Public Health Commons^™

Patient-Centered Medical Homes And Hospital Value-Based Purchasing: Investigating Provider Responses To Incentives, Lauryn Walker

Theses and Dissertations

Provider incentives are a commonly used policy tool to mold provider behaviors.¹ However, while we frequently measure the change in patient outcomes, failure to consistently produce changes in outcomes does not mean that providers are not changing their behavior. This paper focuses on two programs with null or inconsistent quality outcomes to try to identify why such inconsistency occurs. The two programs, both ratified in the Affordable Care Act, are 1) patient-centered medical homes (PCMHs), and 2) the Medicare Hospital Value-Based Purchasing (HVBP) program.

Chapter 1: Using data from the Medical Expenditure Panel survey (MEPS), I match provider characteristic …

Effect Of Access To Health Services On Neonatal Mortality In Uganda, Imelda Atai Madgalene Musana

Walden Dissertations and Doctoral Studies

Since 2006, Uganda has experienced a nonchanging neonatal mortality rate of 27 out of 1,000 live births, which is higher than the global average of 19 deaths for every 1,000 live births. The purpose of this retrospective cross-sectional study was to determine factors affecting access to health services and their impact on newborn deaths in Uganda. Mosley and Chen's model for child survival in developing nations provided the framework for the study. Secondary data from the 2016 demographic and health survey (UDHS) collected by the Uganda Bureau of Statistics (UBOs) was used. A total of 7,538 cases were used and …

The Relationship Of Walkability, Social Capital And The Built Environment In A Blue Zones® Demonstration Site Community, Thomas Manford Flack

Dissertations and Theses @ UNI

Today, communities throughout the world seek to design, develop, and organize their natural and manmade features to promote a higher quality of life and community livability. The term “built environment” includes both natural and manmade areas, facilities, and structures but also social and cultural factors which are unique to a given community; this term is used to frame a dialog around this topic (Flack et al., 2013). Increasingly, greater attention has focused on crafting the built environment to promote more walkable streetscapes, and opportunities for community engagement and social capital have become more prominent in the minds of citizens, community …

Is It Who Am I Or Who Do You Think I Am? Identity Development Of Adolescents With Substance Use Disorders, Danielle N. Treiber

Antioch University Dissertations & Theses

The purpose of this study was to unearth how adolescents with substance use disorders achieve the task of identity formation and the construction of self-concept in the midst of the drug culture and society that exists. It sought to uncover the social constructs designed to ignore and/or remove human complexities and allow an intersectional approach to be brought to a study on this population. Historically, there has been a failure to investigate the underlying social attitudes and behaviors that impact the very delicate and vulnerable process of finding self. Psychosocial and relational adjustment are strongly influenced by the extent to …

An Exploration Of The Critical Success Factors Associated With Implementing A Public Health Plan In Local Governments Within Western Australia, Anne Polley

Theses: Doctorates and Masters

Public Health planning in local governments in Western Australia (WA) is a relatively new approach to addressing local health needs. The Western Australian Public Health Act came into effect in 2016. The Public Health Act 2016 encompasses a range of legislative requirements, some of which include the development of Local Public Health Plans. A range of roles within the local government workforce therefore are likely to require support to plan and implement Public Health Plans, which in the past have not directly been a component of their role. There is limited understanding and evidence of the barriers and enablers that …

Detroit Food Metrics Report 2018, Alex B. Hill, Amy Kuras

Urban Studies and Planning Faculty Research Publications

This report provides a snapshot of data and information on Detroit’s food system as well as trends over time. The report includes a broad range of programs and initiatives that local organizations, the Detroit Food Policy Council, and the City of Detroit are undertaking to address food insecurity, increase healthy food access and awareness, and support a more sustainable and just food system.

Project Renew Worcester, Danni Yue, Amy Zhang, Jing Han, Omid Ashrafi, Yiming Xu

School of Professional Studies

n The client for this capstone project is RENEW Worcester which is a fledgling solar power project whose main goals are to bring renewable energy in the form of solar power into local, primarily low-income communities and are committed to the mission of making the transition off of fossil fuels to clean, renewable power. Based in Worcester, Massachusetts, they are a local chapter of Co-op Power which is a consumer-owned sustainable energy cooperative (co-op) made up of numerous different local chapters all over the New England area as well as the state of New York. The problem that we will …

Fuller Together: An Understanding Of The Nexus Between Disability And Food Security, Zach Curinga

Public Health, Food Studies, and Nutrition

American society is currently structured to function for those individuals bestowed with inherent abilities. As such, it ignores access to participate socially and culturally for those who are disabled. There is a trend that elected representatives often limit access of the socio-cultural rights of others who are unlike themselves, interpreted by their own personal, non-disabled, socioeconomic experience. This trend is the root of the problem for those who are disabled: they cannot access and participate in society fully, which makes them often disregarded by their representatives who do not face their same barriers.

In this thesis, I apply a human …

Maternal Immune Activation (Mia) In Mice: A Study To Phenotype Asd-Related Communication Behaviors And Analyze Maternal Health Outcomes In The Us, Komalpreet Gulati

Honors Scholar Theses

Core symptoms of Autism Spectrum Disorders (ASD) include deficits in social/communicative behaviors, and repetitive/stereotyped behaviors. Mouse models are a highly established paradigm used to study the phenotypic deficits that result from various inducible genotypic or environmental risk factors for ASD. Previous studies have demonstrated a link between maternal immune activation (MIA) and ASD-like behaviors in mouse models. In this model, the maternal immune system is activated during pregnancy by injecting the viral mimic poly(I:C). The resulting offspring are phenotyped and analyzed with regards to their communicative behaviors.

Previous studies have demonstrated that male pups born to dams with immune activation …

Pizza And Hamburger Consumption To Overweight Among Adolescents In Jambi City, Ummi Kalsum, Sahridayanti Nainggolan, Nawi Ng

Kesmas

Junk food is unhealthy and poor in nutrient quality, and may result in weight gain, obesity, and coronary heart disease, if consumed regularly. The prevalence of overweight in adolescents is 5-10% higher in urban areas. Adolescents undergo lifestyle changes, including in food consumption behavior. This study aimed to determine relation between junk food consumption patterns and overweight in adolescents. This study was conducted based on a cross-sectional design. A total of 137 high school students in Jambi City were involved in this study. Patterns of junk food consumption were assessed using food frequency questionnaires that examined the eating habits of …

Adolescents' Attitude Toward Hiv/Aids Prevention In Yogyakarta, Meysa Tiranda, Nanik Setiyawati, Anita Rahmawati

Kesmas

Acquired immunodeficiency syndrome (AIDS) is the second leading cause of death in adolescent groups in the world. In Indonesia, the rate of human immunodeficiency virus (HIV)-infected adolescents increases annually. Yogyakarta, well-known as the education city, has the highest number of HIV/AIDS cases in the productive age group of 20–29 years old, which means that they have been already infected with HIV since teen age. This study aimed to determine influential factors that affect adolescents' attitude toward HIV/AIDS prevention. The study was an analytic survey research with a cross-sectional design. Stratified random sampling was applied to select a sample size of …

Role Stress, Personality Type, Burnout, And Performance Of Midwives Towards Postnatal Care Program Achievement In Surabaya City, Elita Halimsetiono, Thinni Nurul Rochmah, Dewi Retno Suminar

Kesmas

The coverage of postnatal care program in Surabaya City had declined since 2011–2013 and could not reach the target. This analytic observational study used a cross-sectional design and was conducted during April–May 2015 to analyze the effect of role stress, personality type, and burnout on midwives’ performance towards postnatal care program achievement in Surabaya City. A total sample of 45 midwives was collected from eight primary health care centers in Surabaya City with basic emergency obstetric and neonatal care services. Accidental sampling was used for sample selection. This study indicated that most of the midwives were aged 20–30 years and …

Impact Of Budget Increase On Primary Health Care Performance In The Era Of National Health Insurance: Case Study In Buleleng District, Kadek Suranugraha, Ni Made Sri Nopiyani, Pande Putu Januraga

Kesmas

Since 2014, there has been an increase in funds for primary health care (PHC) coming from the National Health Insurance program capitation funds and the Health Operational Assistance Fund. This study aimed to explore the effect of this budget increase on the health care services at PHC. The case study used a qualitative approach and interviews from 19 PHC health workers with the highest and lowest budget. Data were analyzed using thematic analysis and supported by quantitative data. The positive impact of the increasing PHC budget was felt by PHC staff due to the addition of operational equipment and incentives …

Utilization Of Styrofoam As Soundproofing Material With Auditory Frequency Range, Sjahrul Meizar Nasri, Iting Shofwati

Kesmas

The utilization of bricks made of styrofoam is expectedly able to be a soundproof for noise control and as a preventive action to reduce the steadily increasing prevalence of hearing loss. This study aimed to assess the use of sound absorption material in which styrofoam was utilized to reduce the noise exposure. In this study, fine aggregates (sand and styrofoam) were made with a mixture of cement with a composition of 1:4 and 1:6, also the addition of polystyrene waste with a percentage of 0%, 20%, 40%, 60%, and 80%. Determination of acoustical property of the mixture was done by …

Risk Factors Associated With Low Birth Weight, Mohammad Zen Rahfiludin, Yudhy Dharmawan

Kesmas

Neonatal deaths are associated with preterm birth complications. The aim of this study was to analyze risk factors associated with LBW. This was a crosssectional study held in Bulu Primary Health Care, Temanggung, Central Java, Indonesia. The sample size required for this study was 69 based on the Slovin formula. Data were collected using questionnaires and semi-quantitative Food Frequency Questionnaire forms. Data on infant birth weight was taken from midwives’ delivery cohort records. Mid upper arm circumference (MUAC), hemoglobin level, blood pressure, maternal age, parity, nutritional intake, and serum transferrin receptor data were taken from the infant’s mother using a …

Family Perception Towards Health Role In Filariasis Countermeasures Using The Health Belief Model Approach In Aceh Besar District, Said Devi Elvin, Mutia Yusuf, Wirda Hayati, Teuku Alamsyah

Kesmas

Aceh Besar District is a filariasis endemic area. This endemic state is strongly influenced by people’s perception of filariasis countermeasures. This study aimed to determine relation between family perceptions towards health role in filariasis countermeasures using the Health Belief Model. An analytical survey was applied with a cross-sectional study approach. The study population was families at three villages that are Lambaro Bileu, Lambaet, and Cot Preh of Kuta Baro Primary Health Care. This represents 1,113 families with a sample of 92 families that were selected using a proportionate stratified random sampling technique. The study instrument was a questionnaire and data …

Work-Related Skin Diseases Among Workers In The Sewing Section At Pt. X Shoe Company In West Java, Hendra Hendra, Eva Nirwana, Marzuki Isahak

Kesmas

Occupational skin diseases are the most common work-related diseases in many countries. Shoe industry workers are potential to be affected by work-related skin diseases (WRSDs). This study aimed to analyze the risk factors associated with WRSDs among workers in the sewing section at a shoe company in West Java. A total of 477 workers were examined and interviewed using the modified Nordic Occupational Skin Questionnaire-2002/LONG from May 2016 to July 2016. Chi-square test and logistic regression were used to analyze the risk factors related to WRSDs. The results showed that 57.7% of the workers suffered from WRSDs. Most of the …

Health Promotion Toward Knowledge And Intention For Early Detection Of Cervical Cancer In Commercial Sex Workers, Desi Rusmiati, Tiurlan Yunetty Silitonga, Warendi Warendi

Kesmas

Cervical cancer is one of the cancer types that become a haunting danger for many women in the world. In Indonesia, the prevalence rate reached 0.8% or an estimated 98,692 patients. Its prevalence increased to 10% in the commercial sex worker group. This study aimed to explain the effect of health promotion on knowledge and intention for early detection of cervical cancer using the inspection of visual acetate method in the commercial sex workers. This study was quantitative with a quasi-experimental type, one group of pretest and posttest design. The population sample included the commercial sex workers at Genteng Subvillage, …

Prescription Opioids And Heroin Abuse In New Mexico: Swot Analyses Of Possible Policies/Interventions And The Way Forward, Ali Abbasi

Public Administration ETDs

Throughout the last decade or so, Opioid related fatalities are at all-time high in the United States. New Mexico’s problem with Opioids abuse in not a new phenomenon and a large number of New Mexicans are losing their lives almost on a daily basis. The paper highlights the alarming situation of overdose deaths caused specifically by the abuse of Prescription Opioids and Heroin which, in 2016 alone have taken 347 lives in New Mexico. Policy makers along with other stakeholders play a vital part in shaping the politics along with other interventions which can help tackle the epidemic. The paper …

Trying To Cover The Sun With Your Thumb: A Critical Ethnography Of Maternity Care Provision In Rural Northern New Mexico, Abigail Reese

Nursing ETDs

Access to maternity care is disappearing for women across rural America. In the state of New Mexico, women often travel long distances to access hospitals and providers that offer childbirth services, as these resources are concentrated primarily in metropolitan areas. Although data on provider distribution is available, very few studies have explored the maternity care access crisis from the perspectives of the midwives and physicians who work in rural areas. The purpose of this critical ethnographic study was to explore barriers and facilitators to the provision of childbirth services from providers’ perspectives with the intent of informing policy debates around …

Trying To Cover The Sun With Your Thumb: A Critical Ethnography Of Maternity Care Provision In Rural Northern New Mexico, Abigail Reese

Shared Knowledge Conference

Access to maternity care is disappearing for women across rural America. In New Mexico, women often travel long distances in order to access hospitals and providers that offer childbirth services, as these resources are primarily concentrated in metropolitan areas. Although data on provider distribution is available, very few studies have explored the maternity care access crisis from the perspectives of the midwives and physicians who work in rural areas. The purpose of this study was to explore barriers and facilitators to the provision of childbirth services from providers’ perspectives with the intent of informing policy debates around the maintenance of …

The Critical Need For Mental Health Education To Be Mandated In New Mexico's Public Schools, Bonnie L. Murphy

Shared Knowledge Conference

Based on a review of research and best practices in mental health awareness and skills, this inquiry project argues for state legislative policies that would require mental health awareness and skills in the K-12 curriculum. Mental health affects individual accomplishments in every stage of people’s lives beginning in early childhood and throughout the life cycle. Prevention and treatment of mental illness plays a key role in the ability of an individual to cope with loss and develop resiliency and perseverance in challenging times and to make better decisions that improve the individual’s life and the lives of those around them. …

Effectiveness Of The Communication Model, C.O.N.N.E.C.T., On Patient Experience And Employee Engagement: A Prospective Study, Agnes Barden, Nicole Giammarinaro

Patient Experience Journal

Northwell Health is a large integrated healthcare organization comprised of 66,000+ employees, 23 hospitals and over 650 medical practice locations located geographically across New York State. In an effort to align and structure interactions between patients, families and healthcare professionals, Northwell Health created a communication model, C.O.N.N.E.C.T. This unique, humanistic model is an acronym that stands for: Contact, Opening Greeting, Name/Title, Needs, Explanation, Closing and Thank. This prospective 3-part study explores the impact of the C.O.N.N.E.C.T. model on professional education, engagement and patient experience. A holistic approach was utilized including a pre and post e-learning module assessment, direct observation behavioral …

Rules Of Engagement: Strategies Used To Enlist And Retain Underserved Mothers In A Mental Health Intervention, Maureen J. Baker Phd, Rn, Cnl, Beth Perry Black Phd, Rn, Faan, Linda S. Beeber Phd, Pmhcns-Bc, Faan

Patient Experience Journal

Patient engagement has been identified as both a goal and strategy to lower health care costs and improve health care outcomes. However, a lack of consensus and clarity exists as to how the process of patient engagement is implemented in clinical practice. Research addressing the underlying and crucial components of effective patient engagement is limited, leaving a significant gap as to how providers engage patients as active collaborators in their health and health care.

This study provides specific, detailed insight and description into the processes through which advanced practice mental health nurses engaged low-income depressed mothers in a mental health …

What Older Adults Want From Their Health Care Providers, Hazel Williams-Roberts, Sylvia Abonyi, Julie Kryzanowski

Patient Experience Journal

Changing demographic trends and population needs have increased demand for chronic complex care and contributed to rising health care costs. The study sought to identify unmet health care needs of older adults and opportunities for service improvement in a high need suburban neighborhood of a prairie province. The insights provided by older adults informed the service design for a new model of integrated care in community settings. Narrative inquiry methodology was used to understand care experiences through stories. Stories of older adults’ health care journeys were elicited with semi-structured interviews. A paradigmatic approach to analysis was applied with holistic coding, …

Racial/Ethnic And Geographic Differences In Access To A Usual Source Of Care That Follows The Patient-Centered Medical Home Model: Analyses From The Medical Expenditure Panel Survey Data, Zo Ramamonjiarivelo, Delawnia Comer-Hagans, Shamly Austin, Karriem Watson, Alicia Kaye Matthews

Patient Experience Journal

This study examined racial and geographic differences in access to a usual source of care (USC) and it further explored these differences among individuals who had a USC that followed the patient-centered medical home (PCMH) model. Using cross-sectional data from the Household Component of the Medical Expenditure Panel Survey (2008-2013), our sample consisted of non-institutionalized US civilians ages 18-85 (n= 146,233; weighted n = 229,487,016). Our analysis included weighted descriptive statistics and weighted logistic regressions. Although 76% of the respondents had a USC, only 11% of them had a USC that followed the PCMH model. Among respondents who had a …

Barriers And Enablers Of Patient And Family Centred Care In An Australian Acute Care Hospital: Perspectives Of Health Managers, Bradley Lloyd, Mark Elkins, Lesley Innes

Patient Experience Journal

The aim of this study was to identify and explore organisational barriers to, and enablers of, patient and family centred care within an Australian acute care hospital from the perspective of that hospital’s management staff. A qualitative study, incorporating purposive sampling and semi-structured interviews was undertaken in a 215-bed metropolitan acute care public hospital in Sydney, Australia. Fifteen health managers from a broad range of professional groups, including Medicine, Nursing, Allied Health and non-clinical services were interviewed. Interview data were recorded, transcribed, and analysed for key themes using the Framework Approach. The key barriers to patient and family centred care …

Improving The Patient Experience Through Patient Portals: Insights From Experienced Portal Users, Cynthia J. Sieck, Jennifer L. Hefner, Ann Scheck Mcalearney

Patient Experience Journal

Background: Patient portals have become part of the ecosystem of care as both patients and providers use them for a range of activities both individually and collaboratively. As patients and providers gain greater experience using portals, their use and needs related to portals may evolve. Objective: This study aimed to learn from experienced patient portal users to improve our understanding of their perspectives on portal use for collaboration and engagement as well as explore how using a portal influenced their experiences with primary care providers. Methods: Qualitative study involving 29 semi-structured interviews with family medicine patients from a large Academic …

Developing The First Pan-Canadian Acute Care Patient Experiences Survey, Salima Hadibhai, Jeanie Lacroix, Kira Leeb

Patient Experience Journal

The Canadian Institute for Health Information (CIHI) in partnership with stakeholders sought to develop the first pan-Canadian patient experiences survey for inpatient care (CPES-IC). The goal was to provide a national survey standard for comparative patient experience measures to facilitate benchmarking for quality improvement. A cognitive and pilot testing study design was performed using survey data from adult inpatient care settings. Participants included the inter-jurisdictional members (IJ), survey subject matter experts and CIHI (The Group). Cognitive testing of the survey took place in three Canadian jurisdictions in English and French languages. Thirty-nine individuals participated in one-on-one interviews. During pilot testing, …

First, Do No Harm: The Patient's Experience Of Avoidable Suffering As Harm, Ashley Bauer Mha

Patient Experience Journal

Although my entire career has been spent in Patient Experience, nothing I have learned from data, evidence-based practice, or experience-based correlations, has been near as impactful as what I learned from being a patient. This article discusses my own experiences as a patient. I ask readers to consider instances of avoidable suffering as sources of harm that negatively impact patient perceptions, erode trust in care providers and healthcare delivery systems, and create barriers to engaging patients in their care. Recognizing how avoidable suffering creates harm challenges traditional views of Patient Experience as hospitality-based “soft skills” and helps to establish patient …