Doctor of Philosophy, University of Akron, 2011, Public Administration

In the 1959 article written by Charles Lindblom, entitled, “The Science of Muddling Through”, Lindblom argued that in general, people make decisions in relatively small increments rather than in big leaps (Birkland, 2001). The rational comprehensive method of decision making is referred to as the root method because decisions start from the “root” of the [tree] issue (Birkland, 2001). Lindblom describes incrementalism as the [tree] branch of an issue because it builds on prior knowledge about an issue (Birkland, 2001). The history of the Medicare program, focuses on program implementation reform in reference to coverage and reimbursement. In this study, incrementalism was used the academic approach to build on the Medicare program reform from the perspective of program implementation reform for coverage, and the reimbursement in the diabetes diagnosis related group at the healthcare provider level. The purpose of this study was to explore the factors that contribute to Medicare reimbursement payment variations among healthcare providers that treat the diabetic diagnosis related group (DRG). The current regulatory policy practices of the Medicare program where examined for causes in Medicare reimbursement payments variation. In consideration of the type of regulations (i.e. quality, quantity, price and indirect control) used by government agencies, a rulemaking framework was used to recommend alternative policies (i.e. precise, flexible and Pareto Optimum). The study did not suggest that all variation in Medicare reimbursement payments were due to the aforementioned factors. Nor did the study settle on the idea that variation in Medicare reimbursement payments is unexplained or intentionally created for the benefit of some healthcare providers (i.e. rural or urban healthcare providers). Solving all problems in the entire Medicare program is a big leap, therefore this was not the objective of this study. Therefore, findings in this study suggest that a research app (open full item for complete abstract)

Committee: Raymond Cox Dr. (Advisor); RaJade Berry-James Dr. (Committee Co-Chair); Larry Keller Dr. (Committee Member); Namkyung Oh Dr. (Committee Member); Stephanie Woods Dr. (Committee Member) Subjects: Health; Public Administration; Public Policy

Doctor of Education (Educational Leadership), Youngstown State University, 2024, Department of Teacher Education and Leadership Studies

This study explores associations between the number of Medicare-certified hospitals and emergency rooms and student performance on the Ohio State Tests in English Language Arts and Mathematics for third graders enrolled in Northeast Ohio schools in 2019 and 2023. This secondary-research study uses archival data to investigate correlations between topographical and location features (rurality, Appalachian status, ESC) and individual variables (gender, race or ethnicity, economic status, English language learner, homeless, disability) and student achievement. The use of Pearson Zero-Order Correlation analysis determined that no association is present between number of Medicare-certified hospitals and emergency rooms and student achievement in Northeast Ohio. The analysis supported significant, negative correlations between student achievement in ELA and mathematics and the individual variables of Black, NonHispanic, Hispanic, Multiracial, economic disadvantage, ELL, homeless and disability. There were no interaction effects between independent and dependent variables. This research supports the need for future research into associations between alternative forms of healthcare, such as pop-up clinics, and student achievement, given the prevalence of alternative healthcare services in areas of Northeast Ohio that do not have adequate hospital or emergency room access.

Committee: Karen Larwin Ph.D. (Committee Chair); Traci Hostetler Ed.D (Committee Member); Kelly Colwell Ed.D. (Committee Member) Subjects: Education; Health; Health Care; Minority and Ethnic Groups

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

Currently, rural hospitals account for thirty percent of all hospitals in the United States (U.S). However more of these facilities have experienced closure in the last decade than any time in U.S. history. Typical reasons for this occurrence are financial distress stemming from shrinking patient volume, physician departure, and reimbursement reductions. Currently the state of Tennessee has experienced several rural hospital closures to date. Finding opportunities to grow in-patient census while expanding substantial revenue generation is paramount to slow the closure trend. Covid-19 has caused a recent rise and demand for telehealth services in the healthcare industry. Is now a time for rural hospitals to improve telehealth resources to capture greater patient volume and potential improvement in revenue reducing financial burdens? A descriptive causal design utilizing secondary data from four rural hospitals in east Tennessee will determine if telehealth has increased in-patient volume over a four-year period of time. Diagnosis related groups (DRG) will be tested with Pearson's Chi-square with year over year group comparisons for improvement before, during, and since the pandemic. As telehealth use has grown during Covid- 19, have rural hospitals leveraged benefits to care for specialty diseases (i.e., neurology, nephrology, pulmonology) that before may have not been an option? Can comparing hospitals to understand if less or greater telehealth is performed in each studied facility influence in-patient volume? Using Medicare payment codes consideration for this research maybe used in other geographic regions to perform similar analysis in the future.

Committee: Cynthia Smoak (Committee Chair); Jennifer Sheinberg (Committee Member); John Suozzi (Committee Member) Subjects: Health Care; Health Care Management

DNP, Kent State University, 2021, College of Nursing

Advanced Practice Registered Nurses (APRN) are at the forefront of our current patient care systems. The APRN presence has brought questions involving the advanced practice community and their relationship to the medical staff, committees, and administration. Advanced practice registered nurse (APRN) includes the following practitioners: Certified Nurse Midwife (CNM), Certified Nurse Practitioner (CNP), Certified Nurse Specialist (CNS), and Certified Registered Nurse Anesthetist (CRNA). In 2012, the Center for Medicare/Medicaid Services (CMS) expanded the medical staff definition to include non-physician practitioners. This regulation change included advanced practice registered nurses and physician assistants. The Code of Title 42 C.F.R 482.22 allows hospitals and their medical staffs to take advantage of the expertise and skills of all types of practitioners who practice at the hospital when making decisions concerning medical staff privileges and membership. In 2014, Title 42 C.F.R. 482.22 Medicare Conditions of Participation clarified state laws would determine the eligibility for appointments by the governing body. The document does state the membership to the governing body is not a requirement but optional. (CMS, 2012). The DNP project “APRNs and Medical Executive Committee Membership: A Quality Improvement Proposal” highlights an environmental scan and a validation group input. Is there value of the APRN beyond the bedside? Multiple advanced practitioner journals, professional practice organizations, and textbooks direct APRNs toward positions in leadership as part of our professional responsibilities. However, few hospitals have positioned the APRN within the medical executive committee (MEC). The APRN membership on a MEC would reflect the diversity of our healthcare provider climate and is a natural progression of our hospital leadership. The s (open full item for complete abstract)

Committee: Lynn Gaddis Dr (Committee Chair); Kimberly Cleveland Dr (Committee Member); Marilyn Nibling Dr (Committee Member) Subjects: Nursing

Doctor of Business Administration (D.B.A.), Franklin University, 2020, Business Administration

Attaining high Overall Medicare Star ratings (MSR) is essential to the success of managed care organizations (MCOs) in the United States. Leaders are integral to the organizational performance in MCOs. This quantitative study focused on identifying the impact of Leadership practice and Years of leaders' Medicare experience in helping leaders influence high Medicare Star Ratings in MCOs. The study focused on two (2) research questions. (RQ1) Is overall leadership practice useful in predicting a leader's ability to influence the attainment of high MSRs in MCOs? (RQ2): RQ2: Is Years of leader's Medicare experience useful in predicting a leader's ability to influence the attainment of high MSR in MCOs? The study had 35 high (4, 4.5, and 5-Stars) MSR leaders and 35 low (3.5-Stars or less) MSR leaders, consisting of a total of 70 participants. Data for this study was gathered using the Leadership Practice Inventory (LPI ®) tool. The participants included supervisors, managers, directors, and executives in the MCO they worked. Parametric independent T-Test was used to test the statistical significance of the mean difference between the two (2) leader groups. Logistic regression was used to predict leaders' ability to influence the attainment of high MSR with leadership practices and years of Medicare experience. The result indicated a statistically significant relationship between leadership practices and MSR. Also, the practice of the five (5) LPI® themes autonomously cannot significantly predict a leader's ability to contribute to influencing MSR. The findings also showed that leaders' Medicare experience is effective in influencing the attainment of high MSR in MCOs.

Committee: Jeffrey Ferezan (Committee Chair); Dale Gooden (Committee Member); Debra Petrizzo (Committee Member) Subjects: Business Administration; Health; Health Care; Health Care Management; Health Sciences

Master of Arts, Miami University, 2019, Economics

Medicare and Medicaid are U.S. Federal health insurance programs established in 1965 as an amendment to the Social Security Act of 1935. They provide coverage to the aged population (65+), low-income individuals, and to other subsets of the U.S. population. After reviewing the foundations of Medicare/Medicaid, I analyze the political economy of Members of Congress vote choices on the original 1965 Medicare/Medicaid law. I find evidence that the number of doctors per 100,000 individuals in a state is a strong predictor of vote choice and there is statistically significant interaction between percentage of Black Americans and the South. Moreover, there is evidence to suggest that party alignment of constituencies and geographic region played roles in persuading Republicans in party-contested states to defect. The behavior of these defectors is dependent on their party alignment and the party alignment of the majority in Congress. To assess the strength of the model across time and legislation, I run a fully interacted, pooled OLS regression on both the 1965 legislation, and the Medicare Modernization Act of 2003. I find the effects of hospitals do not hold across time. However, I find evidence target populations remain insignificant in both datasets, suggesting they are not strong influencers of vote choice.

Committee: Melissa Thomasson (Advisor); Gregory Niemesh (Committee Member); Deborah Fletcher (Committee Member) Subjects: Economic History; Economics; Health Care; Political Science; Public Policy

Master of Gerontological Studies, Miami University, 2006, Gerontology

The purpose of this research is to explore the views, perceived knowledge, actual knowledge and access to information of seniors regarding the new Medicare prescription drug benefit. This program, enacted in December 2003, is designed to add prescription drug coverage to the benefits provided by Medicare. Structured telephone interviews were conducted with a random sample of 87 seniors. Information regarding participants' impression, knowledge levels, and access to information in relation to the program was gathered and analyzed. Findings suggest a lack of knowledge and confidence by beneficiaries concerning the program. On average, participants correctly responded to 5 out of 8 true/false statements, which tested their knowledge of the program and over half indicated that they did NOT understand the program well or at all. Since this is a benefit that could have a crucial impact on the lives of older adults, the implications of low knowledge and confusion are significant.

Committee: Suzanne Kunkel (Advisor) Subjects: Gerontology

PhD, University of Cincinnati, 2023, Pharmacy: Pharmaceutical Sciences

Background: Immune checkpoint inhibitors (ICI) have advanced the treatment of patients with non-small cell lung cancer (NSCLC), melanoma, renal cell carcinoma, and other cancers; however, the benefit to patients can vary significantly.1 Real-world data has shown that not all patients respond the same to ICI treatment and even less is known for aging patients that may have co-morbidities, altered gut microbiome, and multiple concomitant medications. Understanding the effect of medications known to alter the microbiome in lung cancer patients who receive ICI treatments has shown to be of importance. The objective of this study is to evaluate overall survival in elderly lung cancer patients receiving a type of ICI, programmed death-1 (PD-1) inhibitors, and medications known to impact the gut microbiome. Methods: Surveillance, Epidemiology, and End Results (SEER)-Medicare is a publicly available database that links the SEER tumor registry data with Medicare enrollment and claims files. A retrospective observational study design was conducted to estimate the overall survival of elderly patients with NSCLC that use antibiotics and ICI medications, focusing on PD-L1 inhibitors, nivolumab and pembrolizumab. The study cohort was determined based on lung cancer histology, claims for nivolumab or pembrolizumab, and continuous enrollment. Claims for outpatient antibiotics or proton pump inhibitors (PPIs) were identified in the Part D file and assigned to 14-day, 30-day, or 60-day comparison groups. Patients with no antibiotic claim within 180 days of initiating ICI therapy were assigned to a control group. We will estimate the effect of concomitant use of PD-1 inhibitors and antibiotics or PPIs on overall survival using Kaplan-Meier and Cox proportional hazards regression models. Results: We identified 3,445 patients that had lung cancer and received PD-1 inhibitors, of whom 1,702 (49%) received an antibiotic and 484 (14%) received a PPI within 60 (open full item for complete abstract)

Committee: Ana Hincapie Ph.D. (Committee Chair); Jianfei (Jeff) Guo Ph.D. (Committee Member); Eric Vick M.D. Ph.D. (Committee Member); Alex Lin Ph.D. (Committee Member); Rowena Schwartz (Committee Member); Roman Jandarov Ph.D. (Committee Member) Subjects: Pharmaceuticals

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2021, Health Programs

Routine HIV testing for adults 65 years and older is imperative for prevention and treatment efforts among the vulnerable population. To date, limited research exists that examines associations between sex in HIV testing, HIV risk perception, and HIV risk among adults who are 65 years and older. Certain risk behaviors can lead to missed testing opportunities for some Medicare beneficiaries aged 65 and older, increasing the likelihood of new HIV transmissions and late-stage diagnoses. A federal mandate requires that Medicare Part B (outpatient insurance) cover annual wellness visits, which allow providers and beneficiaries to develop personalized prevention plans of care. However, Medicare does not offer routine HIV testing to beneficiaries 65 years and older, unless they specifically ask for a test (risk perception) or considered at risk (actual risk). This quantitative, cross-sectional, causal-comparative research design was guided by the health belief model (HBM) and theory of gender and power (TGP). Chi-square tests analyzed secondary data from the 2018 National Health Interview Survey, Adult Sample file regarding HIV testing, HIV risk perception and HIV risk among non-institutionalized adults, 65 years and older. The significance of statistical tests was determined at the .05 alpha level. Study findings revealed a significant association between sex and HIV testing prevalence, with men (24.3%) testing more frequently than do women (20.1%). Findings also revealed a significant association between sex and HIV risk. Men (41%), when compared to women (22%), were almost twice as likely to have at least one factor increasing HIV risk. There was no significant association between sex and HIV risk perception. Findings revealed that both men (99.6%) and women (99.6%) equally lacked HIV risk perception.

Committee: Mary Bynum DHA (Committee Chair); Cynthia Smoak DHA (Committee Member); Chenelle Jones PhD (Committee Member) Subjects: Aging; Gender Studies; Gerontology; Health; Health Care; Health Care Management; Health Education; Public Administration; Public Health; Public Health Education

Doctor of Philosophy, Case Western Reserve University, 2019, Clinical Research

Brain metastases (BM) are the most frequent type of brain tumor, and cause significant morbidity and mortality. As imaging modalities improve, treatments improve and diagnoses increase in frequency, epidemiological studies of BM and its clinical outcomes become increasingly relevant and potentially beneficial to cancer patients. Here, we use large population-level data from the Surveillance, Epidemiology, and End-Results (SEER) program combined with Medicare claims to identify measures of BM incidence, claims algorithm concordance with SEER data, treatment patterns, and treatment efficacy for patients with BM arising from primary lung, breast, or skin cancers. We make use of both traditional epidemiological approaches to minimize confounding, such as age adjustment to a standard population, and more advanced methods, such as propensity score matching. By examining the Medicare claims of patients diagnosed with BM, the following chapters shed light on which patients develop BM, how BM patients benefit from an antineoplastic drug that may simultaneously relieve intracranial hypertension, and which patient populations are underserved with respect to BM treatment.

Committee: Jill Barnholtz-Sloan PhD (Advisor); Fredrick Schumacher PhD (Committee Chair); Jeremy Bordeaux MD (Committee Member); Andrew Sloan MD (Committee Member) Subjects: Biostatistics; Epidemiology; Health Sciences; Medicine; Neurology; Oncology

PhD, University of Cincinnati, 2018, Pharmacy: Pharmaceutical Sciences/Biopharmaceutics

Background: Generic Drug Discount Programs (GDDPs) offer many of the most commonly used prescription drugs at low out-of-pocket costs. GDDP-filled drugs are paid for in cash and not necessarily reported to potential payers. No claims may be generated for such purchases, presenting a problem for health-outcomes researchers and policy makers who rely on claims databases for quality and safety. Objectives: For antidiabetic, statin, and antihypertensive drugs available through GDDP programs that are used in Pharmacy Quality Alliance (PQA) performance measures, the objectives were to: (1) estimate national shares of GDDP-filled prescriptions and patients with GDDP-filled prescriptions; (2) determine patient characteristics associated with GDDP-use; and (3) determine covariates associated with GDDP-use in patients with Medicare or private-only insurance. The fourth objective of this study was to quantify the impact of drug exposure misclassification bias due to missing cash-only prescriptions on antidiabetic, renin-angiotensin system antagonist (RASA), and statin adherence measure estimates. Methods: The Medical Expenditure Panel Survey 2010-2014 was used for this study. Prescriptions were classified as GDDP-filled if the total price paid was out-of-pocket and: 1) the price paid and quantity dispensed exactly matched that provided from a total of 123 GDDP lists issued by 54 different pharmacy chains between 2009 and 2014; 2) the price paid and quantity dispensed was a multiple of the price and quantity listed on a GDDP; or 3) the price paid matched the GDDP price listed from pharmacies with a program stipulation of `up to 30 days' or `up to 90 days' and the quantity dispensed was less than the listed 30-day or 90-day quantity. A modified proportion of days covered (PDC) methodology was used to estimate adherence according to PQA-defined methodology. Participants with a PDC = 80% were considered adherent, and for each drug class the proportion of adherent participa (open full item for complete abstract)

Committee: Pamela Heaton Ph.D. (Committee Chair); Christina Kelton Ph.D. (Committee Member); Alex Lin Ph.D. (Committee Member); Heidi Luder PharmD (Committee Member); Erin Winstanley Ph.D. (Committee Member) Subjects: Pharmaceuticals

Master of Gerontological Studies, Miami University, 2017, Gerontology

Ohio has an older population who are more likely to live alone than other states. Older Ohioans are at higher risk of nursing home admission. Additionally, a recent study shows that nursing homes in Ohio have lower quality compared to the rest of the United States. Hence, improving nursing home quality in Ohio is paramount in the field of aging services. The goal of this current study was to identify factors that affect nursing home quality in Ohio using data from the 2013 Biennial Survey of Long-Term Care Facilities in Ohio for Nursing Facilities and 2013 fourth-quarter archived data from the Centers for Medicare and Medicaid Services Five-Star Rating System. Not-for-profit facilities with a low proportion of Medicaid days were more likely to be high performers in Health Inspection, Staffing, and Overall domains. Small facilities were more likely to be high performers in Staffing and Overall domains. Facilities that had no administrator turnover were more likely to be high performers in Health Inspection. Non-chain affiliated facilities performed better in the Staffing domain. Facilities with low STNA retention rates were at higher risk of receiving one- or two- star ratings in Overall. Implications for consumers, policy makers, and providers are discussed.

Committee: Jennifer Kinney (Committee Chair); Jane Straker (Committee Member); Robert Applebaum (Committee Member) Subjects: Gerontology

PHD, Kent State University, 2017, College of Public Health

Background: Medicare risk standardized hospital readmission rates (RSRRs) vary substantially among hospitals in the United States (U.S.). The Centers for Medicare and Medicaid Services (CMS) has indicated that variation in RSRRs suggests quality of care differences between hospitals. However, other factors beyond quality of care have been implicated in this variability. The purpose of this study was to assess the amount of variation in 30-day RSRRs attributable to the county of hospital location among fee-for service (FFS) Medicare beneficiaries with a principal discharge diagnosis of heart failure (HF), acute myocardial infarction (AMI), and pneumonia (PN) in the U.S. Methods: Data for the study were obtained from CMS, American Hospital Association (AHA), Area Health Resources Files (AHRF), County Health Rankings files, and U.S. Census Bureau data sets. Following data mergers, hierarchical linear modeling (HLM), with randomly varying intercepts, was conducted in SAS proc Glimmix. Results: For AMI, HF and PN 13.9, 37.3 and 26.5 percent respectively of variability in hospital-level RSRRs was attributable to the county of hospital location. Second, county-level per capita number of PCPs, percentage black-only resident population, the number of skilled nursing facilities per capita, and smoking rate were found to be statistically and independently associated with re-hospitalization across all three disease categories. Conclusions: Findings from this study indicate that county-level factors explain a notable amount of variability in hospital RSRRs, but the size of explained variability varies by medical condition. These findings underscore the importance of neighborhood factors in explaining variability in hospital-level RSRRs.

Committee: John Hoornbeek Ph.D (Committee Co-Chair); Jonathan VanGeest Ph.D (Committee Co-Chair); Jarrod Dalton Ph.D (Committee Member) Subjects: Health; Health Care; Health Care Management; Public Health; Public Policy

MS, University of Cincinnati, 2017, Engineering and Applied Science: Mechanical Engineering

This thesis presents a unified approach to integrate progressive care processes, multiple financial resources with the objective of satisfying elder's demand for services. Under the proposed elder care framework, several modeling tasks, prediction of elder's remaining life time, classification of elder's preference for care services, estimation of elder's care costs, and optimization of financial decisions are addressed systematically. An elder care financial plan is provided to maximize the elder's care service level with optimal purchasing decisions on financial resources. Markov Chain model is developed for predicting remaining life time. Personal physical profile is introduced in the form of covariates which are age, gender, health indicator and health history. It influences the transition probabilities from a care stage to another, so elders have their unique transition probability matrix in Markov model. Service level and pricing model aims to quantify elder's preference of care services through classification. Three financial resources are modeled: Medicare, long-term care insurance and reverse mortgage. The optimization model selects service fill rate as objective to maximize the depth of demand that is satisfied by the benefits from financial resources. The balance of total care costs, benefits and premiums of financial resources serve as main constraint. Furthermore, a heuristic algorithm is developed to enable these models work together to search for optimal solution. A case study is designed to show optimal decision sets. Purchasing decision set includes daily benefits, benefit period and purchasing age for long-term care insurance, purchasing age and contract rate for reverse mortgage. With the input of personal health profile, an optimal financial plan can be generated and track the wealth status (care cost, savings, benefits, and premium) of elder. Then, sensitivity analysis is carried out to investigate the uncertainty from personal health indica (open full item for complete abstract)

Committee: Samuel Huang Ph.D. (Committee Chair); Jay Lee Ph.D. (Committee Member); Jing Shi Ph.D. (Committee Member) Subjects: Engineering

Doctor of Philosophy, The Ohio State University, 1987, Graduate School

Committee: Not Provided (Other) Subjects: Home Economics

Doctor of Philosophy, Case Western Reserve University, 2015, Nursing

Parenteral nutrition (PN) is an intravenous infusion that is a vital nutrient source for an increasing number of individuals that is more commonly being administered in the home. Patients on home PN, their families and the interdisciplinary health care team, must collaborate to achieve optimal patient outcomes. Prior research on individual and family self-management and health outcomes of persons on home PN is lacking. Purpose and Theoretical framework: The Individual and Family Self-Management Theory (IFSMT) (Ryan and Sawin, 2009, 2014) comprised of the context (physical illness and impairments), process (health behaviors) and proximal and distal outcome dimensions. The relationships among the study variables of these dimensions were explored. Design: Exploratory, descriptive, retrospective analysis of an existing database. The Home Total Parenteral Nutrition database, electronic health record, educational reports and Health Professional Shortage Area Index were examined. Subjects: Adults new to home parenteral nutrition therapy in 2013, on PN therapy for 30 days or longer, and managed by the nutrition support teams were included in the sample. Those excluded required PN therapy for less than 30 days, were prescribed home IV fluids only, had previously received PN or were admitted to long-term care. Data analysis: Descriptive, chi-square and multiple and logistic regression statistics were used to address the research questions. Results: There were significant relationships between context variables: gender, females were 2.5 times more likely to be fully engaged; non-rural subjects were 4.7 times more likely to be fully engaged; subjects with short bowel syndrome (SBS)/malabsorption were 5 times more likely to be fully engaged as compared to those with obstruction/ileus. For every additional day on home PN therapy, the odds for being fully engaged in care increased by one percent. There were no significant relationships noted among (open full item for complete abstract)

Committee: Diana Morris (Committee Chair) Subjects: Nursing; Nutrition

MS, University of Cincinnati, 2014, Pharmacy: Pharmaceutical Sciences

OBJECTIVE: The objective of this study is to determine economic impact of body mass index (BMI) on clinical outcomes in adult renal transplant recipients. RATIONALE: Worse patient outcomes have been reported in renal transplant recipients with lower and elevated BMI; however, the economic consequences associated with BMI on renal transplantation have not been reported. Quantifying costs of BMI and the impact on renal transplant outcomes would allow for future cost-effective analyses to be conducted. METHODS: Data was obtained from a merged database of UNOS renal transplant registry and Medicare claims; collected by USRDS. Eligibility includes adult (>16) primary deceased and living donor kidney transplant recipients with BMI at transplantation and in which Medicare is the primary payer. BMI is categorized as WHO guidelines. Total direct medical costs related to patient morbidity and mortality and allograft function and survival will be assessed. Costs will be taken from the health-system perspective and will be standardized to 2012 dollars. RESULTS: After application of exclusion criteria and data validation, of the 22,616 deceased donor and 7,373 living kidney transplant recipients were evaluated, BMI was a significant predictor of cost up to 6 months post-transplant compared to the base patient case. On multivariable analysis, BMI categories > 35 were attributed to significantly higher charges for deceased donor recipients. We found at a BMI 35-39.9 there was a significant difference in charges at transplant, 1, 3, and 6 months of $4,107 (p=0.005), $1,327 (p=0.008), $1,127 (p=0.005) and $1,214 (p=0.009) respectively. For BMI > 40 there was a significant difference in charges at transplant, 1, 3, and 6 months of $13,662 (P<0.001), $3,061 (p=0.002), $2,835 (p<0.0001), $1,935 (p=0.031), respectively. Average 3-year accumulated charges were $14,874 and $51,922 higher for a BMI of 35-39.9 and BMI > 40. In living donor recipients, charges for B (open full item for complete abstract)

Committee: Jill Boone Pharm.D. (Committee Chair); Mark Eckman M.D. (Committee Member); Paul Volek M.P.H. (Committee Member); Teresa Cavanaugh Pharm.D. (Committee Member); Pamela Heaton Ph.D. (Committee Member) Subjects: Health Sciences

Ph.D., Antioch University, 2014, Leadership and Change

In 2010, an estimated population of the 311,212,863 Americans generated approximately 1,014,688,290 physician office encounters (Moore, 2010). The frequency and number of professional interactions between caregivers and patients/family members in medical office settings equated to a staggering 1,931 visits per minute. Based on the massive volume of interactions that occurred between patients of different races, ethnicities, genders, sexual orientations, and socioeconomic standings that generated an average household income of $49,445 in 2010 (United States Census Bureau, 2010a) with a physician workforce that the Association of American Medical Colleges (2010) captured as being 75% White that earned (primary care specialties) in excess of $190,000 per year in personal income (Hyden, 2011), a paradigm for potential discrimination is created through heterogeneous customers seeking health care services from a mostly affluent homogeneous workforce. What are the experiences of the underinsured in attempting to obtain routine and emergent medical care in the United States? Based on the identified void in the current body of scholarship that leaves silent the voices of millions of underserved and socioeconomically disadvantaged patients, this dissertation will extend the muted voices and, thus, create a platform to learn through the patients' personal contexts and unique health stories. The electronic version of this Dissertation is at OhioLink ETD Center, www.ohiolink.edu/etd.

Committee: Carolyn Kenny PhD (Committee Chair); Alan Guskin PhD (Committee Member); Laura Morgan Roberts PhD (Committee Member); Christine Phillips M.B.B.S. (Other) Subjects: Health Care; Health Care Management

Master of Science in Pharmaceutical Science (MSP), University of Toledo, 2013, College of Pharmacy

Medication non-adherence is commonly seen among patients with cardiovascular disease. However, failure to fill prescriptions, a type of medication non-adherence, is rarely studied among these patients. Failure to fill prescriptions, also known as primary medication non-adherence (PMN), can lead to progression of disease condition and adverse outcomes which can ultimately increase healthcare costs. Therefore, it is important for patients, especially who are newly diagnosed with cardiovascular disease to fill their prescriptions. The incidence of cardiovascular disease is higher in elderly population. Hence, elderly population is susceptible to PMN, but little is known about the extent of PMN for this population and its impact on health service utilization. Recent healthcare reform emphasizes on giving high quality care to elderly patients with chronic conditions such as cardiovascular disease. Since medication adherence is a quality measure for healthcare service received by this population, efforts should be made in identifying ways to improve PMN. Hence, the objective of this study is to measure the rate of PMN, assess reasons and factors that are associated with PMN and compare health service utilization behavior between adherent and non-adherent Medicare covered elderly population with newly diagnosed cardiovascular disease. This was a cross-sectional cohort study of Medicare beneficiaries with newly diagnosed cardiovascular disease using Medicare Current beneficiaries Survey (MCBS) files from 2002 to 2006. Andersen's model of health service utilization was used as a theoretical framework to define factors that may be associated with PMN. Seven thousand five hundred and forty-two Medicare beneficiaries were newly diagnosed with cardiovascular disease from years 2002 to 2006. Out of these, 334 patients did not fill prescriptions which represented 4.43% of the cohort under study. Female gender (OR 0.682, 95% CI 0.522-0.890), lower patient satisfaction score on ov (open full item for complete abstract)

Committee: Varun Vaidya PhD (Committee Chair); Sharrel Pinto PhD (Committee Member); Aliaksandr Amialchuk PhD (Committee Member) Subjects: Health Care; Pharmacy Sciences; Social Research

Master of Health and Human Services, Youngstown State University, 1999, Department of Health Professions

Traditional federal Medicare, which provides health insurance coverage for approximately 13% of the national population, spent $213 billion in 1997. Due to medical advances, escalating healthcare costs and the rising senior population, the existing Medicare program is predicted to be bankrupt by the year 2001. In an attempt to prevent this, the U.S. Department of Health and Human Services enacted legislation to allow commercial insurance plans to offer a managed care Medicare option. Because of low out-of-pocket costs and the extensive use of prevention programs associated with managed care Medicare, senior citizens are rapidly converting to these plans. It is important, then, to examine the quality of healthcare offered by both managed care Medicare and the traditional Medicare plan. This observational study used a descriptive correlation research design composed of a convenience sampling of Allegheny County, PA senior citizens attending community based, congregate senior centers. An adaptation of the Consumer Assessment of Health Plan Survey was used to determine perceptions of quality of care and sociodemographic variables. Using a proportional odds model, it was revealed in the data that the overall quality rating for type of insurance plan was predicted by the rating of physicians' skills, the perception that the plan provided the services needed, the amount of time the physician spent with the subject and educational level.

Committee: Carolyn Mikanowicz (Advisor) Subjects: Health Sciences, General