Health Services Administration Commons^™

Review Of Current Research Describing The Influence Of Non-Health Care Drivers Of Health In Rural And Urban Populations, Katie Youngen, Julia Cecil, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Social determinants of health (SDOH) (also called social drivers of health) are the conditions of the environment where people live, learn, work, and play that are known to affect health outcomes.¹ The primary objective of this literature review is to summarize the most recent literature related to the Healthy People 2030 domains of a) economic stability, b) education access and quality, c) neighborhood and built environment, and d) social and community context.² Our particular focus is on non-health care drivers of health. The secondary objective is to identify gaps in literature applied to rural populations.

Management Of Cardiovascular Disease Risk Factors By Rural And Urban Primary Care Practices, Lars E. Peterson, Zachary J. Morgan

Rural & Underserved Health Research Center Publications

In the United States, over 650,000 people die annually from cardiovascular disease (CVD) with high associated health care and economic costs.1 Despite a strong scientific basis for their beneficial impact on health,2 rates of preventive screening remain low.3 Levels of adherence to preventive guidelines are even lower in African American populations, socioeconomically disadvantaged populations, and underserved rural populations.4 Rural populations have higher rates of modifiable risk factors—obesity, smoking, physical inactivity—for CVD than urban populations and bear a disproportionate burden from CVD.5–7 Rates of undiagnosed and poorly treated high blood pressure are more common in rural areas.8,9 Racial/ethnic minority populations also …

Rural-Urban Differences In Dental Care Utilization After A Public Health Emergency, Quazi Minhaz Tabassum, Redwan Bin Abdul Baten, Ahmed A. Arif

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Past year dental clinic visits declined among both rural and urban populations after the COVID-19 pandemic. However, rural patients are more likely to report delayed dental service utilization than their urban counterparts.

• Participants residing in Medicaid expansion states or with health insurance coverage were 16% less likely to delay dental visits overall.

• The COVID-19 pandemic further worsened the existing challenges in dental healthcare access for urban and rural communities.

Performance Outcomes Of Critical Access Hospitals: A Resource Dependence Theory Evaluation Of Change Of Ownership Versus Independence, Colette Christina Martin

Theses, Dissertations and Capstones

Critical Access Hospitals (CAHs) play a vital role in sustaining healthcare access in rural communities, yet many face persistent financial and operational constraints. A change in hospital ownership is frequently seen as a strategy to sustain these hospitals, improve access to capital, supplement administrative infrastructure, and leverage system-level expertise. However, empirical evidence regarding the effectiveness of acquisition for CAHs remains limited and mixed. Guided by Resource Dependence Theory (RDT) and the Balanced Scorecard framework, this study examines whether ownership change is associated with differences in financial performance, utilization, staffing, and quality outcomes among CAHs.

Using Medicare Cost Reports, the American …

Community Benefit Spending Decisions At Virginia’S Nonprofit Hospitals, Zelda Hinkle

School of Professional and Continuing Studies Nonprofit Studies Capstone Projects

Nonprofit hospitals play a unique role in the healthcare system: in exchange for tax- exempt status, they are expected to provide “community benefits,” such as charity care, health programs, and community investments. While this spending represents a major opportunity to improve population health and address disparities, stakeholders debate how expectations should be set, measured, and regulated to ensure mission adherence while maintaining nonprofit autonomy. This study explores how community benefit spending allocation is actually determined, leveraging interviews with decision-makers at large nonprofit hospital systems in Virginia. Findings consider the role of factors such as Community Health Needs Assessments and strategic …

Incorporating New Guidelines Into School-Based Asthma Management, Jessica Michala Jindra, Angela Duff Hogan

Department of Pediatrics Faculty Publications

Purpose of the Review

The aim of this review is to identify barriers and provide solutions to the implementation of inhaled corticosteroid-formoterol as rescue therapy within schools.

Recent findings

GINA guidelines in 2019 and NAEPP in 2020 recommended inhaled corticosteroids combined with formoterol for a rescue inhaler over the traditional short-acting beta-agonist.

Summary

The findings discussed in this article describe the barriers to the implementation of inhaled corticosteroids combined with formoterol for a rescue inhaler in school systems. Traditional asthma action plans, school nursing and parental education, and differences in dosing are some barriers identified. This paper provides solutions for …

Benefits And Harms Of Copyright Restrictions And Conditions On Burnout And Other Psychometric Assessment Scales, Robert G. Badgett, Sudha Xirasagar, Hayrettin Okut

Publications

INTRODUCTION: Copyright conditions can hinder the scientific and usage impact of essential assessment tools in healthcare, organizational psychology, and other fields. The stories of the Maslach Burnout Inventory (MBI) and the Mini-Mental Status Examination (MMSE) are well-documented. Despite decades-old recommendations to blend copyright restrictions of intellectual property when used for commercial purposes with permissive but distinct copyright terms for non-commercial and scholarly use, few authors of assessment tools do so.

OBJECTIVE

To assess whether restrictive copyrights limit the long-term scientific impact of copyright holders (often medical schools/faculty), by inhibiting downstream use, research, and improvement of measurement tools by other researchers. …

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 …

Enhancing Military Health System Organizational Efficiency And Quality Of Care Through A Social-Ecological Framework, Eric L. Peipelman

College of Graduate Studies: Theses & Dissertations

Timely and fair adjudication of incivility-related actions within the Department of Defense (DoD) and Military Health System (MHS) is increasingly crucial for maintaining accountability, mission readiness, and quality of care. Ongoing delays in resolving workplace complaints and inefficiencies in resource-heavy adjudications highlight the need to shift from reactive complaint handling toward proactive civility promotion and transparent decision-making. This Integrated Learning Experience (ILE) introduces the Peipelman Civility Discussion and Assessment Toolkit (PCDAT)—a comprehensive, evidence-based framework designed to improve civility, optimize resources, and enhance communication, even in the MHS. Based on the Social-Ecological Model (SEM) and adapted from the Workplace Power and …

Sociodemographic Differences In Sepsis-Related Medicare Hospitalizations: A State-Level Analysis Of Diagnosis-Related Groups For Severe Sepsis In 2019 And 2022, Alba Kuqi

College of Graduate Studies: Theses & Dissertations

Introduction: This state-level ecological repeated cross-sectional study examined sociodemographic differences in sepsis-related Medicare hospitalizations assigned to Medicare Severity Diagnosis-Related Groups (MS-DRGs) 871 and 872 in 2019 and 2022.

Objective: The study focused on three outcomes: changes in sepsis-related Medicare discharge volume, changes in average Medicare payment per sepsis discharge, and changes in the proportion of MS-DRG 871 discharges relative to MS-DRG 872 discharges.

Methods: Publicly available Medicare inpatient hospital data and state-level demographic data were used to evaluate whether age, race, gender composition, and median household income were associated with these changes across the 50 U.S. states and …

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 …

Advancing Interoperability Through Governance And Sustainability: A Qualitative Comparative Case Study Of State Health Information Exchanges In The United States, Karterria Finkley

College of Graduate Studies: Theses & Dissertations

This study presents a comprehensive comparative analysis of state-level Health Information Exchanges (HIEs) across all 50 U.S. states and the District of Columbia, examining how governance structures, consent frameworks, funding models, and technical infrastructure influence interoperability maturity, sustainability, and adoption. Guided by Systems Theory and Donabedian’s Structure Process Outcome framework, the research employs a mixed-methods comparative case design integrating systematic documentary review, qualitative thematic analysis, and a policy-anchored analytic scoring methodology. Structural and policy characteristics were operationalized through standardized ordinal (1-5) metrics and aggregated into composite indices representing governance capacity, consent inclusivity, financial sustainability, and technical readiness. This approach enabled …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Assessing And Advancing Pandemic Emergency Preparedness In New York City's Hospitals: A Strategic Management Toolkit Integrating Policy Analysis, Risk Assessment, And Stakeholder Insight, Irrem Jamal

College of Graduate Studies: Theses & Dissertations

This dissertation examines pandemic emergency preparedness in New York City hospitals, which were severely strained during COVID-19, revealing critical gaps between documented plans and operational readiness. Using a multimethod approach combining a survey of 20 stakeholders across city hospitals, semi-structured interviews, and document analysis of policy frameworks and after-action reports, the study identifies a persistent "documentation-execution paradox": while 80% of respondents confirmed clear pandemic plans, only 45% expressed confidence in staffing adequacy, 55% in surge planning realism, and just 45% confirmed regular drills. Qualitative analysis revealed workforce as the single greatest yet most underinvested vulnerability, supply chain fragility rooted in …

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 …

Identifying And Prioritizing Essential Healthcare Services For A Private Start-Up Healthcare Hub In Laxmipasha, Bangladesh, Ferdous Ara Mostofa

Dissertations

This quantitative study identifies and prioritizes essential healthcare services for developing a private start-up healthcare hub in Laxmipasha, Bangladesh, a rural community with significant gaps in healthcare access. Using secondary data from national and international sources, the research analyzed disease burden, population characteristics, and service availability to determine the most urgent health priorities. A structured, evidence-based framework was used to evaluate services based on mortality and morbidity, service gaps, and potential health impact. The findings indicate that Maternal and Child Health (MCH), Non-Communicable Disease (NCD) management, and infectious disease control represent the most critical priorities for initial implementation. The study …

Participatory Development Of Innovation And Implementation Strategy: An Action-Oriented Approach, Miae Lee, Lesley A. Anderson, Emilia Piltonen, Abha Maheshwari, Julian Griffin, Seshadri S. Vasan

Research outputs 2022 to 2026

Background: Healthcare and academic institutions face growing challenges in strategic planning due to rapid advances in medicine and technology, alongside fiscal and workforce constraints that limit traditional consultation. Participatory approaches offer a way to integrate diverse stakeholder perspectives under these constraints, generating contextually relevant strategies that can indicate whether current directions are appropriate or whether priorities have been overlooked.

Methods: A structured, time-limited participatory workshop was conducted at the 10th Grampian Research Conference (June 2025), that brought together National Health Service (NHS) staff, academia, industry and patients and public communities. Participants engaged in 14 parallel roundtable discussions, with contributions captured …

Barriers And Facilitators To Recruiting Older Adult Care Homeresidents Into Clinical Trials Of Medicines And Vaccines: A Scoping Review, Selvarani Subbarayan, Imogen A. Smith-Dodd, Gabriel Nicolson, Jennifer K. Burton, Janet T. Scott, Seshadri S. Vasan, Susan D. Shenkin, Roy L. Soiza, The Watch Consortium

Research outputs 2022 to 2026

Introduction: Excluding Care Home (CH) residents from clinical trials of medicines and vaccines has led to an evidence gap. Findings from younger adults may not be generalisable to CH residents with frailty and dementia. Therefore, it is essential to evaluate pharmacological treatments directly in CH residents to assess their safety and efficacy.

Methods: As part of the Widening Access to Trials in Care Homes project, we conducted a scoping review using Joanna Briggs Institute methodology to identify barriers and facilitators to recruiting CH residents into clinical trials of medicinal products. We searched EMBASE, MEDLINE, PsycINFO, CINAHL, and the Cochrane Library …