Health Services Research Commons^™

Lipid Profile And Admission/Discharge Locations As Predictors Of 60 Day Readmission In Adults 65 Or Older With Type 2 Diabetes Mellitus, Zac Dalton, Terrie Ginsberg, Matthew Mclaughlin

Rowan-Virtua Research Day

Introduction: Reducing 30 and 60 day hospital readmissions is critical to our healthcare systems. Older folks with type 2 diabetes mellitus (T2DM) account for a disproportionate amount of readmissions. Through recognizing factors that correlate to readmissions, patients at risk may be identified.

Objective: To conduct a retrospective review of electronic medical records (EMR) to determine if there is an association between the lipid profile and admission and discharge locations of hospitalized older adults and whether they were rehospitalized 60-days post discharge.

Methods: EMRs were reviewed of 86 randomly selected consenting participants who were admitted to a community hospital and were …

Loss Of Obstetric Services In Rural Appalachia: A Qualitative Study Of Community Perceptions, Caroline R. Efird, David Dry, Rachel F. Seidman

Journal of Appalachian Health

Background: As rural hospitals across the United States increasingly downsize or close, the availability of inpatient obstetric services continues to decline in rural areas. In rural Appalachia, the termination of obstetric services threatens to exacerbate the existing risk of adverse birth outcomes for women and infants, yet less is known about how the cessation of these services affects the broader community.

Purpose: The purpose of this paper is to explain how the loss of local obstetric services affects perceptions of healthcare among multi-generational residents of a remote, rural Appalachian community in western North Carolina.

Methods: An interdisciplinary team of researchers …

An Intersectional Analysis Of Lgbtq+ Healthcare In The United States, Nicole Niles

Senior Honors Projects

LGBTQ+ healthcare has made some significant progress in the last few decades, yet countless studies have shown that the American healthcare system still lags behind in equitable healthcare. My project sought to identify the issues that prevent the LGBTQ+ community from receiving quality healthcare, which involved the curation of over twenty academic journal articles for an annotated bibliography, along with a paper discussing these articles.

One of the most important concepts to gender studies is intersectionality. Coined by legal theorist Kimberlé Crenshaw in 1989, intersectionality describes the concept of how one’s individual characteristics, including race, class, and gender, intersect and …

Medicare-Paid Naloxone: Trends In Non-Metropolitan And Metropolitan Areas, Chris Delcher, Yue Cheng, Minji Sohn, Jeffery C. Talbert, Patricia R. Freeman

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Medicare pays for the largest share (> 30%) of naloxone dispensed from retail pharmacies in non-metropolitan areas.
• Medicare-paid dispensing has grown since 2013, but from 2017-2018 dispensing growth in non-metropolitan areas slowed considerably compared to metropolitan areas (42% v 121%, respectively).
• As of 2018, the rate of naloxone dispensing to Medicare enrollees in metropolitan areas was approximately double that in non-metropolitan areas (4.9 v 2.9 per 1,000 enrollees, respectively).

Social Justice Attitudes And Health: A Cross Sectional Study, Edward Donovan

Senior Honors Projects

Background: Increasingly, social justice is being considered as a key factor associated with health outcome. In addition, there is growing interest in exploring perception of discrimination in healthcare settings. This study explored perceptions of social justice, health care discrimination, health care status and utilization of healthcare resources. The investigators predict a significant association between the level of social justice awareness and healthcare utilization based on the hypothesis that those who are cognizant of social inequities are more likely to be informed self-advocates in healthcare settings.

Methods: First, a survey was created based on a review of existing literature. The …

A Descriptive Case Study Of The Challenges Of Drug And Alcohol Counselors, Ruben Herron

Graduate Theses and Dissertations

Substance abuse is the number one public health problem in Oklahoma and nationally. Annual related expenses of substance abuse in Oklahoma are nearly $2 billion. This qualitative descriptive case study asks the question what are the challenges of substance-abuse counseling? The researcher will be describing in detail the history of drug and alcohol treatment and counseling in America. Using interviews, observations and document collection which will allow the interviews voices to be heard.

Access To Healthcare For The Hispanic/Latino Population, Rebecca Loritz

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: The U.S. Hispanic/Latino population faces significant barriers to accessing healthcare. The most common barriers Latinos face are language barriers, cost barriers, immigration statuses, insurance coverage barriers, transportation barriers, health literacy and education barriers, as well as lack of access to healthcare providers. These barriers impact not only their ability to access healthcare but also the quality of healthcare they receive.

Purpose: To synthesize the existing literature evaluating that identifies barriers to healthcare.

Methods: CINAHL and PubMed were systematically searched, along with a manual internet search for journal articles that studied access to care issues for the Latino population in …

Factors Associated With Health Coverage Gaps And Cost Barriers To Health Services In U.S. Adults Before And After The Aca, Danielle Kilchenstein

Loma Linda University Electronic Theses, Dissertations & Projects

Background

Health law known as the Affordable Care Act (ACA) was passed in 2010 and implemented in 2014 in the U.S. It was intended to reduce cost burdens to health coverage and care.

Purpose

Self-reported health coverage gaps and cost barriers to physical, mental, dental care, and prescription medications of U.S adults before and after the implementation of the ACA in 2014 were examined to determine impacts of health reform on marginalized populations.

Methodology

Cross-sectional secondary data analysis was conducted using National Health Interview Survey Data from the Integrated Public Use Microdata Set (2010-2017). The 140,341 surveys represented an average …

Agreement Success Plan, Miranda Holtz

Capstone Projects and Master's Theses

Monterey County Health Department’s Administration Bureau works with contracts and agreements for the Public Health Bureau, which detail what services programs will complete so that they can receive funding or maintain a partnership with the County. The problem was that a large portion of the management analyst’s time was dedicated towards technical support for agreements. The Agreement Success Pan is aimed to increase efficiency by aiding program staff with agreements through a Prezi, which is similar to a self-paced webinar. The project had three phases; interviews of program supervisors or managers, gathering supporting documents, and final launch. Afterward, a questionnaire …

Rurality As A Moderator Of Perception Of Need For Medical Care And Patient Satisfaction, Kyndal Grammer

Electronic Theses and Dissertations

Many individuals experience barriers to accessing medical care, especially in rural areas. Some barriers are attitudinal and represent perceptions of quality care. Patient satisfaction and perceived need for medical care are two such attitudinal barriers related to health care utilization, yet the relationship between these variables has not been explored. Using data from an online survey, the current study examined the association between these variables, and further, whether rurality status moderated this association. Results indicated a significant correlation between patient satisfaction and perception of need. Although the overall moderation model was significant, perception of need was not significantly associated with …

Nebraska Public Guardianship Of Unbefriended Patients: A Preliminary Review Of Health Outcomes And Cost Savings, Emily N. Berzonsky

Capstone Experience: Master of Public Health

Unbefriended patients often experience an extended length of stay in the hospital while their medical providers await legal appointment of a public guardian to make their medical decisions. The medically unnecessary days the unbefriended patient spends in the hospital equates to high costs for the hospital, but more importantly, negative health outcomes for the patient. The purpose of this study is to provide literature and data to support recommendations for possible changes in Nebraska’s public guardianship appointment process. A literature review seeks to answer: (1) What is the median hospital length of stay for an unbefriended patient without a guardian …

Improving Data Access And Use For Hiv Biomedical Prevention Interventions, Project Soar

HIV and AIDS

Over the past decade, biomedical prevention interventions—including voluntary medical male circumcision (VMMC) and oral pre-exposure prophylaxis (PrEP)—have resulted in substantial gains in controlling the global HIV epidemic. Despite the inclusion of these highly effective interventions in multinational strategies and global prevention toolkits, their effective implementation rests upon context-specific, data-driven delivery to priority populations and geographies. Project SOAR has contributed to the evidence base by increasing access to and use of data through user-friendly interfaces and dissemination strategies, advancing VMMC and PrEP as vital prevention interventions in the global discourse. SOAR’s biomedical prevention portfolio has supported data-driven planning, implementation, and monitoring …

Optimizing Delivery Of Hiv Testing Services To Strengthen The Continuum Of Care, Project Soar

HIV and AIDS

HIV testing is a critical entry point to life-saving antiretroviral therapy (ART) for those diagnosed with HIV and to prevention services for those at high risk of acquiring HIV. Despite advances in testing, there remain a variety of social and programmatic challenges that prevent access to HIV testing services, particularly for men and key populations. HIV program managers and policymakers are increasingly invested in understanding how best to deliver HIV testing services to different populations and to maximize health system resources at facility and community levels. Project SOAR has contributed to the evidence base and catalyzed research use by examining …

Approaches To Research Utilization And Capacity Strengthening, Project Soar

HIV and AIDS

Research plays a critical role in strengthening programming and policymaking. Donors and other stakeholders are increasingly focused on ensuring that their research investments yield positive health and development outcomes. Yet, there are many challenges in ensuring study findings are used by relevant decisionmakers to inform policies and programs. Recognizing the need to invest in research uptake efforts beyond dissemination of final findings, Project SOAR utilized an active approach to facilitating research utilization (RU) to fulfil the commitment of implementation science to promote the systematic uptake of research finding into routine practice. Project SOAR assembled and implemented a systematic and proactive …

Improving Patient Outcomes Through Innovative, Community-Based Hiv Treatment Strategies, Project Soar

HIV and AIDS

Despite the availability of life-saving treatment for HIV, several barriers prevent patient access to high-quality services. HIV program managers and policymakers have shown increasing interest in understanding how best to deliver HIV treatment to different populations and maximize health-system resources at facility and community levels. Project SOAR recognizes the key role that treatment services play in achieving UNAIDS’ 90-90-90 goals for controlling the HIV epidemic through testing, treatment, and viral suppression by 2020. Project SOAR has contributed to the evidence base and catalyzed research use by assessing innovative strategies for antiretroviral treatment (ART) delivery that support different populations in remaining …

Advances In Conceptualizing And Measuring Stigma Among People Living With Hiv, Project Soar

HIV and AIDS

Stigma, defined as the co-occurrence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised, has a negative impact on the health of people living with HIV (PLHIV), contributing to psychosocial stress, coercion and violence, job loss, and social exclusion. Widely recognized as a barrier to accessing HIV care, it is paramount that programs and policies are designed to mitigate HIV-related stigma to achieve the UNAIDS’ 90-90-90 goals. Project SOAR recognizes the importance of addressing stigma to control the HIV epidemic through testing, treatment, and viral suppression. Project SOAR has contributed to the evidence …

Evaluation Of Glutaminase Expression In Prostate Adenocarcinoma And Correlation With Clinicopathologic Parameters, Zin W. Myint, Ramon C. Sun, Patrick J. Hensley, Andrew C. James, Peng Wang, Stephen E. Strup, Robert J. Mcdonald, Donglin Yan, William H. St. Clair, Derek B. Allison

Internal Medicine Faculty Publications

High Glutaminase (GLS1) expression may have prognostic implications in colorectal and breast cancers; however, high quality data for expression in prostate cancer (PCa) are lacking. The purpose of this study is to investigate the status of GLS1 expression in PCa and correlated expression levels with clinicopathologic parameters. This study was conducted in two phases: an exploratory cohort analyzing RNA-Seq data for GLS1 from The Cancer Genome Atlas (TCGA) data portal (246 PCa samples) and a GLS1 immunohistochemical protein expression cohort utilizing a tissue microarray (TMA) (154 PCa samples; 41 benign samples) for correlation with clinicopathologic parameters. In the TCGA cohort, …

Testing Of Patients First In A Real-World Setting, As A Patient Experience Accreditation Tool For Hospitals And Clinics, Carlos Bezos, Rosa M. Salazar, María Caballero

Patient Experience Journal

Many healthcare providers are developing patient experience strategies and investing in this area. Yet, patients have no means to know if a hospital is following proper patient experience standards. For this reason, it is important to certify that hospitals and clinics follow own a patient experience policy and apply patient experience standards. This is the reason why the accreditation Patients First was developed. The goal of this study is to test the accreditations’ feasibility in a real-life environment. The accreditation was tested at the Guadarrama Hospital, nearby Madrid in Spain. A mixed team between Guadarrama staff and the Institute for …

Patient And Provider Perspectives Regarding Criteria For Patient Prioritization In Two Specialized Rehabilitation Programs, Julien Déry, Angel Ruiz, François Routhier, Marie-Pierre Gagnon, André Côté, Daoud Ait-Kadi, Valérie Bélanger, Marie-Eve Lamontagne

Patient Experience Journal

To increase fairness and equity in access to rehabilitation services, a strategy emerging from the literature is patient prioritization. Selecting explicit prioritization criteria is a complex task because it is important to simultaneously consider the objectives of all stakeholders. The of this study was to compare service users’ and service providers’ perspectives regarding patient prioritization criteria in two rehabilitation programs. We conducted a multiple case study in two rehabilitation programs, i.e., a driving evaluation program and a compression garment manufacturing program. We sent a web-based survey asking two groups (patients and providers) to individually produce a set of criteria, then …

Exploring Mental Health Experience In Individuals Living With Temporomandibular Disorders, Wafaa Safour, Richard Hovey

Patient Experience Journal

Despite the evidence supporting deteriorating mental health because of temporomandibular disorders (TMDs) conditions, there is limited evidence of TMD patients' experience regarding how their mental health is affected by the disorders. As a sequence of these conditions, TMD patients suffer from physical and mental complications, not to mention the loss of food enjoyment. In this study, we aim to explore TMD patients' lived experiences who had changed their dietary habits concerning their mental health. Six participants were interviewed to answer open-ended questions during semi-structured interviews regarding their mental health experiences with TMD-related food routine changes. These interviews were held face-to-face …