Other Findings. Characteristics of what an ideal facility would have, and not have:
Other Findings. A total of 268 bed nets were found in the households during the survey which the households did not receive from the campaign. Of these 268 nets, 264 (21%) were covering sleeping spaces and four (1.5%) were still in the original packaging. On average, about one-third of the sleeping spaces were covered with a bed net other than a campaign LLIN. At least 111 of the observed non-campaign nets covered sleeping spaces in the Bosobolo health district, 103 covered sleeping spaces in the Gbadolite health district, and 50 covered sleeping spaces in the Karawa health district (see Table 4.15). The multiple linear regression analysis results showed that the proportion of households owning at least one LLIN (p value= <0.0001) and the proportion of campaign LLINs not hung over sleeping spaces (p value= <0.0001) were found to be significantly associated with predicting the proportion of sleeping spaces covered by a LLIN. Proportion of LLINs other than the campaign LLINs, LLIN hang-up activities, discomfort when sleeping inside an LLIN, and number of sleeping spaces in the households were not significantly associated with predicting sleeping spaces covered by a campaign LLIN.
Other Findings. Based upon information gathered from the subject matter expert (SME) from the EHR company, linking EHRs to EDRs electronically is technologically feasible, data is connected through data mapping and linked via a patient identifier. Interoperability can be supported through a query-based, and push-based approach. Data standards such as Health Level 7® (HL7®), Clinical Data Architecture® (CDA®), and Systemized Nomenclature of Medicine (SNOMED), Fast Healthcare Interoperability Resource® (FHIR®) and Digital Imaging and Communications in Medicine® (DICOM®) is also used for interoperability. Systemized Nomenclature of Dentistry (SNODENT) can be used, however, it requires importing into the system with additional licensing terms and fees for support. Figure 4 below depicts a high-level overview of electronic health and dental record systems linkage. Figure 4 Research also found that Xxxxx Hospital’s ED currently has a very effective dental referral system in place. Patients that present to the ED for non-traumatic dental problems are either referred to Xxxxx’x Oral Surgery Clinic for the treatment of dental infections and extractions, and the remaining patients are referred to dental clinics that perform dental treatment on a sliding scale. Many of the patients that present to the ED for dental problems lack health literacy and the financial resources to pay for treatment. Referring such patients to low-cost dental clinics appears to be a cost-effective solution for the patients and cost-saving solution for Xxxxx’x XX. Patients that return to Xxxxx’x XX are between three to five percent, therefore, it was concluded that Xxxxx currently has an effective solution in place, and linking their EHRs to private-practice EDRs would not be a cost-effective and practical solution for Xxxxx, or private-practice dentists. Further policy measures would need to be put into practice before moving forward with systems integration. Based on the research, there are patient benefits for linking EHRs to EDRs. Oral health disparities would be lowered, provider communication would improve, and better patient treatment decisions could potentially arise from linking the data sources. From a technology standpoint, linking the data sources is feasible and interoperability can be supported. Although linking the data would improve patient outcomes and provider communication, it appears to have its limitations due to indirect provider communication that may be required. From a feasibility s...
Other Findings. Baseline, intervention and post-intervention proportions of due and overdue Pap screenings in the Muscogee County office and in the satellite clinics were also reviewed. The P chart for the Muscogee County clinic (Figure 7) shows the baseline UCL and LCL set at 39% and 16% respectively. The process average is approximately 28%. First quarter results show the proportion of women without current Pap screenings between 20% - 21%. An increasing trend is noted in the proportion of women due or overdue during the second quarter. The proportion rises from about 24% to 35%. The third quarter demonstrates an increase to 42%. During the intervention a shift in the UCL and LCL occurs. The values are now 42% and 19% respectively with a process mean of 31%. A decline in the proportion of due or overdue Pap screenings from 42% to 24% occurs during this four month period. The post-intervention period shows an overall increase in delinquent Pap screenings with a high of 43% being reached. The UCL, LCL, and process mean remain stable. One data point, December 2013, is identified outside of the control limits indicating a Test 1 failure. See possible explanation below. The P chart for the satellite clinics (Figure 8) shows the baseline UCL and LCL set at 75% and 38% respectively. The process average is 56%. During this baseline period, the proportion of women attending the county clinics without a documented Pap screening is consistently >50%. During the intervention, a shift in the UCL and LCL can be seen. The values are 55% and 19% respectively with the process average at 37%. A decline from 65% to 21% in the proportion of due or overdue screenings is demonstrated during these four months. From January 2013 to December 2013, the UCL and LCL remain close to the intervention values. This period has a UCL of 58%, LCL of 21%, and process mean of 39%. Following a low of 18%, a gradual but steady increase in women in need of Pap screening is demonstrated. The post-intervention period culminates in a high of 78%. Four data points, one in the intervention stage (September) and three in the post-intervention phase (January, November, and December), are identified as Test 1 failures. If not for the intervention effect, September 2012’s proportion would have been well within baseline control limits. Immediately after the intervention, an all-time low of 18% is achieved. Again, this is most likely due to patient completion of Pap screenings scheduled during PCM support. The values fo...
Other Findings. In response to what increases risk to my patients, 41% said none of the provide options applied to their employment situation, 32% responded that I am required to care for patients with excessive risk, 32% said I am required to manage the care of too many patients in the office, 26% answered my patients regularly request unnecessary interventions, 17% said my practice protocol are not evidence-based, 15% are required to manage the care of too many patients on call, 13% said physicians do not support the plan of care developed by myself and my patients, 8% said patients declined needed interventions, 6% are not currently taking care of patients, 4% selected other, and 2% said back-up physicians do not respond as quickly as I need them to respond. Study results show that the restrictions placed on the scope of practice of CNM vary at the practice level. What CNMs are allowed to do at their practices are dependent on the practice agreement/protocol, and the development of these agreement/protocol involve more physicians than CNMs (64% vs. 47%, respectively); these practice protocols/agreements do not allow much room for negotiation (only 39% of CNM were able to negotiate their practice agreement/protocol and 29% did not have the option to negotiate even though they wanted to). Close to half of CNMs (45%) are allowed to order screening mammograms independently (without a physician signature and 31% were not allowed). It is surprising, albeit refreshing that this CNMs can order screening mammograms independently because Georgia status limits the situations in which APRNs can order diagnostics tests such as MRI without physician authorization, specifying that APRNs who are delegate this authority can only do so in life-threatening situations (Xxxxxxxx, 2015). Yet, screening mammograms are used as part of breast cancer prevention. The U.S. Preventive Task Force recommends biennial mammography screening for breast cancer for women age 50-74 (Siu, 2016), and breast cancer screening is within the education and skills of CNMs. Therefore, for the 31% of CNMs in this sample that are not allowed to order such screening mammograms independently, it imposes restriction on their scope of practice. Majority of CNMs in this study order prescriptions under GA APRN prescriptive authority for APRNs. In Georgia, the physicians who delegate prescriptive authorities to APRNs cannot have a written protocol agreement with more than four APRNs (Xxxxxxxx, 2015). One consequence of suc...
Other Findings. Interestingly, at Hospital A, a doctor explained how it is the cleaner’s responsibility to remove the trash from the outdoor area shared by patient post-delivery rooms daily during routine cleaning. However, based on structured observations, it was noted that these bags of trash were not removed often as the build-up of bottles but small number of total patients in all patient post-delivery rooms indicated. Additionally, one intern at Hospital A used a glove to tie around a patient’s arm to draw blood but did not actually wear gloves herself. In Hospital B, it is important to note that during one particular session of structured observations of routine cleaning procedures, an intern used a white rag and Hexianos solution to wipe both the bed and counters. However, after being told by a midwife that green rags are typically used to wipe more general areas and that white rags are used to wipe up blood and other bodily fluids, the intern acknowledged her mistake but did not wipe back over the counter using a green rag. In one particular day of structured observations of morning rounds procedures, when asked about her use of gloves during the morning rounds, a midwife explained that she used gloves to tie around the patient’s arm if needed. On the other hand, although not observed during a structured observation period, it is important to note an example of a situation that could have been further observed through using structured observations to gain more clarity and understanding regarding the situation. In a situation at Hospital A, an intern mistakenly told researchers that a speculum had already been sterilized. However, after equipment rinsing was completed to collect the microbial sample from the speculum, the same intern returned to inform researchers that she was mistaken and that the speculum had in fact not been sterilized yet but was expected to be sterilized soon. 1 Quotes from healthcare staff at both hospitals were translated into English from oral Khmer by the researcher conducting unstructured and structured observations. Researchers could not have been inferred or deduced this information solely from collected samples in the research study without the conduction of these unique observations. Nevertheless, by following hospital staff around and observing their behaviors, the observational data collected from conducting structured observations provides a greater insight into and richer data towards possible HAI pathways of transmission.
Other Findings. Preliminary analysis of the data determined that the sample was largely adherent; therefore, the outcome variable days from diagnosis to treatment was used as a proxy for adherence to treatment recommendations. Prior evidence found African-American women were more likely to delay treatment where women who delayed treatment had a 12% lower five-year survival rate (Xxxxxxxx et al., 1999). The current study found once a woman started chemotherapy, she completed treatment as recommended by her healthcare providers. However, some women experienced considerably more days from diagnosis to treatment than other women who started and underwent treatment recommendations.
Other Findings. Survey findings also revealed that the element of poverty was a consistent theme among all study participants. The median household income for Dougherty County, GA is $31,458.27 Most respondents reported having a household income far below the median household income for this area ($12,000 annually), while also reporting their financial situation as being fair. The perception of having a fair financial status among most respondents, while having an annual household income less than the median household income for this area alludes to how pervasive poverty is to the area. Although most respondents were unemployed and earned less than $12,000 a year, their perception of their income status was identified as being fair. The assumption can be made that due to lack of opportunities available in Dougherty County, a diminished quality of life is cultural norm. Unfortunately, for many residents in Dougherty County, living in poverty as the federal government defined it, is a cultural norm. Respondents also felt that barriers to testing and treatment contributes to the increase in HIV/syphilis. The process used by the Dougherty County Health Department STD Clinic to provide a confirmed HIV or syphilis results involve the collection of blood samples to be sent to the State of Georgia Public Health Laboratory in Decatur, GA or Waycross, GA. The timeframe from the collection of the sample to the reporting of results can take between 2 to 3 weeks. During this time, many respondents reported experiencing a level of anxiety while waiting for the confirmatory results. Also, respondents reported that many of those who test preliminary positive often continue to engage in risky behaviors. Respondents reported that residents of Dougherty County have a stigma against seeking healthcare services at the Dougherty County Health Department. Participants feel that patient confidentiality would not be upheld.
Other Findings. The Parties acknowledge that any Customer Satisfaction Benchmark might result in the discovery of continuous improvement opportunities separate from cost competitiveness issues. Any such opportunities identified by the Benchmarker will be the subject of analysis and review, including without limitation, the preparation by Supplier of a formal gap and root cause analysis, as well as a written plan detailing the actions of the parties as may be required to close any such identified gap or opportunities. [***] Confidential treatment has been requested for the bracketed portions. The confidential redacted portion has been omitted and filed separately with the Securities and Exchange Commission. This Amendment Number 1 (the “First Amendment”) to the Master Services Agreement, Effective Date of April 5th, 2004 between Bxx.xxx and vCustomer (the “Agreement”) is effective January 1, 2005 (“Amendment Effective Date”), and modifies, amends and changes the Agreement as set forth below. This Amendment is entered into by and between Bxx.xxx and vCustomer, who are the current parties to the Agreement (the “Parties”).
Other Findings. The Sale does not constitute a de facto plan of reorganization or liquidation or an element of such a plan for any of the Debtors, as it does not propose to: (a) impair or restructure existing debt of, or equity interests in, the Debtors, (b) impair or circumvent voting rights with respect to any future plan proposed by the Debtors; (c) circumvent chapter 11 plan safeguards, such as those set forth in sections 1125 and 1129 of the Bankruptcy Code; or (d) classify claims or equity interests, compromise controversies or extend debt maturities.
