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Tebbe, Hope MEvaluation of Indoor Air Quality in Four Nursing Home Facilities in Northwest Ohio
Master of Science in Occupational Health, University of Toledo, 2017, Occupational Health (Industrial Hygiene)
Indoor air quality (IAQ) is considered one of the top five environmental risks to the public’s health. Older adults are more vulnerable to health complications associated with indoor air contaminants because of their decreased immune system and age-associated health problems, as well as the fact that they spend up to 95 percent of their time indoors. Area air sampling was conducted in the nursing home section of four long term care facilities, three days at each facility (12 days total). Particle concentrations (PM2.5, PM10, Total Particulate matter (TPM), Ultrafine Particles (UFP), temperature, and humidity were measured. Two minute samples were collected during seven Sampling Sessions. Up to nine indoor locations were sampled, representing the various occupied spaces in each nursing home, along with an outside location for comparison. Results of Analysis of Variance (ANOVA) by Facility demonstrated significant differences (p<0.001) in PM concentrations and UFP counts. One Facility had higher particulate concentrations at all Sampling Locations which may include contributions from geographic location, vehicular traffic, or resident clustering. ANOVA by Sampling Location demonstrated significant differences (p<0.001) in PM concentrations and UFP counts. In general, the highest UFP and PM concentrations were seen in the kitchen, satellite kitchen, and hair salon, especially at times when the staff and residents were active in these rooms. Significant differences were seen in UFP counts (Facilities 1 and 3) and PM2.5 (Facility 2) by Sampling Session. The highest concentrations were found for the Sampling Sessions in the mid-morning and mid-afternoon which were during peak times of activity for the residents. Although maximum temperature measurements exceeded ASHRAE winter guidelines, this may be appropriate for older residents who prefer a warmer temperature. While most median particle values were below ASHRAE guidelines, maximum values did exceed occasionally in the hair salon and kitchen at all facilities. Various indoor Sampling Location PM concentrations or UFP counts exceeded the outdoor levels at all four facilities. Although the median PM values did not exceed the ASHRAE standards it is unknown whether older adults may still experience significant health complications with these PM concentrations. In addition staff who spend extended amount of times in the kitchen and hair salon could be exposed to higher levels of PM. IAQ in hospitals and similar environments, such as nursing homes, may require a higher level of care because of the vulnerable population.

Committee:

April Ames, PhD, CIH (Committee Chair); Victoria Steiner, PhD (Committee Member); Akbar-Khanzadeh Farhang, PhD, CIH (Committee Member); Sheryl Milz, PhD, CIH (Committee Member)

Subjects:

Aging; Alternative Medicine; Engineering; Environmental Engineering; Environmental Health; Environmental Science; Environmental Studies; Gerontology; Health; Health Care Management; Health Sciences; Medicine; Occupational Health; Occupational Safety; Public Health; Welfare

Keywords:

Particulate Matter; Nursing Homes; Elderly; Indoor Air Quality; PM; IAQ; ASHRAE; Air Quality; susceptible population; buildings; Aging

Graham, Emily NicoleOptimizing Care for Oncologic and Hematologic Patients with Febrile Neutropenia
Master of Science, The Ohio State University, 2017, Allied Medicine
Background: Febrile neutropenia is considered an oncologic medical emergency. This means that of the Oncology and Hematologic population, those who are at risk for febrile neutropenia are at a higher risk of negative outcomes associated with the care of their illness. Those who develop febrile neutropenia are typically receiving chemotherapy or radiation treatment in response to their cancer diagnosis. Febrile neutropenia has been directly associated with long hospital length of stays and increased mortality rates. This study will evaluate the impact of time from ED arrival to first administered antibiotic based on process changes that were implemented and the impact of time to antibiotic on patient outcomes associated with length of stay. This study also identifies the opportunity for further improvements with this population by exploring risk stratification using the MASCC (Multinational Association of Supportive Care in Cancer) and the CISNE (Clinical Index of Stable Febrile Neutropenia) risk index scores for predicting complications and course of treatment. Design and Methods: The target population for the study consisted of cancer patients who presented to the ED with febrile neutropenia. This is a comparative study of two cohorts: cancer patients who presented to The Ohio State University Wexner Medical Center Emergency Department between October 1st, 2014 and June 30th, 2015, and those who presented between October 1st, 2015 and June 30th, 2016. Descriptive, explanatory and correlational statistical procedures were completed on the data. These procedures included calculating volume, index scores, means, and p-values for statistical significance. Results: The study findings regarding the impact of process improvement interventions revealed t-test equal variance t statistic of 6.716 and 340 degrees of freedom with a p-value of .000 with 95% confidence intervals of 49 and 91; demonstrating reduction in time to antibiotic as well as a reduction in variation between pre and post intervention. The analysis to determine correlation between time from ED Arrival to the first administration of broad spectrum antibiotic for patients who present with febrile neutropenia and Length of Stay Index (Observed to Expected Length of Stay based on UHC’s risk model) proved to have statistical significance. Correlation does not mean causation so the study simply proves that a positive correlation exists between the two variables. In addition two risk models were tested for potential use in risk stratifying febrile neutropenia patients in high and low risk; the MASCC score and the CISNE score. MASCC score has no statistical significance in terms of admit risk of mortality; however the CISNE proved to be statistically significant with a chi square p-value of .011. When the two risk models were compared in another chi square analysis and shown to be significantly associated. Conclusion: It is encouraging that continuing efforts to improve the care associated with febrile neutropenia related to time to antibiotics are directly impacting the outcomes of this population. This study identified certain risk factors that could risk stratify patients with febrile neutropenia in the Emergency Department and the CISNE risk index score demonstrated more significance when used at The Ohio State University Wexner Medical Center Emergency Department than the MASCC score on cancer patients with febrile neutropenia. Working to reduce time to antibiotic and risk stratifying these patients use a risk index scoring system like CISNE will help Emergency departments and clinicians across the continuum to provide better patient care for cancer patients with febrile neutropenia.

Committee:

Susan White (Committee Member); Miranda Gill (Committee Member); Laurie Rinehart-Thompson (Advisor)

Subjects:

Health Care; Health Care Management; Health Sciences; Medicine; Nursing; Oncology

Keywords:

Oncology, Emergency Department, Sepsis, Febrile Neutropenia, MASCC, CISNE, Risk model, Cancer ED, Hematology, Sepsis alert, oncogolic medical emergency

Nabiyouni, NasimA Lean Six-Sigma Approach to Red Bag Waste Management in Hospitals
Master of Science, University of Toledo, 2016, Engineering
Lean Six-Sigma methodology is an approach to improve value streams in term of meeting customer desire by elimination waste and defect. This method is a combination of lean thinking and Six-Sigma. Lean thinking provides an integrated overlook tool to business operations to perform more coherent technologies and assets flow instead of focusing to improve separate departments. Six-Sigma improves quality by decreasing the number of defects. The objective of this thesis is to eliminate errors in Regulated Medical Waste specifically red bag wastes. In order to achieve the goal of the research, lean six-sigma application in healthcare, a full process analysis of red bag waste in hospitals (including human factors), and an economic-environmental impact study of red bag waste and minimization methodology has been studied. Red bag waste is one type of regulated medical waste (RMW), also known as `biohazardous’ waste or 'infectious medical’ waste. This portion of the waste stream by definition is contaminated by blood, body fluids or other potentially infectious materials. In case of improper management, significant risk of transmitting infection would threaten the public heat and environment. In order to prevent confusion and mistakes in discarding these wastes, specified regulations and guidelines are developed. Each category of regulated medical waste has special handling requirements that may be state-specific. This thesis reveals the current red bag waste problems in an existing healthcare facility, a hospital in Toledo, Ohio. The study develops a universal model for improving red bag waste management value stream and focuses on human factors as key elements to improvement.

Committee:

Mathew Franchetti, Prof (Committee Chair); Kumar Ashok, Prof (Committee Member); Spivak Alex, Prof (Committee Member)

Subjects:

Engineering; Health Care Management

Keywords:

Lean, Six-Sigma, Lean in Healthcare, Red Bag Waste Management, Medical Waste Management

Mark, Margaret WoodrowPracticing Sacred Encounters: A Narrative Analysis of Relational, Spiritual, and Nursing Leadership
Ph.D., Antioch University, 2017, Leadership and Change
This research examined one large health system that has, through a stated mission outcome that every encounter is a sacred encounter, sought to enhance relationships occurring within the health care environment. Seeking to understand the lived experience of sacred encounters through the lens of nurse leaders in one acute care hospital settings this study examined how nurse leaders experienced their leadership role in realizing sacred encounters. Participants were defined as nurse leaders from one hospital setting and included nurse managers, directors and one vice president. A narrative thematic analysis framed by situational analysis was the method of inquiry. Data was gathered through an intensive interview process eliciting an in-depth exploration of the experience of the participants, along with their personal interpretation of that experience. Two questions were asked to each participant, the first to gain an understanding about their personal experience with sacred encounters and the second to allow the nurse leader to reflect on his or her personal leadership behavior as it related to the realization of sacred encounters within their primary area(s) of responsibility. A review of research of current literature focused on relational leadership, spiritual leadership and nursing leadership theory. The major finding was that organizational culture can be defined from the top of the organization and, through well-defined and purposeful leadership behaviors, be realized at the point of bedside care. This study was limited to a one-faith-based hospital. Future research should focus on broadening the scope of inquiry about organizational culture and how espoused culture can be translated into action through purposeful leadership behaviors. This dissertation is available in open access at AURA, https://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu/etd

Committee:

Jon Wergin, Ph.D. (Committee Chair); Elizabeth Hollaway, Ph.D. (Committee Member); Peter Vaill, D.B.A. (Other)

Subjects:

Health Care Management; Nursing; Organization Theory; Organizational Behavior

Keywords:

nursing; nurse managers; leadership; nurses; relational leadership; spiritual leadership; spirituality; organizational culture; narrative inquiry; organizational psychology

Brind'Amour, KatherineMaternal and Child Health Home Visiting Evaluations Using Large, Pre-Existing Data Sets
Doctor of Philosophy, The Ohio State University, 2016, Health Services Management and Policy
Introduction: Although popular and prevalent nationwide, maternal and early childhood home visiting interventions are, in many cases, of uncertain effectiveness. Methods: For Studies 1 and 2, the Nurse Family Partnership (NFP) Columbus, Ohio location was evaluated via propensity score matching with non-participants for its impact on a range of health outcomes. For Study 3, the National Survey of Children’s Health (NSCH) was used to create a nationally representative profile of the home visiting population using descriptive statistics and exploratory factor analysis. Results: In Studies 1 and 2, matching revealed greater likelihood to have a C-section, low birth weight, and to be enrolled in WIC for women and infants participating in the Columbus NFP compared to non-participating matches. In Study 3, descriptive statistics and exploratory factor analysis indicated substantial differences between participants and non-participants. Conclusions: There is no conclusive evidence that the Columbus NFP program is effective at achieving its stated goals; however, the studies’ limitations were considerable. The national profile created using the NSCH supports that there are substantial differences between participants and non-participants, with home visiting participants reflecting greater health and environmental risks and lower socioeconomic status, but perhaps better parental engagement. Improved data collection and evaluation methods, as well as confirmatory factor analysis and changes in questions for the NSCH data, may help improve opportunities for home visiting evaluation in the future.

Committee:

Thomas Wickizer (Committee Chair); Phyllis Pirie (Committee Member); Sharon Schweikhart (Committee Member); Sarah Keim (Committee Member)

Subjects:

Educational Evaluation; Families and Family Life; Health; Health Care Management; Health Education; Nursing; Public Administration; Public Health; Public Health Education; Womens Studies

Keywords:

home visiting; prenatal intervention; home health; program evaluation; public health; maternal and infant health; MIECHV; Nurse Family Partnership; National Survey of Childrens Health; propensity score; factor analysis

Lopetegui Lazo, Marcelo AInter-Observer Reliability Assessments in Continuous Observation Time Motion Studies
Master of Science, The Ohio State University, 2014, Public Health
Understanding clinical workflow is critical for researchers and decision makers in healthcare. Continuous observation time motion studies (TMS) enhance clinical workflow studies by providing quantitative data required for in-depth analyses. However, methodological inconsistencies have been reported in continuous observation TMS, potentially reducing the validity of TMS’ data and limiting their contribution to the general state of knowledge. Among the major concerns, the lack of methods to ensure the reliability of human observers stands as a priority. We aimed to contribute to workflow research by studying current Inter-Observer Reliability Assessment (IORA) methods in continuous observation TMS, particularly workflow time studies. We reviewed the current practices, assessed the suitability and limitations, bringing awareness of the limitations of the single-dimensionality evaluation methods. We proposed and validated a first contribution towards a comprehensive and meaningful IORA methodology: a composite IORA protocol evaluating agreement in multiple dimensions (proportion, naming, duration, sequence and timing), providing useful information for observers’ training and a meaningful quantitative IORA report. Applicability in multi-tasking and multi-focus models is the next step in IORA research, finally aiming at a meaningful and valid time motion-driven workflow analysis methodology.

Committee:

Po-Yin Yen, PhD, RN (Committee Co-Chair); Haikady Nagaraja, PhD (Committee Member); Peter Embi, MD, MS (Committee Chair); Philip Payne, PhD (Committee Member)

Subjects:

Health Care; Health Care Management; Industrial Engineering; Medicine; Statistics

Keywords:

Inter-observer reliability; time motion studies; standardization

Qadri, Sara FatimaPerceived Barriers of Adult Medicine Nurses for Providing Self-Management Education to Type 2 Diabetic Patients
Master of Science, The Ohio State University, 2014, Allied Medical Professions
According to available literature, controlling type 2 diabetes through self-management prevents additional complications that will increase healthcare costs. Nurses are in the first line for providing patients with self-management education and training, they typically get to know the patients on a more personal level than the physicians and address feelings and attitudes rather than just the disease itself. The fact that self-management education being provided by nurses is not consistent despite positive results and policy enforcement/recommendation is concerning. This study aims to assess the perceived attitudes and perceived barriers that exist thus contributing to the literature by describing the perceived self-management provider barriers that exist in a city funded Public Health system serving under represented communities, where the need for providing said self-management education is crucial. This study will address the following research objectives: 1. Describe adult medicine nurses perceptions that make giving diabetes self-management education challenging. 2. Describe adult medicine nurses level of training and ability to provide diabetes self-management education. 3. Describe techniques used by adult medicine nurses when providing diabetes self-management education to adult patients. This is a descriptive study utilizing a triangulation technique employing pre-collected de-identified data from both a questionnaire and focus groups/interview to optimize the objectives of the study. The data was collected as a quality assurance program by a second year Master of Public Health candidate completing Practicum hours at a large public health department in a major metropolitan American city. The sample utilized was convenience sample; thirty four participants (both nurses and CMAs) for the questionnaire and eight total nurses (from five different clinics) for the focus groups/interviews. None of the available participants declined participation. The data was examined qualitatively by three separate field experts for the emergence of themes and checked against each other for consensus. Themes emerging as barriers to providing patient education were both patient/provider and organizational in nature. Patient/provider barriers included themes such as: education level of patient, patient understanding/ acceptance of illness, compliance of medication, diet or exercise, language barrier, culture/religion, age of patient and income. Organizational barriers included themes such as: lack of current materials, time, short staffing, and lack of Certified Diabetes Educators. The themes that emerged were consistent with the available literature. Perceived expertise of the nurses was found to be inconsistent between the questionnaire and focus group/interview. Of the nurses who took the questionnaire, 75% felt they were knowledgeable and confident in their ability to provide appropriate self-management training. The other quarter stated their knowledge was &#x201c;adequate&#x201d; and they need more training. The focus groups/interviews, responses painted a different picture. The same nurses responded in these groups stating they did not feel confident in their knowledge and needed more time to perform the function and up to date training and materials to keep up with current practices. This difference is speculated to be due to the different methods utilized to collect the data. Finally, the methods used to provide self-management education identified were in line with adult learning techniques such as repeat, practical, reinforce and teach back. The responses are consistent with what the literature recommends, indicating the nurses know and understand the principles that are found in the literature. However, there is an opportunity to develop a more systematic approach in order to overcome the barriers identified through the first research question and ensure continuity of care.

Committee:

Jill Clutter (Advisor); Georgianna Sergakis (Committee Member); Randi Love (Committee Member)

Subjects:

Health Care Management; Public Health

Keywords:

Type 2 Diabetes; Self-management; Barriers; Perceived barriers

Motter, Asha AAnalysis of The Ohio State University College of Optometry Clinical Referral Process
Master of Science, The Ohio State University, 2014, Vision Science
Purpose: To analyze the effectiveness of the clinical referral process at The Ohio State University College of Optometry (OSUCO). This study should foster better understanding of factors that affect patient attendance at referral appointments as well as to identify clinical practices that will promote improved health care delivery. Method: Fifty records of patients referred from the College of Optometry to a specialist were identified and the data collected. In addition one hundred records were selected for the subsequent study. Subsequent study subjects were interviewed regarding patient’s perceptions of the effectiveness of the referral process. Calculations were performed to determine the probability of associations between each referral process and factors that may have had an effect on patient’s attendance at their referral appointment. Results: Pilot study results indicated it was feasible to obtain referral data from the OSUCO electronic health records and that further study could be considered. In addition the Pilot study did not reveal significant associations between referral processes and attendance at the referral appointment. Subsequent study results found that scheduling of the referral appointment increased with “Letter and Phone Call” referral communications. Caucasian patients were more likely to be referred using “Letter Only” referral communications when compared to other ethnicities. The Binocular Vision Clinic and Low Vision clinic were also more likely to use” Letter Only” referral communications when referring patients. Subsequent study results also found that patients who were referred with “Letter and Phone Call” referral communications had a statistically significant association with positive attendance at the referral appointment. Conclusions: The “Letter and Phone Call” referral communication method resulted in an increase in the patient attendance when compared to the “Letter Only” referral communication method. This difference, however, was not clinically meaningful because the 21.75% difference between the two methods did not meet the pre-set 50% threshold for a clinically meaningful difference. These results suggest that current OSUCO clinical practices are effective in ushering patients towards successful attendance of their referral appointments. It is quite possible that there are unstudied factors that may also affect successful attendance. Future investigations, can elaborate the hierarchy of those factors

Committee:

Jacqueline Davis, OD, MPH (Advisor)

Subjects:

Health Care; Health Care Management

Keywords:

Clinical Referral; Referral Communications; Referral Letters

Johnson, Kimberly LynnThe Structure and Implementation of Respiratory Therapy Orientation for Clinical Staff in Acute Care Hospitals
Master of Science, The Ohio State University, 2011, Allied Medical Professions
BACKGROUND: The healthcare industry relies on hospitals to employ competent individuals providing care to patients in many different specialties. There is a lack of research available that effectively describes the current state of Respiratory Therapy department orientation. The purposes of this study were to describe how respiratory therapy department managers have structured their new employee orientations programs to verify competency (using the competencies from the AARC’s 2015 and Beyond) and describe how these programs were designed to meet the JC standards. METHODS: This study was executed through the use of survey research methodology and used the list serves for the national Management and Education Section Memberships of the AARC to distribute the survey invitation email, which totaled 2,907 members. A request was made in the email for the recipient to forward the survey to the individual in the department who is responsible for new employee orientation. Thirty-seven of the sixty-nine competencies outlined in the 2015 & Beyond initiative were selected. The JC standards originated from the Human Resources section of the 2010 Hospital Accreditation Program Standards. RESULTS: From 449 respondents who accessed the online survey, 333 met the inclusion criteria. Fifty-five percent of respondents described their hospital type as a community hospital, 30.1% as Academic/Teaching, 4.0% as Children’s, and under the other option respondents listed types of hospitals as: LTACHs, specialty, and cardiology. Forty-two percent of respondents described their hospital location as urban, 30.6% as suburban, and 26.9% rural. Two hundred twenty-six (77%) respondents indicated newly hired staff therapists receive individualized orientation programs based on their needs or passed experience. Individuals responsible for conducting newly hired staff therapist orientation reported that additional training had been completed in order to be qualified to assure new staff competency. Of the AARC 2015 and Beyond competencies, 36 of the selected 37 were most frequently assessed with the observation of performing task (check-off) option. Only 8 out of 37 competencies were not assessed by greater than 25% of respondents. The JC topics for assessment used mixed methods, most commonly computer based learning, lecture, and handouts. All JC topics in the survey were covered by greater than 95% of respondents except for early warning signs of a changing patient condition. Significant differences were found between competency assurance for both location and hospital type for several competencies. Probationary periods of 60-90 days were frequently reported as a timeframe where new employees were expected demonstrate competency prior to termination. CONCLUSION: RT departments are qualified and excelling in assessing competency for new staff therapists and should continue to incorporate advanced skills for the 2015 & Beyond initiative. Methods used to assess competency should incorporate those beyond traditional tests and check-offs. Departments should consider the use of simulators due to the added benefits of learning retention, critical thinking, and teamwork skills.

Committee:

Sarah Varekojis (Advisor); F. Herbert Douce (Committee Member); Laurie Rinehart-Thompson (Committee Member)

Subjects:

Health Care; Health Care Management

Keywords:

Respiratory therapy; respiratory care; orientation; training; competency; assessment methods

Zelder, MartinPublic insurance, private insurance, and the demand for hospital care: implications for Medicare and private contracts
BA, Oberlin College, 1983, Economics

The findings of this paper can briefly be summarized. Demand, as measured by hospital admissions rate, is inelastic. Demand, as measured by mean length of stay, is elastic. A given amount of public hospital insurance has a small, but significantly larger effect on demand, by either measure, than an equal amount of private hospital insurance. These estimates can then be applied to several topics. One such topic is the effect of the Reagan Administration's plan to alter the Medicare benefit payment system. A second application measures the welfare loss (Martin Feldstein's phrase) of "excess" hospital insurance coverage, and the gains which would occur if patients were forced to pay a larger share of total costs. Finally, suggestions are made regarding structural changes in private insurance contracts, and ways in which these proposed changes can alter incentives, and thus alleviate tile health care crisis which plagues America.

Chapter 2 is a brief history of private hospital insurance, Medicare, and Medicaid. Chapter 3 is a review of pertinent literature. Chapter 4 describes the methodology used. Chapter 5 enumerates the results. Chapter 6 offers interpretation of the results. Chapter 7 analyzes the implications of the results obtained. Chapter 8 concludes the paper.

Committee:

David Cleeton (Advisor)

Subjects:

Economic History; Economics; Health Care; Health Care Management; Political Science

Keywords:

insurance;Medicare;United States;health care;

Gardner, John WallaceImproving Hospital Quality and Patient Safety - An Examination of Organizational Culture and Information Systems
Doctor of Philosophy, The Ohio State University, 2012, Business Administration

This dissertation examines the effects of safety culture, including operational climate and practices, as well as the adoption and use of information systems for delivering high quality healthcare and improved patient experience. Chapter 2 studies the influence of both general and outcome-specific hospital climate and quality practices on process of care. Primary survey data from 272 hospitals across the U.S. is combined with process of care performance data reported by the Center for Medicare and Medicaid Services (CMS). The results indicate that general safety climate and quality practices establish an environment in which outcome-specific efforts enable process quality improvement. A split-group structural equation modeling (SEM) analysis shows the employment of practices focused on specific outcome goals is found to relate to higher quality of patient care in smaller hospitals, whereas a climate focused on specific outcome goals is found to relate to higher quality of patient care in larger hospitals.

In Chapter 3, we test the influence of the adoption of healthcare information technologies (HIT) in relation to the use of data and analysis for organizational planning and error reduction. Secondary data on the levels of HIT adoption as reported by HIMSS and the Dorenfest Institute is combined with primary survey data from 2009 on the use and analysis of data in 272 U.S. hospitals; these data are combined with secondary data on hospital performance of process of care and patient satisfaction as reported by CMS. The results of hierarchical regression analyses indicate that HIT adoption and data use and analysis influence outcomes in different ways: hospitals with higher levels of HIT adoption and error data analysis are associated with higher process of care quality, while hospitals with higher levels of organizational data use are associated with higher patient satisfaction.

Chapter 4 examines the use of information systems for developing higher reliability in care in relation to the effects of adhering to specified care and workarounds to limitations in HIT. Secondary data on HIT adoption, CMS process of care, and patient experience of care are combined with primary data from a 2012 survey of hospital quality and nurse directors. The primary survey data measures three key factors: 1) the extent to which care providers use information systems in a patient-focused manner, 2) the extent to which providers adhere to specified care, and 3) the extent to which providers work around limitations in information systems. The results indicate that the contextual factors of hospital size and level of HIT investment play a significant role in understanding the use of healthcare information systems (HIS). For example, the use of HIS with focused attention on the patient is found to have a positive and slightly significant association with process of care in hospitals with more IT adoption, but is found to have a negative association with patients’ perceived experience of care in hospitals with less IT adoption.

This research addresses a crossroads of practical and theoretical implications for the future of patient safety culture and the use of healthcare information systems.

Committee:

Kenneth Boyer (Committee Co-Chair); Peter Ward (Committee Co-Chair); John Gray (Committee Member); Sharon Schweikhart (Committee Member)

Subjects:

Business Administration; Health Care; Health Care Management; Information Systems

Keywords:

healthcare; safety culture; information systems; quality

Quinn, Joann FarrellThe Impact Of Social Competencies And Role Factors On The Relational Construction Of Identity And Participation Of Physician Leaders
Doctor of Philosophy, Case Western Reserve University, 2013, Management
Physicians as many other professionals are often promoted into leadership roles based upon their clinical or professional performance. Yet, many do not have the skills or the inclination to lead. In a response to increase the effective influence of professional physician leaders in healthcare organizations, several studies have sought to identify factors that predict effective leadership. However, no exploration has been conducted to understand how physician leaders construe or identify with their leadership roles. In this thesis, I develop a theoretical model that offers an understanding of how a physician leader constructs a leadership identity involving a higher level of participation within their leadership role. The dissertation employs a sequential mixed methods approach to explore the nature and antecedents of effective physician leadership. The initial inquiry employs a grounded theory approach to understand how physician leaders come to construe themselves as effective leaders. The results of the initial inquiry offer evidence that differences in physician leaders’ effectiveness is partly explained by the social construction of their secondary professional identity. This happens through a process of individual, relational and organizational endorsement of their leadership role. To garner further insight and clarification of this role identity and endorsement I hypothesize a research model, which posits that professional participation in leadership roles is mediated by aspects of positive psychological climate. A follow up study seeks further clarification for this effect by examining the extent to which a positive psychological climate and role endorsement mediate the relationship between social competencies and physician leaders’ professional participation in leadership. In sum, these three studies offer new insights into how physicians and other professionals understand effective leadership and the factors that lead to commit themselves as an effective leader. These results expand theories of secondary leadership and also have several implications how organizations can support such leadership.

Committee:

Richard Boyatzis (Committee Chair); Melvin Smith (Committee Member); David Aron (Committee Member); Somers Toni (Committee Member)

Subjects:

Behavioral Psychology; Business Administration; Health Care Management; Management; Organizational Behavior; Personal Relationships; Psychology; Social Psychology; Social Research

Keywords:

physician leadership; competencies; identity; psychological climate

Kypriotakis, GeorgiosA Year in Their Lives: Trajectories of Well-Being Among Patients Diagnosed with Advanced Stage Cancer
Doctor of Philosophy, Case Western Reserve University, 2013, Sociology
Research on the well-being of older adults can increase the knowledge and information of care-providers and patients to better respond to needs pertaining to psychological, physical, spiritual, social and functional dimensions. In oncology there is a considerable amount of material of interventions aiming to improving the patient's well-being. However, in the literature there is a gap on empirical models that provide support of those interventions. The purpose of this study is to analyze longitudinal data on patients with advanced-stage cancer in order to describe multiple dimensions of their experience. Specifically the aims are: to identify trajectories and model the patterns of change of different domains of well-being; to capture variation in well-being outcomes attributed to modifiers such as demographics and utilization; to examine how the different domains of well-being relate overtime. Five hundred seventy six patients analyzed at baseline, who have data until death or for up to one year. In this study,six quality of life domains will be analyzed exploring the development in time and the interplay among them. All domains are assessed at baseline (on average 8 weeks after diagnosis) at 3 months, at 6 months, and at 12 months. Results of the study reinforce the strong presence of linkage among dimensions of well-being, as well as, individual characteristics. Moreover, the illness experience of the patients is been shown to be heterogeneous based on both survival time and personal characteristics, and thus not summarized by a single theory. Indeed, the study found that the illness trajectories are not reflected in the disease trajectory of the patients. From a methodological standpoint the need for complex models that better capture the reality of the patients' experiences is suggested. Findings also revealed important aspects of the patient's experiences relative to policy. Finally, the findings show that short-term survivors have both different patterns of change of well-being and different effects of covariates on their experience. This diverse type of experience must be acknowledged when caring for the advanced-stage cancer patient.

Committee:

Jessica Kelley-Moore (Committee Chair); Gary Deimling (Committee Member); Brian Gran (Committee Member); Julia Rose (Committee Member)

Subjects:

Health; Health Care; Health Care Management; Sociology

Keywords:

cancer; quality of life; well-being; longitudinal; social constructionism

Elsaeiby, AberHealthcare Operations Management: Models for Improving Productivity, Scheduling and Quality
Doctor of Philosophy, University of Toledo, 2015, Manufacturing and Technology Management
The healthcare sector of the economy has traditionally operated on the philosophy “quality service delivery at any cost”. With healthcare cost rising much above inflation rates for many decades, it has become a prime target for improving efficiency, productivity and quality using operations management tools used in the manufacturing sector. Drawing from the concepts and tools used for productivity, scheduling and quality improvement in production and operations management literature, this dissertation attempts to identify factors that enhance productivity and increase value delivered by hospitals through three main essays. The first two essays are focused on productivity and scheduling of operating rooms within hospitals while the third essay explores how structural, process and patient centeredness affect outcome quality of care delivered by hospitals.

Committee:

P.S. Sundararaghavan (Committee Co-Chair); Yue Zhang (Committee Co-Chair); Andrew Casabianca (Committee Member); Vikas Agrawal (Committee Member); Jenell Wittmer (Committee Member)

Subjects:

Health Care Management; Management; Operations Research

Pathak, AmitForecasting Models to Predict EQ-5D Model Indicators for Population Health Improvement
Master of Science (MS), Ohio University, 2016, Industrial and Systems Engineering (Engineering and Technology)
The healthcare sector possesses big issues needing to be addressed in a number of nations including the United States. Problems within and effecting healthcare arena are complex as they are interdependent on several factors. It. To cope this situation and find solutions, best of predictions backed by data for effective decision making are required. Even though predictions are made, it takes extreme cautiousness to make claims for policy inaction. The EuroQol five Dimension (EQ-5D) questionnaire developed by the Euro-Qol group is one of the most widespread used tools assessing the generic health status of a population using 5 dimensions namely mobility, self-care, usual activities, pain/discomfort and anxiety/depression. This thesis develops a methodology to create forecasting models to predict these EQ-5D model indicators using chosen 65 indicators, capable of defining population health, from the World Bank, World Health Organization and the United Nations Development Programme databases. The thesis provides the capability to gauge an insight into the well-being at individual levels of population by maneuvering the macroscopic factors. The analysis involves data from 12 countries namely Argentina, Belgium, Denmark, Finland, France, Germany, Italy, Netherlands, Slovenia, Spain and United States, for both sexes with ages ranging from 18 to 75+. The models are created using Artificial Neural Networks (ANN) and are contrasted with statistical models. It is observed that the ANN model with all 65 indicators performed the best and the age group of 75+ was found to be the most correlated with EQ-5D dimensions. Conclusively the research also provides with the countries and indicators that need the most attention to improve the corresponding EQ-5D parameter. This thesis aims at fostering better policy making for increasing well-being of populations by understanding the impact of predominating factors affecting population health.

Committee:

Gary Weckman (Advisor); Diana Schwerha (Committee Member); Tao Yuan (Committee Member); Andy Snow (Committee Member)

Subjects:

Aging; Artificial Intelligence; Behavioral Psychology; Behavioral Sciences; Behaviorial Sciences; Cognitive Psychology; Demographics; Demography; Developmental Psychology; Economics; Educational Tests and Measurements; Evolution and Development; Finance; Gender Studies; Health; Health Care; Health Care Management; Health Sciences; Higher Education; Industrial Engineering; Information Science; Information Systems; Information Technology; Literacy; Mental Health; Public Health; Public Policy; Sanitation; Social Psychology; Social Research; Statistics; Sustainability

Keywords:

Population Health;EQ-5D;Forecasting;Policy;Artificial Neural Networks;Statistics;Healthcare;Visualize;Data; Decision;World Bank,World Health Organization;WHO;United Nations Development Programme;UNDP; Indicator;Regression;Exploratory;Principal Components

Ellison, Thomas A.Toward Transforming Health Systems: A Practice Study of Organizing and Practical Inquiry in Academic Medicine
Ph.D., Antioch University, 2015, Leadership and Change
Transformation of health care systems will be grounded in new professional relations and collective, cross-disciplinary actions to impact care delivery. Organizing such relations and actions involves practical inquiry rather than applying professional knowledge. This dissertation presents an exploratory, performative study of the initial organizing of the Health Systems Innovation and Research (HSIR) Program in Health Sciences at the University of Utah. The HSIR program was conceived principally to catalyze cross-disciplinary innovation and health services research and enhance care delivery changes by documenting care improvements and publishing research. This study includes a composite narrative of the organizing and practical inquiry work of HSIR organizers, which highlights many questions, issues, possibilities, and priority shifts that would likely face those who would seek to transform care delivery and the cultures of academic medicine. The study identifies improvement, integration, and transformative strategies as pathways to effect change in health systems. The study includes a narrative-based analysis of cultural, dynamic, and narrative resources to enhance understanding of the HSIR story and the implications of cultural and dynamic influences for the Program’s future and health systems transformation. This analysis emphasizes the cultural and dynamic influences of academic and clinical departments and other sources of dynamic influence that were operating to hinder or facilitate the larger objectives of HSIR organizers. The study also explores the significance of collective practical inquiry, exploratory inquiry, and culture change to the practice and theory of leadership and change. The HSIR study was conducted using a practice study methodology developed from practice and narrative theories, with contributions from complexity, process, learning, organizing, social construction, and relational theories and empirical studies of professionals undergoing change. The methodology recognizes an expansive, relational complex of practice as the empirical world to be studied, and was designed to explore practical inquiry, organizing, and collective actions of professionals in changing organizational situations. Methodological design principles focus data collection and analysis on situated activities, local discoveries, practical understandings, dynamic and cultural influences, narrative connections, future possibilities, and significant matters identified by practice participants. The electronic version of this dissertation is at Ohiolink ETD Center, http://etd.ohiolink.edu and AURA, http://aura.antioch.edu/

Committee:

Alan Guskin, Ph.D. (Committee Chair); Laura Roberts, Ph.D. (Committee Member); Jon Wergin, Ph.D. (Committee Member); William Plater, Ph.D. (Other)

Subjects:

Health Care Management; Organization Theory; Organizational Behavior; Social Research

Keywords:

Practice theory; organizing; organizational change; dynamics; culture change; narrative; practical inquiry; exploration; integration; transformation; professionals; collective action; health systems; academic medicine; practice studies; leadership

Gandhari, Revanth Kumar ReddyObstetric Unit Capacity Optimization and Consolidation Analysis Using Simulation Modeling and Using Analytical Hierarchy Process
Master of Science, University of Akron, 2015, Mechanical Engineering
Healthcare costs are exponentially increasing in the world and especially in the US. In such an expensive field, it is important to eliminate all the waste from the system. Waste can be found in many forms like excess resources, staffing, unnecessary process steps, rework etc. Hospitals experience high variation in the incoming patient volume throughout the year. Unlike manufacturing industry, it is impossible to control variation in healthcare. As the years go by, the patient volume varies which could be an upward trend or a downward trend. As the patient volume changes, it is important to stay updated on the number of beds required to accommodate the patients. Many techniques have been used by the hospitals to estimate the bed requirements. Most hospitals use the occupancy method in which the management estimates the bed requirement to reach 80% occupancy. Due to the variation in incoming patient volume, such method would lead to excess delays in patient care. In today’s competitive world, patient satisfaction is extremely important to generate revenue. The task is to minimize delays while keeping the operating costs at minimum. More advanced methods are required to estimate the required amount of resources considering the variation in the patient arrival rate. In case if the hospital management decides to consolidate their facilities, how much capacity do they need? How many patients are they about to see? After literature review, research in such area has not been found. This research concentrates on exploring such scenarios in effort to add to the body of knowledge in the area. In this research, a simulation model is built to study the current operating conditions of the system followed by optimizing the capacity of an Obstetric unit. Patient volume projections in case of consolidation have been estimated followed by estimating the resources required if consolidated. Finally analytical hierarchy process is used to assist in decision making considering numerous decision criteria and alternatives available.

Committee:

Shengyong Wang, Dr. (Advisor); Celal Batur, Dr. (Committee Member); Chen Ling, Dr. (Committee Member)

Subjects:

Engineering; Health Care; Health Care Management; Mechanical Engineering; Obstetrics

Keywords:

Obstetric unit capacity estimation and consolidation

Hamilton, Angela M.The Relationship of Food Insecurity to Health Parameters in Adult Women with Polycystic Ovary Syndrome (PCOS)
Master of Science (MS), Ohio University, 2014, Food and Nutrition Sciences (Health Sciences and Professions)
Polycystic Ovary Syndrome (PCOS) may increase the risk for high blood glucose, infertility, depression, and overweight/obesity. Food insecurity or other nutrition and health factors may precipitate or result from PCOS. This study was designed to examine the relationship of household food security to fasting blood glucose, body mass index (BMI), produce intake, and depression in adult females with PCOS living in rural Appalachian Ohio. Females aged 18 years and older who attended a clinic for the care and management of PCOS were recruited by mailed invitation. A survey included questions from the U.S. Department of Agriculture household adult food security module, a depression scale, and a validated produce intake and behavior survey. Anthropometrics and biochemical indicators for blood glucose and lipid panel results were obtained from the clinics. Pearson’s r and Kendall’s Tau-b correlations were used to assess the relationship of household food security to other parameters. Participants (n = 54) were 32 ± 9 years and had a BMI of 34.5 ± 8.8kg/m2 (n = 39). Participants were primarily fully food secure and lived in households characterized by high household food security (n = 35, 64.8%). However, 19 (35.2%) participants were not fully food secure, and of these women, 7 (13.0%), 9 (16.7%), and 3 (5.6%) lived in households characterized by marginal, low, and very low household food security, respectively. According to the depression scale, 27 of 54 (50.0%) respondents had some degree of depression, with 18 (33.3%) having major depression. Daily vegetable, fruit, and total produce servings (n = 52) were 2.6 ± 1.8, 1.9 ± 0.9, 4.4 ± 2.3, respectively. For all participants with produce intake data (n = 52), 34 (65.4%), 37 (71.2%), and 36 (69.2%) met vegetable, fruit, and, total produce intake recommendations, respectively. Food insecure participants showed significantly higher rates of depression than the food secure participants (r = 0.466, p < .001). Lower food security was also associated with smoking (r = 0.285, p = .026), poorer daily vegetable intake (r = -0.337, p = .015), poorer total daily produce intake (r = -0.315, p = .023), lower perceived benefits of produce (r = -0.293, p = .032), lower predisposing domain score (r = -0.278, p = .042), and a smaller change in all domains (r = -0.280, p = .041). Additionally, the 7-item fruit and vegetable scores were significantly higher in food secure women (r = -0.297, p = .029). Other parameters were not significantly related to household food security. Overall, in females with PCOS, food insecurity was related to depression, smoking, and poorer produce intakes and behaviors. Further exploration is warranted in a larger sample to clarify these trends.

Committee:

David Holben (Advisor); Darlene Berryman (Committee Member); Jay Shubrook (Committee Member)

Subjects:

Health; Health Care; Health Care Management; Health Sciences

Keywords:

food insecurity; food security; polycystic ovary syndrome; PCOS; depression; women; health; diabetes; infertility; fertility; pregnancy; overweight; obesity; gardening; fruit; vegetable; produce intake

Howe, Samantha AnnePublic Engagement in Healthcare Policy Formulation: Contexts, Content, and Identity Construction
Doctor of Philosophy, The Ohio State University, 2013, Public Policy and Management
Background: The passage of the federal Patient Protection and Affordability of Care Act (PPACA) has forced a renewed discussion of the appropriate cost, coverage, and organization of health insurance at the state level. In attempting to address the federal requirements public officials must grapple with complex, technical and politically treacherous issues. In order to address these demands, institutions may find that citizen engagement in the decision process is especially useful. Methods: First, this dissertation introduces a typology of contexts for participation. The typology informs theory and practice and is drawn heavily from the literatures of political science and public administration. It is then supported empirically through application to a sample of case studies already in these literatures. This dissertation then utilizes a case study approach to investigate the application of participatory processes to healthcare. The state of Oregon is seeking to include citizens in the decision-making process as they set about to meet the requirements of the new federal health care laws. Utilizing content analysis of town hall meetings and interviews with decision-makers this research investigates the qualities of citizen participation, including in what ways citizens speak about health care and how officials interpret this input given the highly expertise dominated nature of the discussion. Implications: The typology of this dissertation provides numerous implications for participation scholars; it suggests directions for future research and indicates new potential for utilizing research that has already been conducted. The Oregon case study of participation similarly suggests new avenues of research. This case was chosen because it is in an area in which the outcomes are typically highly technical and expert driven. Yet, it is also one of many areas in which citizens are demanding more control. This implies a discussion that not only must attend to a complex and technical subject matter but also to the rich, value-laden nature of the decisions to be made. The case study approach makes it possible to identify the mechanisms for navigating these multiple, coinciding conversations and the results thereof. Finally, this research suggests new trends in how women participate in healthcare discourse. The findings suggest that concerns about the representativeness of participants should remain a part of the bureaucratic consciousness. Caution regarding who participates and how remains necessary in order to avoid the risk of process capture by those who already retain power.

Committee:

David Landsbergen, JD, PhD (Advisor); Jill Bystydzienski, PhD (Committee Member); Michael Neblo, PhD (Committee Member); Sandra Tanenbaum, PhD (Committee Member)

Subjects:

Health Care Management; Political Science; Public Administration; Public Health; Public Policy

Keywords:

citizen participation; civic engagement; health policy; gender politics

Vincent, Alexander C.What Do People Entering the Field of Long-Term Care Administration Need to Know?
Master of Arts, Miami University, 2012, Gerontology
Given the rapidly changing world of long-term care and the evolving role of administrators and the regulatory standards they are required to meet, it is not clear what new administrators coming into the field need to know to practice effectively. The purpose of this study is to learn out what people entering the field of long-term care administration need to know from licensed administrators. This qualitative study used a three-pronged approach to examine: required curriculum for administrators (Core of Knowledge, Administrator in Training, and licensure testing), relevant texts on effective long-term care administration, and advice about effective practices from seasoned administrators. Seven administrators participated in in-depth interviews. Findings indicate that administrators felt they lacked knowledge in many key areas including: knowing the scope of what the job entails, personnel management, financial management, and documentation. They also stressed that love of older residents was a key component of job success.

Committee:

Kathryn de Medeiros, PhD (Committee Chair); Suzanne Kunkel, PhD (Committee Member); Robert Applebaum, PhD (Committee Member)

Subjects:

Aging; Gerontology; Health Care Management

Keywords:

long-term care administration; long term care; core of knowledge; health care administration; aging; administrator training

O'Connor, Matthew SAssessment of the Measurement Properties of the NHCAHPS Family Survey: A Rasch Scaling Approach
Doctor of Philosophy, University of Toledo, 2013, Foundations of Education - Research and Measurement
The introduction of the Consumer Assessment of Healthcare Providers and Systems (CAHPS), a family of survey instruments designed to capture and report people’s experiences obtaining health care could soon add satisfaction as a consistent dimension of quality that skilled nursing facilities (SNFs) are required to assess and report. The SNF setting has not yet been mandated to implement CAHPS for Nursing Homes (NHCAHPS). Given the critical implications (e.g., comparisons of SNFs on NHCAHPS scores) and decisions resulting from performance on the NHCAHPS survey (i.e., Medicare reimbursement) it was imperative to construct a measure of family satisfaction. The data were analyzed with the Rasch rating scale model. Rasch analyses demonstrate that the NHCAHPS Family Survey has adequate reliability, separation, fit, rating scale functioning, and dimensionality. Particular attention was given to the Overall Rating of Care item. According to the Rasch diagnostic indices, the NHCAHPS Family Survey composite domains did not function well. Results are discussed in terms of their application to usefulness by SNF management teams for process improvement and to include in the Five-Star Quality Rating System.

Committee:

Christine Fox, PhD (Committee Chair); Gregory Stone, PhD (Committee Member); Noela Naughton, PhD (Committee Member); John Gallick, PhD (Committee Member)

Subjects:

Health Care; Health Care Management; Statistics

Keywords:

Rasch; customer satisfaction; healthcare; CAHPS; NHCAHPS; skilled nursing

Gopalkrishnan, PurnimaWorkplace Incivility and Employee Strain Reactions: The Moderating Effects of Perceived Organizational Support and Job Insecurity
Master of Arts (MA), Bowling Green State University, 2011, Psychology/Industrial-Organizational
Workplace incivility was first defined by Anderson and Pearson (1999) as a less intense form of deviant behavior with ambiguous intent to harm. Although past research has established the relationship between incivility and strain reactions experienced by targets of incivility, this paper proposes not only to provide further evidence for this relationship, but also to contribute to our knowledge by exploring the moderating effects of Perceived Organizational Support (POS) and Job Insecurity. POS refers to the belief that the organization cares about its employees and values their contribution. On the basis of social support theory, it was hypothesized that POS would moderate the relationship between incivility and strain reactions by acting as a buffer against negative workplace interactions such as incivility. At the same time, job insecurity would act as a moderator between incivility and strain in such a way that it would be likely to enhance the negative effects of workplace incivility on employee experiences of strain. In this study, strain was measured at both the physical and psychological level. Data was collected from 167 nurses currently registered in the state of Ohio as part of a larger study funded by NIOSH. All of the main effect hypothesis between the independent and moderator variables and the dependent variables were supported. However, the moderation hypotheses were not supported. Also, exploratory analyses were conducted to see if various sources of incivility (for ex. Physicians, other nurses, supervisors etc.) made a difference to the amount of well-being experienced by nurses. Issues relating to small sample size and lack of power as well as future directions are discussed.

Committee:

Steve Jex, PhD (Advisor); Mike Zickar, PhD (Committee Member); William O'Brien, PhD (Committee Member)

Subjects:

Behavioral Psychology; Behavioral Sciences; Behaviorial Sciences; Health Care Management; Occupational Psychology; Organization Theory; Organizational Behavior; Psychology

Keywords:

Incivility; strain; perceived organizational support; job insecurity; moderators;

Zhang, HuilanThree Studies on Lean Implementation in U.S. Hospitals
Doctor of Philosophy, University of Toledo, 2017, Manufacturing and Technology Management
The United States spent over $2.75 trillion on health care in 2013, as compared to costs of $714 billion in 1990, and $253 billion in 1980. Despite having the most expensive healthcare system in the world, the United States ranks last or near last among 11 developed countries on dimensions of quality, efficiency, and access to care, according to a Commonwealth Fund Report (Davis et al., 2014). It is imperative that the healthcare industry pursues strategies to control costs, improve quality, and enhance efficiency. In more than a decade, lean thinking has been implemented by an increasing number of hospitals in the United States. Lean thinking implementation initiatives tend to be driven by the need to reduce costs, and to improve quality and efficiency (Brandao de Souza, 2009; Radnor et al., 2012). Anecdotal evidence shows that lean thinking has been successful in some U.S. hospitals (e.g. Virginia Mason, ThedaCare, Johns Hopkins, and Mayo Clinic). However, it is noted that lean is still in an early stage of development and has not been effectively implemented by a large number of healthcare organizations (Brandao de Souza; Min 2014). This doctoral dissertation is motivated by challenges facing the healthcare industry and the low degree of lean implementation in healthcare industry. The dissertation consists of three independent manuscripts on lean implementation in U.S. hospitals. Manuscript one empirically investigates the characteristics of hospitals that are implementing lean thinking and the performance consequences of lean implementation. Using a panel data set of lean hospitals across the United States and performing two-stage analysis, I find that lean thinking implementation is significantly associated with competition, resource availability and outsourcing. Moreover, there is strong evidence that the association between lean implementation and nonfinancial performance is a function of the “match” between lean implementation and hospital’s characteristics. With respect to financial performance, I find weak support for hypothesis that the relationship between lean implementation and current financial performance is contingent on hospital characteristics. Manuscript two addresses a research gap in the accounting literature by empirically investigating the relationship between board composition and healthcare outcomes in lean hospitals. Using a cross-sectional sample from U.S. short-term, general, acute care hospitals, I find that compared to hospitals with lean implementation in some departments, hospitals with lean implementation across hospitals are likely to have higher patient satisfaction, and higher quality of care in terms of Pneumonia and Stroke. In regard to board independence, I find a positive but not statistically significant relationship between degree of board independence and patient satisfaction / quality of care. Moreover, in regard to physician involvement on the board, I find that lean hospitals with physician on the board are likely to have higher patient satisfaction, and higher quality of care in terms of Heart Failure and Pneumonia. Manuscript three applies a unique two-stage probit least squares (2PSLS) approach (Maddala, 1983) to examine the relationship between lean implementation and managerial ability. Using a panel data set from U.S. short-term, general, acute care hospitals from 2000 to 2015, I find a simultaneous relationship between lean implementation and managerial ability. I further quantify the simultaneity bias by comparing the 2PSLS regression results to those results under a unidirectional approach. I find that the estimation under a unidirectional approach substantially underestimates the effect of lean implementation on managerial ability, as well as the reverse direction effect.

Committee:

Hassan HassabElnaby (Committee Chair); Amal Said (Committee Member); Yue Zhang (Committee Member); Hoblet Karen (Committee Member)

Subjects:

Accounting; Health Care Management

Keywords:

Healthcare; Lean Thinking; Lean Implementation; Performance Consequences; Board Composition; Patient Satisfaction; Quality of Care; Managerial Ability; Simultaneous Relationship

Sah, Janvi HFactors and Outcomes Associated with 90-Days’ Supply of Prescription Medications
Master of Science (MS), University of Toledo, Pharmaceutical Sciences (Health Outcomes and Socioeconomic Sciences)
BACKGROUND: Extended days’ supply is associated with better adherence and lower cost associated with prescription drugs. Adherence increases health outcomes which is the main focus of the healthcare reform. Therefore, it is important to find the determinants of 90 days’ supply so that more and more people can be switched to the extended days’ supply of prescription drugs. OBJECTIVE: The purpose of this study is to determine the Sociodemographic, economic and health insurance related factors associated with the use of 90-day supply of prescription medications. METHODS: The study cohort consisted of 5533 adults above 18years of age, having cardiovascular diseases, hypertension, hyperlipidemia, diabetes mellitus and asthma who participated in Medical Expenditure Panel Survey (MEPS) during 2010-2014. Cohort demographics factors of interest were age, gender, race/ethnicity, education, income, insurance source, access to prescription drugs, prescription drug coverage, primary pharmacy and out-of-pocket payment. Comparisons were made between respondents that filled 30-day supply compared to those that filled 90-day supply using chi square. Multivariable logistic regression was used to identify factors associated with 90-day supply. RESULTS: Out of the entire study cohort (N=5533), 1814 (32.79) individuals filled 90 days’ supply for at least one of their prescription medications. Blacks and Hispanics were less likely to report difficulties in accessing prescriptions age was a significant factor associated with 90-day supply. Individuals who had greater than high school education were found to be negatively correlated to days’ supply. Respondents with Medicare coverage at some point over the year were 36% more likely to fill a 90-day prescription compared to those with private insurance. Similarly, respondents from Medicaid were twice more likely to obtain a 90-day supply. Respondents that use a drug store or a retail pharmacy as primary pharmacy for getting their prescription medications reported a higher likelihood of filling a 90-day supply CONCLUSIONS: Sociodemographic factors affect the utilization of these services as well as the insurance coverage and the type of primary pharmacy used by the respondents. Future studies need to find the source of disparity and interventions are needed to improve the acceptance of 90-days’ supply

Committee:

Varun Vaidya (Committee Chair); Diane Cappelletty (Committee Member); Sadik Khuder (Committee Member)

Subjects:

Health Care; Health Care Management; Pharmacy Sciences

Keywords:

90-day supply of prescription medication, insurance, primary pharmacy

Chouteau, Wendy AUse of a Portable Medical Summary to Provide Continuity across Systems of Care as Youth with Medical Complexity Transition to Adult Care
Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2018, Nursing
Children with special health care needs are surviving into adulthood in increasing numbers, as improvements in care and treatments increase the likelihood of survival. A technical brief published by the Agency for Healthcare Research and Quality reports more than 750,000 of children with medical complexity transition to adult care every year. Fewer than half have the resources needed to adequately make the transition successfully (McPheeters et al., 2014). The use of a portable medical summary was recommended in a Consensus Statement by the AAP, AAFP and ACP in 2002 (American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians-American Society of Internal Medicine [AAP, AAFP, ACP-ASIM], 2002) and by Got Transition/Center for Health Care Transition Improvement as part of the “Six Core Elements for Health Care Transition” (National Alliance to Advance Adolescent Health, 2014, p. 2). The purpose of the project was to increase the number of Pediatric Medical Complexity Algorithm (PMCA) Tier 2 and 3 patients, aged 16-24, who were seen each week for well care or chronic care management visits that have a portable medical summary updated in the past six months from zero to 90%. In this scholarly project, PDSA cycles were used to test the feasibility and usefulness of the portable medical summary, an electronic tool developed in the electronic health record, and shared with families. The portable medical summary was evaluated by providers and families and their feedback led to modifications for its improvement. By the conclusion of this DNP project, there was an increase to 100% of youth who had a portable medical summary initiated.

Committee:

Susan Allen, Ph.D. RN-BC (Committee Chair); Betsy List, Ph.D. MPH RN (Committee Member)

Subjects:

Health Care; Health Care Management; Nursing

Keywords:

Transition to adult care; Portable Medical Summary; Medical complexity; Children and youth with special health care needs; Patient summary; Transfer of care; Chronic illness

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