<p> The purpose of this quantitative correlational study using archived data was to determine if there is a relationship between patient satisfaction and indicators of medical harm in the state of Florida. The study reviewed the archived data for patient satisfaction for the 328 hospitals located in Florida along with archived data of six hospital-acquired infections for the hospitals in the study. The metric used for patient-centered care is patient satisfaction. Although the literature supports a patient-centered model supplanting non patient-centered models, patients continue to suffer medical harm and even die while no one has evaluated the difference between the models. A linear regression and Spearman&rsquo;s rho analysis was performed for each of the six research questions in the study. The results demonstrated a rejection of the null hypothesis for two of the research questions. This outcome indicates a relationship between patient satisfaction and two indicators of medical harm; SSI Colon, and MRSA. Although the results did not support all six of the research questions, leadership of hospitals supportive of a patient-centered environment should continue to investigate the positive relationships demonstrated in this study to duplicate efforts in increasing the quality of care. Additionally, leaders of hospitals who have low patient satisfaction scores may consider implementing a patient-centered model of care to reduce indicators of medical harm.</p>

<p> The purpose of this action research study was to examine the effects of the stigma of mental illness towards individuals with mental illness on services provided by medical professionals, specifically, registered nurses who work in an emergency department (ED). There have been numerous studies on how attitudes towards mental illness can be present in health care professionals; however, none that focused specifically on the attitudes of ED nurses. Nurses working in the ED are often the first health care professional a patient with mental illness sees and their attitude can influence the rest of the ED visit. The Opening Minds Scale for Health Care Workers (Modgill, Patten, Knaak, Kassam, &amp; Szeto, 2014. &ldquo;Opening Minds Stigma Scale for Health Care Providers (OMS-HC): Examination of Psychometric Properties and Responsiveness&rdquo;) and the Caring Nurse Patient Interaction Short Form (Cossette, Cote, Pepin, Ricard, &amp; D&rsquo;Aoust, 2006. &ldquo;A Dimensional Structure of Nurse-Patient Interactions from a Caring Perspective: Refinement of the Caring Nurse-Patient Interaction Scale (CNPI-Short Scale)&rdquo;) were used to measure attitude towards stigma and the perception of the care a nurse gives a patient. Thirty-four nurses from two emergency departments participated in the research with the expectation of there being high levels of stigma which would in turn affect the care given to the patients with mental illness. Descriptive statistics, multiple regression and ANOVA were used to find low to moderate levels of stigma of mental illness, and these nurses had a perception of providing excellent care to their patients. This is in contrast to other studies finding moderate to high levels of stigma in general among health care professionals. This information can be useful in exploring and then using any policies and procedures present in the research sites for the benefit of other emergency departments. Additional research is planned to further review these sites and other emergency departments within the hospital network to ascertain if these results hold true, and if so, identify the dynamics involved.</p><p>

Despite the large proportion of clients who use psychotherapy more than once in their lifetimes, little empirical, theoretical, or technical literature focuses on conducting subsequent therapy. This qualitative study used in-depth interviews of 8 experienced doctoral-level psychologists (all with over 15 years experience conducting therapy) to examine the process of conducting psychotherapy with experienced clients. Psychotherapists in the sample were all trained with a psychodynamic or psychoanalytic orientation and continued to work partially or exclusively in that tradition. Results include analysis by interviewee including presentation of specific cases, as well as thematic analysis across interviewees. Thematic analysis is divided into three sections: classifications of subsequent therapy in relation to previous therapy, practice considerations and recommendations, and therapists' subjective experience and beliefs about experienced clients and subsequent therapy. Findings relate to issues of mental health service utilization such as help-seeking and intermittent use of psychotherapy throughout the life cycle. Findings also address psychotherapy process issues such as beginning the treatment, therapist-directed exploration of previous therapy, deciding whether to contact previous therapists, working with clients' unresolved feelings from previous therapy, making therapeutic use of talking about previous therapy, working with clients who return to the same therapist, and triangulation of previous therapist, subsequent therapist, and client. Therapy with experienced clients was found to be different from therapy with inexperienced clients in certain cases; however, in generalizing about their practices as a whole, the therapists interviewed judged these differences to be small in comparison with other client characteristics affecting therapy.

An original AIDS Attitude Scale was distributed to registered nurses employed in intensive care, medical, medical-surgical, and surgical units of four western Massachusetts hospitals. 439 completed questionnaires, representing a 64.6% response rate, were returned by mail. Results of data analysis indicated that nurses would be more cautious than necessary in using precautions while handling body secretions of or doing nursing procedures with patients with AIDS. Nurses form a small community hospital and those with less experience in caring for AIDS patients would be more cautious than those from a teaching medical center and those who had cared for six or more AIDS patients. Two-thirds of the nurses would feel a great deal of stress in caring for seriously ill adult AIDS patients. Significant differences in mean stress scores for caring for patients with five diagnoses indicate that AIDS patients evoke the most amount of stress, and those with extensive burns, multiple trauma, metastatic cancer, or hepatitis B evoke decreasing amounts of stress, in that order. More than one-half of the respondents indicated that more than one-half of their family members/significant others had expressed concern about their becoming infected with HIV as a result of caring for AIDS patients. Teaching hospital respondents reported a significantly greater percent of concerned persons than did those from community hospitals. Multiple regression analysis of the twelve Likert items indicated that having a family member/personal friend with AIDS, having a greater percent of concerned persons, being male, or being employed in a small community hospital were associated with a less favorable attitude about caring for AIDS patients. The coefficient alpha (Cronbach's alpha) for the Likert scale was.72. Factor analysis of the Likert scale identified five subconcepts: stigma; pregnancy concern; mortality/prognosis stress; resource utilization; and HIV-status knowledge. Study results are limited to the respondents. Implications of the results for health services managers include implementation of a multi-faceted educational and support program for nurses caring for AIDS patients. Suggestions for further research include replication of the study with nurses in different clinical specialties, settings, and geographic regions.

<p> Over the past ten years, community-based palliative care (CBPC) has rapidly expanded as older adults are living in the community longer with advanced illness and high symptom burden. Yet there are no models of standardized care for this population. It has been suggested that primary and secondary palliative care be delivered in the primary care setting to address palliative care needs in the community. However, a description of older adults in primary care with advanced illness and symptom burden who would benefit from primary and secondary palliative care, and a description of the process to deliver care are lacking. The aim of this dissertation was to explore the facilitators and barriers to providing palliative care in primary care, and to describe the prevalence of advanced illness and symptoms of older adults in primary care to identify who would benefit from palliative care in primary care. </p><p> Using a grounded theory methodology, twenty semi-structured interviews were conducted with primary care and palliative care providers in academic and community settings. Four major themes emerged from the data that are facilitators and barriers in care coordination: (i) role clarity; (ii) feedback and communication; (iii) time constraint and workforce; (iv) education. </p><p> A secondary analysis was conducted using the National Ambulatory and Hospital Medical Care Surveys 2009-2011 to examine primary care visits. There were more visits by older adults to primary care for advanced illness and symptoms than to non-primary care. More visits were due to advanced COPD, CHF, dementia, pain, depression, anxiety, fatigue, and insomnia compared to non-primary care. This research contributes to our knowledge of the delivery of palliative care in the community and the patient population that could benefit from primary and specialty palliative care. I offer a conceptual model of the process of primary care and specialty palliative care in order to coordinate care for older adults with advanced illness and progressive symptomatology. </p>

<p> Over the past several years, mental healthcare system in United States has evolved tremendously, however majority of people are still struggling with various forms of mental illness and find it difficult to get appropriate treatment at the right time due to barriers like lack of providers, poor access, high cost and, social stigma. This business plan proposes an online mental health service company PsychWeb, offering telemental health services, with the aim of improving access to mental healthcare in the comfort of one&rsquo;s own living environment.</p><p> Chapter 1 of this business plan is about complete market analysis for the online mental health industry along with the business overview for PsychWeb and its services. It also sheds light on business target population, competitors, growth strategies and proposed future milestones. Chapter 2 shows an in depth feasibility analysis using SWOT that ensures business viability and success. In chapter 3, we have discussed the legal and regulatory issues, along with company formation, and laws around provider and patient use of PsychWeb services laying stress on HIPAA and provider licensure requirements at the state and federal level. Lastly, chapter 4 explains the financial analysis conducted to ensure the business profitability. It gives a detailed breakdown of monthly and yearly expenditures, revenues generated and profit margin projections. All financial statements generated in the process are provided in the appendix of this business plan.</p>

<p> This research used a Delphi methodology to solicit challenges that significantly impact the operational success of pediatric long-term care facilities. Further, this study sought to understand the ability of pediatrics administrators to impact, affect, overcome, or resolve these challenges. Round 1 accomplished the desired goal of eliciting a substantial amount of new qualitative information regarding administrative challenges in pediatric long-term care, which previously had been extant in the literature. In Round 2, data were distilled into categories and unique exemplars which in turn were validated by participants. In Round 3, administrators ranked and rated categories and individual challenges in terms of significance and impact. </p><p> Findings revealed that the most important challenges for administrators are those of working with an inadequate model that is designed for a geriatric population, inadequate Medicaid funding, and the lack of clinical and administrative indicators in pediatric long-term care. The most important challenges that could be affected by the administrators are related to inadequate model, clinical practice, and the need for diversification. Administrators believe they can strongly impact the rules, regulations, and protocols that are currently geriatric focused, develop pediatric long-term care indicators and evidence-based research, and impact their financial security by diversification. </p><p> The Delphi research accomplishes the desired goal of eliciting a substantial amount of new information regarding administrative challenges in pediatric long- term care and contributes to the broader body of knowledge in health services administration. The significant research findings suggest the need for changes in the regulatory and financial models in pediatric long-term care and the need for enhanced clinical practice though evidence-based practice and outcomes.</p>

<p> The capstone project reports the risk factors causing unplanned hospital readmission of vascular patients as well as the effects on healthcare cost. The methods for determining the risk factors include clinical indicators for risk prediction process, and the STAAR (State Action on Avoidable Rehospitalization) initiatives, which can be used as healthcare improvement projects to facilitate the cross-continuum team. The findings indicate a relationship between the patient&rsquo;s engagement in the lower extremity vascular procedure, and effectiveness of follow-up after surgery in the reduction of hospital readmission and healthcare cost. Potential strategies to prevent the risk factors for readmission of vascular patients and to reduce the healthcare cost are discussed. Presenting unplanned readmission for vascular patients and reducing the cost associated with readmission is important for senior leaders and policy makers to improve health care outcome.</p>

<p> HIV/AIDS-related stigma and discrimination (S&amp;D), lack of social support, poverty, and gender inequalities have been identified as factors in the increased prevalence rate of HIV transmission in Enugu, Nigeria, especially among women ages 15 to 49 years. Despite the funding of reduction programs, HIV/AIDS-related S&amp;D remain a major driving force in the increased rate of new HIV cases in Enugu. This study addressed a perceived need for behavioral change intervention approaches that span all societal factors to reduce the HIV infection rate in Enugu Nigeria. The study was guided by Goffman&rsquo;s (1963) social S&amp;D theory. The sample was composed of 132 women living with HIV/AIDS WLWHA ages 21 to 54 years, purposefully sampled from the 4 HIV and AIDS comprehensive initiatives care centers in Enugu, Nigeria. Fifteen WLWHA were interviewed and 114 participated in an online survey. The descriptive statistics and a multiple linear regression analysis and comparison revealed a convergent significant relationship between the S&amp;D determinants (social, political, psychological, environmental, and cultural) and HIV/AIDS-related S&amp;D towards WLWHA in Enugu F (4,109) = 45.09, p &lt;.001). It also revealed that the cultural determinant of S&amp;D was a significant predictor of HIV/AIDS-related S&amp;D towards WLWHA in Enugu (? = 0.81, p &lt; 0.001). The implications for positive social change include providing public health professionals evidence-based data to inform policy change, plan and to implement programs that will change societal attitudes and mobilize broad-based community actions to eradicate HIV/AIDS&ndash;related S&amp;D toward WLWHA in Enugu, Nigeria, and in Sub-Saharan African Countries.</p>

<p> <b>Objectives:</b> This research identified the potential predictors of medication adherence and studied the impact of medication adherence on healthcare utilization and costs among elderly with diabetes who were enrolled in a State Pharmaceutical Assistance Program (SPAP). </p><p> <b>Methods:</b> Pharmaceutical Assistance Contract for Elderly (PACE) programs&rsquo; database was used to identify study population and estimate medication adherence as proportion of days covered (PDC) for 12-months post-index observation period (adherent: PDC &ge; 80%; nonadherent: PDC &lt; 80%). Healthcare utilization and costs for the study period were estimated using Pennsylvania Health Care Cost Containment Council&rsquo;s hospital inpatient discharge records. Healthcare utilization measures included all-cause, diabetes-specific, diabetes-related and diabetes-specific &amp; related number of inpatient hospital admissions and length of stay (LOS). Multiple regression analyzes were performed to determine the predictors of medication adherence and to assess the association of medication adherence with risk of hospitalization, hospital service utilization and costs. </p><p> <b>Results:</b> Among 9,497 elderly PACE enrollees with diabetes, 81% were adherent and 21% were hospitalized. Race, marital status, number of unique medications and out-of-pocket payment were the significant predictors of medication adherence. The odds of being hospitalized were higher for nonadherent patients by the factor 2.030 than adherent patients (95% CI: 1.784&ndash;2.310). After controlling for covariates, non-adherent patients had significantly a greater number of all-cause (IRR 1.2727; 95% CI 1.1937&ndash;1.3569), more diabetes-related (IRR 1.2210; 95% CI 1.0492&ndash;1.4210) and more combined diabetes-specific &amp; related (IRR 1.2106; 95% CI 1.0495&ndash;1.3965) hospital visits than adherent patients. After adjusting for covariates, LOS for non-adherent patients was longer for all-cause (IRR 1.2388; 95% CI 1.1706&ndash;1.3111), diabetes-related (IRR 1.1341; 95% CI 1.0415&ndash;1.2349) and for diabetes-specific &amp; related (IRR 1.1271; 95% CI 1.0357&ndash;1.2267) hospitalization than adherent patients. GLM models showed that medication nonadherence was associated with significant increase in all-cause hospitalization costs ($22,670 vs $16,383; p &lt; 0.0001) and diabetes-related hospitalization costs ($13,518 vs $12,634; p = 0.0003). </p><p> <b>Conclusions:</b> Medication nonadherence was associated with an increased risk of hospitalization, greater number of hospital visits, longer hospital LOS and substantial hospitalization costs among elderly SPAP beneficiaries with diabetes. Utilization of our findings to develop interventions or policies to improve medication adherence would significantly impact the US healthcare system particularly while allocating limited healthcare resources.</p><p>