Chronic kidney disease (CKD) is a condition that requires access to renal replacement therapies (RRTs) to enable patients to live. The use of such therapies has been continuously researched due to the high cost to payers and their patients. This dissertation aimed to analyze the incidence, prevalence, and mortality of renal replacement therapies in patients with end-stage renal disease (ESRD), and document cost trends and analyze possible inequalities in access to these therapies. Based on an integrated health risk management (IHRM) model, this study examined patient characteristics associated with renal replacement therapies in ESRD patients through a pooled cross-sectional study based on USRDS (United States Renal Data System), and examined information related to costs and utilization of health services one year after the initiation of dialysis through a retrospective cohort study. Findings suggest that morbidity and mortality measures of renal replacement therapies continue to increase from 2001 to 2018, and costs continue to decrease from 2014 to 2017 in the United States. In-center hemodialysis (ICHD) (196.2 cases per 100,000 inhabitants) continues to be the most prevalent RRT utilized over home hemodialysis (HHD) (4.4 cases per 100,000 inhabitants) and peritoneal dialysis (PD) (24.7 cases per 100,000 inhabitants). The cost for ICHD (306,705,989 million dollars) is significantly higher than HHD (234,559,170 million dollars) and PD (5,360,136 million dollars). White patients have a 25% lower probability of accessing in-center hemodialysis compared to patients of other races. Hispanic patients were also found to be 31% more likely to access in-center hemodialysis compared to non-Hispanic patients, which would indicate potential inequities in access to these alternative RRTs. Study findings provide critical data to inform decision-makers on the use of HHD, PD, and ICHD among ESRD patients in the US and increase awareness of PD and HHD to reduce long-term costs to the healthcare system.

Today, there are children sleeping under bridges with no food to eat and nowhere to go. Without our help someone's daughter will continue to cry herself to sleep as she sleeps in the woods with only a blanket, someone's son will feed himself with trash from a dumpster, someone's granddaughter sleeping under a bridge will be raped and someone's grandson will commit suicide because he lost all hope. These children need our help. (Enough is Enough, 2022). Although there are some government agencies and organizations that try to identify what can be done to help the homeless youth population, minimal progress is taking place. The United States Government and other organizations are offering some assistance, but more funding is needed to save the lives of this vulnerable population. In addition, homeless youth need to have available access and knowledge that these resources exist and are available to help them fully transition back into society. This study examined the growing reality of youth homelessness and the impact of interventions for housing, mental health, and substance use. The primary goal of this theses is to bring awareness and educate the public on the homeless youth crisis currently being faced throughout our country. In addition, the resource guide that was created with the research found from this study will be distributed in places homeless youth can access such as local schools, shelters, churches, police and fire stations, as well as online databases.

This study builds on the small but growing body of research examining the antecedents and effects of burnout on police and corrections officers. A review of the extant literature on burnout in general and on the literature exploring police and correctional officer burnout in particular identified several variables that contribute to the social-psychological condition of burnout. The variables identified in the literature review were grouped according to biographical factors (gender, race/ethnicity, and age), biographical stressors (marital status and level of education), organizational factors (occupational field, agency size, tenure, and rank), workplace stressors (recent promotions, transfers or discipline, and perceptions of fairness in promotions, discipline, and transfers), or life-event stressors. This study utilized the Maslach Burnout Inventory-General Survey (MBI-GS) to assess burnout. The Social Readjustment Rating Scale (SRRS) developed by Holmes and Rahe (1996) was used to identify life-event stressors. The sample for this study was drawn from police and correctional officers attending professional development training at a regional criminal justice training center in Central Florida. Of the 577 students surveyed, 417 remained in the sample after duplicates were eliminated. A multi-stage analysis, which included analysis of variance (ANOVA), independent sample t-tests, and ordinary least squared techniques (OLS), was conducted to explore the influences of different correlates of burnout on police and correctional officers. Multiple one-way ANOVA models and independent sample t-tests were run first, followed by several stages of multiple regression analysis. In the initial OLS regression models, only the variables for biographical factors, biographical stressors, and occupational factors were entered in the models. In following stage, workplace stressors were added to the regression models, followed by the addition of life-event stressors into the final regression models. The correlates of burnout found to be most significant included race/ethnicity, agency size, and perceptions of fairness in promotions and discipline. Of the correlates that were significant, race/ethnicity and perceptions of fairness were the most noteworthy, since the data indicated White/Caucasian officers experienced greater levels of burnout than minority officers, a finding that appeared related to an officer's perceptions of fairness in promotions and discipline. In addition, a statistically significant difference in professional efficacy scores was detected between officers from smaller agencies (99 officers or fewer) and officers from the largest agencies (1,000 officers or more). The findings from this study seem to suggest that burnout may be influenced by perceptions of fairness in promotional and disciplinary processes, which may be confounded by an officer's race/ethnicity. To address this matter, police and correctional agency administrators might want to consider designing promotional and disciplinary procedures that stress transparency and emphasize merit-based outcomes rather than equality-based outcomes. With regard to agency size, administrators from small agencies should consider steps that make the job more rewarding to their officers so they are less susceptible to burnout.

Despite concerted efforts to decrease costs and increase public health, the embattled U.S. health care system continues to struggle to alleviate these widespread issues. Because the problem of hospital utilizations among patients with heart failure is posited to increase as the population ages, innovative methodologies need to be explored to mitigate adverse events. Remote monitoring harnesses the strength of advanced information and communication technology to affect positive changes in health care quality and cost. By reaching across geographical boundaries, remote monitoring may support increased access to less costly services and improve the quality of home health care. The purpose of the study was to examine the home care quality effects of remote monitoring technology in patients with heart failure and to provide an economic justification for its adoption and diffusion. It compared remote monitoring as a potential intervention strategy to a standard no-intervention group (without remote monitoring). Specifically, it analyzed remote monitoring as a viable strategy to decrease hospital readmissions and emergency department visits. It also compared the cost of remote monitoring against the current standard-of-care. The theoretical framework of Donabedian's Quality Model was used in the evaluation of remote monitoring. A retrospective posttest only, case control study design was used to test the degree which remote monitoring was effective in promoting health care quality (hospital readmissions and decreased emergency department visits). Retrospective chart reviews were performed using electronic medical records (EMR). Analysis of Variance, Path Analysis, Automatic Interaction Detector Analysis (Dtreg), and Cost Outcomes Ratio were used to test the hypotheses and validate the proposed theoretical model. No significant difference was noted in remote monitoring and usual care groups. Results suggested that remote monitoring does not statistically lead to a decrease in heart failure-related hospital readmissions and all-cause emergency department visits. Results of the cost ratio analysis suggested that there was no statistically significant difference in the net income between usual care and remote monitoring; however, data suggest that there were significant increases in cost and intensity of nursing utilization for the remote monitoring intervention. The Automatic Interaction Detector Analysis showed that the unfavorable results in hospital readmissions were due to a decrease in collaborative care and patient education prior to the recommendation for hospitalization. The role of nursing care, whether in hospital or community-based care, in heart failure management is critical to quality outcomes. As the field continues to consider the use of technology in health care, decision makers should think through the process of patient care such that preventable hospital readmissions are decreased and patients received quality care.

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Few studies have examined the intersection of charter school and special education policies. The concerns around the serving of special education students in charter schools must be carefully studied, especially as charter schools continue to grow in numbers and continue to serve a greater percentage of public school students. New policies must not only address equity in access for special education students in charter schools but must also study how charter schools can be leveraged to generate innovative and promising practices in the area of special education. This study examines a recent policy change in the Los Angeles Unified School District that provides great autonomy and increased accountability for charter schools in their provision of special education services. This policy change promotes key tenets of charter schools: (a) autonomy and decentralization, (b) choice and competition, and (c) performance-based accountability with the aim of increasing access for students with special needs and increasing the capacity of charter schools to serve them. The research design utilizes a mixed method approach to collect qualitative and quantitative data to evaluate the goals of this major policy change within this particular school district.

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The primary purpose of this study is to explore financial management strategies among administrators of small nonprofit social services organizations. This study addresses the gap in empirical literature with a specific focus on small nonprofit organizations. This study avers that the available literature on social service organizations is fundamentally flawed. It argues for a reevaluation of the available literature based on apparent errors in methodology and research design. The literature reveals that nonprofit organizational empirical research excludes small nonprofit organizations and disproportionately presents a representation of large- and medium-sized nonprofit organizations as the norm for social service organizational financial operations. Previous studies that explore nonprofit organizational sustainability select organizations with annual revenues or assets at a minimum of $100,000. Furthermore, the empirical research excludes small non-profit organizations by design and offers findings that include generalizations that are erroneously attributable to all nonprofit organizations. This dissertation outlines the aforementioned errors in the first two chapters. In order to appropriately investigate the aforementioned, this study draws upon the Afrocentric Perspective to supplement the dominate focus of the available literature on small nonprofit financial management. In chapter three, this study explains the study’s design rationale and presents this study’s significance to the field of social work administration. Additionally, chapter three elucidates this study’s contributions to nonprofit social service organizational research and knowledge. The research questions consider possible correlations between small nonprofit organizations’ sustainability strategies and social work mangers’ education and experience. The study’s research questions also consider how financial management strategies affect organizational sustainability. The research design notation O occurs through the developed questionnaire titled “Nonprofit Organization Sustainability Survey.” Statistical procedures examined grouped questions by themed content and computed the group variables scales: financial management, business experience, educational influence, organization sustainability strategies, entrepreneur activities, and budget planning. More than two-thirds of respondents reported that they had experiences with establishing a nonprofit organization; however, they are more comfortable working with clients than conducting financial management tasks. Additionally, while nearly all of the respondents believed that they can secure funding for the organization, 60% reported that their organization had challenges with securing funding.