Health Services Research Commons^™

Nudging Health Care Providers' Adoption Of Clinical Decision Support: Protocol For The User-Centered Development Of A Behavioral Economics-Inspired Electronic Health Record Tool, Safiya Richardson, Katherine Dauber-Decker, Jeffrey Solomon, Sundas Khan, Douglas Barnaby, John Chelico, Michael Qiu, Yan Liu, Devin Mann, Renee Pekmezaris, Thomas Mcginn, Michael Diefenbach

Faculty, Staff and Students Publications

BACKGROUND: The improvements in care resulting from clinical decision support (CDS) have been significantly limited by consistently low health care provider adoption. Health care provider attitudes toward CDS, specifically psychological and behavioral barriers, are not typically addressed during any stage of CDS development, although they represent an important barrier to adoption. Emerging evidence has shown the surprising power of using insights from the field of behavioral economics to address psychological and behavioral barriers. Nudges are formal applications of behavioral economics, defined as positive reinforcement and indirect suggestions that have a nonforced effect on decision-making.

OBJECTIVE: Our goal is to employ …

Generation Of A Tree Shrew Breast Cancer Model Using Lentivirus Expressing Pik3ca-H1047r, Li Zeng, Hong-Yan Zhang, Chuan-Yu Yang, Zhuo Cheng, Qiu-Yun Jiang, Yao Luo, Yi Li, Fu-Bing Li, Ce-Shi Chen

Faculty, Staff and Students Publications

No abstract provided.

Characterizing Pediatric Unilateral Brain Damage: Unilateral Spatial Neglect, Balance, And More, Emerson Hart

MUSC Theses and Dissertations

Pediatric unilateral brain damage is a costly, impactful condition. There are many subsequent impairments that children experience after pediatric unilateral brain damage, two of which are unilateral spatial neglect (USN) and balance impairments. This project aims to compile the existing literature regarding USN in children, analyze insurance billing data to characterize the population, and evaluate balance and USN in a small case-control cohort of children with and without unilateral brain damage. The literature search elucidated the scant literature available addressing USN, including a lack of quality assessments to definitively identify USN. Insurance billing analyses showed an incredibly heterogeneous group, very …

Shifting Perspectives: A Qualitative Study To Understand Family Expectations At The Time Of Their Child’S Admission, Rosamarie Maiorella, Avital Fischer, Sumeet L. Banker

Journal of Patient-Centered Research and Reviews

Purpose: Patient-centered approaches to health care acknowledge the important role that families have in patients’ lives. Shared expectations between families and providers have the potential to improve patient and family experience, hospital care, and outcomes. We aimed to understand families’ expectations for their child’s admission from the vantage point of the start of a hospital stay.

Methods: This qualitative research studied families of hospitalized children at a large pediatric tertiary care center. Family members were approached if their child was admitted to the general pediatrics team, was under 18 years of age, had a length of stay less than 5 …

Understanding Quality Of Life In Patients With Acute Leukemia, A Global Survey, Zack Pemberton-Whiteley, Samantha Nier, Jan Geissler, Sophie Wintrich, Bregje Verhoeven, Rita O. Christensen, Sam Salek, Esther Natalie Oliva, Tatyana Ionova, Jennie Bradley

Journal of Patient-Centered Research and Reviews

Purpose: The Acute Leukemia Advocates Network (ALAN) sought to determine which factors are most associated with poor quality of life (QoL) in patients with acute leukemia and to determine key issues and unmet needs through administration of an online survey distributed worldwide via partner patient organizations.

Methods: ALAN developed a questionnaire informed by literature review and based extensively on the hematological malignancy-specific patient-reported outcomes (HM-PRO) measure to assess the impact of acute leukemia on QoL and its relationships with patients’ demographics, disease state, disease impact, and support from health care professionals. Univariate and multivariable statistical analysis was used to investigate …

Neighborhood Condition Prevalence Rates Correlate With Covid-19 Mortality In Milwaukee County, Wisconsin, George L. Morris Iii

Journal of Patient-Centered Research and Reviews

Purpose: We sought to determine if census tract-level (ie, neighborhood) COVID-19 death rates in Milwaukee County correlated with the census tract-level condition prevalence rates (CPRs) for individual COVID-19 mortality risk.

Methods: This study used Milwaukee County-reported COVID-19 death rates per 100,000 lives for the 296 census tracts within the county to perform a linear regression with individual COVID-19 mortality risk CPR, mean age, racial composition of census tract (by percentage of non-White residents), and poverty (by percentage within census tract), followed by multiple regression with all 7 CPRs as well as the 7 CPRs combined with the additional demographic variables. …

Telehealth In Medicine: Predictions 2023–2024, Jiang Li, Ingrid Vasiliu-Feltes, Kathleen Mcgrow, Brendan F. Smith, Paul Barach, Sweta Sneha, Francis X. Campion

College of Population Health Faculty Papers

Each year, Telehealth and Medicine Today asks experts in the field to share their insights into the future and predict how telehealth will influence uptake and healthcare in the new year.

Progressive Interstitial Lung Disease In Relatives Of Patients With Pulmonary Fibrosis, Jonathan A Rose, Maria A Planchart Ferretto, Anthony H Maeda, Maria F Perez Garcia, Nikkola E Carmichael, Swati Gulati, Mary B Rice, Hilary J Goldberg, Rachel K Putman, Hiroto Hatabu, Benjamin A Raby, Ivan O Rosas, Gary M Hunninghake

Faculty, Staff and Students Publications

No abstract provided.

Strengthening A One Health Approach To Emerging Zoonoses, Samira Mubareka, John Amuasi, Arinjay Banerjee, Hélène Carabin, Joe Copper Jack, Claire Jardine, Bogdan Jaroszewicz, Greg Keefe, Jonathon Kotwa, Susan Kutz, Deborah Mcgregor, Anne Mease, Lily Nicholson, Katarzyna Nowak, Brad Pickering, Maureen Reed, Johanne Saint-Charles, Katarzyna Simonienko, Trevor Smith, J. Scott Weese, E. Jane Parmley

Articles & Book Chapters

Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan …

Outcomes Of Patients Treated For Hepatoblastoma With Low Alpha-Fetoprotein And/Or Small Cell Undifferentiated Histology: A Report From The Children's Hepatic Tumors International Collaboration (Chic), Angela D Trobaugh-Lotrario, Rudolf Maibach, Daniel C Aronson, Arun Rangaswami, Beate Häberle, Allison F O'Neill, Irene Schmid, Marc Ansari, Tomoro Hishiki, Sarangarajan Ranganathan, Rita Alaggio, Ronald R De Krijger, Yukichi Tanaka, Soo-Jin Cho, Christian Vokuhl, Rebecca Maxwell, Mark Krailo, Eiso Hiyama, Piotr Czauderna, Milton Finegold, James H Feusner, Marcio H Malogolowkin, Rebecka L Meyers, Dolores Lopez-Terrada

Faculty, Staff and Students Publications

Small cell undifferentiated (SCU) histology and alpha-fetoprotein (AFP) levels below 100 ng/mL have been reported as poor prognostic factors in hepatoblastoma (HB); subsequent studies reported SMARCB1 mutations in some SCU HBs confirming the diagnosis of rhabdoid tumor. The Children's Hepatic tumors International Collaboration (CHIC) database was queried for patients with HB who had AFP levels less than 100 ng/mL at diagnosis or were historically diagnosed as SCU HBs. Seventy-three of 1605 patients in the CHIC database were originally identified as SCU HB, HB with SCU component, or HB with low AFP levels. Upon retrospective review, they were re-classified as rhabdoid …

Feasibility Of Group-Based Implementation Facilitation For Video Telemental Health, Anthony H Ecker, Giselle Day, Amber B Amspoker, Jennifer L Bryan, Stephanie C Day, Miryam Wassef, Kendra Weaver, Jan Lindsay

Faculty, Staff and Students Publications

Video telehealth experienced rapid growth throughout the COVID-19 pandemic in many healthcare sectors, including mental health. The Veterans Health Administration’s video telehealth platform, VA Video Connect, has been widely used to reach veterans who may have experienced difficulty accessing care, such as those living in rural areas or other barriers (e.g., transportation). Implementing VVC requires a multifaceted approach, including training providers on technical skills, increasing access to equipment for providers and veterans, and integrating VVC within the culture and processes of the clinic unit. Prior successful VVC implementation efforts in rural areas have focused on simultaneous one-on-one provider and leadership …

Agreement Between Patient’S Description Of Abdominal Symptoms Of Possible Upper Gastrointestinal Cancer And General Practitioner Consultation Notes: A Qualitative Analysis Of Video-Recorded Uk Primary Care Consultation Data, Victoria Hardy, Juliet Usher-Smith, Stephanie Archer, Rebecca Barnes, John Lancaster, Margaret Johnson, Matthew Thompson, Jon Emery, Hardeep Singh, Fiona M Walter

Faculty, Staff and Students Publications

Introduction: Abdominal symptoms are common in primary care but infrequently might be due to an upper gastrointestinal (UGI) cancer. Patients' descriptions may differ from medical terminology used by general practitioners (GPs). This may affect how information about abdominal symptoms possibly due to an UGI cancer are documented, creating potential missed opportunities for timely investigation.

Objectives: To explore how abdominal symptoms are communicated during primary care consultations, and identify characteristics of patients' descriptions that underpin variation in the accuracy and completeness with which they are documented in medical records.

Methods and analysis: Primary care consultation video recordings, transcripts and medical records …

Preparing For The Next Disaster: Lessons Learned From The Early Experiences Of Autistic Adults During The Covid-19 Pandemic, Amber Pomponio Davidson, Cecilia Feeley, Beth Pfeiffer, Mark Salzer

Internet Journal of Allied Health Sciences and Practice

Purpose: Disasters, such as the worldwide COVID-19 pandemic, create significant disruptions for individuals and their communities. Understanding these disruptions is a first step towards planning for future events and disaster recovery. This research aims to explore how the initial COVID-19 restrictions, including lockdowns, impacted adults with Autism (ASD). Method: Using semi-structured interviews to understand how individuals with ASD experienced the early months of the COVID-19 pandemic, twelve participants were interviewed: six individuals with ASD (ages 20-38), three parents of individuals with ASD, and three support staff for individuals with ASD. Analysis: Grounded theory methods were used to analyze the impacts …

The Factors That Influence Clinicians To Choose Rural Settings To Deliver Health Services, Julia Mattingly

Posters-at-the-Capitol

Years before the COVID-19 pandemic brought on a health care shortage in the United States, its rural areas were already struggling to obtain and attract primary care medical practitioners. The federal government has designed many programs with the intent of exposing clinicians to life in rural areas, but few have been successful at keeping medical practitioners in the long-term. Clinicians who are recruited to rural areas via loan repayment programs or other short-lived incentives often leave after only a few years.

In order to learn more about this long-running health policy problem, we set out to study the factors that …

Epidemiological/Disease And Economic Burdens Of Cervical Cancer In 2010–2014: Are Younger Women At Risk?, Chuhao Xi, Jay J. Shen, Betty Burston, Soumya Upadhyay, Shoujun Zhou

Healthcare Administration and Policy Faculty Research

Objective: Cervical cancer is an important factor threatening women’s health in China. This study examined the epidemiological and economic burden of cervical cancer among the medically insured population, which could provide data support for government departments to formulate policies. Methods: All new cases of cervical cancer under the Urban Employee Basic Medical Insurance (UEBMI) plan in a provincial capital city in eastern China from 2010 to 2014 were collected. The Cox proportional hazard model was used to analyze the factors affecting the survival rates for cervical cancer. Outpatient and hospitalization expenses were used to assess the direct economic burden, and …

Role Of Nativity In Mental Health Service Utilization Among Asian Americans: A Weighted Analysis Of Complex Survey Data, Anne Dumadag, Hadiza Galadima

College of Health Sciences Posters

Asian Americans represent both the fastest-growing population and the smallest group of consumers of mental health services (MHS) in the United States. The current study aimed to identify factors associated with MHS use and explore differences in MHS use by nativity among Asian Americans. Data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) were used to examine past-year MHS use among Asian Americans ages 18 and older. Weighted analyses were used to determine the distribution of the population by nativity and other covariates, and Rao-Scott Chi-Square tests were used to explore the association between past-year MHS use and …

A Systematic Literature Review Of Research From 2010 To 2020 Addressing User-Generated Online Comments Related To Health Issues And Recommendations For Future Research, Muhammad Ittefaq, Mauryne Abwao, Ioana A. Coman, Waqas Ejaz

School of Communication Studies - Faculty Scholarship

This systematic literature review was conducted to provide insights into how online readers’ comments have been studied in the context of health over a 10-year span. About 593 studies published between 2010 and 2020; of these, 34 met the research criteria for inclusion. Our findings reveal that 60% of the studies focused on the United States, and a qualitative method was used in 74.3% of these studies. About 23.5% of the studies explored vaccine-related issues. Our results reveal that among the selected studies, 76.5% and 20.6% had female and male first authors, respectively. Textual analysis of abstracts shows that the …

Addressing The Barriers To Mammography Screening In Rural And Urban Ohio Counties, Carly Perkowski, Isabelle Fox

Scholarship in Medicine - All Papers

Mammography screenings have the potential to protect individuals from the burden of cancer and can even save lives. However, in Ohio, many women are not receiving regular screenings. Recent research indicates that social determinants of health, such as income and education, can impact an individual’s ability to access mammography. Yet, we lack a comprehensive understanding of how these factors hinder an individual's ability to obtain mammography screenings, particularly in urban and rural areas of Ohio. The introduction of mammography has facilitated early detection of breast cancer in women. By identifying gaps in access to mammography and implementing changes to improve …

Disparities In Mental Health Technology Among African Americans: Breaking Cultural Inclusion Barriers, Nyoki Cosey-Brown

DSW Capstone Projects

Mental health technology is a healthcare delivery model of the future. The engagement in virtual healthcare was intensified when traditional healthcare methods were inaccessible during the federal restrictions implemented due to the COVID-19 pandemic. Utilizing digital apparatuses for healthcare improved the convenience, efficiency, and accessibility of various mental health services that were inoperable in past healthcare models. However, the historical constructs of stigma, discrimination, inequity, exclusion, and structural racism in mental healthcare were prevalent problems that remained present in virtual mental health platforms concerning the experiences of African-American patients and professionals who utilized the spaces.

This research explored mental health …

Gaps In Behavioral Health Care In Rural Primary Care Clinics And The Promise Of Vbhi: Perspectives From Clinic Staff, Monique Gill

Articles, Abstracts, and Reports

No abstract provided.

Effects Of Insurance Coverage On Healthcare Access And Outcomes For Children In Ohio, Haley Hurst, Patrick Ruz

Scholarship in Medicine - All Papers

Objective: Despite health insurance coverage correlating to improved child health outcomes and reduced healthcare costs, it is estimated that 8.7% of children in America lack continuous insurance. Although coverage has expanded multiple times through the Children's Health Insurance Program (CHIP) initiated in 1997, rates for child insurance vary drastically across regions of the country. In this study we investigated child insurance rates over time and by state, as well as explored the effects of having insurance and child health outcomes. To do this, we measured the association of uninsured children to primary care physician access and child mortality in the …

Effect Of Medicaid Expansion On Inflammatory Bowel Disease And Healthcare Utilization, Brittany Levy

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Inflammatory bowel disease (IBD) affects over 3 million adults in America, relaying a

need for chronic disease management. Along with 24 other states, Kentucky expanded the

Medicaid program January 1, 2014. We hypothesize, Medicaid expansion adoption results in

reduced emergency healthcare services, and increased elective healthcare services with a

reduction in overall healthcare utilization by individuals in the adult IBD population.

The Hospital Inpatient Discharge and Outpatient Services Database identify encounters

related to ulcerative colitis or Crohn’s disease from 2009-2020, in Kentucky. Patient

demographics, admission type, discharge, length of stay, and hospital charges were compared.

3386 pre-expansion and 24255 post …

Clustering Hospital Performance Using Group-Based Multi-Trajectory Modeling With Singular Bayesian Information Criterion, Gaixin Du

Theses and Dissertations--Epidemiology and Biostatistics

Hospital performance is complex and patient-experience oriented. Currently, the Centers for Medicare and Medicaid Services (CMS) evaluate hospitals yearly with a single score of one to five ("Star Rating") using composite measures from five domains. However, a single composite score cannot fully describe it, and alternative measures should be considered. Healthcare quality improvement needs long-term data to validate effectiveness. Group-based multi-trajectory modeling (GBMTM) estimates probabilities of latent group membership based on longitudinal profiles from multiple outcomes. We use GBMTM to identify groups of hospitals with similar performance in SAS PROC TRAJ.

We downloaded Medicare-eligible hospitals (N=5,111) that provided patient care …

Evaluating The Impact Of Mental Health Needs And Services Disruption: Covid-19 & Wisconsin Children’S Welfare Services, Gavin Rienne

Theses and Dissertations--Epidemiology and Biostatistics

Children’s traumatic experiences have lifelong impacts on their mental health and quality of life, therefore mental health services are a critical part of necessary community resources. The increased frequency and severity of natural disasters such as hurricanes, tornadoes, and pandemics reinforces the need to examine and understand the importance of mental health and child services in response to disaster events. This research assesses the relationship between disasters and subsequent health service utilization amongst children and adolescents. We investigated current research on the relationship between children’s mental health and community mental health resource efficacy and accessibility after a major disaster by …

Alternative Pharmacology: Exploring Ketamine Use For Treatment Resistant Mental Health Disorders, Kiersten L. Ash

Soaring: A Journal of Undergraduate Research

No abstract provided.

Gender Differences In Administration Of Tpa In Treatment Of Ischemic Stroke, Christina Annerino

CURE Proceedings

As medicine and pharmacology advance through the years, new life-saving treatments are studied or discovered every day, and a medical emergency is no longer a death sentence. Even with conditions as serious as ischemic stroke, there is hope for survival and rehabilitation with the ‘clot-busting’ drug, tissue plasminogen activator, colloquially known as ‘tPA’. tPA is a thrombolytic agent, a substance that acts on fibrin in clots to dissolve them so they can no longer cause ischemia in blood vessels that results in a stroke. (Vega, 2022). tPA is an extremely effective treatment for ischemic stroke, demonstrated in 2013 by a …

Addressing Breast Health Disparities Among Recent, Established African-Born Immigrant Women And Second-Generation Americans In Prince George County, Maryland, Omolola Okunromade

College of Graduate Studies: Theses & Dissertations

Background: Breast health disparities and underutilization of screening methods are major concerns in the United States (US), particularly affecting Black women who experience lower survival rates and advanced diagnoses. Despite the rapid growth of the African-born immigrant population, breast health among this group in the US is notably under-examined. This study aims to investigate the breast health knowledge and practices of first-generation African-born immigrants and second-generation immigrant women of African descent, aiming to understand the distinctive attributes of this group and the impact of acculturation on this public health issue.

Methods: Interviews were conducted among First Generation African immigrants and …

Sheprep: Examining The Influence Of The Messaging And The Messenger Associated With Prep Uptake Among African American Women, Christian C. Spears

College of Graduate Studies: Theses & Dissertations

African American Women (AAW) make up less than 15% of the female population in the United States but account for over 50% of new HIV diagnoses among females. This largely preventable health disparity can be mitigated by advocating and prescribing Pre-exposure Prophylaxis (PrEP), a preventive HIV medication, to persons at risk. Despite advances in medication options, there are less than 13% of Black people who could benefit from having been prescribed PrEP, and limited research and promotion on the effectiveness of PrEP for AAW. The “ShePrEP Study” aimed to assess awareness, perceptions, and receptivity toward PrEP among AAW. This study …

What Could Go Wrong? Patient And Hospital Characteristics Associated With Pediatric Quality Of Inpatient Care And Pediatric Adverse Events, Michael H. Samawi

College of Graduate Studies: Theses & Dissertations

This study aims to analyze associations between hospital and patient characteristics with pediatric adverse events (PAE) in the inpatient hospital setting, utilizing the framework of pediatric quality indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ) indicators. Three PDIs were identified and utilized for this purpose: NQI 03 Neonatal Blood Stream Infection, PDI 09 Postoperative Respiratory Failure, and PDI 10 Postoperative Sepsis. The data used for the study is based on an analysis of discharge data from the Healthcare Cost and Utilization Project (HCUP) Kid’s Inpatient Databases (KID) for the year 2019. The findings contribute to the growing …

A Global Perspective Of Advanced Practice Nursing Research: A Review Of Systematic Reviews Protocol, Kelley Kilpatrick, Isabelle Savard, Li-Anne Audet, Abby Kra-Friedman, Reneé Atallah, Mira Jabbour, Wentao Zhou, Kathy Wheeler, Elissa Ladd, Deborah C. Gray, Colette Henderson, Lori A. Spies, Heather Mcgrath, Melanie Rogers

Ellmer School of Nursing Faculty Publications

Introduction

In 2020, the World Health Organization called for the expansion and greater recognition of all nursing roles, including advanced practice nurses (APNs), to better meet patient care needs. As defined by the International Council of Nurses (ICN), the two most common APN roles include nurse practitioners (NPs) and clinical nurse specialists (CNSs). They help ensure care to communities as well as patients and families with acute, chronic or complex conditions. Moreover, APNs support providers to deliver high quality care and improve access to services. Currently, there is much variability in the use of advanced practice nursing roles globally. A …