<p> This business plan proposes a health promotion center to help educate low-income families in Compton suffering from obesity on how to begin and maintain weight loss. Obesity is one of the leading causes of preventable deaths in adults and children. By creating a family and community-based center that provides individualized and group nutrition and fitness services, the rate of obesity can be significantly reduced. </p><p> The center which will be located in east Compton will operate as a non-profit organization. It will offer nutrition and fitness services through certified nutritionist and fitness specialist with emphasis placed on gradual weight loss. Meal planning, label reading and training, and grocery store tours are some of the nutrition services that will be offered, while aerobic training and weight training will be part of the fitness service. There will be a life coach and an on-site daycare at the center. The life coach will help potential families establish their weight loss needs, while the on-site day care will provide care for children while families exercise. Services will be offered at reduced prices, and payment will only be made out-of pocket.</p>

<p> In recent years, the financial barrier to access for prescription contraceptives has been lifted due to the Affordable Care Act. However, there is still a barrier to access because those who want it still need to get a prescription from a provider. This business plan proposes the establishment of Azura Digital Health, a scheduling tool that obstetricians and gynecologists can use to schedule their appointments, while also offering patients convenience for birth control prescriptions and assistance with finding the women&rsquo;s health provider that is right for them. Allowing patients to choose their provider can increase quality for their health, since they can choose the doctor they feel is best for them. Additionally, the convenience of getting their birth control prescription helps patients get a simple prescription for what they need in a timely manner. The scheduling tool allows providers to market themselves and broaden their patient base, as Azura Digital Health would do that work for them. Azura Digital Health hopes to improve women&rsquo;s healthcare quality, breaking the barrier to prescriber access.</p>

<p> Over one-third (78.6 millions) of U.S. adults are obese. Weight management in the typical health care practice is inadequate with fewer than half of primary care physicians consistently providing guidance on diet, physical activity, or weight control. Because 60 percent of Americans get their health insurance through their jobs, employers often bear the bulk of the obesity costs, but are also well-positioned to implement effective lifestyle interventions. The Patient Protection and Affordable Care Act (PPACA) of 2010 included provisions for the incentives and penalties employers and health plans can impose on employees&rsquo; health insurance premiums based on the participation and goal completion in wellness programs giving a major boost to a now rapidly-growing multi-billion dollar workplace wellness industry. Fit4Life, LLC intends to offer on-site wellness, fitness, and nutritional services to medium- to large-size employers with fitness facilities in the Los Angeles Metropolitan area. The company&rsquo;s unique combination of fitness, nutritional, and medical expertise rarely offered by other providers in the Los Angeles area and the convenience of the on-site service model, paired with low start-up and overhead costs are the major strengths likely to contribute to Fit4Life, LLC&rsquo;s success. </p>

<p> <i>Purpose:</i> Implement and evaluate a formal evidence-based risk screening protocol in a rural clinic setting to optimize early identification of prediabetes and T2DM in asymptomatic, non-pregnant adults age 18&ndash;44. </p><p> <i>Significance:</i> Absence of an evidence-based risk screening protocol contributed to under/overutilization in laboratory test referral and inconsistency in prescribed treatments among clinic providers. Early identification of prediabetes and initiation of appropriate treatment plans may assist in preventing T2DM and its associated complications. </p><p> <i>Methodology:</i> Quality improvement project utilizing a retrospective, randomized representative sample of charts, <i>n</i> = 30 and a convenience sample of participants, <i>n</i> = 40. The American Diabetes Association Diabetes Risk Test (ADA DRT) served as a prediabetes risk screening tool. Provider adherence to ADA DRT risk screening and laboratory test referral, type of laboratory test ordered, the relationship between demographic characteristics and the ADA DRT score, participant follow-up, and treatment ordered based on risk screening and laboratory results were analyzed using group data. </p><p> <i>Results:</i> Thirteen (35.7%) participants had laboratory values in the prediabetes or T2DM range and 100% of treatment ordered are substantiated by ADA guidelines. Using the ADA DRT tool, risk screening was completed in 100% of eligible participants; accordingly, appropriate utilization of laboratory test referral improved by 33.33%. </p><p> <i>Recommendation:</i> Incorporation of best-practices for risk screening and laboratory test referral for early identification of prediabetes is needed. APRNs are instrumental in promoting efficacious screening strategies and preventative treatment aimed at improving health outcomes. The benefits of using the ADA DRT as a prediabetes risk screening protocol in primary care should be elucidated in a prospective study.</p><p>

This study investigated the phenomenon of hospital leadership in a free-standing psychiatric hospital attached to a private, non-profit medical center. This phenomenon was studied primarily because little is known about leadership in hospitals. Therefore, the question: What is hospital leadership? was addressed. Secondary issues pertaining to external, internal, and personal aspects of hospital leadership were also addressed. They included developing understanding of: (a) How environmental constraints might affect the practice of hospital leadership; (b) how the practice of hospital leadership might vary internally; and (c) how the values and beliefs of hospital leaders might affect the practice of hospital leadership. / Hospital leadership was considered to be a form of cultural expression; therefore, ethnography was chosen as the method of research. Moreover, ethnography was chosen because it encourages development of grounded concepts and theory; outcomes expected to inform the practice of hospital leadership. / Research proceeded in three stages--entry and orientation, data gathering, and ethnography preparation--and used observation, interviewing, and secondary sources of information to generate data. Data were recorded as fieldnotes, and were analyzed continuously according to Spradley's (1980) Developmental Research Sequence Method. Data were presented as follows: Narrative descriptions of key domains, critical events, and emergent themes; ranked frequency tables for guided interview responses; taxonomies for other domains; and topological and schematic diagrams to summarize the cultural scene and concluding thesis. / This thesis suggests leadership is essentially a process of implementing a mission through the attainment of goals. It involves two major components: Values and power. Values are necessary to establish the mission; power is necessary to overcome goal constraints. Outcomes provide measures of goal attainment and quality of leadership. Feedback provides information on constraints, clarifying where power should be directed. Goals may be modified in the process. / Implications include: Successful leadership requires (a) there be a clear mission, implicitly shared by members of an organization; (b) that a leader have sufficient power to overcome constraints; and (c) that a leader be able to benefit from feedback. Future research possibilities suggested by these implications were discussed. / Source: Dissertation Abstracts International, Volume: 48-12, Section: B, page: 3526. / Thesis (Ph.D.)--The Florida State University, 1987.

<p> The rate of hospitals merging has increased significantly over the last few years. The number of hospital mergers between 2003 and 2009 averaged 55 per year, while mergers for 2010 and 2011 were 72 and 90, respectfully. This research moved beyond anecdotal reports and by using publicly reported data to not only evaluate the financial success of mergers, but also to look at other factors such as size, ownership, geography, environment (urban vs. rural), and market competitiveness to assess impacts on financial outcomes of mergers. This study examined the effect of joining a hospital system based on financial performance. Further, it assessed the relationship of specific organizational and environmental characteristics to determine if these characteristics had any effect on the success of the mergers. </p><p> Resource Dependence Theory (RDT) served as the theoretical framework for this study. Based on RDT precepts, two main hypotheses were studied including (1) Hospitals that join a health system have better financial performance after joining a health system than those that do not join a health system, and (2) For hospitals that have joined a health system, certain organizational and environmental characteristics will have greater influence on financial performance. Data from American Hospital Association, Centers for Medicare and Medicaid, and Area Health Resource File were collected, combined, and analyzed to address the research questions. </p><p> The results demonstrated that hospital operating margins significantly improved after joining a health system. Findings also suggested (at the 90% confidence interval) that hospitals located in rural areas had improved results following the second year of the merger. However, this study found no empirical support for the expectations that operating expenses would improve or that organizational characteristics (i.e., ownership and adjusted patient days), or environmental characteristics (i.e., percentage of people living in poverty, competitiveness) had a statistically significant effect on the success of a merger. </p><p> As hospitals continue to seek ways to remain competitive and to continually serve their mission to care for the members of their communities, this study can serve as a basis for assessing the effect of system membership on financial performance. The results of this study should not be used as the only basis for making merger decisions as the sample size and time period studied were too narrow to reach overarching conclusions. Keywords: mergers, acquisitions, resource dependence theory, affiliations</p>

<p> Racial disparity continues to be a struggle in America. The main purpose of this project was to determine whether there is a relationship between race and the acquisition of health insurance in adult residents of California who are younger than 65 years old. Through secondary data gathering, analysis of an existing racial disparity in health care insurance acquisition was accomplished. The results of the project indicate that a relationship exists between race and health insurance acquisition, thereby promoting an opportunity to determine hindering factors and discuss recommendations that can help to alleviate them. Multiple factors that influence the acquisition of health insurance among residents in California have been cited. Some of these factors such as affordability and immigration status are more relevant in the Latino racial group compared to the others. The awareness of this relationship promotes implications towards a legislative focus on the underserved populations and a development of action plans and public policies that can aid in acquisition of health insurance for all.</p>

<p> Medical errors cost the United States&rsquo; healthcare system approximately $19.1 billion annually. A failure to communicate or speak up is said to be a contributing factor. The purpose of this quantitative correlational study was to examine the relationship between managerial responsiveness, managerial approachability, and prosocial voice among acute-care registered nurses (RNs) from a Greater Northwest facility. The participants were 108 acute-care RNs. Instrumentation included the Supervisor as a Voice Manager developed by Saunders, Sheppard, Knight, and Roth (1992) to measure managerial responsiveness and managerial approachability. Prosocial voice was measured using Van Dyne and LePine&rsquo;s (1998) Prosocial Voice Scale. The relationship between managerial approachability and prosocial voice was positively correlated (<i>p</i> = .001). A positive relationship (<i>p</i> = 0.001) between the linear combination gender, education, years of experience within current acute-care facility, managerial responsiveness and managerial approachability and the RN&rsquo;s use of prosocial voice was found and accounted for 20.0% of the variance in the prosocial voice score. An unexpected serendipitous finding occurred when applying a backward elimination regression to three variables: managerial approachability, managerial responsiveness, and prosocial voice. RNs use of prosocial voice was positively correlated with the RN&rsquo;s level in the organization (<i>p</i> =.01), the RN&rsquo;s perception of managerial approachability (<i>p</i> = .001) while negatively correlated with the RN&rsquo;s perception of managerial responsiveness score ( <i> p</i> = .05). This research adds to current prosocial voice literature and expands the research on managerial approachability and managerial responsiveness. Future research recommendations were identified.</p>

<p> <b>Objective:</b> To describe the characteristics of frequent geriatric users of Mount Sinai&rsquo; Emergency Department (ED). <b>Methods:</b> Patients aged &ge;65 yo with >1 ED visit between February-April 2012 were included. Data was analyzed for demographics, disposition, revisit frequency, primary care provider, and insurance. This study was approved by the Mount Sinai Institutional Review Board. <b>Results:</b> A total of 95 out of 1,077 were frequent geriatric ED users. These patients demonstrated a lower index visit (30%) and 72 hour (15%), a higher 3-7 day (54%), 8-30 day (40%) and >30 day (65%) admission rate, as well as 67% had a primary care provider and 68% had medical insurance. <b>Conclusions:</b> Frequent geriatric ED users are more likely to be discharged upon index and less than 72 hour ED revisit, have higher admission rates on subsequent visits, have primary care providers and are similarly insured when compared to the geriatric ED patient population.</p>

<p> This multiple case study research examines the personal strengths of Chief Executive Officers (CEOs) and how these strengths contribute to their success as they lead their personnel and manage psychiatric hospitals in their charge. The study provides an understanding of the role of personal strengths in the successful CEO and discusses each CEO&rsquo;s utilization and development of those strengths. The Clifton StrengthsFinder 2.0 as found in <i>StrengthsFinder 2.0</i> (Rath, 2007) instrument was employed in the study to provide a common language that facilitated the researcher&rsquo;s conversation with the participants. Used as a heuristic device, the results of the strengths identifier tool were not applied in any comparative analytical format but rather provided a common frame of reference for both the researcher and the participant. The experience of responding to the strengths identifier tool provided a starting point for an interview that allowed the participants to talk about their strengths, their development, and the contribution of their strengths to their success. The theme of self-awareness emerged as an important component of their success, common to all of the participants in the study. Secondary themes of courage and humility, connected to self-awareness, contributed to understanding how the participants utilized their signature strengths to engage in a successful career leading psychiatric hospitals. The participants were able to describe their capacities, strengths, and how they used their abilities in unique ways while leading their hospitals.</p>