<p> This dissertation explores patient trust in their physician and its impact on telemedicine. Telemedicine is using any technology to remotely communicate with a healthcare professional. The first study explores patient trust in their physician by validating the Wake Forest Trust in Physician scale for use in telemedicine research. The original (TIP) scale consists of 10 items and measures four of the five dimensions of trust: Fidelity, Competence, Honesty, and Global Trust. The final validated scale for telemedicine use (T-TIP) consisted of 12 items measuring three subscales: trustworthiness, interpersonal skills, and confidentiality. Study two explores the relationship between patient trust and delivery mode (telemedicine versus traditional interactions). The results from Study 2 indicate that patients trust their physician more in the telemedicine interaction than in the traditional interaction. There was also an effect of location, ethnicity, and frequency of doctor visits on patient trust. Study three delves further into the relationship between patient trust and telemedicine by examining the impact of communication mode on patient trust. Additionally, study three explores the relationship between usability and trust. There was no difference in patient trust scores between text and verbal communication. However, study three did find that as perceived usability of the interface increases, patient trust in their physician also increases. Also, this study found that the text interface had a higher fixation rate and shorter fixation duration than the video interface, indicating that the text interface had less cognitive load. These studies not only provide a tool for measuring patient trust in their telemedicine physician but also demonstrate that there is an impact of patient trust on telemedicine. The fact that patient trust in their physician is higher in telemedicine means that telemedicine could be used to increase patient participation in their own healthcare. Additionally, the relationship between usability and patient trust could be used to increase telemedicine use.</p><p>

<p>Functional Status in Hospitalized Senior Patients: Measurement, Prediction Models, and Cost-Saving Opportunities By Margaret A. Kornuszko-Story Abstract Seniors have declining functional ability which is made worse from immobility during hospitalization. Accountable providers have underestimated how addressing patient function can reduce costs and improve quality by reducing length of stay, readmissions, and discharges to skilled nursing facilities (SNF). This study conducted a budget impact analysis to determine potential cost savings associated with an early patient function assessment and mobility intervention. Binary logistic regression was employed to explore whether prediction models for discharge disposition and 30-day all-cause hospital readmissions can be improved with the addition of Ambulatory Measure Post-Acute Care (AM-PAC) predictors. Semi-structured interviews were conducted with process stakeholders to understand how function measurement and patient mobility can be supported in acute care facilities. Results indicated that acute care facilities in this Network would save a net of $6.4 million; and the Accountable Care Organization by reducing discharges to SNFs and readmissions would generate $4.6 million and $4.5 million respectively. AM-PAC Mobility and Self-Care scores are good predictors of discharge destination (C = 0.890), and while not significant predictors of readmission, improved the C-statistic from 0.792 to 0.811. All interviewees (n=13) stated that a culture of mobility is an important aspect for an early patient assessment and mobility intervention.

<p> The United States health care system has evolved over the years, to be a massive system with many steps required to obtain medical care. With the current shortage of primary care providers, patients are often waiting for an available appointment to receive basic medical treatments, screenings, immunizations, etc. A trip to the physician&rsquo;s office, urgent care, or emergency department can be an entire day ordeal. The emergence of retail clinics since the year 2000, has been tackling this issue to provide convenient medical care in the community. The cost of health care has also risen, leading to many individuals, even those that are newly insured, to avoid seeking treatment. Wellness Check is a new convenient care clinic seeking to fill the gap in the market for patients that wish to be seen quickly and conveniently. This new retail health clinic chain will be in central hubs throughout multiple communities, with the goal of bridging the gap in primary care. The following proposed business plan outlines an analysis of the market, business feasibility, legal and regulatory factors, and finances. Wellness Check will succeed in providing expedient convenient care with tremendous growth potential looking towards the future.</p><p>

<p> Many individuals or couples have a strong desire to have their own biological children. When experiencing difficulty conceiving many struggle with high levels of anxiety, stress, and depression. Infertility is caused by a variety of factors affecting both women and men. Treatment can be medically invasive and expensive. The purpose of this project is to offer a well-rounded perspective on infertility to help clients cope and start a family. WeCare Fertility Support Center will be a comprehensive counseling center improving the lives of many individuals and couples by providing educational guidance on infertility treatments, communication skills, psychological support and direction with adoption. Patient&rsquo;s will have someone to rely on every step of the way offering support and guidance. WeCare Fertility Support Center will provide physical, emotional and psychological well-being for patients in Long Beach CA and its surrounding neighborhoods.</p><p>

<p> The U.S. healthcare industry seeks to improve patient satisfaction as the national trend of increasing diversity and ethnic representation continues. The provision of culturally sensitive health care will not only increase patient satisfaction and outcome metrics but also allow healthcare organizations to thrive financially by meeting patient needs and payer requirements. Just Culture Consulting, LLC. is a start-up, for-profit healthcare consulting firm that will provide cultural competency and language training services for healthcare professionals. Just Culture Consulting, LLC. aims to build a regionally and potentially a nationally recognized brand in specialty healthcare consulting by capitalizing on the growing need for culturally competent providers in healthcare. The Firm will retain a large client base through aggressive marketing and by leveraging the skills of its multicultural staff who possess significant career and native exposure to language, cultural sensitivity, healthcare delivery, and administration.</p><p>

<p> Personal health record (PHR) is considered a crucial part in improving patient outcomes by ensuring important aspects in treatment such as continuity of care (COC), evidence- based treatment (EBT) and most importantly prevent medical errors (PME). Recently there has been more focus on preventive care or monitoring and control of patients symptoms than treatment itself. Nowadays, there are many mobile health applications and sensors such as blood pressure sensors, electrocardiogram sensors, blood glucose measuring devices, and others that are used by the patients who monitor and control their health. These apps and sensors produce personal health data that can be used for treatment purposes. If managed and handled properly, it can be considered patient-generated data. There are other types of personal health data that are available from various sources such as hospitals, doctors offices, clinics, radiology centers or any other caregivers. </p><p> Aforementioned health documents are deemed as a PHR. However, personal health data is difficult to collect and manage due to the fact that they are distributed over multiple sources (e.g. caregivers, patients themselves, clinical devices, and others) and each may describe patient problems in their own way. Such inconsistencies could lead to medical mistakes when it comes to the treatment of the patient. In case of emergency, this situation makes timely retrieval of necessary personal clinical data difficult. In addition, since the amount and types of personal clinical data continue to grow, finding relevant clinical data when needed is getting more difficult if no actions are taken to resolve such issue. Having complete and accurate patient medical history available at the time of need can improve patient outcomes by ensuring important aspects such as COC, EBT, and PME. Despite the importance of PHR, the adoption rate by the general public in the U.S. still remains low. In this study we attempt to use Personal Health Record System (PHRS) as a central point to aggregate health records of a patient from multiple sources (e.g. caregivers, patients themselves, clinical devices, and others) and to standardize personal health records (e.g. use of International Classification of Diseases (ICD- 10) and Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT)) through our proof-of-concept model: Health Decision Support System (HDSS). </p><p> We started out by exploring the barriers in adopting PHRs and proposed a few approaches that can promote the adoption of PHRS by the general public so it is possible to implement continuity of care in community settings, evidence-based care, and also prevent potential medical errors. To uncover the barriers in adopting PHR, we have surveyed articles related to PHRS from 2008 to 2017 and categorized them into 6 different categories: motivation, usability, ownerships, interoperability, privacy, and security and portability. </p><p> We incorporated the survey results into our proposed PHRS, so it can help overcome some of the barriers and motivate people to adopt PHRS. In Our proposed PHRS, we aimed to manage personal health data by utilizing metadata for organizing and retrieval of clinical data. Cloud storage was chosen for easy access and sharing of health data with relevant caregivers to implement the continuity of care and evidence-based treatment. In our study, we have used Dropbox as storage for testing purposes. However, for practical use, secure cloud storage services that are Health Insurance Portability and Accountability Act (HIPAA) complaint can be used for privacy and security purposes, such as Dropbox (Business), Box, Google Drive,Microsoft OneDrive, and Carbonite. In case of emergency, we make critical medical information such as current medication and allergies available to relevant caregivers with valid license numbers only. In addition, to standardize PHR and improve health knowledge, we provide semantic guidance for using SNOMED CT to describe patient problems and for mapping SNOMED CT codes to ICD-10-CM to uncover potential diseases. As a proof of concept, we have developed two systems (prototypes): first, my clinical record system (MCRS) for organizing, managing, storing, sharing and retrieving personal health records in a timely manner; second, a health decision support system (HDSS) that can help users to use SNOMED CT codes and potential disease(s) as a diagnosis result.</p><p>

<p> The purpose of this marketing plan is to identify the need for ASC&rsquo;s in the field of cosmetic and plastic surgery. Outlining an assessment of the market will provide a detailed overview of the industry and a roadmap to building a sustainable business. Each section in the analysis will present information that pertains to the industry, customer, and competitors. The marketing plan will help organize all of the data and research about the business and is useful tool for business owners or potential investors. Beverly Drive Surgery Center intends on offering patients seeking cosmetic or plastic surgery with the optimal surgical environment and exceptional care.</p><p>

<p> The purpose of this action research study was to examine the effects of the stigma of mental illness towards individuals with mental illness on services provided by medical professionals, specifically, registered nurses who work in an emergency department (ED). There have been numerous studies on how attitudes towards mental illness can be present in health care professionals; however, none that focused specifically on the attitudes of ED nurses. Nurses working in the ED are often the first health care professional a patient with mental illness sees and their attitude can influence the rest of the ED visit. The Opening Minds Scale for Health Care Workers (Modgill, Patten, Knaak, Kassam, &amp; Szeto, 2014. &ldquo;Opening Minds Stigma Scale for Health Care Providers (OMS-HC): Examination of Psychometric Properties and Responsiveness&rdquo;) and the Caring Nurse Patient Interaction Short Form (Cossette, Cote, Pepin, Ricard, &amp; D&rsquo;Aoust, 2006. &ldquo;A Dimensional Structure of Nurse-Patient Interactions from a Caring Perspective: Refinement of the Caring Nurse-Patient Interaction Scale (CNPI-Short Scale)&rdquo;) were used to measure attitude towards stigma and the perception of the care a nurse gives a patient. Thirty-four nurses from two emergency departments participated in the research with the expectation of there being high levels of stigma which would in turn affect the care given to the patients with mental illness. Descriptive statistics, multiple regression and ANOVA were used to find low to moderate levels of stigma of mental illness, and these nurses had a perception of providing excellent care to their patients. This is in contrast to other studies finding moderate to high levels of stigma in general among health care professionals. This information can be useful in exploring and then using any policies and procedures present in the research sites for the benefit of other emergency departments. Additional research is planned to further review these sites and other emergency departments within the hospital network to ascertain if these results hold true, and if so, identify the dynamics involved.</p><p>

<p> AAdvocacy Group LLC is a for profit healthcare consulting firm, specializing in improving overall patient experience through its professional consulting services for healthcare organizations and private patient advocacy services to the Los Angeles Community. AAdvocacy Group LLC does not provide legal or clinical advice, and also does not accept any health coverages for patient advocacy services. AAdvocacy Group LLC is a firm believer, and also supported by research, there is a strong correlation between patient experience and patient health outcomes. Through the two distinct services, patient experience consulting services and private patient advocacy services, AAdvocacy Group LLC holds an impact on both a macro (organizational base) and micro (patient) level. In addition, this allows the organization to be abreast with leading industry practices.</p><p>

<p> Acute care hospitals and senior healthcare leaders are facing increasing governmental regulations enacted by the Affordable Care Act (ACA), Value-Based Programing, and a constantly changing political agenda. Senior healthcare leaders are expected to solve these new challenges and lead their employees and organizations during these challenging times. However, the ever-changing healthcare environment, which may be attributing to the high turnover rates and low rates of job satisfaction for senior healthcare leaders, is preventing lasting solutions to the current challenges the healthcare industry is facing (Fiabane, Giorgi, Sguazzin, &amp; Argentero, 2013; Keyko, Cummings, Yonge, &amp; Wong, 2016). Research supports that intrinsic variables of job satisfaction are the key to increasing motivation and job satisfaction for healthcare employees (Janssen, De Jonge, &amp; Bakker, 1999; Lee &amp; Cummings, 2008; Lundh, 1999; Nolan, Nolan, &amp; Grant, 1995; Speedling, 1990). Research also indicated that value congruence is positively related to job satisfaction (Edwards &amp; Cable, 2009; Kristof, 1996; Kristof-Brown, Zimmerman, &amp; Johnson, 2005; Ren &amp; Hamann, 2015) and has a stronger relationship between intrinsic variables of job satisfaction than extrinsic variables of job satisfaction (Caudron, 1997; Fisher, 2010). The purpose of this research study was to explore the relationship between the rates of extrinsic and intrinsic job satisfaction and the degree of person-job value congruence for senior healthcare leaders. Surprisingly, this study&rsquo;s findings indicated that there is no statistically significant relationship between person-job value congruence and extrinsic or intrinsic job satisfaction. Also, contrary to previous literature, extrinsic job satisfaction was highlighted as more important than intrinsic job satisfaction for increasing job satisfaction for senior healthcare leaders. The study&rsquo;s findings also note that female senior healthcare leaders have less extrinsic job satisfaction and feel that they need to achieve more (be more successful, capable, and ambitious) in their roles than male senior healthcare leaders. This study&rsquo;s findings offer acute care hospitals evidence that supports employee engagement strategies that differ from the common practice to focus on intrinsic variables and personal values. Instead, this study&rsquo;s findings suggest acute care hospitals focus on the more explicit extrinsic variables of job satisfaction and explore potential gender differences between senior healthcare leaders.</p><p>