Theses and Dissertations at Montana State University (MSU)
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Item Healthcare analytics at a perioperative surgical home implemented community hospital(Montana State University - Bozeman, College of Engineering, 2022) Sridhar, Srinivasan; Chairperson, Graduate Committee: Bernadette J. McCrory; This is a manuscript style paper that includes co-authored chapters.The Perioperative Surgical Home (PSH) is a novel patient-centric surgical system developed by American Society of Anesthesiologists (ASA) to improve surgical outcomes and patient satisfaction. Compared to a traditional surgical system, the PSH is a coordinated interdisciplinary team encompassing all surgical care provided to patients from the perioperative phase to recovery phase. However, limited research has been performed in augmenting the PSH surgical care using healthcare analytics. In addition, the spread of the PSH is limited in rural hospitals. Compared to urban hospitals, rural hospitals have higher surgical care inequality due to limited availability of clinicians, resources, resulting in poor access to surgical care. With an increase in the rate of Total Joint Replacement (TJR) procedures in the United States (US), rural hospitals are often under-resourced with coordinating perioperative services resulting in inadequate communication, poor care continuity, and preventable complications. This study focused on developing a novel analytical framework to predict, evaluate, and improve TJR outcomes at a PSH implemented rural community hospital. The study was segmented into three parts where the first part explored the effectiveness of the digital engagement platform to longitudinally engage with TJR patients located in rural areas. The second part evaluated the impact of PSH system in the rural setting by analyzing and comparing the TJR surgical outcomes. Finally, the third part explained the importance of machine learning in the rural PSH system to identify critical patient factors, enhance decision-making, and plan for preventive interventions for better surgical outcomes. Results from this research demonstrated the importance of healthcare analytics in PSH system and how it can help to enhance TJR surgical outcomes and experience for both clinicians and patients.Item Rural healthcare assessment: identifying gaps between service and expectations(Montana State University - Bozeman, College of Engineering, 2020) Dorsey, Robert Kenneth; Chairperson, Graduate Committee: David ClaudioThis research project aims to improve patient satisfaction for customers in same-day clinics in rural areas, with emphasis on healthcare services and facilities at Native American Reservations. This project examined potential gaps between clinical staff services and the expectations of the patients. Due to the remote location and low-income level of the community, it is critical for patients to receive care at local healthcare facilities and not have to travel to other facilities for the same care. The low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) satisfaction scores also lead to less funding to the facility as well as lower-ranking in accreditation by Centers for Medicare and Medicaid Services (CMS). Utilizing survey tools and statistical analysis from Industrial and Management Systems Engineering the study looked to understand expectations on both sides. The initial phase used four open-ended questions along with a series of multiple-choice questions that were given to participants, both patients and staff. Data collected in the first phase showed a possible disconnect between the patients and staff from their responses. It also allowed the patients to rate service prior to the visit. Results showed some areas could have potential improvement but also the performance of staff is overall doing well with what they can control. The second phase revealed a more aligned view between the patients and staff in a ranking survey compiled from the first phase of the research. The ranking information allowed nonparametric testing to see if there existed statistically significant differences between the two groups. Results showed one significantly different item and two others that were borderline. The Service Value Gaps are not as prominent in this single clinic to warrant an in-depth improvement process. More information should be collected through other clinics to allow larger sample size to gain additional insight if multiple gaps exist. The items of actual or near significance were not a higher priority to either group.