<p> In spite of a decrease globally, the maternal mortality rate (MMR) in Nigeria and its Jigawa State has remained persistently high. Few efforts to address the MMR in Nigeria have been undertaken. The purpose of this study was to investigate the impact of Jigawa State&rsquo;s Free Maternal and Child Health Program (JSFMCHP), education, employment, and parity of pregnant women on health care utilization (the outcome variable), as measured by antenatal care (ANC) visits. Anderson&rsquo;s behavioral model served as the study&rsquo;s theoretical framework. The sample size included 400 antenatal records of pregnant women who were randomly selected from the state&rsquo;s Health Management and Information data collected between 2011 and 2015. Chi-square tests showed a significant association between those who did not participate in the JSFMCHP, education, employment, with ANC. There was no association between parity and the number of ANC visits. The odds ratio suggested that pregnant women who did not participate in the program were 5.53 times as likely to have 4 or more visits compared to those who participated. Furthermore, the recommended number (4 or more) of ANC visits was predicted by tertiary education and employment. This study&rsquo;s findings indicate the need for a reevaluation of JSFMCHP policy, with a focus on ensuring a minimum recommended number of ANC visits for all program participants. These results can influence positive social change if used by policy makers to strengthen policies that have a beneficial impact on maternal morbidity and mortality in Jigawa State, in particular, and Nigeria, in general.</p><p>

<p> Within the 21^st century, Type II diabetes has emerged as a public health crisis. African Americans and Hispanic Americans have the highest rates of Type II diabetes and obesity compared to European Americans. The purpose of this DNP project was to teach medical assistants (MA) to provide self-management of diabetes and obesity for the African American population in the local clinical setting. An educational tool kit for health providers was developed to guide the educational project. The chronic care model was used to guide the development of the educational toolkit. A pretest posttest design was incorporated into the educational program. The materials were found to be clear, accurate, and easy to read by the medical assistants. Four MAs, who worked at the clinical setting, participated in the educational program that taught them to use the toolkit developed for this project. To evaluate the effects of the educational program for the MAs, the results of the pre and posttests were scored and showed that MAs had significantly increased their knowledge of teaching diabetes and obesity self-management for African Americans (pretest mean score 80, posttest mean score 93). An implication of this scholarly project is that it will give clinicians the resources needed to create social change in health care by addressing education in diabetes and obesity. Positive social change may result as the African American patients who receive education from medical assistants at the clinical site improve their self-management skills to prevent diabetes and obesity or the complications of the disease.</p><p>

<p> Despite concerted efforts to improve the process of shift-to-shift hand-off report (SHR), challenges and barriers continue to threaten the integrity of information shared between nurses. Research studies have demonstrated that vulnerabilities in SHR have been associated with clinical practice demographic factors, lack of a standardized process and tools, and differences in perceived value of SHR. </p><p> A quantitative, descriptive, cross-sectional study was conducted to identify nurse perception of SHR processes, factors that influence nurse perception of SHR, and nurse perception of bedside shift report (BSR) versus alternative SHR methods. Participants included a convenience sample of registered nursing students (n=49) enrolled in RN-BSN or MSN programs at a private southwestern Pennsylvania university. Descriptive statistics, ANOVA, and two independent t-Tests were used to analyze data collected from the Handover Evaluation Scale. </p><p> Study results revealed there was no statistically significant difference between nurse perception of SHR processes, demographic factors that influence SHR, and the locality of SHR (BSR). In addition, the majority of nurses identified a reluctance to change current practice of conducting the SHR process. There was no identified association between nurse perception of the quality of information (<i>p</i>=.22), interaction and support (<i>p</i>=.96), or efficiency (<i>p</i>=.17) of SHR. </p><p> As nurses are key stakeholders in the transfer of crucial up-to-date patient care information, nurse perception of the SHR needs to be further examined and evaluated to improve patient care outcomes. Quality assurance measures are the hallmark of standardized processes to ensure the delivery of safe and effective care.</p><p>

<p> Each year, approximately 10,000 baby boomers will reach age 65. The baby boomer generation encompasses 26% of the total U.S. Population. As members of the baby boomer generation reach older adulthood, they continue to experience mental health issues such as depression, anxiety, as well as medication and alcohol abuse. These mental health conditions are associated with higher rates of health care usage. In addition, an older adult may jointly suffer from a lower quality of life, increased complex illnesses, disability, and mortality/increased risk of suicide. If an older adult does not have the appropriate mental health support services, he or she may overuse the healthcare system. Obtaining mental health services is still considered taboo for some, while for others the services may not be accessible. Conversations from Home Telemental Health aims to employ innovative technology in telehealth to improve mental health delivery services for the baby boomer population. Its mission is to provide accessible and effective evidence-based therapy designed to engage baby boomers, address their mental health needs, and minimalize premature institutionalization. Conversations from Home&rsquo;s goal as a non-profit organization is to become a leading provider of telemental health services to individuals aged 50 and older in the Westside of Los Angeles and the South Bay. This proposal will provide a detailed evaluation of how Conversations from Home will accomplish these objectives.</p><p>

<p> <b>Background:</b> Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care. </p><p> <b>Purpose:</b> The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services&rsquo;, Joint Commission on Accreditation of Healthcare Organization&rsquo;s, and other professional healthcare organizations&rsquo; guidelines for nurses&rsquo; knowledge of evidence-based discharge practices; determine level of nurses&rsquo; knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida. </p><p> <b>Theoretical Framework:</b> The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. </p><p> <b>Methods:</b> Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired <i>t</i> test. An online demographic survey and pre- and posttest surveys were administered to determine nurses&rsquo; knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired <i>t</i> tests. </p><p> <b>Results:</b> A statistically significant difference was found in the pre-posttest survey responses for question 5 (<i>p</i> = 0.046 Wilcoxon; <i>p</i> = 0.041<i>t</i> test), and question 13 (<i>p</i> = 0.022 Wilcoxon; <i>p</i> = 0.018 <i> t</i> test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use. </p><p> <b>Conclusion:</b> A standardized diabetic discharge guideline incorporated into the hospital&rsquo;s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses&rsquo; adherence results in effective nursing practices and an informed patient population. </p><p>

<p> In the United States, many hospitalized patients with indwelling urinary catheters acquire catheter-associated urinary tract infections (CAUTI) during their hospital stay. CAUTI negatively affects peoples&rsquo; health and quality of life and causes a financial burden to individuals and the nation. The purpose of this quantitative cross-sectional study was to explore the relationship between gender, age, and hospital types and CAUTI incidence in New York and North Carolina over a 3-year period. The theoretical framework of choice was the Donabedian model. Simple logistic regression and hierarchical multivariable logistic regression analysis were performed on archival data that was requested from Healthcare Cost and Utilization Project (HCUP) agency. According to the findings, males (<i>n</i> = 61,040) were at a higher risk of developing CAUTI compared to female (<i>n</i> = 66,792) (<i>p</i> &lt; .001) in New York and North Carolina between 2012 and 2014. The odds of getting CAUTI were much higher among age &ge; 45 compared to the &lt; 17 years. These findings fit in with previous literature identifying age and gender as having a significant relationship with CAUTI occurrence. The outcomes in this study may guide the formulation of policies that are age-appropriate, gender-specific, and facility-tailored to reduce the incidence of CAUTI.</p><p>

<p> This dissertation empirically examines the associations between depression and HIV-related outcomes, simulates both care and outcomes under different depression care strategies, and compares the cost effectiveness of various depression care strategies to the current care strategy. </p><p> The empirical investigations reveal the negative associations between depression and HIV-related outcomes using two longitudinal patient-level databases. Furthermore, the patterns and outcomes of depression care are identified and simulated using agent-based modeling. Finally, simulated costs and effectiveness are used to evaluate different depression care strategies for reducing new HIV infections and improving quality of life. </p><p> The current standard of care for depression among patients living with HIV can be characterized as low intensity in terms of screening and treatment; enhanced depression care strategies are proposed and evaluated to be cost-saving. Recommendations are offered to enhance depression care in HIV care settings.</p><p>

<p> Posttraumatic stress disorder (PTSD) is a serious issue for post-deployment United States Marine Corps (USMC) veterans, especially because PTSD can increase the risk of suicide. Marines are screened post-deployment, yet little is known about Marine veterans&rsquo; perceptions of the PTSD screening process. The purpose of this phenomenological study was to explore USMC male veterans&rsquo; perceptions of the Post- Deployment Health Reassessment (PDHRA). The social cognitive theory constructs of a triadic relationship among person, environment, and behavior were the framework for understanding this population&rsquo;s perceptions of the PDHRA and potential stigma. Two research questions focused on how people, culture, and behavior affect Marines perception of the PDHRA and PTSD attached stigma. Interviews were conducted with 10 Marine veterans&rsquo; participants and transcribed interview responses were input into NVivo 11 software to retain a reliable database and Colaizzi&rsquo;s strategy to identify emerging themes. Key findings revealed potential positive social change to military chaplains and veterans&rsquo; health service providers. This knowledge might inform about the perceptions of Marines through informed understanding and may help develop an updated evaluation tool. Future researchers might focus on the forthcoming answers and treatment of PTSD and the attached stigma among Marines by alleviating repercussions for Marines&rsquo; answers on the PDHRA. An understanding of the study&rsquo;s findings may elicit strategies for health care administrators to expound on the PDHRA and provide educational programs to assist in future screening environments and processes through Marines perspectives.</p><p>

The economic study of incentives in firms has traditionally focused on one type of incentive—pecuniary—and one causal mechanism—the direct effect of incentives on effort. This dissertation uses three randomized field experiments to explore non-traditional incentives, and non-traditional incentive effects, in the setting of health care delivery. The first experiment (jointly authored with Nava Ashraf and Oriana Bandiera) addresses an under-appreciated phenomenon: incentives affect not only the effort of agents on the job, but also the selection of agents into the job. We collaborate with the Government of Zambia to experimentally vary the salience of career incentives in a newly created health worker position when recruiting agents nationally. We find that making career incentives salient at the recruitment stage attracts health workers who are more effective at delivering health services, with administrative data showing an improvement in institutional deliveries, child health visits, and immunization rates in the treatment areas. While career incentives attract agents who differ on observables (e.g., they have higher skills and career ambitions), 91% of the performance gap is due to unobservables. The results highlight the importance of incentive design at the recruitment stage for attracting high performers who cannot be identified on observables alone. The second and third experiments examine the use of non-pecuniary incentives in health care. The second experiment (jointly authored with Nava Ashraf and Oriana Bandiera) studies non-monetary awards. Awards may affect behavior through several mechanisms: by conferring employer recognition, by enhancing social visibility, and by facilitating social comparison. In a nationwide health worker training program in Zambia, we design a field experiment to unbundle these mechanisms. We find that employer recognition and social visibility increase performance, while social comparison reduces it, especially for low-ability trainees. These effects appear when treatments are announced and persist through training. The findings are consistent with a model of optimal expectations in which low-ability individuals exert low effort in order to avoid unfavorable information about their relative ability. The results highlight the importance of anticipating the distributional consequences of incentives in settings in which the performance of each worker affects social welfare. The third experiment turns from extrinsic incentives (such as career opportunities and non-monetary awards) to "intrinsic incentives"—that is, incentives that make work more intrinsically rewarding. In the context of a rural health worker program in India, I develop and test a novel, mobile phone-based self-tracking app designed to increase agents' intrinsic returns to effort. At nine months of follow-up, the self-tracking app leads to a 27% increase in performance as measured by the main job task (home visits). Moreover, the app is most effective when it leverages pre-existing intrinsic motivation: it produces a 46% increase in performance in the top tercile of intrinsically motivated workers, but no improvement in the bottom tercile. Evidence from survey and performance data indicates that the treatment effect is mediated primarily by making effort more intrinsically rewarding, and not by other mechanisms such as providing implicit extrinsic incentives. The results suggest the potential for wider use of intrinsic incentives that may increase performance at low cost, when agents are intrinsically motivated. / Health Policy

Abstract not available.