Health Services Administration Commons^™

Forgotten Children & Bonds That Heal: The Critical Nature Of Attachment, August Ashbaker

Lesley University Community of Scholars Day

Human attachment is one of the most critical factors in proper neurological and physiological development. Attachment is built through the mutuality of emotional impact, as well as the regular reception of physical touch. Infants and children who have been deprived of these vital necessities through the lacking initiatives of their caregivers—through neglect—display visible signs of its physiological, cognitive, emotional, and behavioral impact. Research has found neglect to be the highest risk factor for permanent damage to brain development in comparison to other forms of complex trauma (i.e. chronic caregiver interpersonal trauma in childhood); it is also the most prevalent …

New Internal Medicine Residency Program At A Community Hospital Improves Mortality Without Increasing The Cost Or Length Of Stay: A Two-Year Follow Up., Javad Savoj, Christine Mikhail, Rajesh Gulati, Napatkamon Ayutyanont, Alina Popa

Medical Education

Opening new residency programs in community hospitals is one strategy to address to address physician shortage. Previous reports have shown better mortality outcomes in university based hospitals. However, less is known about teaching community hospitals. Disrupting well-established workflows in community hospitals is feared to cause an increased cost and possibly a slide in quality of care. Our aim was to assess the impact of starting a new Internal Medicine residency program in a Graduate Medical Education (GME) naive community hospital.

Ua66/13/2 Ogden College Of Science & Engineering Public Health Centers, Wku Archives

WKU Archives Collection Inventories

Records related to Public Health Centers.

Patient-Centered Medical Homes In Community Oncology Practices: Changes In Spending And Care Quality Associated With The Come Home Experience, Teresa M. Waters, Cameron M. Kaplan, Ilana Graetz, Mary M. Price, Laura A. Stevens, Barbara L. Mcaneny

Health Management and Policy Faculty Publications

PURPOSE:

We examined whether the Community Oncology Medical Home (COME HOME) program, a medical home program implemented in seven community oncology practices, was associated with changes in spending and care quality.

PATIENTS AND METHODS:

We compared outcomes from elderly fee-for-service Medicare beneficiaries diagnosed between 2011 and 2015 with breast, lung, colorectal, thyroid, or pancreatic cancer, lymphoma, or melanoma and served by COME HOME practices before and after program implementation versus similar beneficiaries served by other geographically proximate oncologists. Difference-in-differences analysis compared changes in outcomes for COME HOME patients versus concurrent controls. Propensity score matching and regression methods were adjusted for …

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. …

Supervising Ebt: What Content Do Workplace-Based Supervisors Cover And What Techniques Do They Use?, Shannon Dorsey, Michael D Pullmann, Suzanne E.U. Kerns, Esther Deblinger, Leah Lucid, Julie P Harrison, Kelly Thompson, Lucy Berliner

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Workplace-based clinical supervision in public mental health is an underutilized resource for supporting evidence- based treatments (EBTs) [1], despite the fact that supervisors may offer a cost-effective way to support clinician fidelity to EBT. Very little, however, is known about the content and techniques used by workplace-based supervisors [2]; particularly in the context of EBT implementation [3].

Addressing Hydrocephaly In Viet Nam: A Plausible Prevention And Intervention Medical Support Program Proposal, Chelle Mcintyre-Brewer

UNO Student Research and Creative Activity Fair

Families affected by hydrocephalus in Viet Nam have few options for sustainable treatment for a myriad of reasons, primarily centering on barriers to care prevalent to minority, underserved, and economically disadvantaged populations. High morbidity and abandonment rates often result from these circumstances. An interdisciplinary examination of the factors contributing to causal concerns reveals unique cultural considerations, language and literacy barriers, ethnic and geographic differences, as well as economic and governmental issues greatly impacting patient outcome for this condition. The author contends that a program that addresses sociological concerns, along with the medical treatment of the patient, proffers the opportunity for …

Implementing A Mobile Health System To Integrate The Treatment Of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study, Andrew Quanbeck, David H. Gustafson, Lisa A. Marsch, Ming-Yuan Chih, Rachel Kornfield, Fiona Mctavish, Roberta Johnson, Randall T. Brown, Marie-Louise Mares, Dhavan V. Shah

Health and Clinical Sciences Faculty Publications

Background: Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care.

Objective: The objective of this paper was to report the effects of implementing an mHealth system for addiction in …

The Use Of External Change Agents To Promote Quality Improvement And Organizational Change In Healthcare Organizations: A Systematic Review, Esra Alagoz, Ming-Yuan Chih, Mary Hitchcock, Randall Brown, Andrew Quanbeck

Health and Clinical Sciences Faculty Publications

Background: External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings.

Methods: We searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified …

Objective Coding Of Content And Techniques In Workplace-Based Supervision Of An Ebt In Public Mental Health, Shannon Dorsey, Suzanne E U Kerns, Leah Lucid, Michael D Pullmann, Julie P Harrison, Lucy Berliner, Kelly Thompson, Esther Deblinger

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Workplace-based clinical supervision as an implementation strategy to support evidence-based treatment (EBT) in public mental health has received limited research attention. A commonly provided infrastructure support, it may offer a relatively cost-neutral implementation strategy for organizations. However, research has not objectively examined workplace-based supervision of EBT and specifically how it might differ from EBT supervision provided in efficacy and effectiveness trials.

METHODS: Data come from a descriptive study of supervision in the context of a state-funded EBT implementation effort. Verbal interactions from audio recordings of 438 supervision sessions between 28 supervisors and 70 clinicians from 17 public mental health …

The Effectiveness Of Interventions And Bundles For Central Line-Associated Bloodstream Infections In The Neonatal Intensive Care Unit, Mohamad Alhamwi

Honors Undergraduate Theses

Introduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing CLABSI in NICUs.

Methods: A systematic literature search was conducted using CINAHL Plus with Text, Cochrane Database of Systematic Reviews and MEDLINE from January 2008 up to 2018. There were multiple …

The Effect Of A School-Based Health Center On Access To Care In A Rural Community, Macey Cornwell

DNP Projects

BACKGROUND: Lack of access to healthcare is a nationwide issue that affects underserved, minority, and rural populations. School-Based Health Centers (SBHCs) is one way to help increase access to care for students, staff, and family members.

PURPOSE: The purpose of this project was to provide preliminary data on the impact of a SBHC in a rural Kentucky community on access to care and school attendance.

METHODS: A univariate descriptive analysis was conducted to evaluate the perceived impact of the SBHC on access to care and demographic factors. Data was analyzed using Pearson’s Product Moment Correlation, two-sample t-tests, and The Wilcoxon …

Turning A Blind Eye: How Lack Of Communication With Er Nurses Nearly Cost A Patient Permanent Vision Loss, Kenneth Royal, April Kedrowicz

Patient Experience Journal

This narrative presents a case in which a patient was treated for conjunctivitis, but a breakdown in several layers of communication (between the hospital and the patient, and between hospital personnel) resulted in multiple medical errors that nearly costs the patient permanent vision loss. This real-life case underscores how simple communication errors may lead to life-altering consequences. Recommendations for improving communication to ensure similar errors do not happen to others are provided.

Challenges In Delivering Refugee Health Services, Thy Vo, Fabiana Kotovicz

Journal of Patient-Centered Research and Reviews

Background: Aurora Health Care is the major health care system providing care to refugees in Milwaukee, where half of Wisconsin’s refugee population resides. Like many other institutions caring for refugee patients, Aurora faces significant challenges when trying to address refugee health needs. Even with the assistance of medical interpreters, cultural differences, language barriers and limited patient health literacy, as well as lack of knowledge of refugee patients’ backgrounds, are major obstacles encountered by health care providers in this setting.

Purpose: This quality improvement study aims to assess Aurora providers’ perceptions of the benefits and barriers to working with refugee …

The Lifestyle Initiative: An Innovative Coaching-Based Quality Improvement Study To Improve The Health Of Aurora Health Care Caregivers And Family Members, Tiffany A. Mullen, Jessica J.F. Kram, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Background: Self-management support has been shown to improve clinical outcomes. Health coaching, one form of self-management support, empowers patients within the health care system by providing information and through collaboratively developed care plans.

Purpose: Assess the impact of The Lifestyle Initiative, a coaching-based health program utilized by Aurora Health Care caregivers or family members.

Methods: The Lifestyle Initiative is a coaching-based approach for Aurora caregivers or family members enrolled in Aurora’s health insurance network. Individuals were recruited from the care management database, and all participants had an Aurora primary care provider. Participation was limited to those ≥ 18 years of …

Quality Improvement Study For Postpartum Hypertension Readmissions, Molly K. Lepic, Sara M. Stanenas, Carla J. Kelly, Deborah Simpson, Jeffrey A. Stearns

Journal of Patient-Centered Research and Reviews

Background: Hospital readmission rates are a focus of the Centers for Medicare and Medicaid Services. This was identified as a system opportunity to improve health care quality and patient education in order to reduce preventable readmissions. In 2009, 27% of obstetric readmissions were due to hypertensive disease, and preventable readmissions regarding hypertension are flagged as an area for quality improvement in our health care system. There is limited evidence on specific management of postpartum hypertension.

Purpose: Identify risk factors in our community and reduce postpartum readmissions for hypertension within our hospital.

Methods: We performed a retrospective chart review from November …

Teen, Parent, And Clinician Expectations About Obesity And Related Conditions During The Annual Well-Child Visit, Andrew S. Bossick, Charles Barone, Gwen L. Alexander, Heather A. Olden, Tanya Troy, Andrea E. Cassidy-Bushrow

Journal of Patient-Centered Research and Reviews

Purpose: This study aimed to examine family (patient, parent/guardian) and clinician preferences for identification and management of obesity and obesity-related conditions during the well-child visit.

Methods: Four focus groups with teen patients (n = 16), four focus groups with parents (n = 15) and one focus group with providers (n = 12) were conducted using a structured moderator guide tailored to each population. Eligible patients had a well-child visit during the past 12 months and a diagnosis of overweight, obesity, hyperlipidemia or elevated blood pressure. Parents who attended their child’s well-child visit and whose child met the diagnostic …

Health Care Transitions For Adolescents And Young Adults With Special Health Care Needs: Where Are We Now?, Nicole Mubanga, Dennis J. Baumgardner, Jessica J. F. Kram

Journal of Patient-Centered Research and Reviews

Eventually, all adolescents must “graduate” from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children’s hospitals. This topic synopsis aims to …

Stakeholders' Perceptions Of A Hospital Based Emergency Medicine Education & Training Program: A System Change, Kate Douglass, Jay Pandya, Michael Brennan, Kyle Yoder, Janice Blanchard, Natasha Powell, Zohray Talib

GW Research Days 2016 - 2020

Background: Emergency Medicine (EM) is a new and developing specialty around the world. In India, one model for capacity building has been the development of partnerships between US academic institutions and private healthcare institutions for implementing post-graduate education and training in EM. Initiated in 2007, programs have grown both in number and scope and have continued to attract new students and partner institutions. This study was undertaken to better understand the impact of EM training programs on hospital systems.

Methods: A mixed-methods evaluation was undertaken at 5 program sites across India in the summer of 2016. Two researchers conducted onsite …

Group Medical Visits To Provide Gynecologic Care For Women Affected By Breast Cancer, Sally R. Greenwald, Sarah Watson, Mindy Goldman, Tami S. Rowen

Journal of Patient-Centered Research and Reviews

Purpose

Women with breast cancer have complex and unique gynecologic needs that are challenging to effectively and comprehensively meet in a traditional gynecology visit format. Group medical visits are an effective and well-received model of care in other disease settings and can provide comprehensive health education as an adjunct to one-on-one evaluation and treatment. There are limited data regarding the use of this type of health care delivery in providing gynecology-focused care to women affected by breast cancer.

Methods

A group medical visit model was created for gynecology providers to see new breast cancer patient consults. From May 2012 to …

What Can A Primary Care Physician Discuss With Older Patients To Improve Advance Directive Completion Rates? A Clin-Iq, Judith M. Myers, Edmund Duthie Jr., Kathryn Denson, Steven Denson, Deborah Simpson

Journal of Patient-Centered Research and Reviews

Advance directives (ADs) provide patients with the opportunity to indicate their preferences for medical care while they still maintain the capacity to express their wishes, thus retaining autonomy. ADs increase the likelihood that patients will receive the care they desire, as their family members and physicians will better understand the level of care desired. Despite this, the AD completion rate by elderly patients continues to be low, especially for patients not facing serious illnesses. Primary care physicians (PCPs) are uniquely positioned to engage patients in discussions about ADs before a health crisis arises yet often do not due to time …

Emergency Medical Services And Public Policy In Durban, Kwazulu-Natal, John Buyske

Independent Study Project (ISP) Collection

This project seeks to explore the realities of the emergency medical system in the Durban area, particularly relative to government policy. It contextualizes its findings within the literature on public policy. Data for the project was collected via nine in-depth interviews with various professionals working in the field of emergency medical services, as well as a survey of fourteen citizens conducted in the peri-urban township of Cato Manor. This data was analyzed using qualitative methods. While every participant had different views and a different perspective on emergency services, some recurring themes and trends became evident, allowing for conclusions to be …

Current Practices Of Obesity Pharmacotherapy, Bariatric Surgery Referral And Coding For Counselling By Healthcare Professionals, Christine Petrin, Scott Kahan, Monique Turner, C. Gallagher, William Dietz

Health Policy and Management Faculty Publications

Introduction

Rates of obesity pharmacotherapy use, bariatric surgery and intensive behavioural counselling have been extremely low.

Objectives

The primary objective of this study was to survey healthcare provider beliefs, practice and knowledge regarding obesity management.

Methods

Primary care physicians (PCPs), OB‐GYN physicians and nurse practitioners (NPs) responded to a web‐based survey related to drug therapy practice, bariatric surgery referral and reimbursement coding practice.

Results

Rates of reported use of obesity pharmacotherapy appear to be increasing among PCPs, which is likely related to the approval of four new obesity pharmacotherapy agents since 2012. Rates of pharmacotherapy use among OB‐GYNs and NPs …

The Carefirst Patient-Centered Medical Home Program: Cost And Utilization Effects In Its First Three Years, Alison Cuellar, Lorens A. Helmchen, Gilbert Gimm, Jay Want, Sriteja Burla, Bradley Kells, Iwona Kicinger, Len M. Nichols

Health Policy and Management Faculty Publications

Background

Enhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time.

Objective

To test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits.

Design

We compared medical care expenditures and utilization among adults who participated in the PCMH program to adults who did not participate. We computed difference-in-difference estimates using two-part multivariate generalized …

Implementing A Good Catch Program In Nursing Homes, Leigh Raposo

Muskie School Capstones and Dissertations

Rationale and processes for reporting near misses and evidence-based tools were collected by a literature search, seminal works by Sidney Dekker and James Reason, and websites for the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and the Centers for Medicare and Medicaid Services (CMS). Tools, information, and strategies found in this research were evaluated for implementation in Maine nursing homes. The tools provide a communication vehicle for nursing home staff to safely report to management near misses, or mistakes that do not harm residents. To emphasize a positive approach, the project replaces the term …

User Acceptance Of Neurology Telemedicine Technology In The Emergency Department, Teresa W. Mcneil

Applied Research Projects

There is currently a significant shortage of trained neurologists in the country. In addition to the shortfall of neurologists, there is an increasing need for this specialty due to an aging population, increase in the incident of neurologic diseases and an increasing demand for healthcare (Freeman, 2013). The development of tele neurology technology has been shown to help address these problems. As with any new technology there are multiple barriers to overcome, one of those being user acceptance of the technology. A survey of users of the telemedicine product VGo was conducted at Hunt Regional Medical Center to access the …

Employing The Precautionary Principle To Evaluate The Use Of E-Cigarettes, Ashley M. Bush, James W. Holsinger Jr., Lawrence D. Prybil

Health Management and Policy Faculty Publications

Electronic cigarettes (e-cigarettes) have emerged onto the public market as an alternative to tobacco cigarettes; however, science is inconclusive as e-cigarettes have not been thoroughly investigated, including their short- and long-term risks and benefits (1, 2). The question arises of whether e-cigarettes will become the future tobacco crisis. This paper connects the precautionary principle to the use of e-cigarettes in an effort to guide decision-makers in the prevention of adverse health outcomes and societal costs.

Factors Associated With Unmet Needs Among African-American Dementia Care Providers, P. J. Desin, Allison M. Caban-Holt, Erin L. Abner, Linda J. Van Eldik, Frederick A. Schmitt

Sanders-Brown Center on Aging Faculty Publications

Racial and ethnic minorities currently comprise 20% of the U.S. population; in 2050, this figure is expected to rise to 42%. As a result, Alzheimer’s disease (AD), the 5th leading cause of death for people aged 65 and older, is likely to increase in these groups. Most dementia caregiving for these populations comes from family and friends, especially among families with lower socioeconomic status. A convenience sample of 30 African-American dementia caregivers was interviewed to determine unmet needs. Participants expressed a limited desire for formal services, such as support groups, legal advice, case management, and homemaker services. Instead, commonly expressed …

Harvesting Health: A Community-Based Participatory Evaluation Of The Veggie Rx Program, Natalie Royal, Kristin Brown, Fanny Rodriguez, Bianca Fernandez, Leticia Valle, Elizur Bello

Articles, Abstracts, and Reports

No abstract provided.

Baseline Of Copd Management In A Norton Healthcare Primary Care Clinic, Angela Goldring

DNP Projects

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States (U.S), with rates in Kentucky among the highest in the nation. Quality care in the primary care setting is key to optimizing the health outcomes of those with COPD.

Purpose: The objective of this study was to establish a baseline of COPD patient care in a primary care clinic. The specific aims of this study were to: 1) describe the demographic and health-related characteristics of patients with COPD who have a primary care provider (PCP) at one Norton Healthcare primary care clinic; 2) …