Health Services Research Commons^™

Economic Burden Of Renal Cell Carcinoma (Rcc) And Treatment Patterns, Overall Survival And Healthcare Costs Among Older Metastatic Rcc Patients, Hrishikesh P. Kale

Theses and Dissertations

Background

Renal cell carcinoma (RCC) is the most common type of kidney cancer. Patients diagnosed with metastatic RCC (mRCC) have shorter overall survival compared to those diagnosed at earlier stages. Several targeted therapies, which cost from $7,000 - $16,000 per month have been approved since 2005 to treat mRCC. In addition, there is a growing interest in the use of cytoreductive nephrectomy (CN) with targeted therapies among mRCC patients. However, little is known regarding the economic burden of RCC and role of CN and prescribing patterns of targeted therapies among older mRCC patients.

Objectives

1) To assess the economic burden …

A Comparison Of Quality Indicators Between Medicare Accountable Care Organizations And Health Maintenance Organizations Using Publicly Available Data, William W. Campbell Iii

Theses and Dissertations

The purpose of this study is to explore differences in quality between Medicare Accountable Care Organizations (ACO) and Health Maintenance Organizations (HMO). Three outcomes measures reported by these plans use different methodologies but possess enough alignment to permit comparison: percent of diabetic patients with last HbA1c > 9.0%, colon cancer screening rate and ER visits per 1,000. These outcomes are the dependent variables (DV). A secondary purpose is to explore differences in quality based on the size of the beneficiary population served, using the same measures.

As the Medicare program faces threats to its solvency in coming decades, with 10,000 baby …

The Impact Of The Medicaid Coverage Expansion And The Removal Of Cost-Sharing Under The Affordable Care Act On Mammography And Pap Tests, Abeer Alharbi

Theses and Dissertations

Background: The Affordable Care Act (ACA) aimed at making health care affordable and accessible including the use of preventive care services. To achieve these aims, the ACA expanded Medicaid coverage to population with income below 138% of FPL and removed cost-sharing when using preventive care services recommended by the USPSTF. This study tried to assess the impact of these provisions on the rate of mammography and Pap tests among women. Methods: Data was obtained from the Medical Expenditure Panel Survey - Household Component MEPS-HC. A difference-indifference design was used to determine the effect of Medicaid eligibility expansion on the outcomes …

Factors Affecting Patient Satisfaction With Healthcare System Of Turkey, Serdar Aydin

Theses and Dissertations

The World Health Organization (WHO) defines health system as comprising of all the organizations, resources, and institutions dedicated to improving health. Health systems have a responsibility not just to improve the health of the population they serve but to provide financial protection against the costs of illness and to respond to people’s expectation with dignity. Besides, healthcare satisfaction and consumer satisfaction have become the latest trend in measuring quality to have a competitive advantage or best practice in the healthcare industry. Over the past 30 years, consumer satisfaction has gained widespread recognition as a measure of quality in many services …

Three Essays On Maternal And Child Health, Mandar V. Bodas

Theses and Dissertations

This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the …

Patient Characteristics, Discharge Disposition, And Hospital Factors Associated With All Cause 30-Day Hospital Readmission For Total Joint Arthroplasty In 2014, Hamad Yahya Alzamanan

Theses and Dissertations

Objective: Recent improvements in hospital care have come from a growing knowledge of factors that contribute to readmission. The objective of this work is to identify and describe the national readmission rate after Total Joint Arthroplasty, and to evaluate selected hospitals’ and patients’ factors for their association with the all-cause 30-day readmission rate after TJA in the United States in 2014. Method: Retrospective analysis of 938,504 TJA acute care hospital discharge records was performed, using a nationally representative database that is dedicated to the study of hospital readmissions, and accounts for 51% of total US hospitalizations. Logistic regression models were …

Queer Health Equity And Cervical Cancer: Identifying Social Determinants Of Papanicolaou Test Uptake In A Sample Of Sexual Minority Women And Gender Nonbinary Individuals, Ariella R. Tabaac

Theses and Dissertations

Sexual minority women (SMW) demonstrate lower rates of cervical cancer screening than heterosexual women. This is concerning as lesbian and bisexual women tend to engage in higher rates of substance-related cancer risk behaviors, unprotected sex, and tend to have higher body mass indices, all of which are risk factors for cancer development. Another major risk factor, screening avoidance, places SMW at increased risk for the development of high grade cervical lesions in the absence of early detection practices, which is likely to impact overall cervical cancer morbidity in this population. The aim of the present study was to utilize the …

Family Planning And Hiv Interventions Among Women In Low-Income Settings, Steven P. Masiano

Theses and Dissertations

This dissertation examines the effectiveness of interventions related to family planning and the uptake of HIV-related preventive services among women in low-income settings. Women in low-income settings and living with HIV face many barriers to care, including limited access to services for family planning and HIV-related preventive care. At the same time, national, regional, and global efforts are looking for interventions to help control rapid population growth, create an HIV-free generation, and provide adequate preventive care for those living with HIV. This dissertation cuts across these issues and can help to inform debate and policies to address these issues.

This …

The Effect Of Paid Sick Leave On Physician Office-Based Visits, Korvin Vicente

Theses and Dissertations

This paper uses a balanced sample of workers from cross-sections of the National Health Interview Survey to estimate the causal effects of paid sick leave on the medical care seeking behavior of individuals, as measured by physician office-based visits.

Health Aid In Africa: Placement, Service Utilization, And Benefit, Carrie Dolan

Theses and Dissertations

While the health sector has attracted significant foreign aid, evidence on the effectiveness of this support is mixed. This dissertation examines the allocation of health aid within the context of placement, service utilization, and benefit. The first paper examined the sub-national allocation of Chinese development aid projects across Africa. I determined how political preferencing of Chinese aid specifically, allocating aid to the birth region of the current political leader differs across sectors such as health, education, and transportation. I find some evidence that aid, more broadly defined, is subject to political preferencing in recipient countries, which could potentially limit its …

Understanding Over-The-Counter Medication Use And Decision-Making Among Community-Dwelling Us Older Adults: A Mixed-Methods Approach, Yoshita Paliwal

Theses and Dissertations

Introduction

Older adults are regular consumers of over-the-counter (OTC) medications. OTC medications are generally considered safe, and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers’ perceptions, beliefs, and their decision-making about OTC medication use. The main objectives of this study were: 1) to examine the prevalence and characteristics of OTC medication use among community-dwelling US older adults (65 years and older), 2) to explore older adults’ knowledge, attitudes, beliefs and experiences about OTC medications, and 3) to elicit the OTC medication decision-making process in …

Sustainable Adapted Treatments For Eating Disorders: The Role Of Cultural Adaptation In Prevention, Sarah J. Javier

Theses and Dissertations

Despite demonstrating eating disorder rates equivalent to White women, African American and Asian American women are less likely to seek treatment and are more likely to terminate treatment prematurely. One of the most successful programs for eating disorder prevention has only focused on surface-level cultural adaptations. Prevention literature maintains that deep-structure cultural adaptation (e.g., integrating cultural values and beliefs) can enhance outcomes for ethnic minorities. This dissertation examined the feasibility of Sustainable Adapted Treatments for Eating Disorders (SATED), a pilot intervention that included a culturally- targeted pre-treatment to an eating disorder dissonance-based intervention. A sample of 72 women (ages 18-30) …

The Role Of Afrocentric Features In Mental Healthcare Utilization And Counselor Preferences In Black College Students, Randl B. Dent

Theses and Dissertations

Though mental health issues are prevalent in Black young adults, they underutilize mental healthcare services. This research examined the role of feature-based discrimination in mental healthcare (under)utilization. Study 1, a secondary analysis of the National Longitudinal Study of Adolescent to Adult Health, provided no evidence supporting a link between skin tone and mental healthcare utilization, when controlling for depression diagnosis. However, when controlling for depression symptoms, there was a trend such that Black young adults with darker, as opposed to lighter, skin tone utilized healthcare less. Study 2, an experimental study with 33 Black college students, showed 73% of the …

Provision Of Hospital-Based Palliative Care And The Impact On Organizational And Patient Outcomes, Marisa L. Roczen

Theses and Dissertations

Hospital-based palliative care services aim to streamline medical care for patients with chronic and potentially life-limiting illnesses by focusing on individual patient needs, efficient use of hospital resources, and providing guidance for patients, patients’ families and clinical providers toward making optimal decisions concerning a patient’s care. This study examined the nature of palliative care provision in U.S. hospitals and its impact on selected organizational and patient outcomes, including hospital costs, length of stay, in-hospital mortality, and transfer to hospice. Hospital costs and length of stay are viewed as important economic indicators. Specifically, lower hospital costs may increase a hospital’s profit …

Federal Policies And Prescription Drugs, Ali Bonakdar Tehrani

Theses and Dissertations

This dissertation comprises three discrete empirical papers, with an introductory essay that evaluates the impact of different federal policies on prescription drug prices, utilization, and spending. Two main databases are used: (a) Medicaid State Drug Utilization Data and (b) the Medical Expenditure Panel Survey (MEPS) data. These two databases are designed to track Medicaid drug utilization and overall medical use and expenditures, respectively. The variables of interest in this dissertation are prescription drug price, prescription drug use and spending, and overall drug expenditures.

The objective of the first paper (Chapter 2) is to examine whether oncology drug prices have significantly …

Prevalence, Incremental Cost And Resource Utilization Associated With Opioid Overdoses, Batul Electricwala

Theses and Dissertations

Background –

An increase in opioid prescribing has led to an increase in opioid overdoses.^1,2 No study has estimated the incremental costs subsequent to an opioid overdose event in prescription opioid users, or the prevalence and costs of overdose events in family members of prescription opioid users and in overdose victims with no identifiable source of prescription opioid. The latter group will be referred to as “others”.

Objectives –

The first objective of this study was to estimate the prevalence of opioid overdoses in aforementioned groups. The second objective was to estimate the incremental costs and resource utilization associated …

Chronic Pain Causal Attributions In An Interdisciplinary Primary Care Clinic: Patient-Provider And Provider-Provider Discrepancies, Bryan Jensen

Theses and Dissertations

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed …

Influence Of Public Insurance On Healthcare Access And Cancer Care, Wafa W. Tarazi

Theses and Dissertations

Medicaid expansion under the Affordable Care Act (ACA) facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Tennessee’s Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults in 2005. Pre-ACA expansions were associated with better access to and utilization of healthcare services. However, little is known about the effect of these policy changes on improvement in health outcomes for women diagnosed with breast cancer, access to care for cancer survivors, and the effect of generosity and duration of expansion on access to care.

This dissertation has three …

Cancer Health Literacy And Hospitalization In The First Five Years Following A Cancer Diagnosis, Laura A. Cartwright

Theses and Dissertations

BACKGROUND: The field of health literacy research has been focused recently on developing more accurate measurement tools and understanding the relationship between health literacy and health outcomes. Individuals with lower levels of health literacy have worse health outcomes, including hospitalization rates, compared to those with adequate health literacy. This relationship has yet to be examined in the cancer patient population, although significant relationships between health literacy and cancer knowledge, screening behavior and quality of life have been found. This study is the first to examine the relationship between health literacy and hospitalization rates in a cancer patient population, and the …

Community-Level Factors Associated With Health-Related Quality Of Life Among Older Adults, Yu-Hsiu Lin

Theses and Dissertations

Objective: Health-related quality of life (HRQOL) and well-being is a new topic area for Healthy People 2020 in the U.S. In a broad-based literature review, more research explored individual level factors of HRQOL, and few focused on older adults. Multilevel analysis was seldom adopted to investigate the relationship between area-level socioeconomic or social environment factors and HRQOL. In lieu of the traditional Chapter 4 (Results) and Chapter 5 (Conclusion), two manuscripts representing the two specific research aims are included. The main aim of first manuscript was to explore the association between area deprivation, area health resources and older adults’ HRQOL. …

Analysis Of Patient Information: An Empirical Modeling Approach, Tony A. Murphy

Theses and Dissertations

With rising costs and increasing complexities, many hospitals seek to better understand the intricate details of their operations. Increasingly, these organizations have a strong desire to accurately predict the resources required to effectively treat their patient load. This research investigates patient length-of-stay in a hospital neurological unit using an empirical modeling approach. Factors significantly affecting patient length of stay were identified and used to construct a regression model. The predictive model provides hospital decision makers with a compact tool to input what-if scenarios and predict future patient treatment lengths, thus, allowing the hospital to properly allocate resources.

The Determinants Of Post-Discharge Healthcare Utilization And Outcomes For Veterans With Posttraumatic Stress Disorder: A Social Ecological Perspective, Shyuemeng Luu

Theses and Dissertations

Posttraumatic stress disorder (PTSD) has a persistent nature: PTSD troubles patients

even decades after the occurrence of traumatic events. The “health behavioral model” is

adopted to examine the effects of external environmental, predisposing, enabling, and

need for care factors on the use of VA post-discharge ambulatory care and readmissions.

Data were obtained from the Patient Treatment File (PTF) and the Outpatient Care File

(OPT), the Area Resource File (ARF), American Hospital Association data sets (AHA), and the Uniform Crime Report (UCR).

The use of VA post-discharge ambulatory care is analyzed by using structural equation modeling (SEM). The readmission to VAMCs …

Organizational Slack, Efficiency, And Quality Of Care In Acute Care Hospitals, Kyung Ii Youn

Theses and Dissertations

The relationship between technical efficiency and quality of care in hospitals is studied in the context of resource availability in hospital organizations. The resource availability of hospitals is conceptualized by organizational slack.

An integrated model is developed encompassing the source of organizational slack, its impact on technical efficiency and on quality of care, and its impact on the relationship between efficiency and quality. Organizational threat as an environmental factor affecting the level of slack is measured by the level of competition and regulation. Organizational slack is measured using financial and operational indicators of the hospitals. Technical efficiency is estimated by …

Hospital Quality Assurance And Outcomes Of Hospitalization, Patricia A. Rowell

Theses and Dissertations

This study was undertaken to address the need of professionals responsible for assuring the quality of hospital care for a framework for understanding and evaluating quality assurance mechanisms and their impact on hospital quality of care. Primary data were collected from 70 Virginia short term acute care general hospitals on the design and resources of their quality assurance programs in 1986. Adverse outcome data for 1986 were collected from the Medical Society of Virginia Review Organization. Hospital structural data were obtained from the American Hospital Association computer data base and the Federal Register. The intermediate outcome variables are: rate of …

The Financial Performance Of System Acquired Hospitals, Janet Lynch

Theses and Dissertations

This study investigated the financial performance of not-for-profit hospitals in 10 Southern states acquired by either the for-profit or not-for-profit multihospital systems between the years 1978 through 1982. The impact of system affiliation on acquired hospitals was investigated by looking at average financial performance from the two years before acquisition to 1984/1985. Differences between the performance of hospitals acquired by for-profit and not-for-profit multihospital systems were examined as well. with regard to the latter, major findings revealed both for-profit and not-for-profit multihospital systems increased debt in acquired hospitals and made improvements to plant and equipment. For-profit multihospital systems additionally increased …

Control Of Hospital Strategy In Small Multihospital Systems, Lora Hanson Warner

Theses and Dissertations

Hospitals are joining multihospital systems (MHSs) with growing frequency. About 80% of MHSs are small, composed of 2-7 hospitals. An important management issue in MHSs is the extent to which member hospitals retain control over their own strategic directions.

Using a contingency framework, this study uses both system and hospital—level determinants to explain the extent to which hospital members of MHSs control their own strategies. Survey and secondary data from 272 member hospitals of 62 small multi hospital systems (size 2-7 hospitals) are analyzed. System dispersion, size, ownership, strategic type, and age along with hospital occupancy, size, relationship to the …