Master of Science, Miami University, 2022, Kinesiology, Nutrition, and Health

Access to quality, affordable, and reliable healthcare has been a long-standing challenge in rural areas of developing countries. Rural households often incur high out-of-pocket expenditure for healthcare, resulting in a significant cost burden when seeking treatment for an illness. This study aimed to examine the cost structure of healthcare in a rural, underserved community in the Kaloleni Subcounty of Kilifi, Kenya. We measured the impact of direct healthcare costs on a sample of 37 households, along with the coping strategies and treatment-seeking behavior arising from these costs. Direct healthcare costs were grouped into 3 categories: consultation, diagnostic, and medicine fees. Results show that medicine was the highest direct healthcare cost, accounting for 64% of all expenses paid during an episode of illness. Direct healthcare costs also comprised over 12% of the monthly household expenditure in these households, with the lowest-earning homes being disproportionately affected. Malaria was the most common illness reported in the study area, accounting for 37% of all illness cases. Several strategies are proposed to ease the burden of direct healthcare costs. These include government subsidies for community-level healthcare facilities, increasing the availability of medicines, and improving the distribution/use of treated mosquito bed nets to prevent malaria transmission.

Committee: Philip Smith (Advisor); Paul Branscum (Committee Member); Helaine Alessio (Committee Member) Subjects: Health Care; Health Sciences; Public Health

Master of Science, The Ohio State University, 2012, Dentistry

Several previous studies have looked at odontogenic facial cellulitis in terms of epidemiology, economics, and characteristics of disease. Prior to our 2009 study, no information existed on the impact that rapid treatment in a hospital such as Nationwide Children's Hospital could impact LOS and Total Healthcare Cost (THC). There we found that our average LOS of 2.1 days was lower than previously reported in other studies. In addition, our THC was lower than the average as reported in 2006 in the Kid's Inpatient Database ($4166 vs. $8998) when general anesthesia was not utilized. This study extended the scope of the earlier study by identifying patients prospectively, and, by utilizing electronic medical records, following more variables to better ascertain their relationship to LOS and THC. A total of 43 Patients were identified for this study. The average length of stay was 1.7 days ± 1.5 days (range 0-7 days), which is the lowest mean LOS reported in the literature. THC averaged $10,494.10 ± $8,034.10 and ranged from $3,613.97 to $43,418.18. This mean THC is a significant increase from earlier findings. Statistically significant associations were found for older age and increased LOS (p=.005) when patients were dichotomously divided into groups of 0-8 and 9-18yrs old. Significant associations between CT imaging and both longer LOS and higher cost (both p<.0001) were found. Patients with higher ASA status tended to have longer LOS (p=.003) and higher THC (p= .015). Subjects that were prescribed more than one antibiotic during stay had a significantly longer LOS (p=0.028) Four patients in this study were placed under observation and were not formally admitted. These observation patients had lower costs than similar fully admitted patients (19.5%-60.2% less expensive), but the differences were not statistically significant. Given a larger population, the lower THC could be both statistically and clinically significant and therefore a future study is recommended in (open full item for complete abstract)

Committee: Sarat Thikkurissy D.D.S., M.S. (Advisor); Paul Casamassimo D.D.S., M.S. (Committee Member); Ashok Kumar D.D.S., M.S. (Committee Member); Peter Larsen D.D.S. (Committee Member) Subjects: Dentistry

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2023, Health Programs

Massive bleeding remains one of the leading potentially preventable causes of death in the United States, accounting for more than 50% of mortality rates (Marietta, Marco et al., 2011). Massive transfusion protocol (MTP) is a rapid transfusion of a large amount of blood and blood products (more than ten units of red blood cells in twenty-four hours, or four units of red blood cells in an hour, or any four blood components in 30 minutes) in a short period of time (Thurn et al., 2019). The blood products' ratios included in the massive transfusion protocol are distinct and composed of red blood cells, fresh frozen plasma, and platelets. Developing and establishing electronic records for massive transfusion protocols may improve patient outcomes (Broxton et al., 2017). Using liquid plasma during a massive transfusion protocol may improve patient survival rate by decreasing the blood product delivery time to the patient's bedside and reducing healthcare costs by lowering blood product waste (Beckermann et al., 2022). In this quantitative study, the researcher analyzed retrospective medical records from a Level One Medical Trauma Center in the Southwest United States to answer the research question. Data regarding using liquid plasma in massive blood transfusion outcomes were collected from the hospital records for pre- and post-liquid plasma usage implementation. The study investigated the following research question: For patients who require emergency and massive transfusion, what is the impact of using liquid plasma compared to fresh frozen plasma on blood product wastage and plasma-saving cost one year before and after using liquid plasma?

Committee: Alex Akulli (Committee Chair); Jesse Florang (Committee Member); Gail Frankle (Committee Member) Subjects: Comparative; Health Care; Health Care Management; Health Sciences; Medicine; Pathology; Science Education

Doctor of Philosophy, The Ohio State University, 2010, Pharmacy

This is the first study to evaluate statin medication adherence and associated outcomes in a diabetic population based on a national Medicaid database. A retrospective claims-based study was conducted in patients who were continuously enrolled in Medicaid from January 2004 to December 2006. Patients (≥ 18 years) with diagnosis of hyperlipidemia and type 2 diabetes were identified by international classification of disease 9th revision (ICD-9) codes based on medical claims. Prescriptions of statin or oral antidiabetic medications were identified by national drug code (NDC) based on drug claims. Demographic, clinical and medication related information was extracted from the MarketScan® Medicaid database. The eligible patients starting the use of statin medications in 2005 were followed for one year to measure medication use, hospitalization, outpatient visits, emergency room (ER) visits, and healthcare costs. A conceptual model based on modified health belief model and health services use behavior model was proposed in this study. Propensity scores were used to remove the imbalance of baseline characteristics between patients with diabetes and without diabetes. Regression models were used to compare mediation adherence and healthcare costs. Multiple linear regression analysis was implemented to assess associations between healthcare costs and statin medication possession ratio (MPR) , while logistic regression analysis was conducted to evaluate associations between medical utilization (hospitalization and ER visit) and likelihood of statin medication adherence (MPR ≥ 0.8). A total of 7184 eligible patients with hyperlipidemia were included in the study (5479 for non-diabetic group, 1705 for diabetic group). Overall patients with diabetes presented worse health conditions than those without diabetes based on total number of medications used, frequency of outpatient visits, occurrence of hospitalization and ER visit, and severity of comorbidity. Both groups showed poor (open full item for complete abstract)

Committee: Milap Nahata (Committee Chair); Rajesh Balkrishnan (Advisor); Lacombe Veronique (Committee Member); Seiber Eric (Committee Member) Subjects: Health Care; Pharmaceuticals; Public Health