Health Services Research Commons^™

Nourishing Births: A Program Evaluation Proposal For Community-Based Nutrition Education, Food Access, And Garden Engagement Among Black Birthing People, Naa Deedei-Vera Hammond

Master's Projects and Capstones

Black birthing people in the United States continue to experience unequal maternal health outcomes, shaped in part by racism and barriers to nutritious food, culturally relevant health education, and supportive community spaces. While prenatal nutrition education and food assistance programs can provide important resources, information alone cannot address the challenges many people face when trying to access healthy and affordable food during pregnancy. The Nourishing Births Initiative is a proposed community-based maternal health program designed to respond to these needs by bringing together prenatal nutrition education, help connecting to food resources, community gardening, and peer support for Black birthing people …

An Assessment Of Accessibility And Affordability Of Inpatient Psychiatric Care In Tennessee, Kailee Havrda

Electronic Theses and Dissertations

Introduction: Access to mental health has seen changes over the past decade, but little research and attention have been given to access to inpatient psychiatric facilities. Inpatient psychiatric care is crucial for patients experiencing mental health emergencies who need immediate access to care. Gaps in spatial accessibility, affordability, and the access and assessment process were identified due to a lack of available information in the field.

Methods: Secondary data from the Tennessee Department of Health were used to assess financial accessibility through payer source charges and patient encounters, as well as through mapping of inpatient psychiatric facilities and conducting drive …

Pharmacy Access Is Out Of Reach For One In Six South Carolinians, Bryan L. Love Pharm.D., Tessa J. Hastings Phd, Abby Davies

CORE Research Briefs

No abstract provided.

Building Health Resilience Against The Threat Of “Jakarta Sinking”: A Scoping Review, Risky Kusuma Hartono, Dewi Shinta

Journal of Indonesian Health Policy and Administration

In Jakarta, land subsidence amplifies flood risks—often described as the city “sinking”—which increases exposure to waterborne and vector-borne diseases, disrupts essential health services, and undermines health system resilience. This review examines how subsidence-induced flood amplification impacts health and its implications for system resilience. This study employs a literature review approach that combines narrative synthesis with scoping-oriented evidence mapping. Peer-reviewed articles in English or Indonesian (2015–2025) were searched across PubMed, Scopus, ScienceDirect, Google Scholar, and Portal Garuda using the following terms: flooding, Jakarta land subsidence, health impacts, and health system resilience. Data on hazards, populations, health outcomes, and resilience functions were …

Evaluation Of Disaster Mitigation Policy Implementation And Public Health Integration Through The “Sipatokkong” Program In Strengthening Tourism Village Resilience, Nurul Azisah Sahrani, Andi Alif Raihan Analta

Journal of Indonesian Health Policy and Administration

Disaster risks in tourism villages are increasing, generating multidimensional impacts on environmental, economic, institutional, and public health. In late 2024, Mattabulu Tourism Village experienced an 83% decline in tourist visits following a series of disasters, disrupting tourism activities and weakening local governance capacity. This study uses a qualitative case study design to evaluate disaster mitigation policy implementation through the “Sipatokkong” Program. Evaluation applied four Organisation for Economic Co-operation and Development–Development Assistance Committee (OECD-DAC) criteria: relevance, effectiveness, impact, and sustainability, operationalized through policy implementation, street-level bureaucracy, and collaborative governance frameworks. Data were obtained from five documents and non-participatory field observations conducted …

Perceived Susceptibility And Automatic Compliance In Indonesia's Triple Elimination Screening: A Mixed-Methods Study, Ratna Dewi Puspita Sari, Josef Maria Seno Adjie

Journal of Indonesian Health Policy and Administration

Despite global commitments to eliminating mother-to-child transmission of human immunodeficiency virus, syphilis, and hepatitis B, gaps remain in understanding the behavioral and systemic drivers of screening coverage in decentralized health systems such as Indonesia. This study aimed to analyze individual behavioral determinants and structural health system barriers affecting triple elimination screening coverage among pregnant women, focusing on perceived susceptibility and automatic compliance. A mixed-methods sequential explanatory study was conducted in Central Jakarta, Surabaya, and Karawang. The quantitative phase involved a cross-sectional survey of 1,224 pregnant women, with Health Belief Model variables analyzed using logistic regression. The qualitative phase comprised three …

Why Do Indonesians Travel Abroad For Medical Treatment? A Qualitative Phenomenological Study, Lucky Sarjono Buranda, Aries Wahyuningsih, Steven Busby

Journal of Indonesian Health Policy and Administration

More than one million Indonesian citizens travel abroad for medical treatment each year, generating financial transactions exceeding IDR 180 trillion (USD 11.5 billion). This study aimed to explore the reasons why Indonesians seek medical treatment overseas. A qualitative phenomenological approach was employed using in-depth interviews with Indonesian citizens who had received or were currently receiving medical treatment outside Indonesia. All interviews were recorded, transcribed, and analyzed through coding to identify themes, subthemes, and related properties. Interviews were conducted with 18 participants from three major Indonesian cities (Makassar, Surabaya, and Batam), as well as individuals receiving treatment in Singapore and Malaysia. …

Faktor-Faktor Yang Berhubungan Dengan Kejadian Prediabetes Pada Perawat Di Rumah Sakit X Tahun 2025, Putri Nurhaliza, Chandrayani Simanjorang, Agung Raharjo

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Prediabetes dapat berkembang menjadi diabetes melitus dan meningkatkan risiko penyakit kardiovaskular. Selain itu, beban ekonomi juga meningkat akibat tingginya biaya pelayanan kesehatan dan penurunan produktivitas kerja. Salah satu kelompok berisiko prediabetes adalah perawat karena karakteristik pekerjaannya, seperti penerapan sistem kerja sif serta tingginya beban dan tekanan kerja yang dapat memicu stres. Penelitian ini dilakukan untuk mengidentifikasi faktor-faktor yang berhubungan dengan kejadian prediabetes pada perawat di Rumah Sakit X pada tahun 2025. Desain studi yang digunakan adalah cross-sectional dengan sumber data primer yang dikumpulkan melalui pengisian kuesioner dan data sekunder yang diperoleh dari laporan hasil medical check-up tahun 2025. Populasi dalam …

Exploring Which Ehr Interventions Improve Heart Failure Hospitalization Outcomes Across 10 Hospitals, Sheraz Qamar, Andres Alvarado, Thomas Buckwalter, Patricia C. Henwood, Dana Jordan, Cara Martino, Jeffrey Riggio, Charlotte Sacksteder, Jared Vanderzell, Alan Kubey

Department of Medicine Faculty Papers

BACKGROUND: Heart failure (HF) remains a major cause of mortality and hospitalization despite advances in guideline-directed medical therapy (GDMT). Electronic health record (EHR)-based clinical decision support tools may improve care delivery, but their impact on outcomes remains ill-defined.

PROJECT RATIONALE: As part of a system-wide HF quality improvement initiative, we evaluated 2 EHR interventions: an evidence-based HF admission order set promoting early diuresis and GDMT optimization, and a templated HF documentation tool (HFNOTE) designed to capture clinical complexity.

PROJECT SUMMARY: We analyzed 4,865 HF hospitalizations across 10 hospitals between December 2024 and June 2025. Overall risk-adjusted mortality index was 0.83 …

Cost Analysis Of Integrated Genderaffirming And Sexual Health Services For Transgender Women In Thailand: Evidence From The Tangerine Clinic, Braprut Sawatwipachai, Kunncadah Anuwong, Nittaya Phanuphak, Rena Janamnuaysook, Kritima Samitpol, Sujin Nitadpakorn

The Thai Journal of Pharmaceutical Sciences

Background: Transgender women experience a disproportionate burden of human immunodeficiency virus (HIV) globally and in Thailand. Integrating gender-affirming care into sexual health services may improve uptake of HIV and sexually transmitted infections (STIs) testing, treatment, and prevention. Cost data are essential to inform program planning and policy decisions regarding inclusion of such services within Thailand’s Universal Health Coverage (UHC) system.
Objectives: To estimate the full and unit costs of trans-led, integrated gender-affirming and sexual health services along the HIV care cascade.
Methods: Costs of Tangerine Clinic services in 2021 were assessed from the provider perspective, using standard and activity-based costing …

Pola Rujukan Penyakit Saluran Pernapasan Di Fasilitas Kesehatan Tingkat Pertama: Tantangan Gatekeeper Program Jaminan Kesehatan Nasional Di Jakarta, Syarif Rahman Hasibuan, Melrose Holy Natasha, Fatih Jihadi Ramadan

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Program Jaminan Kesehatan Nasional yang diselenggarakan oleh Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan mewajibkan Fasilitas Kesehatan Tingkat Pertama (FKTP) untuk menyeleksi kasus yang memerlukan rujukan. Penyakit saluran pernapasan yang menjadi penyebab utama kunjungan ke FKTP memiliki pola rujukan yang masih belum banyak diteliti. Oleh karena itu, dilakukan penelitian untuk melihat pola rujukan penyakit saluran pernapasan di FKTP dan mengetahui faktor yang berasosiasi dengan keputusan rujukan. Penelitian potong lintang ini dilakukan terhadap 89.225 klaim FKTP di Jakarta pada periode 2017-2023, dengan kriteria inklusi semua kunjungan dengan diagnosis ICD-10 diseases of the respiratory system. Uji regresi logistik dilakukan untuk mengidentifikasi faktor …

Cost Analysis Of Rheumatoid Arthritis In Insured Patients And Its Determinant Factors: Data From A National Referral Hospital In Indonesia, Rudy Hidayat, Fara Fauzia, Mochammad Alfansyah Dhifanra, Aries Maulana

Kesmas

Rheumatoid arthritis (RA) leads to progressive functional impairment and considerable economic burden. This study estimated the annual (12-month) cost per patient among patients with RA and its determinant factors. A descriptive cross-sectional economic study of RA patients who had been treated for at least one year at the outpatient clinic of a national referral hospital in Jakarta, Indonesia, and met the 2010 ACR–EULAR criteria. Data collected from January 2023 to December 2024 were obtained from medical and billing records for demographic characteristics, direct medical costs, and DAS28-based disease activity, whereas non-medical and indirect costs were collected through structured patient interviews. …

Self-Management Interventions For Adults With Type 2 Diabetes Mellitus In Thai Primary Care And Community Settings: A Scoping Review, Sansanee Seetangkham, Supaluk Seetunya, Subhawan Yodprong

Kesmas

Diabetes mellitus is a leading cause of mortality and economic burden, with significant impacts on health outcomes and quality of life. Effective self-management is crucial for controlling Type 2 Diabetes Mellitus (T2DM). Thailand has implemented diverse self-management interventions for adults with T2DM in primary care and community settings, but the components, delivery, duration, and outcomes of these interventions have not been synthesized. Following the Arksey and O’Malley framework, Joanna Briggs Institute guidance, and PRISMA-ScR, five databases were searched from inception to June 2025. Eligible English-language intervention studies involved Thai adults with T2DM in primary care or community settings. Study characteristics …

From “Fixer” To “Facilitator”: A Clinical Review Of Shared Medical Appointments As A Strategy For Workforce Sustainability, Barbara A. Slusher

Lynchburg Journal of Medical Science

Clinician burnout remains a significant threat to workforce sustainability, particularly in resource-constrained settings managing complex chronic diseases. While shared medical appointments (SMAs) have demonstrated clear benefits in patient satisfaction and access, their impact on clinician well-being and professional fulfillment is less clearly defined. This review evaluates whether participation in SMAs improves clinician satisfaction and mitigates burnout by facilitating a conceptual transition from isolated “Fixer” to collaborative “Facilitator.”

A targeted literature search of PubMed, the Cochrane Library, and Google Scholar identified peer-reviewed publications examining shared medical appointments and clinician-centered outcomes, including burnout, clinician satisfaction, and workforce sustainability. …

Post-Pandemic Telebehavioral Health: Sustaining And Regulating Remote Mental Health Care As A Core Modality, Weiqiao Dong

Dartmouth College Master’s Theses

The United States continues to face a persistent mental health crisis after the COVID-19 pandemic, raising a policy question about the long-term role and regulation of telebehavioral health as a core modality of care. This thesis examines that question through a case study of New York State, an early center of the pandemic and a leader in telehealth policy reform.

Guided by the Health Policy Triangle framework, this thesis integrates longitudinal data from all 62 New York counties for 2010-2025 with a 2025 cross-sectional dataset covering 61 counties. Seventeen standardized indicators are organized into four dimensions: geographic, economic, demographic, and …

Advancing Maternal Health Equity In Nebraska: Examining Prenatal Care Access Disparities, Policy Context, And Doula Integration As A Complementary Solution, Marlette Grace Dulcinee Mabiala-Maye

Theses & Dissertations

Maternal health inequities persist across the United States, with Black, Native American, and immigrant-origin women facing disproportionate barriers to timely prenatal care. This dissertation examined access to prenatal care in Nebraska, a mixed rural and urban state with extensive maternity care deserts, through three interrelated aims. Aim 1 analyzed PRAMS data using survey-weighted regression with race-by-socioeconomic-status interactions to characterize disparities in the timing and barriers to care. Aim 2 evaluated the state’s October 2020 Medicaid expansion across pre-pandemic, acute pandemic, and post-expansion periods. Aim 3 applied qualitative description and the Consolidated Framework for Implementation Research to interviews withtwenty-three maternity care …

Cone Vs. Volumetric Modulated Arc Therapy (Vmat) Stereotactic Radiosurgery (Srs) Planning For Multiple (7) Brain Targets: Dosimetric Tradeoffs And Clinical Decision Guidance, Juan Garcia

Masters Projects

Purpose: This study compared cone-based stereotactic radiosurgery (SRS) and single-isocenter volumetric modulated arc therapy (VMAT) for multiple (7) intracranial targets to evaluate differences in target coverage, conformality, dose falloff, and normal brain exposure.

Methods: A phantom-based study was performed using progressively increasing configurations of 10-mm spherical targets, from one to seven targets. Cone-based SRS and VMAT plans were evaluated using D99, CI100, CI50, gradient index (GI), maximum dose, V12Gy, and V5Gy.

Results: Both planning techniques achieved similar target coverage. Cone based SRS produced a steeper dose gradient, with a mean GI of 2.99 compared with 4.66 for VMAT ( …

Bridging Fiscal Sustainability And Health Equity: A Policy Analysis Of California’S Healthcare Coverage Safeguards, Guadalupe Castaneda Martinez

Master's Projects and Capstones

Without structural policy intervention, approximately 4.6 million Californians remain at risk of being uninsured by 2030, worsening racial and ethnic health disparities and hospital uncompensated care burdens. This policy analysis advocates for a hybrid universal coverage model combining sliding-scale subsidies (California Senate Bill 78) with full-scope Medi-Cal expansion for all income-eligible residents regardless of legal status (California Assembly Bill 133). The framework relies on existing funding mechanisms, including the Managed Care Organization tax and the Health Care Affordability Reserve Fund. Comparative analysis indicates that market-only subsidies leave severe equity gaps, whereas immediate single-payer transitions pose substantial fiscal and administrative risks. …

Rural/Urban Disparities In Utilization Of Diabetes Self-Management Training (Dsmt) To The Fee-For-Service Medicare Population, 2017–2024, Wanying Zhu, Aleksandr Taraskin, Jeffrerey Talbert

Rural & Underserved Health Research Center Publications

Key Report Highlights

• A significant rural DSMT access gap exists. Rural beneficiaries accounted for 20.1% of Medicare beneficiaries with diabetes but only 7.8% of DSMT participants.

• Geographic availability remains limited. Only 16.8% of counties with DSMT utilization were rural.

• Access, not demand, appears to be the primary challenge. Rural counties offering DSMT achieved utilization rates more than twice those observed in urban counties (6.0% vs. 2.5%).

• Expanding rural DSMT capacity may represent a high-impact opportunity to improve diabetes self-management support among underserved Medicare beneficiaries.

Non-Metropolitan Vs. Metropolitan Variations In Alcohol, Illicit Drug, And Prescription Therapeutic Drug Misuse, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Key Findings

Alcohol Use. The prevalence of past year and past 30-day drinking was lower among non-metropolitan (non-metro) than metropolitan (metro) residents. However, non-metro drinkers engaged in more frequent binge drinking than metro drinkers. Drinking 3-5, 6-19, and 20-30 days over the past 30 days were higher among non-metro than metro residents.

Illicit Drug Use. Hallucinogens were the mostly commonly used illicit drugs among non-metro as well as metro residents. Methamphetamine use was significantly higher among non-metro than metro residents.

Prescription Pain Reliever Use. The misuse of prescription pain killers, primarily prescription opioids, was higher among non-metro than …

High-Deductible Health Plans In Rural And Urban Populations: Outpatient Utilization And Out-Of-Pocket Costs, Aaron P. Smith, Jefferey Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings This policy brief explores rural-urban differences in High-Deductible Health Plan (HDHP) enrollment, subsequent healthcare utilization, and out-of-pocket (OOP) costs. ▪ HDHP enrollment was uncommon. Rural residents were slightly less likely to enroll than urban residents across all demographic groups. ▪ Switching plans influenced utilization. Compared to those who did not change healthcare plans, switching from a Traditional plan to a HDHP was associated with a larger reduction in 2022 outpatient visits for both rural and urban residents. Moving from a HDHP to a Traditional plan was associated with a smaller reduction in 2022 outpatient visits for …

Attrition Of The Midwifery Workforce: Understanding Factors Associated With Leaving The Profession, E. Brie Thumm, Amy H. Goh, Elizabeth G. Phillips, Zachary Giano

College of Health Professions Faculty Papers

OBJECTIVE: To understand why advanced practice midwives (certified nurse-midwives and certified midwives) leave the workforce.

STUDY SETTING AND DESIGN: A multi-method, multi-source investigation included secondary analysis of certification data of advanced practice midwives and a cross-sectional online survey with closed- and open-ended items. Advanced practice midwives' active certification data were used to compare self-reported demographic characteristics of advanced practice midwives who reported working in the discipline of midwifery to those who did not (n = 9704). A survey was conducted in 2022 with individuals who allowed their certification to lapse between 2017 and 2021 (n = 303) and individuals who …

Cost-Effectiveness Evaluation Of Artificial Intelligence-Assisted Chest Radiograph Interpretation For Tuberculosis Screening In Rural Health Units In The Philippines, Harold Henrison C. Chiu, Bryan Christopher C. Lao, Gloanne C. Adolor

Graduate School of Business Publications

Background: Tuberculosis remains a major public health burden in the Philippines, where diagnostic delays are amplified by limited radiology capacity in rural health units (RHUs) and geographically isolated and disadvantaged areas (GIDAs). Computer-aided diagnosis (CAD) using artificial intelligence (AI)-assisted chest radiograph interpretation may shorten the screening pathway and reduce reliance on scarce specialist readers. However, its economic value for RHUbased tuberculosis screening has not been fully evaluated.
Methods: We developed a decision-tree cost-effectiveness model in Microsoft Excel 365 to compare AI-assisted chest radiograph interpretation with conventional manual radiologist or teleradiology interpretation among a theoretical annual cohort of 1,000 presumptive tuberculosis …

A Longitudinal Analysis Of Hospital Consumer Evaluation In Virginia, Tulay Akmandor Inac

Health Services Research Dissertations

Suboptimal patient experience signals a need to improve clinical efficacy, patient safety, and healthcare quality. The COVID-19 pandemic intensified hospital resource and staffing demands, reducing hospitals’ capacity to invest in patient experience improvement. Prior studies remain limited because many lack longitudinal structure and organized theoretical models, making temporal inference difficult and weakening analyses of patient experience disparities. To address these limitations, this dissertation incorporates three studies examining patient experience and pandemic-related effects.

In state-level markets comparable to Virginia, limited research has examined longitudinal patient experience trends across regional hospital systems using HCAHPS scores. The first study uses descriptive trend analysis …

Rural And Urban Availability Of Substance Use Treatment Facilities, Aaron P. Smith, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Rural counties have higher per capita numbers of substance use disorder treatment facilities than urban counties on average, but also greater variability and large pockets of unmet need.

• The highest proportions of residents living in counties without any treatment facilities are concentrated in rural areas within the Midwestern and Southern United States.

• Rural and urban treatment facilities offer medications for opioid use disorder (MOUD) at similar rates, with inpatient facilities most likely to provide MOUD, followed by residential and outpatient settings.

Bridging Models And Real-World Performance: Capturing Represented, Hidden, And Unrepresented Dynamics In Complex Systems, Dixizi Liu

All Dissertations

Complex systems often depend on adaptive performance that is difficult to capture using structured data or formal models alone. This dissertation asks how predictive modeling, coordination-cost measurement, and simulation can be integrated to better represent the visible, hidden, and unrepresented dynamics that shape real-world system performance.

Sterile Processing Departments (SPDs) provide the empirical context for this work because they support safe and timely surgical care while operating under high workload variability, time pressure, and tight coordination with operating rooms. Hospitals rely on SPDs to clean, assemble, sterilize, and deliver surgical instrument trays so surgeries can start on time and proceed …

Essays On Opioid Prescription Limit Policy Diffusion, Evaluation, And Opioid Use Disorder Treatment Utilization, Md Ashiqur Rab

All Dissertations

The drivers of the opioid epidemic in the United States include the oversupply of prescription opioids, the availability of illicit drugs, under-resourced healthcare settings, and several socio-economic factors. Federal and state-level initiatives, including policy interventions to curb the oversupply of prescription opioids, providing access to healthcare, prevention and recovery support services, and community-level engagement, have been adopted to combat the opioid epidemic. Motivated by the need to better understand the policy and recovery efforts to address the epidemic, this dissertation examines opioid prescription limit policy diffusion, evaluation, and treatment utilization patterns. This dissertation comprises three manuscripts that offer a comprehensive …

Uncovering The Path To Diagnosis Among Adults With Attention-Deficit/Hyperactivity Disorder: A Constructivist Grounded Theory Mini-Study, Jeffrey D. Whitaker, Rick Zoucha, Melissa Kalarchian

Graduate Student Research Symposium

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, yet many adults are first diagnosed only after years of functional strain, compensation, and alternative explanations for their difficulties. Purpose: This study explored how adults first diagnosed with ADHD in adulthood described navigating the process of obtaining a formal diagnosis. Methods: A constructivist grounded theory mini-study was conducted with seven adults, ages 27 to 43, who reported receiving their first formal ADHD diagnosis at age 18 or later. Participants completed semi-structured Zoom interviews focused on early experiences, symptom interpretation, help-seeking, and formal assessment. Data were analyzed using initial, focused, and theoretical …

Comments Re: Regulation For Federal Financial Assistance, Fred D. Ledley, Edward Zhou, Brian C. Fox

CISI Publication

This comment focuses on the proposed modifications to §200.205 “Federal Agency Merit Review of Proposals” and §200.340 “Termination and suspension” of Title 2 of the Code of Federal Regulations. We argue that the pre-issuance review, discretionary termination provisions, and other constraints of federal research support that would be established under this proposal create impediments to the scientifically-driven process of discovery and innovation that has long provided the foundation for advances in American prosperity, influence, health, and wellbeing. Our comments focus specifically on federal support for biomedical research by the National Institutes of Health (NIH) for the purpose of advancing healthcare …

Identification Of Prognostic Factors For Disease Recurrence-Free Survival (Drfs) In Breast Cancer Patients Using The Cox Proportional Hazards Model, Dwi Cahyaning Putri, Veny Prabaningrum, Samsul Arifin

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Breast cancer remains one of the most common malignancies among women worldwide, with recurrence remaining a major clinical challenge. Despite various treatment efforts, the mortality rate from breast cancer remains high, particularly among patients with worse clinical and molecular conditions. This study aims to identify factors influencing the survival of breast cancer patients using the Cox proportional hazards model. The study analyzes clinical and molecular data of breast cancer patients to identify key risk factors affecting Disease Recurrence-Free Survival (DRFS). Analysis was conducted using Kaplan-Meier, the Log Rank test, and the Cox proportional hazards model. The results showed that nodal …