Programs and Communities
The collection collates collections by schools, centers, programs, and research groups.
Displaying 1 - 10 of 16
Filtering by
- All Subjects: Advance Care Planning
- All Subjects: Sustainable Agriculture
Description
Advance care planning is a process that allows for patient autonomy at the end of life. Yet, less than 30% of Americans over the age of 65 have an advance care plan. Advance care planning has positive effects on patients, families and healthcare systems. However, both patients and healthcare providers report barriers to completing and discussing advance care planning. Many different interventions have been studied to increase advance care planning rates. Engaging patients and providers electronically before or during appointments in outpatient clinics and community settings has shown marked improvement in advance care plan discussions and documentation rates. To address this complex issue, two community-based seminars with electronic pre-engagement for adults has been proposed to improve advance care planning completion rates.
ContributorsCole, Alison (Author) / Nunez, Diane (Thesis advisor)
Created2020-04-24
Description
Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.
The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.
ContributorsBautista, Hija Mae (Author) / Johannah, Uriri-Glover (Thesis advisor)
Created2020-04-30
ContributorsBurns, Eliana (Author) / Ruiz, Marissa (Author) / Hernandez, Haley (Author)
Created2023-04-26
Description
Recent trends show that consumers are starting to prioritize sustainability when they go out to eat now more than ever. Tarbell's, a family-owned restaurant based in Phoenix, Arizona, aims to become a leader in sustainable food service but requires additional expertise in prioritizing and showcasing their sustainability efforts. Founded by Mark Tarbell in 1994, Tarbell’s portfolio includes the main restaurant- Tarbell’s, The Wine Store and Tavern, their catering business, and The Tavern at Phoenix Sky Harbor Airport., Tarbell’s has partnered with the Tarbellas, a group of Master of Sustainability Solutions (MSUS) students at Arizona State University (ASU), to pursue larger impact goals, including conducting a materiality assessment and drafting a sustainability plan of action.
To begin the project process, the Tarbellas completed a landscape analysis. We researched the following categories: restaurant vendor practices; small, international restaurants; small, national restaurants; corporate food retailers; and restaurant-related sustainability certifications. This analysis informed our other research methods, including a best practices assessment and TOWS analysis, ultimately leading us to develop four initial priorities that informed our next steps: 1) hire a staff member to manage all sustainability initiatives and reporting, 2) focus on sustainable procurement across the restaurant, 3) complete the Food Made Good online audit, and 4) work towards and obtain Green Restaurant Association Certification.
With support from Tarbell’s, we developed a job description for a Sustainability Program Manager and a Sustainable Purchasing Policy. We created both by researching existing job postings and purchasing policies, and then adapted them to fit Tarbell’s needs and goals. Tarbell’s also completed the Food Made Good online audit.
Finally, the Tarbellas completed a materiality assessment. In order to do this, we developed an internal stakeholder survey and collected data on Tarbell’s annual spend from 2022. We plotted the results on a materiality matrix and used the results to inform how to prioritize the next steps. This prioritization will help Tarbell’s inform their sustainability strategy in the future.
Going forward, we recommend the following to Tarbell’s: 1) Hire a Sustainability Program Manager, 2) Utilize the Sustainable Purchasing Policy (SPP) we developed, 3) Obtain Green Restaurant Association Certification, and 4) routinely revisit their material impacts. Our report takes the format of a sustainability plan of action, enabling Tarbell’s to continue pursuing sustainability while being a leading example and guide for other small, independent restaurants on their paths to pursuing sustainability.
ContributorsAntidormi, Rachel (Author) / Martin, Azita (Author) / Ouellette, Kelsey (Author) / Queen, Sarah (Author)
Created2023-04-26
ContributorsAntidormi, Rachel (Author) / Martin, Azita (Author) / Ouellette, Kelsey (Author) / Queen, Sarah (Author)
Created2023-04-26
ContributorsAntidormi, Rachel (Author) / Martin, Azita (Author) / Ouellette, Kelsey (Author) / Queen, Sarah (Author)
Created2023-04-26
ContributorsAntidormi, Rachel (Author) / Martin, Azita (Author) / Ouellette, Kelsey (Author) / Queen, Sarah (Author)
Created2023-04-26
Description
More than 10 million visitors traveled to Hawaiʻi in 2019, placing an enormous strain on a food system already burdened by a disproportionate reliance on imported food. Agritourism may be one solution for farmers to diversify their income, increase consumption of locally produced food, and connect farmers to local consumers. But in a place with such a robust tourism infrastructure, how can it be responsibly implemented and utilized in a way that benefits local farmers, residents, the environment, and rural and Native Hawaiian culture? This report endeavors to answer this question through a comprehensive examination of agritourism in the islands as it exists today, and by providing recommendations for agritourism in Hawaiʻi going forward.
ContributorsGifford, John (Author) / Martone-Richards, Abigail (Author) / Mik, Mary (Author) / Pena, Jason (Author) / Perkins, Allison (Author) / Strong, Sharla (Author) / Swette Center for Sustainable Food Systems (Issuing body) / Hawaii Island (Hawaii). Department of Research and Development (Issuing body)
Created2023-04
Description
Purpose: Advance care planning (ACP) allows an individual to discuss and document their personal preferences at end-of-life. ACP has been shown to improve communication and reduce discomfort for patients and their families. The literature supports utilizing formalized, multimodality training programs for healthcare providers in order to increase their confidence in initiating ACP discussions. These findings led to the initiation of an evidence-based practice project in a primary care setting with the purpose of increasing advance care planning discussions between providers and patients with the use of a standardized education tool.
Background and Significance: National regulations mandate that patients are provided information about advance directives in the healthcare setting, but completion rates are not monitored and continue to be low. ACP is now a billable service for healthcare providers, but it has not provided enough incentive to increase completion rates. Barriers for healthcare providers in the outpatient setting include lack of time, protocols, and lack of education on how to initiate and foster advance care planning discussions.
Methods: Healthcare providers in a primary care office attended a 15-minute structured educational session with and a toolkit was provided on the importance of ACP, how to initiate conversations with patients, and bill for the service. Participants completed a portion of the Knowledge, Attitudinal, and Experiential Survey on Advance Directives (KAESAD) survey assessing their confidence in ACP before and three months post intervention. Participant confidence (N = 6) in ACP was analyzed using the Wilcoxin test and descriptive statistics. The number of billed ACP services for the office was collected for four months post intervention and compared to the previous four months. Outcomes: A significant increase in provider confidence after participating in a multimodality education program was found in the results (Z = -2.21, p = .03). There was a 42.1% increase in the number of billed ACP discussions for the office in the four months post intervention.
Conclusion: The future desired state is that ACP discussions become standard practice in primary care leading to the completion of advance directives. This can be accomplished through formalized education sessions and resources for providers in order to increase their confidence in initiating ACP discussions with patients. The ultimate goal is to decrease unnecessary spending at end-of-life while improving patient and family satisfaction with the quality of care received at end-of-life.
Background and Significance: National regulations mandate that patients are provided information about advance directives in the healthcare setting, but completion rates are not monitored and continue to be low. ACP is now a billable service for healthcare providers, but it has not provided enough incentive to increase completion rates. Barriers for healthcare providers in the outpatient setting include lack of time, protocols, and lack of education on how to initiate and foster advance care planning discussions.
Methods: Healthcare providers in a primary care office attended a 15-minute structured educational session with and a toolkit was provided on the importance of ACP, how to initiate conversations with patients, and bill for the service. Participants completed a portion of the Knowledge, Attitudinal, and Experiential Survey on Advance Directives (KAESAD) survey assessing their confidence in ACP before and three months post intervention. Participant confidence (N = 6) in ACP was analyzed using the Wilcoxin test and descriptive statistics. The number of billed ACP services for the office was collected for four months post intervention and compared to the previous four months. Outcomes: A significant increase in provider confidence after participating in a multimodality education program was found in the results (Z = -2.21, p = .03). There was a 42.1% increase in the number of billed ACP discussions for the office in the four months post intervention.
Conclusion: The future desired state is that ACP discussions become standard practice in primary care leading to the completion of advance directives. This can be accomplished through formalized education sessions and resources for providers in order to increase their confidence in initiating ACP discussions with patients. The ultimate goal is to decrease unnecessary spending at end-of-life while improving patient and family satisfaction with the quality of care received at end-of-life.
ContributorsSmith, Arsena (Author) / Nunez, Diane (Thesis advisor)
Created2018-04-30
Description
Many older Americans don’t have an advance directive (AD). ADs are legal documents that allow a person to express what types of medical treatment or cares that they want at the end of their life if they were unable to speak for themselves. Patients without an AD could receive unwanted treatment. Providers can utilize advance care planning (ACP) to educate patients and support them in forming a medical power of attorney (MPOA) and AD. Evidence suggests that having ACP conversations can engage a patient to form an AD. The purpose of this project was to see if ACP discussions with older patients encouraged them to complete an AD and MPOA.
The project used a mixed method design. Participants were recruited from a primary care practice. Descriptive statistics described the sample and outcome variable. An independent t- test measured if there were significant changes in the participant responses for the ACP survey.
The average age (standard deviation) of the chart review sample was 72.22 (SD=9.47). The ages ranged from 60 to 100 years of age. Most of the sample in the chart audit were female with 105 (53%) participants and 95 (48%) were male. Most of the sample, 183 (92.5%) reported having a chronic health condition and 17 (7.5%) of the sample reported having no chronic condition. Overall, the results were inclined towards a significant difference in participants who did the ACP discussions and those who did not when comparing completed AD forms.
The project used a mixed method design. Participants were recruited from a primary care practice. Descriptive statistics described the sample and outcome variable. An independent t- test measured if there were significant changes in the participant responses for the ACP survey.
The average age (standard deviation) of the chart review sample was 72.22 (SD=9.47). The ages ranged from 60 to 100 years of age. Most of the sample in the chart audit were female with 105 (53%) participants and 95 (48%) were male. Most of the sample, 183 (92.5%) reported having a chronic health condition and 17 (7.5%) of the sample reported having no chronic condition. Overall, the results were inclined towards a significant difference in participants who did the ACP discussions and those who did not when comparing completed AD forms.
ContributorsKrasowski, Maria (Author) / Rauton, Monica (Thesis advisor)
Created2018-05-01