<p>Abstract The aim of this quality improvement (QI) project was to explore whether the implementation of an enhanced telephone reminder system improved the rate of attendance at initial follow-up appointment and medication adherence. A total of 86 patients, discharged from inpatient psychiatric units with a follow-up within 7 days of discharge, were eligible to receive the enhanced telephone contact reminder and follow-up text. A preliminary retrospective chart review was conducted to collect historical data on medication and attendance adherence. A prospective interventional design was used to implement the QI project. Patients received telephone contact within 24-72 hours of discharge and text message reminder strategies. A medication adherence assessment was completed at telephone contact and at initial follow-up appointment. An analysis of the data examined the impact of the TCM strategy on patient?s rate of adherence to medication and initial follow-up appointments. Descriptive analysis assessed the frequency of medication adherence in retrospective and implementation data. Inferential statistics analyzed factors of association such as prior clinic services and rate of attendance at follow-up appointment. In the retrospective chart review (n=57), data revealed a 28% attendance rate and an 81% medication adherence at the follow-up appointment, with no statistical difference in a 145 history of prior series on attendance. Implementation data on medication adherence at telephone contact and at first follow-up appointment revealed a 61.5% medication adherence rate at telephone contact and 80% adherence rate at first follow-up appointment. The predictor value of a prior history of service on attendance at first follow-up appointment revealed no statistically significant difference. The project, however, resulted in clinically significant benefits that promoted individual patients? medication-taking behaviors and decisions to attend follow-up appointments, and improved clinical practices at the BHC.

<p> This quantitative study was an evaluation of the effectiveness of the online Training Home software program, designed for use with a national nonprofit business model. This study was undertaken because nonprofits have a difficult time resourcing training. If the Training Home program can deliver a comprehensive training program for minimal cost, then a nonprofit will be better able to deliver on the nonprofit&rsquo;s stated mission. For this study, six research questions centered on measuring the helpfulness of the program, the difference in job function training, improved knowledge of a national nonprofit, and perception of the Training Home program between those that had and or had not used the program. Additionally, cost per unit of training, the number of training vignettes delivered, time spent in training, ease of use by supervisors, and staff ratings of the effectiveness of the training home program. The population studied was the 450 staff at one affiliate of the national nonprofit. This staff group consisted of a mix of genders, ages, and education levels. This study used archival data gathered over the 2013, 2014, and 2015 calendar years and was analyzed using multivariate regression and descriptive analyses. The cost and number of training vignettes delivered in a 24-month period were compared to determine whether the Training Home program was a more cost-effective delivery model than the prior system for the year before the study. Analyses indicate that the Training Home program delivered more training to staff at a lower cost per unit of training when compared to the units of training delivered in the prior model. Supervisors and staff reported the program to be effective in knowledge management and tracking and the training of all staff. The study had positive results for the sample studied. It would be beneficial for any future studies to expand the sample size into other geographic regions.</p><p>

<p> <b>Rationale/Background:</b> Fall prevention is a paramount and lifesaving healthcare initiative. The investigation of interventions for the prevention of falls may lead to a decrease in injuries and promotion of superlative care for patients hospitalized in an acute healthcare environment. </p><p> <b>Purpose: </b>The purpose of this quantitative correlational direct practice improvement (DPI) project is to determine the relationship between the implementation of a fall prevention training program and changes in fall rates over a period over three months. </p><p> <b>Theoretical Framework:</b> The Neuman system model served as the theoretical foundation for this project. The model presents a holistic approach to patient at-risk for falling and guides bedside nursing care, assess stressors, safety needs, and environmental factors suggest potential indicators linked to fall-risk patients. </p><p> <b>Project Method and Design:</b> A quantitative method and correlational design was used to investigate the impact of the intervention. The intervention involved training for a total 28 nurses (N = 28) on two wards. The final data collection included fall rates for 56-patients (N = 56). </p><p> <b>Data Results:</b> The control ward had a fall rate of nearly twice as high than the ward who received the intervention. There is a statistically significant reduction in fall rates on the intervention ward (p = 0.04). </p><p> <b>Implications:</b> Based on the findings of this project, a fall education training program supported safety through a reduction of falls. The training program was adopted as a part of standard education for the site. </p><p>

abstract: One of the critical issues in the U.S. healthcare sector is attributed to medications management. Mismanagement of medications can not only bring more unfavorable medical outcomes for patients, but also imposes avoidable medical expenditures, which can be partially accounted for the enormous $750 billion that the American healthcare system wastes annually. The lack of efficiency in medical outcomes can be due to several reasons. One of them is the problem of drug intensification: a problem associated with more aggressive management of medications and its negative consequences for patients. To address this and many other challenges in regard to medications mismanagement, I take advantage of data-driven methodologies where a decision-making framework for identifying optimal medications management strategies will be established based on real-world data. This data-driven approach has the advantage of supporting decision-making processes by data analytics, and hence, the decision made can be validated by verifiable data. Thus, compared to merely theoretical methods, my methodology will be more applicable to patients as the ultimate beneficiaries of the healthcare system. Based on this premise, in this dissertation I attempt to analyze and advance three streams of research that are influenced by issues involving the management of medications/treatments for different medical contexts. In particular, I will discuss (1) management of medications/treatment modalities for new-onset of diabetes after solid organ transplantations and (2) epidemic of opioid prescription and abuse. / Dissertation/Thesis / Doctoral Dissertation Industrial Engineering 2019

<p> The food industry has experienced changes in the past several years that include the awareness of food choices. Recently, national advertising campaigns have focused on efforts to increase the public awareness of healthy food choices and calorie intake. The healthy food choice campaigns may prove to be effective with a specific population. However, research studies revealed that residents living in disadvantaged areas lacked the income and/or transportation to access the healthy food options. </p><p> The intent of the Livin&rsquo; the Food Life, LLC organic mobile market/caf&eacute; is to introduce and provide hot prepared, organic foods and fresh organic produce at affordable prices to the low-income children and their families. Livin&rsquo; the Food Life, LLC organic mobile market/caf&eacute; will increase awareness through monthly food demonstrations and the distribution of samples to educate the low-income residents of East and South Los Angeles with the benefits of cooking and consuming organics food products.</p>

<p> Youth Centers play an important part in providing adolescent teens with a social and recreational venue to develop physically and expand mentally. The goal of this project is to develop a business plan related to a community based youth center in Long Beach, CA. This venue will offer services targeted towards the prevention of obesity, chronic health conditions, and mental wellness. The purpose of this plan is to propose a youth center that has programs implemented to prevent and reduce the prevalence of obesity and increase high school graduation rates that lead to secondary education programs. Emphasis will be placed on focusing programs aimed at the Black community because Long Beach lacks organizations that focus on this population. </p>

<p> The changing landscape of health care in the United States provides various opportunities for both providers and patients to adapt the way they give and receive their medical services, especially for those individuals in their senior years. EARS2U intends to capitalize on the aging American population and patients&rsquo; desire to have Audiology services come to them. EARS2U seeks to be the only mobile Audiology and Hearing Aid service in the San Diego and Orange county area that provides mobile access. This business plan will show how EARS2U intends to provide mobile service and become a substantially lucrative company.</p>

<p> The Institute of Medicine evaluated the U.S. health system in the 1990s and found an extremely expensive system with clinical outcomes that were ranked lower than a number of other industrialized nations. (Institute of Medicine, 2001) In addition, the per capita spending was almost double that of other nations. The U.S. health care system was fragmented, highly technical, and specialty oriented. Even though the primary care system is the backbone of more efficient and less expensive systems in other countries (Landon, Gill, Antodelli, &amp; Rich, 2010). The primary care system was in a downward spiral in terms of morale and number of U.S. medical students entering primary care specialties. To respond to the call of the Institute of Medicine and the ongoing decline of primary care residents, seven primary care organizations including the American Academy of Family Physicians and the American Board of Family Medicine, published a report called the &ldquo;Future of Family Medicine&rdquo; (Kahn, 2004). The report described a new model of family medicine called the patient-centered medical home (PCMH). The model needed to be standardized to evaluate outcomes. Three bodies provide certification: the Joint Commission, the Accreditation Commission for Health Care, and the National Committee for Quality Assurance (NCQA) (Klein,, Laugesen, &amp; Liu, 2013). The NCQA is the organization that most of the practices use for recognition (Landon et al., 2010). Various organizations have conducted studies on the implementation PCMH and found the PCMH model took about two years to implement, consumed practice resources but led to improved quality and some indication of lower costs (AHRQ, 2012). To become the future landscape of primary care, the PCMH model depends on small practices adopting it because a large percentage of family practices have fewer than five providers (Scholle, et al., 2013). The Hamilton Family Health Center (HFHC) of Community Memorial Hospital (CMH) is a small center with the equivalent of three and a half full-time providers and two specialists. The CMH recently became a critical access rural hospital certified for 25 beds, whose average daily census is 15-16 patients. This project was a combination of participatory action research (PAR) and insider action research (IAR). The project can be classifed as PAR because the staff, providers, and patients were involved and had significant input. The project is considered IAR as well because the author was also a provider in the center. The project goal was threefold: (a) achieve level three PCMH status for a small health center with markedly limited resources, (b) identify the process taken to meet this goal and how it can be improved and (c) learn what the changes will mean for the center. The Hamilton Family Health Center has achieved level three, but the project is ongoing because achieving the NCQA standards is only a step to achieving an ideal practice.</p>

<p> This study examines methods and barriers to minority leadership recruitment in healthcare organizations. Minorities are underrepresented in healthcare organizations at the executive level, even though staff and patient demographics are becoming increasingly diverse. This disparity in minority representation presents the potential for staff and patient needs, interests, and values to be overlooked by senior management and the strategies, policies, and programs they implement. This study conducted interviews with human resources personnel at healthcare organizations identified as top performers to determine whether their organizations engaged in minority recruitment methods, what methods were successful, and what barriers existed to recruitment of minorities. These results were compared to survey data compiled by the Institute for Diversity in Health Management. The results show significant room for improvement in the implementation of comprehensive methods to recruit minority senior management, with significant variation among organizations in the amount and type of methods to recruit minority executives. These findings lead to the conclusion that more pressure needs to be placed on healthcare organizations to identify best practices in minority recruitment and implement these in formal, comprehensive human resources activities related to recruitment, retention, and professional development.</p>

<p> Under the provision of the United States Department of Health and Human Services, the patient centered medical home is a model of primary care transformation that seeks to meet the variety of healthcare needs of patients and to improve patient and staff experiences, outcomes, safety, and system efficiency. Serving the medically underserved and primary care clinic shortage area of Long Beach, California, the Physically Active Centered Medical Home (PAC MH) will be a safe haven for healthy and physically active individuals who are required to avail of health insurance coverage as mandated by the Patient Protection and Accountable Care Act of 2010 (PPACA). PAC MH will offer comprehensive and integrated services that will keep its members healthy and away from the burden of repeated clinical visits. PAC MH understands that medical coverage is the least of the priorities for healthy adults. Hence, PAC MH&rsquo;s payment system is made simple. The value-based care provided at PAC MH will reward the healthcare team for achieving and exceeding the pre-established benchmarks for quality care.</p>