<p> This study examined the effects of care coordination on diabetes management processes and outcomes. The study predicted care coordination increases the likelihood of daily blood glucose monitoring, hemoglobin A1C checks at least twice a year, annual foot exams, annual eye exams, diabetes care plan being developed and a written copy provided to the patient, and self-confidence in ability to control and manage diabetes. The study also predicted a correlation between lack of care coordination and diabetics' non-adherence to diabetes medications, as well as a correlation between lack of care coordination and greater number of emergency room visits and hospitalizations among diabetics for diabetes-related issues. </p><p> Data obtained from the 2011-2012 California Health Interview Survey (CHIS) was analyzed using t-test and Chi-square. Though not all hypotheses were supported, the results of the study showed a significant relationship between care coordination and increased likelihood of hemoglobin A1C checks at least twice a year, annual foot exams, and diabetes care plans being developed and written copy provided to the patient. The study findings warrant further research on the effects of care coordination on diabetes management processes. Additional research on the effects of diabetes management processes on diabetes outcomes is recommended.</p>

<p> Healthcare utilization is a factor that directs quality and cost of health services. The cost of healthcare, income level, and demographics affect the frequency and circumstances, in which patients seek medical attention. One of the main goals of public assistance programs in this study is to facilitate the access to medical services for vulnerable groups of children. This study analyzes the impact of enrollment in various different public assistance programs and the access patterns to healthcare services. The study found that children who are enrolled in public assistance programs are more likely to visit an emergency room but less likely to visit a doctor at least 7 times a year (high utilization) compared to children who are also eligible for public programs but are not enrolled. This difference in patterns has a significant impact on cost of health services for public assistance programs' beneficiaries. A causal multifactorial link is observed, and therefore further research is needed.</p>

<p> A qualitative exploratory case study was undertaken to explore the role of physician assistants (PAs) in a small, rural hospital in the Virgin Islands. The concept of task transfer was examined to determine if PAs could take on more roles assumed by physicians. The study involved the perceptions and experiences of 16 physicians, 11 PAs, 12 hospital administrators, and 10 potential patients. Emerging themes fell into three categories: benefits and challenges of working with PAs, role of PAs, and acceptance of PAs. Within these categories, the following themes were identified: limited/basic PA roles, reduction of the physician workload, and variable PA competency levels. Subthemes to emerge included the role of PAs, improving patient care, filling shortages, the supervision of PAs, developing protocols for duty, and establishing a procedure for delegation of responsibilities. The conclusion was that in patient service in rural areas, maximizing the efficiency of a PA could be improved when task transfer was implemented as a means to the division of labor. The results of this study may assist legislators when re-evaluating and revising physician assistant scope of practice policies.</p>

<p> Healthcare systems are under pressure to eliminate disparities of care. Communication methods used with Limited English Proficiency (LEP) patients was presented in the literature as an essential component to deliver quality and equal care. Several strategies have been implemented to assess and target the communication methods between patients and health care teams. The challenge for health systems workers is to address communication barriers to eliminate disparities of care and medical errors. The purpose of the present qualitative case study was to explore if communication barriers affect the understanding of LEP research participants while participating in the informed consent process during clinical trials. Communication barriers during the informed consent process may affect clinical trial outcomes. In the study, the use of a triangulation data gathering method was associated with a qualitative case study. Data regarding barriers of communication during the informed consent process were gathered by performing semistructured interviews. The study population included six principal investigators, five interpreters, and nine LEP research participants. Data analysis involved reviewing the emerging themes from participants&rsquo; responses. Results indicated four major themes supporting communication challenges. The themes included authority figure, cultural sensitivity, communication barriers, and education. The study suggested the need for further research regarding communication barriers during the clinical trials process.</p>

<p> The purpose of this paper is to evaluate external factors in relation to their effect on adolescent smoking. The author measured smoking rates against variables of family and peer influence, community and school programs, and celebrity role models and the media. Three hypotheses were developed: (1) the less adult supervision there is after school, the higher chance adolescents have of smoking; (2) adolescents with lower levels of school support are more likely to smoke; (3) adolescents with entertainer role models have a higher chance of smoking. The ANOVA test was used to evaluate data from the California Health Interview Survey 2012. The results from this study produced slight but not statistically significant relationships except for celebrity role models and adolescent smoking rates. Studies such as these need to continue in order to decrease the percentage of teens that use tobacco and prevent them from continuing to smoke into adulthood.</p>

<p> Patient safety is a prominent issue in health care as evidenced by the staggering statistics of deaths and harm due to preventable medical errors. As front line clinical leaders, charge nurses (CNs) have key roles in keeping patients safe. There is a gap in knowledge of the specific actions and processes CNs implement to keep patients safe. This study attempted to narrow this gap by exploring actions and processes CNs implement to keep patients safe using a grounded theory design and generating a substantive theory that can inform CN job descriptions, serve as the basis for CN orientation and training, and empower CNs to promote patient safety in practice. This study utilized purposive sampling of CNs on medical-surgical units with data collected through 11 interviews and six observations. The substantive theory that emerged was <i>Navigating through Chaos: CNs balancing multiple roles, maintaining a watchful eye and working with and leading the health care team to keep patients safe</i>. This study contributes to the knowledge base of the CN role related to patient safety. Recommendations to maximize the potential of the CN role in promoting patient safety include clearly defining CN role responsibilities, addressing staffing shortages, and providing CNs with the necessary information to complete their work. The specific actions and processes identified in this study can be incorporated into course content on clinical nursing leadership. The substantive theory can also guide further research to study relationships between specific CN actions and processes and patient safety outcomes.</p>

<p> Health is a multidimensional, holistic, concept integrating physical and mental health. In childhood, the most common cause of physical disability is Cerebral Palsy (CP). For individuals with CP, health and well-being is impacted by the complex interactions among their physical impairments, activity, participation and environmental barriers. Although CP is considered non-progressive, secondary conditions (pain and fatigue) and their functional consequences have been found to worsen as the individual with CP ages. While preliminary evidence shows that many of the physical impairments (pain, fatigue, depression) reported in adults with CP begin during late adolescence, there is little information about the role personal and environmental factors, impairments, activity limitations, and participation restrictions have on health and well-being of young adults with CP. </p><p> To understand the health and well-being of young adults with CP, the International Classification of Functioning, Disability and Health (ICF), a World Health Organization framework, guided the selection of survey instruments for this study. Surveys were sent to 610 young adults (18-30 years) with CP. 95 surveys were returned, 55 were self-reported and 40 were completed by proxies. Increasing severity of impairment was associated with decreased participation in daily activities and social roles, while loss of ambulatory ability, pain, fatigue, depression, and activity level did not differ by severity of impairment. Environmental barriers restricted the level of participation only for the self-report participants. Health status was decreased in those who self-reported increased pain, fatigue, and depression; offset by emotional support. Life satisfaction was decreased by depression and poor health; offset by emotional support. </p><p> Addressing the physical impairments, activity limitations, participation restrictions, personal factors and environmental barriers impacting young adults with CP requires coordinated efforts among the medical, educational and vocational systems. These efforts need to begin early with appropriate assessment and treatment of impairments, provision of assistive technologies and augmentative communication, and adaptation of the environment to facilitate participation in activities and social roles. The health and well-being in young adults with CP can also be improved with enhanced emotional support beyond the family unit through peer support groups, mentors, and other adult role models.</p>

<p> My dissertation research aims to provide greater knowledge about the healthcare industry and federal budgets, within the education and infrastructure. The view point of the financials spent in the United States on healthcare is supported by the economic reports and facts dealing with the studies that the current cost is unstainable. It is also likely that rates of EHR adoption increased after the healthcare legislation associated with the administration of President Barack Obama.</p><p> Together, these two pieces of legislation represent a challenge for healthcare providers in the United States, as such providers will have not only to adopt EHR if they have not done so already, but they must also prepare for a torrent of new patients who typically have not had medical care&mdash;especially those eligible for Medicaid benefits.</p><p> One problem raised by the new healthcare legislation, according to Frenkel (2010), is that it unknown how the adoption of EHR will affect smaller healthcare providers financially and in terms of service, especially those that accept Medicaid reimbursement. Most EHR literature addresses circumstances before the passage of the ARRA of 2009 and the PPACA. While there are reliable figures for nationwide EHR adoption, Frenkel (2010) argued that some key questions remain unanswered:</p><p> 1. Are Medicaid providers more advanced in EHR adoption than non-Medicaid providers?</p><p> 2. What are the main obstacles to, and incentives for, adopting EHR in the new era of American healthcare?</p><p> 3. Are obstacles and incentives different from those in the past before the new healthcare legislation, or are they similar to previous obstacles and incentives?</p>

<p> In 2009 the American Recovery and Reinvestment Act (ARRA) was signed into law. As part of ARRA, the HITECH Act set aside $29 billion in Medicare and Medicaid incentives for healthcare organizations. To collect these incentives, healthcare organizations must install an electronic health record (EHR) system and achieve <i>meaningful use.</i> Implementation of an EHR must be completed by 2015 in order to acquire any of the incentives available. Small medical practices consisting of one to five physicians are finding it easier to implement a <i>cloud-based</i> EHR system due to minimal upfront costs and no need for technical capabilities within the medical practice. This study was done using a modified Delphi technique developed by Roy Schmidt to find critical success factors for the implementation of electronic health record systems within a centralized computing services structure. For purposes of this study a centralized computing services structure was considered a <i> cloud</i> or <i>cloud-based</i> environment. </p><p> This study found that the top five critical success factors for the implementation were the following: (1) EHR Training &ndash; implementing a strong training / education process for EHR users; (2) Usability &ndash; practical application of EHR features in a real medical office setting; (3) Reliability &ndash; Specifically high levels of redundancy and system availability. If the system is down, patient safety is a risk, and that is an unacceptable norm; (4) Strong clinical representation in the project to ensure workflows, processes and education needs are met; (5) Support services such as deployment / implementation services, help desk, and online support. Of these five factors, four are actually related to usability of the system, and not necessarily strictly based on implementation. This leads us to believe that the success of an implementation is reliant upon user perception based on system usage.</p>

<p> This quantitative study of paid home care workers (N=572) used an ex post facto survey design for data collection and structural equation modeling for data analysis in order to explain and predict the relationships among key identity constructs that are inherent in caregiving. The study examined the relationship between predictor variables of (1) role occupancy in caregiving, (2) relational identification within the caregiving dyad, and (3) organizational identification within the caregiving organization as these affected the criterion variable of the caregiving self. A final research question sought to understand (4) how dirty work acted as a moderating variable impacting the relationship between each of the predictor variables and the outcome variable. The outcome variable was measured using the Callero (1985) role merger scale. Predictor variables of relational identification and organizational identification were also measured using scales (Sluss et al., 2012; Mael &amp; Ashforth, 1992). Results supported some but not all of the <i>a priori</i> hypotheses established prior to the research study. Findings supported the hypothesized positive relationships between 1) caregiving role occupancy and the caregiving self, 2) caregiving relational identification and the caregiving self, and 3) caregiving organizational identification and the caregiving self. The hypothesis suggesting the moderating effect of dirty caregiving tasks was partially supported, with findings indicating that higher experience in dirty caregiving tasks moderates the positive association between organizational identification and the caregiving self.</p>