<p> The purpose of this quantitative correlational study using archived data was to determine if there is a relationship between patient satisfaction and indicators of medical harm in the state of Florida. The study reviewed the archived data for patient satisfaction for the 328 hospitals located in Florida along with archived data of six hospital-acquired infections for the hospitals in the study. The metric used for patient-centered care is patient satisfaction. Although the literature supports a patient-centered model supplanting non patient-centered models, patients continue to suffer medical harm and even die while no one has evaluated the difference between the models. A linear regression and Spearman&rsquo;s rho analysis was performed for each of the six research questions in the study. The results demonstrated a rejection of the null hypothesis for two of the research questions. This outcome indicates a relationship between patient satisfaction and two indicators of medical harm; SSI Colon, and MRSA. Although the results did not support all six of the research questions, leadership of hospitals supportive of a patient-centered environment should continue to investigate the positive relationships demonstrated in this study to duplicate efforts in increasing the quality of care. Additionally, leaders of hospitals who have low patient satisfaction scores may consider implementing a patient-centered model of care to reduce indicators of medical harm.</p>

<p> Over the past ten years, community-based palliative care (CBPC) has rapidly expanded as older adults are living in the community longer with advanced illness and high symptom burden. Yet there are no models of standardized care for this population. It has been suggested that primary and secondary palliative care be delivered in the primary care setting to address palliative care needs in the community. However, a description of older adults in primary care with advanced illness and symptom burden who would benefit from primary and secondary palliative care, and a description of the process to deliver care are lacking. The aim of this dissertation was to explore the facilitators and barriers to providing palliative care in primary care, and to describe the prevalence of advanced illness and symptoms of older adults in primary care to identify who would benefit from palliative care in primary care. </p><p> Using a grounded theory methodology, twenty semi-structured interviews were conducted with primary care and palliative care providers in academic and community settings. Four major themes emerged from the data that are facilitators and barriers in care coordination: (i) role clarity; (ii) feedback and communication; (iii) time constraint and workforce; (iv) education. </p><p> A secondary analysis was conducted using the National Ambulatory and Hospital Medical Care Surveys 2009-2011 to examine primary care visits. There were more visits by older adults to primary care for advanced illness and symptoms than to non-primary care. More visits were due to advanced COPD, CHF, dementia, pain, depression, anxiety, fatigue, and insomnia compared to non-primary care. This research contributes to our knowledge of the delivery of palliative care in the community and the patient population that could benefit from primary and specialty palliative care. I offer a conceptual model of the process of primary care and specialty palliative care in order to coordinate care for older adults with advanced illness and progressive symptomatology. </p>

<p> This research used a Delphi methodology to solicit challenges that significantly impact the operational success of pediatric long-term care facilities. Further, this study sought to understand the ability of pediatrics administrators to impact, affect, overcome, or resolve these challenges. Round 1 accomplished the desired goal of eliciting a substantial amount of new qualitative information regarding administrative challenges in pediatric long-term care, which previously had been extant in the literature. In Round 2, data were distilled into categories and unique exemplars which in turn were validated by participants. In Round 3, administrators ranked and rated categories and individual challenges in terms of significance and impact. </p><p> Findings revealed that the most important challenges for administrators are those of working with an inadequate model that is designed for a geriatric population, inadequate Medicaid funding, and the lack of clinical and administrative indicators in pediatric long-term care. The most important challenges that could be affected by the administrators are related to inadequate model, clinical practice, and the need for diversification. Administrators believe they can strongly impact the rules, regulations, and protocols that are currently geriatric focused, develop pediatric long-term care indicators and evidence-based research, and impact their financial security by diversification. </p><p> The Delphi research accomplishes the desired goal of eliciting a substantial amount of new information regarding administrative challenges in pediatric long- term care and contributes to the broader body of knowledge in health services administration. The significant research findings suggest the need for changes in the regulatory and financial models in pediatric long-term care and the need for enhanced clinical practice though evidence-based practice and outcomes.</p>

<p> The capstone project reports the risk factors causing unplanned hospital readmission of vascular patients as well as the effects on healthcare cost. The methods for determining the risk factors include clinical indicators for risk prediction process, and the STAAR (State Action on Avoidable Rehospitalization) initiatives, which can be used as healthcare improvement projects to facilitate the cross-continuum team. The findings indicate a relationship between the patient&rsquo;s engagement in the lower extremity vascular procedure, and effectiveness of follow-up after surgery in the reduction of hospital readmission and healthcare cost. Potential strategies to prevent the risk factors for readmission of vascular patients and to reduce the healthcare cost are discussed. Presenting unplanned readmission for vascular patients and reducing the cost associated with readmission is important for senior leaders and policy makers to improve health care outcome.</p>

<p> HIV/AIDS-related stigma and discrimination (S&amp;D), lack of social support, poverty, and gender inequalities have been identified as factors in the increased prevalence rate of HIV transmission in Enugu, Nigeria, especially among women ages 15 to 49 years. Despite the funding of reduction programs, HIV/AIDS-related S&amp;D remain a major driving force in the increased rate of new HIV cases in Enugu. This study addressed a perceived need for behavioral change intervention approaches that span all societal factors to reduce the HIV infection rate in Enugu Nigeria. The study was guided by Goffman&rsquo;s (1963) social S&amp;D theory. The sample was composed of 132 women living with HIV/AIDS WLWHA ages 21 to 54 years, purposefully sampled from the 4 HIV and AIDS comprehensive initiatives care centers in Enugu, Nigeria. Fifteen WLWHA were interviewed and 114 participated in an online survey. The descriptive statistics and a multiple linear regression analysis and comparison revealed a convergent significant relationship between the S&amp;D determinants (social, political, psychological, environmental, and cultural) and HIV/AIDS-related S&amp;D towards WLWHA in Enugu F (4,109) = 45.09, p &lt;.001). It also revealed that the cultural determinant of S&amp;D was a significant predictor of HIV/AIDS-related S&amp;D towards WLWHA in Enugu (? = 0.81, p &lt; 0.001). The implications for positive social change include providing public health professionals evidence-based data to inform policy change, plan and to implement programs that will change societal attitudes and mobilize broad-based community actions to eradicate HIV/AIDS&ndash;related S&amp;D toward WLWHA in Enugu, Nigeria, and in Sub-Saharan African Countries.</p>

<p> <b>Objectives:</b> This research identified the potential predictors of medication adherence and studied the impact of medication adherence on healthcare utilization and costs among elderly with diabetes who were enrolled in a State Pharmaceutical Assistance Program (SPAP). </p><p> <b>Methods:</b> Pharmaceutical Assistance Contract for Elderly (PACE) programs&rsquo; database was used to identify study population and estimate medication adherence as proportion of days covered (PDC) for 12-months post-index observation period (adherent: PDC &ge; 80%; nonadherent: PDC &lt; 80%). Healthcare utilization and costs for the study period were estimated using Pennsylvania Health Care Cost Containment Council&rsquo;s hospital inpatient discharge records. Healthcare utilization measures included all-cause, diabetes-specific, diabetes-related and diabetes-specific &amp; related number of inpatient hospital admissions and length of stay (LOS). Multiple regression analyzes were performed to determine the predictors of medication adherence and to assess the association of medication adherence with risk of hospitalization, hospital service utilization and costs. </p><p> <b>Results:</b> Among 9,497 elderly PACE enrollees with diabetes, 81% were adherent and 21% were hospitalized. Race, marital status, number of unique medications and out-of-pocket payment were the significant predictors of medication adherence. The odds of being hospitalized were higher for nonadherent patients by the factor 2.030 than adherent patients (95% CI: 1.784&ndash;2.310). After controlling for covariates, non-adherent patients had significantly a greater number of all-cause (IRR 1.2727; 95% CI 1.1937&ndash;1.3569), more diabetes-related (IRR 1.2210; 95% CI 1.0492&ndash;1.4210) and more combined diabetes-specific &amp; related (IRR 1.2106; 95% CI 1.0495&ndash;1.3965) hospital visits than adherent patients. After adjusting for covariates, LOS for non-adherent patients was longer for all-cause (IRR 1.2388; 95% CI 1.1706&ndash;1.3111), diabetes-related (IRR 1.1341; 95% CI 1.0415&ndash;1.2349) and for diabetes-specific &amp; related (IRR 1.1271; 95% CI 1.0357&ndash;1.2267) hospitalization than adherent patients. GLM models showed that medication nonadherence was associated with significant increase in all-cause hospitalization costs ($22,670 vs $16,383; p &lt; 0.0001) and diabetes-related hospitalization costs ($13,518 vs $12,634; p = 0.0003). </p><p> <b>Conclusions:</b> Medication nonadherence was associated with an increased risk of hospitalization, greater number of hospital visits, longer hospital LOS and substantial hospitalization costs among elderly SPAP beneficiaries with diabetes. Utilization of our findings to develop interventions or policies to improve medication adherence would significantly impact the US healthcare system particularly while allocating limited healthcare resources.</p><p>

<p> In the United States, type 2 diabetes mellitus (T2DM) has been categorized as a major health-threatening problem affecting a wide cross section of people. About one third of the population is unaware that they have the disease; however, early recognition of symptoms would lead to prevention, diagnosis for a better prognosis, and, in some cases, the reversal of the disease. Researchers have shown that late diagnosis leads to high mortality, morbidity, disability, loss of productivity, and high costs of health care to individuals, families, and the government. The main purpose of this study was to establish a new model mechanism for the detection and prevention of T2DM using the lived experiences of the primary care physicians. This qualitative study investigated the lived experiences of seven primary care physicians from the Northern California Bay area community. The primary data collection method was by interview through e-mail correspondences and the data were organized, coded, and analyzed on the responses to the interview questions and research questions. The research study resulted in four major themes: (a) lifestyle choices to reduce T2DM, (b) desire to improve the lives of patients, (c) government involvement, and (d) shared perception of T2DM. Recommendations were developed based on the compiled data from this study and future studies could involve health-care accessibility and treatment interventions of T2DM for patients with low socioeconomic status and use of the new model mechanism to improve early detection and prevention of T2DM.</p><p>

<p> In response to the growing need for early disease detection and diagnosis, Mastergene aims to provide genetic testing services ranging from new born screening to diagnostic screening for individuals up to 65 years of age to gain insight into their genetic information &amp; understand their own health &amp; personal information. This information will assist individuals in making treatment decisions for healthy living. Through Indian healthcare market analysis, it is evident that there exists a huge gap between hospitals and patients when it comes to understanding genetic testing and its benefits. Mastergene, with its innovative in-house laboratory, will arise awareness amongst the general population and will facilitate early detection of highly prevalent diseases in the Indian community. As a stand-alone diagnostic laboratory, Mastergene will outsource genetic testing kits from a supplier, send it to its patients on order and obtain patient&rsquo;s sample in that genetic test kit for testing purposes. In conclusion, Mastergene will bring this enormous breakthrough to diagnose the disease from its root cause rather than symptoms alone.</p><p>

<p> The disparities in healthcare and the challenges of healthcare leaders in achieving positive health outcomes are a priority in America. Much discourse and policy is currently evolving in the legislative and executive branches of government. The United States has the highest health expenditures in the world and is classified as one of the unhealthiest countries. Many factors contribute to the disparities. These factors include socioeconomic, cultural competency, social determinants, policy, and health leadership. The challenge for health leaders is to identify strategies to improve the trends and e the status of health quality and well-being for all Americans. This study employed qualitative research using a phenomenological approach; surveying healthcare leaders in the United States. Data collection employed in-depth interviews of healthcare leaders with at least two years of experience in their current role. This qualitative study identified challenges of leaders in health care, best practices of successful healthcare leaders to improve patient access, narrow the gap of health-related disparities, and evaluated techniques and methods to improve health outcomes across racial and ethnic groups.</p><p>

<p> <b>Background:</b> Obesity has recently been classified by the American Medical Association (AMA) as a disease which, if unrecognized and unaddressed in childhood, causes multiple medical and psychological complications that can impact both personal and population health. Unprecedented funding is being invested in electronic health records to improve quality, safety, and delivery of healthcare and reduce healthcare costs. Scant literature has evaluated the use of aids in the electronic health record (EHR) to identify obesity. </p><p> <b>Objectives:</b> The purpose of this study was to determine to what extent the tools available in an EHR for automatic Body Mass Index (BMI) calculation based on height and weight documentation are used by pediatricians to correctly identify obesity in children. Secondary objectives were to evaluate quality of data input (discrete vs. free text) and see if there is any variation in rates of identification among patients of different socio-demographic characteristics and trainees of different levels. </p><p> <b>Methods:</b> We conducted a retrospective chart review for patients aged 2&ndash;18 years seen for a well-child visit at New York Presbyterian Hospital between January 2011 and January 2014, where it is standard practice at these visits to take height and weight measurements. The EHR automatically populates these values onto growth curves, converting them into BMI with percentiles. Standardized definitions from the Centers for Disease Control and Prevention (CDC) 2010 were used to qualify overweight and obese based on BMI. We determined the percentage of patients who were overweight or obese (based on CDC percentiles) that had the diagnosis identified by the pediatrician, and then assessed the quality of data input. We assessed laboratory follow up and referrals for all patients, and assessed for demographic differences among patients properly and not properly documented by providers as obese or overweight. </p><p> <b>Results:</b> We reviewed 700 charts in total. Inclusion criteria were all of the patients who had a BMI between 85&ndash;95% (these were grouped as overweight) and a BMI over 95% (obese). 209 patients were overweight or obese and therefore eligible for inclusion. Of the 209 clinically overweight/obese children, 72.2% had some form of documentation of this diagnosis, although the diagnosis was documented more often in the obese vs. overweight child. The diagnosis was most often captured electronically in the free text progress note. Over half of clinically overweight/obese children aged &ge;8 years did not receive follow-up standard laboratory testing, and only about one-quarter of clinically overweight/obese children had documented in-office nutrition guidance. Diagnosis of overweight was higher in females, but it was almost twice as likely that an obese male would be documented as such. Results showed no identification variation based on age or race/ethnicity. There was no difference in recognition of obesity/overweight based on postgraduate year (PGY) or nurse practitioner (NP) status. </p><p> <b>Conclusion:</b> Despite its importance as a public health priority for children, automatic calculation of BMI by use of an EHR led to documentation by a provider as a child being overweight/obese only three quarters of the time. This study suggests that despite increasing focus on using EHRs to improve individual and population health, including for obesity, clinical decision support remains underutilized.</p>