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 M."

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    Physician Compensation Models and Quality of Healthcare Services in the United Arab Emirates
    (2023) Elrefaey, Mahmoud; Tierney, William Michael; Babich, Suzanne M.; Czabanowska, Katarzyna
    Physicians working in different healthcare systems receive financial compensation by means of several structures (e.g., the salaried model, the fee-for-service model, and the revenue-share model) depending on how and where they practice. Most research on the relationships, if any, between physicians' compensation models and the outcomes of healthcare services has been conducted in North America and Europe, but no equivalent research has been conducted in the United Arab Emirates (UAE). The purpose of my exploratory qualitative research study was to address two open-ended research questions: 1) what are the perceptions of hospital stakeholders about the idiographic effects of different physician payment models on quality of healthcare services in the hospital? 2) What changes might be implemented to physician payment models to improve healthcare services in the hospital? I audio-recorded semi-structured interviews with a purposive sample of N = 17 stakeholders at one private sector hospital in UAE. The heterogenous or maximum variation sample included five hospital leaders, two financial or insurance managers, five physicians, two nurses, and three patients. I conducted a qualitative analysis and identified ten primary semantic themes by deductive reasoning to address the first research question. I based four semantic themes on a template extracted from the literature, specifically: 1) Physician Payment Models Implemented at the Hospital; 2) Environmental Context for Payment Models; 3) Stakeholders Affected by Payment Models; 4) Misuse of Payment models. I underpinned six semantic themes by the dimensions of healthcare quality proposed by the Institute of Medicine, specifically: 5) Payment Models and Safe Care; 6) Payment Models and Effectiveness of Care; 7) Payment Models and Patient-Centered Care; 8) Payment Models and Timely Care; 9) Payment Models and Efficiency of Care; 10) and Payment Models and Equity of Care. Subsequently, I synthesized the semantic themes and identified two latent themes by inductive reasoning, specifically: 1) Relationships between Physicians' Compensation Models and Healthcare Services; and 2) Proposed Changes to Physician Compensation Models. I propose innovative changes underpinned by Kotter's Management Change Theory and Roger's Theory of Diffusion of Innovations. I recommend future confirmatory research using a quantitative correlational design to validate these themes.
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    Stroke Training, Research, and Education Toward Capacity With Hydroxyurea (Stretch)
    (2024-05) Latham, Teresa Smith; Czabanowska, Katarzyna; Babich, Suzanne M.; Ware, Russell E.; Yego-Kosgei, Faith
    Background and Purpose: Sickle cell anemia (SCA) is an inherited hematological disease characterized by chronic pain, susceptibility to infections, and significant morbidity and mortality, particularly among children living in resource-limited settings. Stroke is a complication of SCA that can be prevented through transcranial Doppler (TCD) ultrasonography, a screening tool that identifies children at risk, and treatment with hydroxyurea. This study will inform how public health leaders can mitigate stroke risk among children with SCA in sub-Saharan Africa and how TCD screening fits into a larger context of providing safe, effective care. Methods: Stroke Training, Research, and Education Toward Capacity with Hydroxyurea (STRETCH) utilized a qualitative design that included semi-structured interviews with TCD examiners and stakeholders. There were 17 interviews with TCD examiners who participated in a training and supervision program, TCD trainers, and clinical care providers from 6 countries across sub-Saharan Africa. Interviews were coded and analyzed for themes that were used to identify effective training and program strategies, and to develop a capacity-building model for resource-limited settings. Results: Participants reported satisfaction with the training program, noting that in-person training with sub-Saharan Africa-based examiners was preferable to initial training using a web-based platform, and that ongoing training, supervision, and technical support through collaboration between US-based and Africa-based teams was conducive to skill development. Participants described the major clinical and socioeconomic impact of SCA on children, families and communities and emphasized the role of hydroxyurea in preventing complications and decreasing burden on health systems. Results indicate a call to action for improved education for clinicians, families, and community leaders and stakeholder support for health policy to facilitate access to hydroxyurea. Conclusion: The complexities of healthcare infrastructure and the morbidity and mortality associated with SCA in resource-limited settings warrant a multifaceted approach to capacity building. The STRETCH model integrates education, policy development, and access to hydroxyurea as a holistic approach that leverages geographical partnerships and builds on existing resources in sub-Saharan Africa. By simultaneously addressing education, policy, and access barriers, public health leaders can work collaboratively toward building sustainable capacity that improves outcomes for children with SCA in these settings.