Health Services Administration Commons^™

Enhancing Patient Experience Through Ehr Implementation In Rwandan Rural Health Posts: A Comprehensive Learning Program For Improving The Ehr Adoption, Mugeni Samantha Niyoyita

Regis University Student Publications (comprehensive collection)

This research project aims to develop a tailored learning program for staff at rural health posts (HPs) to ensure the smooth adoption of an Electronic Health Records (EHR). It supports Rwanda's effort to expand Universal Health Coverage (UHC) and aligns with the Ministry of Health's Digitization Directorate General (DDG) program, which focuses on secure data access, continuity of care, and evidence-based decision-making.

Using a design thinking approach, the learning program is centered on the needs of healthcare workers, gathered through interviews and surveys with both the HP staff and the EHR designers. Research identified different levels of digital literacy and …

Steps Towards Operationalizing One Health Approaches, Kim M. Pepin, Keith M. Carlisle, Dean Anderson, Michael G. Baker, Richard B. Chipman, Jackie Benschop, Nigel P. French, Suzie Greenhalgh, Scott Mcdougall, Petra Muellner, Emil Murphy, Dion R. J. Neale, Michael J. Plank, David T. S. Hayman

United States Department of Agriculture Wildlife Services: Staff Publications

One Health recognizes the health of humans, agriculture, wildlife, and the environment are interrelated. The concept has been embraced by international health and environmental authorities such as WHO, WOAH, FAO, and UNEP, but One Health approaches have been more practiced by researchers than national or international authorities. To identify priorities for operationalizing One Health beyond research contexts, we conducted 41 semi-structured interviews with professionals across One Health sectors (public health, environment, agriculture, wildlife) and institutional contexts, who focus on national-scale and international applications. We identify important challenges, solutions, and priorities for delivering the One Health agenda through government action. Participants …

Challenges In Post Graduate General Surgery Training In Tanzania: A Trainee’S Perspective, Shabbir Adamjee

Master of Surgery

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General Surgery residency training is a complex vigorous program which includes long working hours and complex surgical cases, in order to develop and attain the knowledge and the skills the trainee needs by the end of the program. Worldwide, general surgery programs have high attrition rates and residents have identified challenges which may be work related, related to social wellbeing and/or the residency program structure. Tanzania has public and private institutions providing general surgery residency training and although most have a quality assessment program the data is not readily available. Each institution has its personalized curriculum with its unique …

Factors Associated With Antiretroviral Drug Resistance Mutations Among Plhiv Failing To Achieve Virological Suppression On Second Line Treatment In Tanzania., Mabula M. Mabelele

Master of Internal Medicine

v> Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome (HIV/AIDS) is a major public health problem affecting an estimated 38.4 million people globally, with the (54%) of them being from the Eastern and Southern African regions. Despite progress in the availability of multiple classes of antiretroviral drugs and early initiation of treatment with cART, many patients still fail therapy in the first and second-line regimens due to drug resistance driven by continuous acquisition of drug resistance mutation (DRMs). DRMs are high among adults failing treatment regimens, ranging between 50-97%.

Acceptability And Feasibility Of Screening With A Pediatric Care Provider-Led Social Determinants Of Health Identification Tool, Alison Eyre, Janice Cohen, Sarah Funnell, Lynsey James, Sheena Guglani, Hounaida Abi Haidar, Lindy Samson, Michelle Ward, Radha Jetty, Megan Harrison, John Lyons Dr., Leigh Fraser-Roberts, Susan Bennet, Douglas Archibald, Soha Khorsand, Tobey Audcent

Health Management and Policy Faculty Publications

Background Complex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brief pediatric screening tool in primary care and hospital settings.

Methods The framework of the Child and Adolescent Needs and Strengths (CANS) and Pediatric Intermed tools was used to inform the selection of items for the 9-item Child and Adolescent Needs and Strengths-Pediatric Complexity Indicator (CANS-PCI). …

Leveraging Local Knowledge To Contextualize The Opioid Epidemic Within Healing Communities Study Communities: A Photovoice Protocol, Peter Balvanz, Ramona G. Olvera, Margaret Louise Mcgladrey, Marisa Booty, Dacia Beard, Sylvia Ellison, Craig Mcclay, Monica Nouvong, Carrie B. Oser, Owusua Yamoah, Linda Sprague Martinez

Health Management and Policy Faculty Publications

Since its inception 30 years ago, Photovoice has gained increasing popularity as a research method and more recently has been incorporated within randomized controlled trial (RCT) designs. Photovoice is a participatory action research method that pairs photography with focus group discussions to record community strengths and concerns, build critical consciousness, and reach policymakers. Adherence of Photovoice implementation to these original tenets of Photovoice varies. This article provides the Photovoice protocol developed by the authors to improve the methodological rigor of Photovoice integration into RCTs and help contextualize the landscape for the HEALing Communities Study (HCS: NCT04111939), a greater than $350 …

A Sampling Strategy For Longitudinal And Cross-Sectional Analyses Using A Large National Claims Database, Timothy L. Mcmurry, Jennifer M. Lobo, Soyoun Kim, Hyojung Kang, Min-Woong Sohn

Health Management and Policy Faculty Publications

Importance: The United States (US) Medicare claims files are valuable sources of national healthcare utilization data with over 45 million beneficiaries each year. Due to their massive sizes and costs involved in obtaining the data, a method of randomly drawing a representative sample for retrospective cohort studies with multi-year follow-up is not well-documented.

Objective: To present a method to construct longitudinal patient samples from Medicare claims files that are representative of Medicare populations each year.

Design: Retrospective cohort and cross-sectional designs.

Participants: US Medicare beneficiaries with diabetes over a 10-year period.

Methods: Medicare Master Beneficiary Summary Files were used to …

Implementing Social Determinants Of Health Data Collection In A Large Urban Pediatric Hospital Setting, Stormee Williams, Kristina Hill, Barry Owen, Forest Melton

Research

No abstract provided.

Rethinking Health Law Architecture, Ani B. Satz

Faculty Articles

Neither the individualistic regulatory health paradigm nor the vulnerable populations approach of public health can provide the legal structure necessary to address the most pressing problems in health care today. These approaches fail to address conflicts between individuals and populations as well as challenges to qualifying for care and are in inherent conflict with each other, sometimes within the same statute. As health concerns become more global, it is necessary to move past a vulnerable populations approach to a broader population approach that respects individual choice but does not sacrifice community health for liberty interests.

Role Of Social Determinants Of Health And The Renin- Angiotensin Aldosterone System In Risk For Hypertensive Disorders Of Pregnancy And Related Adverse Outcomes., Esther Letushila Ndashaala

Theses and Dissertations--Nutrition and Food Systems

Background: Hypertensive disorders of pregnancy (HDP) represent a significant public health issue, contributing to maternal and fetal morbidity and mortality. Women from lower socioeconomic backgrounds or marginalized racial and ethnic groups face higher risks of HDP, which have been incompletely described. In addition, risk for HDP may be linked to a reduction in the normal activity of the renin-angiotensin-aldosterone system (RAAS). This study investigates the role of socioeconomic factors and RAAS components in the risk for HDP and adverse maternal and neonatal outcomes. Methods: This study is a secondary analysis of data from 180 pregnant individuals from a high-risk maternal-fetal …

The Formation And Operationalization Of Charter(S) For The Lyte Foundation, Inc. (Living Your Truth Empowered), Through The Creation Of Policies, Roles, And Responsibilities Of Charter Leaders, Identification Of Resources, And Identification Of Community Needs, Charles Ngoc Tran

CGU Theses & Dissertations

This study aimed to develop policies and procedures needed for the operationalization of LYTE's charters. Employing a dual-methodology approach in document review and qualitative study, the study addressed two main objectives. The first is through document review and analysis of successful charters and nonprofit organizations in the US. With the insights gained from document analysis, drafts of policies required for LYTE’s charters operationalization were developed. The second is through interviews with organizational leaders and stakeholders such as breast cancer survivors and advocates. This provided perspectives and thematic insights crucial for tailoring policies specific to LYTE’s charters. The resulting deliverables include …

Health Equity Policy In Colombia: Improving Equal Access To Health Care Services For Individuals With Low-Income, Marian Marin

Honors Undergraduate Theses

In 1993, the last health reform “Law 100” was introduced in Colombia. It has been over 30 years since its implementation, and there have been many changes to the healthcare system in Colombia ever since. The policy increased health insurance coverage to almost 95% of the population, providing better and more affordable patient care. However, increasing the availability of resources does not necessarily make them accessible to all of Colombia’s residents. This study aims to analyze the outcomes of “Law 100” to the system and studies critical obstacles that halt healthcare equity in Colombia, particularly for those in rural and …

Gains And Challenges Of The Barangay Health Worker (Bhw) Program During Covid-19 In Selected Cities In The Philippines, Mikhaela Y.T. Baliola, Margaret R. Golpe, Leslie V. Advincula-Lopez

Development Studies Faculty Publications

Background: The Philippine Barangay Health Worker (BHW) program extends the accessibility of health care services at the community level. BHWs are trained volunteers who perform various health-promoting and health-educating tasks and provide primary health care (PHC) services within their communities. However, the weak implementation of policies meant to protect their welfare, like the BHW Benefits and Incentives Act (Republic Act No. 7883), translates to challenges that impact the sustainability of the BHW program. This qualitative study aimed to explore the BHWs' experiences with RA 7883 and how its implementation shaped their overall role as frontline health workers during the pandemic. …

Outcomes Of Upper Gastrointestinal Bleeding In Hospitalized Covid-19 Patients In The United States: A Propensity-Score Matched Analysis Of A Large National Database, Moon Ryu, Mohammed Quazi, Niloy Ghosh, Karthik Gangu, Amir H Sohail, Asif Farooq, Babu S Maringanti, Aman Goyal, Anupa Patel, Muhammad S Khan, Abu B Sheikh

Faculty, Staff and Student Publications

Patients with cirrhosis that are hospitalized with COVID-19 infection have been found to have worse outcomes. No comparative study has been conducted between gastrointestinal (GI) bleeding in patients with cirrhosis who are diagnosed with COVID-19. We utilized the National Inpatient Sample (NIS) database to perform a retrospective analysis of 24, 050 patients diagnosed with cirrhosis and COVID-19. The identified patients were separated into variceal bleeding, nonvariceal bleeding, and no (or neither) GI bleeding groups. After performing propensity sample matching and multivariate analysis of mortality, we found no significant differences in mortality among the three groups. However, the variceal bleed group …

Use Of Machine Learning Approaches To Predict Transition Of Retention In Care Among People Living With Hiv In South Carolina: A Real-World Data Study, Ruilie Cai, Xueying Yang Ph.D., Yunqing Ma, Hao H. Zhang, Bankole Olatosi Ph.D., Sharon Weissman, Xiaoming Li Ph.D., Jiajia Zhang Ph.D.

Faculty Publications

Maintaining retention in care (RIC) for people living with HIV (PLWH) helps achieve viral suppression and reduce onward transmission. This study aims to identify the best machine learning model that predicts the RIC transition over time. Extracting from the enhanced HIV/AIDS reporting system, this study included 9765 PLWH from 2005 to 2020 in South Carolina. Transition of RIC was defined as the change of RIC status in each two–year time window. We applied seven classifiers, such as Random Forest, Support Vector Machine, eXtreme Gradient Boosting and Long–short–term memory, for each lagged response to predict the subsequent year's RIC transition. Classification …

Medicaid Managed Care Restrictions On Medications For The Treatment Of Opioid Use Disorder, Maureen T. Stewart, Christina M. Andrews Ph.D., Sage R. Feltus, Dominic Hodgkin, Constance M. Horgan, Cindy Parks Thomas, Thuong Nong

Faculty Publications

Objective: To examine whether Medicaid managed care plan (MCP) utilization management policies for buprenorphine–naloxone and injectable naltrexone are related to key state Medicaid program policy decisions. Data Sources and Study Setting: We abstracted data on state Medicaid regulatory and policy information from publicly available sources and publicly available insurance benefit documentation from all 241 Medicaid MCPs operating in 2021. Study Design: In this cross-sectional study, we used bivariate and multivariate analyses to examine whether Medicaid MCP prior authorization and quantity limits on receipt of buprenorphine and injectable naltrexone were associated with key state Medicaid choices to leverage federal funds to …

Human Mobility And The Infectious Disease Transmission: A Systematic Review, M. Naser Lessani, Zhenlong Li, Fengrui Jing, Shan Qiao Ph.D., Jiajia Zhang Ph.D., Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

Recent decades have witnessed several infectious disease outbreaks, including the coronavirus disease (COVID-19) pandemic, which had catastrophic impacts on societies around the globe. At the same time, the twenty-first century has experienced an unprecedented era of technological development and demographic changes: exploding population growth, increased airline flights, and increased rural-to-urban migration, with an estimated 281 million international migrants worldwide in 2020, despite COVID-19 movement restrictions. In this review, we synthesized 195 research articles that examined the association between human movement and infectious disease outbreaks to understand the extent to which human mobility has increased the risk of infectious disease outbreaks. …

An Exploration Of Clinical Reasoning Using Simulation-Based Learning In Physical Therapist Education, Susannah Steele

Dissertations and Theses

BACKGROUND: Clinical reasoning instruction and assessment are vital tasks of health professions educators yet execution lacks standardization among programs in physical therapy education. This broad variability in how clinical reasoning is taught and assessed within physical therapy education makes understanding current state and improving implementation challenging. PURPOSE: The purpose of this study was to explore whether simulation-based learning is useful in facilitating the development of clinical reasoning skills in novice physical therapist students, to explore potential correlations and performance trends between two assessments measuring elements of clinical reasoning skills, and to explore the impact of thoughtfully designed simulation learning experiences …

Preparing Healthcare Education For An Ai-Augmented Future, Jiajie Zhang, Susan H Fenton

Faculty, Staff and Student Publications

Artificial intelligence (AI) fundamentally transforms healthcare education as a knowledge enterprise, creating a distributed cognitive system composed of the human brain, which remains relatively unchanged, and AI-based knowledge and cognitive functions, which have accelerated exponentially in scale and power. Education must focus on developing skills to collaborate with AI and on achieving outcomes like problems solved and discoveries made. Curriculum and education policies also need to adapt to this transformation.

Examining The Impact And Implementation Of Protected Administrative Time On Provider Well-Being And Service Delivery Indicators Within A Multi-State Network Of Primary Care Medical Practices, Lauren Junge-Maughan

College of Graduate Studies: Theses & Dissertations

Background:

Primary care is integral to achieving high-quality health outcomes for the population and decreasing healthcare costs. However, primary care clinicians suffer from conflicting demands, impossible expectations, and burdensome processes. With burnout and mental fatigue increasing, leadership must find innovative programs to implement in their organizations. This mixed-methods research study assessed the impact of one such intervention, protected administrative time (PRAT), on improving provider well-being.

Purpose:

The first aim was to evaluate the association of PRAT on the service delivery indicators of primary care clinicians’ productivity, average appointments per day, patient satisfaction (likelihood to recommend), clinician time to the next …