Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

<p><strong> Objective:</strong> The purpose of this systematic review is to identify the effectiveness of KT strategies used to promote evidence-informed decision making (EIDM) among public health decision makers.</p> <p><strong> Methods: </strong>A search strategy was developed to identify primary studies published between 2000-2010.<strong> </strong>Studies were obtained from multiple electronic databases, supplemented by checking the reference lists of included articles and background papers. Two independent reviewers screened studies for relevance, assessed methodological quality and extracted data from relevant studies using standardized tools. Disagreements were resolved through consensus.</p> <p><strong> Results: </strong>The search identified 92, 548 titles related to KT interventions. After duplicate articles were removed 64, 391 were imported into Distiller SR of which 345 articles were deemed potentially relevant on double title and abstract review. Of the 345 articles, 30 met all relevance criteria on full text screen and after revisions to the inclusion criteria, 6 studies of moderate quality were included in this review.</p> <p>KT interventions tested in the systematic review included organization change, provider reminders, education, financial incentives and feedback. Interventions tested in the five primary studies ranged from; educational sessions; dissemination channels including print, CD-ROM and Internet; technical assistance and staff training; and web-based services such as databases, information services, registries of pre-processed research evidence and tailored targeted messaging.</p> <p>KT strategies shown to be less effective included access to registries of pre-processed research evidence or print materials. Simple or single KT interventions were shown in some circumstances to be as effective as multifaceted ones including organizational change, provider reminders and tailored targeted messaging. While knowledge brokering did not have a significant effect generally, results suggest that it did have a positive effect on organizations with low research culture.</p> <p><strong> Conclusion:</strong> KT research in public health is in early stages. Single interventions can be effective. Researchers and practitioners must pay attention to contextual factors.</p> / Master of Science in Nursing (MSN)

Background: The role of community matron (CM) was introduced to provide a single point of access to patients living with co-morbid long-term conditions who had, or were at risk of, frequent emergency admissions to hospital. CMs utilised case management as a means of managing this growing population of patients with fragile health. Since its inception, many changes in service delivery have impacted on the role. Aim: The aim was to undertake a mixed methodology study of the factors that have affected embedding of the community matron role in 3 geographical areas. Methodology: A pragmatic mixed methods approach (QUAL quan) was utilised. Settings and participants: The studies were based in health services within 2 cities and a rural area in central England. Participants for the qualitative components of the study were purposefully sampled. The sample comprised professionals: community matrons (n=21), managers (n=4), former commissioners (n=2) and GPs (n=3); and patients (n=10) and their family carers (n=5). Quantitative data for 212 people with long-term conditions were derived from the anonymised Patients at Risk of Rehospitalisation database (PARR data) held by area 1. Methods: Qualitative data were collected from participants using semi-structured interviews and audio diaries. For the quantitative component using PARR, some patient journeys within area 1 were explored. In addition, a sample of patients who were case managed by a CM (n=106) were matched with a set of patients who were not (n=106) and the data was examined. Findings: Participants were largely positive about the role of CM. However, difficulties with role setup had led to numerous changes which affected how the role has embedded. Additionally, this impacted understanding of the role by health care professionals, and caused practical and emotional difficulties for some CMs as they perceived the role to be eroded. The quantitative findings showed that CMs did not make a significant difference to hospital bed days used by patients on their caseload. Evaluating the role and finding an effective means of showing the work undertaken by CMs, which is often invisible, proved difficult. Conclusion: Embedding of the CM role has been affected by numerous changes in service delivery. Invisibility of community nursing rather than autonomy of the community matron role seems to be a key factor in the challenges of embedding the role. The significance of these findings is that using a mixed method approach and Liaschenko and Fisher’s adapted model may help CMs to improve the visibility of their role, and so helping the role to be less prone to the challenges of service redesign.

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Background: This thesis presents an empirical investigation into the efficacy, types, and performance of community health workers (CHWs)-trained lay people to whom simple medical procedures can be "task shifted" from doctors. It has three objectives: (1) assess the effects of CHW delivered interventions for primary health outcomes in low-and middle-income countries (LMICs), (2) develop a comprehensive taxonomy of CHW characteristics and programme design features, and (3) assess the relative efficacy of different types of CHW programme designs and how they can be used to optimise CHW performance. Structure and Methods: Following the logic of early stage intervention development, this thesis has an iterative and developmental structure in which each section flows out of and builds on the previous section. Objective one is addressed in Chapters 2-4: scoping review, systematic review, and meta-analytic methods are applied to establish the efficacy and effectiveness of CHW-led interventions in LMICs. Objective two is addressed in Chapter 5: inductive, thematic analysis of systematically identified trials, influential papers, and existing information classification systems is used to develop a formal CHW taxonomy for intervention reporting and coding. Objective three is addressed in Chapter 6: systematic review methods are employed to identify interventions for improving the performance of community health workers in LMICs. Results: Objective one: a systematic review of 155 papers reporting 86 trials found high quality evidence that CHW delivered interventions reduce perinatal mortality, improve child nutritional status, and improve tuberculosis completion rates versus facility-based care. There is also moderate quality evidence that CHW delivered interventions improve certain mental, infectious disease, paediatric, and maternal health outcomes. In undertaking this process, an additional, methodological contribution was made in the form of a tool to reduce risk of bias in overviews of reviews. This tool may facilitate early stage intervention development in the future. Objective two: 253 records were used to establish, in a faceted taxonomy, the definitional clarity required for theory building and knowledge accumulation. Two categories (CHW Characteristics and CHW Programme Features) and six dimensions (Integration, Recruitment, Training, Supervision, Incentives, and Equipment) emerged. Objective three: a systematic review of 14 trials identified moderate quality evidence of the efficacy of CHW performance interventions in improving certain behavioural outcomes for patients, utilisation of services, and CHW quality of care. There was no effect on the biological outcomes of interest. Conclusion: In bringing the tools of evidence based practice to bear on community health worker interventions, this dissertation has contributed to the theoretical, methodological, and empirical evidence base from which the field can continue to advance.

Methicillin-resistant Staphylococcus aureus (MRSA) is a problem nationally and affects many people from all walks of life. Community associated MRSA is often ignored and not viewed as significant, thus there is a lack of education on the topic. One area that is at a particular risk for the transmission of Community Associated MRSA is physical activity centers. Education in these areas could improve the knowledge of community acquired MRSA among employees and decrease the likelihood of infection at physical activity centers. In this study a pre-test was given. After the pre-test an educational powerpoint on MRSA was presented and then the participants were given a post-test to complete. The goal of this study was to determine if the staff’s knowledge and opinions of MRSA would change after being educated on the topic.

Research shows that one of the major contributors for an extended stay in a long-term care facility is lack of knowledge regarding goals for rehabilitation after being discharged from an acute care facility. It is important to determine patients’ levels of engagement because individuals who are actively involved in discharge planning and rehabilitation goals are able to manage their ongoing care more effectively, which results in increased quality of life. The data was collected using a survey method and the instrument used was the Patient Activation Measure or PAM which is a highly accurate and reliable tool. The 22 question survey was used to determine the level of patient activation among patients who are currently receiving rehabilitation services at a rehabilitation or long-term care facility. Determining the level of engagement in patients receiving rehabilitation services will provide health care providers insight into the how willing patients are to be engaged in their own care. A total of 11 surveys were completed by patients varying age, gender, and length of stay. Each patient was currently receiving rehabilitation services at National Healthcare Corporation of Johnson City or John M. Reed Health and Rehabilitation Facility in Limestone.

As the Hispanic population continues to grow in the United States, especially in the South, it is critical for healthcare workers to provide culturally competent care as required by certain laws. The Latina experience is of significant importance due to the role Latina mothers play in their families and communities. It is necessary to understand the perspective of this population and the experience of the Latina mother in regards to healthcare; specifically, how have language barriers hindered care, what perceptions of bias or discrimination have been encountered, and how do these factors influence their healthcare decisions and outcomes. Research has been conducted that identifies language and bias as barriers to access; however, further research is necessary to identify how these barriers influence a Latina mother’s perception of the healthcare system with an emphasis placed on East Tennessee. Therefore, it is critical for more studies to be conducted in order to identify what public health officials can change in order to provide equal access to this significant demographic.

This study was designed to create a high-risk fall profile for a specific Appalachian community. Data were obtained from 1,598 individuals with fall-related injuries who had been had been evaluated at a Level 1 Trauma center in Northeast Tennessee throughout 2011 and 2012, ages of individuals were 18 to 85 years. Data collected included: age, gender, county of fall, site of fall, type of fall, number of co-morbidities, season of fall, and time of day of fall. Results showed differences in criteria for categorizing individuals at high risk of falls, as well as data that had not appeared in the literature such as high-risk counties, a new high-risk age range, and the specific type of fall occurring. Tailored interventions should be created to fit the needs of this at risk community.