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Emergency rooms often are used for extremely ill patients, but they also are used and overused for non-urgent acute-care needs, especially in the urban setting where patients might not have access to primary care services. While U.S. legislation has aimed to reduce emergency-room usage for non-emergency needs, the emergency room continues to be an essential support in low-income and urban neighborhoods. Specifically, North Philadelphia residents rely on and use the emergency room for reliable care. The central premise of this thesis is that we should shift from working to curtail emergency room usage, and therefore costs, to fundamentally re-redefining the nature and identity of emergency rooms. / Urban Bioethics

The increased out-of-pocket payments required from today’s insurance plan designs is leading to the advent of patients acting more like regular consumers. They are shopping for the best value for their personal spending on healthcare services. This is leading to an increased use of less hospital and health system centric delivery sites. Enabled by the availability of information on the internet, more patients are using alternative settings such as urgent care centers, retail clinics, etc. Specifically, patients are opting for Urgent Care Centers (UCC) in lieu of the hospital emergency room (ER), principally due to higher out-of-pocket costs for unscheduled care but also a desire for a better overall service experience with amenities and a service orientation towards the consumer/patient. This shift in patient behavior raises questions as to how UCCs compare to ERs. To better understand this, two studies were conducted: the first examining the relative patient experience at UCCs versus ERs, and the second examining the effect of UCC visits on overall cost of service. To better understand the patient experience in UCCs compared to ERs, a quantitative analysis of reviews posted on Yelp for hospital emergency room and urgent care center was conducted. UCCs received significantly higher Yelp ratings than emergency rooms. Machine learning was used to determine which topics in Yelp reviews were most closely correlated with 5-star and 1-star ratings. 16,447 ER Yelp reviews were analyzed from 1,566 hospitals, and 84,502 reviews from 5,601 UCCs. There were more 5-star UCC reviews (n=43,487, 51%, p<0.05) compared to 5-star ER reviews (n=4,437, 27%, p<0.05). The study determined that 5-star reviews for ERs tend to focus on clinical care while UCC reviews focused on convenience. Online patient reviews provide an understanding of what patient’s value in their unscheduled care experience offering insights for health systems and providers in planning the future care delivery systems. To determine if urgent care centers are a less-costly substitute service to hospital-based emergency rooms or a complementary, cost-amplifying service, a second study was completed. The study compared the pre- and post-period spending differences, for selected low-acuity patient conditions, between patients who started their treatment at an urgent care center versus starting at an emergency room using difference-in-differences analysis. The study methodology was based on a sample University of Pennsylvania Health System employees and their dependents seen at an urgent care facility or in the emergency room between 2012-2017 with a primary diagnosis among 15 most common low-acuity conditions seen in those settings. The sample included 3,055 episodes with initial index visits in urgent care and 3,650 initial index visits in a hospital emergency room. Patients who visited the ER spent $1,323 (p < 0.0001) more than those who visited urgent care centers within 30 days following the visit, and $2,152 (p < 0.0001) more within 6 months following the visit. Visiting the emergency room corresponded to a 68.0% greater change in pre- to post-index period cost when evaluating the first 30 days and 40.0% comparing costs over 6 months. Thus, this study demonstrated the significant cost advantage of urgent care centers for treating selected conditions as compared to a hospital emergency rooms when the unit of analysis is total health care spending at 30-day and 6 months. / Business Administration/Interdisciplinary

<p> When the HITECH Act of 2009 set mandates for the transition from paper to electronic health records (EHRs), few realized the far-reaching impact this technological change would have on the entire healthcare environment. This dissertation examines the many facets of this adoption process by exploring perceptions, responses, and reactions of physicians and patients alike as they navigate through this transformative &ldquo;medicological environment.&rdquo; Characterized by influences from legal, political, governmental, medical, social, geographical, economic, and technological factors, this multi-faceted space reveals how a new medium for communication&mdash;the electronic message within secured health portals&mdash;transforms the way in which healthcare is managed and utilized today. </p><p> Multiple methods of observation, including oral histories, surveys, critical incident reports, and content analyses of data mined messages, together reveal the many challenges faced by patients and healthcare professionals alike as they attempt to adapt to this change while still maintaining (or improving upon) primary healthcare needs. As demonstrated by the varied responses from those living in rural and urban areas, it was found that each population approached the transition process from different vantage points. The early-adopting, urban physicians provided patient online communication simply because they felt patients expected it while rural physicians tended to resist the process, arguing that patients were media illiterate, lacked Internet access, and preferred face-to-face interactions. Others cited implementation costs and personnel training issues as a deterring factor. This provides insight into how such a new medium can affect user perceptions about online healthcare, including physician availability, online relationship factors, and overall patient care. Future research suggestions include expanded content analyses of the electronic messages themselves and follow-up, longitudinal research once implementation is more widespread. </p><p> As the Institute of Medicine (2008) states, all patients have the right to varied means of communicating with their physicians, including but not limited to online interactions. Evidence of a paradigmatic shift exists in physician training as well as patient expectations. The influence of online communication within secured health portals certainly has contributed towards this shift as more personalized, patient-centered care becomes a vital part of this ever-changing medicological environment.</p>

<p> This grounded theory study describes how Nurse Practitioners (NPs) provided care to Aboriginal people in British Columbia and proposed a theoretical foundation to guide NPs interactions with Aboriginal people in providing healthcare. This study first explored NPs work with Aboriginal people. Through analysis of interview responses, insight was gained into how NPs provide care to Aboriginal people. Fourteen NPs who worked with Aboriginal people in British Columbia for at least one year during the past five years were interviewed. After each interview data were manually coded for concepts and categories from which to build theory. Memos were written for further clarity and participants were asked to verify whether or not identified concepts and categories worked, fit, and were relevant and modifiable as new data arose. The theory, Engaging Mutually, identified core categories of Initializing Engagement, Sympathetic Mutuality, and Therapeutic Enlightenment as being connected and working together to help provide effective health care. Engaging Mutually was identified as relevant to the theories of oppression, motivational expectancy, social justice, social cognitive, cultural competency, and Watson&rsquo;s caring theory. The significance of this study was to assist NPs to gain a better understanding of how to work with Aboriginal people to improve their health. This study contributes to research, theory, leadership, and nursing and NP practice. Engaging Mutually may assist NPs and other health care providers to develop appropriate health care practices when working with Aboriginal people and potentially with people from other cultures.</p>

<p> This business plan proposes a neurofeedback therapy clinic to treat children diagnosed with Attention-deficit/hyperactivity disorder (ADHD) and are in search of a non-pharmaceutical intervention. ADHD is the most commonly diagnosed disorder among children between the ages 4-18. By stimulating arousal in the frontal portion of the brain through neurofeedback therapy, the symptoms of ADHD can be regulated. This proposal includes a market analysis, a feasibility and SWOT analysis, a review of legal and regulatory issues, and finally, a financial analysis.</p>

<p> YouWin: Young Women&rsquo;s Mind and Body Therapy (YWMBT) is a not-for-profit case management company with the mission coordinating multi-faceted, evidence-based therapy to heal the bodies and minds of adolescent women, in order to facilitate their healthy development into tomorrow&rsquo;s women. The company&rsquo;s top three goals are to lessen the burden of obesity and depression in the local community, help individuals meet their own weight loss and recovery goals, and establish the YWMBT treatment model as the standard of treatment for comorbid obesity and depression in young women. </p><p> This business plan will present the scope of the issue to be addressed, an analysis of the target market and a relevant market strategy, an analysis of the strengths, weaknesses, opportunities and threats to YWMBT, an overview of some of the legal and regulatory concerns associated with establishing and operating the business, and finally a review of the financial viability. </p>

<p>ABSTRACT Electronic medical record (EMR) use has improved significantly in health care organizations. However, many barriers and factors influence the success of EMR implementation and adoption. The purpose of the descriptive qualitative single-case study was to explore health care professionals? perceptions of the use of EMRs at a hospital division of a major medical center. The study findings highlighted the challenges in transitioning from paper records to EMR despite the many benefits and potential improvement in health care. A description of the 16 health care professionals? perceptions of EMR use emerged by adopting the unified theory of acceptance and use of technology (UTAUT) model and NVivo 10 computer software to aid with the analysis of semi-structured, recorded, and transcribed interviews. Themes emerging from the analysis were in five categories: (a) Experience of health care professionals with a subtheme of workflow, (b) Challenges in transition from paper to EMR, (c) Barriers to EMR acceptance, with a subtheme of privacy, confidentiality, and security, (d) Leadership support, and (d) Success of EMR. The findings of the case study may inform health care industry decision makers of additional social and behavioral factors needed for successful EMR strategic planning, implementation, and maintenance.

<p> Managed care through a series of comprehensive health care services is a trend in today&rsquo;s healthcare; and it includes specialized services that can provide plenty of opportunities to many healthcare organizations. Private Medical Service of San Diego currently does not have the necessary medical equipment to provide a comprehensive pain management and the ability to retain availability and flexibility to grow at its own pace and convenience. The new business plan is to acquire fluoroscopic equipment that will be staged in-house to equip its interdisciplinary pain management program. This will help increase the efficacy and safety of the pain management procedures as well as a potential for good profit.</p>