Health Services Research Commons^™

A Characterization Of The Medical-Legal Partnership (Mlp) Of Nebraska Medicine, Jordan Pieper

Capstone Experience: Master of Public Health

This research study was completed at Legal Aid of Nebraska’s Health, Education, and Law Project through the partnership it has formed working with Nebraska Medicine and Iowa Legal Aid. Traditionally, health and disease have always been viewed exclusively as "healthcare" issues. But with healthcare consistently growing towards holistic approaches to help patients, we now know there are deeper, structural conditions of society that can act as strong driving forces of a person's poor daily living conditions that can negatively impact health. The importance of a Medical-Legal Partnership is that it considers a patient's social determinants of health (SDHs). The goal …

Healthcare Utilization For Behavioral Health Disorders: Policy Implications On Nationwide Readmissions, And Outcomes In The States Of Nebraska And New York, Rajvi J. Wani

Theses & Dissertations

The main goal of this dissertation was to estimate national-level inpatient readmissions and state-level hospital-based emergency department (ED) visits with behavioral health (BH) conditions in the states of Nebraska and New York. The dissertation aims to assess the impact of the policy mandates under the Patient Protection and Affordable Care Act on these state and national estimates. The Nationwide Readmissions Database and the State Emergency Department databases maintained by the Healthcare Cost and Utilization Project were used for this dissertation. US Adult population with high-risk of readmissions in the inpatient departments for alcohol-related disorders (ARD) and of visiting ED for …

Identifying The Newly Insurable Medicaid Coverage Gap Population Under The Affordable Care Act: Who They Are And Where They Live, Samuel L. Woodruff

Capstone Experience: Master of Public Health

The goal of this Capstone Project is to better define and geographically locate the potential distribution of individuals who fall within the current Medicaid Coverage Gap and those populations who would be eligible for Medicaid under the expansion of Medicaid within the state of Nebraska. Using data from multiple United States Census Bureau sources, along with available data from the Health Resources and Services Administration (HRSA), this project looks to also locate populations of these individuals that may live within established Medically Underserved Areas (MUA's) or Health Professional Shortage Areas (HPSA's) within the state. American Community Survey 5-year Public Use …

Matters Of Trust: Examination Of The Patient-Provider Relationship In Cancer Care, Krista A. Brown

Capstone Experience: Master of Public Health

Background: The intangible concept of trust is critical in the patient-provider relationship. Cancer patients may experience positive and negative impacts of trust in this relationship to a higher degree due to the inherently serious nature of their disease and the level of dependence upon treatment providers.

Objective: The goal of this study was to compare colorectal cancer patients’ levels of trust in their primary care physician and oncologist, along with examining trust differences associated with demographics and other characteristics.

Methods: Colorectal cancer patients (n=158) treated at Nebraska Medicine and consented into the Integrated Cancer Repository for Cancer Research IRB …

Youth Focus Groups: Design And Analysis Plan For The Bears Project, M. Renee Beacom Claborn

Capstone Experience: Master of Public Health

This capstone project produced a qualitative research design and analysis plan for youth focus groups as part of a Quality Improvement project at OneWorld Community Health Center (OWCHC) School-Based Health Center (SBHC) located at Bryan High School (BHS) in a program called BEARS. The intended use of this project is to serve as a reference guide for BEARS program planners to utilize as part of the data collection and analysis processes. The purpose for collecting qualitative data for this project is three-fold. 1. To explore adolescents’ perspectives of risk behaviors and associated health determinants common to their age group 2. …

Patient-Centered Medical Home Adoption In School-Based Health Centers, Abbey Gregg

Theses & Dissertations

The patient-centered medical home (PCMH) is promoted as a primary care delivery design that can improve health care quality and patient outcomes while controlling health care costs. To achieve PCMH recognition, primary care providers must implement practice-level changes in order to deliver care that is comprehensive, coordinated, accessible, high quality, and whole-person oriented. This practice transformation requires advanced use of health information technology, staff investment in quality improvement and care coordination, and significant investments of both financial and human resources to support these activities. As a safety-net provider, school-based health centers (SBHCs) serve vulnerable children that typically experience barriers to …

Hospital Based Emergency Department Visits With Dental Conditions: Outcomes And Policy Implications In The States Of California, Nebraska And New York, Sankeerth Rampa

Theses & Dissertations

The purpose of this dissertation was to present state-level estimates of hospital-based emergency department (ED) visits with dental conditions across all ages in the states of California, Nebraska, and New York. Also, this dissertation examined the outcomes and impact of changes in Medicaid policies on the utilization of ED with dental problems. State Emergency Department Databases (California, Nebraska, and New York), a component of the Healthcare Cost and Utilization Project (HCUP) was used for this dissertation. Dental conditions were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. High-risk groups visiting EDs with dental conditions were …

Structural Violence And Gender-Based Violence In The United States, Sarbinaz Z. Bekmuratova

Theses & Dissertations

Three components of the dissertation project examined the relationship between three different constructs of structural violence and women’s experience of different violence types in their lifetime in the United States. The violence types examined in the study included psychological aggression, coercive control and entrapment, physical violence, stalking, sexual violence, and rape. 2010 National Intimate Partner Violence and Sexual Violence Survey with the final sample size of 9,827 was used for all three portions of the study to analyze the association of structural violence with six types of violence. Additional datasets used were Institute for Women’s Policy Research’s Status of Women …

Greater Involvement Of Hiv-Infected Peer-Mothers In Provision Of Reproductive Health Services As "Family Planning Champions" Increases Referrals And Uptake Of Family Planning Among Hiv-Infected Mothers., Peter Mudiope, Ezra Musingye, Carolyne Onyango Makumbi, Danstan Bagenda, Jaco Homsy, Mai Nakitende, Mike Mubiru, Linda Barlow Mosha, Mike Kagawa, Zikulah Namukwaya, Mary Glenn Fowler

Journal Articles: Health Services Research & Administration

BACKGROUND: In 2012, Makerere University Johns - Hopkins University, and Mulago National Referral Hospital, with support from the National Institute of Health (under Grant number: NOT AI-01-023) undertook operational research at Mulago National Hospital PMTCT/PNC clinics. The study employed Peer Family Planning Champions to offer health education, counselling, and triage aimed at increasing the identification, referral and family planning (FP) uptake among HIV positive mothers attending the clinic.

METHODS: The Peer Champion Intervention to improve FP uptake was introduced into Mulago Hospital PMTCT/PNC clinic, Kampala Uganda. During the intervention period, peers provided additional FP counselling and education; assisted in identification …

Greater Involvement Of Hiv-Infected Peer-Mothers In Provision Of Reproductive Health Services As "Family Planning Champions" Increases Referrals And Uptake Of Family Planning Among Hiv-Infected Mothers., Peter Mudiope, Ezra Musingye, Carolyne Onyango Makumbi, Danstan Bagenda, Jaco Homsy, Mai Nakitende, Mike Mubiru, Linda Barlow Mosha, Mike Kagawa, Zikulah Namukwaya, Mary Glenn Fowler

Journal Articles: Health Services Research & Administration

BACKGROUND: In 2012, Makerere University Johns - Hopkins University, and Mulago National Referral Hospital, with support from the National Institute of Health (under Grant number: NOT AI-01-023) undertook operational research at Mulago National Hospital PMTCT/PNC clinics. The study employed Peer Family Planning Champions to offer health education, counselling, and triage aimed at increasing the identification, referral and family planning (FP) uptake among HIV positive mothers attending the clinic.

METHODS: The Peer Champion Intervention to improve FP uptake was introduced into Mulago Hospital PMTCT/PNC clinic, Kampala Uganda. During the intervention period, peers provided additional FP counselling and education; assisted in identification …

Meaningful Use Of Electronic Health Records For Population Health Management In U.S. Acute Care Hospitals, Niodita Gupta

Theses & Dissertations

Population health management (PHM) is used to identify the needs of a population and to align strategies to improve the health of the population through care coordination. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 emphasized the meaningful use (MU) of electronic health records (EHRs) to improve clinical and population health outcomes. The American Recovery and Reinvestment Act (ARRA) of 2009 approved the EHRs incentives program for eligible hospitals to demonstrate the MU of EHRs. Further, eligible hospitals which failed to demonstrate the MU of EHRs could face payment adjustments. Given a heightened focus on …

Adoption Of Medication Management Technologies By U.S. Acute Care Hospitals After The Hitech Act, Aastha Chandak

Theses & Dissertations

Medication errors and adverse drug events (ADEs) are a significant public health concern in the United States as they pose a threat to patient safety. The medication management process is a complicated process in U.S. acute care hospitals, consisting of a series of steps such as ordering, transcribing, dispensing and administration and each step is prone to medication errors.The use of technology is considered to be an important intervention in improving the medication management process and thereby reducing medication errors and ADEs and further improve patient safety. The Health Information Technology for Economic and Clinical Health (HITECH) Act, implemented in …

The Impact Of Electronic Health Records On Healthcare Service Delivery, Patient Safety, And Quality, Kate Elizabeth Trout

Theses & Dissertations

The HITECH Act has provided over $30 billion of support through the Meaningful Use program to implement Electronic Health Records (EHRs) with aims to improve healthcare service delivery, efficiency, quality, and patient safety. New healthcare models, such as pay-for-performance and value-based purchasing, were envisioned to aligning quality with reimbursement mediated with the use of EHRs. It is unclear of how EHRs and Meaningful Use have impacted health service delivery, patient safety, and quality of care. Thus, making it difficult to determine if the specific set of objectives for Meaningful Use have had a positive impact on outcomes, which ultimately is …

Modifiable Barriers To Optimal Outcomes In Gout Management, Brian W. Coburn

Theses & Dissertations

Improving patient outcomes in chronic disease is of critical importance to the future of health care. Gout, affecting 4% of the US population, is a highly treatable chronic disease from which patients experience unnecessarily suboptimal outcomes. In this dissertation, I demonstrate how interrelated patient and provider factors affect patient outcomes in gout. First, I describe how only 14% of gout patients know their serum urate (SU) goal for urate lowering therapy (ULT) despite otherwise being knowledgeable about gout and its treatment. I then demonstrate the importance of multiple patient and provider factors in achieving SU goal. Specifically, I demonstrate that …

Essays On Immigration-Related Disparities In Health Behavior And Health Care Utilization, Yang Wang

Theses & Dissertations

The number of immigrants in the United States has recently been increasing significantly. Immigrants may experience some worse health outcomes than natives, due to substantial legal and socioeconomic barriers. Many immigration-related disparities in health behavior and health care utilization still remain unexplored. This dissertation comprises of 3 independent studies examining such disparities across immigration status, including (1) E-cigarette use and acculturation effects; (2) Cancer-related office-based medical provider visits among cancer patients; and (3) Potentially preventable emergency department visits.

Two nationally representative data sources included National Health Interview Survey and Medical Expenditure Panel Survey. We categorized the respondents into three immigration …

The Impact Of Gasoline Prices On Medical Care And Costs Of Motor Vehicle Injuries, He Zhu

Theses & Dissertations

Background Traffic safety has placed a tremendous economic and social burden on individuals and nations. Gasoline prices have been linked to traffic safety in the recent studies. Higher gasoline price may prompt people to reduce expenses by changing travel distance and frequency, transportation mode, or driving behaviors.

Objective This study aims to examine the relationship of gasoline prices to hospital utilization and cost for motorcycle and non-motorcycle motor vehicle injuries in the United States.

Methods Data on inpatient hospitalization for motor vehicle injuries were obtained from the 2001-2010 Nationwide Inpatient Sample, which is part of the Healthcare Costs and Utilization …

Relationships Between Activation Level, Knowledge, Self-Efficacy, And Self-Management Behavior In Heart Failure Patients Discharged From Rural Hospitals., Van Do, Lufei Young, Sue Barnason, Hoang Tran

Journal Articles: Health Services Research & Administration

Non-adherence to self-management guidelines accounted for 50% of hospital readmissions in heart failure patients. Evidence showed that patient activation affects self-management behaviors in populations living with chronic conditions. The purpose of this study was to describe patient activation level and its relationship with knowledge, self-efficacy and self-management behaviors in heart failure patients discharged from rural hospitals. Our study populations were recruited from two hospitals in rural areas of Nebraska. We found that two-thirds of the participants reported low activation levels (e.g., taking no action to manage their heart failure condition). In addition, low patient activation levels were associated with inadequate …