Public Health Commons^™

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

Masters Theses/Capstone Projects

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

Health Insurance And The Undocumented Immigrant, Anja Diercks

Honors Theses

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

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

Master's Projects and Capstones

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

Trends And Factors Associated With Suicide Deaths In Older Adults, Eada Novilla-Surette

Electronic Thesis and Dissertation Repository

Suicide in older adults is a significant overlooked problem worldwide; particularly in Canada where a national suicide prevention strategy has not yet been established. This population-level study utilized and analyzed linked administrative health care databases (from 2011-2015) that were available at ICES (provincial health care administrative data steward), to build a better understanding of suicide (rate; trends; risks/preventive factors) in older adults living in Ontario, Canada. The findings suggest that suicide remains a persistent cause of death in older adults (with an average annual suicide rate of 0.1 per 1000 people over 5 years; the risks include being male, living …

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

Nursing ETDs

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

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

Doctor of Nursing Practice

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

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

Theses/Capstones/Creative Projects

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

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

Master's Projects and Capstones

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

Preventing Falls In Long-Term Care Using Patient-Centered Fall Interventions, Angela Blakley

Student Scholarly Projects

Practice Problem: The practice problem identified within the Community Living Center included continuous falls, despite using current fall prevention strategies and provider-driven interventions. Baseline data reflected a fall rate of 4.2 in the long-term care areas despite improving the fall prevention program.

PICOT: The PICOT question that guided this project was: In older adult residents (P), what is the effect of a standing operating procedure (SOP) using patient-centered interventions (I) compared to physician-driven fall interventions (C) on decreasing falls and falls with injuries (O) within one month (T)?

Evidence: In twelve high-quality articles that fit the eligibility criteria and …

Decreasing Readmissions In Medically Complex Children, Colleen Bartlett

Student Scholarly Projects

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

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

Evidence: The literature revealed 18 …

Understanding The Determinants Of The Cost Of Coronary Artery Bypass Graft Surgery, Hun Lee

Electronic Thesis and Dissertation Repository

Introduction: The relationship between patient demographics, clinical factors, and cost of coronary artery bypass graft (CABG) is complex. Investigation of these relationships is important to aid clinical practice and inform reimbursement models. This thesis analyzes multiple different domains in order to understand the significant factors that impact the cost of CABG at the London Health Sciences Centre (LHSC).

Methods: Model selection, construction of nested descriptive models, exploration of mediation analysis of the impact of peri-operative factors and cost through length of stay, and construction of estimative models were performed.

Results: Several baseline characteristics, socio-demographics, peri-operative variables, and post-operative variables were …

The Determinants Of Physical Activity, Self-Monitoring Of Blood Glucose, And Poor Glycemic Control Among Individuals Diagnosed With Type 2 Diabetes In Saudi Arabia: A Cross-Sectional Study Based On The Saudi Health Interview Survey (Shis), Mohammed Abdulrahman S. Alsuliman

Health Services Research Dissertations

The prevalence of diabetes and poor glycemic control in Saudi Arabia has increased that contributed to the growing number of deaths in Saudi Arabia. It is known that type 2 diabetes (T2DM) can be prevented but there is a lack information about the magnitude of the of diabetes at national level as well as the risk factors for physical activity (PA), self-monitoring of blood glucose (SMBG), and poor glycemic. Thus, through utilizing Health promotion model (HPM), the aims are to examine the personal factors, cognitive-perceptual, and behavioral determinants of three outcomes; physical activity, SMBG, and poor glycemic control. A secondary …

Renal And Cardiovascular Outcomes Associated With Cannabis Use In Veterans With Advanced Chronic Kidney Disease Transitioning To Dialysis, Praveen Kumar Potukuchi

Theses and Dissertations (ETD)

Background: Legalization of cannabis and its constituents may lead to increased exposure of a higher number of consumers to cannabis use, including those with chronic kidney disease (CKD). We expect increase in cannabis use, especially, in patients with compromised kidney function. However, there is sparse literature on the effects of cannabis use on cardiorenal and mortality outcomes among patients with advanced CKD. Objectives: The main goal of the current study was to examine the effect of cannabis use on renal and cerebrovascular outcomes as well as mortality in patients with advanced CKD. Using a nationwide cohort of US veterans with …

An Analysis Of Patients Undergoing Hip And Knee Arthroplasties In An Accountable Care Organization, Harjot Uppal

Honors Theses

Background. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed procedures, with over one million executed each year in the United States (U.S.) (Steiner et al., 2012). By 2030, THA and TKA are projected to become the most frequently performed elective surgical procedures in the U.S. (Cram et al., 2012; Kurtz et al., 2009). Many of the previous studies on THA and TKA procedures have focused on women, primarily because they are at increased risks of developing knee osteoarthritis and sustaining hip fractures (Cummings et al., 1990; Hedlund et al., 1987; Hinton et al., 1995; Myers et …

Development Of A Hospital Readmission Reduction Program For Patients Discharged To Skilled Nursing Facilities: An Application Of Artificial Intelligence And Machine Learning Techniques, Anna Stachel

Dissertations and Theses

Background

Hospital readmissions within 30 days after discharge have drawn national policy attention as they are a reflection of suboptimal patient care. Readmissions are costly, accounting for more than $17 billion in potentially avoidable Medicare expenditures - nearly 78% of readmissions may be avoidable. Rich electronic data from medical records, growing computing capacities, and open source machine learning algorithms offer new opportunities to predict patients at high risk for readmission and prevent readmission through focused interventions. Prediction models might also serve to provide a more nuanced context of patient characteristics that lead to variations in readmission rates. Furthermore, transitional care …

The Evolving Management Of Aortic Valve Disease: Trends In The Utilization And Cost Of Savr, Tavr, And Medical Therapy, Andrew Goldsweig

Theses & Dissertations

Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding usage and cost of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease. From the Nationwide Readmissions Database, we determined utilization and cost trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted 2012-2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. From 2012 through 2016, there was a 48.1% increase in the number of patients hospitalized for aortic valve disease annually. Overall, 19.9%, 6.7%, …

Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn

Evidence-Based Practice Project Reports

Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic …

Fatal & Non-Fatal Opioid Overdoses In Marin County: Using Ems And County Data To Locate The Presence Of Fentanyl, Naloxone Distribution, Repeated Overdoses, And Demographics, Josette Rojo

Global Public Health | Senior Theses

Background. In recent years, the United States has been greatly affected by prescription drug overdose deaths, 68% of which are caused by opioids. Like many communities nationwide, Marin County in California is deeply affected by the opioid epidemic with accidental overdose being one of the leading causes of injury-related death. This study examines how fatal and non-fatal opioid overdoses in Marin County are associated with factors such as suspected fentanyl involvement, naloxone administration (EMS), and repeat overdose events.

Methods. A cross-sectional study was conducted by Marin County’s Health and Human Services using data collected from EMS dispatch calls and vital …

A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser

Evidence-Based Practice Project Reports

In 2015, approximately 30.3 million Americans, including 10.5% of the population of Minnesota, had been diagnosed with diabetes mellitus (American Diabetes Association, 2019). Increased risk of diabetic complications including neuropathy, retinopathy, nephropathy, cardiovascular disease, and chronic wounds has been associated with an elevated hemoglobin A1C (HgA1C). Formal diabetic education has been shown to be a cost-effective intervention to reduce HgA1C. The Office of Disease Prevention and Health Promotion published an objective within HealthyPeople 2020 that seeks to increase the percentage of diabetics receiving formal diabetic education in the United States from 46.9% of adults to 58.4%. The purpose of this …

Opioid Epidemic In West Virginia, Brianna Cole

Theses, Dissertations and Capstones

Introduction: One of West Virginia’s most prominent public health issues and concerns has been the opioid crisis. The opioid epidemic has taken the lives of so many of the West Virginia population. The purpose of this research study was to determine if the opioid epidemic had caused an increase of Hepatitis C among the West Virginia population and access treatment options.

Methodology: The methodology was a literature review. Twenty-five sources were referenced for this literature review from 2007-2020.

Results: This literature review has examined several sources of the Opioid Epidemic in West Virginia. The Opioid Epidemic in West Virginia have …

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 …

Impact On Hospital Profitability Due To Covid Safety Guidelines, Khaja Umair Shariff, Anna Noel Franklin

Theses, Dissertations and Capstones

Introduction: The pandemic of COVID 19 presented a unique challenge to hospitals and healthcare systems that they have been struggling to function in. Operating costs had increased with new protocols, planning, operating space, supplies, and staffing. This coupled with the loss of revenue has led to approximately 10% - 20% salary reductions, furloughs, and loss of benefits such as PTO and vacation days to employees. Hospital’s cash reserves are being depleted due to increased operations costs and reduced revenue. Government funding, such as the CARES Act provided by the sanction of the Department of Health and Human Services Office, …

Evidence-Based Strategies For Improving Medication Adherence Among Psychiatric Patients: A Systematic Review, Omah S. Tsikada

Walden Dissertations and Doctoral Studies

Nonadherence to psychotropic medications among patients with serious and persistent psychiatric disorders, including bipolar disorder and schizophrenia, is approximately 70%. Nonadherence is a common barrier to the treatment of individuals with mental health disorders. However, there is limited awareness of evidence-based interventions and strategies to address this problem. Therefore, the question for this project asks whether a systematic review can identify strategies to improve adherence of psychotropic medications among individuals with serious and persistent mental illness. The purpose of this systematic review was to explore the evidence-based strategies that can aid in increasing medication adherence in patients with mental health …

Advanced Practice Registered Nurses And Their Knowledge Regarding The Hindrance Of Obesity, Crystal Rainey

Walden Dissertations and Doctoral Studies

Advanced Practice Registered Nurses and Their Knowledge

Regarding the Hindrance of Obesity

by

Crystal N. Rainey

MSN, Walden University, 2014

BSN, University of Arkansas in Little Rock, 2011

AASN, Southeast Arkansas College, 2009

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2020

Quality Of Life For Persons With Chronic Disease Utilizing Mobile Integrated Healthcare, Dr John Robert Ash

Walden Dissertations and Doctoral Studies

The use of mobile integrated healthcare-community paramedicine (MIH-CP) has the potential to be integrated into existing chronic disease management initiatives as a means of reducing unnecessary hospitalizations and costs as well as improving quality of life (QOL). The purpose of this study was to analyze the relationships between demographics, noncommunicable disease type (NCD), and changes in self-perceived, self-reported QOL for those who have participated in an MIH-CP program. The research design for this study was a pretest/posttest design using secondary data that were obtained from a research partner using the MIH-CP intervention and collecting QOL data using the Euroqol QOL …

Pharmacy Manager Strategies For Reducing Financial Losses From Adverse Drug Events By Polypharmacy Patients, Francis Rudden

Walden Dissertations and Doctoral Studies

Every year over 100,000 deaths occur in the U.S. from adverse drug events derived from medication errors. Medication errors account for an annual cost of $100 to $200 billion. Healthcare pharmacists lack strategies to reduce adverse drug events and medication errors from taking place. Grounded in complex adaptive system theory, the purpose of this qualitative multiple case study was to explore strategies to reduce advere drug events and medication errors. The participants were 5 pharmacist managers in a county in central Florida. These pharmacists were from different community pharmacies, and each had a minimum of 5 years’ experience in the …

Changes In Operating Performance In Rural Hospitals From 2012 To 2019, Oluwaseyi Tami Young-Harry

Walden Dissertations and Doctoral Studies

Rural hospitals treat patients while dealing with the challenges of an inadequate workforce, limited financial resources, and an isolated geographic location, leading to difficulties in achieving financial viability. The purpose of this quantitative study was to analyze the operating performance of rural, general, medical and surgical hospitals in the United States and to determine if performance had changed from 2012 to 2019. Guided by x-efficiency theory, this study addressed whether hospital ownership explained variation in performance and if performance had changed from 2012 to 2019. A random sample of 394 rural hospitals was used, with data drawn from the American …

Impact Of Medicare Utilization On Mortality And Readmission Rates Of Heart Failure Patients 65 Years And Over, Joanna Alexander

Walden Dissertations and Doctoral Studies

Roughly 25% of individuals 65 years and over hospitalized with heart failure are readmitted within 30 days after discharge. Elderly individuals identified with heart failure possess a 5-year mortality approaching 50%. The purpose of this study was to determine if there is a relationship between Medicare-covered services for care, mortality rates, and readmission rates for beneficiaries 65 years and over with heart failure. To address this topic, the chosen approach was retrospective and quantitative. The theoretical foundation was the Chronic Care Model. The research questions sought to determine if there is a relationship between the Medicare-covered services for care and …

Guidelines For Chronic Back Pain: An Education Module For Health Providers, Ron Pascual

Walden Dissertations and Doctoral Studies

Effective chronic back pain management and patient self-care guidelines are necessary for healthcare providers treating patients with complaints of low back pain (LBP). The purpose of this doctoral project was to provide an evidence-based educational program aimed at improving the knowledge and skills of healthcare professionals regarding the Center for Disease Control (CDC) and American Chronic Pain Association (ACPA) guidelines, emphasizing alternative pain management treatments. The staff education project was supported by the biomedical pain model and chronic care model. A panel of 3 experts including the clinic’s board-certified anesthesiologist and pain management specialist, clinical manager, and leading medical director …

Telehealth Efforts To Reduce Hospital Readmissions Of Congestive Heart Failure Patients, Sirfornia L. Deasfernandes

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is a chronic condition that affects millions of individuals in the United States. There is no cure for CHF, but medical interventions can help treat the symptoms and improve health outcomes. The purpose of this quantitative study was to determine if telehealth services help to reduce the readmission status of patients diagnosed with CHF. The theoretical framework used in this study was the individual and family self-management theory to help focus on self-management behaviors that contribute to improving the patients' health outcomes. The research questions were focused on addressing CHF patients receiving telehealth services and whether …