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.
More information is available at Theses and Dissertations at University of Maryland Libraries.
Browse
3 results
Search Results
Item THREE ESSAYS ON MARYLAND'S GLOBAL BUDGET REVENUE PROGRAM AND HOSPITAL-BASED NEONATAL CARE(2020) Xie, Liyang; Boudreaux, Michel; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Health care spending is a major concern in the United States. State and federal governments have been engaged in a number of health care system reform initiatives designed to contain costs by regulating both price and quantity. Comprehensive evaluations of these initiatives are crucial for policymakers reshaping and expanding reforms. This dissertation evaluates the impact of Maryland's Global Budget Revenue (GBR) program, one of the most innovative statewide hospital payment reforms, on birth-related hospital utilization. The GBR program was designed to provide incentives for hospitals to reduce high-cost services and substitute them for lower-cost population health investments. This is largely accomplished by capitating annual budgets. This dissertation evaluated the effects of GBR on high-cost neonatal services, especially the neonatal intensive care unit (NICU). I examine heterogeneous treatment effects with respect to observable clinical needs and financial incentives. In Chapter One, I provide an overview of Maryland’s GBR program and introduce the conceptual framework. In Chapter Two, I examine the impact of GBR on NICU admissions and infant mortality. I explore the heterogeneity of treatment effects by infant health risk. Chapter Three expands the analysis to broader birth-related hospital services by investigating the impact of GBR on length of stay (LOS), the total cost of care, and utilization of specific high-cost services. Chapter Four departs from GBR and examines NICU utilization related to another critical source of financial incentive – health insurance type. Chapter Five concludes the dissertation. I find that Maryland's GBR program led to a substantial decline in NICU admissions, which was mainly driven by the decrease in admissions of relatively healthy infants, and there are no changes in the infant or neonatal mortality rate. The GBR program is also associated with declines in LOS and high-cost services used for infants. Finally, I observe that infant, maternal, and state characteristics explain the variations in NICU care across insurance type for high-risk infants but not for relatively low-risk infants. My findings provide positive evidence on implementing global hospital budget programs and shed light on the economic incentives affecting NICU care.Item Alcohol exposure in preterm infants in neonatal isolettes(2013) Braun, Rebecca Marie; Sapkota, Amir; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Preterm infants admitted to the NICU may spend up to 12 weeks in isolettes (incubators with controlled air temperature and humidity). Infants receive frequent contact with health-care professionals who use alcohol-based hygiene products. Ethanol is a known developmental neurotoxicant, and inhalation may have long-term effects on infant neurodevelopment. This study assessed alcohol concentration in isolette air after inserting hands cleaned with hand sanitizer, and effects of longer hand rubbing before insertion into the isolette. Each exposure consisted of two squirts (1.5 ± 0.1mL) of hand sanitizer, and hands rubbed for 10 or 20 seconds before insertion into isolettes. Air samples were collected by photoionization detector and breathalyzer. Average ethanol peaks were 387.04ppm (10s) and 104.36ppm (20s). Ethanol levels peaked within 1min, dissipated within 5min, and returned to background within 15 - 20min. Alcohol exposure from ethanol based hand sanitizer may be decreased significantly with longer duration of hand rubbing.Item The Poetics of Bodily Being: The Lived Experience of Breastfeeding an Infant "Out of Reach" in the NICU(2013) Sampson-Kelly, Christy A.; Hultgren, Francine; Lieber, Joan; Special Education; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Babies born preterm (<37 weeks gestation) and at very low birth weight (VLBW, <1500 grams, 3.3 pounds) reside "out of reach" from their mothers in a neonatal intensive care unit (NICU) during the very beginnings of life. As the evidence of breast milk versus formula for infants within this vulnerable population is well established, multiple initiatives call for the provision of breast milk, and NICU professionals are subsequently making efforts to increase numbers of breastfed infants. However, there is a gap in the scholarly literature that brings forth mothers' voices relative to this unique breastfeeding experience. These voices are imperative to making a greater understanding of this phenomenon. This hermeneutic phenomenological study asks the question: What is the lived experience of providing breast milk for one's child who lives in a NICU? My exploration draws upon the writings of several philosophers including Levinas, Heidegger, Merleau-Ponty, Gadamer, and Derrida that relate to the phenomenon and discover how the phenomenon is made visible through them. The wondrous writings of poets are interlaced throughout my journeying, reverberating the deep meaning that lies beneath the surface of things. Max van Manen's depiction of hermeneutic phenomenology provides the methodological structure for the study, which is uncovered through the multiple, individual conversations with and journal entries of ten mothers who share this human experience. As meaning unfolds, breastfeeding emerges centrally, as a remedy and offering a way to transcend the dis-eases of self-blame, dis-place-ment, and dis-member-ment underwent as part of mothering in the NICU. Reflecting on these dis-eases, calls for the offering of pedagogical insights of more welcoming and less judgment in supporting mothers in doing the work of mothering, taking on a view of breast milk as more than pure resource, and the importance of nurturing the nurses. Attending to these stories may help NICU professionals to imagine an environed NICU, were mothers, too, are cared for in their journey to self-forgiveness, em-place-ment, and re-member-ment, amid the strange and wondrous terrain of their beginnings.