UMD Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/3
New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.
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Item COLLABORATIVE CO-DESIGN OF PORTABLE WORK BENEFITS POLICY MODEL AND NON-POLICY PROTOTYPE BASED ON DIRECT CARE WORKERS' NEEDS, ATTITUDES, AND BELIEFS(2024) Kuo, Charlene C.; Aparicio, Elizabeth M.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Direct care workers (DCWs) assist people with disabilities and frail elders with activities of daily living, thereby preventing institutionalization, hospitalization, and other costly medical services. From 2016 to 2060, the number of adults aged 65 and over is expected to increase from 49.2 million to 94.7 million. The number of adults 18 to 64 will remain the same, leading to a shortage of family caregivers. A shortage of family caregivers will require a robust direct care workforce. The direct care workforce is expected to grow by 1.3 million from 2019 to 2029 but this growth will not keep pace with the projected demand. The turnover rate among DCWs is high due to poor work conditions and inadequate compensation. Exploring ways to improve DCW working conditions and compensation is critical to prevent further shortages. DCWs' health is put at risk due to the nature of the work, low wages, and lack of worker protections and traditional work benefits. DCWs are vulnerable to injury, abuse, infectious diseases, and other poor health outcomes due to the previously listed disadvantages (Campbell, 2019c; Hughes, 2020; Jaffe, 2017; M. M. Quinn et al., 2016). DCWs in the United States are predominantly women, members of racial and ethnic minority groups, and one in four workers are immigrants.Work benefits improve health outcomes and protect clients of DCWs from healthcare-associated infections by allowing DCWs to take paid sick leave when ill. Portable benefits are benefits employees can take from job to job, prorated so that multiple employers can contribute, and accessible to all workers. Portable benefits are not widely available. I held 1)individual in-depth interviews and focus groups to explore the needs, attitudes, and beliefs of DCWs regarding work benefits, 2) two co-design sessions and a member checking session with DCWs to develop and refine policy recommendations for Maryland DCWs' portable work benefits, and 3) a co-design session and member checking sessions to develop usability recommendations for websites delivering portable benefits to DCWs. This study provides findings about direct care workers' experiences with inadequate or nonexistent work benefits, their recommendations for policy to support benefits that meet their needs and preferences, and their usability recommendations for portable benefits websites. This study provides information on how to design work benefits for DCWs that protect them, protect those around them, and improve work conditions in hopes of improving work conditions and compensation.Item Road to Recovery: Bringing the Outdoors In(2023) Mencer, Abigail Brurya; Williams, Joseph; Architecture; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Patients in oncology centers experience extreme physical and psychological anguish due to illness. Patients spend a lot of time in these facilities, often during the most turbulent times in their lives. Current healthcare facilities are designed around medical technology. Medical centers thrive on scientific ingenuity and innovative technology. However, through this process the wellbeing of patients is disregarded almost entirely, leaving healthcare facilities barren and cold. Incorporating biophilia into the design of healthcare facilities provides for a patient’s health and wellbeing. Utilizing biophilic design with a focus on health and wellness within healthcare design can transform the recovery of patients as they seek care. This thesis investigates how designing for a patient's wellbeing can benefit their medical experience. The philosophy for the design of this thesis is to utilize biophilic design approaches to focus on the wellbeing of patients as they receive care. This includes design strategies that include natural elements, views to nature, as well as a biophilic approach to materiality and lighting. The context for this project is a cancer center that incorporates biophilic design with the technology of modern medicine resulting in a facility that is designed for a patient's wellbeing.Item A Human-centric Approach to NLP in Healthcare Applications(2021) Shing, Han-Chin; Resnik, Philip; Oard, Douglas W; Computer Science; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The abundance of personal health information available to healthcare professionals can be a facilitator to better care. However, it can also be a barrier, as the relevant information is often buried in the sheer amount of personal data, and healthcare professionals already lack time to take care of both patients and their data. This dissertation focuses on the role of natural language processing (NLP) in healthcare and how it can surface information relevant to healthcare professionals by modeling the extensive collections of documents that describe those whom they serve. In this dissertation, the extensive natural language data about a person is modeled as a set of documents, where the model inference is at the level of the individual, but evidence supporting that inference is found in a subset of their documents. The effectiveness of this modeling approach is demonstrated in the context of three healthcare applications. In the first application, clinical coding, document-level attention is used to model the hierarchy between a clinical encounter and its documents, jointly learning the encounter labels and the assignment of credits to specific documents. The second application, suicidality assessment using social media, further investigates how document-level attention can surface "high-signal" posts from the document set representing a potentially at-risk individual. Finally, the third application aims to help healthcare professionals write discharge summaries using an extract-then-abstract multidocument summarization pipeline to surface relevant information. As in many healthcare applications, these three applications seek to assist, not replace, clinicians. Evaluation and model design thus centers around healthcare professionals' needs. In clinical coding, document-level attention is shown to align well with professional clinical coders' expectations of evidence. In suicidality assessment, document-level attention leads to better and more time-efficient assessment by surfacing document-level evidence, shown empirically using a theoretically grounded time-aware evaluation measure and a dataset annotated by suicidality experts. Finally, extract-then-abstract summarization pipelines that assist healthcare professionals in writing discharge summaries are evaluated by their ability to surface faithful and relevant evidence.Item THE SYNDEMIC EFFECT OF PSYCHOSOCIAL AND STRUCTURAL FACTORS ON HIV TESTING AMONG BLACK MEN AND THE MODERATING EFFECT OF SEXUAL IDENTITY(2018) Turpin, Rodman Emory; Dyer, Typhanye; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Black populations experience the highest incidence and prevalence of HIV in the United States. It has been posited that numerous structural and psychosocial factors contribute to HIV disparities among Black populations, these factors can have an adverse effect on healthcare utilization, including HIV testing. Given the burden of HIV rates among Black men, especially Black gay and bisexual men, it is important to consider possible barriers to HIV testing in this population. Syndemic theory posits a mutually reinforcement of social and structural conditions that cumulatively affects disease outcomes. While syndemic theory has been applied to HIV acquisition, this framework has not been utilized for HIV testing. We tested for a syndemic of depression, poverty, and a lack of healthcare access impacting HIV testing and tested sexual identity as a moderator of healthcare access in a nationally representative sample of Black men. Participants with 2 or 3 syndemic factors were significantly more likely to have never been HIV tested compared to those with 0 or 1 (49.2% to 31.7%). Having 3 syndemic factors was associated with greater prevalence of never having been HIV tested (aPR=1.46, 95% CI 1.09, 1.95). Gay/bisexual identity moderated the association between health insurance and ever having been HIV tested in adjusted models (aPR=4.36; 95% CI 1.40, 13.62), with not having health insurance being associated with HIV testing among gay/bisexual participants only (aPR=4.84, 95% CI 1.19, 19.70). Using latent class analysis, four syndemic classes were identified as significant predictors of having never been HIV tested. In adjusted log-binomial models, compared to the class with the lowest proportion of syndemic factors, the highest prevalence of never having been HIV tested was among the class with the highest proportions of syndemic component factors (aPR=2.27, 95% CI 1.83, 2.82). Overall, there is evidence of a syndemic of depression, poverty, and a lack of healthcare access that negatively affects HIV testing among Black men, with a lack of healthcare access being a significantly greater barrier to HIV testing among gay/bisexual men compared to heterosexual men.Item Application of Mathematical and Computational Models to Mitigate the Overutilization of Healthcare Systems(2017) Hu, Xia; Golden, Bruce; Barnes, Sean; Applied Mathematics and Scientific Computation; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The overutilization of the healthcare system has been a significant issue financially and politically, placing burdens on the government, patients, providers and individual payers. In this dissertation, we study how mathematical models and computational models can be utilized to support healthcare decision-making and generate effective interventions for healthcare overcrowding. We focus on applying operations research and data mining methods to mitigate the overutilization of emergency department and inpatient services in four scenarios. Firstly, we systematically review research articles that apply analytical queueing models to the study of the emergency department, with an additional focus on comparing simulation models with queueing models when applied to similar research questions. Secondly, we present an agent-based simulation model of epidemic and bioterrorism transmission, and develop a prediction scheme to differentiate the simulated transmission patterns during the initial stage of the event. Thirdly, we develop a machine learning framework for effectively selecting enrollees for case management based on Medicaid claims data, and demonstrate the importance of enrolling current infrequent users whose utilization of emergency visits might increase significantly in the future. Lastly, we study the role of temporal features in predicting future health outcomes for diabetes patients, and identify the levels to which the aggregation can be most informative.Item Applications of parametric and semi-parametric models for longitudinal data analysis(2014) Talukder, Hisham; Corrada Bravo, Héctor; Applied Mathematics and Scientific Computation; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)A wide range of scientific applications involve analyses of longitudinal data. Whether it is time or location, careful considerations need to be made when applying different statistical tools. One such challenge is to correctly estimate variance components in observed data. In this dissertation, I apply statistical tools to solve problems involving longitudinal data in the field of Biology, Healthcare and Networks. In the second chapter, I apply SSANOVA models to find regions in the genome that have a specific biological trait. We introduce a direct approach of estimating genomic longitudinal data of two different biological groups. Using SSANOVA we then produce a novel method to estimate the difference between the two groups and find regions (location or time) where this difference is biologically significant. In the third chapter, we analyze longitudinal network data using an overdispersed Poisson model. We build a network of musical writers yearly for a 42 year period. Using statistical models, we predict network level topology changes and find covariates that explain these changes. Network level characteristics used for this chapter include average node degree, clustering coefficient and network density. We also build a visualization tool using R-Shiny. The fourth chapter uses data partitioning to study the difference between insured patients and uninsured patients in health outcomes. There is a disparity in health outcomes depending on an individual's type of insurance. The level of risk for an injury is the longitudinal aspect of this dataset. We partition the data into four pre-defined risk categories and evaluate the disparity between insured and uninsured patients using logistic regression models.Item Examining Healthcare Expenditures: Mechanical Ventilation & An Evaluation of Long-Term (Acute) Care Hospitals(2013) Frank, Jared; Lee, Sunmin; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study analyzed demographic and clinical characteristics, actual hospital/facility costs, and Medicare charges/payments among beneficiaries discharged to, and from, long-term (acute) care hospitals (LTCHs), skilled nursing facilities (SNFs), or inpatient rehabilitation facilities (IRFs) following an acute inpatient hospitalization under Medicare-severity diagnosis-related group (MS-DRG) 207, "respiratory system diagnosis with ventilator support for greater than 96 hours." We also examined the likelihood of discharge by provider type to determine criteria informing patient discharge to a LTCH, SNF, or IRF for treatment. Concerning discharges to LTCHs, patients were not significantly older, did not have the highest length of stay, and had comparable diagnoses and diagnosis counts to those discharged elsewhere. Discharges from LTCHs had significantly higher diagnosis counts and lengths of stay. Costs, charges, and payments were significantly higher among discharges to, and from, LTCHs. Multinomial logistic regression analyses indicated numerous associations between certain variables and discharge location.Item LEARNING MECHANSIMS AND HEALTH INFORMATION TECHNOLOGY(2012) Kothari, Anupama Kunal; Agarwal, Ritu; Viswanathan, Siva; Business and Management: Marketing; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Health information technology (HIT) is gaining momentum and widespread use globally in healthcare institutions through the implementation and use of HIT such as telemedicine and electronic medical records. Literature has discussed various aspects of health information technology such as increasing the accessibility of healthcare, improving the efficacy and reducing associated errors. However, the potential of HIT as a medium of learning has largely been ignored by extant literature. This dissertation seeks to understand the mechanisms of learning in the context of health information technologies, specifically- telemedicine and electronic medical records. The two essays investigate the characteristics of learning under telemedicine and under electronic records. The first essay uses a quantitative mode of investigation, while the second essay utilizes a qualitative mode of research. The first essay deals with telemedicine, a healthcare information technology that provides healthcare across geographic boundaries. The essay investigates how the telemedicine process facilitates synchronous learning in terms of a facilitator-learner theoretical model. It explores the impact of facilitator characteristics and learner characteristics on synchronous learning. Additionally, the essay also examines the impact of organizational variables such as technology on the relationship between learning and facilitator-learner mechanics. Data for this essay is drawn from surveys administered over several hospitals that use telemedicine in India. The second essay studies the role of electronic medical records in information dissemination and learning. In this essay, the role of electronic medical records in providing healthcare personnel with asynchronous learning opportunities is investigated. It explores the impact of individual and organizational factors on discovery learning through electronic medical records. The essay identifies factors such as case complexity, status, familiarity with technology and clinical specialty that influence learning through electronic medical records. The second essay draws on interviews of members of a healthcare team in a multiple specialty hospital that uses electronic medical records. Together, the essays explore various aspects of learning through health information technology, including synchronous learning, asynschronous learning, learning mechanics and motivations for learning.Item Architecture in Defense of Dignity(2008) Derenick, David; Noonan, Peter V; Architecture; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Architecture can help people defend dignity when they most need it. This thesis investigates three areas in which a place may offer support: identity, or personhood; liberty, or control over environment; and vitality, or sense of purpose. The thesis proposes a design for an inpatient rehabilitation center, for people who have suffered from traumatic brain injury (TBI). Challenges to dignity are not limited to health care settings, but TBI highlights these challenges by impairing a patient's own defenses and straining a family's ability to cope. Among proposed architectural elements are rooms allowing self-expression yet offering respite; luminous shafts providing for control of daylight, fresh air, and information; and empowering dining and garden spaces. Rehabilitation is transitional, occurring after acute hospital treatment and ideally leading to a return home. A site in Philadelphia near hospital campuses, but rooted in a residential neighborhood, is an ideal for a place of dignified transition.Item PROGRAM VS. CONTEXT: UNDERSTANDING THE ROLE OF INSTITUTIONAL BUILDINGS IN THE CITY(2004-05-20) Pancham, Satya; Schumacher, Thomas L.; ArchitectureInstitutional buildings are necessary in any community whether it is an urban or suburban setting. Typically, these are large program driven buildings that do not relate very well to their surrounding communities because they are often envisaged as large object buildings that create vast undefined spaces. In order to positively promote buildings that are beneficial to the urban fabric, institutional buildings must be studied as a contextual and space defining type instead of being an isolated object in an amorphous field. The institutional building type to be studied is the hospital because these are often large program driven buildings. The area of interest is southeast Washington DC and the site is located at the end of Massachusetts Avenue and 19th Street. This site is significant because of its accessibility and its larger impact on the healthcare network of the city.