Programs and Communities

Background and Purpose: Over 30 million people in the United States (U.S.) have diabetes mellitus, which comprises about 9% of the population, and about 90% of individuals with diabetes have type 2 diabetes (Centers for Disease Control and Prevention [CDC], 2017). Adults with type 2 diabetes at a local internal medicine clinic were consistently having high glycated hemoglobin (HbA1C) levels, demonstrated by data collected from the electronic health record (EHR), and there was no ordering process for referring patients to diabetes management education and support (DSMES) services. The purpose of this project was to improve glycemic control, demonstrated by lower HbA1C levels, and reach a diabetes education attendance rate of 62.5% at an internal medicine clinic in Chandler, Arizona.

Methods: An electronic health record (EHR) template was created and brief staff training was completed to connect patients with diabetes in the community to a local formal diabetes education program. HbA1C levels were measured before and three months after adults with education program. HbA1C levels were measured before and three months after adults with type 2 diabetes mellitus (T2DM) received physicians’ orders for a DSMES program, and rates of attendance to the program were calculated. Data was collected through the EHR and through feedback from the DSMES program. Descriptive statistics were used in data analysis.

Outcomes: The participants’ results did not demonstrate significant differences in pre-referral and post-referral HbA1C results after they were ordered DSMES services (p = .506). The proportion of education attendance (30%) was lower than the project goal of 62.5%, but increased from the clinic baseline.

Conclusions: EHR template implementation for referral to DSMES may increase rates of formal diabetes education and improve glycemic control. Larger sample sizes, longer project periods, alternative methods of communication, and increased follow-up of participants may be required to produce significant results.

Phoenix is the sixth most populated city in the United States and the 12th largest metropolitan area by population, with about 4.4 million people. As the region continues to grow, the demand for housing and jobs within the metropolitan area is projected to rise under uncertain climate conditions.

Undergraduate and graduate students from Engineering, Sustainability, and Urban Planning in ASU’s Urban Infrastructure Anatomy and Sustainable Development course evaluated the water, energy, and infrastructure changes that result from smart growth in Phoenix, Arizona. The Maricopa Association of Government's Sustainable Transportation and Land Use Integration Study identified a market for 485,000 residential dwelling units in the urban core. Household water and energy use changes, changes in infrastructure needs, and financial and economic savings are assessed along with associated energy use and greenhouse gas emissions.

The course project has produced data on sustainable development in Phoenix and the findings will be made available through ASU’s Urban Sustainability Lab.

Hybrid system models - those devised from two or more disparate sub-system models - provide a number of benefits in terms of conceptualization, development, and assessment of dynamical systems. The decomposition approach helps to formulate complex interactions that are otherwise difficult or impractical to express. However, hybrid model development and usage can introduce complexity that emerges from the composition itself.

To improve assurance of model correctness, sub-systems using disparate modeling formalisms must be integrated above and beyond just the data and control level; their composition must have model specification and simulation execution aspects as well. Poly-formalism composition is one approach to composing models in this manner.

This dissertation describes a poly-formalism composition between a Discrete EVent System specification (DEVS) model and a Cellular Automata (CA) model types. These model specifications have been chosen for their broad applicability in important and emerging domains. An agent-environment domain exemplifies the composition approach. The inherent spatial relations within a CA make it well-suited for environmental representations. Similarly, the component-based nature of agents fits well within the hierarchical component structure of DEVS.

This composition employs the use of a third model, called an interaction model, that includes methods for integrating the two model types at a formalism level, at a systems architecture level, and at a model execution level. A prototype framework using DEVS for the agent model and GRASS for the environment has been developed and is described. Furthermore, this dissertation explains how the concepts of this composition approach are being applied to a real-world research project.

This dissertation expands the tool set modelers in computer science and other disciplines have in order to build hybrid system models, and provides an interaction model for an on-going research project. The concepts and models presented in this dissertation demonstrate the feasibility of composition between discrete-event agents and discrete-time cellular automata. Furthermore, it provides concepts and models that may be applied directly, or used by a modeler to devise compositions for other research efforts.

In the spring of 2016, the City of Apache Junction partnered with the School of Geographical Sciences and Urban Planning at Arizona State University on three forward-thinking plans for development in Apache Junction. Graduate students in the Urban and Environmental Planning program worked alongside City staff, elected officials and the public to identify opportunities and visions for:
       1. Multi-modal access and connectivity improvements for City streets and open space.
       2. Downtown development.
       3. A master-planned community on state land south of the U.S. 60.

The following sections of the report present Apache Junction’s unique characteristics, current resident demographics, development needs and implementation strategies for each project:
       1. Community Profile
       2. Trail Connectivity Master Plan
       3. Downtown Visioning
       4. State Land Visioning

The Trail Connectivity Master Plan optimizes existing trails and wide road shoulders to improve multi-modal connections across the city. The proposed connections emphasize access to important recreation, education and other community facilities for pedestrians, equestrians and bicycles. Trail and lane designs recommend vegetated buffers, wherever possible, to improve traveler safety and comfort. The proposals also increase residents’ interaction with open space along urban-rural trails and park linkages to preserve opportunities to engage with nature. The objectives of the report are accomplished through three goals: connectivity, safety improvements and open space preservation.

Downtown Visioning builds on a large body of conceptual design work for Apache Junction’s downtown area along Idaho Road and Apache Trail. This report identifies three goals: to establish a town center, to reestablish the grid systems while maintaining a view of the Superstition Mountains, and to create an identity and sense of place for the downtown.

State Land Visioning addresses a tract of land, approximately 25 square miles in area, south of the U.S. 60. The main objective is to facilitate growth and proper development in accordance with existing goals in Apache Junction’s General Plan. This is accomplished through three goals:
       1. Develop a foundation for the creation of an economic corridor along US-60 through
           preliminary market research and land use planning.
       2. Create multi-modal connections between existing development north of US-60 and
           future recreational space northeast of US-60.
       3. Maintain a large ratio of open space to developed area that encompasses existing
           washes and floodplains using a master planned community framework to provide an
           example for future land use planning.

Stress of transitioning to parenthood, hormonal fluctuations as well as physical changes, and complications during postpartum could be addressed at the routine postpartum follow-up visit to avoid long-term adverse effects. While emphasis on preconception and prenatal care has increased nationwide, attendance at this important visit is on the decline. The purpose of this project was to investigate how enhanced prenatal education and concurrent scheduling of a well-baby visit at four weeks, instead of the traditional six weeks, could increase adherence to recommended follow-up care at a federally qualified health clinic in the Southwestern United States.

The Theory of Reasoned Action guided the intervention while Rosswurum and Larrabee’s evidence-based practice model was used to develop the project. The pre-existing weekly prenatal education program was enhanced with information regarding the importance of a four-week postpartum follow-up visit. Front desk schedulers were educated to offer same day appointments for the postpartum care visit and one-month well-baby appointment. Data collection took place for three months after implementation of the project and was compared to adherence rates during the three months prior to the intervention. Providers and scheduling staff members participated in a short post-intervention interview. Prenatal education and convenience of concurrent scheduling increased the percentage of adherence to follow-up visits over a three-month period. Providers and clinic staff recommend continuing with the process changes to increase patient’s access to family centered care.

Purpose/Aims: The purpose of this project was to evaluate how patient education can improve medication adherence.

Background and Significance: An exhaustive literature search was conducted with critical appraisal and evidence synthesis to evaluate the effectiveness of patient education on medication adherence. The search concluded that adherence is crucial to chronic disease processes. However, there was no one intervention that emerged as being superior for improving medication
adherence. Working with patients individually to address needs through a variety of methods appeared was the best way to improve medication non-adherence.

Methods: A project to improve medication adherence in an outpatient mental health clinic incorporated electronic medical record (EMR) technology with patient education materials. The project evaluated provider satisfaction with the EMR handout system and evaluated providers’ perceptions of improved medication adherence. Providers (n=9) were followed for eight weeks once system was live. Appraisal was conducted on the providers and pre-test, mid project test, and an eight week post-test were administered. The instrument used was the Technology Acceptance Model-2 (TAM-2).

Outcomes: Friedman Test was conducted. Results obtained showed no significant difference between the three tests (χ2 (2) =2.889, p>0.05). The pretest had a standard deviation of 14.24. The posttest standard deviation was 23.75.

Conclusion: Providers educate patients about a variety of topics such as chronic conditions and wellness. It is beneficial to focus on education more broadly, instead of only medication adherence.

Keywords: patient education, medication adherence, physician perceptions