Medicare reimbursement rates across the United States have varied by as much as 49-130% across healthcare facilities. Geographic adjustments and severity of medical diagnoses attribute to some dissimilarity; however, the source of longer hospitalization and higher re-admission rates among Medicare patients requires financial consistency. The research encompassed (N = 3000) patients with hypertension as the focus for the study because this is a critical group of Medicare patients with a chronic disease that has been identified as a silent killer. The principal goal that drove this research study was to explain the variations in length of stay for Medicare patients with hypertension. The theoretical framework was the epidemiological triad model composed of person, place, and time variables. A secondary data set was acquired from the Healthcare Cost and Utilization Project Nationwide database of the National Inpatient Sample for the duration of 2011 - 2013. A multiple logistic regression analysis was conducted to determine if there was a correlation between length of stay and reimbursement rates for hypertensive Medicare patients. The findings of this research study provided an analytical explanation for the forces that have been driving Medicare patients' LOS, and rate of reimbursement. The research study yielded variations in the rate of reimbursement for a government entity in medical charges by illustrating the utilization of geographic price variations. The findings revealed that the categorical variable LOS and reimbursement rates for Medicare hypertensive patients had a significant correlation, and with higher reimbursement rates that were associated with longer hospital duration. The findings of the research study may inform Medicare decision-makers to eliminate geographic price variation and provide greater consistency in the rate of reimbursement, as well as a uniformity in length of stay across all regions of the United States.

Professional licensing directly affects about 29% of U.S. workers and is considered a primary means to establish and maintain health care practitioner competence. Clinical laboratory practitioner licensing was largely ignored in the literature with only 2 studies 30 years apart that provided conflicting conclusions regarding wage effects. This research provided the first study of clinical laboratory practitioner licensing effects on wages after controlling for human capital and individual characteristics wage determinants. This nonexperimental correlational study extended the literature on licensing effects on wages, including women's wages and professions not uniformly licensed across 50 states. The theoretical foundation relied on the human capital wage model that wages vary according to human capital investment, namely education and experience. Census 2000 5% Public Use Microdata Sample provided wages and control variable data, including educational attainment, experience, gender, marital status, and children. Using hierarchical regression analysis, this study found clinical laboratory practitioner wages were significantly higher (5.8%) in licensing states compared to nonlicensing states after controlling for these human capital and individual characteristics, R 2change (p < .001). Female clinical laboratory practitioners working in licensing states earned significantly higher wages (5.0%) compared to those in nonlicensing states, R 2change (p < .01). This study has potential for positive social change in clinical laboratory practitioner licensing policy development, implementation, and analysis by providing urgently needed empirical wage data for legislators to make informed decisions on costs to adopting such legislation.

Discrimination against immigrants based on country of origin, gender, or race is known to contribute to wage inequality, lower morale, and decrease worker satisfaction. Healthcare leaders are just beginning to study the impact of gender and race on the wages of internationally educated nurses (IENs). Grounded in Becker's theory of discrimination, this cross-sectional study examined nursing wages for evidence of wage inequality among IENs working in the United States using secondary data collected in the 2008 quadrennial National Sample Survey of Registered Nurses. Ordinary least square regression coupled with the Blinder-Oaxaca wage decomposition was used to analyze the wages of 757 IENs working in the U.S. healthcare system. T tests with effect size were calculated to find the impact of gender, race, and country of education on wage. The study found that white male IENs earned higher wages than all other immigrant groups, followed by nonwhite males and nonwhite females (R2 = .143; F(8,748) = 15.60; p =.000;). White female IENs earned the least, at 80%, 88%, and 91% of wages earned by white male, nonwhite male, and nonwhite female IENs, respectively (p < .005). The relationship between hourly wage and being a white female was negative and statistically significant (p = .006) and white females earned 19.6% less per hour than white male IENs. Working in tertiary care contributed 21.60% of wages for white IENs and 10.30% of wages for nonwhite IENs. Inequality in nursing wages was related to an interaction between race and gender for wages of white female IENs but not in wages for nonwhite female IENs. Results of this study promote positive social change by motivating nursing departments to equalize wages and policymakers to strengthen equal pay statutes.

Research currently indicates patient perceptions of the doctor-patient relationship are central to health outcomes. Theoretically, the current study is grounded in two literatures: the placebo effect and the broader literature examining empirically tested predictors of the doctor-patient relationship. Two factors not yet studied relative to patient perceptions of the doctor-patient relationship include the direct effect of medical gatekeeper characteristics along with the interaction between gatekeeper characteristics and existing healthcare attitudes/behaviors. This quantitative archival study utilized a MultiCare Survey dataset of 10, 579 participants who were general practitioner patients in northwestern United States. This study first examined the individual impact of healthcare attitudes/behaviors as measured by the Health Matters scale and gatekeeper characteristics as measured by the Front Office scale on patient perceptions of the doctor-patient relationship assessed by the Provider and Education scales. Second, this study assessed the interaction of these variables in predicting doctor-patient perceptions. Regression analyses revealed that both healthcare attitudes/behaviors and gatekeeper characteristics individually predicted and interacted to predict doctor-patient perceptions. Findings from the study contribute to social change by identifying the importance of training those individuals who first engage the patient as part of establishing a holistic approach to positive patient relationships.

Emergency Department (ED) providers and staff experience challenges with using electronic health record (EHR) software to document and communicate about patient care. These difficulties are often caused by inadequate training in the use of the organization's EHR system. Challenges with EHR use have been linked to increased ED patient wait times, which impacts patient safety by delaying care and increasing the potential for medication errors. Providing education that addresses EHR software; EHR usability; and collaboration among staff, providers, and EHR system managers has been shown to reduce ED wait times and decrease the risk of medication errors. The purpose of this project was to evaluate a new ED Safety EHR educational module and to identify provider and staff difficulties when operating ED EHR software. The goal of this project was to provide relevant education to ED providers and staff, which could minimize the impact of EHR use on patient safety in the emergency setting. Relational coordination theory and Kolcaba's theory of comfort framed this project. Five local ED staff and providers considered experts in EHR software utilization were chosen to review and validate the content of the educational module using a ten question, 4-point Likert scale survey. All five experts agreed that the content of the ED Safety EHR educational module was easy to read, comprehensible, and relevant. One noted area of weakness involved the technical language used in the educational module. Participants requested language simplification prior to implementation. This project promotes social change by addressing the need for ED EHR education as a strategy to reduce ED patient wait times and minimize the risk of medication errors in the emergency setting.

Changing regulations, increased competition, and evolving customers' expectations have necessitated significant organizational changes in the health care industry. This multiple case study investigated the strategies of senior managers from 3 California health care organizations to implement significant change initiatives. The participating organizations had a positive reputation for successfully implementing change. Data from interviews and a review of organizational documents were analyzed through the conceptual lens of Lewin's phases of change model and Kotter's 8-step process for implementing change. The analysis revealed 3 general themes: communications, training, and employee involvement. The managers of each participating organization emphasized the importance of keeping employees informed, and the importance of continuous bidirectional communication between all levels of the organization. They emphasized that communication facilitated a smooth and timely implementation of the planned change; they also noted the importance of training to assist employees in adapting to new job requirements and new technology. However, it was noted that the managers did not undergo any formal training in change implementation. Participants also emphasized the importance of employee involvement in the form of consultation concerning aspects of the implementation. Contrary to Lewin and Kotter's assumptions, the employees had no say in the initial decision to change, how to change or when to change. These findings have positive social change implications by assisting managers of health care organizations to improve their strategies for implementing change initiatives.

Registered nurses leaving the workplace are estimated to cost healthcare organizations and society between $1.4 and $2.1 billion annually. The purpose of this multiple case study was to explore what strategies leaders of healthcare organizations from the Eastern and Northern regions of Virginia can use to mitigate the effects of nurse turnover and its cost to the organization. The target population consisted of 8 RNs who experienced turnover during their nursing careers. The conceptual framework for this study was Herzberg's dual-factor theory. Face-to-face semistructured interviews were conducted and publically available documents were garnered. Thematic reduction of participants' interviews, coupled with data triangulation between narratives and publically available documents resulted in the emergence of 4 common themes: immediate nurse supervisor training, staff support within departments, nurse pay commensurate with the time demands, and education requirements. All participants cited burnout, stress, and career development as reasons for seeking new employment, and the topics of pay and staffing had high frequencies of occurrence. The RNs interviewed expressed nurses have different sources of satisfaction and these sources affect motivation and intent to leave. Social implications include providing insights into conditions that could strengthen the healthcare workplace environment and contribute to patient care improvements, reduce turnover costs, and increased productivity. Improved retention could also result in greater stability of the RN workforce in health care organizations.

Approximately 25% of those hospitalized with congestive heart failure are readmitted within 30 days after discharge. Because researchers and policy makers consider hospital readmission within 30 days for patients with heart failure to be a quality of care issue, the Centers for Medicare and Medicaid Services has imposed financial penalties of up to 3% of a hospital's Medicare revenue for 1 year for excessive readmissions, potentially impacting the financial sustainability of some organizations. The purpose of the study was to address the research gap regarding the outcome quality measure of hospital admissions from the emergency department (ED) and 2 each process and structure variables. The Donabedian conceptual framework was used to assess quality of care through the triad of structure, process, and outcome. The quantitative study comprised analysis of cross-sectional archival data from the 2015 National Hospital Ambulatory Care Survey using cross-tabulations with chi-square followed by multiple logistic regression analysis. Findings showed that process quality measures of being seen in the ED within 72 hours and total laboratory tests obtained in the ED were predictive of lower likelihood of admission. The structure quality measure of insurance was not predictive; however, being seen by provider type consulting physician was predictive of higher likelihood of admission, whereas being seen by a nurse practitioner was predictive of lower likelihood of hospital admission. The implications of this study for social change are helping hospitals maintain financial stability through avoidance of financial penalties for heart failure readmission, supporting access to care for patients by avoiding hospital closures.

The purpose of this study was to examine the impact of overweight and obesity on veterans' careers. Obesity, once thought unproblematic for the military, is being recognized as a health concern that has expansive implications for the health and readiness of service men and women, as well as for veterans. There is an abundance of information on obesity within the general population, but research on the impact of obesity on military careers is limited. This quantitative, cross-sectional research study investigated how obesity is a challenge throughout a veteran's career, from enlistment to retirement, using an online survey to gather data related to demographics including rank, age, race/ethnicity, education level, marital status, and years of service. Data were analyzed using descriptive statistics, independent t tests, Levene's test, and the Mann-Whitney test. Results of the analyses showed that military veterans' overweight at separation contributes to their likelihood of adverse weight-related experiences while in the service, and that military veterans who are overweight or obese have more adverse weight-related experiences than those who were not obese when they separated from the military. Among respondents who were not overweight at separation, women had more adverse weight-related experiences than men. The findings of this study could change how military leaders and policy makers develop new programs, promoting a focus on the prevention of obesity rather than on causes of obesity. Understanding how overweight and obesity affect service members' careers could lead to increased appreciation of the importance of ensuring military readiness through interventions that address multiple levels of influence.

Despite knowledge regarding the need for regular physical exercise, little is known about the most effective ways to encourage and maintain regular physical activity among primary care patients. New approaches to education about and support of physical activity are needed for everyone, but especially for groups susceptible to diseases related to sedentary lifestyles. This project evaluated a web-based educational intervention guided by the health belief model to address the lack of regular physical activity among 25 Hispanic patients in a South Florida clinical practice. The physically inactive patients were identified through the clinic's electronic medical records and consented to participate. Quantitative data were obtained before and 8-weeks after the education using the International Physical Activity Questionnaire. The data were analyzed to find the median weekly minutes for each domain on the questionnaire (work domain, active transportation domain, domestic and garden domain, and leisure domain). Participants' median scores increased after the intervention for moderate physical activity at work (1440 minutes to 2400 minutes), vigorous physical activity during leisure time (0 minutes to 1920 minutes), and walking for transportation (0 minutes to 792 minutes). Inferential statistics were not employed, so the statistical significance of these increases were not determined. The social changes that may occur from wider implementation of this educational approach include decreased disability and decreased health care costs for patients at risk of developing diseases linked to a sedentary lifestyle.