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.

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    Exploring remote service provision in adult day centers during the COVID-19 pandemic
    (2023) Marte, Crystal; Lazar, Amanda; Vanderheiden, Gregg; Library & Information Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    The COVID-19 pandemic profoundly impacted the long-term services and supports (LTSS) sector, necessitating a rapid shift from in-person services to remote. Adult day service centers (ADSCs) – a type of LTSS – offer in-person community-based programs comprised of health and wellness services to historically underserved populations, such as communities of color, low-income, and older adults. Based on data collected from 23 semi-structured interviews with 22 providers from eight ADSCs across a Mid-Atlantic state, this thesis explores the experiences of ADSC providers – such as directors, activity staff, and nurses – as they navigated pandemic-related closures. To ensure uninterrupted services, centers leveraged their existing infrastructure and adapted to a remote service model. An intricate interplay of technical (e.g., access to devices, internet) to non-technical (e.g., digital literacy, sociocultural context, limited staff) variables affected the overall success of remote services. Simultaneously, ADSCs grappled with limited reimbursement for remote services – which directly impacted their operations and the sustainability of remote services. These findings offer insights into the challenges and adaptations providers experienced amidst an unprecedented crisis, shedding light on the systemic issues throughout this period. The study seeks to inform future interventions that promote the sustainability of remote services in ADSCs, with a specific focus on preventing service disruptions for historically underserved populations.
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    Comparative Analysis of the Effectiveness and Safety of Drug-eluting Versus Bare-metal Coronary Stents Among Patients Registered in the Multi-Payer Claims Database
    (2015) Bermudez, Jessica; Carter-Pokras, Olivia; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    There is conflicting evidence as to whether bare-metal stents (BMS) or drug-eluting stents (DES) are more effective at preventing restenosis. The purpose of this study is to compare the safety and effectiveness of BMS versus DES in the coronary artery using unconventional and potentially more efficient post-market surveillance methods. A retrospective cohort study was conducted of 217,654 Medicare, Medicaid, and private insurance beneficiaries ages 41 years and older who were treated with coronary stenting between January 2007 and December 2010. Incidence of coronary health outcomes was measured for 2-3.5 years after stent implantation using claims data and assessed using Cox proportional hazards regression models stratified by gender and race. At baseline, DES recipients were younger, had higher rates of ischemia and high cholesterol, and had lower rates of prior myocardial infarction and hypertension compared to BMS recipients. Compared to BMS, DES use was associated with a significant reduction of myocardial infarction (Hazard Ratio (HR): 0.811; CI: [0.774, 0.84]), coronary artery bypass graft (HR 0.627; CI: [0.590, 0.666]), and repeat percutaneous coronary intervention (HR 0.910; CI: [0.888, 0.933]) at a median follow-up of 659 days. Use of DES was associated with superior CHD outcomes compared to BMS regardless of gender. Increased event-free probability for DES compared to BMS was seen among whites and Asians for AMI, among whites only for CABG, and across all races for repeat stenting.
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    The Impact of Formal Social Support on Outpatient Care Among a Sample of Adults Living with HIV/AIDS in the United States
    (2007-11-19) Matoff-Stepp, Sabrina A; Boekeloo, Ph.D., Bradley O.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Background The HIV Cost and Services Utilization Study and HIV Research Network (HIVRN) clinical studies showed disparities among HIV-positive men and women in outpatient care use in the U.S. Formal social support provided by case managers may help patients access outpatient care. The primary purpose of this study was to determine if having case managers is associated with levels of outpatient care visits among 797 individuals living with HIV/AIDS, and whether this association varies by patient sex. Other aims were to determine if the number of in-person case management visits and the type of formal social support are associated with these same outcomes. Outpatient visit levels were defined as 2-5 (average) or 6+ (high). Based on Andersen's (1995) Behavioral Model of Health Services Use, a conceptual model was developed as a framework for examining the study's hypothesized relationships. Methods The HIVRN is a convenience sample of 17 U.S. clinical sites serving more than 15,000 people living with HIV/AIDS. In 2003, interviews were conducted with a stratified sample of 951 clients at 14 HIVRN sites. The current study sample consisted of 797 adult respondents (543 males and 254 females). Logistic regression was used to identify significant predictors of outpatient care visit levels. Results Patients who had one or two case managers versus no case managers were significantly more likely to have 6+ outpatient visits, while patients who were employed and had higher self-reported perceptions of their health were significantly less likely to have 6+ outpatient visits. These relationships did not vary by patient sex. Level of outpatient visits also did not vary by patient sex. No significant associations were found between the number of in-person case management visits or the type of formal social support and level of outpatient visits. In sub-analyses that separated patients with one case manager from those with two case managers, no new predictors emerged. Conclusion Case management was associated with higher levels of outpatient visits for both male and female patients in this study. This finding suggests that utilization of HIV-related outpatient care may be increased among both men and women with case management.