<p> The purpose of this exploratory qualitative study was to identify experiences or barriers that arise during the first year as Certified Registered Nurse Anesthetists (CRNAs) transition into management and; if these shared experiences can prepare future CRNA managers by providing insight into what knowledge, skills, and abilities are necessary to ensure a smooth and successful career transition. </p><p> A representative sample by email and Facebook (FB) elicited 18 phone interviews of current and past Certified Registered Nurse Anesthetist (CRNA) managers. One interviewer asked 16 questions: seven demographic and nine open-ended. Survey information was (1) transcribed, (2) reviewed and de-identified, and (3) coded for content and classical analysis by two experienced independent coders. A coding tree was developed by coders after independent and random assessment of codes with an IRR (0.93). NVivo 11 software was used to assist with analysis of codes. </p><p> CRNA participants (66%) had less than five years of CRNA management experience, and 61% had no previous management experience or education before accepting their first role as a CRNA manager. An incidental finding, 83% of participants were reluctant managers and 76% of CRNA managers devoted greater than 50% of their time to performing clinical duties over managerial duties. Two resources that CRNA participants agreed were helpful resources during transition included: mentors (83%) and previous education or experiences (44%), especially in business, finance, or management. The skills CRNA participants believed were important during transition included people skills (56%), financial knowledge (33%), and communication (28%). </p><p> CRNA managers are more likely to be reluctant managers that may be relatively new in the role, and with no previous management experience or education. Recommendations for new CRNA managers during transition included; mastering &ldquo;people skills,&rdquo; either through relationship management or communication skills. Derailment may be avoided if new managers consider the results of this investigation.</p><p>

<p> Dramatic shifts in the way healthcare and related healthcare services are delivered and managed in the United States are unfolding at an unrelenting pace. Concurrent with ongoing changes in United States&rsquo; delivery of medicine, some argue that traditional notions of power are undergoing an equally transformative shift (Mintzberg, 2015; Na&iacute;m, 2013). The confluence of the emerging reconsideration of the role of power in our society and organizations along with the dramatic changes in the American healthcare system provides a fertile backdrop and context for this study of power. </p><p> At the center of this transformation, the physician maintains a unique and &ldquo;very special position&rdquo; in the hospital setting (Freidson, 1970). This grounded research study investigates the ways in which 24 physicians in modern hospital healthcare setting (MedHealth) conceptualize their exercise of power, autonomy, and control in their day-to-day interactions in the practice of medicine. </p><p> I find physicians at MedHealth chose to conceptualize their exercise of their power, autonomy and control unitarily. Physicians in all three participant groups at MedHealth (surgeons, pediatricians and others) conceptualized a significant loss of power, autonomy, and control, in the practice of medicine. Additionally, physician conceptualizations of their exercise of power, autonomy, and control in the practice of medicine are shaped and fashioned by micro, meso, and macro level interactions. </p><p> I present a theoretical model in an effort to gain a richer appreciation of how physicians at MedHealth conceptualize their power, autonomy, and control (PAC). I argue a reconceptualization of their PAC is necessary given the transformative changes to the US healthcare model. Last, I offer numerous implications for theory and practice, and recommendations for areas for future research that emerged from this research project.</p><p>

<p> Escalating health care costs in the military health system are not sustainable long term. Regular physical activity has been shown to improve health and reduce health care costs. Military members serving in the United States Air Force (USAF) are encouraged to maintain physical fitness year-round and undergo mandatory physical fitness assessments (PFAs) annually. The purpose of this quantitative correlational study was to determine the nature of the relationship between the timing of the PFA and health care utilization (HU) by active duty service members assigned to the United Kingdom's USAF military treatment facility. Donabedian's framework and the logic process model were used to design the study. Archived fitness and health care utilization data were obtained on 361 military members. Findings indicated a strong, positive correlation between the timing of the PFA and HU, which was strongest during the PFA month. Monthly HU 6 months prior to PFA was compared using a 1-way repeated measures ANOVA. Findings indicated a significant difference between T-1 (PFA month), T-2 (1 month prior to PFA), and T-5 (5 months prior to PFA). Paired-samples t tests demonstrated a statistically significant increase in HU from T-5 to T-2. Although findings are not generalizable, they signal a need for further study to evaluate HU variability between populations, to identify at-risk groups, and to inform health and fitness policies that affect the readiness and retention of military members. The DNP project may promote interdisciplinary collaboration between health care providers and senior military leadership, innovation in health care delivery, and evidence-based and cost-conscious policies.</p><p>

Context. There has been increasing attention concerning the use of DNA-based genetic tests in health care. Many have argued that the use of genetic technologies should be subject to public debate and scrutiny. However, few in the general population can offer views informed by actual experience with genetic services. Prenatal and newborn screening programs are examples of genetic services that are routinely offered to the general population. Objectives. To determine if conjoint analysis is a useful tool for eliciting user preferences for newborn screening services. Methods. Discrete choice conjoint analysis (CA). Results. Counterintuitive results identified issues concerning the validity of the CA instrument that was developed. As a result limitations to the usefulness of aggregate logit regression for the analysis of CA data were identified. Other analytical approaches, such as latent class analysis, merit further examination to determine their validity and the value of the information they may provide.

<p> As the aging population continues to increase, the move to assisted living facilities (ALFs) is becoming a popular choice as an alternative to remaining at home. The majority of older adults entering assisted living facilities have one of more chronic conditions that prevent them from performing their activities of daily living, thereby requiring assistance from direct care workers (DCWs). These DCWs are unregulated, and their training varies from state to state and from ALF&rsquo;s. Hence, there could be an apparent shortfall in the care provided to residents in ALFs by DCWs. Stake&rsquo;s case study methodology was used to answer the research question about the issues that family members experience with the care provided by DCWs for a relative in assisted living facilities. A gap was identified in the literature that signals the need to have the input of the family members on how care is given in ALFs. Open-ended interview questions were used to capture the issues family members saw with the care their loved ones receive. Data analysis took the form of direct interpretation, categorical aggregation, finding patterns, identifying themes within case, and establishing linkages between cases. The final phase of the data analysis was the interpretive phase where conclusion was drawn. Five main themes emerged after analysis of the data. They were: training for DCWs, satisfaction with care, cultural competencies, expectation of care, and need for improvement. The findings suggest that there are several issues family members have with the care provided in ALFs. These finding could then be used to devise training for the DCWs that are geared to provide adequate care to the residents in ALFs. The implications from the study suggest that more training should be implemented and based on humanistic theory resulting in individualized care with the person focus approach. Well trained direct care workers in assisted living facilities will enhance the quality of life for older adults and preserve the integrity of the assisted living industry. </p><p>

<p> This dissertation examines several key aspects regarding health insurance policies in the United States. The development of the United States health insurance market began in the 1920s with life insurance companies selling traditional indemnity health insurance plans and hospitals offering hospital care plans on a pre-paid basis. This market has evolved over the last century into a heavily regulated market dominated by employer-sponsored, managed-care plans. Reviews in the introduction of this dissertation include the overall market, health insurer evolution, the history of managed care operations, the progression of employer-sponsored health insurance plans and regulation specific to health insurance. Analysis of health insurance market evolution can offer a better understanding of how past developments in U.S. health care can inform and shape future policy. </p><p> The second chapter of this dissertation provides an analysis of adverse selection in the U.S. health insurance market. Adverse selection is a phenomenon inherent in insurance contracting. Using a rich, unique dataset consisting of multiple insurers, across states for the years 2013&ndash;2015, I document a correlation between coverage and risk. Results show that adverse selection is present both in the individual and group markets. Additionally, I test for the presence of adverse selection by state and by insurer. I find that factors such as the health of the state population, regulatory environment, insurer competition and insurer size are not associated with the likelihood that a state or and insurer experiences the presence of adverse selection. </p><p> The third chapter of this dissertation relates adverse selection and consumer satisfaction in health insurance plans. I exploit a dataset rich with respondent demographics and health insurance plan information to evaluate the relationship between adverse selection and health insurance plan satisfaction. I find that respondents who are more likely to have adversely selected into the health insurance plan are more satisfied with their plan. This is evidence that respondents may use private information on their risk level to choose plans to their advantage.</p><p>

<p> Buy24x7.com is an online pharmacy registered as a limited liability company with its head office in Los Angeles, CA. The sole purpose of Buy24x7.com is to provide prescription medicines at a reasonable price to its customers and we plan to achieve this by working efficiently and cutting down the operating cost. The company&rsquo;s top three goals are to provide prescription medicines to the customers at a lower price in the market, make prescription medicines easily available to the customers and be known as Americas most reliable and trusted pharmacy. Buy24x7&rsquo;s unique selling proposition is an overnight delivery system which promises to deliver drugs to the doorsteps. Additionally, there will be a discount for the customers within 5-km radius of the warehouse. This business plan will present an analysis of target market, company&rsquo;s marketing goals and objectives and the strategies to attract customers, a SWOT analysis discussing the strengths, weaknesses, opportunities, and threats to the company, a birds-eye view of the legal and regulatory concerns surrounding the business, and finally a review of the financial viability </p><p>

<p> Medical errors have been detrimental in the field of medicine. They have impacted both patients and doctors. While physicians recognized that error disclosure was an ethical and professional obligation, most remained silent when mistakes happened for different reasons. Guided by the theory of planned behavior and Kant's deontological theory, the purpose of this quantitative study was to investigate the perceived barriers affecting physicians' willingness to report major medical errors. An association was tested between the independent variables physician fear of disclosure of errors, organizational culture toward patient safety, physician apology, professional ethics and transparency, physician education, and the dependent variable physician willingness to disclose major medical errors. Using a cross-sectional method, 122 doctors out of 483 surveyed, completed the online and paper-based survey. Multiple linear regression and descriptive statistics models were used to analyze and summarize the data. The results showed there was a statistically significant relationship between the independent variables organizational culture toward patient safety, physician apology, professional ethics and transparency, and physician education and the dependent variable physician willingness to disclose major medical errors. There was no relationship between the independent variable fear of disclosure of errors and the dependent variable. The findings added to the knowledge base regarding barriers to physicians' medical errors disclosure. The results and recommendations could provide positive social change by helping hospitals raising doctors' awareness regarding major medical errors disclosure. </p><p>

<p> Perfect economic conditions in the national unemployment rate, healthcare crisis in the medical management of acute and chronic conditions, aging population, and the promotion of an active lifestyle culminate in the need of services for physical therapy to address the medical necessity in the healthcare management of musculoskeletal disorders. A private practice in the City of Redondo Beach is primed to provide the needed services patients are seeking to help address all their musculoskeletal needs and goals. The combination of specialized training, advance education, and excellent patient satisfaction is placing Ascend Physical Therapy at the forefront as the first and best choice for physical therapy. Patient outcomes will exceed expectations and will form a relationship with both patients, provider and referral source that will foster a healthy active lifestyle.</p><p>

<p> The current study focused is on the underrepresentation of registered nurses in hospital CEO positions. There are several existential gaps in chief executive officer (CEO) leadership in the United States. The gender gap in CEO positions across all sectors demonstrates that females represent 31% of CEO positions in the United States. However, females represented only 12% of hospital CEOs in 2007 (Plant, 2008). In 2016, females represented 36% of hospital CEOs. Nevertheless, a far greater gap exists as registered nurses represented 2.5% of hospital CEOs in 2007 (Plant, 2008), and 3.0% of hospital CEOs in 2016. The chronic underrepresentation of registered nurses (RNs) is irrespective of education, experience preparation, knowledge, attitude, skills, and habits as RN executives aspiring to become hospital CEOs often have more education and experience than their non-registered nurse counterparts have. The sample for the current qualitative grounded theory study had 30 participants including 10 RN executives currently employed and holding the title of hospital CEO, 10 non-RN executives currently employed holding the title of hospital CEO, and 10 decision-makers who have authority over the hospital CEO candidate selection process. The current study employed grounded theory method to develop a substantive grounded theory of why the phenomenon of the underrepresentation of registered nurses in hospital CEO positions exists. The substantive grounded theory developed in the study might help decision-makers involved in the hospital CEO selection process adjust their selection strategies so they evaluate hospital CEO candidates equitably. Registered nurses aspiring to become hospital CEOs might also benefit from the study by altering their career development strategies so the decision-makers perceive them as qualified candidates for the position of hospital CEO.</p><p>