Community Health and Preventive Medicine Commons^™

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

MaineHealth Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …

Aligning Opioid Prescribing Pathways, Andrea Lai, Outpatient Pharmacy, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

MaineHealth Maine Medical Center

There is a drug epidemic sweeping the State of Maine and it continues to worsen each passing year. In 2017, the Maine legislature passed Public Law Chapter 488 to strengthen the controlled substance prescription monitoring program. An outpatient pharmacy, located in a large acute care hospital, created a performance improvement project to clarify opioid prescription and resolve any non-compliance with Chapter 488.

After a root cause analysis, several KPIs were established to include tracking the number of phone calls made by pharmacists to non-compliant providers to clarify scripts, provide one on one education and ultimately resolve non-compliance. Repeat offenders were …

Food Insecurity And Its Impact On Health Status Among Homeless Individuals: An Integrative Literature Review, Jacqueline Munyasya

Grace Peterson Nursing Research Colloquium

FOOD INSECURITY AND ITS IMPACT ON HEALTH STATUS AMONG HOMELESS INDIVIDUALS:

AN INTEGRATIVE REVIEW

Jacqueline Munyasya

Faculty Sponsor: Dr. Shannon Simonovich

Background: Food insecurity is a serious problem in the United States and the number of people affected by food insecurity in the United States has risen dramatically in recent years. The homeless population is disproportionately affected. The combination of homelessness and food insecurity is a problem has the combined effect that is extremely costly to the public and the overall health of the population. As nurses, we will encounter these populations and treat them in both community and acute …

Effective Methods For Domestic Violence Screening In The Emergency Department, Megan Bryan

Grace Peterson Nursing Research Colloquium

Abstract

Background: The CDC reports that one in four women and one in ten men will experience some form of domestic violence in their lifetime that will have either a short-term or long-term impact on their well-being. Often the first place these victims are seen where they can receive help is the emergency department. Objectives: The goal of this systematic integrative literature review was to explore existing literature on domestic violence screening methods used in the emergency department and determine which methods prove most effective. Concurrently, this review examined the barriers to effective domestic violence screening and how nursing education …

Patient-Centered Medical Home Adoption In School-Based Health Centers, Abbey Gregg

Theses & Dissertations

The patient-centered medical home (PCMH) is promoted as a primary care delivery design that can improve health care quality and patient outcomes while controlling health care costs. To achieve PCMH recognition, primary care providers must implement practice-level changes in order to deliver care that is comprehensive, coordinated, accessible, high quality, and whole-person oriented. This practice transformation requires advanced use of health information technology, staff investment in quality improvement and care coordination, and significant investments of both financial and human resources to support these activities. As a safety-net provider, school-based health centers (SBHCs) serve vulnerable children that typically experience barriers to …

Community-Based Asthma Intervention Programs And Their Impact On Childhood Health Outcomes And Burdens On The Healthcare System, Danika Ng

Master's Projects and Capstones

Since 1997, asthma prevalence rates have increased by 3% annually, leading to a current rate of 18.4 million adults and 6.2 million children with asthma, high hospitalization and emergency department visit rates, and an overall healthcare spending of 50 billion dollars. However, this increase in prevalence is disproportionately impacting children. Asthma is the third leading cause for hospitalization in children, have higher proportions of children being hospitalized with asthma symptoms, and have higher rates of asthma attacks. Recent literature shows that perceived lack of adequate education in areas such as medication adherence, medical device usage, asthma trigger avoidance, lack of …

Advancing Learning Health Systems Through Embedded Research: The 23rd Annual Conference Of The Health Care Systems Research Network, Harold S. Luft, Ming Tai-Seale, Sarah M. Greene

Journal of Patient-Centered Research and Reviews

The 23rd annual conference of the Health Care Systems Research Network (HCSRN, formerly the HMO Research Network) was held in San Diego, California, March 21–23, 2017, attracting 387 attendees. As a consortium of 20 research organizations embedded in or affiliated with large health care delivery organizations, the HCSRN has held annual research conferences since 1994. The overall aim of the conferences is to bring researchers, project staff, research funders and other stakeholders together to share latest scientific findings and foster new research ideas and collaborations. The 2017 conference was hosted by the Palo Alto Medical Foundation Research Institute.

Each host …

Creating A Taxonomy Of Local Boards Of Health Based On Local Health Departments’ Perspectives, Gulzar H. Shah, Sergey Sotnikov, Carolyn J. Leep, Jiali Ye, Timothy W. Van-Wave

Health Policy & Community Health: Faculty Presentations (1993-2023)

Objectives: To develop an LBoH classification scheme and empirical definitions to provide a coherent framework for describing variation in the LBoHs.

Data and Methods: This study is based on data from the 2015 Local Board of Health Survey, conducted among a nationally representative sample of LHD administrators, with 394 responses. The classification development consisted of the following steps: (a) theoretically guided initial domain development, (b) mapping of the survey variables to the proposed domains, (c) data reduction using principal component analysis and group consensus, and (d) scale development and testing for internal consistency.

Results: The final classification scheme included 60 …

Providing Patient-Centered Enhanced Discharge Planning And Rural Transition Support: Verifying Discharge Orders During Rural Transitions, Tom Seekins

Health and Wellness

Patients typically leave a hospital with numerous tasks that need to be performed in order to complete their treatment successfully. The discharge process is designed, in part, to describe the services a patient needs to secure or the tasks they need to perform in order to complete treatment and promote recovery once he or she gets home. Many of the orders or services planned should be implemented immediately or soon after discharge to be useful. Some involve additional medical treatment. Others may involve starting long-term services that address chronic conditions.

In this delicate transition, hospital staff may not convey the …

Providing Patient-Centered Enhanced Discharge Planning And Rural Transition Support: Building A Rural Transitions Network Between Regional Referral And Critical Access Hospitals, Tom Seekins, University Of Montana Rural Institute

Health and Wellness

Residents of rural and frontier counties experience significant disparities in healthcare access and outcomes when compared to their urban counterparts. The organization of health care delivery contributes significantly to these disparities. Simply put, rural residents can face many challenges when they have to go to a hospital in a distant city for treatment and then return home to recover. The transition back home is also problematic because discharge planning generally does not adequately account for limited access to care in rural areas. The specific aim of this research project was to ascertain rural patients’ actual experience of the discharge planning …

Providing Patient-Centered Enhanced Discharge Planning And Rural Transition Support: Conducting A Rural Transition Needs Assessment, Tom Seekins

Health and Wellness

Researchers have suggested that readmissions following hospital discharge might be reduced by providing additional resources to patients most likely to be re-hospitalized. They have suggested three broad approaches to assessing the likelihood of readmission and prioritizing patients for extra support. These approaches include: (1) medical risk, (2) personal capacity, and (3) environmental. While work on assessing medical risk and personal capacity has been reported, few researchers have explored the role of environmental factors.

We used the third approach, an environmental perspective, to develop and test a Rural Transition Needs Assessment. This process involved patients in assessing their practical needs for …

Providing Patient-Centered Enhanced Discharge Planning And Rural Transition Support: Developing A Local Health And Human Services Resource Bank For Rural Communities, Tom Seekins

Health and Wellness

Patients may have a wide range of needs when they are discharged from a regional hospital back home to a small town or rural community. Discharge planners and other staff at the regional referral hospital are seldom aware of the range of services and resources that a patient could use to facilitate their recovery close to home. Indeed, in our research, regional providers acknowledged that they lacked information about the many small towns they served in their catchment area. Patients, regional referral hospital staff, and small town providers all reported that this frequently led regional providers to refer patients to …

A Mixed-Methods Study Of Sexual Assault In Lesbian, Gay, And Bisexual Adults In The U.S., Sasha Nichole Canan

Graduate Theses and Dissertations

Background. Previous research finds that (1) lesbian and bisexual (LB) women as well as gay and bisexual (GB) men have higher rates of rape victimization compared to their heterosexual (H) peers and (2) perceived familial support reduces the impact of some of rape’s negative health outcomes in heterosexual victims. However, specific contextual factors regarding rape and assessment of familial support for LGB victims are severely lacking. Also, measurements of sexual assault victimization have yet to be validated in this population.

Methodology. The current study used a mixed-methods design that included two phases of data collection. Phase 1 was a national …

Prevalence, Age Profile, And Associated Risk Factors For Hymenolepis Nana Infection In A Large Population-Based Study In Northern Peru, Percy M. Vilchez Barreto, Ricardo Gamboa, Saul Santivañez, Seth E. O'Neal, Claudio Muro, Andrés G. Lescano, Luz M. Moyano, Guillermo Gonzálvez, Hector H. García

OHSU-PSU School of Public Health Faculty Publications and Presentations

Hymenolepis nana, the dwarf tapeworm, is a common intestinal infection of children worldwide. We evaluated infection and risk factor data that were previously collected from 14,761 children aged 2-15 years during a large-scale program in northern Peru. We found that 1,124 of 14,761 children (7.61%) had H. nana infection, a likely underestimate given that only a single stool sample was examined by microscopy for diagnosis. The strongest association with infection was lack of adequate water (adjusted prevalence ratio [aPR] 2.22, 95% confidence interval [CI] 1.82-2.48) and sanitation infrastructure in the house (aPR 1.94, 95% CI 1.64-2.29). One quarter of …

Assessment Of The Campus Food Environment Using Components Of The Healthy Campus Environmental Audit, Candace Sorden

Department of Nutrition and Health Sciences: Dissertations, Theses, and Student Research

The objective was to assess whether the food environment at the University of Nebraska-Lincoln (UNL) campuses supports healthy eating behaviors using components of the Healthy Campus Environmental Audit (vending, dining, and convenience store audits). Secondary aims were to compare the UNL food environment to other college campuses and explore whether there are existing health promotion and obesity prevention initiatives, programs, pledges and/or policies at UNL.

Research team members accessed a secure online website to review training materials prepared by Syracuse University. Evaluators did audit practice trials to meet inter-rater reliability score standards (>80%). audits were conducted at designated sites …

Planning And Designing The Improving Addiction Care Team (Impact) For Hospitalized Adults With Substance Use Disorder, Honora Englander, Melissa B. Weimer, Rachel Solotaroff, Christina Nicolaidis, Benjamin Chan, Christine M. Velez, Alison Noice, Tim Hartnett, Ed Blackburn, Pen Barnes, P. Todd Korthuis

School of Social Work Faculty Publications and Presentations

People with substance use disorders (SUD) have high rates of hospitalization and readmission, long lengths of stay, and skyrocketing healthcare costs. Yet, models for improving care are extremely limited. We performed a needs assessment and then convened academic and community partners, including a hospital, community SUD organizations, and Medicaid accountable care organizations, to design a care model for medically complex hospitalized patients with SUD. Needs assessment showed that 58% to 67% of participants who reported active substance use said they were interested in cutting back or quitting. Many reported interest in medication for addiction treatment (MAT). Participants had high rates …

Rna Sequencing In The Development Of Cancer-Cachexia, Thomas Allen Blackwell

Graduate Theses and Dissertations

Introduction: Cancer is a major public health problem in the U.S. and the world. In 2013 there were an estimated 1,660,290 new cases of cancer in the U.S. Cancer-Cachexia (CC) is a common effect of many cancers, and is directly responsible for 20-40% of cancer-related deaths. The mechanisms that control the development of CC are not well understood. Most investigations of CC focus on the post-cachectic state and do not examine the progression of the condition. The purpose of this study was to utilize RNA sequencing to analyze transcriptomic alterations throughout the progression of CC. Methods: Lewis Lung Carcinoma cells …

Assessing Patient Perceptions Of Self-Care: Examining Chronic Disease In An Underserved Rural Area, Somer Leigh Overshon

Graduate Theses and Dissertations

The Affordable Care Act of 2010 mandated healthcare reform in the United States by requiring insurance coverage for more Americans. Further, the law deemed healthcare providers, communities and individuals throughout the nation were responsible for fighting chronic disease and escalating healthcare costs. Preventive care and self-care have been cited as low-cost options for initiating change in the American population by helping individuals have access, information and resources to make better healthcare choices and manage their chronic diseases. The purpose of this ethnographic study was to identify the perceptions of self-care from patients living with chronic disease in an underserved, rural …

Testing An Integrated Model Of Help Seeking With Ethnically Diverse Primary Care Patients, Bianca Teresa Villalobos

Graduate Theses and Dissertations

Structural and attitudinal barriers prevent many individuals from accessing professional mental health services and often times lead to the premature termination of treatment. Although research findings suggest that the integration of mental health services in primary care can increase access to services and reduce stigma for typically underserved populations, dropout occurs at high rates. The current study aims to: (1) identify correlates of attitudinal and structural barriers in a primary care setting, and (2) test the ability of the Integrated Model of Seeking Help (IMoSH) to predict follow-up for behavioral health visits. In particular, it was hypothesized that attitudinal barriers …

Bibliography Of Physician Wellness Resources, Elizabeth C. Lawrence

Office of Physician and Student Wellness (OPSW)

Current list of articles and books on physician wellness.

How To Effectively Improve Nurse-Physician Communication, Savannah R. Lacoste

Honors Theses

A study of the issue of Nurse-Physician communication, its causes, effects, importance, and possible improvements through research. The results suggest both physicians and nurses agree that nurse-physician communication is an important problem, and can be effectively improved in many ways including: a required nurse-physician communication class for pre-medical and pre-nursing students at an undergraduate level, improved and structured communication tools, and inter-professional education (IPE) between nurses and physicians. The research provides the outlooks of twenty-five nurses and twenty-five physicians independently, as well as demonstrating the nurse-physician disconnect through data comparison and analysis.

Community Health News, Georgia Southern University

Health Policy & Community Health: News & Publications (2011-2018)

• Georgia Southern Faculty Named APHA Social Worker of the Year

Optimizing Heart Failure Outcomes Through Diet: A Review, Farley B. Neasman Iii

Marshall Journal of Medicine

Heart failure is a growing epidemic that will add significant monetary and human costs to an already overtaxed health-care system. Though promising new medications have recently been approved, this complex condition is largely preventable through aggressive risk factor modification, with diet being shown to have a greater effect than exercise. An underrated component of a healthy diet is the simple addition of nuts – the anti-inflammatory fatty acids, healthy proteins, and general availability have been shown to improve survival and reduce the primary risk factors contributing to heart failure, making the addition of nuts and legumes to the diet an …

Community Health News, Georgia Southern University

Health Policy & Community Health: News & Publications (2011-2018)

• Georgia Southern Faculty Assess Disease Intervention Specialist Education for the Future

Pilot And Feasibility Test Of An Implementation Intention Intervention To Improve Fruit And Vegetable Intake Among Women With Low Socioeconomic Status, Michele A. Debiasse Phd, Rdn, Deborah J. Bowen Phd, Sherry L. Pagoto Phd, Joseph M. Massaro Phd, Nawfal Istfan Md, Phd, Lisa M. Quintiliani Phd, Rd

Journal of Health Disparities Research and Practice

Fruit and vegetable intake (FVI), a modifiable risk factor for chronic diseases, is lower in low socioeconomic status (SES) populations. Implementation intentions (a specific type of planning that extends the Theory of Planned Behavior) has been studied to improve FVI, but not exclusively with low SES groups. Using mixed methods, we evaluated the feasibility, acceptability, and preliminary efficacy of an implementation intention intervention (versus a general plan) to increase FVI in women with low SES. For the pilot randomized controlled trial, demographics, body mass index, attitude, perceived behavioral control, goal intention strength, and FVI were measured at baseline and FVI …

Investigation Of The Cultural Context Of Sugars Consumption Behavior In Low-Income Mexican-American Women, Tanya J. Benitez, Colleen Keller, Kathryn Coe, Natasha Tasevska

Journal of Health Disparities Research and Practice

Despite the recent federal dietary recommendations to limit consumption of added sugars to less than ten percent of daily caloric intake, there is a gap in published literature examining the influence of food preparation behaviors on sugars consumption among low-income Mexican-American women. The purpose of the study was to describe the cultural context of Mexican-American women in procuring, preparing and presenting added sugars in their families’ diets.

Five focus groups were conducted to examine sugars consumption behavior in thirteen overweight/obese low-income Mexican-American women ages 27-40 years. Themes that emerged during the sessions included: changes in food procurement to include high-sugar …

Exposure To Secondhand Smoke And The Development Of Childhood Caries: Nhanes (2011-2012), Deborah Mattheus Phd, Msn, Pnp, Krupa Gandhi Mph, Eunjung Lim Phd, Maureen Shannon Cnm, Fnp, Phd

Journal of Health Disparities Research and Practice

Dental caries continue to plague young children worldwide with numerous adverse effects including pain, poor growth and development, decreased quality of life as well as the potential for the development of life threatening secondary infections. Factors associated with the development of childhood caries are complex as they relate to social, economic and/or cultural behaviors. Recent evidence has linked secondhand smoke to the development of childhood dental caries. The purpose of the study is to re-examine the association between the frequency and extent of exposure to secondhand smoke with the development of childhood caries in the United States. Cross-sectional data of …

Community-Level Characteristics Of High Infant Mortality: A Tool To Identify At-Risk Communities, Brandi M. White, Lee S. Horton, Kit N. Simpson

Journal of Health Disparities Research and Practice

Infant mortality (IM) rate is a key indicator of population health and has been gradually improving in the United States. However, it is still a public health problem among minority and low-income communities. Maternal factors explain some of the variation, but community-level factors may also be a contributor. This study examines measures to identify a set of indicators that explain variations in IM at the community-level. Data for 77 communities in a city were obtained from local health databases. We used multivariable linear regression models to examine the strength of the association between IM and maternal, population, community wealth, and …

Dataset On Psychosocial Risk Factors In Cases Of Fatal And Near-Fatal Physical Child Abuse, Mary Clyde Pierce, Kim Kaczor, Deborah Acker, Tina Webb, Allen Brenzel, Douglas J. Lorenz, Audrey Young, Richard Thompson

Psychiatry Faculty Publications

This article presents the psychosocial risk factors identified in the cases of 20 children less than four years of age who were victims of fatal or near-fatal physical abuse during a 12 month period in the Commonwealth of Kentucky. These data are related to the article “History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse” (Pierce et al., 2017) [1].

The Impact Of African American Male Incarceration Rates On The Racial Disparities In Hiv/Aids Rates, Michelle S. Aelion

DePaul Discoveries

In the United States, HIV/AIDS disproportionately impacts African Americans and African American communities. The nature of this national health disparity is complex and cannot be explained simply by one factor or an individual’s behavior within a given community. This paper suggests that the disparity in African American male incarceration rates is among the most important factors to consider in the racial disparities of HIV/AIDS rates. Existing studies on relevant subjects were examined and used to create a conceptual model of factors. This model presents an outline of factors during pre-incarceration, incarceration, and post-incarceration that contribute to the racial disparities in …