Doctor of Philosophy, The Ohio State University, 2023, Public Health

Introduction: Hepatitis C virus (HCV) causes more morbidity and mortality in the US than any other bloodborne infectious disease, despite highly effective treatments. Significant challenges remain in identifying patients with HCV and linking them to care. IV drug use is widely recognized as the most important driver of current HCV transmission. However, other routes, such as sexual transmission, also occur but are comparatively understudied except in certain subpopulations such as men who have sex with men (MSM). It is unknown how gender and sexual orientation interact to modify the importance of sexual risk factors for HCV for the entire population. This research aimed to explore correlates to HCV seropositivity across patient subpopulations and investigate factors associated with linkage to care. Methods: For 14,718 patients tested for HCV between 2017-2020 at the Columbus, Ohio public health department, multivariate logistic regression was used to investigate how HCV seropositivity was associated with patient characteristics, health behaviors, and history of sexually transmitted infections (STI) including HIV, and how gender and sexual orientation modified these associations. A second analysis of correlates to linkage to care used logistic regression models to explore how patient characteristics and Medicaid policy changes were associated with linkage to care outcomes, using data from the Ohio Disease Reporting System (ODRS) for a cohort of HCV RNA-positive patients in urban central Ohio. Results: There were differences in how sexual risk behaviors were associated with HCV between strata of gender and sexual orientation in multivariate models. IV drug use was positively associated with HCV for all strata; however, number of sexual partners was associated with HCV for MSM (AOR 1.01; 95% CI 1.00-1.02) and WSM (AOR 1.02; 95% CI 1.00-1.03) but not MSW or WSW. Sex with an IV drug user was positively associated with HCV across all strata except MSM (AOR 6.72; 95% (open full item for complete abstract)

Committee: JaNelle Ricks (Advisor); Alison Norris (Committee Member); Jose Bazan (Committee Member); Maria Gallo (Committee Member) Subjects: Public Health

Psy. D., Antioch University, 2014, Antioch New England: Clinical Psychology

In 2009, Gawande published an article in The New Yorker that put the unknown mid-sized South Texas city of McAllen on the map. The article stated that McAllen was one of the most expensive health care markets in the country; it caused such media-frenzy that in a few days President Barack Obama (2009) began citing McAllen in his speeches for health care reform. Gawande concluded that overspending in the area was due to overutilization of medical services. The present study examined whether mental health services are overutilized based on archival data on McAllen's mental health services collected from Medicaid, Tropical Texas Behavioral Health (a McAllen area community mental health center [CMHC]), and The Behavioral Center at Doctors Hospital at Renaissance (a McAllen area private hospital). Findings yielded that diagnostic-related groups significantly impacted the average length of stay, as well as total costs for psychiatric inpatient treatment in McAllen, TX. Schizophrenia spectrum disorders required more days of treatment within the hospital than Bipolar disorders and further more days than Depressive disorders. Correspondingly, inpatient treatment of Schizophrenia spectrum disorders cost an additional $5,554.80 when compared to Bipolar disorders and $9,095.16 more than for Depressive disorders. Additionally, the readmission rate at Doctors Hospital was 26.72%, with nearly 1/4 of patients being readmitted at least once, and nearly 7% had 4 or more psychiatric hospitalizations within a one-year period. This readmission rate was higher than the national average perhaps because of inadequate after-care outpatient treatment in McAllen. Medicaid data showed that Texas consistently failed to contribute any state moneys to mental health spending; and that Massachusetts saw a considerably smaller increase in mental health expenditures over a 10-year period for both inpatient and outpatient services when compared to the United States as a whole (i.e., 26% vs. 260% for (open full item for complete abstract)

Committee: Gargi Roysircar Ph.D. (Committee Chair); David Hamolsky Psy.D. (Committee Member); Carlotta Willis Ph.D. (Committee Member) Subjects: Clinical Psychology

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

To address the unprecedented economic challenges faced by the healthcare industry, healthcare employees are expected to cross traditional, professional and disciplinary boundaries and innovate. Many healthcare organizations are shifting focus from a profession-centered strategy (surgery, orthopedics, neurology, etc.) to patient-centered care; a move that requires a modification from singular professional expertise to interprofessional teams. There is little extant research about how physical work environment impacts interprofessional healthcare teams and the management interventions used to assist in the integration of interprofessional teams to improve the quality of patient-centered care. This dissertation employs a sequential mixed methods approach to explore the lived experiences of interprofessional teams collocated in a large Midwestern urban academic healthcare setting. Phase 1 utilizes a grounded theory study to investigate a high functioning interprofessional team to better understand the drivers for successful outcomes. Findings revealed that physical work environment (PWE) fostered access to xiv collaboration and showed evidence of reflexivity caused by trust in team structure. Phase 1 study findings informed the Phase 2 quantitative inquiry model investigating the possible mediating effect of PWE between Attitudes Value Teamwork (AVT) and Patient Centeredness (PC) and Attitudes Team Efficacy (AET) and PC. Responses from physicians (n=144) in this study indicated that AVT has a positive impact on patient centeredness (ß=.280; p<.000; indirect ß=380; p<.000). An unexpected finding was that there appeared to be no significant relationship between physician AET and PC. Phase 3 was conducted using a blended study employing latent- and manifest coded analysis of the historical artifacts generated from three interprofessional management design intervention projects. Findings from this phase indicate that successful integration of disparately located interpro (open full item for complete abstract)

Committee: Tony Lingham PhD (Committee Chair); Bonnie Richley PhD (Committee Member); J.B. Silvers PhD (Committee Member); James Young MD (Committee Member) Subjects: Health Care; Health Care Management; Management; Organizational Behavior