Saudi Cultural Missions Theses & Dissertations
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Item Restricted Influence of Participation in the BPCI-A Initiative on 30-Day Heart Failure Unplanned Readmission Rates Among U.S. Hospitals(University of Texas Health Science Center at Houston, 2025) Balhareth, Ibrahim Ali; Linder, StephenBackground: The Bundled Payments for Care Improvement Advanced (BPCI-A) initiative incentivize participating hospitals if they achieved less than the target spending amount for the selected condition and penalizes them if they exceeded the target. The BPCI-A program aims to enhance care quality and reduce spending. One of the quality measures targeted by BPCI-A is hospital readmissions. Heart failure is one of the leading causes of hospital readmission effectiveness of BPCI-A in reducing cardiac-related readmissions, particularly for heart failure, and the influence of hospital characteristics on program outcomes remain uncertain. This series of studies comprehensively evaluated the impact of BPCI-A on heart failure readmission rates. Methods: First, a scoping review was conducted to synthesize the existing literature on hospital characteristics, BPCI-A participation, and associated readmission outcomes, specifically focusing on cardiac care. Subsequently, a second study utilizing a propensity score matching (PSM) with national hospital-level datasets compared the baseline characteristics and readmission outcomes between hospitals participating in the program and a matched group of their counterparts that never participated in the program. Lastly, a retrospective matched-cohort study was conducted to validate the findings from the second study by evaluating whether participation in the BPCI-A program influenced 30-day heart failure readmissions, including subgroup analyses by hospital size, ownership, and teaching status, using weighted regression modeling and interaction analyses. Results: The scoping review revealed limited effectiveness of BPCI-A in reducing cardiac-related readmissions broadly, emphasizing existing disparities among hospitals. Empirical findings from Journal Article 2 demonstrated significant baseline differences: BPCI-A hospitals were larger, urban, teaching-oriented, and for-profit institutions. Post-matching analyses indicated a modest but significant association between BPCI-A participation and reduced heart failure readmissions (4.1 percentage points lower, p<0.001). Confirmatory analyses from Journal Article 3 validated these results, showing a 4.2 percentage-point reduction in readmissions associated with participation, with substantial heterogeneity by hospital characteristics. Small, public, and non-teaching hospitals benefited disproportionately from participation. Conclusion: Participation in BPCI-A is modestly associated with lower heart failure readmission rates, especially among hospitals historically disadvantaged by resource constraints. However, BPCI-A alone appears insufficient to eliminate persistent disparities or achieve substantial reductions universally. Future bundled payment policies must be tailored to hospital contexts, address under-resourced institutions by providing targeted support to enhance equity and effectiveness in reducing heart failure readmissions.23 0Item Restricted Improving Heart Failure Management in Saudi Arabia: A Quality and Safety Improvement Project Using Telemedicine(University of Nottingham, 2024) Alansari, Dareen; Stacy, JohnsonHeart failure is a common and complex healthcare problem in Saudi Arabia. Due to the lack of emphasis on primary and secondary prevention, the ageing population, and the increased prevalence of heart failure risk factors, especially among the younger population, the number of people with HF is expected to increase, leading to an increased burden on the national healthcare system in Saudi Arabia. This proposed quality improvement project will utilise telemedicine to monitor the progression of heart failure and heart failure risk factors, facilitate early identification of disease worsening and prompt referral to specialists, as well as educate people about the importance of managing their disease, in an effort to delay the development of heart failure and to improve the quality and safety of existing heart failure care in Saudi Arabia. Well-recognised quality improvement methodology and tools, including the Model for Improvement and Davidge’s Seven Steps to Measurement, supported by statistical process control charts as well as qualitative methods, will be used to guide the improvement process. A high emphasis will be placed on stakeholders involvement through an appropriate leadership style and engagement of stakeholders in the development of the design of this project at the early stages. This proposed quality improvement project provides a sustainable solution that is well-aligned with the vision of Saudi Arabia as well as the Institute of Medicine’s six domains of healthcare quality, taking advantage of a well-established technology infrastructure to tackle a persistent healthcare threat.33 0Item Restricted The Effeciveness of Combining both Exercise Training and Inspiratory Muscle Training in the Treatment of Patients with Heart Failure to Improve their Quality of Life: A Systematic Review(2023-03-20) Jaber, Amal; Tame, Jo-DeeBackground: Heart failure is a multi-organ dysfunction that affects multiple systems, including the cardiovascular, and respiratory systems, potentially becoming a major contributor to oedema, dyspnoea and exercise intolerance. Dyspnoea and exercise intolerance are associated with a poor prognosis, worsened by raising physical activity levels during regular everyday activities. Consequently, poor quality of life is reported in heart failure patients as they are less healthy or able to engage in daily activities. Exercise training alone has enhanced the quality of life for heart failure patients as has inspiratory muscle training alone. Combining exercise with inspiratory muscle training may offer additional benefits in terms of patients’ quality of life. This review aims to determine the benefits in quality of life when combining exercise and inspiratory muscle training for therapy with heart failure patients. Objectives: To determine if there is evidence that exercise and inspiratory muscle training combined enhance people with heart failure's quality of life. To identify any evidence that indicates that using exercise and inspiratory muscle training combined is more beneficial for treating people with heart failure than using either one alone, in terms of enhancing quality of life. To determine the course of future research in this field. Methods: To meet the aim and objectives, a systematic review was conducted. Randomised control trials were selected for this review. Several sources were used between September first and November 18, 2022, including EMBASE, CINAHL, Web of Science, Scopus, Trip PRO, ASSIA and Dimensions.ai. Each randomised control trial’s methodological quality was evaluated by two independent reviewers. Data was synthesised using a narrative synthesis because of heterogeneity of the data. Results: There were found to be five randomised control trials of moderate to high quality with a total of 402 participants. The combination of exercise and inspiratory muscle training was shown to be statistically significant regarding quality of life outcomes pre-post intervention in all five trials (P < 0.05). There were statistically significant findings regarding quality of life outcomes pre-post inspiratory muscle training alone but not for exercise alone. Conclusion: The use of exercise training and inspiratory muscle training together to improve quality of life in people with heart failure is consistently supported by the present data, according to this systematic review. This combination may improve the quality of life in heart failure patients more than exercise alone, but to an extent that is similar to inspiratory muscle training alone. Further research is required to investigate the effects of specific types of exercise and inspiratory muscle training on quality of life outcomes in patients with heart failure, in addition to comparing the results of the combination intervention with exercise or inspiratory muscle training alone. Keywords: Inspiratory muscle training, exercise, quality of life, heart failure.27 0