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Describing Healthcare Service Delivery in a Ryan White Funded HIV Clinic: a Bayesian Mixed Method Case Study Georgia State University ScholarWorks @ Georgia State University Educational Policy Studies Dissertations Department of Educational Policy Studies Spring 5-13-2016 Describing Healthcare Service Delivery in a Ryan White Funded HIV Clinic: A Bayesian Mixed Method Case Study Stephanie Beane Georgia State University Follow this and additional works at: https://scholarworks.gsu.edu/eps_diss Recommended Citation Beane, Stephanie, "Describing Healthcare Service Delivery in a Ryan White Funded HIV Clinic: A Bayesian Mixed Method Case Study." Dissertation, Georgia State University, 2016. https://scholarworks.gsu.edu/eps_diss/152 This Dissertation is brought to you for free and open access by the Department of Educational Policy Studies at ScholarWorks @ Georgia State University. It has been accepted for inclusion in Educational Policy Studies Dissertations by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact [email protected]. ACCEPTANCE This dissertation, DESCRIBING HEALTHCARE SERVICE DELIVERY IN A RYAN WHITE PROGRAM FUNDED HIV CLINIC: A BAYESIAN MIXED METHOD CASE STUDY, by STEPHANIE BEANE, was prepared under the direction of the candidate’s Dissertation Advisory Committee. It is accepted by the committee members in partial fulfillment of the requirements for the degree Doctor of Philosophy in the College of Education and Human Development, Georgia State University. The Dissertation Advisory Committee and the student’s Department Chair, as representatives of the faculty, certify that this dissertation has met all standards of excellence and scholarship as determined by the faculty. William Curlette, Ph.D. T. Chris Oshima, Ph.D. Committee Chair Committee Member Janice Fournillier, Ph.D. Ira Schwartz, M.D. Committee Member Committee Member Date William L. Curlette, Ph.D. Chair, Department of Educational Policy Studies Paul A. Alberto, Ph.D. Dean, College of Education and Human Development AUTHOR’S STATEMENT By presenting this dissertation as a partial fulfillment of the requirements for the advanced degree from Georgia State University, I agree that the library of Georgia State University shall make it available for inspection and circulation in accordance with its regulations governing materials of this type. I agree that permission to quote, to copy from, or to publish this dissertation may be granted by the professor under whose direction it was written, by the College of Education and Human Development’s director of graduate studies and research, or by me. Such quoting, copying, or publishing must be solely for scholarly purposes and will not involve potential financial gain. It is understood that any copying from or publication of this dissertation which involves potential financial gain will not be allowed without my written permission. Stephanie N. Beane NOTICE TO BORROWERS All dissertations deposited in the Georgia State University library must be used in accordance with the stipulations prescribed by the author in the preceding statement. The author of this dissertation is: Stephanie N. Beane 194 Friars Head Dr. Suwanee, GA 30024 The director of this dissertation is: Dr. William Curlette Department of Educational Policy Studies College of Education and Human Development Georgia State University Atlanta, GA 30303 CURRICULUM VITA Stephanie Nichole Beane ADDRESS: 194 Friars Head Dr. Suwanee, GA 30024 EDUCATION: Ph.D. 2016 Georgia State University Education Policy Studies Research, Measurement, and Statistics M.Ed. 2005 University of Georgia Education Psychology Cognition and Development B.S. 2002 University of Georgia Psychology PROFESSIONAL EXPERIENCE: 2015-Present Senior Evaluation Specialist Karna, LLC, Atlanta, GA 2010-2015 Associate Director of Evaluation and Research Southeast AIDS Training and Education Center Emory University, Atlanta, GA 2007-2010 Office of Research and Testing Data Analyst Clayton County Public Schools, Jonesboro, GA 2005-2007 Research Analyst Scientific Games, Alpharetta, GA 2004-2005 College Education Research Assistant University of Georgia Athens, GA PROFESSIONAL SOCIETIES AND ORGANIZATIONS: 2007-Present American Evaluation Association 2004-2010 American Educational Research Association PRESENTATIONS AND PUBLICATIONS: Beane, S., Culyba, R., DeMayo, M., & Armstrong, W. (2014). Exploring the medical home in Ryan White HIV care settings: A pilot study. Journal of the Association of Nurses in AIDS Care, 25(3),191-202. doi: 10.1016/j.jana.2013.10.007 Myers, J., Bradley-Springer, L., Dufour, K., Koester, K., Beane, S., Warren, N., Beal, J. & Frank, L. (2012). Supporting the integration of HIV testing into primary care settings. American Journal of Public Health, 102(6), e25-32. doi: 10.2105/AJPH.2012.300767 Beane, S. (2011, November). A powerful method for the evaluator’s toolbox: Using meta- analysis with small sample sizes. Paper presented at the American Evaluation Conference, Anaheim, CA. Beane, S. (2011, August). Assessing immediate outcomes of an early intervention program. Paper presented at the National HIV Prevention Conference, Atlanta, GA. Johnson, C., Cutts, Q., & Beane, S. (2009, November). Program evaluation and public schools, confronting the challenges. Paper presented at the American Evaluation Association Conference, Denver, CO. Beane, S. & Cutts, Q. (2009, November). Using Dimensions products to streamline survey creation. Paper presented at the SPSS Conference, Las Vegas, NV. Beane, S. (2009, April). Learning in two languages. Paper presented at the American Education Research Association Conference Graduate Student Research Gala, San Diego, CA. Beane, S. & Jack, A. (2006, November). Getting more out of your data: Using SPSS Text Analysis to determine lottery player motivation. Paper presented at the SPSS Conference, Chicago. DESCRIBING HEALTHCARE SERVICE DELIVERY IN A RYAN WHITE PROGRAM FUNDED HIV CLINIC: A BAYESIAN MIXED-METHODS CASE STUDY by Stephanie N. Beane Under the Direction of William L. Curlette 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. DESCRIBING HEALTHCARE SERVICE DELIVERY IN A RYAN WHITE PROGRAM FUNDED HIV CLINIC: A BAYESIAN MIXED-METHODS CASE STUDY by Stephanie N. Beane A Dissertation Presented in Partial Fulfillment of Requirements for the Degree of Doctor of Philosophy in Educational Policy Studies in the Department of Educational Policy Studies in the College of Education and Human Development Georgia State University Atlanta, GA 2016 Copyright by Stephanie N. Beane 2016 ACKNOWLEDGMENTS This dissertation has been the greatest and most difficult academic endeavor of my life. A great many people have supported me throughout the challenging process of writing this dissertation. Without the encouragement and support of my family, academic mentors, colleagues, and friends this dissertation would not be possible. First and foremost I thank my parents, Alan and Angela Camp, who have been extraordinary role models and constant sources of love throughout my life. My parents have been exemplars of persistence and hard work and my mother, a committed educator, has been my biggest champion throughout my doctoral studies. I also thank my loving husband, Roy Clarke, who I met early in my doctoral studies and has been by my side throughout the entire process. I am so grateful for his friendship,
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