Highly variable health care and patient outcomes occur in different regions of the U.S. According to a report from the American Cancer Society, deaths from colon cancer have declined in all but three regions of the country: eastern Virginia/North Carolina, lower Mississippi delta, and west-central Appalachia. The U.S. colon cancer death rate has declined by half over the past decades, partly due to screening, but there are large differences between states (Preidt, 2015a). Another study showed that 36% of counties in the U.S. are more than 50 miles from the nearest doctor specializing in ovarian, uterine, and cervical cancers, putting many women at a disadvantage for quality care and positive outcomes (Preidt, 2015b). Lastly, kidney dialysis rates in the U.S. are higher in poor neighborhoods (Preidt, 2015c). Possible reasons for these differences include less access to care, greater exposure to environmental toxins, and lifestyle habits.DISCUSSION QUESTIONS1. What can or should be done when populations are disproportionately unhealthy or at higher risk for certain health conditions?2. You are a health educator working for the state Department of Public Health. How do you prioritize on what health conditions or concerns your Department focuses?3. What data sources will you rely on?4. How do you help hospitals in the geographic region address these health disparities?REFERENCESPreidt, R. (2015a, July 8). Colon cancer deaths falling, but 3 U.S. regions lag behind. HealthDay. Retrieved from http://consumer.healthday.com/cancer-information-5/colon-cancer-news-96/colon-cancer-deaths-falling-except-in-3-u-s-regions-701056.htmlPreidt, R. (2015b, June 15). Many U.S. women live far from gynecologic cancer care: Long distances may impede evaluation, treatment, researcher says. HealthDay. Retrieved from http://consumer.healthday.com/cancer-information-5/cervical-cancer-news-95/many-u-s-live-miles-from-gynecologic-care-700352.htmlPreidt, R. (2015c, June 24). U.S. dialysis patients increasingly live in poor areas: One-third with kidney failure come from low-income neighborhoods, study finds. HealthDay. Retrieved from http://consumer.healthday.com/diseases-and-conditions-information-37/misc-kidney-problem-news-432/dialysis-patients-in-u-s-increasingly-live-in-poor-areas-700497.htmlused in-taxt citation name of the book is introduction to health care management INTRODUCTION TO HEALTH CARE...-W/ACCESSAuthorBUCHBINDEREdition/Copyright3RD 17Published Date2017ISBN9781284081015

Health Care Delivery and Cross Cultural Health Perspectives Assignment:Discuss the advantages and disadvantages of a company having healthcare insurance for their workers. Is this cost effective when we see a worker missing work for weeks at a time? What are the legal implications if one is not allowed to take as much time as they need to recuperate? Expectations: 1 page, 3 cited sources from required readingRequired ReadingBlavin, F., Shartzer, A., Long, S. K., & Holahan, J. (2015). An early look at changes in employer-sponsored insurance under the affordable care act. Health Affairs, 34(1), 170-177. doi:http://dx.doi.org/10.1377/hlthaff.2014.129Boulanger, R. F., Hunt, M. R., & Benatar, S. R. (2016). Where caring is sharing: Evolving ethical considerations in tuberculosis prevention among healthcare workers. Clinical Infectious Diseases, 62(suppl 3), S268-S274.Chai, S. J., Mattingly, D. C., & Varma, J. K. (2013). Protecting health care workers from tuberculosis in China: a review of policy and practice in China and the United States. Health policy and planning, 28(1), 100-109.Kilgour, E., Kosny, A., Mckenzie, D., & Collie, A. (2015). Healing or harming? Healthcare provider interactions with injured workers and insurers in workers' compensation systems. Journal of Occupational Rehabilitation, 25(1), 220-239. doi:http://dx.doi.org/10.1007/s10926-014-9521-xLaurence, Y. V., Griffiths, U. K., & Vassall, A. (2015). Costs to health services and the patient of treating tuberculosis: a systematic literature review. Pharmacoeconomics, 33(9), 939-955.Li, Y., Ehiri, J., Hu, D., Oren, E., & Cao, J. (2015). Framework of behavioral indicators evaluating TB health promotion outcomes: A modified Delphi study of TB policymakers and health workers. Infectious Diseases of Poverty, 4.Radonovich, L. J., Bessesen, M. T., Cummings, D. A., Eagan, A., Gaydos, C., Gibert, C., . . . Perl, T. M. (2016). The respiratory protection effectiveness clinical trial (ResPECT): A cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel. BMC Infectious Diseases, 16 doi:http://dx.doi.org/10.1186/s12879-016-1494-2Verkuijl, S., & Middelkoop, K. (2016). Protecting our front-liners: Occupational tuberculosis prevention through infection control strategies. Clinical Infectious Diseases, 62(suppl 3), S231-S237.von Delft, A., Dramowski, A., Sifumba, Z., Mosidi, T., Ting, T. X., von Delft, D., & Zumla, A. (2016). Exposed, but not protected: More is needed to prevent drug-resistant tuberculosis in healthcare workers and students. Clinical Infectious Diseases, 62(suppl 3), S275-S280.Yassi, A., Adu, P. A., Nophale, L., & Zungu, M. (2016). Learning from a cluster randomized controlled trial to improve healthcare workers’ access to prevention and care for tuberculosis and HIV in Free State, South Africa: the pivotal role of information systems. Global Health Action, 9, 10.3402/gha.v9.30528. http://doi.org/10.3402/gha.v9.30528

The Direct Practice Improvement (DPI) Project incorporates 10 key or strategic points that need to be clear, simple, correct, and aligned to ensure the project is doable, valuable, and credible. These points, which provide a guide or vision for the project, are present in almost any research. These 10 points are defined and instructions for completion of the “DPI Project Milestone: Outline of 10 Strategic Points” assignment are provided in "The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project," resource located in the DC Network.Directions:Download The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project. (The 10 strategic point included below)Complete the table in the 10 strategic points DPI.DPI PICOT Question: Do postpartum mothers who participate in early and direct skin-to-skin contact, compared to mothers who do not participate in early and direct skin-to-skin contact report increased breastfeeding initiation rate, within first 24-hours after birth?ORIn postpartum mothers and newborns, how does direct skin-to-skin contact, compared to no skin-to-skin contact, affect breastfeeding initiation as measured by infant’s ability to latch-on and effective suckling, when practiced within the first 24-hours after birth?The 10 Strategic Points for the Prospectus, Proposal,and Direct Practice Improvement ProjectIntroductionIn theProspectus, Proposal, and Direct Practice Improvement Project, there are 10 key or strategic points that need to be clear, simple, correct, and aligned to ensure the project is doable,valuable, and credible. These points, which provide a guideor vision for the project, are present in almost any project. The 10 Strategic Points are defined within this document and a template provided. The ten strategic points are developed in a table format, as noted below.The Process for Defining the 10 Strategic PointsThe order of the 10 Strategic points listed below reflects the order in which the learner completes the work product. The first five strategic points focus primarily on defining the purpose or focus for the project based on a clearly defined need or gap from the literature as well as the learner’s passion and specialty area focus. First, learners identify a broad topic area to investigate for their Direct Practice Improvement (DPI) Project. Second, learners complete a review of the literature to define the need or gap to be addressed, the theories and models that will provide a foundation for the project, related themes that are needed to demonstrate the learner's expertise in the field and to define the key strategic points behind the learner's proposed project. Third, the learners develop a clear, simple, one-sentence problem statement that defines the problem or gap that will be addressed by the DPI project. Fourth, learners identify a potential population from which sample data will be collected for the project. Fifth, learners develop the clinical/PICOT question(s) that will define the data needed to address the problem statement. Based on the first five strategic points above, learners next define the key aspects of the project methodology through the last five strategic points. The sixth point describes the independent and dependent variables. Seventh, learners determine if the project will be a qualitative, quantitative, or mixed methodology. Due to the evidence-based natureand feasibility of the DPI project requirement, most DPI projects will be utilizing a quantitative method because learners are not creating new evidence like that determined through qualitative or mixed methods. For the eighth strategic point, learners develop a purpose statement by integrating the problem statement, methodology, design, sample, and location. Ninth, learners identify the data they will need to collect to address the clinical questions or PICOT components.This includes the variables, level of measurement, and method used to collect the data (e.g., interviews, focus groups, observations, tested and validated instruments or surveys, databases, public media, etc.). Tenth and last, learners identify the appropriate data analysis, based on their project design and variables, which will be used to answer the clinical questions and address the problem statement. Criteria for Evaluating the 10 Strategic Points: Clear, Simple, Correct, and AlignedWhen developing a project, it is important to define the 10 Strategic points, so they are simple, clear, and correct in order to ensure that anyone who reviews them will easily understand them. It is important to align all of the 10 Strategic points to ensure it will be possible to conduct and complete the project. The problem statement must be derived from the literature or practice problem. The clinical questions must be used to specify the variables or data to be collected to answer the problem statement. The methodology and design must be appropriate for the problem statement, clinical,and PICOT question(s). The data collection and data analysis must provide the information to answer the PICOT questions. Developing the 10 Strategic Points document begins in DNP-815 begins as a two-or three-page document that can help ensure clarity, simplicity, correctness, and alignment of each of these 10 key or Strategic points in the prospectus, proposal, and Direct Practice Improvement Project. Developing these 10 Strategic points using this easy-to-use use template ensures the 10 Strategic points will always be worded the same throughout the prospectus, proposal, and Direct Practice Improvement Project manuscript. Please see the table below regarding the development of the citation requirements expected per course.Value of the 10 Strategic Points DocumentThe 10 Strategic Points document can be used for communicating and aligning key stakeholders for the Direct Practice Improvement Project. This document can be used to obtain agreement between the learner and the chair regarding the initial focus and approach for the project. The document can be used to review the proposed project with the people or organizations from whom learners need to gain permission to conduct their project, a critical step required before learners can develop their proposal. The document also proves useful for communicating the Direct Practice Improvement Project focus when attracting a Content Expert, as well as for reviewing the proposal with the Direct Practice Improvement Project committee and the AQR reviewers. Learners may choose to consult methodologists, statisticians, and editors in the process of developing the final manuscript from the 10 Strategic points. Examples of the 10 Strategic Points DocumentIt is important that the 10 Strategic points are clear, concise, doable, and aligned throughout the prospectus, proposal, and Direct Practice Improvement Project. Provided below is an example of a completed 10 Strategic Points document for a quantitative project. Following the example, a blank 10 Strategic PointsTable template is provided for learners to use when developingtheir own10 Strategic Point documents.Example: 10 Strategic Points Document for a Quantitative ProjectTen Strategic Points The 10 Strategic Points Broad Topic Area Broad Topic Area: Literature Review: Problem Statement: PICOT Questions or Clinical Question: Sample (and Location): Define Variables:Methodology and Design: Purpose Statement: Data Collection Approach:Data Analysis Approach: Hint: What would I title my project? Literature Review List primary points for four sections in the Literature Review: Background of the problem/gap, theoretical foundations (models and theories to be the foundation for the project); review of literature topics with the key theme for each one; and summary. Background of the Problem/Gap:Theoretical Foundations (models and theories to be the foundation for the project): Review of Literature Topics with Key Themesand SubthemesSummary Rural ambulatory clinics have had to reorganize their management structures to enhance reimbursement.Access to appropriate health services for rural Americans needs to be improved in areas where specialists are not available (Schoenberg, 2012). Telehealth nursing services can be provided through rural health clinics to support specialty clinics (Schoenberg, 2012).Approximately 200 telemedicine networks have been established nationwide. (American Telemedicine Association, 2017)The Greenhalgh’s Dissemination of Innovations model (Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005) can be used to implement rural telehealth services for rural Americans.The D&M Information System Success model (DeLone &McLean, 2003) is a framework to conceptualize and operationalize information system success.Path constitution theory combines two contrasting perspectives on technology, path dependence, and path creation (Singh, Mathiassen, & Mishra, 2015).Rural telehealth can improve care in burn patients (McWilliams, Hendricks, Twigg, Wood, & Giles, 2016); smoking cessation (Carlson, Lounsberry, Maciejewski, Wright, Collacutt, & Taenzer, 2011), psychotherapy (Gonzales & Brossart, 2015);cancer education (Doorenbos et al., 2011); diabetes (Holloway, Coon, Kersten, & Clemins, 2011).Rural health clinic/hospital (Carlson et al., 2011); Doorenbos et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011). Home-based (Demiris et al., 2103).Community center (Demiris et al., 2103).Library (Demiris et al., 2103).Smartphone, computer-based (Forchuk et al., 2016).National Committee for Quality Assurance (n.d). Disease Management Accreditation. Retrieved from http://www.ncqa.org/programs/accreditation/disease...American Association of Critical-Care Nurses (n.d.). CCRN-E: Certification for Tele-ICU Nurses. Retrieved from https://www.aacn.org/certification?tab=First-Time%...Acute stroke ready designation (Slivinski, Johes, Whitehead, & Hooper, 2017).American Telemedicine Association: approximately 200 telemedicine networks have been established nationwide (Frederick, 2013). Tablet PC Enabled Body Sensor System: a continuous real-time collection of physiological parameters (Panicker, Kumar, 2016).Gap/Problem: There is a need to implement evidence-based methods of improving the health outcomes of rural residents through the use of telehealth.Prior studies: Prior studies show that telehealth improves patient outcomes in diverse settings, including rural areas.Quantitative application: Sources of data exist to collect numerical data on the rate of follow-up with the primary care provider in rural areas.Significance: Improving the rate of follow-up with the primary care provider will improve the health outcomes of rural residents. Gap/Problem: Prior studies: Quantitative application: Rural Telehealth Services: (Theme example) Population Specific Telehealth Services: Community-based telehealth: Home-based telehealth can enhance older adults’ access to care and facilitate patient-provider collaboration, which may, in turn, improve patient self-management (Hsieh, Tsai, Chic, & Lin, 2015).Chronically ill: Disease management needs of chronically ill patients include prescription refills, medication and symptom management, lab results, and patient education (Vinson, McCallum, Thornlow, & Champagne, 2011). Rural Native American telehealth: Telehealth can improve health disparities in Native American communities (Kruse, Bouffard, Dougherty, & Parro, 2016). Diabetes education and management:Telehealth education improves glycemic control (Barker, Mallow, Theeke, & Schwertfeger, 2016).Mental health emergencies can be managed effectively through telehealth services (Saurman et al., 2011). Settings: Certifications: Network Systems: Problem Statement Describe the variables/groups to project, in one sentence. A well-written problem statement begins with the big picture of the issue (macro) and works to the small, narrower, and more specific problem (micro). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as: “It is not known if and to what degree/extent...” or “It is not known how/why and….” It was not known if or to what degree the implementation of __________________would impact ______________ when compared to _______________ among ___________ (population). While the literature indicates that telehealth is an important emerging technology for rural patient access, it is unknown if the implementation of telehealth impacts the rate of patient follow up for patients living in a rural area. Clinical or PICOT Questions (P) Among adult patients in a rural care setting, (I) how does the implementation of a telehealth program (C) compare to traditional commute-for-care (O) impact rate of follow-up with the primary care provider (T) over a period of four weeks? Clinical Question: To what degree does the implementation of _______________ (intervention) impacts __________________ (what) when compared to _____________ among _____________ (population) patients in a ______ (setting) in _______ (state)? Sample Identify sample, needed sample size, and location (project phenomena with small numbers and variables/groups with large numbers). Location: Arizona Population(Participants)Sample: 40 participants include a power analysis if appropriate.Inclusion CriteriaWho can participate?Exclusion CriteriaWho cannot participate Define Variables Independent Variable (Intervention): Telehealth program.Dependent Variable: Follow-up rate with the primary care provider. Methodologyand Design Name the selected methodology and specific design to address the problem statement and clinical questions: This project will use a quantitative methodology with a quasi-experimental design. Purpose Statement Provide one sentence statement of purpose including the problem statement, sample, methodology, and design: The purpose of this quantitative, quasi-experimental project was to determine if or to what degree the implementation of _________________ (intervention) would impact ______________(what) when compared to _______________________ among ___________(population)in a ________ (setting ie: primary care clinic, ER, OR) in ________ (state) over _____ time. Data Collection Approach Describe primary instruments that will be used to answer the clinical question. Think about your step by step data collection approach from start to finish. Data Analysis Approach Descriptive statistics will describe the sample characteristics and variable results. Explain the test used to obtain the statistical analysis and results of the measurable patient outcome. What method will be used to justify the sample size? 10 Strategic Points Table(Use this table to complete the 10 Strategic Points document for your project.) The 10 Strategic Points Broad Topic Area Broad Topic Area/Title of Project: Literature Review: Problem Statement:Clinical/PICOT Questions:Sample (and Location):Define Variables and Level of Measurement: Literature Review Background of the Problem/Gap:Theoretical Foundations (models and theories to be foundation for the project): Review of Literature with Key Organizing Themesand Sub-themes(Identify at least two themes, with three sub-themes per theme)Summary Theme1 (placeholder only; name theme): Sub-theme 1 Grouped findings related to Theme 1 Sub-theme 2 Sub-theme 3 Significance: Problem Statement It was not known if or to what degree the implementation of __________________would impact ______________ when compared to _______________ among ___________ (population). Clinical/ PICOT Questions To what degree does the implementation of _______________ (intervention) impacts __________________ (what) when compared to _____________ among _____________ (population) patients in a ______ (setting) in _______ (state) over four-weeks? Sample a.Location: Urban/Rural (State) b.Population (Participants) c.Sample: Specify the sample size desired and perform a power analysis if appropriate. d.Inclusion Criteria Who can participate?Who cannot participate? e.Exclusion Criteria Define Variables Independent Variable (Intervention):Dependent Variable: Methodology and Design Methodology and Design: Purpose Statement Purpose Statement: The purpose of this quantitative, quasi-experimental project was to determine if or to what degree the implementation of _________________ (intervention) would impact ______________(what) when compared to _______________________ among ___________(population)in a ________ (setting ie: primary care clinic, ER, OR) in ________ (state) ___ time. Data Collection Approach Data Collection Approach: Data Analysis Approach Data Analysis Approach: References APA formatted sources. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback 10 Strategic points Topic: Provides a broad project topic area/title. Literature Review: Lists primary points for four sections in the Literature Review: (a) Background of the problem/gap and the need for the project based on evidence from the literature; (b) Theoretical foundations (models and theories to be foundation for project); (c) Review of literature topics with at least two organizing themes and three sub-themes for each theme (d) Summary. Minimum number of themes and sub-themes met per course requirement? Problem Statement: Describes the problem in a single declarative sentence to address through the project based on defined gaps or needs from the literature. Sample and Location: Identifies sample, needed sample size,location, and inclusion and exclusion criteria. Clinical/PICOT Questions: Provides clinical/PICOT questions to all of the collected data needed to address the problem statement. Variables: Provides variables for each project PICOT question component. Methodology and Design: Describes the selected methodology and specific research design to address problem statements and clinical/PICOT questions. Purpose Statement: Provides a one-sentence statement of purpose including the problem statement, methodology, design, population sample, and location. Data Collection: Describes primary instruments and sources of data to answer research questions. Reliability and Validity of the instruments are addressed. Data Analysis: Describes the specific data analysis approaches to be used to address clinical/PICOT questions. The statistical test(s) that will be used must be identified and must be appropriate for the level of data and the clinical/PICOT question.