<p> The purpose of this qualitative instrumental single case study was to explore how patients living with Type 2 diabetes (T2D) in Barbados manage the disease and what role health literacy might play. Purposeful sampling aided in selecting the sample for the study. The sample was 23 participants who were 40 years and older, diagnosed with T2D, living in Barbados, and attending the Endocrine Center for treatment. Participants responded to 13 open ended questions used to answer the research questions. Information was coded using NVivo 10 software and the software provided the themes based on the participants&rsquo; responses to the interview questions. The themes provided were managing T2D, diet, exercise, and understanding T2D and related information. The interpretation of the findings were that patients in Barbados had a moderate understanding on how to manage T2D and managed the disease with moderate effectiveness. The findings also revealed that health literacy might have a meaningful impact on how to manage T2D but other factors might be involved. Recommended strategies are to improve communication between patient and providers and to provide initiatives to improve patients&rsquo; self-efficacy. The findings might provide health care leaders, and policy makers with insight on how patients living in Barbados with T2D manage the disease and the role that health literacy might play.</p>

<p>Average compensation of a CEO of publicly-traded hospitals was about $4 million a year for the period 2011 to 2016. Their compensation is growing while people have a hard time to pay the medical bills. The passage of the Affordable Care Act of 2010 has a significant effect on the healthcare system specifically on hospital operations. Hospitals account for 32% of the total healthcare costs. Through the passage of the ACA, lawmakers intended to reduce costs and increase the quality of care. Publicly-traded entities because of the separation of the management (agent) and ownership (principal) have conflicts of interest that lead to agency problems and costs such as the cost of monitoring and low return to shareholders. The publicly-traded hospitals are no exception. Hospitals provide incentives to the CEOs to reduce these costs and align their and shareholders? objectives. The purpose of the quantitative study was to examine the following question. What correlation, if any, existed between CEO compensation and financial performance of the U.S. hospitals post the ACA Act of 2010 for 2011-2016? The following metrics, operating margin, return on assets, return on equity, occupancy rate, length of stay, and profit per discharge, were used to perform multiple regression analysis. Initially, seven hospitals were selected, but one hospital was excluded because of missing data. Spearman?s rho correlation was used because data violated some of the parametric assumptions. The Operating margin, occupancy rate, and profit per discharge variables were statistically significant in explaining the CEO compensation. Other variables affected the CEO compensation but were not statistically significant. Finally, including all six variables explained less than 30% of CEO compensation, which would indicate agency problems exist in the hospitals. Future studies should identify what other variables explain the change in CEO compensations

<p> With the push for national EHR adoption and the subsequent increase in meaningful use of HIT applications, the healthcare industry has sought to realize reduced cost, increased safety, and improved patient outcomes. In an effort to evaluate the goal of improved patient outcomes, this study examines the effect of HIT adoption stage on the length of stay (LOS) for children admitted with an asthma diagnosis. Asthma is a chronic disease affecting millions of children each year, and has significant health, monetary, and emotional costs. As asthma is in the top three of most common conditions requiring hospital admissions for children and that nearly 50% of inpatient pediatric patients are covered by Medicaid, improving quality outcomes for this condition has large implications across the healthcare delivery system. </p><p> Using comparisons from the KID 2009 and 2012 datasets, the differences between mean LOS for pediatric asthma patients between stages of adoption of Health IT as measured by the EMRAM scale are statistically significant at the p &lt; .05 level, demonstrating that increased use of Health IT has lowered the mean length of stay for this population. Thus, the utilization of a medical best practice, here the adoption of Health IT, resulted in shorter hospital stays and thus cost savings, in this defined pediatric patient population. While further studies examining Health IT implementation in other patient populations are necessary, these results demonstrate that the implementation of Health IT can lead to both better standards of care and lower healthcare costs, which should be of significant interest to those charting the future course of healthcare and healthcare reimbursement in this country.</p><p>

<p> Patient falls present challenges in acute care settings. It was unknown if hourly patient rounding using an electronic whiteboard system (EWS) impacted fall rates on a 16-bed surgical unit in a community hospital in Philadelphia, PA. The clinical questions for this project were what impact does the EWS have on hourly patient rounding and fall rates, and what impact does patient rounding logs have on hourly patient rounding and fall rates. Roy&rsquo;s adaptation model, capacity building, and Kurt Lewin&rsquo;s change theory were the theoretical and conceptual frameworks used in this project. Descriptive analyses were used to interpret data from the EWS and patient rounding logs completed on 220 randomly selected patients, in two nursing units, totaling 7,689 patient rounds. A quantitative correlational design determined the impact of the EWS on hourly patient rounding. A chi-square (&chi;²) test of independence determined the expected and actual numbers of missed and completed patient rounds. The results indicated a statistically significant relationship between the EWS and hourly patient rounding, <i>X²</i> = (1, <i>N</i> = 7,689) = 371.3; <i>p</i> = &lt; 0.05. A statistically significant relationship was found between hourly patient rounding completed on dayshift compared to nightshift, <i>X²</i> = (1, <i>N</i> = 7,689) = 38.7, <i>p</i> = &lt; 0.05. However, using the EWS did not reduce fall rates on the control unit (<i>n</i> = 7.04). The findings of this project support the use of an EWS to enhance hourly patient rounding and is being considered as a standard of care for the future. </p><p>

CF is an autosomal recessive disorder caused by mutations in the CFTR gene. The life expectancy for patients with CF remains severely shortened, with the median predicted survival for patients currently estimated at 36.5 years. For patients with a life-limiting disease such as CF, the decision to participate in a clinical trial is often based on the desire to improve quality of life and/or increase the likelihood of long-term survival. Recent advances in CF care have increased the number of therapies available for CF patients which in turn has increased life expectancy and diminished disease progression. The CFF has developed a patient registry and has worked with individual CFF-accredited care centers in the US to approach all patients followed at these CF centers to participate in an observational prospective cohort study. Using data from 504 patients followed at Boston Children's Hospital and submitted to the data registry maintained by the CFF, we examined disease progression, as measured by the decline in pulmonary function tests between 2007 and 2012 and compared multiple subsets of CF patients: those who participated in interventional studies, those who participated in observational studies only, and those who did not participate in any research studies. Results suggest a lower amount of lung function decline for adults who participate in interventional trials; however, the opposite pattern is true for children, with a higher amount of lung function decline seen for children who participate in interventional trials.

Hospitals face significant pressure to improve patient safety. This dissertation examines how organizational learning influences three processes critical to hospital efforts to identify, prioritize, and promote safety improvements. The first study, a systematic scoping review, investigates if and how safety toolkits identify learning mechanisms that are important for hospitals to achieve safety improvements. Fewer than half of the peer-reviewed toolkit articles (n=36) identified all of the organizational learning mechanisms required to optimize improvement from safety interventions. Further, articles rarely included all relevant measure types (staff perception, process, outcome) that assess and facilitate learning from the toolkit-based interventions in order to improve safety. The second study draws on in-depth qualitative interviews (sixteen informants at four hospitals) to describe how hospitals’ organizational learning capabilities relate to the identification of safety practices and information sources used to prioritize hospital safety improvements. Hospitals varied in the safety practices and information sources used to determine priorities. Hospitals with learning-oriented leadership or a supportive learning environment appear more likely to learn from multiple safety practices and various information sources. Barriers in organizational learning capabilities may hinder hospitals’ potential for improvement and thereby their safety performance. The third study explores whether a relationship exists between hospital staff perceptions of their organizational culture and staff involvement in large-scale adverse events (LSAEs) using survey data (209 respondents from six hospitals). Hospitals are often advised to modify their organizational cultures in order to promote safety. Respondent perceptions differed between respondents involved in an LSAE relative to those that were not involved in an LSAE on all ten cultural factors considered. Results from an adjusted logistic regression model indicated that one culture factor was key: less favorable respondent perceptions of employee engagement were associated with an increased likelihood of the respondent’s involvement with an LSAE. Hospitals with an organizational culture supportive of learning for safety improvement, and in particular more favorable employee engagement, appear to be better protected against the risks of LSAEs. Collectively, these studies highlight opportunities for hospitals to improve patient safety by managing their organizational learning capabilities. Future research should examine how hospitals develop their organizational learning capabilities. / 2020-10-23T00:00:00Z

<p> How Medicare beneficiaries utilize CMS star ratings data as part of their Medicare Advantage (MA) health insurance selection criterion was the focus of this qualitative exploratory case. Limited published research exists on how Medicare beneficiaries utilize the CMS star ratings data. Without published research, ascertaining the impact of the CMS star ratings program on the intended end users is difficult. Twenty senior adults from Hillsborough County Florida comprised the sample. Three primary themes emerged from data analysis: change aversion, generalized distress, and hassle-free experiences. Study participants were change averse, preferring to retain their existing MA coverage. Participants experienced generalized distress pertaining to their MA coverage and the process of insurance procurement. Participants desired hassle-free experiences related to MA health coverage. Study participants had very limited awareness of the CMS star ratings program. Of the few participants with program awareness, none utilized the data when selecting MA health coverage. The current study involved theory triangulation to interpret and support the findings. One conceptual framework with three components was triangulated as part of the analysis of these research outcomes. Stakeholders, leaders, policy makers, and the like should consider modifying how CMS star ratings data are shared with seniors. If seniors had a better understanding of the value of these data, they may be more likely to utilize the data as part of their MA plan selection criterion. </p><p>

<p> Mitigating ED crowding will not be solved by working harder and faster, and is not a one-solution problem. There are tactics the ED can implement, tactics the inpatient units can implement, and tactics that should be implemented to support the transitioning of patients from the ED to the inpatient units. This DNP project focuses on implementing a pilot to evaluate the use of hall beds in the inpatient units for ED patients awaiting placement. This will be a significant change for the inpatient caregivers, and time and attention must be committed to the initial phase to promote cultural readiness in order to achieve success. Crowding in the ED is a facility problem, not an ED problem. A multipronged approach when mitigating ED crowding must emphasize safe, efficient patient care that leads to the best possible outcomes without delays in treatment, while still maintaining standards of care, respect for privacy, and clear communication with the patient. This project focuses on both providing care to adult general medical-surgical patients admitted to a Midwestern level-1 trauma center through the ED and reducing the volume of patients who leave before treatment complete or without being seen. In the end, this practice change will benefit patients seeking care in addition to capturing the lost patients and reimbursement that accompanies the care. </p><p>

This thesis is concerned with current debates as to the value of patient satisfaction research. The thesis reports two surveys by means of which the scope of patient satisfaction research is considered. Conceptual and methodological problems in this field of research and alternative theories of the social process whereby patients evaluate health care are reviewed. The two surveys are presented in terms of an introduction to the particular field of medicine involved, the methods of enquiry used, survey responses and discussion of results. The first survey is of patients attending outpatient neurological clinics presenting with headache. This study was conducted with intensive interviews, one before the neurological consultation and a second at home, one month later. The problems of making sense of patients' accounts in terms of 'expectations' and 'satisfaction' are outlined. Instead different perceptions of the value of clinic visits are related to four different concerns felt by patients in relation to their headaches, concerns for reassurance, explanation, prevention and symptomatic treatment. The second survey is of patient satisfaction with outpatient care in a department of genito-urinary medicine. This survey was conducted with two questionnaires: one completed whilst patients waited in the clinic for theirconsultation, and a second which was mailed to patients one month later. Survey results are used to examine an interactionist model of patient satisfaction developed by Ben Sira. The data is examined by various methods to suggest limitations of and modifications to the original model. Finally the thesis assesses the contribution of the two surveys to an understanding of how patients evaluate medical care. Alternative models of patient satisfaction are reexamined. It is argued that some perspectives have too restricted a view of patients' abilities. The implications of the two surveys are reviewed in terms of the different interests researchers may have in surveying patients' views.

The management and control process in an Accident and Emergency (A/E) department of a District General Hospital is investigated and the functional relationship between the A/E department and the inpatient hospital service is discussed. Attention is focused on resource allocation and methods are proposed towards reconciling levels of service and resource utilisation. Within the framework of control problems inside the A/E department, a computerised patient record system has been designed and implemented, on an experimental basis, to allow easy access to patient-related information for performance evaluation. Established statistical techniques are employed to demonstrate how such information can be utilised in medium-term management activities in the A/E department and to provide a sound basis for defining areas where specific problems arise. A method is developed, which uses patient data to the extent that they are routinely available through the patient record system, for allocating physicians to weekly shifts in a way which takes account of the fixed number of physician hours per week; of physician preferences with regard to shifts; and of the patient assessment of the service provided. With regard to the role of the A/E department as an essential link between the community at large and the hospital service, a simulation model is developed for determining the number of beds in hospital inpatient departments on the basis of expected demand and according to a pre-specified set of measures of hospital efficiency. The measures used are the rapid admission of emergency patients; high occupancy rates; and short lengths of waiting lists. A further study on bed capacity planning concerns the contemplated development of an observation ward in the A/E department. Owing to the increased uncertainty in planning for prospective units, approximation is accepted for the sake of procedural simplicity and an analytic infinite server queueing model is employed to evaluate various numbers of beds for the unit interms of the average occupancy rates and of hourly and daily service levels.