Public Health Commons^™

Factors Which Predict The Use Of Active Transportation To School Among Children In Clark County, Nv, Sheila G. J. Clark

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Active transportation to school (ATS) shows promise for increasing activity levels in children, but prevalence and correlates vary widely in cities and regions with different barriers and supports for active travel. Classification of ATS users is a current issue in the field. The purpose of this study was to determine the prevalence of ATS use and develop a predictive model of ATS for the novel population of children enrolled in grades K-8 in Clark County School District, a large metropolitan school district in Southern Nevada. Methods: This study used a secondary data from the National Center for Safe Routes …

The Reduction Of Central Line-Associated Bloodstream Infections In Intensive Care Units Through The Implementation Of The Comprehensive Unit-Based Safety Program, Michael Andrew Basinger

UNLV Theses, Dissertations, Professional Papers, and Capstones

Central line-associated bloodstream infections (CLABSIs) are one of the most significant healthcare-associated infections (HAIs) in the Intensive Care Unit (ICU) setting resulting in increased lengths of stay, increased healthcare costs, and higher mortality rates (Institute of Healthcare Improvement [IHI], 2012). Evidence that CLABSIs are largely preventable has created opportunities for healthcare organizations to implement evidence-based bloodstream infection prevention practices to reduce or eliminate these infections (Lissauer, Leekisa, Prease, Thom, & Johnson, 2012). Other efforts to reduce CLABSIs include implementation of safety programs to improve the safety culture in ICUs (Lissauer et al., 2012). One program, the comprehensive unit-based safety program …

The Relationship Among School Playground Design And Conditions And Physical Activity Levels In Children, Ipuna Estavillo Black

UNLV Theses, Dissertations, Professional Papers, and Capstones

Almost 20% of children aged 6 to 11 years are obese in the United States, tripling over the last ten years. The rise in childhood obesity challenges nurses in their efforts to improve community health and sustainability. A decrease in physical activity (PA) levels has been associated with an increase in obesity. Schools have been identified as a primary setting to provide children adequate amounts of daily PA, and nurses working in the area of child health promotion can work with schools to provide opportunities for children to increase PA levels. The playground is one environment where children can increase …

Determining The Presence Of Carbapenem Antibiotic Resistance In Clinical Isolates, Fidelis Uzoma Enyinnaya

UNLV Theses, Dissertations, Professional Papers, and Capstones

Carbapenems are β-lactam antibiotics reserved for the treatment of severe microbial infections, especially those targeting the Enterobacteriaceae. Introduced in the 1980s, carbapenems have been used successfully in hospitals, and in the 1990s resistance was discovered. Carbapenem resistance is conferred through the production of carbapenemases. In the U.S., the most common carbapenemase is Klebsiella pneumoniae carbapenemase (KPC). In 2012, the National Healthcare Safety Network reported a carbapenem resistance rate of 13.0% among Klebsiella pneumoniae infections, and indicated that the mortality rate associated with carbapenem resistant Enterobacteriaceae (CRE) infections ranged from 48.0-71.9%. According to the Food and Drug Administration (FDA), carbapenem resistance …

Determinants Of Head And Neck Cancer Survival In Nevada For 1995-2008, Xiao Q. Li

UNLV Theses, Dissertations, Professional Papers, and Capstones

Head and neck cancer (HNC), also known as oral cavity and pharyngeal cancer, comprises a group of cancers that arise in the head or neck region, such as the nasal cavity, sinuses, lips, mouth, salivary glands, and pharynx. Use of tobacco, alcohol, or a combination of the two, are major risk factors for head and neck cancer. Approximately 75% of oral cancers are attributable to smoking and/or alcohol consumption. More recently, the human papilloma virus (HPV) has also been associated with the development of head and neck cancer.

The objective of the present study is to investigate head and neck …

Caregiving And The Experience Of Health And Illness In Children Living With Hiv/Aids In Gulu District Northern Uganda: An Ethnographic Research Narrative, Constantine S.L. Loum Phd

Patient Experience Journal

In this paper we discuss the experience of caregiving for children living with HIV in a resource poor environment in Gulu municipality in northern Uganda; the main research questions of the study were: what are the perceptions of caregivers on the care of children with HIV, and what barriers and enablers exist that undermine or promote better care for children respectively? The experience of caregivers and their perceptions on managing HIV in children is believed to shape the health seeking behaviour towards treatment and efforts to cope with its negative impact on the body. Women and children are the greatest …

The Role Of Governing Boards In Improving Patient Experience: Attitudes And Activities Of Health Service Boards In Victoria, Australia, Marie Bismark, Susan Biggar, Catherine Crock, Jennifer M. Morris, David M. Studdert

Patient Experience Journal

The authors sought to determine the attitudes of public health service board members and senior executives toward patient experience and to describe the governance activities of the boards in this area. The study was based on an online survey of 322 board members from 85 public health services and semi-structured interviews with 35 board members and senior executives from 13 public health services in Victoria, Australia. The results showed that while some health service boards had high aspirations and clear plans for improving patient experience, others remained sluggish or even cynically resistant to changing their existing models of care. Interviewees …

Patients’ Experiences In The Uk: Future Strategic Directions, Sophie Staniszewska, Neil Churchill

Patient Experience Journal

Over the last decade policy has emphasised the importance of a good patient experience as a cornerstone of high quality health and social care in the UK, with many initiatives attempting to develop patient-centred practice. More recently, the Francis Inquiry has addressed the significant failings in care identified at Mid Staffordshire NHS Foundation Trust in England and has been pivotal in raising the importance of patient experience.¹ The Francis report made 290 recommendations, with many emphasizing the importance of patient experience through their focus on specific ways in which the quality of experiences can be enhanced, for example, by …

What Matters Most To Patients? Participative Provider Care And Staff Courtesy, Andrew H. Van De Ven

Patient Experience Journal

Although there is growing recognition of the importance of having satisfied patients, we know little about what aspects of care matter most to patients. The sources of patient satisfaction and how care delivery can influence them need more empirical study. The objective of this study was to identify which aspects of a patient’s experience of care are most important to patient satisfaction, and how dimensions of care relate to clinic size, economic performance, and employee job satisfaction. To explore our question, longitudinal survey data were obtained on patients and employees over two years (1996 and 1997). Relationships between patient satisfaction …

Psychometric Properties Of The New Patients’ Expectations Questionnaire, Ann Bowling Bsc, Msc, Phd, Gene Rowe Phd

Patient Experience Journal

The authors explore the development of the Patients’ Expectations Questionnaire (PEQ) and examination of psychometric characteristics it encompasses by reviewing surveys of primary care and hospital outpatients before and after their clinic visit. Three scales were developed for Pre-visit Ideal and Realistic expectations, and Post-visit Experiences (met expectations), based on literature review, semi-structured interviews, and subsequently piloted and refined. Patients completed the questionnaire about their ideal and realistic expectations before they saw the doctor, and were asked if their expectations had been met afterwards. The results show the scales met acceptability criteria for reliability (Cronbach’s alphas exceeded α 0.70), administration …

Factors In Patients’ Experience Of Hospital Care: Evidence From California, 2009–2011, Edmund R. Becker Phd, Jason M. Hockenberry Phd, Jaeyong Bae Ma, Ariel C. Avgar Phd, Sandra S. Liu Phd, Mba, Ira Wilson Md, Msc, Arnold Milstein Md, Mph

Patient Experience Journal

The use of measures of patient-centered care to evaluate hospital care is mandated by The Patient Protection and Affordable Care Act of 2010. Using three years of data from 315 California acute-care hospitals and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, we seek to evaluate patients’ hospital-care experience by (1) analyzing patients’ experience-of-care scores in light of these hospitals’ patient profiles, structural characteristics, and outcomes in 2011, and (2) determining and analyzing the extent of changes in patients’ experience of care over the three-year period 2009–2011. For 2011, we find significant …

Veterans’ Experiences Of Patient-Centered Care: Learning From Guided Tours, Sara M. Locatelli Phd, Stephanie Turcios Bs, Cepep, Sherri L. Lavela Phd, Mph, Mba

Patient Experience Journal

In this paper the authors seek to examine Veterans’ experiences with patient-centered care (PCC) at 2 United States Veterans Affairs (VA) facilities. The authors conduct their research through a process of guided tours, in which the participant leads the evaluator through an environment and shares thoughts, feelings, and experiences. Tours were conducted in April 2013 with 30 Veterans receiving care at these VA facilities. Via the tours participants discussed aspects of the environment of care, and described some as ‘welcoming,’ while describing others as ‘chaotic.’ Participants provided multiple examples of PCC, frequently defining PCC in terms of accessibility of appointments, …

Patient Care Experiences And Perceptions Of The Patient-Provider Relationship: A Mixed Method Study, Jennifer Tabler Ms, Debra L. Scammon Ms, Phd, Jaewhan Kim Phd, Timothy Farrell Md, Andrada Tomoaia-Cotisel Mph, Mha, Michael K. Magill Md

Patient Experience Journal

Improving interpersonal continuity of care—the personal relationship forged between a patient and their primary care provider (PCP) over time—is often considered a goal of primary care. Continuity of care is frequently assessed in terms of longitudinal continuity, or the proportion of encounters with one practitioner, overlooking aspects of the patient-provider relationship that are key to interpersonal continuity of care. Further, few studies explore patients’ perspectives regarding which care experiences enhance or detract from the patient-provider relationship. This study, using focus group interviews, a patient experience CAHPS-PCMH survey, and electronic medical records, explored how patients’ experiences at 10 primary care clinics …

The Impact Of The Resident Duty Hour Regulations On Surgical Patients’ Perceptions Of Care, Shital Shah Phd, Mary Katherine Krause Ms, Fache, Francis Fullam Ma, Susan Vanderberg-Dent Md, Amie E. Solber Ms

Patient Experience Journal

Implementation of the 2003 Accreditation Council for Graduate Medical Education (ACGME) resident duty-hour regulations and access to publicly reported patient satisfaction measures have challenged administrators and clinicians to balance resident’s educational experience, patient care quality, and patients’ satisfaction and perceptions. A pre-post retrospective study design investigated association between implementation of ACGME regulations and patient satisfaction/perceptions using multinomial logistic regressions. The sample consisted of all surgical inpatients (July 2001 – June 2005), who responded to surveys at an academic medical center. Patients gave lower ratings for physician interactions (patient-physician interaction time, clinical updates, and courtesy) following the implementation of post-duty hour …

Physician-Led Patient Experience Improvement Efforts: The Connect Program, An Emerging Innovation, Harris P. Baden Md, Jennifer E. Scott Mha

Patient Experience Journal

In 2009, the leadership of the Children’s University Medical Group (CUMG) embarked on an effort to answer the question, “What would it take to promote and foster a culture of service amongst the medical staff?” The challenge was to engage the physician group in leading patient and family experience improvements within Seattle Children’s. In this article, an innovative, physician-designed and led approach to improving the patient experience is described. The effort focuses on encouraging local, grass roots strategies rooted in readily available and validated best practices. In support of that effort, novel tools that were developed and deployed …

Improving The Patient Experience Through Provider Communication Skills Building, Denise M. Kennedy Mba, John P. Fasolino Md, David J. Gullen Md

Patient Experience Journal

The doctor’s interpersonal skills are arguably the most important to clinical outcome and patient experience. A peer-facilitated, communication skills-building course for physicians has been provided twice annually since its inception in 2004. The course was designed to increase personal awareness, as well as to help physicians develop new communication and interpersonal skills. Satisfaction data from 3,561 patient surveys on 80 providers who attended the course between 2006 and 2010 were analyzed one year before and one year after course participation. After completing the course, the proportion of “excellent” ratings of provider service (the highest rating on a 5-point scale) increased …

Transforming The Patient Experience: Bringing To Life A Patient- And Family-Centred Interprofessional Collaborative Practice Model Of Care At Kingston General Hospital, Anndale Mctavish Ma, Cynthia Phillips Rrt, Med

Patient Experience Journal

The Kingston General Hospital strategic plan includes transforming the patient experience and bringing to life new models of interprofessional care and education. The implementation of the Interprofessional Collaborative Practice Model has been the foundation of this transformational change. Areas identified for improvement included communication, discharge planning, and purposeful engagement of patients and families in the care process. Through a system-wide approach to change, it was expected that the organization would be better prepared to deliver safer, higher quality care and enriched experiences for patients, families and practitioners. From March to October 2009, 54 representatives from various disciplines and services gathered …

Patients And Families As Partners In Safety, Quality, And Experiences Of Care, Amy Jones, Kathy Dutton

Patient Experience Journal

This case examines the highlights of Vidant Health’s journey to a more intentional focus on patient experience. Organizational inconsistencies lead to a focused long term plan putting a culture of patient centeredness at the core of Vidant’s efforts. The results show a clear and measured improvement in safety, quality and experience overall.

A Daughter’S Frustration With The Dearth Of Patient- And Family-Centered Care, Cindy Brach

Patient Experience Journal

Patient involvement in decision-making is an increasingly recognized ethical imperative, one that requires attention to health literacy. Health care that is truly patient- and family-centered, however, is the exception rather than the rule. This first person account of a hospitalization describes the lack of patient and family inclusion in decision-making, failure to use plain language and other health literacy strategies, and disregard for patient and family preferences. The author concludes that if the health care system is going to shift from paternalistic to patient- and family-centered, providers must be trained how to communicate and partner with patients and families. Even …

“Working The System”: The Experience Of Being A Primary Care Patient, Michelle La Nelson Phd, Mark G. Torchia Phd, Jennifer B. Mactavish Phd, Ruby E. Grymonpre Pharmd

Patient Experience Journal

Health care providers and system administrators are in the midst of a paradigm shift; moving from paternalism toward an egalitarian approach. For patient centred care to occur, health care providers must prioritize patient needs; provide information regarding treatments while taking patient preferences and expectations into account. While there is literature regarding patient centredness, there is less information from the patient perspective about the experience of being a patient and the influence on behaviour. Using phenomenological research methods and the theory of planned behaviour as a theoretical framework, this study addressed the questions, a) what is the essence of being a …

Evaluation And Measurement Of Patient Experience, Sherri L. Lavela Phd, Mph, Mba, Andrew S. Gallan Phd

Patient Experience Journal

Despite the increasing presence of a variety of measures of patient health care experiences in research and policy, there remains a lack of consensus regarding measurement. The objectives of this paper were to: (1) explore and describe what is known about measures and measurement of patient experience and (2) describe evaluation approaches/methods used to assess patient experience.

Patient-experience does not simply reflect clinical outcomes or adherence–driven outcomes; rather it seeks to represent a unique encompassing dimension that is challenging to measure. Several challenges exist when measuring patient experience, in part, because it is a complex, ambiguous concept that lacks a …

How Does Patient Experience Fit Into The Overall Healthcare Picture?, Karen Luxford Bsc(Hons), Phd, Faim, Faaqhc, Sue Sutton Rn, Phd, Fhimss

Patient Experience Journal

Understanding the experience of patients provides insight into health care as well as being a crucial first step towards partnering with patients to drive improvement. Increasingly, health care organizations gain feedback from patients about their experience through surveys. Patients are also turning to other avenues, including the internet, to document their experiences.

Although long recognised as a domain of quality, evidence of the link between patient experience and clinical outcomes has emerged more recently. Organizations that succeed in improving patient experience have adopted a strategic approach to patient focus that incorporates both patient feedback and consumer engagement.

Adopting a patient …

Defining Patient Experience, Jason A. Wolf Phd, Cpxp, Victoria Niederhauser Drph, Rn, Dianne Marshburn Phd, Rn, Ne-Bc, Sherri L. Lavela Phd, Mph, Mba

Patient Experience Journal

In recent years, perceptions of performance and quality of healthcare organizations have begun to move beyond examining the provision of excellent clinical care, alone, and to consider and embrace the patient experience as an important indicator. There is a need to determine the extent to which clear and formal definitions exist, have common overarching themes, and/or have unique, but important constructs that should be considered more widely. In this article, we provide a 14-year synthesis of existing literature and other sources (2000-2014) that have been used to define patient experience. A total of 18 sources (articles or organizational websites) were …

Concern For The Patient’S Experience Comes Of Age, Irwin Press Phd

Patient Experience Journal

In this special guest editorial for the inaugural issue of Patient Experience Journal. Dr. Press reflects on how the focus on patient experience has evolved. He starts with a reflection, "A journal devoted exclusively to the patient’s experience? A patient satisfaction survey mandated by CMS for all hospitals and a portion of reimbursement dependent upon the scores? An Institute and an “Association” addressing Patient Experience? A new hospital administrative position labeled “Chief Experience Officer”? Some 30 years ago no one would have predicted any of these."

Dr. Press helps us explore and review how the patient experience movement has …

Expanding The Dialogue On Patient Experience, Jason A. Wolf Phd

Patient Experience Journal

It is with great excitement that I welcome you to the inaugural issue of Patient Experience Journal (PXJ). This publication in so many ways epitomizes all that is right and good about the patient experience movement itself. That being: no one individual or organization owns this conversation or can claim to have every answer, but rather it is a true effort of a community of voices from research to practice, from caregivers to patients and family members, across the care continuum and into the reaches of resources provided and concepts yet unknown.

This journal is a product of and …

Assessing The Impact Of Misclassification When Comparing Prevalence Data: A Novel Sensitivity Analysis Approach, Ninet Sinaii, Sean D. Cleary, Pamela Stratton

Epidemiology Faculty Publications

Background: A simple sensitivity analysis technique was developed to assess the impact of misclassification and verify observed prevalence differences between distinct populations.

Methods: The prevalence of self-reported comorbid diseases in 4,331 women with surgically-diagnosed endometriosis was compared to published clinical and population-based prevalence estimates. Disease prevalence misclassification was assessed by assuming over-reporting in the study sample and under-reporting in the general (comparison) population. Over- and under-reporting by 10%, 25%, 50%, 75%, and 90% was used to create a 5×5 table for each disease. The new prevalences represented by each table cell were compared by p-values, prevalence odds ratios, and 95% …

Health Care In The Motor City: Thriving Or Surviving?, Sally Coberly, William J. Scanlon

National Health Policy Forum

This site visit explored the forces shaping the delivery of health care in Detroit. Health care providers in Detroit face the twin challenges of controlling costs and serving a bifurcated metropolitan area that includes large numbers of uninsured, low-income, and vulnerable residents as well as more prosperous residents of a reviving inner core and the surrounding suburbs and counties. The program looked at the underlying economic, social, and physical conditions that make improving the health of the city's residents extremely challenging. Efforts to contain costs through payment innovations such as the Blue Cross Blue Shield of Michigan's Physician Group Incentive …

Performance Of The Oraquick Hcv Rapid Antibody Test For Screening Exposed Patients In A Hepatitis C Outbreak Investigation, Fengxiang Gao, Elizabeth A. Talbot, Carol H. Loring, Jill J. Power, Jodie Dionne-Odom

Dartmouth Scholarship

During a nosocomial hepatitis C outbreak, emergency public clinics employed the OraQuick HCV rapid antibody test on site, and all results were verified by a standard enzyme immunoassay (EIA). Of 1,157 persons, 1,149 (99.3%) exhibited concordant results between the two tests (16 positive, 1,133 negative). The sensitivity, specificity, positive predictive value, and negative predictive value were 94.1%, 99.5%, 72.7%, and 99.9%, respectively. OraQuick performed well as a screening test during an outbreak investigation and could be integrated into future hepatitis C virus (HCV) outbreak testing algorithms.

Tumor Microenvironment-Based Feed-Forward Regulation Of Nos2 In Breast Cancer Progression, Julie L. Heinecke, Lisa A. Ridnour, Robert Y.S. Cheng, Christopher H. Switzer, Michael M. Lizardo, Chand Khanna, Sharon A. Glynn, S. Perwez Hussain, Howard A. Young, Stefan Ambs, David A. Wink

United States Public Health Resources

Inflammation is widely recognized as an inducer of cancer progression. The inflammation-associated enzyme, inducible nitric oxide synthase (NOS2), has emerged as a candidate oncogene in estrogen receptor (ER)-negative breast cancer, and its increased expression is associated with disease aggressiveness and poor survival. Although these observations implicate NOS2 as an attractive therapeutic target, the mechanisms of both NOS2 induction in tumors and nitric oxide (NO)-driven cancer progression are not fully understood. To enhance ourmechanistic understanding of NOS2 induction in tumors and its role in tumor biology, we used stimulants of NOS2 expression in ER- and ER+ breast cancer cells and examined …

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College of Public Health: News & Publications

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