Health Care Administration

Permanent URI for this collectionhttps://hdl.handle.net/11274/15389

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Colorectal cancer education and screening program for the un- or under- insured in a primarily rural setting in Northeast Texas: Design and methods
(Company of Scientists and Physicians, 2019-10-20) Orsak, Gabriela; Allen, Carlton M.; Miller, Anastasia; Singh, Karan P.; McGaha, Paul
Background: Although early detection and screening for colorectal cancer saves lives, screening rates remain suboptimal, especially for minorities, underserved populations, older adults (>60), men, un/under insured, and those living in rural settings. The goal of the colorectal cancer education and screening program is to target the un- or under- insured in a 19-county primarily rural target area to provide: 1) education concerning CRC and CRC screening to 12,000 individuals, and 2) CRC screenings (colonoscopy and/or FIT) to 5,1613 un- or under- insured individuals. Methods: The education outreach team targets local health fairs, clinics, churches, etc. to educate individuals on CRC and the importance of screening. The program aims to then have those individuals electively undergo a colonoscopy and/or a FIT test. The number of those educated and screened is recorded. The results related to colonoscopy, FIT, and follow-up are collected. Results: Primary outcomes include number of individuals educated, number of FIT test/colonoscopies performed and results of screening procedures. Conclusions: This education and screening outreach program is designed to reach primarily rural and underserved populations eligible for colorectal screening. Results of efficacy of program will advance knowledge on how to conduct colorectal cancer outreach programs in rural settings.
Comparison of multiple chronic obstructive pulmonary disease (COPD) indices in Chinese COPD patients
(The Korean Academy of Tuberculosis and Respiratory Diseases, 2018-04) Zhang, Jinsong; Miller, Anastasia; Li, Yongxia; Lan, Qinqin; Zhang, Ning; Chai, Yanling; Hai, Bing
Background: Chronic obstructive pulmonary disease (COPD) is a serious chronic condition with a global impact. Symptoms of COPD include progressive dyspnea, breathlessness, cough, and sputum production, which have a considerable impact on the lives of patients. In addition to the human cost of living with COPD and the resulting death, COPD entails a huge economic burden on the Chinese population, with patients spending up to one-third of the average family income on COPD management in some regions is clinically beneficial to adopt preventable measures via prudent COPD care utilization, monetary costs, and hospitalizations. Methods: Toward this end, this study compared the relative effectiveness of six indices in predicting patient healthcare utilization, cost of care, and patient health outcome. The six assessment systems evaluated included the three multidimensional Body mass index, Obstruction, Dyspnea, Exercise capacity index, Dyspnea, Obstruction, Smoking, Exacerbation (DOSE) index, and COPD Assessment Test index, or the unidimensional measures that best predict the future of patient healthcare utilization, cost of care, and patient health outcome among Chinese COPD patients. Results: Multiple linear regression models were created for each healthcare utilization, cost, and outcome including a single COPD index and the same group of demographic variables for each of the outcomes. Conclusion: We conclude that the DOSE index facilitates the prediction of patient healthcare utilization, disease expenditure, and negative clinical outcomes. Our study indicates that the DOSE index has a potential role beyond clinical predictions.
Coping mechanism and professional quality of life in northeast Texas EMS personnel during the COVID-19 pandemic: An exploratory study
(SAGE, 2021-06-10) Miller, Anastasia; Brown, Lee Warren
Introduction - The purpose of this study was to conduct an exploratory evaluation of employee professional quality of life and factors associated with it at an emergency medical service (EMS) agency in northeast Texas in the United States. Initially, we intended to evaluate typical day-to-day factors, however we ended up capturing these factors during the unique environment of the COVID-19 pandemic. Methods - We conducted an exploratory cross-sectional survey at an EMS agency in northeast Texas in November 2020. Surveys were web-based and anonymous. They included the ProQOL 5, the Survey of Perceived Organizational Support, the Brief Resilience Survey, the RAND Social Support Survey Instrument, the Kessler-6, the Workplace Incivility Scale-Revised, the General Self-Efficacy Scale and the Brief Cope Scale. Results - The survey had a response rate of 19% (38 participants). Findings suggest a positive relationship between utilising religion as a coping mechanism and higher compassion satisfaction. There was also a relationship associated between increased perceived organisational support leading to an increase in compassion satisfaction. The most significant predictors of burnout were two different coping mechanisms. Those who relied more heavily on behavioral disengagement and those who employed humour as a coping mechanism displayed average increased levels of burnout. Finally, those who experienced workplace incivility and those who relied on self-blame as a coping mechanism experienced on average higher levels of secondary traumatic stress. Conclusion - This study adds to the limited literature examining coping mechanisms, stress and burnout in EMS personnel. It is also unique for examining how EMS personnel are coping with stress during a prolonged pandemic.
Emergency medical service personnel injury and fatality in the United States
(SciEdu Press, 2018-05-23) Miller, Anastasia
INTRODUCTION: Emergency Medical Services (EMS) personnel comprise an intricate part of the public safety net in the US. The purpose of this study was to synthesize data sources to understand the major workplace dangers facing EMS providers. METHODS: This study examined four data sources: The BLS Census of Fatal Occupational Injuries (CFOI), BLS Survey of Occupational Injuries and Illnesses (SOII), Firefighter Fatalities and Statistics from USFA, and the EMS Voluntary Event Notification Tool (E.V.E.N.T.). Characteristics of the most common causes of injury and fatalities were described and compared. RESULTS: SOII reports covered 13 years and 64,780 nonfatal reported cases. CFOI covered 12 years and 149 fatalities. 111 fatalities from the USFA dataset who had been identified as EMS in some manner in their rank between 2003-2016 were inspected. 21 cases where a firefighter died in the course of providing EMS/patient care were also identified and discussed. All events submitted to E.V.E.N.T. were read and categorized. 214 events were identified as near-miss EMS provider injuries and included in the study. CONCLUSION: The biggest mortal threat to private EMS personnel is vehicular incidents. Among firefighters/EMTs Heart Attacks was the most common nature of death. The biggest nonfatal concerns are violence, slips, trips, and falls, and overexertion in addition to vehicular incidents. Most violent events were the result of a patient with a Temporarily Altered Mental Status. There is clearly a need for further research to develop evidence-based methods and policies to reduce injury and death in EMS personnel from an agency level.
Generational conflict, alcohol use and brotherhood: An exploratory survey of a rural career fire department in the Midwest
(Emerald Insight, 2021-05-11) Miller, Anastasia; Jahnke, Sara A.; Singh, Karan P.
Purpose: The purpose of this article was to identify factors impacting burnout, resilience and quality of life in rural career firefighters. In addition, sources of stress and the impact of generational differences were explored. Design/methodology/approach: An exploratory cross-sectional survey was conducted at a rural career fire department. Findings: The findings of the project indicate that the firefighters had high levels of compassion satisfaction (CS) and relatively low levels of secondary traumatic stress and burnout; displayed moderate to high psychological resilience and the majority felt moderate to high organizational support, but there was a noticeable minority who did not feel supported by the department. Findings indicate that organizational support is significantly related to both burnout and resilience. The majority of the men (88.3%) reported moderate to high risk for alcohol-related problems and over three-quarters (78.6%) reported binge drinking behavior in the past year. Qualitative findings highlight generational differences and chain of command challenges as primary stressors. Originality/value: This is a unique study in that it focuses on a rural career department. What was found were issues similar to those facing urban career fire departments.
Healthcare utilization disparities among lung cancer patients in US hospitals during 2010– 2014: Evidence from the US Hispanic population’s hospital charges and length of stay
(Dovepress, 2022-02-09) Miller, Anastasia; Kim, Sun Jung; Medina, Mar; Delgado, Rigoberto; Chang, Jongwha
Lung cancer remains a leading cause of death in the United States as the second most common cancer. In 2018, there were 218,520 new lung cancer cases, and it was the leading cause of cancer death that year. That same year, 10,183 lung cancer cases were from Hispanic patients, and 5540 Hispanic patients died. Comparatively, there were 23,417 new lung cancer Black patients, 1353 new cases in American Indian and Alaskan natives, and 6590 new cases in Asian and Pacific Islander patients. Despite advances in screening, treatment, and tobacco prevention, lung cancer attributed to over 1.8 million worldwide deaths in 2018 and was about 23.5% of all cancer deaths in 2019 in the United States. Worldwide, in 2020, there were 2,206,771 new lung cancer cases and 1,796,144 new lung cancer deaths, second in both categories only to female breast cancer. Lung cancer also has the highest cancer mortality rate in men worldwide. By 2021, the estimated number of new lung cancer cases in the United States will be 12.4% of all cancer cases and contribute to 21.7% of cancer deaths.
Individual and organizational influences of the professional quality of life of Florida public safety personnel
(Emerald, 2019) Miller, Anastasia; Unruh, Lynn
PURPOSE: Public safety personnel (law enforcement, firefighters, emergency medical services and dispatchers) face work environments which are high stress. These can lead to burnout, secondary traumatic stress and a reduction of compassion satisfaction. However, very little is known about what individual and work factors influence these negative coping mechanisms in public safety personnel. It is also unknown how perceived organizational and coworker support, debriefing methods, or individual characteristics are associated with the aforementioned coping mechanisms. The differences between these fields are also unknown. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: A cross-sectional administration of surveys to Florida public safety personnel was done. A total of 1,360 public safety individuals completed the survey. Three regression analyses were carried out, utilizing the three Professional Quality of Life Version 5 subscales as the dependent variables. The Perceived Coworker Support Survey, Survey of Perceived Organizational Support, the Brief Resilience Survey and questions regarding debriefing practices were included. FINDINGS: Public safety personnel cannot be treated as a singular population for many things. An exception of this was that perceived organizational support and psychological resilience were associated with positive outcomes, albeit, to varying degrees in all fields. The other individual and organizational factors had very distinct impacts on the varying fields. RESEARCH LIMITATIONS/IMPLICATIONS: There are limitations due to the nature of cross-sectional survey design and due to the sample size. ORIGINALITY/VALUE: This study displays statistical relationships between factors which public safety agencies could use to increase employee job satisfaction and potentially reduce turnover. It was the only study the authors could find which include dispatchers when comparing these four public safety fields.
Potential predictors of hospital length of stay and hospital charges among patients with all-terrain vehicle injuries in rural Northeast Texas
(Kermanshah University of Medical Sciences, 2020-01) Miller, Anastasia; Gallegly, Jeanie; Orsak, Gabriela; Huff, Sharon D.; Peters, Jo Ann; Murry, Jason; Ndetan, Harrison; Singh, Karan P.
Background: All-Terrain Vehicles (ATVs) have become popular for recreation use in recent years. Texas has had more ATV related fatalities than any other state in the nation, with rural Northeast Texas having even higher rates of injuries. There is limited data examining the relationship between ATV injuries and the length of hospital stay, as well as hospital costs. This paper examines both issues in children as well as adults. Methods: The regional trauma registry was analyzed for all ATV related injuries between January 2011- October 2016. Injury Severity Score, Glasgow Coma Scale and if they are seen at a Level I Trauma center are predictive for both hospital length of stay and charges. Results: Length of Stay was predicted positively by Injury Severity Score, Emergency Department Respiration Rate and facility at which patients were treated and negatively by Glasgow Coma Scale. Hospital charges were predicted positively by age, Injury Severity Score, facility of treatment, means of transportation, and Emergency Department pulse and negatively by Glasgow Coma Scale. Conclusions: The study found that vital signs can be useful in predicting length of stay and hospital charges. This study not only confirms the findings of other studies regarding what predictors can be used, but expands the research into rural traumatic injuries. It is hoped that this data can help contribute to the development of algorithms to predict which patients will be most likely to require resource intensive treatment.
Return on investment of free colorectal cancer screening tests in a primarily rural uninsured or underinsured population in Northeast Texas
(SpringerNature, 2019) Orsak, Gabriela; Miller, Anastasia; Allen, Carlton M.; Sing, Karan P.; McGaha, Paul
BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in the USA. Its economic impact is extensive, and preventive screening services are warranted to help prevent it. OBJECTIVE: We sought to examine the return on investment, in terms of reduced costs attributed to cancer prevention, of a CRC screening outreach program providing education and screening in a primarily rural region targeting the uninsured and underinsured. METHODS: The expenditures of the Northeast Texas CRC screening program were calculated for the years of 2016 and 2017. Prices ($US) were adjusted for inflation and converted to year 2017 values. The costs saved were calculated using the estimated costs of CRC care present in the literature. RESULTS: For fiscal years 2016 and 2017, the program provided an average return of $US1.46–2.06 for every tax dollar spent. Estimated cost avoidance was $US165,080 per avoided case and estimated cost avoidance of $US245,601 among early-stage cancer cases detected, resulting in potential savings ranging from $US3,893,676 to $US4,837,923. CONCLUSION: A CRC outreach program providing education and screening operating in less densely populated regions yields a positive return on investment.
Strategies to achieve competencies during disruptive change: Emerging employer needs and their impact on program deliverables in the healthcare sector
(University Programs in Health Administration, 2019) Murdock, Sandra; Delgado, Rigoberto; Gammon, Elizabeth; Raole, Neha
The impacts of disruptive change on competency-based education are receiving considerable attention from educators in many sectors across the globe. Systemic disruptive change in healthcare involves substantial changes in institutional performance measurement and reimbursement, and requires timecritical adoption of responsive innovation and management skills on the part of healthcare leaders. From the educational perspective, however, the challenge under disruptive change is the identification of emerging employer needs and corresponding program deliverables of required student competencies. This study presents the results of a focus group of 22 senior executives across various health entities and regions as part of a strategy to develop innovative approaches to address required competency changes in health management education. This paper identifies four major focus areas: (a) required technical competencies; (b) competencies to address change; (c) anticipated challenges; and (d) educational strategies for healthcare management programs. Needed competencies and changes in program objectives were developed through a systematic, evidence-based, consensus building approach using interviews to elicit information that would serve as a foundation for healthcare management education redesign. The needed competencies included enhanced interpersonal skills, transformational leadership skills, collaborative communication, concise presentation skills, and strong skills in data analysis.

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