<p> Childhood obesity is a disease that affects 17% of children aged 2-19. This disease, best described by a social ecological perspective, is multifactorial in nature and includes individual, familial, community, and societal contributors. As the causes are multifactorial, so too should be prevention and treatment. Healthcare providers, specifically physicians, can play an important role in the diagnosis, prevention, and treatment of childhood obesity, especially if they appropriately utilize nutrition behavior change counseling to facilitate lifestyle changes. Behavior change falls within the realm of the social and behavioral sciences, disciplines that will receive greater emphasis on the newly designed MCAT 2015^&reg;; therefore, premedical and medical programs may need to alter their approaches to disseminating this discipline-specific knowledge. Nutrition education is currently limited in medical education; and thus, just as premedical programs seek to increase the social and behavioral sciences, so too should they increase nutrition education. In light of these recommended curricular changes, researchers sought to investigate the current state of premedical and medical students. views of childhood obesity. This dissertation describes three studies conducted for that purpose. In study 1, researchers investigated 30 pre-healthcare undergraduate seniors. views of childhood obesity and their sources of knowledge through in-depth qualitative interviews. Investigators found that students with specialized coursework and significant volunteer and/or internship experience had a deeper understanding of childhood obesity; however, as a whole, students failed to see the role of healthcare providers in prevention and treatment. These findings provide justification for premedical programs to guide students to see their role in prevention and treatment through educating them on the social ecological model and providing them with relevant service-learning opportunities and guided reflection. In study 2, researchers conducted a similar nationwide qualitative investigation in 78 third and fourth year medical students. These students described student-, patient- and healthcare system-centered barriers, including their lack of knowledge, patients. lack of access, and their lack of time in practice. Students also requested more applicable information and counseling training in order to equip them to prevent and treat childhood obesity. Much like the pre-healthcare seniors, these medical students failed to discuss their role in prevention and treatment. Therefore, medical schools need to help their students overcome barriers by providing them knowledge and skills and helping them understand their role in prevention and treatment. In study 3, researchers built on the knowledge gained from study 1 and study 2 and developed a valid and reliable computerized tool, the Childhood Obesity Prevention Self-efficacy (COP-SE) survey. Factor analysis of 444 completed surveys from students at 53 medical schools revealed a two factor structure with a correlation of 0.637 between factors. Factor 1 assesses self-efficacy in nutrition counseling while Factor 2 measures self-efficacy to assess readiness to change and initiate nutrition lifestyle changes. There was high reliability within factors (Factor 1 = 0.946; Factor 2 = 0.927), and the correlation (0.648) between the COP-SE survey and a general self-efficacy survey confirmed that the COP-SE measures domain-specific self-efficacy. This valid and reliable survey can be used by medical schools as a formative or summative assessment of students. self-efficacy in childhood obesity prevention and treatment. Further research should include confirming the factor structure and exploring the significance of response trends seen in this sample. The findings of all three studies can be used by premedical and medical programs to maximize the effectiveness of their preparatory programs to provide students with the necessary skills for prevention and treatment of childhood obesity. With the appropriate preparation, future healthcare providers can build their self-efficacy in disease prevention and treatment, hopefully resulting in improved patient outcomes.</p>

<p> Low health literacy impacts an individual's ability to comprehend communication from healthcare providers, reduces access to healthcare, and contributes to increased mortality. The purpose of this study was to evaluate the impact of learning style on adult health literacy education. The health belief model, protection motivation theory, the transtheoretical model, and social cognitive theory were used to analyze the data in this study, and to further develop effective health literacy education. The research questions addressed the effectiveness of educational intervention adjusted to their appropriate learning style in comparison to a standardized health literacy intervention and potential difference, according to type of learning style, in the amount of changed performance between pretest and posttest. A sample of 80 adults in an urban community was recruited through organizations serving low-income individuals. The participants were assessed for baseline health literacy level, followed by identification of learning style, educational intervention, and posttest assessment, which led to determination by <i>t</i> test that changes between pretest and posttest scores were statistically significant between the control group and the study groups. This finding suggests that health education should be delivered to patients according to individual learning style in order for patients to comprehend and retain information provided. Social change implications include healthcare professionals appropriately addressing health literacy so that patients may participate more actively in their personal healthcare decisions to improve healthcare quality outcomes, decrease long-term costs of delivering healthcare services, and improve the general health of the community.</p>

<p> Individuals enrolled in both the Medicare and Medicaid programs, the "dually eligible," are generally vulnerable and face a wide range of health care needs; numerous studies have found that their health care is beset with problems of cost and quality. Health policy researchers find that these problems are directly associated with the inadequate coordination of benefits and services, but studies about care coordination have largely used quantitative approaches and focused on providers&mdash;they have not explored the critical perspective of patients receiving the care. To improve the complex processes of care coordination, this hybrid case study examines the experience of a sample of dual eligible enrollees served in North Carolina's patient centered medical home, and care managers. The subjects were generally independently living, and at lower-risk that typical dual eligibles. Although some experienced some continuity of care issues within NC's PCMH, generally they described receiving the right care, at the right time, in the right care settings. However, some experienced barriers to accessing necessary care, especially in the areas of prescription drugs and navigating the health care delivery system. Some of these challenges could potentially be resolved by NC's PCMH, but many issues are outside the program's control. Care managers who were interviewed suggested modifications to the Agency for Healthcare Research and Quality's Care Coordination Ring, which represents care coordination for a more stable, middle-class population than the dual eligibles they serve.</p>

<p> The present study examined the relationship between compassion fatigue, burnout, compassion satisfaction, and self-care among counselors and counselors-in-training. Additionally, the current study investigated if recent life changes, age, sex, race, years of experience, education level, and work/internship setting impacted counselors' and counselors'-in-training self-reports of compassion fatigue, burnout, compassion satisfaction, and self-care. </p><p> A total of 253 counselors and counselors-in-training were surveyed through a professional conference, internship classes, and email listservs. Variables were measured through the use of a demographic questionnaire, the Professional Quality of Life Scale (ProQOL 5), the Self-Care Assessment Worksheet (SCAW), and the Recent Life Changes Questionnaire (RLCQ). Pearson-product moment correlations, analysis of variances (ANOVAs), and t-tests were utilized to determine potential relationships between variables. </p><p> Results indicated that recent life changes impact both burnout and compassion fatigue. Compassion satisfaction appeared to influence burnout, but not compassion fatigue. Results also determined that burnout and compassion fatigue are positively correlated with each other. </p><p> When examining the demographic variables, results revealed that women experience higher levels of compassion fatigue than men. Burnout was found to be higher for participants who are working or interning in agency and school settings than those in private practices or hospitals. Participants in agency and school settings were also found to be associated with lower amounts of self-care than those in private practices. Nonstudent agency workers were determined to have higher amounts of compassion satisfaction with age and increased engagement in psychological self-care activities. However, self-care was negatively correlated with compassion satisfaction for participants in school settings. </p>

<p> Healthcare spending has risen astronomically over the recent past. Some of the blame has been placed upon an inefficient healthcare system. Whether true or not, we are in the midst of burdensome financial trend in healthcare that cannot continue. Thus, private payers, government payers and taxpayers alike, are looking at ways to reduce such spending. At the same time, healthcare providers wish to remain profitable enough to continue delivering care, well into the future. One proposed answer to the conditions plaguing an inefficient and expensive health system is the new focus on collaborative care models for healthcare delivery. This paper examines collaboration, particularly the joint venture between hospitals and healthcare providers. This paper also assesses the financial viability of such organizations, and recommends areas for further exploration in collaborative design.</p>

<p> "<b>Healthcare organizations rely heavily on communications to deliver services and certify quality treatment outcomes. Specifically, communication and communication processes are critical determinants in whether a dental practice succeeds or fails. There has been a substantial amount of research on communication and its influence on patient satisfaction, employee morale, and work productivity within various organizations. However, limited existing qualitative research examines communication processes and their impact on health institutions. This research study explored the communication process and its influence on employee work performance within a dental practice. The researcher conducted semi-structured interviews to obtain descriptive, information-rich responses from a purposeful sample of 10 participants regarding their perception of the communication process. Utilizing an embedded, exploratory, case study research design, descriptions and experiences from leaders and employees revealed four major gaps within the organization's communication process. Consequently, six themes emerged that identified the four intricacies of an effective communication process within a private dental practice. The following complexities, lack of comprehension, lack of employee awareness, lack of precision and clarification of instruction, and inconsistent exchange of information, are crucial facets of the communication process. From the perspective of study participants, improvement in these areas would foster employee engagement, produce desirable outcomes, and enhance employee work performance</b>"</p>

<p> Electronic Medical Records (EMRs) are increasingly being used in healthcare organizations. However, there are few factors influencing the physician adoption rate of EMRs. The purpose of this paper is to investigate the meaningful use incentives, and the type of specialty practices in relationship to the physician use of EMRs. Data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed to how meaningful use incentives and the type of physician practices affect the physician use of EMRs. The Chi-Square test and ANOVA test have been use to examine the hypothesis, and the association was found to be statistically significant.</p>

<p> This thesis compared the perceptions of older adult recovering substance abusers with the perceptions of alcohol and drug treatment providers on what each sample believed would be the most appropriate delivery methods and locations for alcohol and drug treatment services to individuals 50 years of age and older. Sixty participants, 30 subjects from each sample group, completed a questionnaire created by the researcher. Results showed there were no significant differences in perceptions of older adult substance abusers and drug treatment providers about the most appropriate treatment methods and locations for treatment. Additional findings included suggestions from participants about ways to improve current treatment modalities and locations. Results suggested the need for provider education on age-specific issues faced by the older adult addict. </p>

<p> Heart failure poses a significant public health issue in the United States, consuming a disproportionate share of the Centers for Medicare and Medicaid&rsquo;s annual expenditures (Ramani, Uber, &amp; Mehra, 2010). The purpose of this retrospective quantitative study is to compare the inpatient mortality and 30-day readmissions for heart failure patients based on the patient&rsquo;s proximity to the hospital treated at either New York University Hospital (NYU), located in downstate NY with a very high population density, or Albany Medical Center (AMC), located in upstate NY in a less densely populated city. A subgroup analysis of race, socioeconomic status, and gender was completed to attempt to identify potential high risk groups. The hypothesis testing did not find a statistically significant overall difference in regard to 30-day readmission rates between the two hospitals or within any of the subgroup analyses. However, both hospitals had a significantly lower percentage of multiple admissions from patients residing in the distant quartile located farthest from the hospital as compared to heart failure patients residing in the distance quartile nearest the hospital. The study did detect statistically significant inpatient mortality differences in the socioeconomic status subgroup analysis between NYU and AMC as well as a difference in the overall study population. The study results add further empirical evidence to the existence of a &ldquo;decay effect&rdquo; of health care service utilization as patient proximity to those services decreases.</p>

<p> The research investigated factors that affect the sustainability of nonprofit community behavioral healthcare organizations (CBHOs) with annual revenues > $10 million. The theoretical framework encompassed resource dependence, institutional, strategic choice, and organizational effectiveness theories and used a systems model to delimit variables of interest. Using survey methodology, the quantitative study examined relationships between variables of resource dependence, institutional pressure, strategic choice, and financial performance (effectiveness) across a population of 508 CBHOs within the United States. To accomplish this, measures previously introduced by Bielefeld (1992a, 1992b) and Tuckman and Chang (1991) were adapted to align with the influencing environment of CBHOs. The following correlations were statistically significant: resource dependence and a revenue-seeking strategy; institutional pressure and a revenue-seeking strategy; institutional pressure and a legitimation strategy; resource dependence and financial performance; and a revenue-seeking strategy and financial performance. The study examined the extent to which variables of resource dependence, institutional pressure, and strategic choice explained variation in financial performance. The equity financial model was significant (<i>R</i>² = .13, <i>F</i> (5, 89) = 2.6, <i>p</i> &lt; .05). The revenue concentration financial model was also significant (<i> R</i>² = .13, <i>F</i> (4, 90) = 3.16, <i> p</i> &lt; .05). The administrative expense financial model was not significant. Findings revealed the close linkage between the resource and institutional environment and a high level of dependence of the sector on government funding. Revenue-seeking strategy was significant in two of three financial models. The research holds promise for replication in other homogenous nonprofit sectors.</p>