Doctoral Dissertation Defense

Submitted to the Graduate Faculty of Argosy University, Phoenix

Graduate School of Business and Management

In Partial Fulfillment of the Requirements for the Degree of Doctor of Education

Organizational Leadership

By Vincent Bridges

December XX, 2016

A QUALITATIVE STUDY OF CURRICULUM OUTCOMES OF MEDICAL ASSISTING PROGRAMS AT THREE

MIDWESTERN UNITED STATES SCHOOLS

John Opinski, Ph.D, Committee ChairGraduate School of Business & Management

David Blake, Ph.D, Committee MemberGraduate School of Business & Management

Dale Mancini, Ph.D, Department ChairGraduate School of Business & Management

DISSERTATION COMMITTEE MEMBERS

Dissertation Defense Agenda Problem Background Purpose and Importance of the Study Problem Statements Themes and Concepts Research Questions Review of Literature Methodology and Study Design Results and Findings Findings Summary Conclusions and Recommendations Future Research and Summary

Background to the Problem

Increasing number of jobs and future projection. (U.S. Bureau of Labor Statistics, 2012)

Education and Preparedness Training of Medical Assistants

Changing role of the Medical Assistant

Shortage of Primary Care Physicians and Nurse Practitioners

(Bodenheimer, Willard-Grace & Ghorob, 2014) Medical Assistant Expanded

Responsibilities (American Association of Medical Assistants, 2015)

Ascertain the effectiveness of the medical assistant program outcomes for three Midwestern United States schools.

Ensuring Quality Patient Care through quality education and training.

Allow educational institutions to align educational delivery with stakeholder needs.

Continuous effort to ensure competent and confident graduates

Purpose and Importance of Study

Problem Statements Medical assistant graduates are encountering job responsibilities that

are traditionally not a part of their formal didactic education and training, due to the changing medical environment and the requirements of the medical assistants to perform expanded job duties to help ensure quality patient care.

Some medical assistant graduates are not considered strong enough candidates as those who have had additional skill set training as it relates to the expanded job duties and functions.

Patient Centered Medical Home Teams vs Traditional Disease Management

Health Coaching vs Traditional Patient Motivation and Education

Panel Management vs Traditional Quality of Care and Patient Care Outcome Management

Medical Scribing vs Traditional Documentation Process and Patient Interaction

Themes and Concepts

How do the program outcome for the medical assisting program at three Midwestern United States schools meet the needs of its stakeholders?

What program decisions or changes can be made by educational leaders of three Midwestern United States schools, as a result of these study results, to enhance or better meet stakeholder needs that may be identified?

Research Questions

The Role of the Medical Assistant Traditional Expanded

Medical Assistants and Healthcare Quality Diabetes Study – UNITE Health Center Hypertension, Hyperlipidemia & Uncontrolled Type 2 Diabetes Study Colon Rectal Cancer (CRC) Screening Study

Review of Literature

Scope of Practice Varies by State Not addressed by some states Delegation of Duties

Delegation of Duties Exclusions Definition of the M.A’s Scope of Practice (McCarty, 2012) As of 2012 , 11 states passed laws recognizing clinical scope of practice

(McCarty, 2012)

Review of Literature – Continued

Medical Assistants and Meaningful Use of Electronic Medical Records Centers for Medicare and Medicaid Services Initiative Electronic Health Records and Computerized Physician Order Entry

Review of Literature – Continued

Study Methodology: Qualitative Study Study Design: Descriptive Design Data Collection Tool & Design Method: A two page survey with seventeen

open and closed-ended questions. Data Collection Method: Online - Preferred, Email, and Mail Sampling Method: Purposive Sampling to identify appropriate professionals

that have experience hiring medical assistants and understand their job responsibilities, and/or managing their day-to-day administrative and clinical responsibilities.

Methodology and Study Design

The study participants must meet the following criteria to participate: Work(ed) for a medical organization, physician practice, healthcare institution or urgent care;

and, Hire(d) Medical Assistants and understand their job duties and requirements; or,

Manage(d) day-to-day clinical and administrative responsibilities of medical assistants (Present or Recent Past); and, Reside in one of the Midwestern United States, including Oklahoma; and, At least 18 years of age.

The study will seek 20-25 healthcare professionals that meet the study participation requirements to complete the online survey.

Population/Sample

Informed Consent and ConfidentialityConsent Documentation and ProcessInformation and Participant Confidentiality and Security

Population/Sample – Continued

Organization Affiliation EMR/EHR Usage/Type EHR Modules (CPOE) PCMH Team Models Medical Scribing Practices Administrative Functions Clinical Function

Data Collection

Simulation Training Laboratory Analysis Skills Microbiology Proficiency Survey Participants Demographics

Total Number of Participants - 25 Gender Make-Up - Female – 64% and Male 36% Participant Educational Level

Some College – 4%, 1 ParticipantAssociate Degree - 28%, 7 ParticipantsBachelor’s Degree – 40%, 10 ParticipantsMaster’s Degree – 16%, 4 ParticipantsDoctorate Degree – 12%, 3 Participants

Participant Profile

Participant Organizational Affiliation Physician Practice – 36%, 9 Participants Hospital or Free-Standing Clinic – 24%, 6 Participants Urgent Care – 20%, 5 Participants Other – 20%, 5 Participants

Chiropractic Medicine, Dialysis, Medical Employment Partners, and Practice Management Leadership Consultants

Participant Profile - Continued

First Coding Cycle Two Elemental Methods Used:

In-Vivo Coding – Use of words or short phrases from the actual language. These codes are identified by “xxxx”.

Descriptive Coding – Summarizing in a word or short phrase the basic topic of a passage of qualitative data.

Second Coding Cycle Pattern Coding – Pulls together a lot of material into a more

meaningful unit of analysis. Frequency – How often or seldom a word or short phrase happens.

Data Review and Coding Process

Streamlined Code and Theory Model

(Saldana, 2016)

Four-Step Process Step 1: Identify what was taught by each institution.

(Institution Catalog & Course Description) Step 2: Identify what the stakeholders considered important.

(Participant Survey) Step 3: Apply a frequency pattern to the stakeholder information

and feedback. (Frequency Tables) Step 4: Compare the data in step three to data in step one.

(Review & Analysis)

Coding Process

School Curriculum Outline

What was identified from the data: 10 Category 17 Sub-Category 152 Codes

Code, Sub-Category and Category Totals

Code, Sub-Category, and Category Table

Code Assignment Table – Clinical Codes

Top Three Code Frequency Table Compilation

Stakeholder/Institution Service ReviewSymbol Grading System

✓ Needs Met × Needs Not Met ✶ Needs Partially Met ≠ Unable to Determine

Results and FindingsCodes Affecting All Institutions

Additional Results and FindingsInstitution “A”

The Areas of Review and Recommendation were discussed under the previous slide “Codes Affecting All Institutions”

“No Additional Findings”

Additional Results and FindingsInstitution “B”

Additional Results and FindingsInstitution “C”

Findings Summary

Institution “A” – Eight (8) Significant FindingsInstitution “B” – Ten (10) Significant FindingsInstitution “C” – Nine (9) Significant Findings

Conclusions and RecommendationsRQ1 - How do the program outcome for the medical assisting program at three Midwestern United States schools meet the needs of its stakeholders?

Overall – All institutions are for the most part meeting the expected stakeholder needs, many of the findings were related to some of the expanded duties and enhancement of some of the traditional functions already being taught and are addressed under RQ2.

Conclusions and Recommendations RQ2 - What program decisions or changes can be made by educational leaders of

three Midwestern United States schools, as a result of the evaluation results, to enhance or better meet stakeholder needs that may be identified?

Enhance Critical Thinking (Exams and Didactic Courses) Incorporate learning and Instruction related to PCMH teams Incorporate learning and Instruction related to CPOE Add Complex Medication Management Add Legal Course Related to Pharmacology & Medication Delivery Introduce Complex Medical or Clinical Scenarios to Promote Critical Thinking and

Decision-Making within the Scope of Practice

Phlebotomy Practice Consider incorporating “live sticks” – using student-student practice

Conclusions and Recommendations - CONT Microbiology (Infection Control)

Include Laboratory Component Inoculate Agar Microscopic Microbe Analysis

Incorporate Chain of Infection Model Include Morphology of Bacteria Teach Various Methods to Break Chain of Infection

Conclusions and Recommendations - CONT Laboratory Test

Urinalysis Glucose Hematocrit

Patient Education Disease Management Goals Patient Out-Reach

Survey Larger Population and Sample Add Additional States – Incorporate M.A. Legislation for Specific States and

analyze impact related to current functions and expanded duties. Research Oversight and Regulation Concerns

Sample – Physicians Regarding Auspice and Oversight and include feedback from various boards such as the Board of Medical Examiners, Board of Osteopathic Examiners, and the various Nursing Boards.

Future Research and Summary

American Association of Medical Assistants. (2015). What is a medical assistant. Retrieved 06 17, 215, from American Association of Medical Assistants: http://www.aama-ntl.org/medical-assisting/what-is-a-medical-assistant

Bodenheimer, T., Willard-Grace, R., & Ghorob, A. (2014, 07). Expanding the roles of medical assistants: Who does what in primary care? Journal of the American Medical Association, 174(7), 1025-1026.doi:10.1001/jamaintemmed.2014.1319

McCarty, M. (2012). The lawful scope of practice of medical assistants: 2012 update. Retrieved from American MedTech: http://www.americanmedtech.org/portals/0/pdf/news/scopeofpracticearticle_june%202012.pdf

References

Saldana, J. (2016). Coding manual for qualitative researchers. Los Angeles: Sage Publishing

U.S. Bureau of Labor Statistics. (2012). Occupational outlook handbook: Medical assistants. Retrieved 06 17, 2015, from U.S. Bureau of Labor Statistics: http://www.bls.gov/ooh/healthcare/medical-assistants.htm

References – Continued

Questions?

Q & A