Health Services Administration Commons^™

Healthcare Access And Community Nursing Outreach Effectiveness In Underserved Zip Codes In Central Florida, Miah Sanchez

Honors Undergraduate Theses

Access to healthcare depends on more than whether healthcare services are available. A person’s ZIP code, income, education, transportation options, health literacy, and neighborhood resources can all affect whether care is reached at the right time and in an appropriate setting. This literature review examines healthcare access and the role of community nursing outreach in underserved ZIP codes across Central Florida. The review synthesizes current literature on social determinants of health, geographic disparities, medically underserved populations, and community-based nursing interventions to better understand how these factors shape access to care. Across the literature, poverty, limited transportation, lower educational attainment, neighborhood …

Do Fair Schedules Matter? Work-Home Conflict And Justice In Emergency Medicine, Maresca J. Brand

Graduate Studies Theses and Dissertations 2026

Emergency physicians work in a high-demand environment requiring irregular, around-the-clock schedules, which can contribute to elevated work-home conflict and burnout. While previous research has focused on objective schedule characteristics such as length of shift or time of day worked, less attention has been given to how emergency physicians perceive the fairness of the scheduling process itself. Drawing on Work-Home Resources Theory and Personal Resource Allocation Theory, this study examines whether perceptions of schedule justice influence work-home conflict via schedule satisfaction. I propose that perceived fairness in schedule creation functions as a contextual resource that shapes whether a schedule is experienced …

Examining Patient Safety Culture Trends In U.S. Healthcare Through A Multi-Year Analysis, Hassan Alabdullah

Graduate Studies Theses and Dissertations 2026

Patient Safety Culture (PSC) is recognized as a cornerstone of healthcare quality and a key determinant of patient outcomes. Despite the Institute of Medicine’s early calls to establish safety-oriented systems, evidence on the long-term stability of PSC in U.S. hospitals has remained limited. This dissertation addresses this gap through a multi-year evaluation of PSC using the Hospital Survey on Patient Safety Culture (HSOPSC v1.0) and advanced statistical methods. Drawing on one of the largest national datasets—comprising over 993,000 healthcare providers from 1,601 U.S. hospitals across three survey cycles (2013–2020)—the study employed a longitudinal repeated cross-sectional design. Analyses combined descriptive statistics, …

Bridging The Gap: How Sociodemographic Factors Shape Adults’ Decisions To Pursue Hearing Aids, Logan Lorié

Graduate Studies Theses and Dissertations 2026

Despite hearing aids becoming more accessible to adults with hearing loss, hearing aid uptake rates remain low, partly due to sociodemographic factors that influence an adults’ decision to pursue amplification. This study systematically reviewed research on how sociodemographic factors – to include age, gender, socioeconomic status, education level, race/ethnicity, and military status – contribute to the decision-making process. This review guided an analysis of these variables using the National Health and Nutrition Examination Survey (NHANES), a large public health database. To ensure enough hearing aid users were included in the analysis, NHANES data were combined across survey cycles from 1999 …

Teledentistry: A Path To Minimize Emergency Department Dependency For Dental Issues, Aishwarya Joshi

Graduate Studies Theses and Dissertations 2026

Teledentistry has been promoted as a strategy to minimize emergency department (ED) visits for non-traumatic dental conditions (NTDCs). However, it remains unclear whether structural readiness or temporary policy expansion drives sustained reductions in reliance on the ED. This study integrates Andersen’s Behavioral Model of Health Services Use and Diffusion of Innovation (DOI) theory to examine determinants of Medicaid NTDC ED utilization and Tele-dentistry adoption.

Andersen’s model posits that utilization is shaped by predisposing, enabling, and need factors, whereas DOI theory emphasizes structural attributes that influence adoption, including relative advantage, compatibility, complexity, trialability, and observability. Combining these frameworks allows for a …

Disaster Exercise: Evaluating Mci Triage Training, Michael J. Steflovich Jr, Jodie Stobierski, Alexis Davis, Natasha Pavlinetz, Nela Isic, Nicole Roberson, Earl Best Md

Florida Journal of Emergency Medicine (FJEM)

Abstract

Study Objectives

The primary objective of this study was to evaluate the effectiveness of a didactic lecture-based training on mass casualty incident (MCI) triage performance among first- and second-year medical students. Specifically, the study aimed to measure improvements in overall triage accuracy, as well as reductions in over-triage and under-triage rates for both adult and pediatric patients.

Methods

This study employed a pre-test/post-test design involving 31 participants. Participants completed an electronic pre-test consisting of 30 patient scenarios (20 adult and 10 pediatric) before attending a 40-minute didactic lecture on MCI triage principles. The lecture covered the identification of MCI …

Health Equity Policy In Colombia: Improving Equal Access To Health Care Services For Individuals With Low-Income, Marian Marin

Honors Undergraduate Theses

In 1993, the last health reform “Law 100” was introduced in Colombia. It has been over 30 years since its implementation, and there have been many changes to the healthcare system in Colombia ever since. The policy increased health insurance coverage to almost 95% of the population, providing better and more affordable patient care. However, increasing the availability of resources does not necessarily make them accessible to all of Colombia’s residents. This study aims to analyze the outcomes of “Law 100” to the system and studies critical obstacles that halt healthcare equity in Colombia, particularly for those in rural and …

Utilization And Costs Of Home Hemodialysis, In-Center Hemodialysis, And Peritoneal Dialysis Among Patients With End-Stage Renal Disease (Esrd) In The United States, Andres Mauricio Garcia Sierra

Electronic Theses and Dissertations, 2020-2023

Chronic kidney disease (CKD) is a condition that requires access to renal replacement therapies (RRTs) to enable patients to live. The use of such therapies has been continuously researched due to the high cost to payers and their patients. This dissertation aimed to analyze the incidence, prevalence, and mortality of renal replacement therapies in patients with end-stage renal disease (ESRD), and document cost trends and analyze possible inequalities in access to these therapies. Based on an integrated health risk management (IHRM) model, this study examined patient characteristics associated with renal replacement therapies in ESRD patients through a pooled cross-sectional study …

High Medicaid Nursing Homes: What Nursing Home And Resident Characteristics Are Associated With Covid 19 Cases?, Abigail A. Cobbina

Honors Undergraduate Theses

The coronavirus pandemic exposed the systemic issues faced by nursing homes with a higher percentage of Medicaid residents. By using the Brown University's Long-Term Care focus facility-level data and the Centers for Medicare and Medicaid Services data, the study examines the association between the nursing home and resident characteristics with Covid-19 cases in high-Medicaid nursing homes. Fifty-eight facilities in Florida were identified as having residents whose primary support was Medicaid. The findings from the study suggest a higher proportion of Medicaid residents, for-profit status, and chain affiliation status, were associated with a higher prevalence of Covid-19 cases among nursing home …

Relationship Between Patient Race And Provider Communication, Kristin M. Marino

Honors Undergraduate Theses

Health disparities by race in the United States have been persistent over decades and one possible reason for that could be that physicians are communicating differently with different races. The purpose of this study was to systematically review literature regarding the relationship of patient race/ethnicity with physician-patient communication. The overall project of which this is a part is a mixed methods review, but my part of the study involved only studies using observational data such as audio and video recordings of physician-patient encounters. This study investigated research that compares physician communication with patients across a wide range of ethnic groups, …

The Relationship Between Methadone Familiarity And Methadone Opinions Among Community Corrections Staff, Luis Israel Culcas

Honors Undergraduate Theses

The United States is in the midst of an opioid crisis. Fortunately, effective treatments for opioid use disorder exist (OUD); however, they are underutilized. Medications for opioid use disorder (MOUDs) decrease death by 50 %. These MOUDs are particularly relevant in the criminal justice population given that this population has a higher OUD disease burden but is less likely than the general population to receive this life-saving treatment. Research has identified negative attitudes toward MOUDs among corrections staff as a barrier to utilizing MOUDs. This thesis examines the relationships between community correction staff familiarity with methadone, one type of MOUD, …

Macro-Level Factors Impacting Colorectal Cancer Screening Behavior Among Church-Going Chinese Immigrants In The U.S.: A Convergent Mixed-Method Study, Xian Cao

Electronic Theses and Dissertations, 2020-2023

Chinese immigrants (CIs) had low colorectal cancer (CRC) screening rates. Macro-level health determinants may affect CIs' CRC screening; however, this is not well established. Thus, this research looked at the macro-level social factors of CRC screening among CIs. The POET theoretical framework guided this study, which includes four components: population (P), organization (O), environment (E), and technology (T). A convergent mixed method was used to investigate whether sociodemographic, acculturation, religious social capital, and mobile media-based cancer information seeking may predict CIs' endoscopic screening, and how these variables impact it. A validated survey and an interview covering the same factors were …

Patient Perceptions Of Shared Decision-Making In The Acute Care Hospital And Their Association With Patient Experience And Readmission, Jill Haladay

Electronic Theses and Dissertations, 2020-2023

Avoidable hospital readmissions continue to be a concerning and costly healthcare issue. While the emphasis on reducing avoidable hospital readmissions persists, incentivization strategies are evolving. Initial strategies prioritized medical care delivery, but recent regulation highlights the value of effective transitional (discharge) care planning, and particularly, patient involvement in that process. This latter aspect of care has a clear indication for the application of shared decision-making. Shared decision-making (SDM) practice in the acute care setting largely represents a gap in the literature; yet understanding patient perceptions of SDM during hospitalization is an important and timely first step in exploring the effectiveness …

Predictors Of Hospital Quality And Efficiency, Hoda Fotovvat

Electronic Theses and Dissertations

American hospitals have made serious efforts to implement and expand their health information technology capabilities and to integrate different specialized care or high-tech services in order to maximize the efficiency and quality of care. In providing a variety of HIT-related services, these hospitals expanded their national reputation in line with integrated care goals. As a result, hospitals are encouraged to establish effective communication channels to facilitate patient-physician sharing of the patient care experience, to enhance effective pain management, and to transform patient-centered care modalities to solidify the adequacy of patient care processes. By analyzing national data sets publicly available, this …

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 …

Risk In Privacy Breach Determination: The Application Of Prospect Theory To Healthcare Privacy Officers, Amanda Walden

Electronic Theses and Dissertations

A significant concern in healthcare is that of patient privacy and how organizations protect against unauthorized access to protected health information. The federal government has responded by instituting policies and guidelines on requirements for protection. However, the policy language leaves areas open to interpretation by those following the guidelines. Reporting to the Office for Civil Rights and/or the patient can open an organization to risk of financial and possible criminal penalties. There is a risk of harm to their reputation which could impact patient visits and market share. Therefore, Privacy Officers might view risk in different ways and therefore handle …

Work And Family Conflict: A Comparative Analysis Among Staff Nurses, Nurse Managers, And Nurse Executives, Amanda Raffenaud

Electronic Theses and Dissertations

The nursing workforce increasingly faces issues that affect clinical and managerial practice. One such issue is work-family conflict (WFC) and family-work conflict (FWC). Nurses face role strain as they confront the pressures from often competing work-and-family roles. This study assessed WFC/FWC among varying nurse roles: staff nurses, managerial nurses, and nurse executives. A random sample of 5,000 nurses, generated from registered nurses practicing in the state of Florida, was surveyed for this research study. Nurses were surveyed on demographics, perceptions regarding the work environment, and perceptions of WFC/FWC. Descriptively, nurses experienced more work-family conflict than family-work conflict. Regression analyses and …

Interaction Between Income, Health Insurance, And Self-Rated Health: A Path Analysis., Atalie Ashley West

Electronic Theses and Dissertations

The political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of health, with income being the most consistent predictor. As a result, this study investigated whether earned income is related …

The Influence Of Perceived Organizational Support, Perceived Coworker Support & Debriefing On Work-Related Compassion Satisfaction, Burnout, And Secondary Traumatic Stress In Florida Public Safety Personnel, Anastasia Miller

Electronic Theses and Dissertations

The purpose of this study was to examine the relationships between perceived organizational support, perceived coworker support, and debriefing on the one hand, and compassion satisfaction, burnout, and secondary traumatic stress on the other hand in Florida law enforcement, fire, emergency medical services, and dispatch public safety workers. In order to explore the relationships between these constructs, the research questions examined the relationships of the work environment of Florida public safety by administering surveys gauging perceived organizational support, perceived coworker support, psychological resilience, and debriefing activities that the personnel participate in. The Professional Quality of Life: Compassion Satisfaction and Compassion …

Political, Economic, And Health Determinants Of Tuberculosis Incidence, Ashley Rutherford

Electronic Theses and Dissertations

The epidemiologic transition has shifted major causes of mortality from infectious disease to chronic disease; however, infectious diseases are again re-emerging as a major global concern (Diamond, 1997; Karlen, 1995; McNeil, 1976). This research aimed to identify potential areas of infectious disease influence that are not health-related in order to help governments and policymakers establish new policies, correct current policies, or further address these issues in order to effectively prevent and combat infectious disease. This study employed a retrospective, cross-sectional, non-experimental design via structural equation modeling (SEM) and examined tuberculosis incidence rates at the country-level. Secondary data from open-source, international …

Unicondylar Knee Arthroplasty In The Inpatient Vs Outpatient Setting: Impact On Process Time, Quality Outcomes, And Patient Satisfaction, Ibrahim Zeini

Electronic Theses and Dissertations

The implications of rising healthcare expenditures are of great concern nationally and internationally. Performing procedures in the outpatient setting can be one solution to this crisis. However, there is a lack of research on systematic approaches for transitioning procedures to the outpatient setting. Unicondylar knee arthroplasty (UKA) presents an opportunity, as it is already in the early stages of transitioning to the outpatient setting. The key step in facilitating an effective transition to the outpatient setting is comparing outpatient UKAs with inpatient UKAs with a focus on process time, quality outcomes, and patient satisfaction. This study retrospectively compares 400 UKA …

Evaluation Of A Quality Management Initiative And Hiv Ambulatory Services Performance In Thailand, Meemon Natthani

Electronic Theses and Dissertations

The accomplishment of pilot implementation of the HIVQUAL-T model, an innovative HIV care quality management tool, has led to an authoritative decision to scale up the use of the model nationwide in Thailand. However, the level of implementing this model varies across target hospitals. Some hospitals have fully adopted the model by conducting quality improvement (QI) activities following performance measurement (PM) results while others have partially adopted only PM or have not used this model at all. The differential level of implementation could be a contributing factor accounting for discrepancies in the quality of care across different HIV ambulatory care …

Cultural Competence In Long Term Care : A Qualitative Phenomenological Study Of Nursing Home Administrators' Knowledge And Perception Of Cultural Competence, Sashai A. Green

HIM 1990-2015

This qualitative phenomenological study examined central Florida's nursing home administrators' knowledge and perception of cultural competence and how they perceive that their knowledge and perceptions impact residents, families, and healthcare. The theoretical framework for this study was explained through Campinha-Bacote's interdisciplinary model of The Process of Cultural Competence in the Delivery of Healthcare Services. The theoretical framework was used to guide research questions, and individual interview questions to obtain nursing home administrator's knowledge and perception of cultural competence. The study explored the level of cultural competence reported by nursing home administrators, their individual perception of cultural competence, their degree of …