Assistive technology may delay cognitively impaired elders' need for long-term institutionalization, and the promote independence. Its use is on the rise, yet the gap between the needs of the cognitive impaired elderly and what developers of the assistive technologies design, manufacture, and implement, remains to be filled. Using Inayatullah's 6-pillar approach, as the guide to the future of assistive technology, the purpose of this qualitative study was to explore how assistive technologies may fulfill the daily functional needs of the cognitively impaired elderly with Alzheimer's or other dementia by 2037. Data were collected from a focus group of 10 seniors at a senior center in a large mid-Atlantic city, as well as survey data from with 5 family members of the cognitively impaired elderly and 16 technology developers from an engineering society. These data were coded according to the thematic content analysis and causal layered analysis. The future triangle analysis served as a second layer of analysis. Findings indicated that the most desirable outcome for 2037 is that of the "happy retiree," characterized by flourishing cultural and financial opportunities, and the least desirable is that of the "struggling pensioner" characterized by monetary gains of the social elite at the expense of the poor and working class. The most expected outcome, though, is the "caring robot" that is characterized by the use of technology and artificial intelligence to promote equitable social and health care benefits to aging citizens. Positive social change may be achieved through recommendations to state, local, and national policy makers that support the improvement in the elders' well-being, the delay of hospitalization, and greater support for the duties of family members, and greater caretaker independence.

Extended hospital length of stay (LOS) causes increased health care costs and incidence of never events, such as hospital-acquired infections, pressure ulcers, and falls, which are not reimbursed by Medicare. This study examined if there would be a statistically significant decrease in the LOS of patients after the implementation of a discharge process improvement initiative (DPII), The model for improvement and small tests of change concept were used to guide the DPII at a hospital in northern California. Sources of data included archival data obtained from the hospital's quality improvement department that showed LOS prior to and after the implementation of the DPII. The LOS for 2015 and 2017 were compared using the t test for independent samples. The LOS in 2015 was longer (M = 4.59, SD = 3.66) than in 2017 (M = 4.09, SD = 3.81), a statistically significant difference, M = 0.50, 95% CI [0.32, 0.67], t (77) = 5.574, p = .005, d = 1.3, showing that the implementation of the DPII led to a reduction in the LOS. This reduction cannot be attributed solely to the DPII because other projects were implemented at the same time, such as the Clinical Decisions Unit and multidisciplinary rounds. Future research could focus on the relationship between reduced LOS and readmission and the degree of collaboration among health care team members. The implications of this study for social change include the potential to lower health care costs and increase patients' awareness of their responsibility for their own health.

Healthcare centers face increasing revenue risk under the Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA). The purpose of this multiple case study was to explore strategies that successful leaders of healthcare centers use to mitigate the risk of reimbursement penalties under MACRA. The conceptual framework of this study was Generation 3 cultural-historical activity theory (CHAT-III), and the analysis process used was Yin's recursive and iterative phases. Participants of this study were 6 leaders of healthcare centers in the United States identified as having high quality and low cost via the Centers for Medicare and Medicaid public use files. Semistructured interviews were used to explore the identification of strategic opportunity, strategy formation, implementation, and control. Themes for organizational culture that emerged from data analysis included a foundation core with flexibility and iterative process-improvement practice. Themes in the strategy formation process included total employee involvement and a quality-first, cost-benefit strategy structure. Themes in the implementation process included multiple departmental and organizational collaboration, task-based implementation, and data transparency. Localized cadence meetings were a theme in the control process. Improvements to the organization as a result of this study include a series of standards for organizational culture, a toolbox including CHAT-III as a tool for the identification of strategic opportunity and a methodology for strategy formation and implementation, and control to help ensure financial sustainability. Implications for positive social change include the increased probability of continued ready access to healthcare, improved population health, and lower mortality rates for the communities served.

The roles of immigration status in preventive health care services among Nigerian immigrants in the United States were investigated in this quantitative, cross-sectional survey study. About 260,724 Nigerian immigrants reside in the Unites States, but many do not complete lifesaving preventive health services such as immunization and screening, a major factor contributing to the rise in the cost of healthcare resultant from their use of emergency room services. This study investigated the extent to which immigration status independently explains the relationship between health disparities and risks in non-completion of preventive health care among Nigerian immigrants in the United States by comparing data from Nigerian immigrant adults residing in the United States to data from the African American adults in the United States. Socio-cognitive theory and the social behavioral model served as the conceptual framework for this study. There were 291 adult Nigerian immigrants in the cross-sectional survey using a purposive sampling technique. The data were analyzed using the Levene's test for homogeneity of variances, the Pearson's Chi- Square test and the Kruskal-Wallis non-parametric test. The Kruskal-Wallis results showed that there was a significant difference in screening for preventive care services among the 4 immigrant status categories (p = .000) based on length of residency in the United States. Understanding the health disparities of this population according to their country of origin and immigration status will assist health providers with awareness of population-specific health needs, and may be beneficial in designing public health programs for this population group.

The use of electronic health records (EHR) has the potential to improve relationships between physicians and patients and significantly improve care delivery. The purpose of this study was to analyze the relationships between hospital attributes and EHR implementation. The research design for this study was the cross-sectional approach. Secondary data from the Health Information and Management Systems Society (HIMSS) Analytics Database was utilized (n = 169) in a correlational crosssectional research design. Normalization Process Theory (NPT) and implementation theory were the theoretical underpinnings used in this study. Multiple linear regressions results showed statistically significant relationships between the 4 independent variables (region, ownership status, number of staffed beds [size], and organizational control) and the outcomes for the dependent variables of EHR software application attributes (Clinical Decision Support Systems (CDSS) components), EHR software application attributes (major systems), and successful implementation of Meaningful Use (MU) (p = .001). A statistically significant relationship (p = .001) was also found between the 2 independent variables (EHR software application attributes [CDSS components] and EHR software application attributes [major systems]) and the outcome of successful implementation of MU when combined. This evidence should provide policy makers and health practitioners support for their attempts to implement EHR systems to result in positive Meaningful Use which has been shown to be more cost effective and result in better quality of care for patients.The potential social change is improved medication prescribing and administration for hospitals and, lower cost and better quality of care for patients.

Health care leaders are challenged with addressing addiction and the treatment of addiction. Many studies have been conducted around addiction treatment; however, no studies have been conducted on Christian-based recovery programs that use the same approach regardless of the addiction. The purpose of this phenomenological study was to explore the experiences of participants in a Christian-based recovery program that uses the same approach for all addictions. The social learning theory provided the framework for this study. Data were collected by interviewing participants of the Christian-based recovery program Free Grace Recovery (FGR). Eight participants selected had a variety of reasons for program participation from substance abuse, codependency issues, anger management problems, control issues, and sex addiction. The data were analyzed using MAXQDA software, coded by topic, and arranged into broader categories. Through that process, five central themes emerged from the data: spiritual religious experiences, program experiences, positive experiences with people, skills, acquisition experiences, and acts and services experiences. The implications for social change are that programs like FGR can be beneficial for many addictions, habits, and vices, and the need for program specialization may not be necessary because participants reported similar experiences despite having different addictions or other issues they were addressing. This would make recovery possible for a larger group of people.

Pediatric bipolar disorder (PBD) is a growing public health problem in the United States, especially among adolescent children. Despite awareness of the diagnosis and the effects that it has on the child, little attention has been given to the effects that PBD has on the guardian. The purpose of this qualitative phenomenological study was to explore the factors influencing guardians' experiences related to PBD. Penchansky and Thomas' Theory of Access and Family Systems Theory were used in this study to explore guardians lived experiences of PBD, its effects on the entire family system, and mental health service treatment. This approach was composed through interviewing 6 guardians caring for adolescents diagnosed with PBD. Interviews were conducted, transcribed and coded using NVivo12 software. The findings revealed the emergent themes as follows: disbelief of initial diagnosis, coping mechanisms, advice, barriers, burdens, stressors, and challenges. The themes described the experiences of guardians that led to feelings of denial, frustration, embarrassment, and resentment. Damaged relationships, medical problems, and financial hardships are only some of the challenges that guardians expressed during the interview. The issues that the guardians experienced provide evidence to fill the gap in the literature regarding effects on guardians. Further research into mental health services and guardians' perceptions on PBD is needed. This study promotes social change by informing mental health providers of the feelings and stressors of the guardians of PBD patients, which may lead to improved care for the family unit.

Although a modest body of literature exists on accreditation, little research was conducted on the impact of accreditation on primary healthcare organizations in the Middle East. This study assessed the changes resulting from the integration of Accreditation Canada International's accreditation program in a primary healthcare organization in the State of Qatar. The study also investigated how accreditation helped introduce organizational changes through promoting organizational learning as well as quality improvement initiatives. Pomey's Dimension of Change framework and questionnaire was used to measure the effect of Accreditation Canada International standards on the perceived quality performance and the progress towards organizational learning. The study explored the quality improvement initiatives resulting from the introduction of Accreditation Canada International accreditation program at the institutional level. It also aimed to identify the organizational learning resulting from application of accreditation standards across the various levels in the organization. Applying a quantitative design, a structured questionnaire was used to collect data from 500 staff. The study used T-test, Spearman's correlation coefficient, ANOVA to analyze the collected survey data. The results of this study provided much-needed insights on the possible changes that organizations might go through concerning quality improvement and organizational learning. The results would potentially support a smooth accreditation preparation process and ultimately contribute to positive social changes at the level of the safety and wellbeing of the people accessing the health services in the community.

With more than 700,000 new diagnoses annually, congestive heart failure (CHF) is a chronic condition that affects the chambers of the heart. When not managed correctly, the disease rapidly progresses to substantial fluid volume overload that impacts activities of daily living and the overall quality of life. The financial implications for poor CHF management cost a mean annual medical expenditure of $33,427 per patient per year. The need for a diagnostic and prognostic at-home protocol is needed in the medical community, as there is currently no such tool on the market. Donabedian's framework was used to guide the formulation and interpretation of this research. The purpose of this project was to design a CHF protocol using evidence-based research for clinicians making home visits to homebound patients with a primary diagnosis of CHF with an individualized protocol focusing on disease management, in home support system, knowledge base and financial factors for homebound patients. The protocol was released through a snowballing campaign to clinicians who work with CHF, transitional care, or homecare who then evaluated the protocol on its perceived efficacy if integrated into practice. Findings were analyzed using simple descriptive statistics by 32 nurses and other health care professionals who responded work in home care, cardiology, medical surgical nursing hospitalists, or skilled nursing facilities. Thirty-one of the 32 respondents deemed the protocol useful and stated a clinical need of protocol as evidenced by completed the AGREE II Questionnaire. The findings demonstrate that the CHF Practice Protocol provides clinicians with an evidence-based guidance to manage homebound patients with CHF on a small scale.

The purpose of this study was to explore senior leaders integration of the National Center for Healthcare Leadership (NCHL) competency model within their employee evaluation system. This case study was conducted to explore how the NCHL leadership competency model is used within their organization's employee evaluation system. The NCHL leadership competency model guided this study. The research was an exploration of themes in leadership competencies used in the healthcare organization. Data collection included in-depth interviews with 10 healthcare junior leaders in a single healthcare organization in the Midwestern United States who had at least 1 year of experience as a leader and a review of secondary data related to their job skills and annual evaluations. Using Saldana's method of data analysis, 4 primary themes emerged: leaders are transformed by vision and focus, leaders need continuous training, leaders like accountability, and leaders like influence goal creation. The 4 themes indicated that participants perceived NCHL leadership competencies integrated in their performance evaluation system to be of benefit. The findings revealed senior leaders might benefit from integrating the NCHL competency model in new leader orientation competencies, leadership training, and performance assessment tools. Positive social change may result by successful implementation of the NCHL leadership competency model strategies from this study, improving societal healthcare through efficient healthcare delivery.