Health Services Research Commons^™

Quality Improvement (Qi) Project Aimed At Reducing Unnecessary Antibiotic Usage Among Older Adult Patients By Addressing Inappropriate Antibiotic Prescribing In Primary And Long-Term Care Settings, Pamela M. Thomas

Seton Hall University Dissertations and Theses (ETDs)

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and …

Quantifying Black Carbon Concentrations In Georgia And Analyzing Associated Public Health Risks, Khloe R. Osborne

Honors Theses

Quantifying Black Carbon Concentrations in Georgia and Analyzing Associated Public Health Risks

One of the most daunting challenges of the industrial world is air pollution. Within this broad spectrum, there is an inhalable particle group named PM2.5, which contains black carbon. Black carbon has evidence that supports the generation and worsening of adverse health impacts, which may include birth complications, cognitive deficits in children, pulmonary aggravation, asthma, cardiovascular issues, neurological degenerative patterns, and cancer risk. This is especially seen in vulnerable populations, like children, elderly, and those who already suffer from weakened health, many of which reside in the southern …

Determinants Of Hypertension Awareness And Control In Kenya: A Secondary Analysis Of National Survey Data, Alexander K. Davis

Poster Presentations

No abstract provided.

Improving Identification And Referral Of Xylazine‑Associated Wounds In Homeless Healthcare, Ramon A. Gambino

Doctor of Nursing Practice Scholarly Projects

Background: Xylazine-adulterated fentanyl is linked to distinctive necrotic wounds and complex care needs in unsheltered populations. This quality improvement (QI) project implemented a brief survey and referral log at Albuquerque Health Care for the Homeless (AHCH) to track suspected xylazine-associated wounds and referrals to advanced care. Methods: Final data were exported from Qualtrics, cleaned to retain finished responses, standardized categories, and de-identified. The analytic sample included 18 encounters. Results: Results showed that 55.6% (n = 10) documented suspected xylazine-associated wounds; 5.6% (n = 1) reported no suspicion; 38.9% (n = 7) were uncertain. Referrals were rarely documented overall at AHCH …

Costs, Demographics, And Causative Agents In Patients Hospitalized For Drug Induced Liver Injury: Trends In A Large Academic Healthcare System, Megan Kozar, Yunisse Gonzalez, Dina Halegoua-De Marzio

Department of Medicine Faculty Papers

PURPOSE: Drug-induced liver injury (DILI) is an uncommon but potentially life-threatening condition. To date, the burden of DILI on a single, large healthcare system has not been investigated, preventing adequate resource allocation. This study aims to quantify DILI-related healthcare utilization within the Jefferson Health System (JHS) and identify case-related factors associated with high resource requirements; such information is crucial to focus efforts toward resource reduction.

PATIENTS AND METHODS: This study characterizes trends of 48 DILI cases within JHS, including demographics, payer status, causative agent, and DILI pattern. These variables were correlated with length of stay (LOS) and cost relating to …

Navigating End-Of-Life Decisions: Cultural Considerations For Latine Patients, Michelle Carbajal Hernandez

Honors Capstones

Healthcare professionals face many challenges when communicating terminal illness prognoses for individuals. This responsibility to address a terminal prognosis is further complicated when communicating with Latine patients who may face multiple barriers within the healthcare system and whose cultural preferences influence end-of-life care planning (Carrion, 2010). For example, Latines are less likely to enroll in end-of-life (EOL) care services (e.g., hospice) (Barragan-Carrillo et al., 2022). As well as engage in end-of-life care planning than White Non-Latines (Shen et al., 2016). To understand this hesitancy towards EOL care options, this literature review aims to explore how terminally ill Latine and …

Investigating Social Justice Implications Of Glyphosate Residues In Human Urine, Ananya Malhotra

Electronic Theses, Projects, and Dissertations

Background: Glyphosate, the nominal active ingredient in professional-grade Roundup weed and grass killer, is the most extensively used herbicide globally and in the United States (U.S. Environmental Protection Agency, 2020). An increasing level of concern has surfaced regarding its health consequences, particularly because of contamination of our food supplies. Recent research indicates distressing levels of detection of glyphosate in human blood and urine samples, revealing many instances of frequent human exposure (Conrad et al., 2017; Zhang et al., 2020).Most of the research about exposure is focused on agricultural workers or individuals living in close vicinity to agricultural lands.  Few …

Evaluating Sensory Sensitivities Among Children With Autism Spectrum Disorder In An Adaptive Gymnastics Program, Aicha Kaouss, Bradley Eppinger, Austin Ebbrecht, Kailash Ram, Kaitlin P. Hardy Md

Knowledge and Creativity Expo

Introduction: Children with autism spectrum disorder (ASD) participate in physical activity at lower rates than their neurotypical peers1. Sensory sensitivities, reported in approximately 75–95% of children with ASD, may contribute to this disparity2. Gymnastics environments involve bright lighting and loud noise, which can precipitate sensory overload. The impact of specific sensory features on participation in adaptive gymnastics remains underexplored.

Methods: A cross-sectional study recruited caregivers of children aged 3–12 years with an ASD diagnosis enrolled in the EVMS Adaptive Gymnastics Program. Caregivers completed the Sensory Experiences Questionnaire–Third Edition (SEQ-3)3 and supplemental survey items on Redcap which assessed environmental triggers and …

The Role Of Gynecologic Oncologists In Improving Survival Outcomes Of Epithelial Ovarian Cancer: A Retrospective Cohort Study, Widyorini Lh Hanafy, Bambang Dwipoyono, Asri C. Adisasmita, Yosephine E. Regina, Airine S. Lians, Oktaviani P. Rahayu, Jane G. Auwelia

Kesmas

Epithelial ovarian cancer (EOC) is a leading cause of gynecological cancer mortality and is often diagnosed at an advanced stage, resulting in poor survival outcomes. Access to specialized gynecological oncology services has been associated with improved prognosis; however, data on its impact in Indonesia remain limited. This study aimed to evaluate the association between gynecologic oncologist (GO) services and disease-free survival (DFS) in patients with EOC. This retrospective cohort study included 76 patients with EOC who were treated at a national cancer hospital in Jakarta between 2015 and 2018. Patient data were obtained from medical records and followed for three …

Low-Dose Prophylaxis Versus On-Demand Treatment For Children With Severe Hemophilia A In Indonesia: A Conceptual Model, Levina Chandra Khoe, Nur Atika, Dhia Ticha Pertiwi, Septiara Putri

Kesmas

Hemophilia A is a rare bleeding disorder caused by a deficiency of clotting factor VIII, leading to recurrent bleeds, joint damage, and disability. Low-dose prophylaxis has been shown to achieve better clinical outcomes than on-demand treatment in reducing bleeding frequency. However, in Indonesia, access and affordability remain key challenges. This study aimed to develop a conceptual model for conducting a health economic evaluation of low-dose prophylaxis treatment for children with severe hemophilia A in Indonesia. This study followed the ISPOR-SMDM Modeling guidelines, outlining two-stage processes: conceptualization of the clinical problem and model development. A systematic literature review was conducted to …

Private Sector Healthcare Investment In Indonesia: Leveraging Australia-Indonesia Partnerships For Health System Transformation, Susan Josephine Neuhaus

Journal of Indonesian Health Policy and Administration

Australia and Indonesia are strategic partners with expanding bilateral trade valued at AUD 26.7 billion (2022-23). Health care partnerships between the two countries offer significant opportunities for private sector engagement. Indonesia’s large population, rapidly growing middle class, and implementation of Universal Health Coverage (UHC) through the Jaminan Kesehatan Nasional (JKN) present partnership opportunities to strengthen health system capacity, address infrastructure gaps and workforce shortages, and contribute to shared economic and prosperity goals. This study explores how Australian private healthcare investment can complement government initiatives in supporting Indonesia’s UHC while advancing Australia’s regional engagement. A descriptive qualitative analysis was conducted using …

Analysis Of Coverage Of Tuberculosis Prevention Therapy (Tpt): Literature Review, Septia Rahmalina, Ede Surya Darmawan

Journal of Indonesian Health Policy and Administration

Tuberculosis Preventive Therapy (TPT) is a crucial intervention for tuberculosis (TB) control, particularly among high-risk groups such as household contacts of TB patients and people living with Human Immunodeficiency Virus (HIV). Despite being recommended by the World Health Organization (WHO), TPT implementation still faces challenges at the primary care level. This study employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method to review 11 articles published between 2021 and 2025 that were relevant to TPT implementation in various high-TB burden countries, including Indonesia. The main barriers identified were input (logistics, training), process (tracing, education, monitoring), and output …

Prophylactic Antibiotic Analysis In Obs-Gyn, Orthopedics, Gastrointestinal Surgery At A South Tangerang Hospital, January-March 2024, Evelina Endang Nurjaman, Helen Andriani

Journal of Indonesian Health Policy and Administration

Inappropriate use of prophylactic antibiotics (PAs) remains a primary driver of antimicrobial resistance (AMR); however, global adherence to established prescribing guidelines remains suboptimal. This study aimed to analyze the compliance and rationality of PA prescription and to evaluate the underlying causes of physician non-adherence in obstetrics, orthopedic, and gastrointestinal surgeries at a hospital in South Tangerang City, Indonesia. Adopting a mixed-methods approach, this investigation combined a quantitative assessment of 208 surgical patient records (January–March 2024) with qualitative exploratory interviews conducted with three specialist peer group heads. This design allowed the triangulation of prescribing data with underlying clinical perspectives. PA rationality …

Harmonization And Ambiguity In Regulations For Physicians With Family Medicine Competence Post-Law No. 17 Of 2023, Danar Wahyu Giwang Katon, Dumilah Ayuningtyas, Purnawan Junadi, Wahyu Sulistiadi, Roberth J. Pattiselanno, Fitria Fitria, Ika Fitri Alfiani

Journal of Indonesian Health Policy and Administration

Strengthening primary care services in Indonesia requires that community health centers, namely Pusat Kesehatan Masyarakat (Puskesmas), involve medical personnel with family medicine competence. However, the fulfillment of physicians with this competence, especially Primary Care Family Medicine Specialists or Spesialis Kedokteran Keluarga Layanan Primer (Sp.KKLP), still face significant obstacles. This qualitative research uses the integrated Easton's System Model and Buse's Policy Framework to analyze the dynamics of this policy. The findings reveal a gap between the strong legal foundation and weak implementation mechanisms on the ground. First, there is ambiguity in terminology and lack of harmonization among regulations, especially concerning the …

The Relationship Between Accessibility Factors And Post-Inpatient Control Visits Among Non-Jkn Participants At Hospital X, Putri Candaika, Desy Kartika Ningsih, Risky Kusuma Hartono

Journal of Indonesian Health Policy and Administration

The rate of post-inpatient control visits remains relatively low due to various factors, including accessibility. At Hospital X, 220 of non-Jaminan Kesehatan Nasional (JKN) participants scheduled for post-inpatient control visits between January and March 2025, 71.82% attended, and 28.18% did not. Patients who did not attend control visits were twice as likely to be readmitted. This study aimed to determine the relationship between accessibility and post-inpatient control visits for non-JKN participants at Hospital X. This quantitative study employed an analytical cross-sectional design, with a population of 220 patients and a sample of 142 patients selected using probability sampling. Bivariate …

M-O-M-S On The Bayou: Implementation Of An Intervention To Improve Mental Health After Disaster, E. W. Harville, Gloria Giarratano, M. Patterson, M. Schultheis, K. S. Dorans, S. Turner, S. Harris, S. Longo, K. Weis

School of Nursing Faculty Publications

Pregnant women are a vulnerable population after disaster. Their health may be improved through community-based support programs in addition to their standard prenatal care. We conducted a prenatal peer support program, Mentors Offering Maternal Support (M-O-M-S), focused on improving mental health in hurricane-affected areas in southern Louisiana. M-O-M-S consists of six biweekly sessions covering pregnancy acceptance, maternal role identification, family and partner relationships, preparation for labor/fears around labor, well-being/safety of self and baby, and post-delivery health and maternal-infant bonding. The program is led by a “mentor”, an experienced mother but not necessarily a clinician or social worker, who guides the …

Guidelines For Community Engaged Health Research, Carrie Leach, Hayley Thompson, Alex Sass, Patricia Wren, Rodlescia Sneed, Rhonda Dailey, Elizabeth Towner, Maha Albdour, Carla Caringi, Alyssa W. Beavers, Theresa A. Hastert, Vanessa Rorai, Peter A. Lichtenberg, Angulique Outlaw, Ijeoma Nnodim Opara

Institute of Gerontology

Executive Summary:

Wayne State University’s Guidelines for Community Engaged Health Research provide a practical framework for designing, conducting, and evaluating ethical, equitable, and impactful health research that engages community experts in projects that advance health equity in Detroit.

Purpose 

Developed for WSU faculty, staff, and research teams, the guidelines support the meaningful involvement of community experts across all phases of research. They respond to common challenges in community-engaged work, including limited experience with engagement approaches, the need for reflexive and equitable practices, and the time and coordination required for authentic collaboration.

The document defines Community-Engaged Research (CEnR) as collaborative work …

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 …

Food Stamp Participation And Health Outcomes In Ca Immigrants, Esther Kang

Scripps Senior Theses

The U.S. social welfare system includes programs aiming to increase access to nutritious food to reduce nutrition insecurity. However, studies suggest that immigrants continue to face disproportionate risks of nutrition insecurity and may face barriers to enrollment due to legal status. This study, using secondary data from the 2023 California Health Interview Survey, examines the associations between food stamp participation, food insecurity, and clinical diagnosis of diabetes among adult U.S.-born, naturalized, and non-citizen adults in California. The findings suggest that those enrolled in food stamps are more likely to report food insecurity than those who are not enrolled, and that …

Maternal Healthcare In The United States: An Exploration Of The Organizational And Political Determinants Of Maternal Healthcare Quality And Outcomes, Tamaya S. Browder

College of Graduate Studies: Theses & Dissertations

Despite having an advanced U.S. healthcare system, childbirth remains risky in the US, especially for socially vulnerable populations. Medicaid covers a large portion of births and is equipped to implement large-scale interventions to improve maternity care and patient outcomes. Two studies were conducted to (a) examine the relationship between organizational factors in U.S. hospitals and adverse clinical outcomes among Medicaid-insured maternity patients, and (b) analyze state-level Medicaid bundled payment models for maternity care. Guided by the Donabedian Quality of Care Model, Study One used logistic regression on data from the 2018-2020 National Inpatient Sample to explore how hospital organizational factors …

Exploring Acculturation And Its Role In Substance Abuse Behaviors Among Refugee Populations In Bowling Green, Ky: An Interactive Learning Experience Through Provider’S Perspectives., Aishwarya Potluri

College of Graduate Studies: Theses & Dissertations

Substance use among refugee populations is an emerging public health concern shaped/influenced by cultural, social, and structural factors associated with resettlement. This qualitative study explored providers’ perspectives on substance use behaviors among refugees in Bowling Green, Kentucky. Using Health Behavior Theory with acculturation as a contextual construct, semi-structured interviews were conducted with 10 providers working with refugee-serving organizations. Data collected through the interviews was analyzed using thematic analysis in NVivo. The findings indicate that substance use is being influenced by peer exposure, occupational stress, and the increased availability of substances in the United States. Providers identified cultural stigma surrounding mental …

The Effect Of The Affordable Care Act Medicaid Expansion On The Risk Of Hospital Closure And Adolescent Hpv Immunization In Rural Counties, Juliette Des Rosiers

Scripps Senior Theses

From 2005 to 2025, over 200 rural hospitals shut their doors, often citing increased operational costs, staffing shortages, low patient volume, regulatory barriers, financial challenges exacerbated by the COVID-19 pandemic, and uncompensated care as common contributors to the closures. Rural patients are often referred by their primary care physician to a hospital for regular immunizations, since smaller clinics have less capacity to provide immunizations due to a shortage of pediatricians and limited vaccine stock. A crucial vaccine that is not required by schools and underutilized in rural areas is that against human papillomavirus (HPV), a virus that infects cutaneous and …

Ensuring Rich Rigor Of Qualitative Methodologies In Behavior Analytic Research, Daria K. Lorio-Barsten, Selena J. Layden

Human Movement Studies & Special Education Faculty Publications

Quantitative methods remain the hallmark of research in applied behavior analysis. Yet, such methods frequently fail to capture the nuances of context where behavior analysis is practiced. Therefore, qualitative methods can provide complementary means to gain deeper insight into changes in socially significant behavior. We believe that researchers within the field of behavior analysis have much to gain from embracing qualitative methodologies. We propose that more researchers can and should consider conducting rigorous qualitative research to elevate the voices of the participants and relate the depth and complexities of their nuanced experiences. This article discusses Tracy’s “big tent” quality criteria …

Referral Strategies For Recruitment And Engagement Of Community Adults Into Online Extension Health Programs, Cheryl L. Eschbach, Dawn A. Contreras, Holly B. Tiret

Journal of Human Sciences and Extension

This article shares details behind building organizational capacity to establish program referrals for statewide recruitment of community adults into Cooperative Extension’s online health programs. This study explores the role of intentional recruitment strategies (active and passive) to increase participant program enrollment into health education and shares examples from one state that has created a trained workforce that offers ongoing research- and evidence-based programs. After many years of trying paper, phone, and electronic medical record methods to increase program reach, Michigan State University Extension tried an electronic referral process via a QR code and web link, accompanied by program marketing, to …

Diabetes And Hypertension Frequencies And Trends In The Health Districts Of Sololá, Alejandro Cerón, Sophie Perfetto, Ana Textor, Sidona Alemayehu, Emilia Alvear Escobar, Adele Beard, Sarah Berson, Rachel Bryant, Jennifer Calzontzi, Rylee Castro, Eva Cress Palencia, Jake Czarnecki, Jordyn Epstein, Nikki Harris, Patience Hinojos, Max Hippisley, Erin House, Jackson Hullett, Nathan Johnson, Amelie King, Saule Lankelyte, Juan Loya, Ashley Mackenzie, Ilana Mighdoll, Molly Morrill, Maria De Jesus Ramos Jimenez, Lilly Teklemedhin, Joseph Trujillo, Lauren Verachtert, Nathan Verachtert, Violet Vreeland, Alex Welch, Jada Wright

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students, Graduate Teaching Assistants, and instructor of “The Social Determination of Health” class taught in the fall of 2025 at the University of Denver. The report was prepared for Dr. Luis Pablo Méndez, of the Vice Ministry of Health Regulation, Surveillance and Control, of the Ministry of Public Health and Social Assistance of Guatemala. The work used the following guiding question: How can available data about service production can be used to inform the planning process for the implementation of the Global Hearts Initiative’s HEARTS technical package in the Distrito de Redes Integradas de …

A Quantitative Exploration Of Risk And Protective Factors Affecting The Mental Health Of Chitimacha Tribal Youth, Daphnie Vilcan-Tanner

LSU New Orleans Theses and Dissertations

This study examines the relationships between demographics, risk factors, and protective factors with mental distress among Chitimacha Tribal adolescents aged 12 to 18. Using a Positive Youth Development framework, the research aimed to identify the prevalence of mental distress, trauma, discrimination, and protective factors, as well as their collective and individual impacts on mental health. Data were collected through online surveys completed by 73 participants residing on or near the Chitimacha Tribal Reservation. Descriptive statistics and multiple linear regression analyses were conducted to analyze the data. Results revealed that while trauma and discrimination collectively predicted mental distress, family and community …

Young Adults And Early-Onset Psychosis: A Grounded Theory Study Of Experiences Of Identity Development, Katherine Hayden-Lewis, Deborah Rubel

The Qualitative Report

While identity development is a crucial task for young individuals ages 15-25, current research inadequately centralizes identity development in the context of first-time psychosis related to schizophrenia spectrum disorders. This study addresses the knowledge gap by exploring the grand research question, “How does a young person experience their identity development after the first episode of psychosis?”. Constructivist grounded theory methods influenced by critical frameworks were used to collect and analyze data with seven young adults engaged in first episode psychosis programs. Participants were young adults, between the ages of 19-24, that at the time of the study were enrolled in …

Post-Release Health Insurance Utilization Among Ex-Prisoners: A Scoping Review, Icha Khaerunnisa, Megah Andriany, Luky Dwiantoro

Kesmas

The lack of health insurance coverage after prison release significantly reduces access to essential healthcare services, hindering the continuity of care during community reintegration. The evidence on studies of health insurance use following prison release is limited. This scoping review aimed to summarize research on health insurance utilization after release from prison. Literature searches were conducted across databases including ScienceDirect, PubMed, and Scopus. Relevant articles were selected through a two-stage screening process. Data were extracted from the included studies and presented in tabular and descriptive formats. The keywords used were "health insurance AND post-release" and "inmates OR prisoners." This scoping …

Design Considerations For Conversational Agents To Assess The Social-Emotional Well-Being Of Young Children In Low-Income South African Communities, Lucretia A. Williams, Elizabeth A. Ankrah, Catherine E. Draper, Caylee J. Cook, Franceli L. Cibrian, Jesus A. Beltran, Kimberley D. Lakes, Gillian R. Hayes

Engineering Faculty Articles and Research

A variety of digital technologies have been used to support early childhood development (ECD) programs in low-income South African communities. Even though technology has provided opportunities to increase access to health interventions, the lack of trust and socio-economic constraints under which these tools would need to work pose complex challenges. We examine home visitors’ work processes, experiences, and preferences of a conversational agent to support their work of administering social-emotional well-being assessments to young children ages 0-5. Analysis of the results of focus groups with 51 home visitors indicates the need for designing conversational agents that support ECD in the …

Social Vulnerability Associations With Hypopharyngeal Carcinoma Treatment And Prognostic Disparities, Camaren M. Cuenca, David M. Bruss, David J. Fei-Zhang, Jill N. D'Souza, Anthony M. Sheyn, Jeffrey C. Rastatter, Daniel C. Chelius

School of Medicine Faculty Publications

Objectives: Prior studies investigating the impacts of social determinants of health (SDoH) on hypopharyngeal cancer have only assessed the impact of individual factors on patient outcomes. This study uses the CDC's Social Vulnerability Index (SVI) and a national patient cohort to examine how the interrelational influence of SDoH affect hypopharyngeal cancer prognosis, treatment, and follow-up. Methods: This retrospective cohort study analyzed patients from 1975 to 2017 with a diagnosis of hypopharyngeal carcinoma in the NCI-SEER database. Net social vulnerability and its contributions from 15 SDoH variables were ranked and scored across all US counties, yielding a SVI. SVI scores were …