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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: The Relationship of State Political Instability and Economic Failure to Predatory Organized Crime in Multiple Nations: A Global Comparative Anaylsis.
Creator: Ruth, Terrance, Wan, Thomas, Zhang, Ning, Winton, Mark, Matusitz, Jonathan, University of Central Florida
Abstract / Description: ABSTRACTThis dissertation examines the relationship of political instability and economic failure to predatory organized crime in multiple nations. This is an important issue since each year the increase in predatory crime networks contributes to international economic failure, security risks, and the spread of organized crime. In an effort to understand the relationship between state failure and economic failure on the one hand, and organized crime on the other, this study will seek to...
Show moreABSTRACTThis dissertation examines the relationship of political instability and economic failure to predatory organized crime in multiple nations. This is an important issue since each year the increase in predatory crime networks contributes to international economic failure, security risks, and the spread of organized crime. In an effort to understand the relationship between state failure and economic failure on the one hand, and organized crime on the other, this study will seek to address three goals. First, the study tests the degree to which variables that imply economic failure and state failure correlate with predatory organized crime. Second, the study determines the extent of the relationship between the social and economic indicators and predatory organized crime in multiple nations. Third, the study examines the future implications of predatory organized crime predictor variables in the context of national strategies to eradicate or reduce organized crime.This study investigates the relationship in failed states between predatory crime groups and various economic and state stability indicators. In particular, this study examines the impact of seven predictor variables on the variation in Predatory Organized Crime in 122 countries. The findings suggest that the state failure hypothesis correctly articulates the failure of the state to offer key social goods such as security, stability, and justice, thereby producing an environment where crime groups assume state responsibilities. The findings also support the economic failure hypothesis that poor economic outcomes such as high unemployment, low SES, and a dependency on an underground economy encourage the development of criminal groups.The ultimate goal of this study is to assist policy makers, policy analysts, scholars, and officials at donor agencies and international financial institutions in establishing effective tools for identifying and removing predatory organized crime units. Analytical results provide general support to all hypotheses. Moreover, policy implications for predatory organized crime control in developing countries are discussed. The author's objective is to increase understanding of this issue and show the need for further research.
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Date Issued: 2013
Identifier: CFE0005546, ucf:50296
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005546

Title: Cities of Service: A Grounded Theory Exploration of Volunteer Service.
Creator: Hill, Brandy, Martin, Lawrence, Bryer, Thomas, Kapucu, Naim, Wan, Thomas, University of Central Florida
Abstract / Description: This research explores how volunteer service can be both included and impactful in strategies to address local challenges. Prior research would suggest that volunteer service has largely been overlooked when it comes to governmental efforts to solve society's biggest problems, particularly at the local level. Ignoring the potential for volunteer service in problem-solving approaches may hinder the development of effective problem-solving strategies. This research describes the ways cities...
Show moreThis research explores how volunteer service can be both included and impactful in strategies to address local challenges. Prior research would suggest that volunteer service has largely been overlooked when it comes to governmental efforts to solve society's biggest problems, particularly at the local level. Ignoring the potential for volunteer service in problem-solving approaches may hinder the development of effective problem-solving strategies. This research describes the ways cities drive demand for volunteer service. In particular, volunteer service demand can be explained through certain motivational bases(-)economic, aspirational, and need-based(-)together with various feasibility considerations. A grounded theory model for volunteer service demand from the perspective of the city and a generalized logic model for service as a strategy to address local challenges are presented.
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Date Issued: 2013
Identifier: CFE0004690, ucf:49849
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004690

Title: Factors Influencing unmet Medical Need among U.S. Adults: Disparities in Access to Health Services.
Creator: Khanijahani, Ahmad, Wan, Thomas, Malvey, Donna, Liu, Albert Xinliang, Anderson, Kim, University of Central Florida
Abstract / Description: Inequities in access to health services has negative consequences on individual well-being, and imposes financial and emotional burden on patients, families, health care systems, and the public. Inequities engendered from differences in socioeconomic status, health insurance coverage, race, and other characteristics can engender disparities. This study aimed to identify the potential predictors of unmet medical need among the civilian noninstitutionalized U.S. adults. Inability to receive...
Show moreInequities in access to health services has negative consequences on individual well-being, and imposes financial and emotional burden on patients, families, health care systems, and the public. Inequities engendered from differences in socioeconomic status, health insurance coverage, race, and other characteristics can engender disparities. This study aimed to identify the potential predictors of unmet medical need among the civilian noninstitutionalized U.S. adults. Inability to receive needed medical care or receiving medical care after a delay, due to the associated costs, constructed unmet medical need. This study used a four-year (2014-2017) National Health Interview Survey (NHIS) data (sample size: 296,301 adults) and implemented a conceptual framework to study disparities in access to health services and estimate the relative importance of predisposing, enabling, and need factors as the predictors of unmet medical need. Findings from machine learning and logistics regression models highlight the importance of health insurance coverage as a key contributing factor of health disparities. About 60% of variation in unmet medical need was predictable, with over 90% accuracy, solely with health insurance coverage status. Self-rated health status, family structure, and family income to poverty ratio were other statistically significant predictors. Even after controlling for a wide variety of sociodemographic and health status variables such as age, gender, perceived health status, education, income, etc., health insurance remains significantly associated with unmet medical need (OR: 5.03, 95%CI: 4.67-5.42). To ensure precise national estimates, proper survey data analysis methods were incorporated to account for the complex sampling method used by NHIS. Furthermore, the enabling factors (health insurance and income) exert much more weight on unmet medical need than predisposing factors and need factors. The findings raise the concerns about the existence and magnitude of disparities in health care access and provide a comprehensive framework to a target population for understanding the sources of health inequities with data-driven evidence. Results can be utilized to address potential areas for designing public policy and program interventions by identifying the relative vulnerability of different population groups for lacking access to affordable health services. Future studies using longitudinal panel data are necessary to establish a causal relationship between the predictors and unmet medical need.
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Date Issued: 2019
Identifier: CFE0007477, ucf:52686
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0007477

Title: Constructing and Validating an Integrative Economic Model of Health Care Systems and Health Care Markets: A Comparative Analysis of OECD Countries.
Creator: Helligso, Jesse, Wan, Thomas, Liu, Albert Xinliang, King, Christian, Hamann, Kerstin, University of Central Florida
Abstract / Description: This dissertation argues that there are three basic types of health care systems used in industrial nations: free market (private insurance and provision), universal (public insurance and private provision), and socialized (public insurance and provision). It examines the role of market forces (supply and demand) within the health care systems and their effects on health outcomes by constructing an integrative model of health care markets and policies that is lacking within the scientific and...
Show moreThis dissertation argues that there are three basic types of health care systems used in industrial nations: free market (private insurance and provision), universal (public insurance and private provision), and socialized (public insurance and provision). It examines the role of market forces (supply and demand) within the health care systems and their effects on health outcomes by constructing an integrative model of health care markets and policies that is lacking within the scientific and academic literature. The results show that, free market systems have decreased access to care, good quality of care, and are economically inefficient resulting in 2.7 years of life expectancy lost and wasted expenditures (expenditures that do not increase life expectancy) of $3474 per capita ($1.12 trillion per year in the U.S.). Socialized systems are the most economically efficient systems but have decreased access to care compared to universal systems, increased access to care compared to free market systems and have the lowest quality of care of all three systems resulting in 3 months of life expectancy lost per capita and a saving of $335 per capita. Universal systems perform better than either of the other 2 systems based on quality and access to care. The models show that health insurance is a Giffen Good; a good that defies the law of demand. This study is the first fully demonstrated case of a Giffen good. This investigation shows how the theoretically informed integrative model behaves as predicted and influences health outcomes contingent upon the system type. To test and substantiate this integrative model, regression analysis, Time-Series-Cross-Section analysis, and structural equation modeling were performed using longitudinal data provided and standardized by the Organization for Economic Cooperation and Development (OECD). The results demonstrate that universal health care systems are superior to the other two systems.
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Date Issued: 2018
Identifier: CFE0007335, ucf:52114
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0007335

Title: Predictors of hospital quality and efficiency.
Creator: Fotovvat, Hoda, Wan, Thomas, Liu, Albert Xinliang, Ramirez, Bernardo, Yu, Chia-Yuan, University of Central Florida
Abstract / Description: American hospitals have made serious efforts to implement and expand their health information technology capabilities and to integrate different specialized care or high-tech services in order to maximize the efficiency and quality of care. In providing a variety of HIT-related services, these hospitals expanded their national reputation in line with integrated care goals. As a result, hospitals are encouraged to establish effective communication channels to facilitate patient-physician...
Show moreAmerican hospitals have made serious efforts to implement and expand their health information technology capabilities and to integrate different specialized care or high-tech services in order to maximize the efficiency and quality of care. In providing a variety of HIT-related services, these hospitals expanded their national reputation in line with integrated care goals. As a result, hospitals are encouraged to establish effective communication channels to facilitate patient-physician sharing of the patient care experience, to enhance effective pain management, and to transform patient-centered care modalities to solidify the adequacy of patient care processes. By analyzing national data sets publicly available, this investigation explored the relationship of acute-care hospitals' performance to the contextual, organizational and patient characteristics, using a cross-sectional study design. This study developed and evaluated the quality and efficiency of hospitals with respects to the structural complexity, process adequacy, efficiency, and quality of care. The structure-process-outcome theory in quality of care developed by Donabedian (1980), is adopted for this investigation. Statistical methods such as confirmatory factor analysis (CFA) and covariance structure model are employed. The population surveyed by the American Hospital Association (AHA) are acute care hospitals throughout the United States, including more than 3000 acute care hospitals of all types of ownership. The data provided by HIMSS Analytics and AHA are available for 2015 and the data provided CMS quality indicators are available for 2016. The key finding of this research is that process adequacy mediates the relationship between hospital structure and performance variables. The efficiency variable played an important role in shaping quality. The location and hospital teaching status have a moderate impact in determining hospital performance by affecting the structure and process of hospitals.
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Date Issued: 2019
Identifier: CFE0007888, ucf:52796
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0007888

Title: An Ecological Analysis of Social and Economic Influences on Black and White Infant Mortality Risk In Orange County, FL.
Creator: Lopez-Littleton, Vanessa, Liberman, Aaron, Wan, Thomas, Wright, James, Lieberman, Leslie, University of Central Florida
Abstract / Description: Black health disparities are a salient public health issue with blacks in every socioeconomic level at a greater health disadvantage than their white counterparts. In particular, disparity in infant mortality rates between blacks and whites have widened in recent decades to differentials never before experienced in the United States. Social ecologists investigating the myriad of individual and environmental risk factors have failed to fully account for the persistent differential. This study...
Show moreBlack health disparities are a salient public health issue with blacks in every socioeconomic level at a greater health disadvantage than their white counterparts. In particular, disparity in infant mortality rates between blacks and whites have widened in recent decades to differentials never before experienced in the United States. Social ecologists investigating the myriad of individual and environmental risk factors have failed to fully account for the persistent differential. This study examines the relationships between individual and environmental influences on the health risk experienced by blacks, whites, as well as the differential between the two populations. This multi-level analysis was conducted using five-year aggregate data centering on the 2000 decennial census (1998 - 2002) as the most recent census data available. During the study period, the 193 census tracts in Orange County, Florida, experienced 504 infant deaths which included 242 black and 241 white infant deaths. Using the infant mortality target rate developed for Healthy People 2000 as the (")normal(") infant mortality rate, risk was calculated as the percentage of deviation from the (")normal("). A rate was also calculated to demonstrate the difference between black and white percent deviations from the (")normal("). Structural equation modeling was used to examine the relationship between socioeconomic influences (Socioeconomic Disadvantage), social risk factors (Social Disorganization), and behavioral risk factors (Poor Behavioral Choices) using a latent variable approach based on a conceptual model which integrated the social determinants of health framework and conflict theory. In this study, an inverse association was found between socioeconomic disadvantage and infant mortality risk for black infants. This finding is contradictory to the expected finding and may have been due to multicollinearity or the operationalization of the endogenous study variable for black infant mortality risk. Thus, this study highlights the complexity of unraveling the interrelationship between social and economic risk factors. The results of this study demonstrate the importance of the latent variable approach in public health research as well as the need to broaden the approach to selecting indicators. This study concludes with specific policy recommendations aimed at improving the health outcomes of vulnerable populations using the social determinants of health framework.
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Date Issued: 2011
Identifier: CFE0004129, ucf:49109
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004129

Title: The Response of American Police Agencies to Digital Evidence.
Creator: Yesilyurt, Hamdi, Wan, Thomas, Potter, Roberto, Applegate, Brandon, Lang, Sheau-Dong, University of Central Florida
Abstract / Description: Little is known about the variation in digital forensics practice in the United States as adopted by large local police agencies. This study investigated how environmental constraints, contextual factors, organizational complexity, and organizational control relate to the adoption of digital forensics practice. This study integrated 3 theoretical perspectives in organizational studies to guide the analysis of the relations: institutional theory, contingency theory, and adoption-of-innovation...
Show moreLittle is known about the variation in digital forensics practice in the United States as adopted by large local police agencies. This study investigated how environmental constraints, contextual factors, organizational complexity, and organizational control relate to the adoption of digital forensics practice. This study integrated 3 theoretical perspectives in organizational studies to guide the analysis of the relations: institutional theory, contingency theory, and adoption-of-innovation theory. Institutional theory was used to analyze the impact of environmental constraints on the adoption of innovation, and contingency theory was used to examine the impacts of organizational control on the adoption of innovation. Adoption of innovation theory was employed to describe the degree to which digital forensics practice has been adopted by large municipal police agencies having 100 or more sworn police officers.The data set was assembled primarily by using Law Enforcement Management and Administrative Statistics (LEMAS) 2003 and 1999. Dr. Edward Maguire`s survey was used to obtain 1 variable. The joining up of the data set to construct the sample resulted in 345 large local police agencies. The descriptive results on the degree of adoption of digital forensics practice indicate that 37.7% of large local police agencies have dedicated personnel to address digital evidence, 32.8% of police agencies address digital evidence but do not have dedicated personnel, and only 24.3% of police agencies have a specialized unit with full-time personnel to address digital evidence. About 5% of local police agencies do nothing to address digital evidence in any circumstance. These descriptive statistics indicate that digital evidence is a matter of concern for most large local police agencies and that they respond to varying degrees to digital evidence at the organizational level. Agencies that have not adopted digital forensics practice are in the minority. The structural equation model was used to test the hypothesized relations, easing the rigorous analysis of relations between latent constructs and several indicator variables. Environmental constraints have the largest impact on the adoption of innovation, exerting a positive influence. No statistically significant relation was found between organizational control and adoption of digital forensic practice. Contextual factors (task scope and personnel size) positively influence the adoption of digital forensics. Structural control factors, including administrative weight and formalization, have no significant influence on the adoption of innovation. The conclusions of the study are as follows. Police agencies adopt digital forensics practice primarily by relying on environmental constraints. Police agencies exposed to higher environmental constraints are more frequently expected to adopt digital forensics practice. Because organizational control of police agencies is not significantly related to digital forensics practice adoption, police agencies do not take their organizational control extensively into consideration when they consider adopting digital forensics practice. The positive influence of task scope and size on digital forensics practice adoption was expected. The extent of task scope and the number of personnel indicate a higher capacity for police agencies to adopt digital forensics practice. Administrative weight and formalization do not influence the adoption of digital forensics practice. Therefore, structural control and coordination are not important for large local police agencies to adopt digital forensics practice.The results of the study indicate that the adoption of digital forensics practice is based primarily on environmental constraints. Therefore, more drastic impacts on digital forensics practice should be expected from local police agencies' environments than from internal organizational factors. Researchers investigating the influence of various factors on the adoption of digital forensics practice should further examine environmental variables. The unexpected results concerning the impact of administrative weight and formalization should be researched with broader considerations.
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Date Issued: 2011
Identifier: CFE0004181, ucf:49081
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004181

Title: A Root Cause Analysis of the Barriers to Transparency among Physicians: A Systemic Perspective.
Creator: Perez, Bianca, Liberman, Aaron, Oetjen, Dawn, Wan, Thomas, Abel, Eileen, University of Central Florida
Abstract / Description: Transparency in healthcare relates to formally reporting medical errors and disclosing bad outcomes to patients and families. Unfortunately, most physicians are not in the habit of communicating transparently, as many studies have shown the existence of a large medical error information gap. Research also shows that creating a culture of transparency would mutually support patient safety and risk management goals by concomitantly reducing medical errors and alleviating the malpractice crisis....
Show moreTransparency in healthcare relates to formally reporting medical errors and disclosing bad outcomes to patients and families. Unfortunately, most physicians are not in the habit of communicating transparently, as many studies have shown the existence of a large medical error information gap. Research also shows that creating a culture of transparency would mutually support patient safety and risk management goals by concomitantly reducing medical errors and alleviating the malpractice crisis. Three predictor variables are used to represent the various dimensions of the context just described. Perfectionism represents the intrapersonal domain, socio-organizational climate represents the interpersonal and institutional domains, and medico-legal environment represents the societal domain. Chin and Benne's normative re-educative strategy provides theoretical support for the notion that successful organizational change hinges upon addressing the structural and cultural barriers displayed by individuals and groups.The Physician Transparency Questionnaire was completed by 270 physicians who were drawn from a multi-site healthcare organization in Central Florida. Structural equation modeling was used to determine whether perfectionism, socio-organizational climate, and medico-legal environment significantly predict two transparency outcomes, namely, error reporting transparency and provider-patient transparency. Perfectionism and socio-organizational climate were found to be statistically significant predictors. Collectively, these variables accounted for nearly half of the variance in each transparency outcome. Within socio-organizational climate, policies had the greatest influence on transparency, followed by immunity and professional norms. Multiple group analysis showed that the covariance model developed in this study generalizes across gender, medical specialty, and occupation. In addition, group means comparisons tests revealed a number of interesting trends in error reporting and disclosure practices that provide insights about the behavioral and cognitive psychology behind transparent communication: 1) Physicians are more inclined to engage in provider-patient transparency compared to error reporting transparency, 2) physicians are more inclined to report serious errors compared to less serious errors, and 3) physicians are more inclined to express sympathy for bad outcomes than they are to apologize for a preventable error or be honest about the details surrounding bad outcomes. These results suggest that change efforts would need to be directed at medical education curricula and health provider organizations to ensure that current and future generations of physicians replace the pursuit for perfectionism with the pursuit for excellence. Also, a number of institutional changes are recommended, such as clearly communicating transparency policies and guidelines, promoting professional norms that encourage learning from mistakes rather than an aversion to error, and reassuring physicians that reporting and disclosure activities will not compromise their reputation. From the perspective of patient safety advocates and risk managers, the results are heartening because they emphasize a key principle in quality improvement - i.e., small changes can yield big results. From an ethical standpoint, this research suggests that healthcare organizations can inhibit (or facilitate) the emergence of professional virtues. Thus, although organizations cannot make a physician become virtuous, it is within their power to create conditions that encourage the physician to practice certain virtues. With respect to leadership styles, this research finds that bottom-up, grassroots change efforts can elicit professional virtues, and that culture change in healthcare lies beyond the scope of the medico-legal system.
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Date Issued: 2011
Identifier: CFE0004153, ucf:49083
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004153

Title: Predicting Risk to Reoffend: Establishing the Validity of the Postive Achievement Change Tool.
Creator: Martin, Julie, Wan, Thomas, Winton, Mark, Martin, Lawrence, Chen, Hsueh-Fen, University of Central Florida
Abstract / Description: In recent years, there has been increased reliance on the use of risk assessment in the juvenile justice system to predict and classify offenders based on their risk to reoffend. Over the years, the predictive validity of risk assessments has improved through the inclusion of actuarial assessment and dynamic risk factors. The predictive validity of certain assessments, such as the Youth Level of Service/Case Management Inventory (YLS/CMI), has been well established through numerous...
Show moreIn recent years, there has been increased reliance on the use of risk assessment in the juvenile justice system to predict and classify offenders based on their risk to reoffend. Over the years, the predictive validity of risk assessments has improved through the inclusion of actuarial assessment and dynamic risk factors. The predictive validity of certain assessments, such as the Youth Level of Service/Case Management Inventory (YLS/CMI), has been well established through numerous replication studies on different subgroups of the population. The validity of other instruments, such as the Positive Achievement Change Tool (PACT), is in its infancy having only been validated on the sample of the population for which it was created. The PACT, a relatively new juvenile risk assessment tool, was adapted from the Washington State Juvenile Court Assessment and validated on the Florida juvenile population. This study sought to demonstrate the predictive validity of the PACT risk assessment, analyze gender differences in juvenile recidivism, and determine the relative importance of individual-level, social-level, and community-level variables in the prediction of recidivism for a sample of juveniles in Tarrant County, Texas. The results of this research confirmed the predictive validity of the PACT for juveniles served by Tarrant County Juvenile Services (TCJS). Despite possessing adequate predictive validity for the entire population, gender-specific analyses revealed differences in the ability of the PACT to accurately classify female delinquents based on risk to reoffend. Not only did gender differences emerge in the predictive validity of the PACT, but males and female recidivism was also predicted by different social-level indicators. The results of this research provided further evidence for social-causation theories of crime and delinquency, with social-level indicators exerting the strongest relationship with recidivism when compared to individual-level and community-level predictors. The inability of community-level predictors to enhance the predictive accuracy of the assessment suggest broad application of the PACT across jurisdictions. TCJS has invested a considerable amount of time, resources, and funding in the implementation and maintenance of the PACT. The results of this study provided support and direction for the continued use of the PACT at TCJS. In addition, establishing the predictive validity of the PACT on the Tarrant County juvenile population satisfied the legislative requirement for a population specific validation of the risk assessment implemented in each county.
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Date Issued: 2012
Identifier: CFE0004221, ucf:48992
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004221

Title: Cross-Sector And Inter-Organizational Collaborative Capacity In Community Disaster Resilience And Sustainability: Evidence From Central Florida Counties.
Creator: Demiroz, Fatih, Kapucu, Naim, Hawkins, Christopher, Knox, Claire, Wan, Thomas, Rivera, Fernando, University of Central Florida
Abstract / Description: This study examines the relationships between interorganizational network development and sustainability, organizational capacity for emergency management, technology utilization, and community disaster resiliency. It is proposed that cross sector and interorganizational collaboration (i.e., network development and sustainability), information communication technology (ICT) utilization, and organizational capacity have a positive impact on disaster resiliency. Disaster resiliency is measured...
Show moreThis study examines the relationships between interorganizational network development and sustainability, organizational capacity for emergency management, technology utilization, and community disaster resiliency. It is proposed that cross sector and interorganizational collaboration (i.e., network development and sustainability), information communication technology (ICT) utilization, and organizational capacity have a positive impact on disaster resiliency. Disaster resiliency is measured with a three dimensional metric which includes effectiveness of disaster response, effectiveness of disaster recovery, and adaptive capacities.A questionnaire was sent to organizations that are part of the emergency management system in 11 counties in Central Florida. These organizations were identified by each county's comprehensive emergency management plans. County emergency managers served as the liaison people to reach organizations. They distributed the questionnaire and sent reminders to participants. The study aimed to reach an entire population of 855 emergency management affiliated organizations. The survey had a 25.28% response rate. Structural equation modeling was used to determine the impact of interorganizational network development, interorganizational network sustainability, information communication technology utilization, and organizational capacity on community disaster resiliency. The results of the study show that one third of the total variation in disaster resiliency was explained with the exogenous variables in the structural equation model (R2=.31). There was no statistically significant relationship between network development and disaster resiliency. Also, a correlation was hypothesized between organizational capacity and ICT utilization, according to the study findings no correlation was found between these two variables. Network development, organizational capacity, and ICT utilization were found to be positively associated with disaster resiliency. Among all the variables, organizational capacity had the highest impact on disaster resiliency (?=.36). ICT utilization and network development had almost equal regression weights (?=.25, ?=.26 respectively). A correlation was also found between network development and ICT utilization with ?=.23.The results suggest that organizations that are part of emergency management systems in Central Florida counties could enhance disaster resiliency of their communities by focusing on interorganizational and cross-sector network development, information communication technology utilization, and organizational capacity. Managerial craft has a critical role in developing relationship as most of the interorganizational ties are established with informal connections and mutual trust. Building relationship, installing technological systems, and carrying out joint trainings often exceeds financial capacities of organizations. Enabling more funding for these initiatives is another key point to which policy makers may pay attention.
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Date Issued: 2012
Identifier: CFE0004505, ucf:49286
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004505

Title: Organizational Complexity, Emergency Management Plan Adequacy, and Nursing Home Resiliency: A Contingency Perspective.
Creator: Boyce, Cherie, Wan, Thomas, Zhang, Ning, Oetjen, Reid, Rivera, Fernando, Kapucu, Naim, University of Central Florida
Abstract / Description: Some social and organizational behavior scientists measure resiliency through anecdotal qualitative research, i.e. personality analyses and stories of life experience. Empirical evidence remains limited for identifying measurable indicators of resiliency. Therefore, a testable contingency model was needed to clarify resiliency factors pertinent to organizational performance. Two essential resiliency factors were: 1) a written plan and 2) affiliation with a disaster network.This contingency...
Show moreSome social and organizational behavior scientists measure resiliency through anecdotal qualitative research, i.e. personality analyses and stories of life experience. Empirical evidence remains limited for identifying measurable indicators of resiliency. Therefore, a testable contingency model was needed to clarify resiliency factors pertinent to organizational performance. Two essential resiliency factors were: 1) a written plan and 2) affiliation with a disaster network.This contingency study demonstrated a quantifiable, correlational effect between organizational complexity, disaster plan adequacy and organizational resiliency. The unit of analysis, the skilled nursing facility proved vulnerable, therefore justifying the need for a written emergency management plan and affiliation with a disaster network. The main purpose of this research was to verify the significance of emergency management plans within a contingency framework of complexity theory, resource dependency, systems theory, and network theory. Distinct sample moments quantified causal relationships between organizational complexity (A), plan adequacy (B) and resiliency (C). Primary and secondary research data were collected from within the context of public health and emergency management sectors within the State of Florida.
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Date Issued: 2015
Identifier: CFE0005929, ucf:50842
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005929

Title: Factors Influencing Hypoglycemia Care Utilization and Outcomes Among Adult Diabetic Patients Admitted to Hospitals: A Predictive Model.
Creator: Kattan, Waleed, Wan, Thomas, Ramirez, Bernardo, Gurupur, Varadraj, Stevenson, Robyne, Pratley, Richard, University of Central Florida
Abstract / Description: Diabetes Miletus (DM) is one of the major health problems in the United States. Despite all efforts made to combat this disease, its incidence and prevalence are steadily increasing. One of the common and serious side effects of treatment among people with diabetes is hypoglycemia (HG), where the level of blood glucose falls below the optimum level. Episodes of HG vary in their severity. Nevertheless, many require medical assistance and are usually associated with higher utilization of...
Show moreDiabetes Miletus (DM) is one of the major health problems in the United States. Despite all efforts made to combat this disease, its incidence and prevalence are steadily increasing. One of the common and serious side effects of treatment among people with diabetes is hypoglycemia (HG), where the level of blood glucose falls below the optimum level. Episodes of HG vary in their severity. Nevertheless, many require medical assistance and are usually associated with higher utilization of healthcare resources such as frequent emergency department visits and physician visits. Additionally, patients who experience HG frequently have poor outcomes such as higher rates for morbidities and mortality.Although many studies have been conducted to explore the risk factors associated with HG as well as others that looked into the level of healthcare utilization and outcomes among patients with HG, most of these studies failed to establish a theoretical foundation and integrate a comprehensive list of personal risk factors. Therefore, this study aimed to employ Andersen's health Behavior Model of health care utilization (BM) as a framework to examine the problems of HG. This holistic approach facilitates enumerating predictors and examining differential risks of the predisposing (P), enabling (E) and need-for-care (N) factors influencing HG and their effects on utilization (U) and outcomes (O). The population derived from the national inpatient sample of the Healthcare Cost and Utilization Project (HCUP) database and included all non-pregnant adult diabetic patients admitted to hospitals' Emergency Departments (EDs) with a diagnosis of HG from 2012-2014. Based on the BM framework, different factors influencing HG utilization and outcome were grouped under the P, E, or N component. Utilization was measured by patients' length of stay (LoS) in the hospital and the total charges incurred for the stay. Outcome was assessed based on the severity ranging from mortality (the worst), severe complications, mild complications, to no complications (the best). Structural Equation Modeling (SEM) followed by Decision Tree Regression (DTREG) were performed. SEM helped in testing multiple hypotheses developed in the study as well as exploring the direct and indirect impact of different risk factors on utilization and outcome. The results of the analysis show that N is the most influential component of predictors of U and O. This is parallel to what was repeatedly found in different studies that employed the BM. Regarding the other two components, P was found to have some effect on O, while E influences the total charge. Interaction effects of predictors were noted between some components, which indicate the indirect effect of these components on U and O. Subsequently, DTREG analysis was conducted to further explore the probability of the different predictor variables on LoS, total charge, and outcome. Results of this study revealed that the presence of renal disease and DM complications among HG patients play a key role in predicting U and O. Furthermore, age, socio-economic status (SES), and the geographical location of the patients were also found to be vital factors in determining the variability in U and O among HG patients.In conclusion, findings of this study lend support to the use of the BM approach to health services use and outcomes and provide some practical applications for healthcare providers in terms of using the predictive model for targeting patient subgroups (HG patients) for interventions among diabetic patients. Moreover, policy implications, particularly related to the Central Florida area, for decision makers regarding how to approach the growing problem of DM can be drawn from the study results.
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Date Issued: 2017
Identifier: CFE0006611, ucf:51304
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006611

Title: Variations in Health Services Utilization by Patients with Prostate Cancer.
Creator: McKee, Roberta, Wan, Thomas, Martin, Lawrence, Zhang, Ning, Sivo, Stephen, University of Central Florida
Abstract / Description: Among men living in the United States, prostate cancer is the second leading cause of cancer death, and, excluding skin cancers, it is the cancer diagnosed most frequently. While incidence and mortality rates have been declining, the American Cancer Society estimated that there were 220,800 men diagnosed with prostate cancer and more than 27,500 prostate cancer deaths in 2015. Various patient-level and community-level factors have been shown to influence the differential patterns of diagnosis...
Show moreAmong men living in the United States, prostate cancer is the second leading cause of cancer death, and, excluding skin cancers, it is the cancer diagnosed most frequently. While incidence and mortality rates have been declining, the American Cancer Society estimated that there were 220,800 men diagnosed with prostate cancer and more than 27,500 prostate cancer deaths in 2015. Various patient-level and community-level factors have been shown to influence the differential patterns of diagnosis, care, and outcomes for men with prostate cancer. Detailed information regarding the utilization of health services by prostate cancer patients, particularly those with higher propensity for health services use, could be used to inform efforts intended to improve the coordination and delivery of care to work towards the elimination of disparities. The purpose of the study is to facilitate a better understanding of the determinants of health services utilization by older males with prostate cancer in the United States by examining the relative influence and interaction effects of factors characterizing individual patients and their county of residence. Andersen's behavioral model of health services utilization is used as a framework to guide this study. A cross-sectional design is used to analyze administrative claims data from the 2008 Medicare Provider Analysis Review (MEDPAR) file (n=5,754). County-level data from Area Health Resources File (ARHF) are merged to include the community and contextual characteristics. American Hospital Association (AHA) annual survey data are also used to examine the importance of hospital attributes in a subset analysis (n=555). A two-stage approach is used for analyzing the data. First, several social and demographic variables are included in automatic interaction detector (AID) analysis to identify relatively homogenous subgroups of patients with similar service utilization patterns for emergency room visits and hospital length of stay. Second, regression analysis is performed in the full dataset including all patients, and in each subgroup to determine the amount of variance explained by predictor variables categorized as predisposing, enabling, and need-for-care factors. Hierarchical logistic regression is performed to analyze the variability in emergency room use, and hierarchical multiple regression is performed to analyze the variability in hospital length of stay. The results show that the need-for-care factors are dominant predictors of service use. However, the relative importance of the predictor variables varies by subgroups of prostate cancer patients identified in the initial AID analysis. The findings lend some support of the use of an integrated approach to examine the personal and social determinants of health services utilization by prostate cancer patients enrolled in the U.S. Medicare program. The theoretical framework and analytic approach employed in this study make it possible to obtain an in-depth understanding of the influential factors associated with emergency room use and length of stay for all-cause hospitalizations, which can be used to inform future research and efforts aimed at developing targeted interventions to improve the coordinated care and to reduce health disparities among Medicare beneficiaries with prostate cancer.
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Date Issued: 2016
Identifier: CFE0006352, ucf:51523
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006352

Title: Determinants of hospital efficiency and patient safety in the United States.
Creator: Shettian, Kruparaj, Wan, Thomas, Noblin, Alice, Gurupur, Varadraj, Cobb, Enesha, Anderson, Kim, University of Central Florida
Abstract / Description: Hospitals engage in undertakings on a continual basis to enhance IT capabilities, diffusion of innovations, hospital-physician integration, and standardization to improve their performance. This empirical study explored the interdependence of three macro-level structural factors and their independent impact on the hospital performance measures efficiency and patient safety, with standardization as an important mediator. The researcher conducted a cross-sectional analysis of multiple data sets...
Show moreHospitals engage in undertakings on a continual basis to enhance IT capabilities, diffusion of innovations, hospital-physician integration, and standardization to improve their performance. This empirical study explored the interdependence of three macro-level structural factors and their independent impact on the hospital performance measures efficiency and patient safety, with standardization as an important mediator. The researcher conducted a cross-sectional analysis of multiple data sets from public user files on the acute care hospital industry. The theoretical underpinnings of the study included the structure-process-outcome theory and institutional isomorphism theory. The statistical analysis comprised confirmatory factor analysis (CFA) and covariance structural equation modeling (SEM). The study comprised data for 2,352 acute care hospitals in the United States, which represented more than half of the hospital population. As expected by the hypotheses, the study demonstrated that IT capability, hospital-physician integration, and innovativeness directly affect the variability in standardization, but they did not directly influence the variation in hospital efficiency and patient safety. This revealed that hospitals should focus on standardization because it is the mediating process between structural variables and performance variables. The results indicated a strong negative influence of standardization on hospital efficiency and a weak positive influence on patient safety. The study confirmed the triadic model that (")structure(") influences the process, which in turn influences organizational outcomes. As standardization through coercive, mimetic, and normative pressure mechanisms becomes more common through system integration and increased collaborative governance, more research on how the implementation of standards may perpetuate isomorphism or uniformity is imperative. The researcher recommends future studies to employ a longitudinal study design to explore the determinants of a variety of performance and outcome indicators, such as patient satisfaction, timeliness of care, the effectiveness of care, and equity/financial performance in addition to patient safety and hospital efficiency.
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Date Issued: 2017
Identifier: CFE0006794, ucf:51810
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006794

Title: Local Health Department Adoption of Health Information Technology and Its Impact on Population Health.
Creator: Yeung, Tina, Wan, Thomas, Cortelyou-Ward, Kendall, Liu, Albert Xinliang, Dziegielewski, Sophia, University of Central Florida
Abstract / Description: Since the enactment of the HITECH Act in 2009, the US has invested billions in building a robust health information technology (HIT) infrastructure that is secure, capable of the electronic transfer of data and allows for real-time access of patient medical data, among others. This empirical study explored the driving forces (coercive, mimetic, and normative) in the adoption of HIT (i.e. EHRs and HIEs) by local health departments (LHDs) and how it has impacted the population health of...
Show moreSince the enactment of the HITECH Act in 2009, the US has invested billions in building a robust health information technology (HIT) infrastructure that is secure, capable of the electronic transfer of data and allows for real-time access of patient medical data, among others. This empirical study explored the driving forces (coercive, mimetic, and normative) in the adoption of HIT (i.e. EHRs and HIEs) by local health departments (LHDs) and how it has impacted the population health of counties in the US. The researcher conducted a cross-sectional, quantitative study using secondary data sources. The study included data on 505 local health departments and 433 counties' population health data. Institutional theory guided this research and generalized estimating equations, logistic regression, and multiple linear regression were utilized to analyze health IT adoption by LHDs and its impact on county-level health outcomes. Results showed that normative forces, measured by the employment of IS specialists was most impactful in the adoption of both EHRs and HIEs. Mimetic forces, measured by the completion of a CHA and coercive forces measured by the implementation of the HITECH Act were not found to be statistically significant in the adoption of EHRs or HIEs. Finally, EHR adoption was statistically significant at improving population health at the county level. This research study has contributed in three areas: 1) to fill a knowledge gap on the impact of health IT adoption by LHDs on health outcomes; 2) to formulate a theoretically grounded framework to study population health and its variability; and 3) to identify target areas for public health interventions. In conclusion, a substantial amount of resources dedicated in creating a robust health IT infrastructure requires close analysis of the impact health IT has on the population health of our nation.
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Date Issued: 2017
Identifier: CFE0006825, ucf:51801
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006825

Title: The Diffusion and Performance of the Accountable Care Organization Model.
Creator: Lin, Yi-ling, Wan, Thomas, Malvey, Donna, Liu, Albert Xinliang, Steen, Julie, University of Central Florida
Abstract / Description: Background: Unity in pursuit of the Triple Aim: better health, better care, and lower per capita cost, can be achieved through a well-designed health care delivery system. The accountable care organizations (ACOs) model is considered a key component of health care delivery system improvement because the model fosters better coordination of care through clinical integration and financial accountability. Within the six Centers for Medicaid (&) Medicare Services (CMS) ACO programs, the Medicare...
Show moreBackground: Unity in pursuit of the Triple Aim: better health, better care, and lower per capita cost, can be achieved through a well-designed health care delivery system. The accountable care organizations (ACOs) model is considered a key component of health care delivery system improvement because the model fosters better coordination of care through clinical integration and financial accountability. Within the six Centers for Medicaid (&) Medicare Services (CMS) ACO programs, the Medicare Shared Savings Program (MSSP) ACO has the largest size with a total of 432 ACOs formed; the service subjects of the MSSP ACO are the fee-for-service beneficiaries. Recently, academicians and researchers have been attracted to exploring ACOs' formation and performance. However, most of the early ACO research types are either descriptive or case study. Also, early researchers had limited access to ACO data sets, so they could utilize only regional and demographic factors to identify the predictors of ACO formation.Purpose: An integrative theoretical framework, Rogers' diffusion of innovation theory and Duncan's POET model, was used to examine ACO formation and performance. The first purpose of this study was to determine the relative influences of contextual variables and ACO characteristic variables on how early an ACO model was adopted. The second purpose was to examine how executives' perceptions of ACO performance and the ACO first-year performance are influenced by the contextual variables, ACO characteristic variables, and timing of the adoption of an ACO model. Methods: A cross-sectional design was formulated to gather data from a survey supplemented by secondary data with the analysis unit at the organization level. Study participants in the ACO survey included 2012, 2013, 2014, and 2015 ACO cohorts. Logistic regression was performed to examine the effects of POET and Rogers' five core characteristics in the early adoption of an ACO model (dichotomous). Additionally, multiple linear regression analysis was used to examine the effects of POET and the timing of adoption of an ACO model in the perceptions of ACO performance. ACO first-year performance dataset consisted only of ACO cohorts from 2012 through 2014. Finally, confirmatory factor analysis and structural equation modeling were conducted to examine the measurement model of the ACO first-year performance and a full latent variable model, respectively. Major Findings: A survey of ACO executives/managers between October 2015 and February 2016 was conducted. The 447 MSSP ACOs in my mailing list yielded a response rate of 13.65 % (n=61). Of the 61 MSSP ACOs, 42 (52.5%) were late adopters whose contractual agreement with CMS started in 2014 or 2015, and 36 (59.0%) were with hospital-based composition. Among ACOs that participated in my survey, their current degree of IT adoption in functionalities (62.27 vs. 52.50 points), usage levels (65.19 vs. 49.49 points), and integration levels (62.24 vs. 53.37 points) were better than their initial years. The multiple logistic regression presented that MSSP ACOs were more likely to be early adopters of a CMS if their service areas had high unemployment rates (OR=2.23; 95% CI: 1.13 - 4.39). In the multiple linear regression analysis, the executives in the early ACOs perceived their organizations as more effective than the late adopters, with 12.65 points higher in an aggregate of eight ACO quality domains (p = .005). Three hundred and seventeen MSSP ACOs, with contractual agreements with CMS before 2015, had retained their year-one performance records (the actual ACO performance with eight quality domains). The variability in the actual ACO performance was explained by the predictor variables of the study with an R-square of 15%. The actual ACO performance was likely to be improved if ACOs had more Medicare assigned beneficiaries or had the hospital-based composition. On the other hand, if ACOs' service areas were located in areas of high poverty concentration, a high unemployment rate, or a lower competitive index, their ACO performance was relatively lower than their counterparts. Implications: The findings suggest that managers should consider strategies to increase economies of scale in size and to have hospital involvement in their ACOs in order to increase effective management. Inadequate capital for information technology improvements is the biggest barrier inhibiting healthcare providers' willingness to join an ACO. Regardless of rural or urban areas, financial support is still important for those potential ACO participants who are planning to invest in necessary infrastructure. ACOs that involved hospitals also showed better performance than those ACOs without hospital involvement. This information may help health policy makers to define core principles of the best ACO model in the future. Conclusions: This study makes a unique contribution using a theoretically integrative framework with Rogers' diffusion of innovation theory coupled with Duncan's POET model to examine ACO formation and ACO performance. In the early ACO adopters, three-fifths of the ACOs had hospital involvement; and the levels of their current IT degree in functionalities, usage levels, and integration levels are higher than the late ACO adopters. This study demonstrates that contextual variables, such as unemployment rates at ACO service areas, relatively influence how early an ACO model was adopted. Executives in the early ACOs had higher perceptions of overall organizational effectiveness as compared with the late adopters. The first-year performance of 2012, 2013, and 2014 ACO cohorts is positively influenced by the size of assigned Medicare beneficiaries and hospital-based ACO and is negatively influenced by the poverty rate, unemployment rate, and market competition scores (Herfindah-Hirschman Index).
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Date Issued: 2016
Identifier: CFE0006347, ucf:51576
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006347

Title: Emergency Room Utilization Disparities among Older Adults Treated by Rural Health Clinics.
Creator: Bagwell, Matt, Wan, Thomas, Zhang, Ning, Ortiz, Judith, Hofler, Richard, Bushy, Angeline, University of Central Florida
Abstract / Description: Examining the persistence of disparities over time is an important obligation in terms of rectifying, maintaining, and improving community health and social well-being for all. This study analyzed the individual factors of (a) race/ ethnicity and (b) dual eligibility, as a proxy measure of socioeconomic status, as well as the environmental factor of (c) place of residence, and the organizational factor of (d) Rural Health Clinic (RHC) type on emergency room (ER) utilization of older adult...
Show moreExamining the persistence of disparities over time is an important obligation in terms of rectifying, maintaining, and improving community health and social well-being for all. This study analyzed the individual factors of (a) race/ ethnicity and (b) dual eligibility, as a proxy measure of socioeconomic status, as well as the environmental factor of (c) place of residence, and the organizational factor of (d) Rural Health Clinic (RHC) type on emergency room (ER) utilization of older adult Medicare patients treated by RHCs within the Department of Health and Human Services' (DHHS) Region 4. A prospective, multi-level, longitudinal design was employed to analyze potential health disparities or gaps that may exist among RHC Medicare beneficiary patients (+65) using longitudinal, mixed multilevel modeling in SPSS. The years of investigation were 2010 through 2012. R4 has continually lagged behind other Regions in the Nation in having higher Health Disparities and ER Utilization rates related to Race, Poverty, and Rural Isolation. A key question is: Do these disparities persist? This study's findings support that dual eligible RHC patients utilized ER services at higher rates than non-dual eligible, Medicare only RHC patients at: 77%, 80%, and 66%, in 2010, 2011, and 2012, respectively; and above the White reference group, Black RHC Medicare patients utilized ER services at higher rates of: 18%, 20%, and 34%, in 2010, 2011, and 2012, respectively. These findings support that dual Medicare and Medicaid eligibility, as a proxy measure of socioeconomic status, and race continue to influence higher rates of ER utilization in Region 4. In terms of health and utilization disparities, strikingly and persistently, as recent as 2012, Black, dual eligible RHC Medicare beneficiary patients age 65 and over are twice as likely to utilize ER services for health care than their more advantaged counterparts. Health care leaders and policymakers are seeking evidence-based performance measures as tools for detecting gaps in health care and using those subsequent findings as leverage to implement policy change for the purpose of increasing health care delivery performance system-wide while lowering health disparities across various patient populations. Toward that goal, communicating and disseminating the findings of this study contributes to the body of knowledge and enables policy leaders to better make decisions based on empirical evidence in order to strengthen the health care delivery system for older adults in diverse rural contexts. From a health and public affairs policy perspective, crafting in tandem targeted, top-down, population health and bottom-up, community interventions to curb poor health outcomes and high health care utilization would be in the public interest at-large within this region of the Southeastern United States.
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Date Issued: 2016
Identifier: CFE0006259, ucf:51051
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006259

Title: Home Care Quality Effects of Remote Monitoring.
Creator: Williams, Cynthia, Wan, Thomas, Oetjen, Dawn, Burg, Mary Ann, Zhang, Ning, University of Central Florida
Abstract / Description: 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...
Show moreDespite 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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Date Issued: 2014
Identifier: CFE0005442, ucf:50383
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005442

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

structural equation modeling (5)	+ -
Efficiency (3)	+ -
Structural Equation Modeling (3)	+ -
Turkish National Police (3)	+ -
social capital (3)	+ -

Data Envelopment Analysis (DEA) (2)	+ -
Performance Measurement (2)	+ -
Productivity (2)	+ -
Social Disorganization (2)	+ -
Structural Equation Model (2)	+ -
disaster resilience (2)	+ -
efficiency (2)	+ -
health disparities (2)	+ -
health insurance (2)	+ -
income (2)	+ -
institutional theory (2)	+ -
isomorphism (2)	+ -
patient safety (2)	+ -
police (2)	+ -
social network (2)	+ -
Accountable Care Organizations (1)	+ -
Andersen’s health Behavior Model of health care utilization (1)	+ -
Balance of Power (1)	+ -
Caspian (1)	+ -
Central Asia (1)	+ -
Central Florida (1)	+ -
Clinical Engineering (1)	+ -
Collaborative Disaster Management (1)	+ -
Combat (1)	+ -
Complex Adaptive Systems (1)	+ -

University of Central Florida (60)	+ -
Wan, Thomas (56)	+ -
Zhang, Ning (11)	+ -
Kapucu, Naim (7)	+ -
Liu, Albert Xinliang (5)	+ -

Martin, Lawrence (4)	+ -
Anderson, Kim (3)	+ -
Dziegielewski, Sophia (3)	+ -
Fottler, Myron (3)	+ -
Hancock, Peter (3)	+ -
Karwowski, Waldemar (3)	+ -
Liberman, Aaron (3)	+ -
Noblin, Alice (3)	+ -
Ramirez, Bernardo (3)	+ -
Steen, Julie (3)	+ -
Winton, Mark (3)	+ -
Gurupur, Varadraj (2)	+ -
Knox, Claire (2)	+ -
Malvey, Donna (2)	+ -
Matusitz, Jonathan (2)	+ -
Oetjen, Dawn (2)	+ -
Rivera, Fernando (2)	+ -
Stevenson, Robyne (2)	+ -
Wolf, Ross (2)	+ -
Abel, Eileen (1)	+ -
Agiro, Abiy (1)	+ -
Alhujailli, Ashraf (1)	+ -
Allaf, Mamoon (1)	+ -
Andrews, Diane (1)	+ -
Applegate, Brandon (1)	+ -

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