Date of Award

Spring 5-13-2016

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Educational Policy Studies

First Advisor

Dr. William Curlette

Second Advisor

Dr. Chris Oshima

Third Advisor

Dr. Janice Fournillier

Fourth Advisor

Dr. Ira Schwartz

Abstract

This dissertation describes health care delivery in a Ryan White Program (RWP) HIV clinic, with a focus on medical home care, using the Bayesian Case Study Method (BCSM). The RWP funds medical care for uninsured HIV patients and Pappas and colleagues (2014) suggested enhanced HIV care build upon medical home models of care rooted in the RWP. However, little research describes how RWP clinics operate as medical homes.

This study developed the BCSM to describe medical home care at a RWP clinic. The BCSM combines a case study framework with Bayesian statistics for a novel approach to mixed method, descriptive studies. Roberts (2002) and Voils (2009) used mixed-method Bayesian approaches and this dissertation contributes to this work. For this study, clinic staff and patients participated in interviews and surveys. I used Bayes’ Theorem to combine interview data, by use of subjective priors, with survey data to produce Bayesian posterior means that indicate the extent to which medical home care was provided. Subjective priors facilitate the inclusion of valuable stakeholder belief in posteriors. Using the BCSM, posterior means succinctly describe qualitative and quantitative data, in a way other methods of mixing data do not, which is useful for decision makers.

Posterior means indicated that coordinated, comprehensive, and ongoing care was provided at the clinic; however, accessible care means were lower reflecting an area in need of improvement. Interview data collected for subjective priors captured detailed service delivery descriptions. For example, interview data described how medical and support services were coordinated and highlighted the role of social determinants of health (SDH). Namely, coordinated and comprehensive services that addressed SDH, such as access to housing, food, and transportation, were necessary for patients to focus on their HIV and utilize healthcare. This case study addressed a gap in the literature regarding descriptions of how RWP clinics provide medical home care. For domains with high posterior means, the associated interview data can be used to plan HIV care in non-RWP settings. Future research should describe other RWP HIV medical homes so this information can be used to plan enhanced HIV care across the healthcare system.

Available for download on Tuesday, May 08, 2018

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