Richard M. Fairbanks School of Public Health Theses and Dissertations

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Browsing Richard M. Fairbanks School of Public Health Theses and Dissertations by Author "Babich, Suzanne"

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    Aligning Priorities Between Community Need for Lung Cancer Screening Programs and Hospital Effectiveness - A Policy Analysis
    (2025-05) Tackett, Scott Michael; Marstein, Egil; Babich, Suzanne; Culbertson, Richard
    Objective: Investigate structural factors impacting the prioritization and funding of public health preventive lung cancer screening programs in U.S. hospitals. Additionally, provide change leadership recommendations on policies to improve the implementation of evidence-based practices. Data sources and study setting: Data was gathered through a systematic literature review and primary qualitative research from health system or hospital organizational leadership across the U.S. Study design: The research employed a descriptive, non-experimental, convergent mixed-methods approach. Quantitative and qualitative data were collected and analyzed independently, then combined to obtain detailed insights from various perspectives across a diverse system for a situational analysis. Data Collection and Methods: A systematic literature review, combined with semi-structured interviews with Chief Medical Officers, Chief Financial Officers, and lung cancer program executives, was conducted across U.S. hospitals and health systems. Purposive sampling included thirteen dyad executive pairs and two executives from integrated delivery network lung cancer programs, representing various regions with a 'representative voice' of 6% of U.S. hospitals. Principal findings: The data synthesis identified 18 factors affecting lung cancer screening programs, categorized into five themes: differing missions, governance models, misaligned economics, competing goals, and broad agreements. These themes illustrate national discussions influencing the implementation of these types of preventive public health programs in hospitals and integrated delivery network organizations. Discussion: Despite efforts to implement evidence-based practices, outcomes and annual adherence rates remain low, showing room for improvement. This study is the first to provide empirical evidence that system-level factors in healthcare governance, processes, economics, and strategic decisions significantly influence the prioritization and investment in lung cancer screening programs and initiatives to implement an evidence-based practice. Summary & Conclusions: CMS should implement policies linking quality measurement with economic incentives in lung cancer care. These policies aim to prioritize investments supporting implementation practices. Their adoption requires political and agency leadership and represents a significant shift in approach. Aligning with these types of motivating economic incentive policies could impact the entire U.S. healthcare system.
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    Establishing Policy Governance for Department of Defense Global Health Engagement Supporting United States Government Security, Defense, and Global Health Security Priorities: A Policy Analysis
    (2025-02) Cincotta, Jacqueline Viola-Ann; Babich, Suzanne; Marstein, Egil; Petzing, Stephanie
    Introduction. The United States (U.S.) Department of Defense (DoD) conducts DoD Global Health Engagement activities to support U.S. national, defense, and global health security priorities. The guiding policy for DoD Global Health Engagement is DoDI 2000.30 “Global Health Engagement Activities.” Problem Statement. The current DoDI 2000.30 “Global Health Engagement Activities” lacks an established governance framework and structure to oversee and ensure DoD Global Health Engagement activities enable U.S. national, defense, and global health security priorities. Methods. A complete policy analysis was conducted to devise policy alternatives for establishing DoD Global Health Engagement governance in DoD Global Health Engagement policy. Results. The policy analysis identified direct and indirect linkages DoD supports U.S. national, defense, and global health security priorities, as well as associated gaps in current DoD Global Health Engagement policy. Policy Alternatives & Plan-of-Action: A proposed DoD Global Health Engagement Governance Framework is introduced to recommend incorporating into DoD Global Health Engagement policy, as well as a plan-of-action utilizing social marketing to facilitate uptake of the proposed governance framework.
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    Healthcare-Associated Infections (HAI) in Kazakhstan: Can We Trust Reporting? A Mixed-Methods Study of Institutional Culture, Context and Leadership in Hospitals and State Public Health Agencies
    (2023-11) Aiypkhanova, Ainur; Marstein, Egil; Deryabina, Anna; Babich, Suzanne
    Background. Health care-associated infections (HAI) are among the most common adverse events in health care delivery globally, with up to 7% of patients in high-income countries and up to 15% in low- and middle-income countries acquiring one during their hospital stay [1]. However, HAI rates in Kazakhstan did not exceed a fraction of one percent for decades [2, 3]. While up to 70% of HAI are preventable through effective infection prevention and control (IPC) practices [1], not knowing the real rate reduces the sense of urgency for national and local leaders and delays action to improve patient safety. Such low HAI rates in Kazakhstan led public health leaders to suspect underreporting, prompting a WHO-sponsored pilot point-prevalence survey, which found a 3.2% HAI rate in 2022, 90 times higher than the reported rate of 0.35% for the same year [4]. This study aimed to find out why health care organizations (HCO) are not reporting HAIs to health authorities, and based on the influence of institutional culture, organizational and country context, how public health leaders can best improve HAI surveillance. Methods. This is a mixed-methods study that used triangulation and grounded theory to analyze data collected in 4 stages: 1) desk review of national policies; 2) secondary datasets collected in a national study of 78 hospitals; 3) qualitative primary data collected from 12 key informants (public health leaders); 4) repeated desk review. safety and get involved in IPC. Epidemiologists from public health agencies must become the source of methodological support and have their training needs met as well. While this study generated evidence in support of multiple recommendations, the water of systems change model [9] can help policymakers appreciate the importance of implicit change conditions such as the culture, often ignored in change efforts undertaken in the post-Soviet countries. Conclusions. HAI rate remains abnormally low in Kazakhstan due to the long-lasting effect of the Soviet approach to IPC and the resulting punitive culture and punitive policies that deter providers from reporting. Findings from this study should be used by national, regional and HCO leaders in Kazakhstan and other countries with similar context to prioritize and design system-wide improvements in IPC and HAI surveillance. Recommendations should not be limited to traditional leadership actions such as policy change, more training and introduction of evidence-based protocols and procedures, but also include an implicit change condition – culture change – to create an environment conducive of truthful reporting of adverse events such as HAIs.