Ph.D., Antioch University, 2024, Leadership and Change

The persistent tension and power struggle between healthcare executives and physicians is a prevalent issue in healthcare organizations, often leading to a culture of organizational mistrust. This dynamic stems from perceived conflicting goals: executives are frequently seen as primarily focused on financial outcomes, while physicians are viewed as resistant to change. This study explored how physician fulfillment is experienced at work, with the ultimate goal of identifying potential interventions to bridge the gap between these groups. There is vast research and literature available regarding burnout in healthcare; this research focused on understanding what physicians find fulfilling in their work and identifying actionable factors healthcare system leaders can address to enhance their fulfillment. Key factors identified from the literature include meaningful patient contact, quality of professional relationships, and organizational decision-making input. At the same time, challenges such as administrative burden and loss of autonomy were noted as detriments to fulfillment. After conducting and transcribing semi-structured phenomenological interviews with physicians, the data were coded for meaning, resulting in 169 codes. The prevalence of these broad themes varied concerning each research question, reflecting the complex and multifaceted nature of physician fulfillment. By identifying patterns and connections in the physicians' experiences, this study highlighted the importance of addressing both systemic and individual factors to enhance professional fulfillment. Key findings of the study include the importance of humanizing healthcare goals and several directions for iv healthcare organizations: addressing moral injury, improving patient outcomes, obtaining and utilizing physician input consistently, fostering a supportive culture, and creating time and space for peer support. Targeted interventions to enhance physi (open full item for complete abstract)

Doctor of Education , University of Dayton, 2024, Educational Administration

Cardiovascular disease continues to be the number one killer of women in America, yet barriers to lifesaving healthcare increase (Centers for Disease Control and Prevention, 2022). Incidence of sexism in medicine proves to be a leading cause of these barriers including underrepresentation of female patients in crucial research studies, lack of understanding and education of female specific cardiac symptoms, and the underutilization of advanced diagnostic imaging tests for female patients who could produce suboptimal results in lesser diagnostic testing causing misdiagnosis. Feminist critical theories were used to challenge the gender gap within the medical field and research along with the communities of practice theory, showing how embedded sexism to the medical field creates an unconscious social learning upholding norms. Practical action research was used to conduct this study due to the direct connection between testing and diagnosis of patients, having the potential to make an impact on patient care on a larger scale. Research was conducted utilizing HIPAA compliant cardiology patient data obtained to observe the ordering patterns of physicians within cardiology practices. An anonymous Physicians' Knowledge of PET Eligibility and Symptoms for Female Patients scale survey was used to collect data from practicing cardiologists to view opinions, attitudes, and education around female specific cardiac symptoms. This data was analyzed using Chi-square tests to understand the relationship between various factors such as qualifying ICD-10 (diagnosis) codes, sex of the patient, and qualification for a cardiac PET scan. The results show that there was no significant relationship between sex and if the patient qualified for a cardiac PET scan, showing that physicians have a lack of understanding of the incredible benefits of cardiac PET for female patients, who are exceptional candidates for PET due to attenuation artifacts. Results also show a positive statistical rela (open full item for complete abstract)

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

Thousands of teenagers and young adults are confirmed victims, and many more are at risk of maltreatment and neglect. Foster care is a temporary solution by providing 24/7 care for these victims in kinship and non-kinship foster boarding homes. The study examined child welfare social workers in New York State in the child welfare field on their experiences that impact the delivery of quality healthcare and mental health services for teenagers and young adults in foster care. The qualitative study aimed to explore the experiences of child welfare caseworkers in New York's child welfare system regarding providing psychological and medical services to teenagers and young adults. By conducting interviews with professionals from various child welfare non-profit organizations, the research aimed to identify common themes and subthemes that impact the delivery of quality healthcare and mental health services to this vulnerable population. The researcher interviewed 15 child welfare caseworkers who coordinated providing needed psychological and medical services for teenagers (ages 13-19) and young adults (ages 20-21) in the state of New York's child welfare system. The Zoom media platform was utilized while all security protocols were followed by the researcher. The interviews were recorded and transcribed. The interview transcriptions were coded using ATLAS.ti to assist in identifying common themes and subthemes pertaining to the key issues affecting child welfare caseworkers and the delivery of psychological and physical medical services to teenagers and young adults.

Doctor of Business Administration (D.B.A.), Franklin University, 2024, Business Administration

This qualitative descriptive study explored how healthcare administrators (Pulmonary, Cardiology, or both) describe the influence of Palliative Care on savings for hospitals in the United States. Palliative Care is a supportive service that collaborates with specialists, Primary Care, patients, and families to provide quality care for those with chronic and serious illnesses. Palliative Care is a holistic service that meets physical, social, psychological, and spiritual needs. Patients with congestive heart failure and chronic obstructive lung disease tend to overutilize healthcare services such as the emergency room, admissions, readmissions, and intensive care unit stays. Palliative Care savings are not easily demonstrated on a revenue report but spread across the healthcare system. Hospital leadership may not provide resources for services with a perceived decrease in return on investment. Systems Theory is the central concept used for this study. Systems Theory is how the sum of individual teams or people work together to benefit the patient and, therefore, savings to the hospital. The study's question inquired about the healthcare administrator's experience with Palliative Care and associated hospital savings. The study collected 17 anonymous online surveys utilizing Microsoft Forms from healthcare administrators in the United States. The term healthcare administrators included healthcare administrators, directors, medical directors and managers working in Pulmonology, Cardiology, or both. This researcher invited participants through a recruitment flyer on the investigator's personal Facebook and LinkedIn pages, Facebook and LinkedIn group pages, and Reddit. An invitation was also sent to LinkedIn Connections and Facebook Friends by direct message for those who may be eligible for the study. Participants participated anonymously, and the researcher asked them to refrain from responding over direct messages. The researcher analyzed data using ATLAS (open full item for complete abstract)

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

The United States pediatric population is unique in that the epidemiological trends differ from those seen in the adult population. When discussing the pediatric emergency department (ED), this is typically a setting with high patient flow which requires swift diagnoses and treatment. Ideally, all patients should have equal opportunity to receive their highest possible level of quality healthcare, regardless of social determinants of health (SDOH) such as patient race/ethnic background, preferred spoken language, socioeconomic status, and insurance status. This is essentially the concept of health equity. The goal is to provide responsible and ethical healthcare to patients. If healthcare delivery is disproportionate, this may result in the overcrowding of EDs, delays in patient care, economic burden on the healthcare system, and increased morbidity and mortality. Some scholars have claimed that both individual and systemic biases have resulted in inequitable healthcare delivery. The following research study investigated health equity in the United States pediatric ED via the following question: What government and organizational policy changes can be made to enhance ED pediatric patient equity by utilizing first-hand information from ED physicians? The selected methodology for this research was qualitative and utilized in-depth semi-structured interviews of 15 pediatric ED physicians via Franklin University's Zoom platform. ATLAS.ti software was used to assist in identifying key themes and sub-themes from the code transcriptions.

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

As of the end of the twentieth century, biological drug therapies were at the forefront of health research for treating life-threatening diseases. Despite their therapeutical benefits stemming from providing great treatment hope against lethal diseases, biological drugs end up placing a financial burden on the American healthcare system. In the last decade, biological drug skyrocketing prices have significantly impacted net drug expenditures. The biological drug market needs more competitors. This impacted the passage of the Biological Price Competition and Innovation Act in 2010, introducing biosimilars, the highly safe and effective but less expensive biological copycat alternative drugs. However, a decade after biosimilars introduction, healthcare administration barriers limit American pharmacists and physicians from adopting biosimilars. Hence, the current low American health care provider biosimilar adoption rate must be improved to realize significant healthcare savings. Although many literature studies have examined biosimilar clinical adoption hurdles among American pharmacists and physicians in their siloed medical care settings, they have yet to focus on creating a comprehensive un-siloed biosimilar adoption plan based on their inputs. Therefore, to determine the essential elements to boost biosimilar adoption, this qualitative exploratory study thoroughly examined the literature. It then gathered the viewpoints of pharmacists and physicians who were acquainted with biosimilars by conducting semi-structured question interviews with 13 pharmacists and 8 physicians for a total of 21 participants. The findings of this study suggest that to create a dynamic and competitive biosimilar comprehensive clinical adoption plan, increasing HCPP education, having sufficient healthcare reimbursement, improving the roles of essential stakeholders, and increasing communication among key stakeholders are all necessary to increase biosimilars' trust and adoption, facilitati (open full item for complete abstract)

Master of Athletic Training, Marietta College, 2024, Athletic Training

Objective/Context: This research study aims to investigate changes, if any, to cardiovascular screening in the pre-participation physical examination (PPE) in the collegiate setting following the COVID-19 pandemic. The study aimed to identify modifications made to the PPE process along with certified athletic trainers' (ATs) perceptions of cardiac conditions occurring in Division III college athletes. Design and Setting: Cross-sectional online survey. Participants: The participants for this study were Division III Head ATs, with at least five years of experience in their current role and actively involved in collegiate athletics within the Midwest NATA districts 4, 5, and 11. This study was sent to 121 ATs and completed by 19 participants. Intervention: Participants completed an electronic survey consisting of demographic questions and questions about the PPE process. The survey collected data on baseline components of the cardiovascular assessment in the PPE process before COVID-19, modifications if any to the PPE process post-COVID-19, and ATs' perceptions of cardiac conditions among college athletes since COVID19. The survey instrument was distributed via email using the Microsoft Forms online platform. Data was collected over a five-week period. The research team developed the survey. The validity of the survey was assessed through experts in the field. Main Outcome Measurement: The survey assessed changes in the PPE process specific to cardiovascular health and ATs' perceptions of cardiac conditions for student athletes prior to and after COVID19. Results: Findings revealed consistent baseline components of the cardiovascular assessment in the PPE process before and after COVID-19, with minimal modifications made to the cardiovascular screening process post-pandemic. ATs reported stable perceptions of cardiac conditions among college athletes, with no significant increase post-COVID-19. The majority of respondents did not observe a rise in the prevalence (open full item for complete abstract)

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2024, Nursing

Chronic kidney disease (CKD) is the ninth leading cause of death in the United States. This project aimed to enhance Nurse Practitioners' (NP) knowledge and confidence in managing CKD through an innovative educational intervention. The project spanned six weeks. The interventions used in the project included an interactive workshop. The investigator created online education modules and case-based surveys. The interventions were intended to assess the NP's current and post-project knowledge regarding kidney preservation in high-risk populations and interventions and slowing disease progression. Data analysis initially indicated some positive support for the project. Despite challenges, adaptability proved crucial in ensuring the achievement of project goals. Limitations in the project hinged on the small sample size and limited participation. The project holds implications for interprofessional collaboration and population health partnerships and offers recommendations for sustained strategic planning. The findings highlighting the importance of ongoing adaptability and technology integration. Keywords: Chronic Kidney Disease, Kidney Function, Nurse Practitioners, Case Study

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

Female breast cancer contributes to over two million cancer cases each year worldwide and remains a top contributor to mortality. Expedient treatment may mean the difference between positive and negative survivor outcomes but when facing an aggressive subtype with no targeted treatment, how do oncologists get quick and correct care to their patients? Triple negative breast cancer accounts for approximately 15% of all breast cancer diagnoses each year. These patients are faced with a highly aggressive cancer that lacks positivity for all three molecular markers that can guide treatment. These patients are often younger, have multiple comorbidities, and have socioeconomic disparities that may affect their access to care. Understanding that triple negative breast cancer is chemosensitive, polychemotherapy remains the backbone of TNBC treatment. This research will delve into predictors that can affect time to treatment and survivor outcomes based on chemotherapy setting administration (adjuvant or neoadjuvant). This quantitative study utilizes the National Cancer Database – Public Use Files to identify triple negative breast cancer patients residing within the mid-Atlantic (New York, New Jersey, Pennsylvania) between 2004 and 2014 who had both chemotherapy and surgery as their treatment protocol (n = 4,528). Using generalized linear models and Cox Proportional Hazard Regressions, the data found that women treated in a comprehensive community cancer program had an average time to treatment of 3.7 days from date of diagnosis. Patients who were privately insured encountered a margin decrease in treatment time, waiting 3.5 days. Additionally, the analysis indicated that there is no significant difference in survivor outcomes at 60 months between adjuvant or neo-adjuvant chemotherapy administration. Hospital administration and healthcare leaders must be capable of providing insight and support to clinicians and encourage multidisciplinary collaboration. This colla (open full item for complete abstract)

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

Barriers for patients with limited English Proficiency (LEP) were identified decades ago but still plague the healthcare system in the United States. These inequities were further exposed during COVID-19 and challenge policy makers and researchers to examine the health system under a different lens. Literature is replete with providers providing insight on several shortcomings of telehealth such as the process in which technology is implemented within organizations, inefficiencies in workflows and barriers for some communities. Further, the coupling of telehealth encounters with language interpretation services creates more hesitancy amongst clinicians according to Rodriguez et al. (2020). Recently, Garber and Gustin (2022) published that a lack of available training is a common theme when studying physician hesitancy and the rate at which physicians adopt telehealth. Medical schools increasingly provide formal training on conducting telehealth visits (American Association of Medical Colleges, 2022). Yet, there remains a gap in training on how to effectively conduct synchronous video visits that include professional language interpreters. This study explored the impact of providing providers with practical tips on how to partner with professional language interpreters during telehealth encounters. This research measured the perceived ease-of-use component within the technology acceptance model (TAM) (Davis, 1989). Findings from this research have the potential to improve digital health equity by informing future curriculum development for medical education and training of providers to provide culturally and linguistically appropriate care during telehealth encounters.

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

Healthcare regulatory bodies require incident reporting and investigation as a way to identify operational hazards and shortcomings in safety. The goal of such reporting is to reduce factors that create unsafe conditions (OSHA, 2015). This often equates to finding problems and fixing them. Learning from errors is known to some researchers as Safety-I or improvement from learning from mistakes. Some research now suggests that there is more to be gained by learning from most healthcare episodes: the things that go right. The relationship between the old and new view of safety is sometimes proposed as one of substitution and sometimes as one of supplementation, but what is agreed upon is the underlying assumption that the complexity of current healthcare systems requires safety scientists to start thinking radically differently about how to create and sustain a safe and resilient healthcare system for patients (Pendersen, 2016). By emphasizing the importance of understanding the uncertainties and trade-offs in everyday work with its successes and failures, Safety-II offers a unique perspective on harm reduction in healthcare. Therefore, this qualitative study uses text data to examine and explore how condition reports advance Safety-II in occupational healthcare settings.

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

This study examined the representation of racial minorities in the demographic subpopulation of Hospital Consumers Assessment of Healthcare Providers and Services (HCAHPS) survey respondents. These survey scores are the basis for a substantial portion of financial compensation from the Centers for Medicare and Medicaid Services; they are used to drive the process improvement of patient-centered care. Considerable previous research has focused on factors that affect HCAHPS scores and made adjustments to the scores of many other demographic factors. However, none has focused specifically on race and representativeness, which is needed to ensure benefits for all health care consumers. Reliance on this mechanism as the single measure of patient experience on which financial decisions are made and improvement efforts are centered may be a further example of systemic racism in a system with an established history of racism. This study examined the use of a representative sample from a social justice perspective utilizing Rawls' framework from A Theory of Justice. Following the logic of this work, most people would not choose failing to hear diverse patient voices at a representative rate when blinded to their own identity, as this would not represent the choice most likely to result in patient-centered care for all health care consumers. This mixed-method, convergent parallel design study compared the sample of patients returning HCAHPS surveys, the inpatient population, and contextualized those results with semi-structured interviews with patient experience professionals to provide context to the need for a representative sample.

DNP, Walsh University, 2024, Nursing

Hypertension (HTN) is one of the most diagnosed conditions and is increasing in prevalence at an extreme rate. Although evidence-based recommendations include self-measured blood pressure (SMBP) twice daily, many older adults do not monitor their blood pressure outside of the clinic setting. Consistent education from healthcare professionals to patients on how to correctly measure blood pressure and address other risk factors of hypertension is lacking. This research study was designed to implement and evaluate the effectiveness of an SMBP training program for registered nurses (RNs) providing case management support to community-based older adults with essential hypertension in a Managed Care Organization (MCO) across Wisconsin. RN case managers completed a learning module and their hypertension management knowledge was measured at three points, pre-intervention, immediately post-intervention, and one-month post-intervention. Results were then compared via RM-ANOVA. A retrospective review of patient charts was also completed to determine if there was an increase in the patient recorded frequency of SMBP following the RN case manager training and compared via independent t-tests. The RN case managers' hypertension management knowledge increased significantly following education, with a slight decrease in scores over time. Retrospective chart reviews revealed that the frequency of documented patient blood pressure self-measurements increased significantly following RN case manager education. Implementing an evidence-based SMBP training program for RN case managers is a successful intervention to support the management of essential hypertension in community-based older adults.

PHD, Kent State University, 2024, College of Public Health

This study focused on evaluating the patient-reported psychological outcomes (PRPOs), including anxiety, depression, cancer-related post-traumatic stress disorder symptoms (CR-PTSD), fear of cancer recurrence (FCR), and post-traumatic growth (PTG), among surgically treated colorectal cancer (CRC) patients. Additionally, this study examined the association between coping strategies and these PRPOs. The research involved 23 CRC patients undergoing curative surgery. With the exception of FCR, which was measured only post-surgery, the study conducted assessments of all PRPOs and coping strategies at two crucial points: before and after the surgical intervention. Results demonstrated a significant reduction in anxiety levels post-surgery, while depression scores remained unchanged. PTG, particularly in the dimensions of Relating to Others and Appreciation of Life, showed significant increases, indicating potential positive psychological adaptation following surgery. In contrast, CR-PTSD symptoms were minor and exhibited negligible changes that were not statistically significant. For coping strategies, there was a significant improvement in problem-focused coping post-surgery, whereas emotion-focused and avoidant coping strategies remained unchanged. Despite improvements in certain psychological outcomes and coping strategies, the study identified a high frequency of FCR among participants post-surgery, with 70% reporting elevated levels (≥12). Regression analysis showed that problem-focused coping strategies were significantly associated with reduced anxiety levels and positively correlated with PTG factors over time. These findings highlight the importance of adaptive coping mechanisms in affecting psychological outcomes after CRC surgery. The persistent high levels of FCR post-surgery underline the need for targeted psychosocial interventions to address this prevalent concern among CRC survivors. In conclusion, this research underscores the complexity of psychological (open full item for complete abstract)

DNP, Otterbein University, 2024, Nursing

Nurses are known to be overworked, overwhelmed, undervalued, and understaffed atdangerous levels throughout various inpatient hospital units across the United States (U.S.). Nurses are known to be overworked, overwhelmed, undervalued, and understaffed at dangerous levels throughout various inpatient hospital units across the United States (U.S.). Hospital registered nurse (RN) turnover is a significant issue that has accelerated since the COVID-19 pandemic, resulting in economic impacts and other burdens for organizations, individuals, and communities. Evidence suggests that evaluating Registered Nurses' Turnover intention (NTI) and Organizational Commitment (OC) can help maintain a ready and capable team of skilled RNs; however, most healthcare organizations (HCOs) do not collect or analyze NTI and OC data and focus on staffing numbers and monetary incentives to get adequate nursing numbers. Research shows that RNs with higher OC tend to demonstrate lower NTI and stay in their profession, jobs, and HCO longer. In a local example of one 32-bed stroke unit at a large regional medical center in the Midwest, high staff RN attrition resulted in inadequate RN staffing and closed unit beds, delaying patients' access to timely care. Despite increasing staffing by 3.6 Full-Time RNs, the degree of NTI and OC among nurses working on the stroke unit remains unknown, placing the unit at increased risk of closing beds and disrupting care access in the future. Therefore, the purpose of this Quality Improvement (QI) Project was to provide new data to the Nursing Leadership and the healthcare executives who oversee RN staffing. The project was guided by the Plan-Do-Study-Act QI framework and aimed to evaluate the relationship between NTI and OC through a systematic record review of staff RN questionnaire response data following a unit's recent increase in RN staffing levels. Due to the sensitive nature of the data, the project's data collection could not occur. Despite the limitat (open full item for complete abstract)

Doctor of Education , University of Dayton, 2024, Educational Administration

School-based health centers (SBHCs) are a model of healthcare where services are delivered in clinics on school campuses (Kjolhede et al., 2021; Harris et al., 2016), with research indicating the delivery model has several educational benefits (Kjolhede et al., 2012; Arenson et al., 2019; Knop et al., 2016). Research findings supporting the use of SBHC; yet, these centers report low utilization of services. Teachers were identified as a main source of referral for students to SBHCs due to the amount of time teachers spend with students (Wade et al. 2008), connecting them as a driving source of inquiry for increasing further use of services for SBHCs. This study explores how to increase the use of services for a site-specific SBHC from the perspective of teachers and school administrators. The researcher used a case study methodology with data collected through eight semi-structured interviews with teachers and administrators at the research site. The findings report several themes contributing to underutilizing services for the SBHC: lack of information and communication on processes and procedures, under- developed relationships between SBHC and teachers and administrators, absence of teacher empowerment, and need for teacher and parent engagement with the SBHC. The findings were transferable with other SBHC studies; a formative concept of empowerment is unique to this study. compared to the three data sources used to create codes for the literature. Based on the findings, three recommendations were generated to improve the problem of practice: the research site should develop a formalized process for its SBHC and share information on the resources and processes concerning the SBHC with teachers; cultivate trust and develop meaningful relationships between teachers and the SBHC; and, empower teachers, structurally with policy development and psychologically with creating meaning on the impact and importance of referring students to the (open full item for complete abstract)

DNP, Otterbein University, 0, Nursing

Within the operating room (OR), identifying deteriorating patient conditions and effectively communicating are essential to delivering safe and efficient care. Although rare, the critical nature of emergent events necessitates early recognition and prompt intervention by an experienced anesthesia provider. The complexity of emergency management is often related to diagnostic ambiguity, individual provider experience, and disruptions of the fast-paced OR environment, requiring appropriate training methods for proficient execution. However, student registered nurse anesthetists (SRNAs) often lack sufficient exposure to emergent clinical scenarios, leading to delayed intervention and diminished confidence during crisis management. An evidence-based simulation education guideline for intraoperative emergency management was developed following a comprehensive literature review. This project aims to implement evidence-based practice guidelines for crisis resource management education using simulation for nurse anesthesia students in central Ohio. The evidence suggests that simulation learning effectively improves recognition of deteriorating patient conditions, critical decision-making, interdisciplinary teamwork, and student confidence.

Master of Science, The Ohio State University, 2024, Biostatistics

Accurate forecasting of weekly number of influenza (flu) lab tests and positive cases is vital for hospitals to provide adequate patient care at the right time. It also helps prevent shortages or overages of staffs and supplies. In this paper we present a practical implementation of a Bayesian Kalman filter to forecast weekly flu test and positive cases in a hospital environment. By integrating real time hospital data, this framework offers a robust methodology for accurately predicting flu volume one to four weeks out with a reasonable accuracy.

Master of Arts, The Ohio State University, 2024, Medical Humanities and Social Sciences

This pilot study considers how the reception of health information and risk perceptions are shaped and reshaped by reading others' confessions and accumulating one's own experiences. In addition, it will analyze how both work together to affect health decisions. For its object of focus, this research analyses Chinese author Fang Fang's Wuhan Diary (2020) and reviews the audience's reactions to the COVID-19 crisis, an event widely studied following the diary's publication (Wang & Rieger, 2022; Yu et al., 2023). Fang's work has proven to be controversial, drawing the attention of COVID-19 conspiracy theorists for its provocative political content and subsequent academic debate regarding the work's translation. Yet rather than focus on the book's political or literary content, this paper addresses Wuhan Diary as a source of information, seeking to understand how and to what extent Fang Fang's writings prompted the public to take preventive measures in any future public health crisis. Hence, this analysis shall uncover the significant factors influencing people's decisions around preventive health action.

Doctor of Philosophy, Case Western Reserve University, 2024, Management

This dissertation synthesizes two studies at ambulatory clinics of an academic medical center to understand the transition from exclusive telemedicine use during the pandemic to a preference for in-person care and the varied telemedicine practices among clinical specialties and individual clinicians. I used a multi-method approach incorporating process and variance methods and multilevel analysis over time to examine telemedicine's evolution and impact on the sociotechnical (ST) system and work practices. ST systems are analyzed using a novel second-generation framework of ST fusion and punctuated change over time, combining three frameworks to emphasize their co-evolution going beyond a specific state of “fit” at a singular level. The first study utilizes a systems dynamics model to illustrate how clinical actions, accessibility, and digital options dynamically interact during aggressive telemedicine implementation, leading to different outcomes based on implementation decisions. Varying influences create feedback and feedforward loops, potentially pushing the system toward a state of constrained access and action due to the increasing shift to in-person visits post-pandemic, workflow burdens, divergent clinical actions, and the absence of necessary contextual information for care. The second study shows significant variability in telemedicine for the same diagnoses, with clinicians being the primary driver of this variability and clinicians' perceptions of telemedicine use contingent on its ability to improve access. Time-based visualizations indicate consistent trends in low telemedicine users and declining trends among medium, high users with distinct clinician typologies based on in-group characteristics: Traditionalists (low), Pragmatists (medium), and Empiricists (high). Traditionalists prefer in-person visits for their relational aspects and professionalism, pragmatists value flexible, patient-centered care with a utilitarian telemedicine approach, and emp (open full item for complete abstract)