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Title: THE IMPACT OF DEMOGRAPHIC AND PERCEPTUAL VARIABLES ON A YOUNG ADULT'S DECISION TO PURCHASE HEALTH PRIVATE INSURANCE.
Creator: Cantiello, John, Fottler, Myron, University of Central Florida
Abstract / Description: Each year the number of uninsured individuals in the United States continues to grow. This unfortunate occurrence creates negative consequences for those who are uninsured, but also for those who are covered by health insurance plans. Through cost-shifting practices, hospitals and other healthcare organizations are increasing the cost of other healthcare services to help subsidize the care they must provide for those who cannot pay for that care. There have been attempts to solve this problem...
Show moreEach year the number of uninsured individuals in the United States continues to grow. This unfortunate occurrence creates negative consequences for those who are uninsured, but also for those who are covered by health insurance plans. Through cost-shifting practices, hospitals and other healthcare organizations are increasing the cost of other healthcare services to help subsidize the care they must provide for those who cannot pay for that care. There have been attempts to solve this problem, but a successful solution has not been implemented. Rather than attempt to study the entire uninsured population, this study seeks to determine precisely why young adults between the ages of 18 and 24 are the largest segment of our population that does not purchase health insurance. Socioeconomic status, perceived health, cost, gender, race, and perceived need are all examined in order to determine what type of relationship each one has with a young adult's decision to purchase private health insurance. Structural equation modeling is used to analyze data obtained from the 2005 Medical Expenditure Panel Survey. This study is unique because is includes latent variables and examines a variable that is not often included in health insurance studies that exist in the literature, perceived need. The results of the study indicate that being uninsured is largely a matter of having a higher socioeconomic status and being a non-minority. Perceived health, cost, gender, and perceived need were not shown to have a significant relationship with the dependent variable, private health insurance coverage.
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Date Issued: 2008
Identifier: CFE0002147, ucf:47527
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002147

Title: VALUING VOLUNTEERS:THE IMPACT OF VOLUNTEERISM ON HOSPITAL PERFORMANCE.
Creator: Hotchkiss, Renee, Fottler, Myron, University of Central Florida
Abstract / Description: Volunteers have been present in healthcare settings for centuries, however there is little empirical evidence supporting the impact that volunteers make on hospital performance. Since the 1990s, hospitals in the United States have had a great deal of pressure to produce high quality care at minimum expense. With the pressures of managed care and accrediting agencies, the benefits of using volunteers in a hospital setting are multiplied. Furthermore, as the population of the United States...
Show moreVolunteers have been present in healthcare settings for centuries, however there is little empirical evidence supporting the impact that volunteers make on hospital performance. Since the 1990s, hospitals in the United States have had a great deal of pressure to produce high quality care at minimum expense. With the pressures of managed care and accrediting agencies, the benefits of using volunteers in a hospital setting are multiplied. Furthermore, as the population of the United States grows and the aging population creates more healthcare needs, the need for volunteers in hospitals may increase. This study utilized multiple regression analysis to explore the belief that the volunteer workforce is cost effective and can greatly enhance quality in a hospital setting. Hospitals throughout the state of Florida were invited to participate in the study by completing a brief questionnaire about their volunteer programs. Performance indicators of profit margin, volunteer cost savings, and patient satisfaction scores were analyzed using American Hospital Association and Agency for Health Care Administration data sets along with data obtained from the questionnaire. Results indicate that the use of volunteers offer significant cost savings to hospitals. Furthermore, the assignment of volunteers in patient settings can enhance a hospital's patient satisfaction scores. It also suggests that there is a need to further explore the impact of volunteers on other performance measures. Future research opportunities and policy recommendations are suggested.
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Date Issued: 2007
Identifier: CFE0001846, ucf:47359
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0001846

Title: WORK ENVIRONMENT AND THE EFFECT ON OCCUPATIONAL COMMITMENT AND INTENT TO LEAVE: A STUDY OF BEDSIDE REGISTERED NURSES.
Creator: Cortelyou-Ward, Kendall, Fottler, Myron, University of Central Florida
Abstract / Description: The purpose of this research was to determine the effect work environment has on occupational commitment and intent to leave the profession for bedside registered nurses. Subscales of autonomy, control over the practice setting, nurse-physician relationship, and organizational support were incorporated into the analysis to determine which aspect of work environment most directly effects occupational commitment and intent to leave the profession. The research was undertaken in order to help...
Show moreThe purpose of this research was to determine the effect work environment has on occupational commitment and intent to leave the profession for bedside registered nurses. Subscales of autonomy, control over the practice setting, nurse-physician relationship, and organizational support were incorporated into the analysis to determine which aspect of work environment most directly effects occupational commitment and intent to leave the profession. The research was undertaken in order to help administrators determine the ways in which work environment can be improved upon in order to retain bedside registered nurses in the profession. An explanatory cross sectional survey was distributed to 259 direct care bedside registered nurses employed at a rural, system affiliated hospital in Central Florida. Human subject protection was assured through the University of Central Florida Institutional Review Board. A 77 item questionnaire containing 9 demographic questions, 57 questions from the Nursing Work Index- Revised (NWI-R), 8 questions from Blau's occupational commitment scale, and 3 questions from Blau's intent to leave scale was distributed to all direct care nurses. Subjects were also given the opportunity to complete 3 short answer questions. A 32.8 percent response rate was achieved for a total of 85 complete and usable surveys. Data analysis showed that the work environment is positively related to occupational commitment and negatively related to intent to leave. In addition each of the four subscales (autonomy, control over the practice setting, relationship with physicians, and organizational support) were also positively related to occupational commitment and negatively related to intent to leave the profession. Implications for organizations, public policy and future research are discussed.
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Date Issued: 2007
Identifier: CFE0001851, ucf:47343
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0001851

Title: THE INFLUENCE OF MEDICAL EDUCATION ON THE FREQUENCY AND TYPE OF MEDICAL BOARD DISCIPLINE RECEIVED BY LICENSED FLORIDA PHYSICIANS.
Creator: Bonnell, III, Richard, Fottler, Myron, University of Central Florida
Abstract / Description: It has been estimated that in the United States, between 44,000 to 98,000 patients succumb to medical errors each year. Due to a shortage of graduates of domestic medical schools, many graduates of foreign medical schools are practicing in the United States. The medical education received in foreign medical schools may not be equivalent to the medical education received in domestic medical schools, which are schools located in the United States, Puerto Rico and Canada. Differences due to the...
Show moreIt has been estimated that in the United States, between 44,000 to 98,000 patients succumb to medical errors each year. Due to a shortage of graduates of domestic medical schools, many graduates of foreign medical schools are practicing in the United States. The medical education received in foreign medical schools may not be equivalent to the medical education received in domestic medical schools, which are schools located in the United States, Puerto Rico and Canada. Differences due to the educational backgrounds of the foreign-schooled physicians may contribute to an increase in medical board disciplining. Furthermore, graduates of medical schools where the instruction is not conducted in the English language may receive increased medical board disciplining when compared to the graduates of medical schools where English is the language of instruction. Finally, domestic medical schools that are ranked low according to The Gourman Report, 8th Edition may provide a substandard medical education, causing their graduates to have increased rates of discipline when compared to peers who have graduated from higher ranked medical schools. This study examines the effects of undergoing foreign medical training as opposed to domestic medical training and receiving medical school instruction in the English language or another language, on the frequency and severity of disciplinary action taken by the Florida Board of Medicine against medical doctors licensed in Florida since 1952 (N = 39,559). Also examined are the effects of attending domestic medical schools that are ranked lower than other domestic medical schools on the frequency and severity of disciplinary action taken by the Florida Board of Medicine against medical doctors licensed in Florida since 1952 (n = 25,479). Control variables used in this logistic regression analysis include whether the medical doctor is specialty board certified or not, the specialty practiced and the medical doctor's race and gender. Archival data from the Florida Department of Health were used for this study. This study found that the graduates of medical schools where the instruction is not in the English language are more likely to receive discipline and are more likely to receive more severe types of discipline than graduates of medical schools where the instruction is in the English language. It was also found that medical doctors who are ABMS certified, are practicing either a surgical specialty, obstetrics, gynecology, psychiatry, emergency medicine, family medicine or diagnostic radiology, or are male have increased odds of being disciplined by the Florida Board of Medicine.
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Date Issued: 2008
Identifier: CFE0002392, ucf:47736
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002392

Title: A SURVEY OF PROGRESSIVE AND AFFIRMATIVE EMPLOYEE DISCIPLINE SYSTEMS IN FLORIDA'S HOSPITALS.
Creator: Johnson, Mark, Fottler, Myron, University of Central Florida
Abstract / Description: Conflict between managers and employees is inevitable in any organization, whether public or private. Often, the source of the conflict is employee non-compliance. Managers are responsible for disciplining those employees whose performance or conduct is sub-standard or inappropriate. Therefore, the ability to effectively address employee non-compliance is an essential skill for all managers. Most employee discipline systems fall into one of three categories: traditional, progressive, and...
Show moreConflict between managers and employees is inevitable in any organization, whether public or private. Often, the source of the conflict is employee non-compliance. Managers are responsible for disciplining those employees whose performance or conduct is sub-standard or inappropriate. Therefore, the ability to effectively address employee non-compliance is an essential skill for all managers. Most employee discipline systems fall into one of three categories: traditional, progressive, and affirmative. Traditional systems were prevalent in the late-nineteenth and early twentieth centuries. An autocratic, demanding manager would mete out punishment to non-compliant employees both as an action against the employee and as a warning to other employees. Employees were often terminated for their first offense. With the advent of labor unionism and fair labor practices in the first half of the twentieth century, organizational leaders were required to develop more progressive employee discipline systems which protected employee "due process" and which allowed time and opportunity for improvement by the non-compliant employee. Progressive employee discipline systems are the most prevalent discipline systems in America's workforce today. These systems entail three or four steps, with each successive step usually resulting in more severe penalties for the same offense or more severe offenses. Progressive employee discipline allows the employee an opportunity to respond to non-compliance issues and to try to improve it to the extent required to maintain their position. A new employee discipline system, affirmative discipline, has gained adherents in the private sector primarily. Affirmative employee discipline systems do not use punishment to correct employee non-compliance but instead, ask managers to "coach" and "counsel" the non-compliant employee to better behavior and performance. Rehabilitating the employee's non-compliance is the primary goal of affirmative systems. The emphasis is not only upon the non-compliant employee, but on rehabilitating the "marriage" of non-compliant employee and direct supervisor. Little evidence exists to determine the extent to which progressive and affirmative employee discipline systems are being utilized in the modern organization. No evidence exists that indicates the prevalence of these systems in Florida's healthcare institutions. A survey-based analysis of the use of progressive and affirmative employee discipline systems in Florida's hospitals resulted in respondents indicating frequent utilization of formal progressive employee discipline systems. Designed in three or four steps, these progressive systems allow the employee to improve his/her behavior. Two common tools in progressive systems, the verbal warning and the performance counseling statement, are utilized frequently based upon those respondents surveyed. The use of affirmative employee discipline systems, on the other hand, is relatively rare. The use of written behavior contracts to elicit improved employee compliance is also quite rare. The vast majority of respondents appear to be unfamiliar with the use of written behavior contracts to elicit improved employee compliance.
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Date Issued: 2005
Identifier: CFE0000738, ucf:46580
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0000738

Title: Searching for Meaningful Use of Health Information Technology: A Study of Cardiovascular Disease Care in Veterans General Hospitals.
Creator: Thaldorf, Carey, Wan, Thomas, Fottler, Myron, Liberman, Aaron, Campbell, Robert, University of Central Florida
Abstract / Description: The cost of healthcare in the United States is on an upward trajectory towards an unsustainable level. In order to address this, Congress and the Obama Administration passed the American Recovery and Reinvestment Act (ARRA) of 2009 to begin the process of controlling these costs. Within the ARRA is the Health Information Technology for Economic and Clinical Health (HITECH) section which creates financial incentives to invest in Health Information Technology (HIT) and to develop a means to...
Show moreThe cost of healthcare in the United States is on an upward trajectory towards an unsustainable level. In order to address this, Congress and the Obama Administration passed the American Recovery and Reinvestment Act (ARRA) of 2009 to begin the process of controlling these costs. Within the ARRA is the Health Information Technology for Economic and Clinical Health (HITECH) section which creates financial incentives to invest in Health Information Technology (HIT) and to develop a means to measure the Meaningful Use of specific functions of Electronic Health Records (EHRs). This research examines the widely used Joint Commission datasets to determine their suitability as a basis of meeting the government mandated measuring of Meaningful Use. The datasets used for this study consists of hospital level performance measures with a sample size of 370 hospital samples of HIT Use Intensity and Cardiovascular Performance attained from the Veterans Health Administration (VHA). An Organizational Network Theoretical approach was applied to the data in a non-experimental, sample-resample design to data collected in 2007. A Structural Equation Model (SEM) was built to test for the strength of the correlation between HIT Use Intensity and Cardiovascular Performance and a Latent Growth Curve Model (LGM) was built to examine the effect of the trajectory of HIT Use Intensity on the trajectory of Cardiovascular Performance. The SEM found a weak (.18) correlation between HIT Use Intensity and Cardiovascular Performance and the model only captured 12 percent of the variance. The LGM found no convergence between the trajectories of HIT Use Intensity and Cardiovascular Performance. This may have been the result of the data being non-normally distributed and heavily skewed to the high end of the scale. The policy implications of this study indicate that while Joint Commission data capture only a small amount of the variance attributed to HIT Use it does show a weak but positive correlation between increases in HIT Use Intensity and Increases in Cardiovascular Performance at the hospital level. Future research into adjustments to Joint Commission data measures (or others) may prove to be valuable in measuring the Meaningful Use of HIT systems in order to help hospitals make educated decisions on which HIT systems to purchase and the potential benefits associated with them.
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Date Issued: 2011
Identifier: CFE0004488, ucf:49319
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004488

Title: The Effect of Public Information Sources on Satisfaction with Patient Search for a Physician.
Creator: Loyal, Michael, Wan, Thomas, Fottler, Myron, Noblin, Alice, Golden, Adam, University of Central Florida
Abstract / Description: The purpose of this research study is to examine the effect of public information sources on an individual's satisfaction with the search process undertaken to select a physician. A quasi-experimental research design was adopted to randomly divide the medical staff of a large central Florida medical group into control and intervention groups of approximately 77 physicians each. The intervention involved insertion of the website address to online physician report cards on to each intervention...
Show moreThe purpose of this research study is to examine the effect of public information sources on an individual's satisfaction with the search process undertaken to select a physician. A quasi-experimental research design was adopted to randomly divide the medical staff of a large central Florida medical group into control and intervention groups of approximately 77 physicians each. The intervention involved insertion of the website address to online physician report cards on to each intervention group physician's profile in the physician directory on the medical group's website. After two months, data were collected consisting of all individuals who had scheduled first-time appointments with one of the medical group's physicians during the two-month intervention period. A random sample of patients was drawn from each group and sample members were mailed a 62-item questionnaire along with a cover letter, summary of the research and postage-paid reply envelope. A total of 706 questionnaires were mailed and 61 completed questionnaires were returned, an 8.64% response rate.Intent-to-treat analysis was conducted using independent-samples t-tests to compare the research study's continuous variables' mean scores for control and intervention group participants. The analysis revealed no significant difference in scores for control and intervention groups with the exceptions that the control group was somewhat more committed to conducting a search and selecting a new physician. The control group said the physician's communications skills influenced their satisfaction with the search and selection of a new physician quite a lot while the intervention group said physician communication skills somewhat influenced their satisfaction with search and selection.Results of the covariance structure analysis demonstrated that information use and level of commitment to search and select a new physician independently predict search satisfaction. As information use and search commitment increase, a patient's satisfaction with the search increases as well. Furthermore, as information use increases, the variety of information sources relied upon or used also increases. The findings support the alternative hypothesis that the positive or direct effect of physician report cards is demonstrated in the time and cost of patient search for a physician for both intervention and control groups. One other alternative hypothesis was partially supported, i.e., the effect of household income is confirmed in patient search and satisfaction in selecting a physician. The alternative hypotheses that proposed that physician report cards are more likely to be used to search for a medical specialist and that physician experience, office location and accepted insurance effect patient search and selection of a physician were not tested. Two other alternative hypotheses were rejected. The research findings also indicated that predictors of health care information search satisfaction vary based upon the environment and contextual factors in which the search is conducted.
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Date Issued: 2013
Identifier: CFE0005030, ucf:49992
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005030

Title: Work and Family Conflict: A Comparative Analysis Among Staff Nurses, Nurse Managers, and Nurse Executives.
Creator: Raffenaud, Amanda, Unruh, Lynn, Liu, Albert Xinliang, Fottler, Myron, Andrews, Diane, University of Central Florida
Abstract / Description: The nursing workforce increasingly faces issues that affect clinical and managerial practice. One such issue is work-family conflict (WFC) and family-work conflict (FWC). Nurses face role strain as they confront the pressures from often competing work-and-family roles. This study assessed WFC/FWC among varying nurse roles: staff nurses, managerial nurses, and nurse executives. A random sample of 5,000 nurses, generated from registered nurses practicing in the state of Florida, was surveyed...
Show moreThe nursing workforce increasingly faces issues that affect clinical and managerial practice. One such issue is work-family conflict (WFC) and family-work conflict (FWC). Nurses face role strain as they confront the pressures from often competing work-and-family roles. This study assessed WFC/FWC among varying nurse roles: staff nurses, managerial nurses, and nurse executives. A random sample of 5,000 nurses, generated from registered nurses practicing in the state of Florida, was surveyed for this research study. Nurses were surveyed on demographics, perceptions regarding the work environment, and perceptions of WFC/FWC. Descriptively, nurses experienced more work-family conflict than family-work conflict. Regression analyses and ANOVAs indicated that staff nurses experienced less work-family conflict than nursing managers (second most) and nursing executives (highest). None of the nurse roles experienced significant levels of FWC. White nurses, compared to non-white nurses, experienced less WFC and FWC. WFC increased with shift length but FWC was not significantly affected by it. Paid leave for childbirth was associated with lower FWC. This study holds significant implication for the nursing workforce. Nurse managers and executives showed significantly higher WFC than staff nurses. This may discourage a nurse from taking on leadership roles or lead to leaving them. In an era where nurse managers and leaders are needed, efforts must be taken to decrease WFC/FWC factors. Nonwhite nurses reported higher levels of both WFC and FWC. This may contribute to tension at the workplace and a difficult family life. Leaders must continue to create platforms for nurses of all races and ethnicities to voice their work and family needs, and to be supported when doing so. Nurses working shifts over 8 hours had higher WFC levels. Although 12-hour shifts have been popular among staff and management, their use should be reevaluated. Finally, paid leave for childbirth is a program worth supporting, as it was a factor in lower FWC.
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Date Issued: 2018
Identifier: CFE0007081, ucf:51997
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0007081

Title: The Effect of Health Education on Clinical and Self-Reported Outcomes of Diabetes in a Medical Practice.
Creator: Rav-Marathe, Karen, Wan, Thomas, Fottler, Myron, Matusitz, Jonathan, Zhang, Ning, March, Allan, University of Central Florida
Abstract / Description: A majority of diabetes self-management programs have been shown to improve knowledge, attitude, practice, and health care outcomes. However, in the literature the underlying causal mechanisms for the improvement attributable to health education have not been explored, especially, how diabetes educational intervention may affect diabetes care outcomes. The purpose of the present study was to identify the causal mechanisms responsible for improved knowledge, attitude, practice and outcomes, so...
Show moreA majority of diabetes self-management programs have been shown to improve knowledge, attitude, practice, and health care outcomes. However, in the literature the underlying causal mechanisms for the improvement attributable to health education have not been explored, especially, how diabetes educational intervention may affect diabetes care outcomes. The purpose of the present study was to identify the causal mechanisms responsible for improved knowledge, attitude, practice and outcomes, so that educational interventions can be tailored efficiently and effectively to patients who are most likely to benefit from self-care management. The study used the knowledge, attitude, practice and outcome (KAP-O) framework. The specific purpose of the study was to examine the causes of variation in the outcomes of glycated hemoglobin (A1C), low-density lipoprotein cholesterol (LDLC), functional capacity (FC), and poor perceived health (PPH).An experimental study with a randomized control trial design involving 141 participants was conducted. The experimental group (N = 87) and control group (N = 52) were comparable in terms of demographics and major diagnoses. The experimental group received diabetes education. The control and experimental groups received usual customary care. Knowledge, attitude, practice, functional capacity and poor perceived health were measured before and after intervention using reliable and valid instruments. The study used a tailored attitudinal instrument. Glycated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDLC) were measured before and after intervention. Multiple analytic strategies were applied to examine the experimental data.The four outcome variables of (A1C), (LDLC), (FC), and (PPH) did not constitute one common factor measurement model for outcome evaluation. Results of the Independent sample t-test showed that health educational intervention directly improves knowledge about diabetes. The path analysis of panel regression showed that health educational intervention directly lowers glycated hemoglobin (A1C). The causal modeling of {(Exp_Status)-(K-T2)-(A-T2)-(P-T2)} model showed that health educational intervention also indirectly improves preventive practice via knowledge. The effect of attitude (A-T2) was greater than the effect of knowledge on preventive practice of self-care. The difference-in-differences analysis showed that difference in practice (DP) statistically significantly affects the difference in glycated hemoglobin (DA1C). The greater the preventive practice, the greater the lowering of glycated hemoglobin (A1C), indicating a better control of diabetes. The data from this experiment do not support a strong causal path of experimental effects on outcomes via knowledge, attitude, and practice of self-care.The study should be replicated using the KAP-O model in research based on multi-centers, multiple providers, and a diverse population of Type 2 diabetes patients. The study should assess outcomes more than four times over a period of one to two years to elicit the trajectory of change in outcome variables. Knowledge and attitude should be assessed at baseline and continuously improved for the duration of the study.?
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Date Issued: 2014
Identifier: CFE0005541, ucf:50311
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005541

hospital (2)	+ -
Domestic Medical School (1)	+ -
Foreign Medical School (1)	+ -
Health Information Technology (1)	+ -
Health Insurance (1)	+ -

Identify causal mechanisms for improved knowledge (1)	+ -
Meaningful Use (1)	+ -
Medical Doctor (1)	+ -
Medical Education (1)	+ -
Medical Malpractice (1)	+ -
Performance (1)	+ -
Physician Discipline (1)	+ -
Uninsured (1)	+ -
Young Adult's (1)	+ -
affirmative discipline (1)	+ -
attitude (1)	+ -
bedside RN (1)	+ -
cost savings (1)	+ -
employee discipline (1)	+ -
health information seeking (1)	+ -
healthcare administration (1)	+ -
information search satisfaction (1)	+ -
intent to leave profession (1)	+ -
nursing (1)	+ -
nursing leadership (1)	+ -
nursing workforce (1)	+ -
occupational commitment (1)	+ -
patient satisfaction (1)	+ -
patient search for a physician (1)	+ -
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Fottler, Myron (9)	+ -
University of Central Florida (9)	+ -
Wan, Thomas (3)	+ -
Andrews, Diane (1)	+ -
Bonnell, III, Richard (1)	+ -

Campbell, Robert (1)	+ -
Cantiello, John (1)	+ -
Cortelyou-Ward, Kendall (1)	+ -
Golden, Adam (1)	+ -
Hotchkiss, Renee (1)	+ -
Johnson, Mark (1)	+ -
Liberman, Aaron (1)	+ -
Liu, Albert Xinliang (1)	+ -
Loyal, Michael (1)	+ -
March, Allan (1)	+ -
Matusitz, Jonathan (1)	+ -
Noblin, Alice (1)	+ -
Raffenaud, Amanda (1)	+ -
Rav-Marathe, Karen (1)	+ -
Thaldorf, Carey (1)	+ -
Unruh, Lynn (1)	+ -
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