A shift in medical paradigm, from a focus on curing disease to a focus on preventing it, demands a totally new type of medical infrastructure. Through an analysis of the preventative paradigm, two key architectural implications of disease prevention are revealed: the need to reach out to the healthy population; and the system nature of preventative care, which links seemingly unrelated lifestyle factors to health. The site of the former Queen Elizabeth High School, on the Halifax peninsula in Halifax, Canada, is chosen as the site to explore the programmatic and spatial implications of preventative care. Through attention to the concepts of habitat and flow, a design is created which blurs the boundaries between building and landscape, between diverse programs, and between patient and passer-by.

Diabetes affects approximately 10% of the American population with an annual expenditure of approximately $174 billion dollars. The utilization of electronic medical records (EMR) combined with the meaningful use (MU) initiative may ensure that diabetic patients receive the recommended preventative care. Dorthea Orem's self-care deficit theory and the transtheoretical model of behavior change was utilized to design this quality improvement project. Medical professionals at a small private practice received education on American Diabetic Association (ADA) treatment standards and how to use the EMR system to track patients receiving the recommended diabetes care. The project question examined the effectiveness of provider education on improving ADA treatment standards and on using the EMR system to adhere to MU objectives of providing diabetic preventative care measures of annual dilated eye examinations, annual microalbumin levels, and annual microfilament foot examinations. A convenience sample of 3 providers and 309 patients was used and data were collected on Excel spreadsheets pre and post intervention through the Crystal Reports system to assess the percent improvement in the rates of preventative care. An impact evaluation revealed that the project achieved its objectives showing a 5.07% increase in diabetic preventative care. The program evaluation determined that the project is worth sustaining in the clinical setting as it provides a practical and economical way of improving diabetic patient care. This improvement project suggests that MU and adherence to ADA treatment standards has the potential to make a positive social change through increasing the amount of diabetic patients receiving preventative care.

This thesis aims to examine the current state of oral health promotion with respect to fluoridation, the impact that the lack of dental care has financially on the patient and the overall health system and a discussion of alternative options that could help to improve the current state of oral health care. While acknowledging research and official reports that indicate dental caries as the most prevalent preventable health condition in the lives of children, this thesis is a literature review studying the positive and negative effects of systemic and topical fluoride on both adults and children. Exploring differing perspectives of fluoridation's benefits and efficacy as a preventative oral health care measure, including community water fluoridation and topical fluoride application, this thesis will examine its effects on dental caries nationally and internationally. Although the prevalence of caries has decreased, to date, no systematic reviews have addressed adequately the disparities between incidence, severity, and recurrence of dental caries especially between children and adults. Likewise, substantial research has not yet adequately addressed the differences found in children that may make them more susceptible than adults to over fluoridation through a combination of systemic, topical fluoridation and water consumption. The literature review also includes the breakdown of costs and cost-effectiveness of dental care, including factors that increase cost, as well as suggestions to shift towards an emphasis on preventative care in attempt to reduce overall costs. Improving access to care especially to the underinsured is discussed. Furthermore, a review of the dental therapist occupation utilized successfully in other countries is discussed as this could be a viable solution for the shortage of dental professionals in areas with minimal access of care here in the United States. This is turn may reduce the number of disparities in oral health care, by reducing the severity of oral health disorders that result from an increased delay or neglect in treating the onset of dental caries from a preventative perspective. The primary measure of impact reported in several studies reviewed was the reduction in advanced care restorations, including surgery, needed with increased preventative care measures. Evidence of the effectiveness of preventative oral health care including systemic and topical fluoridation implementation and city-specific school-wide initiatives to administer dental sealants for children covered by government-sponsored programs are growing. Moving forward towards a more prevention-based system with early detection and better access for all, these changes should help lead to increased oral health initiatives and improved oral and healthcare overall.

Background: Type 2 diabetes mellitus (T2DM) is a complex health condition that impacts multiple organ systems and contributes to both acute and chronic health problems. In the United States (U.S.), T2DM is a growing health concern with increasing prevalence among both adult and pediatric populations (American Diabetes Association [ADA], 2015; Dea, 2011). Developing a comprehensive plan of care that incorporates a multifaceted treatment and prevention plan is necessary to address this growing health concern and reduce overall morbidity and mortality. Problem: The Edmund Primary Care (EPC) practice data for routine annual diabetic foot exams, annual eye exams, annual urine microalbumin, smoking cessation education and recommendations for pneumococcal polysaccharide do not meet the ADA (American Diabetes Association, 2015) recommendations for patients with T2DM.Design: Quality improvement (QI) project applying the Plan-Do-Study-Act (PDSA) cycle to develop a process change to improve diabetic preventative care measures for hemoglobin A1C, urine microalbumin, diabetic foot exams, and optometry referrals. Setting: A small, nurse practitioner owned, family practice clinic targeting patients 18 years and older with a diagnosis of T2DM.Intervention: A fishbone diagram to conduct a root cause analysis led to identification of key factors contributing to the problem. A comprehensive process change integrating a Diabetic Assessment Flow Sheet (DAFS) and diabetic foot exam sheet was developed to address the problem. Expected Outcome: Increase in rates of completion to at least 90% over eight weeks. Results: Analyzed with run charts demonstrating an increase in rates of completion to 100% for A1C, urine microalbumin, diabetic foot exams, and optometry referrals. A positive percent of change for each measure is as follows: A1C 7%; urine microalbumin 43%; diabetic foot exams 150%; and referrals to optometrist 43%. Significance: This QI project emphasizes the importance of implementing a system to evaluate the quality of care being delivered. It also highlights the usefulness of the PDSA cycle as a method to implementing quality improvement measures in health care. Lastly, this QI project demonstrated the effectiveness of flow sheets in improving the quality of care delivered to patients with T2DM.

Preventative care services allow patients to be fully equipped with the knowledge, tools, and other resources to help them discover and treat many diseases and illnesses so that the burden of costs will not fall on patients and their families. Since the passage of the Affordable Care of Act (ACA) by President Barack Obama, the requirement for health insurance coverage has not translated to utilization of preventative care services. The purpose of this study is to determine the motivation for African Americans who have insurance coverage and access to care who are not taking advantage of opportunities for screenings and health education. The health belief model was used to determine how belief and modifying factors influence health decisions. The quantitative study required use of a secondary dataset to determine utilization of preventative care services, insurance affordability, future access to care and understanding of the health care law. The study included testing the statistical significance of these factors among African Americans, White Americans, and Hispanic Americans who participated in the Healthy Americas Survey. Using the program SPSS to process data analyzation and organize output, results reveal that African American participants are concerned about the future ability to access and afford care. With a history of distrust amongst African Americans and the health industry, social implications are for administrators and providers to bridge the gap by offering health education to those in their immediate communities and requesting and implementing feedback from those same individuals.

Barriers to Colorectal Cancer Screening in People Obtaining Care From Community Mental Health Agencies by Kelly Gardiner MSN, Wayne State University, 1997 BSN, Wayne State University, 1988 Dissertation Submitted in Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Despite being highly treatable with early intervention and preventative screenings, the overall mortality rate of colorectal cancer is substantially higher in participants with a preexisting mental disorder. Variables affecting the likelihood of completing screening for those with mental illnesses were unknown in people who obtain services from a Community Mental Health agency. Using the Health Belief Model, the proposed study investigated the effects of access to transportation, referral to screening, physical ability to complete the colonoscopy prep, type of procedure, awareness of the purpose of screening, anxiety, embarrassment, gender, race, and age to determine which affect completion of colorectal cancer screening. Significant relationships existed between embarrassment, fear of pain, fear of cancer, anxiety, physical ability to do testing, awareness of screening at age 50, FOBT vs Scope procedures, age of first screening, being told to get screening, knowing someone who had screening, and completion of colorectal cancer screening. In the binary logistic model Anxiety was negatively correlated and being told to get screening was positively correlated to completion of colorectal cancer screening and those choosing Scope were more likely to complete than those choosing FOBT. The results of this study may effect positive social change by providing healthcare providers with an increased understanding of variables that influence colorectal cancer screening completion among persons with a diagnosed mental illness, resulting in a changing agenda for effective mental and physical health care in this population.

With an aging population that suffers from comorbidity, healthcare is facing grand challenges. In order to meet the demand, digitalization is thought to be an opportunity. Digitalization of curative care, such as diagnostics and treatment, have been initiated and is today used and appreciated. Preventative care, on the other hand, has not been included in the digital adaptions to the same extent and there are few scientific studies within the area. Nonetheless, a further proactive care that meets patients and healthcare personnel are of interest to several actors. The Swedish Government has a vision that Sweden, in 2025, will be world leading within eHealth. For that to be possible, digital preventative care have to support and complete the preventative work that is performed today. The present study has investigated the attitude towards Connected Medical Devices for Prevention (CMDfP) within the primary care. By a mixed-methodology including questionnaires, the opinions of 24 health center personnel and 17 patients prescribed with Physical Activity on Prescription (PAP) were collected and analyzed. The results show that health center personnel are willing to prescribe connected eHealth devices for prevention and patients are willing to use the devices prescribed. Additionally, among the respondents there is a belief that CMDfP could facilitate in order to increase the adherence to PAP without any major impact on the personnel's workload. By digitalizing preventative care, it is possible that people will be able to live healthier and therefore not require care to the same extent as today. Reasons to the possible results are that digital tools within curative care have been shown to generate positive outcomes to chronically ill patients that utilize home care. Additionally, studies of preventative care have generated positive outcomes to the health of the population in several countries. It is therefore likely that the combination, digital preventative care, would be rapidly relished. These thoughts align with the positive results on attitudes of this study. Before CMDfP could be prescribed to patients, pilot studies have to be performed and new work routines including reimbursement models, have to be established within healthcare. These are all areas of future work within medical engineering. / Med en åldrande population som lider av samsjuklighet, står hälso- och sjukvården inför stora utmaningar. För att möta behovet är digitalisering en möjlighet. Digitalisering av åtgärdande vård, så som diagnostik och behandling, har redan påbörjats och är idag uppskattat. Preventiv vård har, å andra sidan, inte varit inkluderad i den digitala utvecklingen och därav saknas det vetenskapliga studier inom området. Dock är en mer proaktiv vård av stort intresse för flera aktörer. Sveriges regering har en vision att Sverige, år 2025, ska vara världsledande inom eHälsa. För att detta ska vara möjligt måste digital preventiv vård möta och komplettera det preventiva arbete som bedrivs idag. Denna studie har undersökt attityderna till Uppkopplade Medicinsktekniska Hjälpmedel för Prevention (UMHfP) bland primärvården. Genom en metod som inkluderat enkätundersökningar, inhämtades och analyserades attityden av 24 personer från personalen på vårdcentraler och 17 patienter med Fysisk Aktivitet på Recept (FaR). Resultaten visade att primärvårdspersonal är villiga att förskriva UMHfP och att patienter vill använda de hjälpmedlen som förskrivs. Dessutom har respondenterna tro att UMHfP kan underlätta att förbättra följsamheten till FaR utan att påverka personalens arbetsbörda nämnvärt. Genom att digitalisera den preventiva vården är det troligt att befolkningen kommer få ett hälsosammare leverne och därför inte behöva vård i samma utsträckning som idag. En anledning till detta är att digitala hjälpmedel för åtgärdande vård har visat sig vara positivt för kroniskt sjuka patienter som hemsjukvårdas. Dessutom har studier inom preventiv vård indikerat flera positiva konsekvenser för invånares hälsa världen över. Det är därför troligt att digitala hjälpmedel i kombination med preventivt arbete snabbt kommer bli uppskattat. Dessa spekulationer sammanfaller väl med det positiva resultatet från denna studie. Innan UMHfP kan förskrivas till patienter måste pilotstudier genomföras och nya arbetssätt inklusive betalningsmodeller måste införas i hälso- och sjukvården. Detta är kommande arbeten inom medicinsk teknik.