College of Health Professions
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Browsing College of Health Professions by Department "Health Administration"
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Item A Publicly Available Cost Simulation of Sustainable Construction Options for Residential Houses(Multidisciplinary Digital Publishing Institute, 2020-04) Fulton, Lawrence V.; Beauvais, Bradley; Brooks, Matthew; Kruse, Clemens S.; Lee, KimberlyA major consideration for consumers and the residential construction industry is the cost–benefit and break-even of various sustainable construction options. This research provides a publicly available simulation that allows users to compare baseline construction options versus sustainable options and evaluates both break-even costs as well as environmental effects. This R Shiny Monte Carlo simulation uses common pseudo-random number streams for replicability and includes options for solar, rainwater harvesting, wells, Icynene foam, engineered lumber, Energy Star windows and doors, low flow fixtures, aerobic/non-aerobic/city waste treatment, electric versus gasoline vehicles, and many other options. This is the first simulation to quantify multiple sustainable construction options, associated break-even points, and environmental considerations for public use.Using user default parameters, coupled with a 100% solar solution for a baseline 3000 square foot/279square meter house with 2 occupants results in a break-even of 9 years. Results show that many of the sustainable options are both green for the environment and green for the pocketbook.Item A Publicly Available Simulation of Battery Electric, Hybrid Electric, and Gas-Powered Vehicles(Multidisciplinary Digital Publishing Institute, 2020-05) Fulton, Lawrence V.Volatility in energy markets has made the purchase of battery electric vehicles (BEV) or hybrid vehicles (HEVs) attractive versus internal combustion engine vehicles (ICEVs). However, the total cost of ownership (TCO) and true environmental effects, are difficult to assess. This study provides a publicly available, user-driven simulation that estimates the consumer and environmental costs for various vehicle purchase options, supporting policymaker, producer, and consumer information requirements. It appears to be the first to provide a publicly available, user interactive simulation that compares two purchase options simultaneously. It is likely that the first paper to simulate the effects of solar recharging of electric vehicles (EV) on both cost-benefit for the consumer and environmental benefit (e.g., carbon dioxide, oxides of nitrogen, non-methane organic gasses, particulate matter, and formaldehyde) simultaneously, demonstrating how, as an example, solar-based charging of BEVs and HEVs reduces carbon emissions over grid-based charging. Two specific scenarios are explicated, and the results of show early break-even for both BEV and Plug-in HEV (PHEV) options over ICEV (13 months, and 12 months, respectively) with CO2 emissions about 1/2 that of the gasoline option (including production emissions.) The results of these simulations are congruent with previous research that identified quick break-even for HEVs versus ICEV.Item A Report Card on Prevention Efforts of COVID-19 Deaths in US(Multidisciplinary Digital Publishing Institute, 2021-09) Shanmugam, Ramalingam; Fulton, Lawrence V.; Ramamonjiarivelo, Zo; Betancourt, Jose; Beauvais, Bradley; Kruse, Clemens S.; Brooks, MatthewCOVID-19 (otherwise known as coronavirus disease 2019) is a life-threatening pandemic that has been combatted in various ways by the government, public health officials, and health care providers. These interventions have been met with varying levels of success. Ultimately, we question if the preventive efforts have reduced COVID-19 deaths in the United States. To address this question, we analyze data pertaining to COVID-19 deaths drawn from the Centers for Disease Control and Prevention (CDC). For this purpose, we employ incidence rate restricted Poisson (IRRP) as an underlying analysis methodology and evaluate all preventive efforts utilized to attempt to reduce COVID-19 deaths. Interpretations of analytic results and graphical visualizations are used to emphasize our various findings. Much needed modifications of the public health policies with respect to dealing with any future pandemics are compiled, critically assessed, and discussed.Item A Simulation of Rainwater Harvesting Design and Demand-Side Controls for Large Hospitals(Multidisciplinary Digital Publishing Institute, 2018-05) Fulton, Lawrence V.Inpatient health buildings in the United States are the most intensive users of water among large commercial buildings. Large facilities (greater than 1 million square feet) consume an average of 90 million gallons per building per year. The distribution and treatment of water imposes a significant electrical power demand, which may be the single largest energy requirement for various states. Supply and demand-side solutions are needed, particularly in arid and semi-arid regions where water is scarce. This study uses continuous simulations based on 71 years of historical data to estimate how rainwater harvesting systems and demand-side interventions (e.g., low-flow devices, xeriscaping) would offset the demand for externally-provided water sources in a semi-arid region. Simulations from time series models are used to generate alternative rainfall models to account for potential non-stationarity and volatility. Results demonstrate that hospital external water consumption might be reduced by approximately 25% using conservative assumptions and depending on the design of experiment parameters associated with rainfall capture area, building size, holding tank specifications, and conservation efforts.Item Accounting with “LIFO” vs. “FIFO”: The devil is in the details(Medical Group Management Association, 2015-04) Lieneck, Cristian H.The ongoing collaboration between the International Financial Reporting Standards (IFRS) and Federal Accounting Standards Board (FASB) has tax-related implications for medical group practices. One of the goals of this collaboration — harmonization of accounting standards across countries — has been pursued since post-World War II economic integration. Generally accepted accounting principle (GAAP) negotiations involve increased global transparency and similarity of accounting standard.Item Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance?(Multidisciplinary Digital Publishing Institute, 2021-07) Brooks, Matthew; Beauvais, Bradley; Kruse, Clemens S.; Fulton, Lawrence V.; Mileski, Michael; Ramamonjiarivelo, Zo; Shanmugam, Ramalingam; Lieneck, Cristian H.The relationship between healthcare organizational accreditation and their leaders’ professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.Item Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance?(Multidisciplinary Digital Publishing Institute, 2021-07) Brooks, Matthew; Beauvais, Bradley; Kruse, Clemens S.; Fulton, Lawrence V.; Mileski, Michael; Ramamonjiarivelo, Zo; Shanmugam, Ramalingam; Lieneck, Cristian H.The relationship between healthcare organizational accreditation and their leaders’ professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.Item Adopting Telemedicine for the Self-Management of Hypertension: Systematic Review(JMIR Publications, 2017-10) Mileski, Michael; Kruse, Clemens S.; Catalani, Justin; Haderer, TaraBackground: Hypertension is a chronic condition that affects adults of all ages. In the United States, 1 in 3 adults has hypertension, and about half of the hypertensive population is adequately controlled. This costs the nation US $46 billion each year in health care services and medications required for treatment and missed workdays. Finding easier ways of managing this condition is key to successful treatment. Objective: A solution to reduce visits to physicians for chronic conditions is to utilize telemedicine. Research is limited on the effects of utilizing telemedicine in health care facilities. There are potential benefits for implementing telemedicine programs with patients dealing with chronic conditions. The purpose of this review was to weigh the facilitators against the barriers for implementing telemedicine. Methods: Searches were methodically conducted in the Cumulative Index to Nursing and Allied Health Literature Complete (CINAHL Complete) via Elton B Stephens Company (EBSCO) and PubMed (which queries MEDLINE) to collect information about self-management of hypertension through the use of telemedicine. Results: Results identify facilitators and barriers corresponding to the implementation of self-management of hypertension using telemedicine. The most common facilitators include increased access, increase in health and quality, patient knowledge and involvement, technology growth with remote monitoring, cost-effectiveness, and increased convenience/ease. The most prevalent barriers include lack of evidence, self-management difficult to maintain, no long-term results/more areas to address, and long-term added workload commitment. Conclusions: This review guides health care professionals in incorporating new practices and identifying the best methods to introduce telemedicine into their practices. Understanding the facilitators and barriers to implementation is important, as is understanding how these factors will impact a successful implementation of telemedicine in the area of self-management of hypertension.Item Adoption Factors Associated with Electronic Health Record Among Long-Term Care Facilities: A Systematic Review(BMJ Publishing Group, 2015-01) Kruse, Clemens S.; Mileski, Michael; Alaytsev, Vyachelslav; Carol, Elizabeth; Williams, ArianaObjectives: The Health Information Technology for Economic and Clinical Health (HITECH) Act created incentives for adopting electronic health records (EHRs) for some healthcare organisations, but long-term care (LTC) facilities are excluded from those incentives. There are realisable benefits of EHR adoption in LTC facilities; however, there is limited research about this topic. The purpose of this systematic literature review is to identify EHR adoption factors for LTC facilities that are ineligible for the HITECH Act incentives. Setting: We conducted systematic searches of Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), Google Scholar and the university library search engine to collect data about EHR adoption factors in LTC facilities since 2009. Participants: Search results were filtered by date range, full text, English language and academic journals (n=22). Interventions: Multiple members of the research team read each article to confirm applicability and study conclusions. Primary and Secondary Outcome Measures: Researchers identified common themes across the literature: specifically facilitators and barriers to adoption of the EHR in LTC. Results: Results identify facilitators and barriers associated with EHR adoption in LTC facilities. The most common facilitators include access to information and error reduction. The most prevalent barriers include initial costs, user perceptions and implementation problems. Conclusions: Similarities span the system selection phases and implementation process; of those, cost was the most common mentioned. These commonalities should help leaders in LTC facilities align strategic decisions to EHR adoption. This review may be useful for decision-makers attempting successful EHR adoption, policymakers trying to increase adoption rates without expanding incentives and vendors that produce EHRs.Item Alarming and/or Alerting Device Effectiveness in Reducing Falls in Long-Term Care (LTC) Facilities? A Systematic Review(Multidisciplinary Digital Publishing Institute, 2019-03) Mileski, Michael; Brooks, Matthew; Topinka, Joseph B.; Hamilton, Guy; Land, Cleatus; Mitchell, Traci; Mosely, Brandy; McClay, RebeccaPerceptions against the use of alarming devices persist in long-term care environments as they are seen as annoying, costly, and a waste of time to the staff involved. Ascertaining whether these perceptions are true or false via the literature was a focus of this study. Proper information to educate staff and to work past these perceptions can be a positive effector for resident safety. Many facilitators for the use of alarming devices were found, as well as many barriers to their use as well. New technology is changing the perceptions regarding these types of devices as time passes. Education is a key component for staff, residents, and families. There are “traditional” issues with the use of alarms such as alarm fatigue by caregivers, high costs of implementation, and issues with proper implementation of alarms. Alarms are perceived as intrusive and the noise from them can be a potential cause of falls. However, alarming devices can be a key intervention in the safety of those residents who are prone to falls. This requires proper implementation and education for all parties involved, and proper oversight surrounding use of the devices.Item An Evaluation of Alternatives for Providing Care to Veterans(Multidisciplinary Digital Publishing Institute, 2018-08) Fulton, Lawrence V.; Brooks, MatthewIn 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran’s care through 2018 reveal ongoing and systematic problem. In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC VA Medical Center including failures to track patient safety events accurately, ineffective sterile processing and more than 10 thousand open or pending prosthetic/sensory aid consults. The VHA clearly has problems with access and quality in a budget-constrained environment. In this policy analysis, four separate interventions that address the gap between the magnitude as well as the use of the VHA’s fixed budget versus access and cost expectations are explored. These policy interventions include maintaining the status quo, returning to a “VHA-only” option, transitioning to a CMS central payer system and consolidating care under the DoD TRICARE insurance plans. An objective evaluation suggests that extending TRICARE to veterans during the phasing out the VHA’s care responsibilities, while politically unpalatable, would likely provide the best of four possible solutions under various criterion weighting schemes. A central payer solution under the CMS would also be a viable consideration. Results suggest that TRICARE patient perceptions of quality are superior to VHA and non-VHA/non-DoD, that access provided by the TRICARE program is ranked second in terms of venue acceptance only to the CMS solution set based on primary provider acceptance and that the cost per beneficiary of a TRICARE solution ($6.5 K/beneficiary) is far better than a VHA-only solution ($14.0 K/beneficiary), the CMS central payer solution ($12.2 K/beneficiary), or the status quo (between $12.2 K and $14.0 K/beneficiary). The intent of this paper is to provoke thoughtful consideration of solutions for providing access to high-quality healthcare for veterans within or outside of the VHA.Item An Investigation of Quality Improvement Initiatives in Decreasing the Rate of Avoidable 30-day, Skilled Nursing Facility-to-Hospital Readmissions: A Systematic Review(Dove Press, 2017-01) Mileski, Michael; Topinka, Joseph B.; Lee, Kimberly; Brooks, Matthew; McNeil, Christopher; Jackson, JennaObjectives: The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. Problem: The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting: The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. Results: The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion: These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions.Item Analysis of a Global Futures Trend-Following Strategy(Multidisciplinary Digital Publishing Institute, 2019-06) Nokes, Derek; Fulton, Lawrence V.Systematic traders employ algorithmic strategies to manage their investments. As a result of the deterministic nature of such strategies, it is possible to determine their exact responses to any conceivable set of market conditions. Consequently, sensitivity analysis can be conducted to systematically uncover undesirable strategy behavior and enhance strategy robustness by adding controls to reduce exposure during periods of poor performance/unfavorable market conditions, or to increase exposure during periods of strong performance/favorable market conditions. In this study, we formulate both a simple systematic trend-following strategy (i.e., trading model) to simulate investment decisions and a market model to simulate the evolution of instrument prices. We then map the relationship between market model parameters under various conditions and strategy performance. We focus, in particular, on identifying the performance impact of changes in both serial dependence in price variability and changes in the trend. The long-range serial dependence of the true range worsens performance of the simple classic trend-following strategy. During periods of strong performance, the dispersion of trading outcomes increases significantly as long-range serial dependence increases.Item Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review(Multidisciplinary Digital Publishing Institute, 2021-05) Lieneck, Cristian H.; Herzog, Brooke; Krips, RavenThe delivery of routine health care during the COVID-19 global pandemic continues to be challenged as public health guidelines and other local/regional/state and other policies are enforced to help prevent the spread of the virus. The objective of this systematic review is to identify the facilitators and barriers affecting the delivery of routine health care services during the pandemic to provide a framework for future research. In total, 32 articles were identified for common themes surrounding facilitators of routine care during COVID-19. Identified constructed in the literature include enhanced education initiatives for parents/patients regarding routine vaccinations, an importance of routine vaccinations as compared to the risk of COVID-19 infection, an enhanced use of telehealth resources (including diagnostic imagery) and identified patient throughput/PPE initiatives. Reviewers identified the following barriers to the delivery of routine care: conservation of medical providers and PPE for non-routine (acute) care delivery needs, specific routine care services incongruent the telehealth care delivery methods, and job-loss/food insecurity. Review results can assist healthcare organizations with process-related challenges related to current and/or future delivery of routine care and support future research initiatives as the global pandemic continues.Item Assessing the other “R” in RHIOs: Risk and Liability of Electronic Privacy Implications(Medical Group Management Association, 2013-09) Lieneck, Cristian H.Regional Health Information Organizations (RHIOs) have developed at a rapid pace ever since the genesis of the Office of the National Coordinator for Health Information Technology (ONC) in 2004 as well as the legislative mandate for EHR adoption and meaningful use of such technology by the Health Information Technology and Clinical Health (HITECH) Act of 2009. With the intent of improving the health status of the population, this enhanced availability and exchange of health information creates an unavoidable risk for medical group practices at various levels within regional health information exchanges (HIEs).Item Attitudes, Perceptions, and Geospatial Analysis of Water Quality and Individual Health Status in a High-Fracking Region(Multidisciplinary Digital Publishing Institute, 2019-08) Stigler Granados, Paula; Hildenbrand, Zacariah L.; Mata, Claudia; Habib, Sabrina; Martin-Sandoval, Misty; Carlton, Doug; Santos, Ines C.; Schug, Kevin A.; Fulton, Lawrence V.The expansion of unconventional oil and gas development (UD) across the US continues to be at the center of debates regarding safety to health and the environment. This descriptive study evaluated the water quality of private water wells in the Eagle Ford Shale as well as community members’ perceptions of their water. Community members (n = 75) were surveyed about their health status and perceptions of drinking water quality. Water samples from respondent volunteers (n = 19) were collected from private wells and tested for a variety of water quality parameters. Of the private wells sampled, eight had exceedances of maximum contaminant limits (MCLs) for drinking water standards. Geospatial descriptive analysis illustrates the distributions of the well exceedance as well as the well owners’ overall health status. Point-biserial correlational analysis of the haversine distance between respondents and well exceedances revealed four statistically significant relationships {Well 11, Well 12, Well 13, Well 14} with correlations of {0.47, 53, 0.50, 0.48} and p-values of {0.04, 0.02, 0.03, 0.04}, respectively. These correlations suggest that as distance from these northwestern wells increase, there is a higher likelihood of exceedances. Those relying on municipal water or purchased water assessed that it was less safe to drink than those relying on private wells for drinking (p < 0.001, Odds Ratio, OR = 44.32, 95% CI = {5.8, 2003.5}) and cooking (p < 0.003, OR = 13.20, 95% CI = {1.8, 589.9}. Tests of proportional differences between self-reported conditions and provider-reported conditions revealed statistical significance in most cases, perhaps indicating that residents believed they have illnesses for which they are not yet diagnosed (including cancer). In many cases, there are statistically significant differences between self-reported, provider undiagnosed conditions and self-reported, provider diagnosed conditions.Item Barriers Over Time to Full Implementation of Health Information Exchange in the United States(JMIR Publications, 2014-01) Kruse, Clemens S.; Regier, Verna L.; Rheinboldt, Kurt T.Background: Although health information exchanges (HIE) have existed since their introduction by President Bush in his 2004 State of the Union Address, and despite monetary incentives earmarked in 2009 by the health information technology for economic and clinical health (HITECH) Act, adoption of HIE has been sparse in the United States. Research has been conducted to explore the concept of HIE and its benefit to patients, but viable business plans for their existence are rare, and so far, no research has been conducted on the dynamic nature of barriers over time. Objective: The aim of this study is to map the barriers mentioned in the literature to illustrate the effect, if any, of barriers discussed with respect to the HITECH Act from 2009 to the early months of 2014. Methods: We conducted a systematic literature review from CINAHL, PubMed, and Google Scholar. The search criteria primarily focused on studies. Each article was read by at least two of the authors, and a final set was established for evaluation (n=28). Results: The 28 articles identified 16 barriers. Cost and efficiency/workflow were identified 15% and 13% of all instances of barriers mentioned in literature, respectively. The years 2010 and 2011 were the most plentiful years when barriers were discussed, with 75% and 69% of all barriers listed, respectively. Conclusions: The frequency of barriers mentioned in literature demonstrates the mindfulness of users, developers, and both local and national government. The broad conclusion is that public policy masks the effects of some barriers, while revealing others. However, a deleterious effect can be inferred when the public funds are exhausted. Public policy will need to lever incentives to overcome many of the barriers such as cost and impediments to competition. Process improvement managers need to optimize the efficiency of current practices at the point of care. Developers will need to work with users to ensure tools that use HIE resources work into existing workflows.Item Barriers to Electronic Health Record Adoption: A Systematic Literature Review(Springer, 2016-10) Kruse, Clemens S.; Kristof, Caitlin; Jones, Beau; Mitchell, Erica; Martinez, AngelicaFederal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Roughly one in four hospitals not adopted even a basic EHR system. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. We wanted to assemble an updated and comprehensive list of adoption barriers of EHR systems in the United States. Authors searched CINAHL, MEDLINE, and Google Scholar, and accepted only articles relevant to our primary objective. Reviewers independently assessed the works highlighted by our search and selected several for review. Through multiple consensus meetings, authors tapered articles to a final selection most germane to the topic (n = 27). Each article was thoroughly examined by multiple authors in order to achieve greater validity. Authors identified 39 barriers to EHR adoption within the literature selected for the review. These barriers appeared 125 times in the literature; the most frequently mentioned barriers were regarding cost, technical concerns, technical support, and resistance to change. Despite federal and local incentives, the initial cost of adopting an EHR is a common existing barrier. The other most commonly mentioned barriers include technical support, technical concerns, and maintenance/ongoing costs. Policy makers should consider incentives that continue to reduce implementation cost, possibly aimed more directly at organizations that are known to have lower adoption rates, such as small hospitals in rural areas.Item Barriers to the Use of Mobile Health in Improving Health Outcomes in Developing Countries: Systematic Review(Journal of Medical Internet Research, 2019-01) Kruse, Clemens S.; Betancourt, Jose; Ortiz, Stephanie; Valdes Luna, Susana Melissa; Bamrah, Inderdeep Kaur; Segovia, NarceBackground: The use of mobile health (mHealth) technologies to improve population-level health outcomes around the world has surged in the last decade. Research supports the use of mHealth apps to improve health outcomes such as maternal and infant mortality, treatment adherence, immunization rates, and prevention of communicable diseases. However, developing countries face significant barriers to successfully implement, sustain, and expand mHealth initiatives to improve the health of vulnerable populations. Objective: We aimed to identify and synthesize barriers to the use of mHealth technologies such as text messaging (short message service [SMS]), calls, and apps to change and, where possible, improve the health behaviors and health outcomes of populations in developing countries. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Deriving search criteria from the review's primary objective, we searched PubMed and CINAHL using an exhaustive terms search (eg, mHealth, text messaging, and developing countries, with their respective Medical Subject Headings) limited by publication date, English language, and full text. At least two authors thoroughly reviewed each article's abstract to verify the articles were germane to our objective. We then applied filters and conducted consensus meetings to confirm that the articles met the study criteria. Results: Review of 2224 studies resulted in a final group of 30 articles for analysis. mHealth initiatives were used extensively worldwide for applications such as maternal health, prenatal care, infant care, HIV/AIDS prevention, treatment adherence, cardiovascular disease, diabetes, and health education. Studies were conducted in several developing countries in Africa, Asia, and Latin America. From each article, we recorded the specific health outcome that was improved, mHealth technology used, and barriers to the successful implementation of the intervention in a developing country. The most prominent health outcomes improved with mHealth were infectious diseases and maternal health, accounting for a combined 20/30 (67%) of the total studies in the analysis. The most frequent mHealth technology used was SMS, accounting for 18/30 (60%) of the studies. We identified 73 individual barriers and grouped them into 14 main categories. The top 3 barrier categories were infrastructure, lack of equipment, and technology gap, which together accounted for 28 individual barriers. Conclusions: This systematic review shed light on the most prominent health outcomes that can be improved using mHealth technology interventions in developing countries. The barriers identified will provide leaders of future intervention projects a solid foundation for their design, thus increasing the chances for long-term success. We suggest that, to overcome the top three barriers, project leaders who wish to implement mHealth interventions must establish partnerships with local governments and nongovernmental organizations to secure funding, leadership, and the required infrastructure.Item Beyond self-actualization(Southern Public Administration Education Foundation, 2007-12) Greene, Lloyd; Burke, George C.No abstract prepared.