteria and control options for violence against HWs were identified and extracted using a review of previous studies. At the next stage, criteria for selection of control measures were prioritized using the FAHP. Finally, control measures of workplace violence were …

The Prevalence Of Secondary School Sport Safety Policies Within State Athletic Associations And Legislation, Samantha E. Scarneo, William M. Adams, Susan W. Yeargin, Madeline A. Konz, James E. Potter, Douglas J. Casa

Internet Journal of Allied Health Sciences and Practice

Purpose: The location of secondary school health and safety policies impacts how they are implemented by the sports medicine team and stakeholders. Yet, a comprehensive list of each state’s policy locations has not been established. The purpose of this study was to describe where secondary school health and safety policies were located at the state level within the United States. Method: Emergency related health and safety policies were designated as either being located in the state high school athletics association (SHSAA), state legislation (LEGIS), or in both SHSAA and LEGIS (BOTH). Designation was determined by two researchers who independently …

Digital Technologies As Antecedents To Process Integration And Dynamic Capabilities In Healthcare: An Empirical Investigation, Tulika Chakravorty, Karunakar Jha, Sunil Barthwal, Samyadip Chakraborty

Journal of International Technology and Information Management

Healthcare has been in focus over the past decade due to its criticality and continuous revolution. In this digital era, with the advent of various technologies, healthcare is undergoing a massive transformation. This study attempts to analyze the impacts of three major digital technologies which are being adopted in the healthcare sector which are electronic medical records (EMR), enterprise resource planning (ERP) and internet-of-things (IoT) enabled medical wearables in the hospital context. Focusing towards analyzing the impact of these technologies towards process-integration and further towards dynamic capabilities like quality, agility and responsiveness; the study framework is well-grounded by two theoretical-underpinnings …

Protecting The Rights Of People With Disabilities, Elizabeth Pendo

All Faculty Scholarship

One in four Americans — a diverse group of 61 million people — experience some form of disability (Okoro, 2018). On average, people with disabilities experience significant disparities in education, employment, poverty, access to health care, food security, housing, transportation, and exposure to crime and domestic violence (Pendo & Iezzoni, 2019). Intersections with demographic characteristics such as race, ethnicity, gender, and LGBT status, may intensify certain inequities. For example, women with disability experience greater disparities in income, education, and employment (Nosek, 2016), and members of under-served racial and ethnic groups with disabilities experience greater disparities in health status and access …

Reinventing Privatization, Fabiana Turino, Jonathan Filippon, Francis Sodré, Carlos Eduardo Siqueira

Gastón Institute Publications

The Brazilian state apparatus was reformed throughout the 1990s, influenced by New Public Management (NPM). NPM was embodied in the health care sector by the creation of Social Health Organizations (Organizacões Sociais de Saúde or OSS), private non-profit entities to provide welfare services. We performed a systematic review of the literature outlining the origins and role of OSS in Brazil. Our selected articles (peer-reviewed) cover the origins/performance of OSS and their services provision between 1998 and 2018, in English or Portuguese. Databases used were Lilacs, Bireme, Medline, Pubmed, and SciELO. We identified 4,732 articles applying a pre-defined set of descriptors, …

Standardized Knowledge And Behavior Of Food-Protection Staff To Help Reduce The Potential For Incidences Of Foodborne Illness, Joshua A. Dufresne

College of Graduate Studies: Theses & Dissertations

Background: Environmental public health has always been at the forefront of issues that affect the health and wellbeing of the general public when it comes to food safety. However, with the workforce moving from one of technological laggards toward faster progress toward new and improved systems in performing food service, the question becomes: What are the needs of the environmental health and food safety workforce, and how does one get there? Logically, another question follows: are our current training programs helping to make a difference in the number of foodborne-illness risk-factor violations being issued?

Purpose: This study was to …

Association Between Factors Related And Stress, Depression And Suicidal Risk Among Health Care Personnel During Covid-19 Second Outbreak In Thailand, Aphichaya Polrak

Chulalongkorn University Theses and Dissertations (Chula ETD)

Health care personnel are one of most affected by COVID-19 situation. The aim of this study was to identify the prevalence of stress, depression and suicidal risk and associated factors among health care personnel during COVID-19 second outbreak in Thailand. This study was cross-sectional study, which used secondary data collected during December 17, 2020 to February 23, 2021. Total of 4,970 health care personnel participated in this research. The instruments of this research were ST-5, 9Q and 8Q. Multivariable logistic regression analysis was performed to identify factors associated with stress, depression and suicidal risk outcomes. The prevalence of stress, depression …

Determinants Of Maternal Health Services Utility Among Adolescent Mothers In Indonesia : An Analysis Of 2017 Indonesia Demographic And Health Survey, Dewi Nuryana

Chulalongkorn University Theses and Dissertations (Chula ETD)

Maternal Mortality Ratio (MMR) in Indonesia remains high with 305 death per 100,000 live birth in 2015. Approximately 36 of 1000 adolescent girls (15-19 years old) in Indonesia experienced childbirth and face the higher risk for maternal mortality than older women. The aims of this study are to assess maternal health services utility (antenatal care (ANC), delivery services, and postnatal care (PNC)) level and to identify determinants of maternal health services utility among adolescent mothers in Indonesia. The design of this study is cross-sectional survey using secondary data from 2017 Indonesia Demographic and Health Survey (IDHS). The study population is …

The Relationships Among External Environments, Organizational Structures, And Performance In Pursuit Of The Clinical And Academic Missions At Academic Health Centers, Eric J. Strucko

Theses and Dissertations

Clinical and academic missions place Academic Health Centers (AHCs) at the center of the American health care system, and the future viability of these institutions requires successful performance in competitive environments. AHCs are organizations involving hospitals, physician group practices, and medical schools, and treat patients with complex conditions, conduct bio-medical and health science research, and educate future physicians and health professionals. AHCs account for 20% or $540 billion of national health care expenditures, conduct over 80% of all heart, liver, and lung transplants, utilize over $27 billion in annual sponsored research funding, and graduate approximately 17,300 medical doctors annually. Financial …

Cost-Effectiveness Of A Mobile Health-Supported Lifestyle Intervention For Pregnant Women With An Elevated Body Mass Index, Elizabeth O'Sullivan, Salwa Rokicki, Maria Kennelly, Kate Ainscough, Fionnuala M. Mcauliffe

Articles

Objective To assess the cost-effectiveness of a mobile health-supported lifestyle intervention compared with usual care.

Methods We conducted a cost-effectiveness analysis from the perspective of the publicly-funded health care system. We estimated costs associated with the intervention and health care utilisation from first antenatal care appointment through delivery. We used bootstrap methods to quantify the uncertainty around cost‐effectiveness estimates. Health outcomes assessed in this analysis were gestational weight gain (GWG; kg), incidence of excessive GWG, quality-adjusted life years (QALYs), and incidence of large-for-gestational-age (LGA). Incremental cost-effectiveness ratios (ICERs) were calculated as cost per QALY gained, cost per kg of GWG …

Financial Consequences Of Covid-19 For U.S. Hospitals, Laura Petty, Trevor Mullins

Theses, Dissertations and Capstones

Introduction: The coronavirus pandemic has caused many financial issues for many businesses including putting a substantial strain on hospitals in the U.S. The impact of COVID-19 on the financial well-being of hospitals has been evaluated and the severity is still being measured as the pandemic is ongoing. The purpose of this research was to assess the financial consequences of the COVID-19 pandemic for hospitals in the United States.

Methodology: A literature review with a semi-structured interview with an expert from a local hospital was used for the methodology of this qualitative study. Five government websites and five databases …

Insured And In Debt, Virginia Jeffries

Capstones

Many Americans with employer-sponsored health insurance are still going into debt to pay medical bills.

http://virginia-jeffries.com/cap/

How Does Access To Healthcare Affect Life Expectancy?, Yara Mahmoud

Senior Honors Projects, 2010-2019

Access to health care is a pressing issue in the United States, whether it be the cost of care or not having enough of it. To emphasize the importance of this topic, this paper assesses the impact of access to health services on life expectancy. A comparison is made between the universal health systems in France and Spain and the mixed system in the United States. Even though the United States spends the most on health care in the world, its statistics fall below those of other developed countries. After addressing other risk factors, it was found that individuals under …

Partial Psychiatric Hospitalization Program Availability In Non-Metropolitan And Metropolitan Hospitals Nationally, Timothy Williams, Tyrone F. Borders, Lindsey Jasinski

Rural & Underserved Health Research Center Publications

Overview of Key Findings

Partial psychiatric hospitalization programs (PPHPs) are intended to reduce or avoid inpatient stays by allowing patients to reside at home while receiving intensive psychiatric services in outpatient settings.

A significantly smaller proportion of non-metropolitan than metropolitan hospitals offer PPHPs.

• 11.4% of non-metropolitan compared to 38.7% of metropolitan hospitals offer PPHPs.
• Regardless of location, hospitals that offer PPHPs have higher patient volumes and more beds than hospitals that offer PPHPs through affiliated providers or do not offer PPHPs at all.

Examining Racial & Ethnic Disparities In The Reach Of The Medicare Shared Savings Program, Lindsey Arneson

Capstone Experience: Master of Public Health

It is important to understand the quality of health care for racial and ethnic minorities covered under the largest U.S. government-run insurance program, Medicare, because the demographics of the U.S. are becoming older and more diverse. A new value-based program under Medicare is the Shared Savings Program (MSSP), which creates incentives to improve care quality and health outcomes for Medicare beneficiaries with a specific focus on increasing the provision of preventive care services. This capstone project aims to understand the representation of racial/ethnic minority Medicare beneficiaries, namely African Americans/Blacks and Hispanics/Latinxs, that receive care from providers or facilities (i.e., Accountable …

Organizational Culture Change In The United States Government And Its Application In State And Local Public Health Agencies: A Literature Review, Katherine Barrow

Capstone Experience: Master of Public Health

State and local health agencies play a critical role in the assessment and assurance of public health in the United States. Their authority to shape the structure and delivery of health services makes organizational culture change imperative for the improvement of government services and ultimately, the health of the public. A systematic literature review using SCOPUS, PsycINFO, Business Source, and Academic Search Premier was conducted to 1) analyze organizational culture change efforts in United States federal, state, and local government settings and 2) make recommendations on how to implement organizational culture change initiatives in state and local health agencies. Of …

Using Community Pharmacy Immunization Screening Forms To Identify Potential Immunization Opportunities, Albert T. Bach, Jeffery A. Goad

Pharmacy Faculty Articles and Research

Immunization screening forms are completed for each patient that is to be vaccinated in the pharmacy. Screening forms contain demographic and health questions, which are used to determine if a patient is contraindicated to receive a vaccine. The objective is to determine if patient responses to questions on these forms can be used to identify potential vaccine indications. De-identified data was retrospectively collected from 11 community pharmacies in California and Michigan that included basic demographics, answers to immunization screening questions, and vaccine(s) administered during that visit. The Advisory Committee on Immunization Practices (ACIP) recommendations were used to forecast vaccine needs …

Seven Steps To Successful Change: How A Large Academic Medical Center Prepared Patients For Organizational Change, Brian Carlson, Madison Agee, Terrell Smith, Paul Sternberg Jr, Jason Morgan

Patient Experience Journal

Vanderbilt University Medical Center (VUMC) launched a new electronic health record (EHR) in a “big bang” implementation that saw the new software go live across multiple hospitals, clinics and geographic locations in a single morning. The organization rightly focused most of its energy on preparing its nearly 25,000 employees for the impacts of the transition, but it also considered the effects that would be felt by its patients and families. Survey data indicate that patient satisfaction scores demonstrably dip before, during and after an EHR implementation, and take approximately a year to recover. A team at DMC employed a seven-step …

Are You My Doctor? Utilizing Personalized Provider Cards To Improve Patient/Doctor Connections, Jessica Colyer, Tina Halley, Melissa Winter, Jennifer Coldren, Martha Parra

Patient Experience Journal

In the setting of large, multidisciplinary medical care teams, it can be difficult for patients and families to identify their primary providers in the inpatient hospital setting. A review of our institutional patient satisfaction scores reflected a low rating with respect to families identifying their provider. We sought to improve patient and family connections with front line providers using personalized provider cards. We developed trading cards with pictures and biographies of the doctors on each card as well as an explanation of provider roles. The cards were piloted on a single inpatient unit without trainees. We had great provider engagement …

Effect Of Change In The Cg Cahps Survey Instrument Recall Period On Patient Experience Scores On Healthcare Utilization, Kimberley Marshall-Aiyelawo Phd, Usn, Msc (Ret), Richard Bannick Phd, Usaf, Msc (Ret), Sharon Beamer Aud, Melissa Gliner Phd, Terry Mcdavid Ms, Daniel Muraida Phd, Janice Ellison Usaf Nursing Services (Ret), Beatrice Abiero Phd, Alan Roshwalb Phd, Mark Andrews

Patient Experience Journal

Standardized patient experience survey instruments play an important role in informing healthcare quality and process improvement. However, any changes in standardized instruments can impact the interpretation, trending, and analysis of patient reported data. This study investigates how the change in Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) survey recall period, from 12- to 6-months, can impact the accuracy and quality of patient experience data. This study used primary survey data on patient experience collected in 2016. Analyses included tests of proportion and t-tests for a comparison of: 1) experience ratings, and 2) administrative data to …

Volunteer Contributions In The Emergency Department: A Scoping Review, Sophie Glanz, Brittany Ellis, Shelley L. Mcleod, Cameron Thompson, Don Melady, Michelle Nelson

Patient Experience Journal

The objective of this scoping review was to identify published and unpublished reports that described volunteer programs in the emergency department (ED) and determine how these programs impacted patient experiences or outcomes. Electronic searches of Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were conducted and reference lists were hand-searched. A grey literature search was also conducted. Two reviewers independently screened titles and abstracts, reviewed full text articles, and extracted data. The search strategy yielded 4,589 potentially relevant citations; 87 reports were included in the review. Volunteer activities were categorized as non-clinical tasks …

Conceptual Frameworks And Degrees Of Patient Engagement In The Planning And Designing Of Health Services: A Scoping Review Of Qualitative Studies, Umair Majid, Anna Gagliardi

Patient Experience Journal

Increasingly, patients are being recognized as essential partners in the solutions to healthcare system problems. Patient engagement has been referred to as the “holy grail” and next “blockbuster drug” of health care because it may be revolutionary for transforming the design, delivery, and responsiveness of health services. Patients engage in a variety of healthcare activities, and there are multiple frameworks that depict the degrees of patient engagement in these activities. The literature also uses a variety of terms and concepts to depict the degrees of patient engagement. Moreover, meaningful patient engagement is a concept widely utilized in the literature without …

Patient-Initiated Second Opinions During Acute Hospital Care, Roni Gagin, Neta Hagani, Esti Zigelboim, Shiri Shinan-Altman

Patient Experience Journal

Second opinions are used in medicine in order to make better-informed decisions. Only a few studies have examined patient-initiated second opinions, and even fewer have examined it in the context of acute hospitalization. It is not clear whether patients and families are aware of this right and how often they exercise it during acute hospitalization. The objective of this paper is to identify factors associated with the awareness and utilization of patient-initiated second opinions. A survey was conducted among 92 neurosurgical patients who completed a questionnaire that included information regarding: awareness of second opinion consultations, reasons for not seeking a …

Using Patient Experience In Optimizing The Total Knee Arthroplasty Patient Journey, Nienke Wolterbeek, Dieuwertje J. Hiemstra, Fiona A. Van Der Hoeven, Kiem G. Auw Yang

Patient Experience Journal

Information was used to improve the patient journey and to achieve patient-centered care. Patients (>18 years, purposive sampling) were interviewed once at one point of their total knee arthrosis journey within the hospital setting. Patients were accompanied and observed during their hospital visit by one of the 19 healthcare professionals which were trained as interviewers. A qualitative research approach with in-depth and semi-structured interviews using a standardized interview guide were used to gather an in-depth understanding of the perceptions of patients. Interviews were written out with the emphasis on positive and negative feedback, quotes and observations that were made. …

Service User Interview Panels For Recruitment To Uk Child And Adolescent Mental Health Services: A Questionnaire Study Exploring The Experiences Of Young People, Staff And Candidates, Sophie M. Allan Ms, Emma Travers-Hill Dr

Patient Experience Journal

Service user involvement is increasingly important in health and social care policy, including in Child and Adolescent Mental Health Services (CAMHS), but evidence evaluating involvement initiatives is lacking. This questionnaire study evaluated the use of young people’s (YP) interview panels in the recruitment of CAMHS staff, from the perspectives of YP, candidates and members of the staff interview panels. Self-report questionnaires were administered to YP, candidates and staff interview panel. This included quantitative and qualitative “free text” responses. YP’s panels were found to be important in hearing the voices of YP; participants all stated they would like YP to take …

From Diagnosis To Routine Care In Type 1 Diabetes In Children: Parents’ Experiences, Géraldine Heilporn, Maude Laberge, André Côté, Monia Rekik

Patient Experience Journal

Having a child who lives with a Type 1 Diabetes (T1D) can represent a high burden for parents. The objective of our study is to identify and analyze the main challenges expressed by parents so that health care services better meet the needs of parents of T1D children. Semi-structured interviews were conducted with parents of 19 T1D children regarding detection and diagnosis, initial management at the hospital, post-discharge adaptation including daycare or school reintegration, and long-term T1D monitoring. Data analysis was performed following an inductive approach. The results showed a lack of knowledge regarding T1D in the society, especially for …

Refugees' Perceptions Of Primary Care: What Makes A Good Doctor's Visit?, Anne Mutitu, Bev Zabler, Jeana M. Holt

Patient Experience Journal

Redesigning primary care is a national priority, as the United States (US) struggles with issues of poor access, high cost, and suboptimal quality. Refugees are among the populations who suffer from America’s disjointed health care system, resulting in disproportionate health disparities. Although there are many studies on refugee health, few share refugees' perceptions of primary care. We asked local refugees who were seen for primary care services at a midwestern academic nurse-led clinic, what makes a good doctor's visit?  The clinic served as the hub of a federally funded refugee Community Centered Health Home (CCHH) pilot project. This qualitative study …