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Walker, Madelyn Grace. "Architectural Mediation: A Community Anxiety Center in Alexandria, VA." Thesis, Virginia Tech, 2019. http://hdl.handle.net/10919/90291.
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Anxiety Disorders are the most common mental illness in the United States. While nearly 18% of Americans will experience an anxiety disorder within any given year, only one-third of those will receive treatment. Current mental health treatment facilities must navigate opposing needs for both awareness and access as well as privacy and respite.
This thesis explores the ability of architecture to influence emotion and mediate between opposites through the design of a community anxiety treatment center in the heart of Old Town Alexandria, VA. The building combines community services, outpatient treatment, and in-patient treatment under one roof. Rather than a treatment facility that is removed from the city, the center is placed within an urban community, creating increased awareness and access to treatment as well as an expanded care journey through community connectivity.
The building itself mediates between urban and therapeutic space, sequentially removing patients from urban stimuli as they move through increasing levels of treatment. As patients recover and begin to return to the city itself, the building gradually reintroduces them to the urban environment. Post-treatment, the location in Alexandria, VA allows patients to continue recovery through community support groups and activities.Master of Architecture
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Robisnon, Brenda Joyce. "Is there an Association between Non-VA Medical Care Coordination and Utilization of Care?" ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2376.
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The Non-Veteran Administration Care (NVC) is a program in which the Veterans Health Administration purchases health care when it cannot provide the health services needed for eligible Veterans. The rising cost of this program led to audits by the Office of the Inspector General and other entities. The scholarly problem for this DNP Project was the lack of oversight, accountability, and management, found throughout the audits of NVC, as well as a lack of evaluation of NVC. The purpose of this project was to ascertain if there was a relationship between the Non-VA Care Coordination program (NVCC) and utilization of care. The NVCC was implemented to eliminate the deficiencies cited by audits. Sleep study and chiropractic consults for FY 2013 (pre-NVCC) and FY 2014 (post-NVCC) were examined. Sleep apnea service was available at the local Veteran Administration Medical Center and chiropractic service was not. Utilization of care was determined by emergency room (ER) visits and admissions related to the consult. A logic model was used to conceptualize the project and the longer-term implementation and evaluation of NVCC, and descriptive statistics were used to analyze trends in the chiropractic data (sleep study consults were excluded from the analysis due to the minute number). There were a total of 859 chiropractic consults and 2,184 approved visits analyzed. The results revealed that Veterans who utilized the consults had no ER visits or admissions related to referrals for chiropractic consults. Completed chiropractic consults remained proportionality the same both years. NVCC had no association with the utilization of care. This scholarly project contributes to social change by empowering consumers and providing transparency in the government through audits that facilitate quality improvement and evaluation of the NVCC program.
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Asomaning, Margaret. "Impact of a Wellness Clinic Visit on Cardiovascular Risk Biomarkers in Employees of a VA Medical Center." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3713.
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Background: Worksite screening programs are increasingly being provided by employers as a means to reduce cardiovascular risk in employees. A screening program that consists of fasting serum analysis of glucose plus a lipid panel is offered yearly to employees at the VA medical center in Tampa. A retrospective study was conducted to determine if a wellness clinic exposure resulted in significant changes in employees' markers of cardiovascular risk.
Methods: Computerized records were used to follow serial outcomes for glucose, triglycerides, HDL cholesterol, and LDL cholesterol in employees whose screening results showed abnormal levels of one or more of these markers. An intervention group with 66 subjects received a wellness clinic visit including a health risk assessment and education for lifestyle change, and a reference group with 109 subjects received only serum analysis. Outcomes at repeat screening were compared for the two groups.
Results: Both groups showed improvement in cardiovascular risk. In the intervention group there was significant intra-subject improvement from baseline for all markers except glucose. For triglycerides and LDL cholesterol there was a significantly greater proportion of subjects who improved in the intervention group. In addition, the improvement for triglycerides was significantly better in the intervention group.
Conclusions: This investigation confirms the value of a worksite wellness program in reducing cardiovascular risk in the population studied. A differential impact of age and gender was seen for glucose and triglycerides and indicates that such modifiers should be considered through covariate analysis in assessing wellness program effectiveness. Increasing levels of employee wellness participation to targets identified in this study and adding a health risk assessment for everyone screened will help to identify the specific benefits of the face to face wellness counseling intervention.
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Arana, Carla Paola. "WeCare Fertility Support Center| A Business Plan." Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10839065.
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Many individuals or couples have a strong desire to have their own biological children. When experiencing difficulty conceiving many struggle with high levels of anxiety, stress, and depression. Infertility is caused by a variety of factors affecting both women and men. Treatment can be medically invasive and expensive. The purpose of this project is to offer a well-rounded perspective on infertility to help clients cope and start a family. WeCare Fertility Support Center will be a comprehensive counseling center improving the lives of many individuals and couples by providing educational guidance on infertility treatments, communication skills, psychological support and direction with adoption. Patient’s will have someone to rely on every step of the way offering support and guidance. WeCare Fertility Support Center will provide physical, emotional and psychological well-being for patients in Long Beach CA and its surrounding neighborhoods.
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Devine, Debbie T. "Levels of Distress Among Women Veterans Attending a Women’s Health Specialty Clinic in the VA Healthcare System." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6490.
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Currently, between 21.9 and 23 million veterans have served in the United States armed forces. Of those, 2 million are women, and of those, only 6.5% use the Veterans Health Administration system. These females often suffer from physical and mental health disorders, and overall impaired quality of life (QOL), rendering their healthcare needs complex. Seeking, and providing care in this specialty area may become overwhelming not only for the women seeking the care, but also for healthcare systems that are unfamiliar with the specific needs of this population.
A retrospective medical records review was completed of 51 female veterans between the ages of 40 and 60 years, and who attended a women’s health specialty clinic in a women’s health center in the VA healthcare system. This center provides comprehensive women’s health services to female veterans. By attending this center, female veterans are having most if not all of their healthcare needs met in one location. Some of the services provided at the center include: primary care; gynecology; other gender specific health care needs; mental health care; and social assistance among other issues that may be associated with the overall QOL and depression.
Despite this study having a small sample size (n = 51), the participants were ethnically diverse: White (52.9%); African American (29.4%); Hispanic/Latino (15.7%); and Asian/Pacific Islander (2%). The overall results of this study reveal that female veterans who attend this clinic, have significantly lower baseline scores for QOL when compared to a North American population reference value. Means and standard deviation for total Menopause Rating Scale (MRS) score were; (n = 51, M = 21.2, SD = 9.2) compared to the North American women population reference values (n = 1,376, M = 9.1, SD = 7.6), z = 9.41, p < .0001, cohens d = 1.31. These results were significantly lower for all MRS subsets. The higher the means and standard deviation, the lower the QOL. A paired sample t-test indicated significant improvement in QOL after treatment in QOL (t = 7.80, p < .0001), and depression levels (t = 3.74, p < .0001) among female veterans attending the women’s health specialty clinic. Forward stepwise multiple linear regression models were fit to explore the association between the following variables and the outcomes of QOL and depression levels: low socioeconomic status (SES); number of deliveries; years of service; and military sexual trauma (MST). The only predictor that appeared to be significantly associated with higher MRS scores at baseline was a history of MST (β = .363; t = 2.44; p = 0.02). Higher MRS scores can be interpreted as lower QOL among female veterans.
Despite the complexities and unique needs of female veterans, the findings of this study suggest that timely, comprehensive and gender specific healthcare can significantly improve overall QOL and depression levels. In addition, further studies are need to assess what other variables may have a direct association with QOL, depression levels, and overall health of female veterans.
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Koppenhaver, II Kenneth E. "Effects of an Integrated Electronic Health Record on an Academic Medical Center." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2666.
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The debate about healthcare reform revolves around a triple aim of improving the health of populations, improving the patient experience, and reducing the cost of care. A major tool discussed in this debate has been the adoption of electronic health record (EHR) systems to record and guide care delivery. Due to low adoption rates and limited examples of success, the problem was a lack of understanding by healthcare organizations of how the EHR fundamentally changes an organization through the interactions of people, processes, and technology over time. The purpose of this case study was to explore the people, processes, and technology factors that change as a result of an EHR implementation. Complexity theory was used as the lens to evaluate the effects of the EHR on the holistic system of healthcare. Data were collected using semistructured interviews and observations of physicians, nurses, and administrators, as well as document reviews of organizational documents related to the EHR. Data were analyzed using open coding to identify themes and patterns of usage that redesign or restructure institutional resources. The results of this study demonstrated positive changes in the interactions of healthcare providers with increasing collaboration on process changes and reliance on EHR for communication. These findings may positively affect government policy and the organizational approach to adoption and ongoing use of EHRs to create organizational change beyond the implementation of such systems, thus benefiting both health care employees and patients.
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Jones, Cathy. "Creation of a Diabetic Health Literacy Program for Staff Of a Rural Federally Qualified Healthcare Center." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5633.
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Adult residents in rural communities have a higher incidence of chronic diseases. This fact coupled with low health literacy and a lack of primary and specialty care services makes the management of diseases such as diabetes difficult. The purpose of this doctoral project was to develop a diabetic health literacy program for staff of a rural federally qualified health care center (FQHC) that is the largest primary care center within a 5-county area in a rural mid-Atlantic region of the United States. Most residents have difficulty understanding diabetic information as it is presented to them, which leads to an increase in nonadherence to treatment plans, decreased health stature, increased comorbidities, and an increase in utilization of emergency room and acute care resources. A prior study of 140 randomized adult diabetic patients was the basis for the need of this project. Designed as a staff development in-service to educate nursing and the care provider team, this program integrated health literacy and therapeutic communication techniques into diabetic care. Using the health literate care model universal precautions approach, the project began as a pilot at one of the FQHC's clinical sites by assessing all patients for health literacy using the Newest Vital Sign screening tool. Staff were instructed on the validity of using health literate therapeutic communications as a bridge to adherence to diabetic treatment regimens. The project has potential to improve the overall health and promote positive social change in the rural community.
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Miles, James Leon. "The Center for Total Health: Healthcare Reform in Cook County, Illinois." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1856.
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The Patient Protection and Affordable Care Act (PPACA) of 2010 requires hospital systems in the United States to shift the culture of patient care from a focus on sick-care to a focus on prevention and wellness care. Little is known about how hospital systems will make this culture shift while retaining quality patient care. The purpose of this case study of a pioneering hospital-based PPACA-compliant initiative was to answer the research question of how Wallace's revitalization movement theory (RMT) "a rapid culture change model"could serve as a transferable evaluation framework for PPACA prevention and wellness care compliance in hospital-based programs. Kingdon's policy streams theory provided a conceptual framework. Data analysis included iterative, thematic coding of interviews with 3 primary stakeholders responsible for developing the policy, planning, and program implementation strategies of the Center for Total Health (CTH). Nineteen extensive primary source documents were included in the analysis as well. Findings supported the utility of the RMT structure and definitions in the identification of culture change dynamics in CTH. Additionally, this structure served as a scaffolding for grouping individual and institutional rapid culture change dynamics into stages that could be evaluated in terms of PPACA compliance. These stages effectively identified a Kingdon policy window in which PPACA mandates could be expected to result in culture change in multiple streams of public policy development, not only in wellness and sickness prevention, but also in local, state, and national health cost-saving initiatives in food-as-medicine, community identity, public health support networks. It could also reduce chronic disease and the rising institutional care delivery costs.
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Jackson, Robert Jackson. "Discovering Opportunities to Improve Profitability at a Federally Qualified Health Center." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3565.
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Federally Qualified Health Center (FQHC) organizations, which provide health care services to low-income, underserved patients, are underfunded. From 2000 to 2007, the cost of treating an FQHC patient increased by $146, while federal compensation to FQHCs increased by only $44 per patient. One FQHC organization in rural Alabama experienced financial losses from the fiscal year 2011 through 2014, jeopardizing services to approximately 6,000 low-income patients. The purpose of this qualitative case study was to analyze the subject organization and discover opportunities to improve financial performance. The research question pertained to the opportunities for improving profitability at the subject organization. The conceptual framework was the systems thinking model. Along with data from the literature review, reviews of the organization's archived data containing employee feedback and feedback from unstructured interviews of four of the 14 FQHC chief executive officers in Alabama were used to develop the profitability model. No employees were interviewed or surveyed during this study, however, a review of archived documents revealed information provided by employees that was helpful in developing the profitability model. To help determine the subject organization's performance, data from independent auditors, technical assistants, FQHC performance reports, the organization's electronic health record system, accounting system, meeting minutes and performance reports were coded, classified, and analyzed. Data from these sources was compared to the profitability model and a gap analysis was used to identify the areas and causes of poor performance. The results indicated that the rural environment impacted the organization's financial performance. The subject FQHC organization may be able to use the results of this study to improve profitability. This study contributes to positive social change by providing a profitability model that other FQHC organizations may use to improve their financial viability and expand services to underserved patients throughout the United States.
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KRZYWKOWSKI-MOHN, SARA M. EdD. "Diabetic Control and Patient Perception of the Scheduled In Group Medical Appointment at the Cincinnati Veterans Administration Medical Center." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1210103113.
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Fargo, Roland Jason. "Development of a vascular diagnostics center at Downtown Hospital: A feasibility study." CSUSB ScholarWorks, 2007. https://scholarworks.lib.csusb.edu/etd-project/3197.
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Reddy, Hari Mallam. "Case study on costs and efficiency of Urgent Care Center Desert Valley Medical Group, Victorville." CSUSB ScholarWorks, 2001. https://scholarworks.lib.csusb.edu/etd-project/1733.
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Hariss, Jimly. "National Center for Healthcare Leadership Competency Model Use in a Midwestern Healthcare Organization." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2545.
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The purpose of this study was to explore senior leaders integration of the National Center for Healthcare Leadership (NCHL) competency model within their employee evaluation system. This case study was conducted to explore how the NCHL leadership competency model is used within their organization's employee evaluation system. The NCHL leadership competency model guided this study. The research was an exploration of themes in leadership competencies used in the healthcare organization. Data collection included in-depth interviews with 10 healthcare junior leaders in a single healthcare organization in the Midwestern United States who had at least 1 year of experience as a leader and a review of secondary data related to their job skills and annual evaluations. Using Saldana's method of data analysis, 4 primary themes emerged: leaders are transformed by vision and focus, leaders need continuous training, leaders like accountability, and leaders like influence goal creation. The 4 themes indicated that participants perceived NCHL leadership competencies integrated in their performance evaluation system to be of benefit. The findings revealed senior leaders might benefit from integrating the NCHL competency model in new leader orientation competencies, leadership training, and performance assessment tools. Positive social change may result by successful implementation of the NCHL leadership competency model strategies from this study, improving societal healthcare through efficient healthcare delivery.
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Cruz, Enriquez Enrique A. "The Johnson City Community Health Center: A Qualitative Analysis of the Center's Strengths, Weaknesses, Opportunities, and Threats in Johnson City, Tennessee." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/honors/230.
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The Johnson City Community Health Center is one of over 1200 community health centers serving over 22 million patients across the United States. Community health centers primarily serve patients with low income or without health insurance, but most serve all the members of their communities. These centers provide many services and treat health problems in a holistic manner in order to improve the health of their communities and also allow the members of those communities to progress. The Johnson City Community Health Center is compared to successful CHCs from across the nation to determine if it has characteristics to be successful in this community. A SWOT Analysis is conducted by evaluating the Marketing Mix, or the Product, Price, Placement, and Promotion, of the center and also by examining the Political, Economic, Social, and Technological environments it operates in. This research determines the internal Strengths and Weaknesses and external Opportunities and Threats of the Johnson City Community Health Center and concludes that it does have the characteristics needed to be successful in the community. This research can be used by center management to improve services, but it can also be used by other researchers to continue evaluations of community health centers across the nation.
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Turpin, Rebecca L. "Psychometric Testing of the Presence of Nursing Scale: Measurability of Patient Perceptions of Nursing Presence Capability of Nurses in an Academic Medical Center." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etd/3096.
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Introduction: Nursing presence occurs when nurses expend themselves on the behalf of a unique patient. This phenomenon requires further research to develop instruments. The Presence of Nursing Scale (PONS) measures the patient’s perspective (Kostovich, 2012). Psychometric testing of PONS-Revised using exploratory factor analysis is warranted to further develop a reliable and valid measure of nursing presence. Contextual workplace variables need exploration in inpatient settings for correlation with nursing presence.
Method(s): A convenience sample of 122 adult inpatients from ten acute-care nursing units in a Southeastern Magnet hospital were surveyed to conduct the first psychometric testing of this revised instrument using exploratory factor analyses. Seven research questions evaluated potential correlations between the PONS-R, patient satisfaction using nurse-sensitive measures of HCAHPS, nursing unit-specific workforce factors and patient demographic factors.
Results: PONS-R demonstrated high internal consistency reliability (r = .974), test-retest reliability (statistically significant at the .01 level) and divergent validity (p=.002). PONS-R compared to nurse HCAHPS measures was statistically significant at the .01 level, (r = .736). EFA revealed one factor (eigenvalues over 1), with a weak secondary factor centered on intimacy factors suggesting addition of items and repeated study with a larger sample size to further psychometrically develop the instrument. Unexpected negative correlations were found with unit-workforce factors including average RN experience level (r= -.185, significant at the .05 level), and average RN age (r = - .218). An unexpected positive correlation was found - percentage of Associate degree nurses (r = .269, statistically significant at the .05 level. The Triangle region was correlated with a higher PONS-R score (p = .038; n=4), otherwise no statistically significant correlations were found for PONS-R and patient demographics nor patient-specific variables such as estimated number of RN providing care, nor length of stay on the unit.
Discussion & Conclusions: Further psychometric testing is indicated with larger samples and perhaps with the inclusion of intimacy factor items. Additional correlational studies focused on other patient quality outcomes measures with expansion of nurse demographics is indicated to explore for confounding variables.
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Hatano, Tamaki Pantyp Ramasoota. "Women's role in household sanitation management at blue light cluster in the area of health center no. 54, Bangkok metropolitan administration /." Abstract, 1999. http://mulinet3.li.mahidol.ac.th/thesis/2542/42E-TamakiH.pdf.
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Robbie, Robbie Gail. "An Outcome Evaluation of an Evidenced-Based Leadership Framework on Nursing Retention in a Tertiary Medical Center." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1369.
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An evidence-based leadership (EBL) framework is an intervention designed to facilitate organizational changes such as the reduction of nursing turnover and the improvement of nursing job enjoyment. This project provides an overview of the effect of nursing turnover on an organization, presents the components of the EBL framework, and provides an evaluation of the influence of EBL on nursing turnover and job enjoyment. The EBL framework provided a method for reducing variance in leadership skill and behavior by outlining specific methods necessary to reduce inconsistency. The project objective was to determine if the implementation of an EBL framework for 820 nursing staff in 10 clinical units at a tertiary medical center improved turnover and job satisfaction, as evidenced by turnover data from the unit-specific dashboards and the National Database of Nursing Quality Indicators (NDNQI) job enjoyment scores. All data were collected retrospectively, pre-implementation to post-implementation of the EBL framework, to determine whether significant improvement occurred in turnover percentages and job enjoyment scores. Results of a t test indicated no statistically significant improvement in turnover percentages or job enjoyment scores 7 months after the implementation of the EBL framework. The nonsignificant results could be attributed to several factors including senior leadership turnover, lack of specific accountability measures for failure to implement the EBL framework (insert comma here) and the restricted time frame of the evaluation period. Despite these nonsignificant results, the evaluation provides a baseline for future longitudinal studies to determine if an EBL framework can influence nursing turnover and job enjoyment after having been in place longer than the 7 months post implementation used for this evaluation.
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Balčiūnienė-Balčiauskienė, Dijana. "Židikų pirminio sveikatos priežiūros centro veiklos strategijos formavimas ir valdymas." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2007. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2007~D_20070816_162623-65917.
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Magistro darbe suformuluotos nedidelio sveikatos priežiūros centro veiklos strategijos formavimo ir valdymo problemos, išanalizuoti Lietuvos ir užsienio autorių teiginiai veiklos strategijos formavimo ir valdymo aspektu. Darbe išsiaiškintas gyventojų požiūris į sveikatos priežiūros paslaugų prieinamumą ir kokybę, identifikuoti pagrindiniai veiksniai, įtakojantys medicininių paslaugų prieinamumą ir kokybę, nustatytas šių veiksnių ir demografinių faktorių tarpusavio ryšys, taip pat nustatyti veiksniai, įtakojantys medicinos darbuotojų darbo sąlygas ir patį darbą, išanalizuotas jų ryšys su demografiniais rodikliais. Patvirtinta autorės suformuluota mokslinio tyrimo hipotezė, kad nedidelės pirminės sveikatos priežiūros įstaigos, aptarnaujančios kaimo apylinkių gyventojus, gali sėkmingai plėtoti savo veiklą konkurencinėmis sąlygomis. Magistro darbo pabaigoje pateikiamos išvados ir rekomendacijos.The focus of this thesis is strategy development and management problems of a small health care center as well as study of propositions made by Lithuanian and foreign researchers with respect to development and management of certain policies and strategies. This study also presents an attitude of residents towards the quality and availability of health care services, identifies main factors that affect quality and availability such services as well as working conditions and work itself of the health care personnel, analyses how such factors correlate with the existing demographic indicators. The research gives evidence the authors’ hypothesis stating that small primary health care institutions that provide services to the rural population of the country can establish themselves as successfully operating and competitive entities under the existing market conditions. The final part of the study sets forth conclusions and recommendations of the author.
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Bergan, Britta L. "Demographic Characteristics and Trauma Symptomology in Juvenile Justice Residents at Echo Glen Children's Center." Antioch University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1459871411.
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McCants, Zauditu Esther. "A study of whether African American students in the Atlanta university Center schools were knowledgeable of public health policies and programs concerning abused and neglected children." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2009. http://digitalcommons.auctr.edu/dissertations/68.
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This study analyzed whether African American students in the Atlanta University Center schools were knowledgeable about public health policies and programs concerning abused and neglected children. Two hundred and one (201) participants were selected utilizing convenience sampling. The study surveyed males and females of which 91% were African American students. A survey questionnaire was utilized to collect data. The findings of the study indicated that a majority or 57.2% of the students were not knowledgeable about public health policies for abused and neglected children. However, a majority of the students indicated that they were knowledgeable about public health problems and programs for this population. A majority or 84.1% indicated that they were not abused and neglected as children, but a significant percentage or 15.9% indicated that they were abused and neglected. When the chi square test for significance was applied, the null hypothesis was accepted indicating that there was no statistically significant evidence at the .05 level of probability that the students were abused and neglected when they were children.
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Polk, Katrina. "Multifamily Subsidized Housing Seniors' Awareness of Aging and Disability Resource Center Services." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3255.
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Over 75% of adults 60 years of age or older who live in Washington, D.C. are unaware of access to Aging and Disability Resource Centers' (ADRC) community-based services. Approximately 25% of these individuals are low-income and reside in multifamily subsidized housing. With a theoretical basis in Penchansky and Thomas' construct of access, this phenomenological study explored whether increased awareness of access to ADRC service delivery may potentially better meet the needs of this socioeconomically marginalized population. Data were collected through semi-structured interviews with 20 senior citizens in Washington, D.C. who received some programmatic assistance, such as housing or meal delivery, but not necessarily through an ADRC. Interview data were inductively coded and analyzed using Braun and Clarke's thematic analysis method. Findings indicate that while there is an apparent need for community-based services, many participants who were not aware of ARDC services wanted more information about how to access the service delivery system to age in place, avoid burdening children, retain housing vouchers, and prevent nursing home placement. In contrast, seniors who accessed ADRC, based on the construct of access, found services acceptable, accessible, affordable, available, accommodating, and helpful in allowing them to remain independent and at home. The results of this study contribute to positive social change by recommending that program administrators focus on outreach to the program's target population, thereby improving access to resources so they can be self-reliant and prolong residential longevity for aging-in-place demands.
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Amonge, Augustine O. "Application of Goldratt’s Thinking Process to Constraints Within an Emergency Department—A Case Study." TopSCHOLAR®, 2015. http://digitalcommons.wku.edu/theses/1551.
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Emergency department (ED) acts as a feeder to many hospitals as it determines a large proportion of admissions. ED also acts as a buffer zone for many patients who cannot get care in other institutions due to insurance issues. Most hospitals are trying to invest heavily on their EDs, but cannot meet patients’ satisfaction in terms of cost and quality of care. There is great need for EDs to understand customers’ expectation given the rising cost of healthcare.
The focus of this study is at an ED center in Bowling Green Kentucky, using theory of constraints (TOC) thinking process application tools to capture in detail the core and apply TOC to resolve the problems identified. The research was able to identify the core problems as: Backlog of patients in ED, delay in making dispositions, and patients waits on ED to transfer to another facility. The research was able to address the core issues by answering three questions: What to change? This was answered by the CRT “ED unable to meet patients’ expectation.” What to change to? This was answered by the EC “Positive patient outcomes”. How to change? This was answered by the FRT by using injections that resulted to “ED is able to meet patients’ expectations most of the time."
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Babb, Ellen Burkhardt. "Oral Nutritional Supplement Use in Relation to Length of Stay in Heart Failure Patients at a Regional Medical Center." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2082.
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Improving the nutritional status of hospitalized patients has been shown to reduce length of stay (LOS), hospital costs, readmission rates, complication rates, and mortality. Provision of nutrient-rich, liquid, oral nutrition supplements (ONS) is one approach to improving nutritional status. ONS use has been associated with improved outcomes among patients with diagnoses of orthopedic injuries and pressure ulcers, mainly using prospective designs among elderly and/or malnourished patients. Less information is available for other diagnoses, and no analysis of the effects of ONS could be found that considered the epidemiological triad of person, place, and time. This study used a quantitative, retrospective design to examine whether routine ONS use was associated with hospital length of stay (LOS) among 570 adult inpatients at a regional medical center diagnosed with heart failure, adjusting for significant personal, locational, and time variables. It was unique in the inclusion of epidemiological triad variables. Using multiple logistic regression to control for covariates, ONS use was associated with higher LOS in this sample (odds ratio=2.43). High LOS was also associated with higher Charlson Comorbidity Index (CCI) values, discharge destination, White ethnicity, female gender, and hospital room location. This study is expected to contribute to positive social change by helping inform hospital staff on factors affecting patient outcomes and LOS, and highlighting the need for continued research on interventions to improve care in hospitals.
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Saaty, Hans Philip. "A feasibility study for establishing a dedicated breast magnetic resonance imaging center in the city of Redlands." CSUSB ScholarWorks, 2007. https://scholarworks.lib.csusb.edu/etd-project/3190.
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Carmack, Heather J. "How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program." Ohio : Ohio University, 2008. http://www.ohiolink.edu/etd/view.cgi?ohiou1209039528.
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Bills, Randy K. "Aligning salary expense and workload output In a complex military medical system /." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2004. http://library.nps.navy.mil/uhtbin/hyperion/04Jun%5FBills.pdf.
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Harmon, Anna Lisa. "A Descriptive Study of Military Family Needs Following a Polytraumatic Injury." VCU Scholars Compass, 2007. http://hdl.handle.net/10156/1611.
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Greene, Joseph Harrison. "Development of a social service program for college health services." CSUSB ScholarWorks, 2001. https://scholarworks.lib.csusb.edu/etd-project/1869.
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The initial development of a social services program in a college health setting is presented, with discussion regarding causes, methods, and outcomes. Both empirical and anecdotal data which were influential in the initial formation of the program are reviewed, in the context of an examination of the research literature relating to this area. The actual development and implementation of the program is followed through its first year of existence. Outcomes are presented in the form of qualitative data analysis and case studies. Discussion of the results and recommendations for both future research and improvements to the program are presented.
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Dilworth, Joyce Carroll. "The relationship of nutritional status to unreimbursable costs and length of hospital stay." CSUSB ScholarWorks, 1992. https://scholarworks.lib.csusb.edu/etd-project/721.
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Staškevičius, Lukas. "Sporto ir sveikatingumo centro „Impuls“ teikiamų paslaugų kokybės vertinimas." Bachelor's thesis, Lithuanian Academic Libraries Network (LABT), 2014. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2014~D_20140620_112452-45271.
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Tyrimo problema: kaip klientai vertina sporto ir sveikatingumo centro „Impuls“ teikiamų paslaugų kokybę? Darbo tikslas - įvertinti teikiamų paslaugų kokybę sporto ir sveikatingumo centre „Impuls“. Darbo uždaviniai: 1. Apibūdinti paslaugos, kokybės ir paslaugų kokybės teorinę sampratą; 2. Išanalizuoti paslaugų kokybės vertinimo modelius SERVQUAL, SQAS ir QUESC; 3. Įvertinti sporto ir sveikatingumo centro „Impuls“ paslaugų kokybę. Rezultatai: atlikto tyrimo metu nustatyta, kad geriausiai vertinami paslaugų kokybės veiksniai sporto ir sveikatingumo centre "Impuls" yra šie: atsakingumas, tinkamos programos parinkimas, trenerio patirtis, dėmesys klientui treniruotės metu, aplinkos saugumas ir švara, įrenginių saugumas, programos tinkamumas, programos prieinamumas, individualios treniravimo programos sudarymas, patogus laikas, kaina ir informacijos apie paslaugas pakankamumas.Research problem: how customers appreciate the service quality of fitness and health center "Impuls" ? Research purpose: to assess the quality of service sports and health center Impuls. Research goals: 1. Describe the service, quality of service and the quality of the theoretical concept; 2. Analyze service quality assessment models, SERVQUAL, and SQAS QUESC; 3. To assess services quality in sports and fitness center „Impuls”. Results: The survey was aimed at finding out what the quality of service criteria of fitness and wellness center Impuls customers the same as the highest quality . It was found that the highest ranked criteria are: responsibility, proper program selection, coaching experience , customer focus during training , environmental safety and cleanliness , facilities, security, program eligibility, program availability, the individual training program of a convenient time, cost and service information sufficiency.
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Astrauskas, Mindaugas. "Vartotojų elgsenos ypatumų nustatymas sveikatingumo centre „Linija“." Bachelor's thesis, Lithuanian Academic Libraries Network (LABT), 2012. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2012~D_20120620_120933-27080.
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Darbo objektas: vartotojų elgsenos ypatumai. Darbo tikslas: nustatyti vartotojų elgsenos ypatumus sveikatingumo centre „Linija“. Darbo uždaviniai: 1. Apžvelgti vartotojų elgsenos teorinius aspektus. 2. Pagrįsti vartotojų elgsenos tyrimo aktualumą. 3. Išanalizuoti vartotojų elgsenos ypatumus sveikatingumo centre „Linija“. Pagrindiniai rezultatai ir išvados Bakalauriniame darbe analizuojamos paslaugų vartotojų elgsenos savybės ir jai įtaką darantys veiksniai. Tema yra aktuali tuo, kad sveikatingumo paslaugos yra populiarios, perspektyvos, vis labiau naudojamos ir vertinamos, vartotojai vis daugiau laisvo laiko skiria tokioms paslaugoms. Apibendrinti tyrimo rezultatai parodė, jog vartotojų elgsenai įtaką daro daugelis veiksnių: kultūriniai, socialiniai, asmeniniai, psichologiniai faktoriai. Prieš įsigydamas prekę ar paslaugą kiekvienas pirkėjas pereina visus pirkimo proceso etapus, tačiau vieni užtrunka ilgiau, kiti trumpiau, kol galiausiai juos visus įveikia.Determination of consumer behaviour features in health center “Linija”.
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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
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Erickson, David James Breslich. "An Ethnography of Bureaucratic Practice in a New York State Federally Qualified Community Health Center." Thesis, 2020. https://doi.org/10.7916/d8-zvf4-yf42.
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Federally Qualified Community Health Centers - aka FQHCs, Community Health Centers (CHCs), Neighborhood Health Centers, or simply Health Centers - are public and private non-profit healthcare organizations funded under Section 330 of the Public Health Service Act, directed by a consumer board of directors, and complying with Federal requirements to serve medically underserved populations. In 2017 FQHCs saw more than 27 million individual patients in the United States, of whom approximately two million were seen by health centers in New York State (Bureau of Primary Health Care 2017). Despite these staggering figures, relatively little academic work has investigated how these health centers operate at an administrative and bureaucratic level.
To study the bureaucratic practice of FQHCs, this research utilizes an ethnographic approach, conducted over a period of three-plus years at a FQHC in New York State (pseudonymously called Care Center). It incorporates structured interviews, informal interviews, the collection of fieldnotes, and participant observation, as well as qualitative data analysis. Collectively this research approach produces a complex portrait of how bureaucratic activity at the specific FQHC field site was organized, conducted, and structured within the context of substantial growth in the FQHC program. The setting of the study offers a unique opportunity to explore the implications of this bureaucratic activity on FQHCs and, by extension, other safety-net healthcare institutions in the United States.
This research also delivers a substantial historical account of the emergence of the FQHC program in order to connect that account to the broader arc of healthcare history in the United States during the 20th and 21st centuries. This connection demonstrates the linkages between specific aspects of FQHC bureaucratic practice and larger trends in health care more generally. The emphasis on “need” as a discursive object that is frequently referenced and utilized as an organizing mechanism by FQHC bureaucracy allows us to better understand and problematize the use of need as a criterion for organizational growth.
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"Exploring the Leadership Position of Schools of Medicine Within Academic Health Center Administration: Implications for National Institutes of Health Funding Utilizing Resource Dependence Theory." Tulane University, 2009.
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Maxey, Hannah L. "Understanding the Influence of State Policy Environment on Dental Service Availability, Access, and Oral Health in America's Underserved Communities." Thesis, 2014. http://hdl.handle.net/1805/5993.
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Indiana University-Purdue University Indianapolis (IUPUI)Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.