Changes to the country's health care political landscape in 2012 resulted in the development of federal programs aimed at containing costs and improving the quality of care delivered. Accountable Care Organizations (ACO) emerged linking performance to rewards. Guided by Conrad's value-based performance incentive theory as the theoretical foundation, the purpose of this quantitative study was to determine the relationship between financial incentive size and ACO performance measures. The research questions examined the predictive relationship of incentive size and acute care readmission rates, emergency department (ED) visits, and per capita spending of the ACO Medicare Shared Savings Program population. The study included 348 participating ACOs serving 7.8 million Medicare enrollees. Secondary archival data were analyzed using multiple linear regression models to test the relationship patterns of the three dependent variables. The findings showed a significant association between incentive size and acute readmission rates β = .001; 95% CI, .000185, .001342; p = .010; and a significant inverse association with per capita spending, β = -6.28E-7; 95% CI, -.000001, -1.61E-7; p = .009, but no association with the frequency of ED visits β = -5.06E-6; 95% CI, -.000011, 7.04E-7; p = .085. The study results support that incentive size is linked with higher acute care readmission rate and lower per capita spending but not frequency of ED visits. Incentive size was found to be associated with better and worse ACO provider performance depending on the outcome. Social change implications include improved performance on ACO spending, which might potentially lead to political and regulatory changes supporting larger financial incentives by the federal government.

Chronic obstructive pulmonary disease (COPD), a progressive and nonreversible disease, is a leading cause of mortality and morbidity throughout the world. Detecting COPD early in the disease process will help in decreasing later stage COPD severity. Because airway inflammation is a hallmark of COPD, it has been proposed that measuring exhaled nitric oxide, a marker of inflammation, in exhaled breath condensate could prove to be an inexpensive and efficient method to detect COPD in outpatient settings. Using the hypothetico-deductive theory as a guideline, this study used secondary data from the National Health and Nutrition Examination Survey 2007 to 2010 to test the association between exhaled nitric oxide (eNO), COPD, and COPD severity. In addition, this study explored whether occupation modifies the association between eNO and COPD. Descriptive statistics, chi-square analyses, and regression analyses were used to analyze data from a sample size of 10,214 individuals. The prevalence of COPD was 7.2%, based on self-reported physician diagnoses and 11.4% based on prebronchodilator spirometry analysis, strengthening the argument that COPD is often under- or misdiagnosed in clinical settings. This study found no statistically significant association between eNO, COPD, and COPD severity, and occupational status did not appear to modify the association between eNO and COPD. The findings of this study highlight the importance of using objective measures such as spirometry in clinical settings for early diagnosis and management of COPD. Early diagnosis helps to slow the progression of the disease, resulting in fewer related comorbidities and complications.

Influenza is the eighth leading cause of death in the United States, accounting for 56,000 deaths annually and leading to an average of more than 200,000 hospitalizations every year. Adults 65 years of age and older account for 50% to 60% of influenza-related hospital admissions and an estimated 90% of influenza-associated deaths occur in people age 65 and older. During the 2011 to 2012 influenza season, approximately 50 % of veterans between 45 and 70 years of age refused the influenza vaccine within the metro-area outpatient Veteran Administration (VA) facility in Atlanta, Georgia. The aim of this project was to identify and to identify barriers to influenza vaccinations in veterans. The health belief model was utilized to organize the evidence-based practice data obtain from the literature reviews on the barriers to the influenza vaccine. An Influenza vaccination educational pamphlet was developed using data obtained from the literature reviews. No information was obtained from the veterans. The educational pamphlet listed the identified barriers and ways to overcome the barriers to the influenza vaccination. The influenza vaccination educational pamphlet will be utilized by veterans and staff in the outpatient clinic. The pamphlets will to be placed in the veteran's waiting areas, medication rooms, and lobby areas prior to the beginning of the influenza season at the end of September. The organization's outpatient quarterly influenza data report will be utilized to disseminate the results to the educational tool's effectiveness after implementation at the end of the influenza season in May. The social impact of solving this issue is the opportunity to decrease the major infrastructure demands placed on the healthcare system as well as human suffering caused by influenza.

There are more than 79 million people in the U.S. currently infected with human papillomavirus (HPV), with an estimated 14 million new infections annually. There is a lack of knowledge about the maternal socioeconomic influences and uptake of the HPV vaccine series. Infection with HPV can cause cervical cancer in women, and there are over 11,000 cervical cancer diagnoses in the U.S. responsible for 4000 deaths annually. Vaccination coverage to prevent HPV infection does not meet the Healthy People 2020 goals of an 80% vaccination rate in the U.S. In this study, associations were tested between maternal SES variables and uptake of the HPV vaccine in male and female adolescents ages 13-17 from 1,125 participants who lived within the estimation areas of New York City, New York and Houston, Texas in 2014. The health belief model was used as the theoretical framework for the study. This was a cross-sectional quantitative study using multiple logistic regression analysis of 4 maternal predictor variables. It was found that 3 of the variables (income, p > .05, education β = -.026, p > .05, and age β = -.096, p > .05) were not significantly related to uptake of the HPV vaccine series, whereas ethnicity was found to be significant (Non-Hispanic White β = .429, p = .029, Non-Hispanic Black β = .587, p = .002, and Non-Hispanic Other β = .586, p =.011). Hispanics were nearly 2 times more likely to be vaccinated than other groups. The potential social change implications of this research are that public health workers can use the findings to develop targeted interventions to increase HPV vaccination uptake and reduce the incidence of cervical cancer.

Chronic pain syndrome continues to be a national health concern among all medical specialties. It has an impact on the entire health care system and if current trends continue, the economic impact alone will exceed 100 billion dollars. In 2014, 254 million prescription opioids were written in the United States. During this time, an increase in prescription opioid related deaths was seen, with approximately 20,101 deaths occurring in 2015. Properly trained clinicians across the health care system are needed to achieve successful patient outcomes, while reducing cost, morbidity, and mortality. The purpose of the scholarly project was to develop a comprehensive, opioid-specific, expert reviewed and evidenced-based educational module for health care clinicians of all specialties. Using the guidelines offered by the Center for Disease Control in 2016, the content of the project was developed with a primary focus on the clinical processes, pharmacological properties, and appropriateness of opioids in the treatment of chronic pain. The educational module was disseminated to 10 experts in the field of pain management and family practice. Each of them was asked to evaluate the educational module and evaluate it from an expert standpoint via Likert-scale evaluation form. The data revealed a median score of 4.5 out of 5 for most all categories, demonstrating the project's ease of use, evidenced-based content, and its ability to further expand the knowledge of clinicians. The project will be presented to stakeholders and state representatives for wide spread distribution. Educating health care professional over the continuum will ensure effective social change and shift the current trends in prescription opioid related mortality and morbidity.

The U.S. health care system is evolving from medical centric to patient centered, augmenting the importance for patients to comprehend and process medical information. The Department of Education indicated that 77 million Americans have a basic or below basic health literacy proficiency and 12% register as health literacy proficient. Animation is a time-tested device for improving health by enhancing comprehension. Chronic constipation (CC) complexity entails physiological, anatomical, and environmental mechanisms. Using the cognitive theory of multimedia learning and dual-channel auditory and visual processing, the primary research question addressed whether an animated educational video improved health literacy for CC more than a traditional written educational pamphlet. A secondary dataset of 100 CC subjects from the University of Michigan was collected using a cross-sectional study design with a convenience sampling strategy of CC patients who underwent anorectal functional testing. Dependent variables were CC Pretest Quiz and CC Posttest Quiz scores, and independent variables included CC education intervention, demographics, health literacy proficiency, and environmental learning variables. Descriptive and analytical statistical methods were employed for data summarization and comparison. The animated educational video had minimal impact (p = 0.20) on improving health literacy; however, pretest scores (p -?¤ 0.001), age (p = 0.03) and highest level of education achievement (p = 0.03) influenced the largest variance between quiz scores. Enhancing health literacy influences social change by empowering individuals with CC to improve quality of life metrics, increase work productivity, and decrease health care utilization costs.

Two Human Immunodeficiency Virus (HIV) outbreaks occurred almost simultaneously in the United States (US) (2014-2015) and in Cambodia (2015). Information is lacking on HIV-related knowledge, stigmatizing attitudes, and high-risk behaviors (KAB) among the general population, which may affect the transmission of HIV and lead to outbreaks. The current study aimed to: 1) assess KAB among the general population in a high-risk county in the US, 2) analyze KAB among the general population of Cambodia, and 3) compare KAB across samples from a high-risk county in Northeast Tennessee and a province in Cambodia. Tennessee data were collected in 2017 and Cambodian Demographic and Health Survey data were from 2014. Descriptive, Kruskal-Wallis, Wilcoxon, Bonferroni, and Spearman’s correlation as well as simple and multiple logistic regression analyses were conducted on individual questions and KAB variables. Among Northeast Tennessee participants, 92.6% had heard of HIV, 43.5% knew that HIV could not be transmitted by mosquitos, and 67.8% of participants had never tested for HIV. Cambodian females aged 20-29, 30-39, and ≥40 were more likely to have a high level of HIV knowledge than those aged 15-19 (Odds Ratio (OR): 1.4, 1.6, and 1.6, respectively). Cambodian males who completed secondary and higher education had significantly higher odds of having a high level of HIV knowledge (OR: 2.3 and 2.9, respectively) and lower odds of engaging in some high-risk behaviors (OR: 0.3 and 0.2, respectively) than those who had completed no level of education. Battambang participants were more likely to have a high level of HIV knowledge (OR: 4.44; 95% CI: 2.14-9.24) and less likely to have at least one stigmatizing attitude (OR: 0.47; 95% CI: 0.24-0.94) and one high-risk behavior (OR: 0.16; 95% CI: 0.08-0.33) compared to Northeast Tennessee participants. Future studies are needed to determine associations between results and policies/laws, frequency of personal contact, and other differences between the two locations. KAB can greatly impact the outcome of HIV prevalence within a community. Having a greater understanding of KAB and creating interventions based on that understanding can have a positive influence on HIV infection and related outcomes.

African Americans diagnosed with diabetes are less likely to self-manage diabetes-specific modifiable risk factors. As a result, utilization of healthcare services occurs at a greater rate than other racial groups, and thereby incurs higher than expected healthcare costs. This ethnographic study explored the elements of diabetes educational material African Americans in a large city in the southern part of the United States found most useful to facilitate self-management of their disease. Bandura's self-efficacy theory provided the theoretical framework. Research questions addressed the preferred educational content, layout of material, and methods for educational delivery and caregiver support. A purposive sample of 30 African Americans with diabetes who had engaged in diabetes education classes participated in this study. Data were collected through in-depth personal interviews, which were inductively coded and then categorized around emergent themes. A key finding of this study is that participants preferred group learning formats, but perceived educational material to be confusing and difficult to understand. They also expressed some preferences for the use of color, pictures, and presentation of graphical information that may provide the basis for a revision of educational materials. Interestingly, participants indicated a tendency to seek out church members rather than family for support. The positive social change implications of this study include recommendations to healthcare professionals to adopt educational curricula that reflect cultural nuances and needs of target populations in order to support better health outcomes for at-risk populations and cost efficiency improvements.

More people in the United States are approaching retirement age, a trend which has resulted in increased study on life satisfaction and psychological well-being of the elderly. Previous researchers have focused on the relationship between religious social support and life satisfaction; however, there remains a gap in the literature regarding how race and gender may influence this association. Knowledge of interactions between religiosity, gender, and race will enable counselors working with different groups of religiously inclined clients to develop and implement religious-based interventions specific to their clients. Guided by the social ecological model, the purpose of this study was to examine how gender and race influence religious social relationships and psychological well-being, optimism, and self-rated health among the elderly, using data from the Religion, Aging, and Health Survey. Pearson bivariate correlations and hierarchical linear regression were used to examine multicollinearity among variables and whether the association between the religious variables measured and the psychological well-being of the elderly varied by gender and/or race. All 3 religious constructs significantly predicted positive well-being outcomes. However, only gender and race interactions were significant for the religious-based relationships with others variable. Income and marital status were found to be significant covariats for this study. Also, both income and marital status were significantly associated with the relationship between religious variables and the psychological well-being of the elderly. Findings from this study can aid religious leaders and public health practitioners in developing programs and policies to improve perception of health and psychological wellbeing among the elderly.

Breast cancer is one of the most widespread chronic diseases and a major cause of death among women in the United States. African American women have a higher incidence of breast cancer than their counterparts from other ethnic/racial groups. The purpose of this cross-sectional survey of 126 African American females from the western US metropolitan area was to assess knowledge, attitudes, and behavior with respect to breast cancer manifestation, detection services, and the role of mammography in breast cancer prevention and control. The health belief model guided this study. A 41-item, ethnically sensitive, self-administered, and gender-specific instrument, the Champion Revised Susceptibility, Benefits, and Barriers Scale for Mammography Screening, was used in this study. Analysis of variance, the Scheffe post hoc tests, and Fisher's exact test were used to analyze the data. The results showed that all but three participants (97.6%) reported having had breast cancer screening; almost all of the participants were compliant and answered the knowledge question. The findings also showed that the women with high levels of education reported lower benefits of mammography scores and lower barriers to mammography scores; and higher cues to action scores. Income was not significantly related to attitude toward breast cancer screening. The implication for positive social change is that these results may help to facilitate continued development of intervention strategies to encourage African American women to utilize early breast cancer detection services.