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Interaction between income, health insurance, and self-rated health: A path analysis.
Title
Interaction between income, health insurance, and self-rated health: A path analysis.
Creator
Ashley West, Atalie, Unruh, Lynn, Malvey, Donna, Gau, Jacinta, Martin, Lawrence, University of Central Florida
Abstract / Description
The political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of...
Show moreThe political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of health, with income being the most consistent predictor. As a result, this study investigated whether earned income is related to insurance status on the one hand and self-rated health on the other; whether the association between income and self-rated health is indirectly influenced by the presence of health insurance (-)namely private health insurance; whether there are differences in self-rated health between the privately insured, the publicly insured, and the uninsured; and if duration of uninsurance was inversely associated with self-rated health. As hypothesized, higher income was associated with having health insurance, and in particular private insurance. Among all included predictor variables, higher income and private insurance are the strongest predictors of higher self-rated health, and lower income and Medicaid were the strongest predictors of lower self-rated health. This study affirms that the health of persons with Medicaid is more similar to persons who are uninsured, and the health of persons with private insurance is more similar to those with Medicare. The association between income and self-rated health is indirectly influenced by health insurance. Age and education exerted the strongest overall influence on self-rated health: older respondents had lower self-rated health, and more educated respondents had higher self-rated health. And as uninsurance duration increased, self-rated health decreased. Additional studies are recommended to improve health insurance policy.
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Date Issued
2018
Identifier
CFE0007308, ucf:52151
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0007308
The Self-described Experience of Coping and Adaptation Associated with Workplace Stress of Registered Nurses in the Acute Care Setting in Florida: An Ethnographic Study
Title
The Self-described Experience of Coping and Adaptation Associated with Workplace Stress of Registered Nurses in the Acute Care Setting in Florida: An Ethnographic Study.
Creator
Burr, Joyce, Bushy, Angeline, Sole, Mary, Andrews, Diane, Malvey, Donna, University of Central Florida
Abstract / Description
ABSTRACTLittle is known about how nurses learn and use coping and adaptation skills in the workplace. Quantitative studies have identified the factors, nature, and outcomes of nursing stress. However, qualitative studies describing the human experience associated with workplace stress are lacking. The phenomenon of interest for this study using focused ethnographic method is the self-described experience of coping and adaptation associated with workplace stress of registered nurses working 12...
Show moreABSTRACTLittle is known about how nurses learn and use coping and adaptation skills in the workplace. Quantitative studies have identified the factors, nature, and outcomes of nursing stress. However, qualitative studies describing the human experience associated with workplace stress are lacking. The phenomenon of interest for this study using focused ethnographic method is the self-described experience of coping and adaptation associated with workplace stress of registered nurses working 12-hour shifts employed in acute care hospital facilities in east central and central Florida. Three aspects of the phenomena were examined: the self-described experiences of stress, the manner in which coping skills are acquired, and the manner in which adaptation strategies are developed by experienced bedside nursing working 12-hour shifts in acute care hospital facilities. The purposive sample included nine female bedside nurses with five or more years' experience, working 12 hour shifts in acute care hospital facilities on bedside units, with patient ratios of 4:1 or greater. Data were collected using semi-structured, digitally recorded interviews at mutually convenient locations. The qualitative data were analyzed using inductive, constant, comparative process of coding, sorting, generalizing, and memoing to guide exploration and identify emergent themes and patterns. The predominant theme of stress emerged as the overwhelming sense of duty to the patient. Additional themes of coping and adaptation were noted. Recommendations for research, education, practice and policy are offered to support a healthy and sustainable nursing workforce.
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Date Issued
2012
Identifier
CFE0004525, ucf:49280
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004525
The Effect of Registered Nurse Supply on Population Health Outcomes: A Distributed Lag Model Approach
Title
The Effect of Registered Nurse Supply on Population Health Outcomes: A Distributed Lag Model Approach.
Creator
Sampson, Carla Jackie, Unruh, Lynn, Malvey, Donna, Liu, Albert Xinliang, Neff, Donna, University of Central Florida
Abstract / Description
Registered nurses (RNs) are essential to providing care in the healthcare system. To date, research on the relationship between healthcare provider supply and population health has focused on physician supply. This study explored the effect of RN supply on population health outcomes in the U.S. This is a retrospective, cross-sectional study of U.S. counties and county equivalents using national data. Seven population health outcomes (total and disease specific mortalities and low infant birth...
Show moreRegistered nurses (RNs) are essential to providing care in the healthcare system. To date, research on the relationship between healthcare provider supply and population health has focused on physician supply. This study explored the effect of RN supply on population health outcomes in the U.S. This is a retrospective, cross-sectional study of U.S. counties and county equivalents using national data. Seven population health outcomes (total and disease specific mortalities and low infant birth weight rate) were the response variables. The predictor variable, RN supply, and some control variables were anticipated to have an asynchronous effect on the seven outcome variables in the hypothesized relationship. Therefore, these variables were examined using three different models: contemporaneous; a three-year lagged; and a distributed lag (both contemporaneous and lagged variables). Quadratic terms for RN and physician supply variables were included. Because the Area Health Resource File (AHRF) outcome variables were skewed toward zero and left censored, Tobit regression analyses were used. Data were obtained from 19 states using historical RN Supply data for 1,472 counties, representing 47% of the total target population of 3,108 U.S. counties and county equivalents. Regions with rural populations(-)the Midwest and Southeast(-)were overrepresented. Higher RN supply is positively related to higher mortality rates from ischemic heart disease, other cardiovascular disease, and chronic lower respiratory disease in the distributed lag models. Higher RN supply is not significantly related to rates of low infant birth weight, infant mortality, or mortality from cerebrovascular disease in any model. Higher RN supply is positively related to total deaths in the contemporaneous and lagged model. The results suggest a counter-intuitive, but non-linear relationship between RN supply and health outcomes. More research is needed to understand these relationships and policies must be devised to reduce the current and growing future RN shortage.
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Date Issued
2018
Identifier
CFE0007091, ucf:51933
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0007091
Factors Influencing unmet Medical Need among U.S. Adults: Disparities in Access to Health Services
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
Social Media as a Healthcare Tool: Case Study Analysis of Factors Influencing Pediatric Clinicians' Behavioral Intent to Adopt Social Media for Patient Communication and Engagement
Title
Social Media as a Healthcare Tool: Case Study Analysis of Factors Influencing Pediatric Clinicians' Behavioral Intent to Adopt Social Media for Patient Communication and Engagement.
Creator
Mustonen, Rachel, Hou, Su-I, Malvey, Donna, Gurupur, Varadraj, Wisniewski, Pamela, University of Central Florida
Abstract / Description
Social media aids communication among users worldwide. However, a notable gap exist among social media users, healthcare professionals utilizing social media in the work place. While the concept of harnessing social media as a professional tool is not novel, healthcare professionals have yet to embrace the practice as standard workflow. This study identifies factors influencing clinicians' behavioral intent to adopt social media for patient engagement and communication. A new framework, the...
Show moreSocial media aids communication among users worldwide. However, a notable gap exist among social media users, healthcare professionals utilizing social media in the work place. While the concept of harnessing social media as a professional tool is not novel, healthcare professionals have yet to embrace the practice as standard workflow. This study identifies factors influencing clinicians' behavioral intent to adopt social media for patient engagement and communication. A new framework, the Healthcare Social Media Adoption Framework (HSMA), guided this mixed-method approach to assess 7 factors identified by theory and literature as adoption influencers. A custom, web-based survey collected data from 60 full-time, pediatric clinicians (47 quantitative) at the case institution (a pediatric hospital). Additionally, individual interviews of 6 participants provided their prospective on using social media for patient communications and engagement. Results: Privacy concerns were the only statically significant factor; with an inverse relationship to positive adoption intent, indicating higher privacy concerns influence lower behavioral intent to adopt social media for patient engagement and communication. The qualitative analysis revealed privacy concerns encompass two themes, personal privacy for patient and providers (boundaries), and cybersecurity. The qualitative inputs also uncovered perceived unprofessionalism as a new factor influencing clinician adoption. The implications for these findings indicate a need for both healthcare organizations and healthcare regulators to establish cyber-security defenses for security and use protocols for privacy to aid the diffusion and adoption acceptance of social media use by pediatric healthcare professionals. This research has contributed in four areas: 1) fill a knowledge gap by identifying new factors that influence the behavioral intent of pediatric clinicians to adopt social media; 2) confirm/reject behavioral intent influences found in the literature; 3) formulated a new HSMA framework that measures functional, cognitive, and social aspects of social media adoption; and 4) prioritizes policies and global standard focus.
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Date Issued
2018
Identifier
CFE0007062, ucf:51998
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0007062
Stressors Experienced by Emergency Department Registered Nurses at the Bedside: A Phenomenological Study
Title
Stressors Experienced by Emergency Department Registered Nurses at the Bedside: A Phenomenological Study.
Creator
Heglund, Stephen, Wink, Diane, Andrews, Diane, Leuner, Jean, Malvey, Donna, Chase, Susan, University of Central Florida
Abstract / Description
The Emergency Department (ED) as a workplace for the Registered Nurse (RN) is a stressful environment. Reasons are thought to include interactions with other members of the interdisciplinary team as well as the situations associated with the environment of the ED such as trauma, death, sadness, joy and the general unpredictability of each moment. Studies have documented general health care workplace stress and its influence on staff, but a very limited number of studies have concentrated on...
Show moreThe Emergency Department (ED) as a workplace for the Registered Nurse (RN) is a stressful environment. Reasons are thought to include interactions with other members of the interdisciplinary team as well as the situations associated with the environment of the ED such as trauma, death, sadness, joy and the general unpredictability of each moment. Studies have documented general health care workplace stress and its influence on staff, but a very limited number of studies have concentrated on the ED. No widely published studies have identified stressors from the perspective of the ED RN.This dissertation is an interpretive phenomenological study that seeks to understand the experience of being an ED RN through the exploration of the perceptions of stress as lived by individuals who practice their art and science in this unique setting. Materials for evaluation and thematic identification were obtained through personal interviews of practicing nurses. The stories told by the participants communicated what each individual found to be negatively stressful as well as what each found to be positively stressful.Conclusions based on the findings of this work suggest a need for the ED RN to be able to depend on the presence of several factors in order to be able to function with as little distress as possible. The optimal ED environment for the RN is posited to be supportive of the individual goals of the RN, provide adequate resources and foster a communicative interdisciplinary environment. Recommendations are made to improve resource management and interdisciplinary relations.
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Date Issued
2012
Identifier
CFE0004384, ucf:49408
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004384
The Diffusion and Performance of the Accountable Care Organization Model
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