<p> Due to the wide-scale adoption by the market and consumers of healthcare goods that track fitness, sleep, nutrition, and basic metabolic parameters through ubiquitous devices or mobile apps, it is vital to understand physicians&rsquo; attitudes towards consumer healthcare devices. No study had previously examined constructs related to technology acceptance and how they impacted behavioral intention for ubiquitous devices that produce SMD. A quantitative, non-experimental study was conducted to examine SMD acceptance, intent to use, and other factors important to physicians regarding SMD from ubiquitous devices. The researcher randomized the American Medical Association (AMA) membership list and sent out 5,000 invitations to physicians for participation. The final sample included 259 subjects, which consisted of 75.2% (N=194) male and 24.8% (N=64) female participants. The results from statistical analysis of the data gathered through survey methodology showed that the UTAUT2 constructs of performance expectancy, hedonic motivation, and price value were positively associated with the behavioral intention of SMD by physicians, while effort expectancy and social influence were not. Further, social influence was associated with use, while performance expectancy, effort expectancy, and hedonistic motivation were not. Major positive implications of the findings include contribution to the body of literature in the IT-healthcare arena regarding factors the influence technology acceptance and potential increase in the adoption of SMD among patients. Limitations of the study and recommendations for future research are discussed.</p>

<p> Medical error, patient safety and nurses&rsquo; performance are some of the critical concerns within healthcare systems. Several factors contribute to nurses&rsquo; performance and patient safety including fatigue, sleepiness and work system parameters.</p><p> Furthermore, because of a shortage of nurses, working nurses are often experiencing high workloads. They often work in 12- hour shifts and/or consecutive night shifts without receiving enough sleep or recovery. Thus, they frequently are fatigued and suffer from sleep deprivation, which again is negatively associated with patient safety. Therefore, health care researchers and decision makers are interested in developing policies and tools that help decrease nurses&rsquo; errors and increase their performance.</p><p> Thus, there is a need for a promising approach to understanding nurse fatigue and its causes and consequences that is able to capture dynamic nature of the problem. This study aimed to address this need. In the first step, data were collected from a private hospital. Next, a data mining technique was applied to uncover the patterns and associations among contributing factors that affect performance and patient safety. Finally, a model was developed to measure nurses&rsquo; responses to different work system parameters and stressors.</p>

Cost containment measures instituted in the early 1980s are responsible for moving the health care industry to a more competitive composition. As a result of placing hospitals in a more cost conscious environment, they will no longer be able to finance uncompensated care through cross-subsidization. In three separate empirical studies, this dissertation investigates issues concerning the consequences procompetitive actions may have on the provision of hospital care to the poor. / In the first study, Certificate of Need (CON) regulation is likened to regulation allocated on a public interest standard. To test this analogy, probit analysis is used to isolate the objectives of CON regulators as reflected in their decisions regarding hospital investment applications. The results reveal some tendency for regulators to favor hospitals providing relatively large amounts of uncompensated care. This suggests that the benefits of CON protection are used to reward hospitals for providing uncompensated care. / The second study examines efficiency among hospitals providing different levels of uncompensated care. If the few hospitals providing the majority of uncompensated care are relatively inefficient, a more competitive market may force them to change their mode of operation, be bought out, or even close down. Estimates of a multiproduct cost function indicate that hospitals providing relatively large amounts of uncompensated care are less efficient on average. Thus, competition in the health care industry will not only affect the financing of indigent care, but also the providers. / The third study offers a more accurate depiction of those who generate uncompensated care and the hospitals that provide it. Previous studies have relied on characteristics of the uninsured population to make inferences about those who generate uncompensated care. A unique survey from Florida includes patient characteristics along with the amount of uncompensated care generated. Estimates from a type-two tobit model indicate that many of the conclusions derived from studies of the uninsured also hold true for the indigent. Of particular interest is the result that many of the indigent are employed but uninsured. Thus, policies aimed at the employed uninsured are likely to be effective at alleviating the problem of uncompensated care. / Source: Dissertation Abstracts International, Volume: 50-03, Section: A, page: 0742. / Major Professor: Gary Michael Fournier. / Thesis (Ph.D.)--The Florida State University, 1989.

This dissertation investigates the effects of market forces and government regulation on the innovation decision of firms. Using Florida data on the adoption of high technology equipment in hospitals I analyzed the effects of market share, concentration, ownership including teaching status, cost and revenue, background demand such as population and income of the relevant market. / In addition, the effects of regulatory changes such as Prospective Payment System (PPS) and Certificate of Need (CON) deregulation were investigated using dynamic Weibull regression model. The Model shows the impact of explanatory variables on the likelihood of innovation and changes in the marginal probability of adoption flowing through time. / The result of estimation shows that leading firms in more competitive markets adopt earlier than others. Teaching status of a hospital, which offers technological advantage, encourages it to innovate earlier than others. The behavioral change of regulating agency rather than official deregulation appeared to affect innovation decision of firms. It is hoped that this study will better clarify the relative importance of the key variables as well as the usefulness of dynamic econometric modelling approaches so that policy makers may obtain clearer intuition about how hospitals approach major adoptions, and what factors to consider in shaping innovation policies. / Source: Dissertation Abstracts International, Volume: 52-03, Section: A, page: 1013. / Major Professor: Gary M. Fournier. / Thesis (Ph.D.)--The Florida State University, 1991.

<p> When patients present with complaints of anxiety or depression, providers in the primary care setting often prescribe anxiolytics or antidepressants without conducting an early emotional trauma or adverse childhood experiences assessment. Several studies demonstrate the link between early emotional trauma (EET) or adverse childhood experiences (ACEs) and the increased risk of anxiety or depression as adults. This Clinical Scholarly Project (CSP) implemented the use of the Adverse Childhood Experience (ACE) Questionnaire with patients who had a diagnosis of anxiety or depression in the primary care setting to increase patient access to resources and align clinical practice with practice guidelines. Participants included eight primary care providers, 30 patients and 21 chart review patients. The CSP utilized a quasi-experimental design to determine if the use of the ACE Questionnaire by patients with anxiety or depression would result in patients receiving more community resources (to include counseling), strengthen the provider-patient relationship, increase provider comfort in discussing ACEs with their patients and result in patients receiving care that was evidence based. Patient sample participants received significantly more resources (M = 8.27, SD = 2.27) than the chart audit sample (M = 0.90, SD = 0.30). Patient sample members received an average of eight resources (M = 8.27) and utilized an average of five resources (M = 5.07). Use of the ACE Questionnaire resulted in more trust in provider-patient relationship by patients (80.0%) and the majority of the provider sample more comfortable discussing ACEs after the project (85.7%). </p><p>

<p> Heart failure readmissions place a significant financial burden on the healthcare system. Stakeholders of this system have utilized many approaches to reduce the number and costs of heart failure readmissions, without significant improvement. The purpose of this practice improvement project was to determine whether education on the financial impact associated with readmissions improved a patient&rsquo;s measured quality of life, encouraged adherence to a therapeutic regimen, and thereby reduced readmission rates in Medicare and Medicaid patients diagnosed with heart failure. Theoretical support is derived from the theory of self-care of chronic illness, which recognizes the complex self-care processes a patient with chronic illness negotiates. The project used a quantitative methodology with a pre-test/post-test design. A convenience sample was enrolled of 10 Medicare and Medicaid patients who had recurrent heart failure readmissions. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to collect pre/ post-intervention data which was then analyzed by two-tailed paired t-test. There was no statistically significant difference from the intervention to determine any impact on the participant&rsquo;s measured quality of life (<i>p</i> = .953; &alpha; = .05). However, none of the participants were readmitted during the 30 day period of this project. The findings indicate heart failure patients acknowledge their financial constraints but quality of life is not as impacted by finances as anticipated. Polypharmacy and uncertainty with managing daily regimens during symptom exacerbation were the greatest concerns. It is recommended that heart failure patient education should be persistent and individualized to address the patient&rsquo;s unique needs. </p><p>

Over the last 20 years, cancer clinicians have begun to improve the efficacy of cancer care through tumor boards, meetings of multidisciplinary patient care teams used to educate attendees and align treatment plans. In addition to the potential for collaboration between different disciplines, these meetings allow for the incorporation of information from peer-reviewed literature. Despite their use, very little research has been done on the effect of tumor boards on treatment efficacy. Within this small body of work, the indicators used are often inherently biased, and little concern is given to their confounding effects. This document will discuss alternative metrics that provide a less biased estimate of the impact of tumor boards. Given their educational aspects, tumor boards are beginning to be used in an international context to support clinicians in developing nations. Despite the relative lack of evidence supporting use of tumor boards, they provide a low-cost method for improving clinician education in a setting where treatment protocols vary greatly. Moreover, international tumor boards provide a way for low-resource hospitals to tap into facilities of high-resource hospitals, receive resource-sensitive guidelines for future practice, and collaborate with clinicians from other hospitals. However, there are serious barriers to implementing international tumor boards, including technological, logistical, linguistic, and oversight issues. This document outlines potential issues and methods to circumvent them, as well as benefits of international tumor boards (including future collaboration).

<p> The purpose of this study was to assess the relationship between emotional intelligence and work engagement in the context of frontline nurses in acute care settings. The relationship between age, gender, years of experience, educational attainment, and specialization was investigated in relation to frontline nurses&rsquo; emotional intelligence and work engagement. This quantitative nonexperimental study was conceptualized to bridge a knowledge gap regarding the extent to which emotional intelligence and demographic factors are associated with work engagement in nursing. This study was based on theories concerning emotional intelligence and work engagement constructs. Participants included 142 frontline nurses working in an acute care setting within the United States. All data were gathered quantitatively using an online survey. The survey instrument included a compilation of two measurement scales (the Assessing Emotions Scale [AES] and the Utrecht Work Engagement Scale [UWES]) and a demographic questionnaire. The data analysis procedures included one-way analysis of variance, Spearman&rsquo;s <i> rho</i> correlations, independent <i>t</i>-tests, and multiple regression analysis. The results of the study revealed that there is no statistically significant correlation between age, gender, years of experience, educational attainment, and specialty with emotional intelligence. Moreover, the findings revealed that there was a statistically significant positive correlation between emotional intelligence and age with work engagement level among frontline nursing. There was no statistically significant correlation found between gender, years of experience, educational attainment, and specialty with work engagement. The study results provide a pathway for researchers to better understand nurse emotional intelligence and work engagement in relation to demographic variables.</p><p>

<p> Cyberattacks have occurred for many decades, but some organizations are not implementing measures to reduce the risk of these threats. The healthcare industry has had more than 30 years' worth of cyberattacks, yet many healthcare organizations do not have adequate measures against these risks. The problem addressed by this study was that healthcare organizations are vulnerable to cyberattacks, yet leadership at few healthcare organizations actively implement adequate cybersecurity practices. The purpose of this qualitative multiple case study with in-person interviews was to identify how employee motivation affects cybersecurity implementation in healthcare facilities in Southeast Michigan and Mid-Michigan areas. The researcher used protection motivation theory to explore how employee motivation affects cybersecurity implementation in healthcare facilities. A qualitative multiple case study with in-person interviews was used to collect the data. The study population was employees at healthcare facilities. The study sample was five employees from each of two healthcare facilities in Southeast Michigan and Mid-Michigan areas. Participants expressed knowledge regarding the seriousness of the threats and implemented some safeguards, but they do not believe the threat likelihood is severe enough to motivate any additional action or interest. Most participants believed current preventative measures were effective, however since the threats were unlikely there was no motivation for additional preventative measures. The literature review indicated that most companies had experienced cyberthreats, creating a potential disconnect with these participants' perceptions.</p><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>