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Hospital Admission from the Emergency Department for Patients Dia.pdf

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Walden UniversityScholarWorksWalden Dissertations and Doctoral StudiesWalden Dissertations and Doctoral StudiesCollection2019Hospital Admission from the EmergencyDepartment for Patients Diagnosed with HeartFailureTammy YoungWalden UniversityFollow this and additional works at:Part of theHealth and Medical Administration CommonsThis Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has beenaccepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, pleasecontact[email protected].
Walden UniversityCollege of Health SciencesThis is to certify that the doctoral study byTammy Younghas been found to be complete and satisfactory in all respects,and that any and all revisions required bythe review committee have been made.Review CommitteeDr. James Rohrer, Committee Chairperson, Health Sciences FacultyDr. Cynthia Newell, Committee Member, Health Sciences FacultyDr. Rabeh Hijazi, University Reviewer, Health Sciences FacultyChief Academic OfficerEric Riedel, Ph.D.Walden University2019
AbstractHospital Admission from the Emergency Department for Patients Diagnosed with HeartFailurebyTammy YoungMS, Walden University, 2016BS, Jacksonville State University, 1998BS, Jacksonville State University, 1990Doctoral Study Submitted in Partial Fulfillmentof the Requirements for the Degree ofDoctor of Healthcare AdministrationWalden UniversityMay 2019
AbstractApproximately 25% of those hospitalized with congestive heart failure are readmittedwithin 30 days after discharge.Because researchers and policy makers consider hospitalreadmission within 30 days for patients with heart failure to be a quality of care issue, theCenters for Medicare and Medicaid Services has imposed financial penalties of up to 3%of a hospital’s Medicare revenue for 1 year for excessive readmissions, potentiallyimpacting the financial sustainability of some organizations.The purpose of the studywas to address the research gap regarding the outcome quality measure of hospitaladmissions from the emergency department (ED) and 2 each process and structurevariables.The Donabedian conceptual framework was used to assess quality of carethrough the triad of structure, process, and outcome.The quantitative study comprisedanalysis of cross-sectional archival data from the 2015 National Hospital AmbulatoryCare Survey using cross-tabulations with chi-square followed by multiple logisticregression analysis.Findings showed that process quality measures of being seen in theED within 72 hours and total laboratory tests obtained in the ED were predictive of lowerlikelihood of admission.The structure quality measure of insurance was not predictive;however, being seen by provider type consulting physician was predictive of higherlikelihood of admission, whereas being seen by a nurse practitioner was predictive oflower likelihood of hospital admission. The implications of this study for social changeare helping hospitals maintain financial stability through avoidance of financial penaltiesfor heart failure readmission, supporting access to care for patients by avoiding hospitalclosures.

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