Health Services Administration Commons^™

Patient Engagement In Patient Portals In Appalachia V. Surrounding U.S. Census Regions: An Analysis Of Hints (Health Information National Trends Survey) Data, 2017–2020, Heather Lea Tudor, Rick Ingram, Sarah Wackerbarth

Journal of Appalachian Health

Introduction: Those living in the Appalachian Region face a greater number of significant health disparities than residents of other areas of the U.S. Patient portals can decrease disparities, increase health literacy, and improve health outcomes.

Purpose: This study explores if those living in the Appalachian Region are offered access to and use their patient portals differently than those in the surrounding U.S. Census regions. Additionally, the study aims to determine if there was a difference in reported reasons for the non-use of patient portals.

Methods: A secondary analysis was completed using data from the National Cancer Institute's Health Information National …

Developing An Ethical Framework-Guided Instrument For Assessing Bias In Ehr-Based Big Data Studies: A Research Protocol, Shan Qiao Ph.D., George Khushf, Xiaoming Li, Jiajia Zhang Ph.D., Bankole Olatosi Ph.D.

Faculty Publications

Introduction The emergence of Big Data health research has exponentially advanced the fields of medicine and public health but has also faced many ethical challenges. One of most worrying but still under-researched aspects of the ethical issues is the risk of potential biases in data sets (eg, electronic health records (EHR) data) as well as in the data curation and acquisition cycles. This study aims to develop, refine and pilot test an ethical framework-guided instrument for assessing bias in Big Data research using EHR data sets.

Methods and analysis Ethical analysis and instrument development (ie, the EHR bias assessment guideline) …

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 …

Improving Minors' Access To Treatment For Opioid Use Disorder: A Policy Analysis, Sara Jane Hamilton

Master's Projects and Capstones

As the opioid epidemic continues to have devastating effects on our communities, medications to treat opioid use disorder (MOUDs) are severely underutilized especially for adolescents. Unlike adults, minors need parental approval before obtaining MOUDs presenting a key barrier to timely treatment. Being able to treat adolescents as soon as they are ready is critically important for people with OUD, and while cost and other barriers have been addressed in the literature, there is a paucity on how parental consent affects the accessibility of treatment. This paper aims to explore a potential policy in California that addresses the lack of access …

An Exploration Of Policies, Equity, And Emerging Threats To The Traffic Safety Environment In The U.S., Sachi Verma

Theses & Dissertations

Road traffic crashes are among one of the leading causes of death around the globe. Additionally, it also causes long-term physical disabilities, mental trauma, and financial pressure. By implementing road safety guidelines such as speed limits, drug and alcohol checkpoints, restraints, and penalties, motor vehicle crashes can be reduced. Road traffic crash survival primarily depends on emergency medical service's timely triaging. Rapid triaging and reduced response times can help road traffic crash morbidities and mortalities. However, several factors can be responsible for EMS delays in responding to a fatal crash. This dissertation aims to observe multiple factors related to EMS …

Changes In Medicaid Fee-For-Service Benefit Design For Substance Use Disorder Treatment During The Opioid Crisis, 2014 To 2021, Angela Shoulders, Christina Andrews, Melissa A. Westlake, Amanda J. Abraham, Colleen M. Grogan

Faculty Publications

Importance: Medicaid is the largest payer of substance use disorder treatment in the US and plays a key role in responding to the opioid epidemic. However, as recently as 2017, many state Medicaid programs still did not cover the full continuum of clinically recommended care. Objective: To determine whether state Medicaid fee-for-service (FFS) programs have expanded coverage and loosened restrictions on access to substance use disorder treatment in recent years. Design, Setting, and Participants: In 2014, 2017, and 2021, a survey on coverage for substance use disorder treatment was conducted among state Medicaid programs and the District of Columbia with …

Patient-Centered Care Frameworks, Models And Approaches: An Environmental Scan, Aghna Wasim, Maria Sajan, Umair Majid

Patient Experience Journal

Although the definition of patient-centered care (PCC) remains unclear, researchers and healthcare professionals describe the concept as treating the patient as a unique human being with consideration for their physical and psychosocial needs and emphasize the importance of shared-decision making between patients and healthcare professionals. However, discussion around the connection and overlap between PCC and patient and family engagement (PE) has been limited. Some authors describe PE as an operationalization of PCC, while others consider PE a type of PCC. An enhanced understanding of PCC might allow for improvements in implementing PE across healthcare systems. Insight into the operationalization of …

Dietary Intake During A Pragmatic Cluster-Randomized Weight Loss Trial In An Underserved Population In Primary Care, John W. Apolzan, Corby K. Martin, Robert L. Newton, Candice A. Myers, Connie L. Arnold, Terry C. Davis, William D. Johnson, Dachuan Zhang, Christoph Höchsmann, Vivian A. Fonseca, Kara D. Denstel, Emily F. Mire, Benjamin F. Springgate, Carl J. Lavie, Peter T. Katzmarzyk, Phillip Brantley, Ronald Horswell, Tina K. Thethi, Jonathan Gugel, Eboni Price-Haywood, Kathleen B. Kennedy, Daniel F. Sarpong

School of Medicine Faculty Publications

Background: Currently there are limited data as to whether dietary intake can be improved during pragmatic weight loss interventions in primary care in underserved individuals. Methods: Patients with obesity were recruited into the PROPEL trial, which randomized 18 clinics to either an intensive lifestyle intervention (ILI) or usual care (UC). At baseline and months 6, 12, and 24, fruit and vegetable (F/V) intake and fat intake was determined. Outcomes were analyzed by repeated-measures linear mixed-effects multilevel models and regression models, which included random cluster (clinic) effects. Secondary analyses examined the effects of race, sex, age, and food security status. Results: …

The Impact Of Social Determinants Of Health And Acculturation On Quality Of Life In Older Chinese American Adults With Chronic Pain: A Quantitative Study, Chi Lam

Dissertations

Despite a rapid increase in the older Chinese American adult population, there are very few research studies examining the impact of social determinants of health and acculturation on the quality of life in older Chinese American adults. The purpose of the study was to determine the impact of social determinants of health and acculturation on quality of life in older Chinese American adults with chronic pain. This quantitative, descriptive correlational study utilized Madeleine Leininger’s Transcultural Theory as its theoretical framework. Two research questions guided this study: (1) Was there a difference in the quality of life in older Chinese American …

African-American Parents’ Cultural Understandings Of The Concept Of Autism And Implications For Parental Communication And Health Management, Kellie J. Fennell

Communication & Theatre Arts Theses

In 2023 the Centers of Disease Control reported that around 1 in 36 children are diagnosed with Autism in America and that the prevalence has increased by 178% since 2000 (CDC, 2023). Despite increases in awareness and diagnosis past research finds that the discussions of ASD in African American communities is minimal (Fombonne, 2003; Yeargin Allsopp et al., 2003). This disparity is important considering that African American children receive an ASD diagnosis years later than their white counterparts and are much more likely to be misdiagnosed (Mandell et al., 2009, 2002).

Given the history of a lack of representation of …

Identifying Patient Perceptions Of Inequality In Public Health Care Services: Evidence From A Single Indian Administrative District, Barnali Biswas, Piyal Basu Roy

Journal of Patient-Centered Research and Reviews

Purpose: Assessment of patient experiences is an essential step to revamp patient-centered care and identify systemic effectiveness as part of universal health coverage. This paper analyzes the variation of health care at different levels of the public health care system in India by measuring patients’ experience with the care they have received in the Alipurduar district of India.

Methods: From May 2021 to April 2022, stratified sampling technique was applied to collect primary data from 450 patients having different health problems from different levels of the public health care system. In addition, Consumer Assessment of Healthcare Providers and Systems (CAHPS) …

Previous Health Care Experiences’ Influence On Health Care Perceptions Among Residents In Six Homeless Shelters In Seattle, Washington, July–October 2021, Ashley A. Meehan, Sarah N. Cox, Nicholas B. Thuo, Julia H. Rogers, Amy C. Link, Miguel A. Martinez, Natalie K. Lo, Brian J. Manns, Melissa A. Rolfes, Eric J. Chow, Helen Y. Chu, Emily Mosites, Morhaf Al Achkar

Journal of Patient-Centered Research and Reviews

Purpose: The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care.

Methods: Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July–October 2021. All residents (age ≥ 18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose.

Results: Participants received health care …

Examining Racial Disparities In Unemployment Among Health Care Workers Before, During, And After The Covid-19 Pandemic, Jason Semprini

Journal of Patient-Centered Research and Reviews

Among the U.S. health care workforce, the COVID-19 pandemic appeared to greatly impact employment levels in 2020. However, no research has examined how the pandemic’s impact on employment varied by racial/ethnic group or beyond the initial emergency year. Our study aimed to quantitatively evaluate workforce trends by race/ethnicity before, during, and after the COVID-19 pandemic. This study analyzed each March supplement of the Current Population Survey over a 5-year span (2018–2022). We restricted the sample to nurses, physician assistants, and other non-physician health care workers (HCW), per specific census occupation codes, and constructed an event-history study to test for differential …

Applying Customer Discovery Method To A Chronic Disease Self-Management Mobile App: Qualitative Study, Nallely Mora, Zoe Arvanitakis, Merly Thomas, Holly Kramer, Elaine H. Morrato, Talar W. Markossian

Parkinson School of Health Sciences and Public Health

Background: A significant health challenge is evident in the United States, with 6 in 10 adults having a chronic disease and 4 in 10 adults having 2 or more. Chronic disease self-management aims to prevent or delay disease progression and disability and reduce mortality risk. The evidence to support the use of information technology tools, including mobile apps, web-based portals, and web-based educational interventions, that support disease self-management and improve clinical outcomes is growing. Customer discovery and value proposition design methodology is a form of stakeholder engagement and is based on marketing and lean start-up business methods. As applied in …

Examining The Associations Of The Kidney Allocation System With Patient Sensitivity, Wait Time To Transplant, And Donor Distance, Shamika Danielle Jones

Theses and Dissertations

Background

The Kidney Allocation System (KAS) was created in 2014 to address long wait times for a kidney transplant, inappropriately matched kidneys, and high re-transplantation rates. This research examines the associations of the KAS with the percentage of sensitized patients receiving a kidney transplant, wait time to transplant and the distance between donor and recipient hospitals.

Methods

Data from the Scientific Registry of Transplant Recipients (SRTR) was used for this research. The study population included adults over 18 in the United States who received a kidney transplant between December 4, 2009, and December 4, 2018. Patients simultaneously waitlisted for other …

Beyond Vaccination Coverage: A Critical Look At Zero-Dose Children In Sub-Saharan Africa, Chamberline Ekene Ozigbu

Theses and Dissertations

Background: Despite continuous efforts to enhance childhood vaccination coverage, a considerable number of children in sub-Saharan Africa (SSA) remain unvaccinated (zero-dose). Recent estimates indicate that approximately 17 million zero-dose children reside mainly in 10 Low- and Middle-Income Countries (LMICs) in SSA. The Immunization Agenda 2030 (IA2030) aims to reduce the number of zero-dose children by half, necessitating research to identify populations and groups at higher risk of being unvaccinated.

Objectives: This research sought to (1) examine individual and contextual factors associated with zero-dose status in SSA, (2) assess the geographical clustering of zero-dose children aged 12-59 months in SSA and …

Complementary And Integrative Health (Cih) And Opioid Use Among Adults With Chronic Noncancer Pain In The Us, Yi-Wen Shih

Theses and Dissertations

Chronic noncancer pain (CNCP) is defined as persistent pain lasting for more than three months due to conditions other than malignancy. This condition affects one in five American adults annually. The prescribing of opioids to individuals experiencing CNCP has been recognized as a critical contributor to the ongoing opioid crisis. In 2016, the Centers for Disease Control and Prevention (CDC) recommended Complementary and Integrative Health (CIH) as a nonpharmacologic treatment to be used among adults with CNCP. Despite the potential benefits of CIH for pain relief, there may be a discrepancy between individuals with CNCP and their insurance coverage for …

Patient Experiences And Disparities In Telehealth Hiv Care During The Covid-19 Pandemic: Study Results From The Southern United States, Valerie Yelverton

Theses and Dissertations

Background: To maintain HIV care continuity during the COVID-19 pandemic, most HIV care facilities in the United States adopted telehealth. However, not everyone was participating in telehealth equally. This dissertation seeks to understand experiences with and the use of telehealth in HIV care, and decision processes guiding the selection of visit type during the COVID-19 pandemic.

Methods: Qualitative interviews explored people living with HIV’s (PWH) and HIV care provider’s experiences with telehealth HIV care and visit type decision processes. Quantitative analyses of electronic health record (EHR) data characterized patterns of and disparities in telehealth HIV care during the COVID-19 pandemic. …

Measuring Quality At The Surgeon Level, Elias A Chamely, Jonah J Stulberg

Faculty, Staff and Student Publications

Patients expect high-quality surgical care and increasingly are looking for ways to assess the quality of the surgeon they are seeing, but quality measurement is often more complicated than one might expect. Measurement of individual surgeon quality in a manner that allows for comparison among surgeons is particularly difficult. While the concept of measuring individual surgeon quality has a long history, technology now allows for new and innovative ways to measure and achieve surgical excellence. However, some recent efforts to make surgeon-level quality data publicly available have highlighted the challenges of this work. Through this chapter, the reader will be …

Analysis Of The Distribution Of Health Workers And Health Facilities In Karanganyar Regency In 2022, Annisaa Annisaa, Ema Novita Deniati

Preventia: The Indonesian Journal of Public Health

Health, as one of the pillars of a nation's development, has an important role. This is in line with the understanding of the World Health Organization that there are 12 public health indicators as proxies for health indicators in the Sustainable Development Goals. However, in Karanganyar Regency, the typography is located on the slopes of Mount Lawu, and most of them are rural areas, resulting in an uneven distribution of health workers and health service facilities. Therefore, this study aims to determine the distribution of health workers in Karanganyar Regency so that it can be a concern in formulating policies …

Building Up Cal Poly Global Brigades Student Group: Reflections On Designing And Implementing One Undergraduate-Led Community Info Session, Caroline Nicole Smith, Jafra D. Thomas

Kinesiology and Public Health

Intro: Global Brigades, an international non-profit organization, trains college students and other pre-professionals in community-based health promotion by mobilizing community service trips around the world, which are taught and led by local community groups. Cal Poly’s Global Brigades student group was founded in 2018, and thus far, they have carried out three annual, medically-focused brigades to Honduras (two in-person, one virtual).

Purpose: The aim of this report is to present the findings of one experiential senior project to promote Cal Poly’s Global Brigades student group^[1] (conducted January to March 2023).

Methods: The student designed material for …

Diabetes Prevalence And Monitoring In Nonmetropolitan And Metropolitan Areas Within A Commercially Insured U.S. Population, Lindsey R. Hammerslag, Jeffery Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Enrollees living in nonmetropolitan areas had 22% higher likelihood of having diabetes, even after controlling for factors like age and region.
• The prevalence of diabetes in 2019-2020 was 7.9% in nonmetropolitan areas and 6.2% in metropolitan areas.
• Annual hemoglobin A1c (HbA1c) testing occurred for 85.1% of nonmetropolitan and 85.7% of metropolitan enrollees with diabetes. After controlling for other factors, we found significantly lower testing for those in nonmetropolitan areas.
• For diabetic enrollees, having an HbA1c test in 2019 was associated with an 8% decrease in the likelihood of non-cardiovascular complications related to diabetes and a 6% …

Incidence Of Chronic Kidney Disease Following Acute Coronavirus Disease 2019 Based On South Carolina Statewide Data, Roy O. Mathew, Jiajia Zhang Ph.D., Xueying Yang, Shujie Chen, Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Background: Coronavirus disease 2019 (COVID-19) was associated with severe acute illness including multiple organ failure. Acute kidney injury (AKI) was a common finding, often requiring dialysis support.

Objective: Define the incidence of new clinically identified chronic kidney disease (CKD) among patients with COVID-19 and no pre-existing kidney disease.

Design Participants: The South Carolina (SC) Department of Health and Environmental Control (DHEC) COVID-19 mandatory reporting registry of SC residents testing for COVID-19 between March 2020 and October 2021 was included.

Design Main Measures: The primary outcome was a new incidence of a CKD diagnosis (N18.x) in those without a pre-existing diagnosis …

Perceptions Of Health Workers Regarding The Covid-19 Vaccine Report Application In Ogan Ilir Regency, South Sumatra, Haerawati Idris, Amrina Rosyada, Anggun Budiastuti, Nurmalia Ermi

Journal of Indonesian Health Policy and Administration

The Lapor Vaksin COVID-19 Application was developed to support a vaccination coverage surveillance database sourced from community self-report. This application provides data on vaccination coverage and allows users to view updates to educational content about vaccines and visualization of COVID-19 vaccine data in real-time. This study aims to analyze the perception among health worker about Lapor Vaksin COVID-19 application in the community. This study uses descriptive research with a case study design. This study was conducted in September 2021 through a virtual zoom meeting, in Ogan Ilir Regency, South Sumatra. The research sample was 42 health workers consisting of vaccine …

Implementation Analysis Of The Pariaman City Regional Regulation No. 9 Of 2015 Concerning The Drinking Water Depot Business Permit, Melia Roza

Journal of Indonesian Health Policy and Administration

To regulate the existence of Drinking Water Depots (DAM) in the city of Pariaman, the Pariaman City government issued Regional Regulation (Perda) Kota Pariaman No. 9 of 2015 concerning Business Permits for Drinking Water Depots. However, many depot owners do not implement these regulations. The purpose of this study was to analyze the implementation of Pariaman City Regional Regulation No. 9 of 2015 concerning Drinking Water Depot Business Permits. This research is a type of qualitative research. Data collection was carried out through in-depth interviews with informants involved in the implementation of Pariaman City Regional Regulation No. 9 of 2015 …

Health Care Spending For Cardiovascular Disease Under National Health Insurance Scheme In Indonesia Before And During Covid-19: Descriptive Analysis And Policyrecommendations, Atik Nurwahyuni, Prastuti Soewondo, Mardiati Nadjib, Yuli Farianti, Mazda Novi Mukhlisa, Helmi Wahyuningsih, Emmy Ridhawaty Mangunsong, Athiyah Athiyah, Yunita Yunita, Sekar Arum Handarbeni Sayekti, Kurnia Sari, Amila Megraini

Journal of Indonesian Health Policy and Administration

The Cardiovascular disease (CVD) prevalence continues to increase. This study aims to identify the CVD spending and utilization in the Indonesia National Health Insurance (JKN) scheme 2017-2021 using the JKN claims classified by Disease Accounts analyzed descriptively. The CVD spending increased by $125,4 million in 2019 compared to 2017 and mostly for the hospital (91% in 2019) with the highest spending occurring in the age above 60 years. Moreover, the hospital inpatient spending was dominated during these five years. The highest portion of spending by severity level was at mild level, followed by moderate and severe levels. Health facilities’ capacities …

Strengthening The Marketing Of Pediatric Cardiac Surgery Services To Support The Transformation Of Health Services In Indonesia, Felicia Gunardi, Puput Oktamianti

Journal of Indonesian Health Policy and Administration

This study aims to determine the marketing strategy 7P carried out by cardiac surgery services in Indonesia and to identify actionable policy recommendations. This study is observational descriptive research. Data were collected from Cardiothoracic and Vascular surgeons and hospital websites with cardiac surgery services. Through the marketing analysis approach of 7P, this study identifies problems and policy recommendations that can be alternative solutions. The price of the service is high, but most of the patients used BPJS, and it is found that the hospital rate is higher than BPJS claims. The actionable recommendation to respond to it is that the …

Hospital Ambulance Standardization In Jakarta: Narrative Review, Roy Michael Suranta, Ascobat Gani

Journal of Indonesian Health Policy and Administration

Ambulance is one of the hospital infrastructures that must meet service standards, security, and occupational safety and health in hospital operations. Therefore, it is the obligation of every hospital to ensure the standard of ambulance service. In the DKI Jakarta area, every ambulance, including hospital ambulances, must meet the standards in accordance with regulations and have an ambulance operating license. Based on data until the end of 2021, there were 82 (34.9%) hospital ambulances in Jakarta that carried out the recommendation process for an ambulance operation license from a total of 235 hospital ambulances, meaning that most hospital ambulances in …

Nutrition In Times Of Crisis: A Qualitative Study In Siargao Island, Philippines, During The Covid-19 Pandemic, Gideon Lasco, Vincen Gregory Yu, Julie Madelo Compra, Phetdavanh Leuangvilay, Rapeepong Suphanchaimat, Yunting Zhang, Charina Javier

Development Studies Faculty Publications

Objectives

Despite the public-health significance of both malnutrition and crises, little has been done to explore the convergence of the two domains and develop ways to improve policies and practices, especially in rural communities. This article remedies that knowledge gap by focusing on nutrition-related changes, responses, and practices during crisis situations in Siargao Island, Philippines, using the COVID-19 pandemic as a backdrop.

Methods

Forty-six (46) semi-structured interviews were conducted among parents, caregivers, local health workers, and local officials of Del Carmen, Siargao Island. Principles of thematic analysis were applied to data analysis using NVivo 12. Afterwards, the preliminary data were …

Association Of Selected State Policies And Requirements For Buprenorphine Treatment With Per Capita Months Of Treatment, Bradley D. Stein, Brendan K. Saloner, Olivia K. Golan, Barbara Andraka-Christou, Christina M. Andrews Ph.D., Andrew W. Dick, Corey S. Davis, Flora Sheng, Adam J. Gordon

Faculty Publications

IMPORTANCE Expanding the use of buprenorphine for treating opioid use disorder is a critical component of the US response to the opioid crisis, but few studies have examined how state policies are associated with buprenorphine dispensing. OBJECTIVE To examine the association of 6 selected state policies with the rate of individuals receiving buprenorphine per 1000 county residents. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used 2006 to 2018 US retail pharmacy claims data for individuals dispensed buprenorphine formulations indicated for treating opioid use disorder. EXPOSURES State implementation of policies requiring additional education for buprenorphine prescribers beyond waiver training, continuing medical …