Matching Items (14)
Description
It is well known that the lack of care coordination in the healthcare system causes numerous problems including cost inefficiency and inconsistent care, specifically for complex pediatric and adult patients. Many pediatric patients have complex medical and social service needs which can be expensive for both the patient’s parents and the general healthcare system. Therefore, it is difficult for the healthcare system to deliver the highest quality care possible, due to the number of appointments that have to be scheduled (with some being out of state), the large volume of physical health records, and overall lack of time parents have to coordinate this care while also caring for themselves and other family members. It is integral to find a more efficient way to coordinate care for these patients, in order to improve overall care, cost efficiency, and outcomes. <br/>A number of stakeholders in Arizona came together to work on this problem over several years. They were funded through a PCORI Eugene Washington Engagement grant to investigators at ASU. This project, Take Action for Arizona's Children through Care Coordination: A Bridge to Action was developed in order to further develop a research agenda and build the network (PCOR). Regional conferences were conducted in Flagstaff, Yuma, Phoenix, and Tucson, as well as a final capstone conference held in Phoenix. At these conferences, frustrations, suggestions, and opinions regarding Children with Special Health Care Needs (CSHCN) and navigating the healthcare system were shared and testimonials were transcribed.<br/>This study focused on the capstone conference. The study design was a strategic design workshop; results of the design analysis were analyzed qualitatively using descriptive content analysis. Themes described parent’s common experiences navigating the system, impacts resulting from such experiences, and desires for the care coordination system. Quotes were then grouped into major themes and subthemes for the capstone conference. After these themes were determined, the overarching goals of stakeholders could be assessed, and implementation projects could be described.
ContributorsBrennan, Bayley (Author) / Doebbeling, Bradley (Thesis director) / Lamb, Gerri (Committee member) / College of Health Solutions (Contributor, Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
Description
COVID-19 has been challenging for nearly everyone in different ways. Healthcare organizations have had to quickly change policy, modify operations, reorganize facilities, hire, and train staff to overcome COVID-19 related challenges to be able to still provide care for patients, all while being mindful of the protection of their staff. Some healthcare organizations have responded particularly well, perhaps due to preparedness, planning, or exceptional leadership in times of crisis. To explore this, we invited seven healthcare system leaders from three different organizations in Arizona to talk about how they overcame challenges at the beginning of this pandemic with effective strategies and any leadership tips they had for the future. After the interviews were conducted, the interviews were transcribed, coded qualitatively, and separated into themes and categories to analyze their answers to the questions asked. The results and conclusions included strategies such as having open and honest communication, teamwork, rapidly developing communicating policies, and widely adopting new work practices like Telemedicine, Zoom, and working at home as crucial. This report is designed to assist in aiding and inspiring future or other leaders to be better prepared for solving various challenges with other emergencies that arise in the future.
ContributorsDarira, Saigayatri (Author) / Doebbeling, Bradley (Thesis director) / Don, Rachael (Committee member) / Franczak, Michael (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
Description
Over-prescription of opioid medications for chronic pain has been a major driver of the opioid abuse epidemic. Arizona has an opioid prescription rate of 50.7/100 persons annually, which is about the average US rate of 51.4/100 persons. Novel approaches to treat chronic pain and reduce opioid overuse are promptly needed. Using analysis of Medicaid prescribing data from across Arizona, Mountain Park Health Center was identified to have the lowest opioid prescribing rates among all Community Health Centers (CHC) in Arizona (14.2/100 persons) using analysis of Medicaid prescribing data from across Arizona. A healthy work culture of patient engagement, behavioral health integration into primary care (BHI), and active case management of SDoH issues were critical to successful opioid prescribing and management. In order to account for the complex systemic contributors towards opioid over-prescription, the underlying theoretical framework, positive deviance (PD), was used to uncover effective practices for notably low opioid prescribing. Focus groups of interdisciplinary provider teams (physicians, nurses, pharmacists, and behavioral health) were structured around the PD inquiry approach. Participants were asked about practice and culture factors that might foster or enable low-prescribing practices. Focus group interviews were audio-recorded and transcribed. Six critical themes were identified after extensive qualitative analysis of focus group transcripts: medication management; non-opioid pain management; service integration; preventive strategies; patient and family engagement; underlying factors (including medical/behavior comorbidity and socioeconomic factors). These findings illustrate that this CHC system has a culture which values a high level of care integration, internal systems, and community partnerships to address patient social determinants of health, and patient engagement and provider norms to provide alternatives to opioid prescription. Behavioral health integration into the care team is another key aspect of the culture. Our findings, if confirmed in other settings, could be useful in planning organizational interventions and training. We anticipate that efforts to implement and spread these approaches may be effective in decreasing opioid overuse, promoting health equity by targeting CHCs with room for improvement, and informing the larger research goals: to inform practice change and opioid prescribing across Arizona CHCs.
ContributorsCheng, Esther (Author) / Doebbeling, Bradley (Thesis director) / Daniulaityte, Raminta (Committee member) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
Description
Electronic Health Records (EHRs) began to be introduced in the 1960s. Government-run hospitals were the primary adopters of technology. The rate of adoption continually rose from there, doubling from 2007 to 2012 from 34.8% to about 71%. Most of the growth seen from 2007 to 2012 is a result of the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Reinvestment and Recovery (ARRA) Act. $19 billion dollars were made available as part of these two acts to increase the rate of Health Information Technology (HIT), of which EHRs are a large part. A national health information network is envisioned for the end stages of HITECH which will enable health information to be exchanged immediately from one health network to another. While the ability to exchange data quickly appears to be an achievable goal, it might come with the cost of loss of usability and functionality for providers who interact with the EHRs and often enter health data into an EHR. The loss of usability can be attributed to how the EHR was designed.
ContributorsRobinson, Lillie Elizabeth (Author) / Doebbeling, Bradley (Thesis director) / Chiou, Erin (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
Description
The unprecedented amount and sources of information during the COVID-19 pandemic resulted in an indiscriminate level of misinformation that was confusing and compromised healthcare access and delivery. The World Health Organization (WHO) called this an ‘infodemic’, and conspiracy theories and fake news about COVID-19, plagued public health efforts to contain the COVID-19 pandemic. National and international public health priorities expanded to counter misinformation. As a multi-disciplinary study encompassing expertise from public health, informatics, and communication, this research focused on eliciting strategies to better understand and combat misinformation on COVID-19. The study hypotheses is that 1) factors influencing vaccine-acceptance like socio-demographic factors, COVID-19 knowledge, trust in institutions, and media related factors could be leveraged for public health education and intervention; and 2) individuals with a high level of knowledge regarding COVID-19 prevention and control have unique behaviors and practices, like nuanced media literacy and validation skills that could be promoted to improve vaccine acceptance and preventative health behaviors. In this biphasic study an initial survey of 1,498 individuals sampled from Amazon Mechanical Turk (MTurk) assessed socio-demographic factors, an 18-item test of COVID-19 knowledge, trust in healthcare stakeholders, and measures of media literacy and consumption. Subsequently, using the Positive Deviance Framework, a diverse subset of 25 individuals with high COVID-19 knowledge scores were interviewed to identify these deviants’ information and media practices that helped avoid COVID-19 misinformation. Access to primary care, higher educational attainment and living in urban communities were positive socio-demographic predictors of COVID-19 vaccine acceptance emphasizing the need to invest in education and rural health. High COVID-19 knowledge and trust in government and health providers were also critical factors and associated with a higher level of trust in science and credible information sources like the Centers for Disease Control (CDC) and health experts. Positive deviants practiced media literacy skills that emphasized checking sources for scientific basis as well as hidden bias; cross-checking information across multiple sources and verifying health information with scientific experts. These identified information validation and confirmation practices may be useful in educating the public and designing strategies to better protect communities against harmful health misinformation.
ContributorsSivanandam, Shalini (Author) / Doebbeling, Bradley (Thesis advisor) / Koskan, Alexis (Committee member) / Roschke, Kristy (Committee member) / Chung, Yunro (Committee member) / Arizona State University (Publisher)
Created2023
Description
Usability problems associated with electronic health records can adversely impact clinical workflow, leading to inefficiencies, error, and even clinician burnout. The work presented in this dissertation is concerned with understanding and improving clinical workflow. Towards that end, it is necessary to model physical and cognitive aspects of task performance in clinical settings. Task completion can be significantly impacted by the navigational efficiency of the electronic health record (EHR) interface. Workflow modeling of the EHR-mediated workflow could help identify, diagnose and eliminate problems to reduce navigational complexity. The research goal is to introduce and validate a new biomedical informatics methodological workflow analysis framework that combines expert-based and user-based techniques to guide effective EHR design and reduce navigational complexity. These techniques are combined into a modified walkthrough that aligns user goals and subgoals with estimated task completion time and characterization of cognitive demands. A two-phased validation of the framework is utilized. The first is applied to single EHR-mediated workflow tasks, medication reconciliation (MedRec), and medication administration records (MAR) to refine individual aspects of the framework. The second phase applied the framework to a pre/post EHR implementation comparative analysis of multiple workflows tasks. This validation provides evidence of the framework's applicability and feasibility across several sites, systems, and settings. Analysis of the steps executed within the interfaces involved to complete the medication administration and medication reconciliation and patient order management tasks have provided a basis for characterizing the complexities in EHR navigation. An implication of the work presented here is that small tractable changes in interface design may substantially improve EHR navigation, overall usability, and workflow. The navigational complexity framework enables scrutinizing the impact of different EHR interfaces on task performance and usability barriers across different sites, systems, and settings.
ContributorsDuncan, Benjamin (Author) / Grando, Adela (Thesis advisor) / Doebbeling, Bradley (Thesis advisor) / Kaufman, David (Committee member) / Greenes, Robert (Committee member) / Arizona State University (Publisher)
Created2021
Description
Native American COVID vaccination trends have deviated from the vaccinated trends for other vaccines such as the HPV and flu. Native Americans are reporting the highest vaccinations in the nation compared to all racial and ethnic groups in the country. Despite this, some are still hesitant in taking the vaccine. This study investigates the factors that influence vaccine uptake and hesitancy among Native American Youth in Arizona. The study utilizes data from the Arizona Youth Identity Project, a mixed-methods study examining young adults’ political engagement and sense of identity as Americans. 10 out of 13 individuals at the time of the study had received the COVID vaccine. Three themes, trust, knowledge, and social responsibility were identified. Most of the reasons for hesitancy came from distrust of government and biomedicine. Most participants had no knowledge of vaccine effectiveness, mechanism or effects but viewed getting vaccinated as a social responsibility to protect their families and communities. These findings indicate that the main goal of vaccinations among Native American youth was to protect the most vulnerable elders.
ContributorsAbaidoo, Joy (Author) / Gonzales, Angela (Thesis director) / Doebbeling, Bradley (Committee member) / Barrett, The Honors College (Contributor) / Hugh Downs School of Human Communication (Contributor) / School of Life Sciences (Contributor)
Created2022-05
Description
Since the onset of the COVID-19 pandemic, the world has been turned upside down. People everywhere are recommended to self-isolate and social distance to limit the spread of the deadly virus. Older adults specifically are being forced into isolation because they are at the highest risk for severe illness—illness that can result in hospitalization, intensive care, or even death. But this isolation is not new. Even before COVID-19, the older adult population has been suffering through a social isolation epidemic. And now, with social distancing measures in place, even more adults are being socially isolated to remain safe and healthy. But when individuals are isolated for long periods of time and no longer have an active social network to connect with, this social isolation can become harmful. Social isolation is known to increase the risk of cardiovascular disease, obesity, and stroke, and it is associated with anxiety, depression, and cognitive decline. Furthermore, the risk of premature death from any cause increases because of social isolation. With all these negative consequences, it is crucial that we confront the toll that COVID-19 countermeasures have taken on older adults and look for ways to prevent social isolation. Venture Together, a multi-user social media platform designed for older adults, attempts to do just this and more.
ContributorsHouchins, Michelle (Author) / Doebbeling, Bradley (Thesis director) / Mejía, Mauricio (Committee member) / Barrett, The Honors College (Contributor) / Computer Science and Engineering Program (Contributor) / School of International Letters and Cultures (Contributor)
Created2022-05
Description
Diabetes is becoming a serious problem in China. At the same time, China’s medical
system has faced a difficult situation because of the lack of medical resources and the unequal medical resource distribution between the BHs and BLHs. BH doctors are tremendously busy with both serious and minor illnesses while BLH medical providers are worried about a sufficient source of patients. This study aims to find the potential feasibility of a new service model in managing diabetes which will solve these medical problems. The study was conducted using an extensive literature review in addition to employing an interview and survey method to explore the perception and current situation in workload and income of medical providers from one BH and one BLH in China. Furthermore, this study tried to understand the acceptance of online medical technology in these medical provider groups. The results showed that doctors in the BH do not have the time needed to engage in extra work. This population is not satisfied with their work responsibilities and income structure. They want to engage in diagnosing and prescribing tasks, with respect to diabetes management. They would like to distribute the management work to BLH. On the other hand, medical providers in BLH have extra time and enthusiasm in doing extra work to improve their income. They are not satisfied with their workload and income, and want to change it. BLHs are willing to do the management work assisting the BH doctors. Additionally, the study showed that online medical technology requires a broader user education for medical providers from both big and BLHs. The conclusion can be summarized as design research advice for future service design in healthcare management. The proposed online medical service should meet different level medical providers' position and requirements regarding time, payment, and value. BH doctors are more suitable for diagnosing and prescribing and BLH medical providers are more suitable for follow-up service. This service should reflect the value of the BH doctors' professional service and the value of BLH medical providers' health management service. (discuss how design can improve this situation through app development)
system has faced a difficult situation because of the lack of medical resources and the unequal medical resource distribution between the BHs and BLHs. BH doctors are tremendously busy with both serious and minor illnesses while BLH medical providers are worried about a sufficient source of patients. This study aims to find the potential feasibility of a new service model in managing diabetes which will solve these medical problems. The study was conducted using an extensive literature review in addition to employing an interview and survey method to explore the perception and current situation in workload and income of medical providers from one BH and one BLH in China. Furthermore, this study tried to understand the acceptance of online medical technology in these medical provider groups. The results showed that doctors in the BH do not have the time needed to engage in extra work. This population is not satisfied with their work responsibilities and income structure. They want to engage in diagnosing and prescribing tasks, with respect to diabetes management. They would like to distribute the management work to BLH. On the other hand, medical providers in BLH have extra time and enthusiasm in doing extra work to improve their income. They are not satisfied with their workload and income, and want to change it. BLHs are willing to do the management work assisting the BH doctors. Additionally, the study showed that online medical technology requires a broader user education for medical providers from both big and BLHs. The conclusion can be summarized as design research advice for future service design in healthcare management. The proposed online medical service should meet different level medical providers' position and requirements regarding time, payment, and value. BH doctors are more suitable for diagnosing and prescribing and BLH medical providers are more suitable for follow-up service. This service should reflect the value of the BH doctors' professional service and the value of BLH medical providers' health management service. (discuss how design can improve this situation through app development)
ContributorsLiu, Maozhen (Author) / Takamura, John (Thesis advisor) / Doebbeling, Bradley (Committee member) / Herring, Donald (Committee member) / Arizona State University (Publisher)
Created2018
Description
According to the ADA (American Diabetes Association), diabetes mellitus is one of the chronic diseases with the highest mortality rate. In the US, 25 million are known diabetics, which may double in the next decade, and another seven million are undiagnosed. Among these patients, older adults are a very special group with varying physical capabilities, cognitive functions and life expectancies. Because they run an increased risk for geriatric conditions, Type 2 diabetes treatments for them must be both realistic and systematic. In fact, some researchers have explored older adults’ experiences of diabetes, and how they manage their diabetes with new technological devices. However, little research has focused on their emotional experiences of medical treatment technology, such as mobile applications, tablets, and websites for geriatric diabetes. This study will address both elderly people's experiences and reactions to devices and their children's awareness of diabetes. It aims to find out how to improve the diabetes treatment and create a systematic diabetes mobile application that combines self-initiated and assisted care together.
ContributorsLu, Chenyang (Author) / Takamura, John (Thesis advisor) / Herring, Donald (Committee member) / Doebbeling, Bradley (Committee member) / Arizona State University (Publisher)
Created2017