Objective: To investigate current HCP stillbirth aftercare practices and use findings to inform suggestions for stillbirth aftercare guidelines. Study Design: Participants (n=18) were HCPs (MDs, DOs, or NPs) in the field of Obstetrics and Gynecology or Maternal Fetal Medicine. Focus groups and surveys were conducted. A phenomenological approach was used to explore and understand current stillbirth aftercare practices and thoughts about protocols for stillbirth aftercare. Descriptive statistics were used to analyze demographics of participants and prevalence of references to stillbirth aftercare topics. Results: Sixteen obstetric HCPs (medical doctors and nurse practitioners in the fields of obstetrics and gynecology and/or maternal and fetal medicine) participated in Focus Groups and two obstetric HCPs alternatively completed surveys. Current stillbirth aftercare practices and perceptions related to stillbirth aftercare protocols and guidelines were clustered around the following themes: recommendations made to mothers after stillbirth, subsequent pregnancy care, perceptions and use of protocols for stillbirth aftercare, and responsibilities of nurses and nurse practitioners after stillbirth. Conclusion: Findings were used to develop a list of stillbirth aftercare practice suggestions and may be used to help design future research related to HCPs' stillbirth aftercare practices and the need for training on existing guidelines and development of further protocols or guidelines.

As a medical scribe working in an Emergency Department (ED) at Banner Gateway Medical Center (BGMC), the researcher was able to identify how the work flow and satisfaction of those in the ED would decrease when there were no Physician Assistants (PA's) being utilized during specific shifts. As for other shifts where PA's were on shift and were being utilized, the work flow would drastically increase, more patients would be seen in less time and the satisfaction of the researchers co-workers would increase. This paradigm of how PA's are implemented brought the researcher to understand the overall success of having Physicians Assistants in partnership with Physicians, consulting physicians and management in the ED. The researcher conducted a five-month long analyses of how implementation of Physician Assistants in the ED could effect overall satisfaction. The researcher looked at the satisfaction of the PAs themselves, attending physicians, nurses, nursing assistants, ED manager, ED director, ED co-director and the patients themselves. The researcher collected questionnaires, conducted interviews and retrieved data from Banner Health Services for the year 2014 to compare her data. The researcher conducted the study both at Banner Gateway Medical Center (BGMC) Emergency Department and also at Banner Baywood Medical Center (BBMC) ED. In comparison of the data collected from BGMC ED to BBMC ED resulted in a significant difference in overall satisfaction based on implementation. Although both emergency departments are owned by the same Banner corporation and only a few miles apart in distance, they implement Pas differently. The difference in the implementation did prove to effect the overall satisfaction. BGMC ED employees as well as manager and patients were more satisfied than those of BBMC ED. Some of the noted differences were that BBMC PAs see more patients per hour, they see higher acuity patients, are less compensated, are placed further apart from their attending physicians and other staff in the ED, there is minimal communication, PAs feel there voice is not heard and they feel pushback on feedback with no plan for improvement. BGMC PAs reported overall increase in satisfaction as compared to BBMC because of the increased communication, placement of PAs within the ED is closer to attending physicians and other staff, they see lower acuity patients, are better compensated and monthly meetings on improvements that can be made and the PAs feel their voice is being heard. Productivity scores for BGMC ED PAs were 1.71 patients per hour as compare to BBMC ED which was 1.86 patients per hour. BBMC PA patient satisfaction on average was 60.6 as compared to BGMC where the PA average satisfaction was 67.8.

The Patient Protection and Affordable Care Act (PPACA or ACA) Public Law No: 111-148, substantially changed health insurance access in the United States. One group that the law particularly affects is young adults, defined as individuals between the ages of 19 to 26. Specifically, the expansion of young adult dependent coverage was one of the first provisions that went into effect after the ACA’s enactment. This dissertation comprehensively studies the impact of the ACA’s dependent coverage provision on young adults. Across three empirical chapters, the dissertation examines outcomes related to health insurance coverage, labor market outcomes, and educational enrollment. Chapter 1, titled “Impact of the Affordable Care Act on Young Adults Insurance Coverage,” documents the changes in health insurance take-up for the young adults population, which has historically had the lowest rates of such coverage. Changes in coverage are also evaluated separately for sub-groups of young adults. Chapter 2, titled “Labor Market Outcomes for Young Adults,” evaluates whether the law altered employment decisions and earnings for this group. It also assess whether the ACA led to increased job mobility for young adults. Finally, Chapter 3, titled “Does having Dependent Coverage from the ACA impact Educational Enrollment,” evaluated changes in educational enrollment levels for young adults following the expansion of parental dependent coverage. The research conducted in this dissertation provides evidence of the ACA’s impact on health insurance coverage, employment, and education. It also provides support for the claim that the ACA covers insurance gaps that young adults might experience as they go through life transitions when they are likely to lose coverage.

Intake of alcohol, tobacco, and illicit substances such as marijuana and methamphetamine during pregnancy can have significant deleterious effects on a developing fetus and the resulting infant. The existence of substance-exposed newborns also has negative impacts on society as a whole; these include financial burdens placed on taxpayers and the additional time and resources required by health care professionals, social workers, and law enforcement authorities to properly care for such infants. Existing literature show a strong correlation between prenatal care and improved birth outcomes, including abstinence from or reduction of prenatal substance abuse. The Health Start Program in the state of Arizona attempts to mitigate the incidence of substance-exposed newborns, among other goals, by employing community health workers who identify high-risk pregnant and postpartum women, inform these women about how to receive prenatal care services, educate them on appropriate prenatal and neonatal care, and provide program and referral services to both pregnant and postpartum women. Community health workers interact directly with women most at-risk for prenatal substance abuse and should be well-versed in the understanding of the complex issues related to substance-exposed newborns. In an attempt to discover, analyze, and compile those complex issues with which community health workers should be knowledgeable, this project explores existing federal regulations regarding substance-exposed newborns, compares Arizona’s regulations to Minnesota’s, Virginia’s, and Washington’s, and analyzes prevailing literature in the field about the various implications associated with screening and reporting substance-exposed newborns to law enforcement authorities. After an intensive literature review, this project concludes that the Health Start Program needs a comprehensive resource document which enumerates federal and select state policies, landmark cases involving substance-abusing pregnant women and the precedence set by each, and recommendations from medical and public health experts. The document should also provide clear guidelines by which each stakeholder should abide and why, and recommend potential best practices the state of Arizona could adopt into law based on other state policies which have proven to be effective.