ORCID Identifier(s)

0000-0002-0096-6361

Graduation Semester and Year

2019

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Nursing

Department

Nursing

First Advisor

Kathryn Marie Daniel

Abstract

Background: Thirty-day hospital readmission is a significant quality of care and economic problem for adults aged 65 years and older in the United States. The diagnoses most commonly problematic include heart failure (HF), pneumonia (PNE), and chronic obstructive pulmonary disease (COPD). Review of Literature: Multiple factors have been found to influence thirty-day hospital readmissions. Patient specific contributing factors include: depression, cognitive function, level of functional mobility, socioeconomic forces, and race. Exogenous factors include: patient education, pharmacologic agents, and health care providers quality of care. Interventions most effective in decreasing thirty-day hospital readmission include utilization of a team approach and a focus on modifying and supporting both patient specific and exogenous factors. Methods and Design: This is a pilot study and retrospective review of medical records utilizing convenience sampling. Two groups were analyzed; one receiving a transitional care intervention, the second receiving home based primary care. The subjects in both groups had been recently discharged from an acute care setting with HF, PNE, or COPD. Thirty-day hospital readmission was the primary outcome indicator. Levels of cognitive function and mobility were compared between groups. Results: Thirty-three records were reviewed, 26 in the transitional care group and 7 in the home based primary care group. There was no significant association between group membership and 30-day hospital readmission OR 3.07, CI 95% [.401, -23.44]. Analyses indicated that subjects in the home based primary care practice were significantly more likely to have cognitive impairment than those in the transitional care program OR 16, CI 95% [2.0,-127.9]. A Mann-Whitney U test revealed a significant difference in levels of functional impairment between the transitional care program and home based primary care practice groups, z=3.57, p<.001. Summary: The direction of the data for this pilot study suggests no difference in 30-day hospital readmissions between the transitional care program and the home based primary care practice. A fully powered study may provide additional insights.

Keywords

Older adults, Hospital readmission, Home based primary care, Transitional care

Disciplines

Medicine and Health Sciences | Nursing

Comments

Degree granted by The University of Texas at Arlington

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