WGU D520: Healthcare Leadership and Administration Capstone Task 2 |Latest Update with Complete Solution

WGU D520: Healthcare Leadership and Administration
Capstone Task 2 |Latest Update with Complete Solution



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D520: Healthcare Leadership and Administration Capstone

Task 2: Prospectus

Reducing Readmission Rates Due to AMA Discharges



*This..task..received..an..Excellence..Award


A:..Executive..Summary

Over..the..past..sixty..years,..the..rates..of..patients..who..discharge..themselves..from..an..inpat

ient..hospitalization..against..medical..advice..(DAMA)..have..increased..(Haines..et..al.,..2020)...A..re

cent..study..showed..that..DAMA..discharges..account..for..over..338,000..inpatient..hospitalizations,

..with..an..average..annual..increase..in..prevalence..of..1.9%..(Haines..et..al.,..2020)...When..a..patient..


decides..to..leave..before..their..physician..has..approved..a..safe..transition..upon..completion..of..treat

ment..for..their..acute..care..needs,..the..consequences..for..the..patient..can..be..dire,..including..a..high

er..risk..of..30-

day..readmissions,..repeat..DAMA..events,..and..worsening..of..their..clinical..condition..up..to..and..i

ncluding..potential..death..(Southern..et..al.,..2012)...Readmissions..due..to..a..DAMA..event..can..cre

ate..up..to..a..56%..higher..cost..to..treat..than..would..be..expected..had..the..patient..remained..for..the..i

nitial..hospitalization..through..to..a..physician-
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,ordered..discharge..(Alfandre,..2009).. . A..study..in..2020..found..that..readmissions..for..patients..wh

o..leave..against..medical..advice..accounted..for..more..than..400,000..inpatient..days..at..a..total..cost..

burden..for..healthcare..of..more..than

$800..million..annually..(Tan..et..al.,..2020).

Patients..decide..to..leave..before..their..acute..care..treatment..is..completed,..commonly..due..t

o..personal..or..financial..obligations..(Haines..et..al.,..2020)...In..my..own..experience..as..both..a..form

er..bedside..registered..nurse..and..now..as..an..inpatient..medical..coder,..I..daily..see..patients..who..ar

e..willing..to..put..their..health..in..jeopardy..to..get..home..as..the..sole..caregiver..of..a..dependent..spou

se,..parent,..or..child...Other..reasons..may..include..the..need..to..return..to..work,..or..for..others,..once..

the..immediate..acute..needs..are..met..and..they..feel..better,..they..see..no..point..in..continuing..treatm

ent..(Haines..et..al.,..2020),..such..as..additional..days..to..complete..a..full..course..of. . IV..antibiotics..o

r..continued..observation..of..a..condition..that..the..physician..feels..remains..clinically..concerning...S

till

others..may..object..to..the..non-

smoking..campus,..or..they..have..other..addictions..that..override..their..willingness..to..stay..for..a..comple

te..course..of..treatment.

A..solution..for..hospital..organizations..to..mitigate..DAMA..events,..for..whatever..reason..th

e..patient..is..unwilling..to..stay,..is..to..offer..(for..patients..who..qualify)..a..patient-

centered..care..model..that..fuses..home..health..care..and..hospital-

quality..acute..care..delivered..in..the..patient’s..home...Acute..care..at..home..(ACH)..is..a..program..tha

t..bridges..the..gap..in..care..by..providing..the..same..physician-

..ordered..medications,..supplies,..equipment,..clinical..staff,..and..services..that..would..have..been..de


livered..in..the..hospital..setting...This..ensures..that..the..patient..at..risk..for..leaving..against..medical..

advice..receives..the..full..course..of..required..treatment..to..resolve..their..acute..care..issues..while..al
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,lowing..them..to..attend..to..their..personal..needs..and..obligations..at..home..without..further..risking..

their..health..and..potentially..their..lives.

By..removing..the..qualifying..patients’..barriers..to..remaining..inpatient..for..care,..an..organi

zation..can..better..meet..their..patients’..needs..by..largely..reducing..or..eliminating..the..risk..of..read

missions..(thereby..reducing..the..cost..of..healthcare..delivery),..improving..the..patient’s..healthcare.

.experience,..and..improving..their..service..population’s..health..(including..reduced..mortalities),..al


l..of..which..meet..the..triple..aim..of..healthcare..(Berwick..et..al.,..2008).

The..feasibility..of..this..program..will..be..less..challenging..for..medium..to..larger..hospital..o

rganizations..that..either..already..have..the..resources..and..technology..infrastructure..available..to..a

dapt..to..provide..acute..care..at..home,..or..that..have..the..financial..resources..for..hiring..new..staff..an

d..purchasing..the..required..technology...Today,..more..than..95%..of..hospitals..utilize..an..electronic.

.health..record..(EHR)..system..(The..Office..of..the..National..Coordinator..for..Health..Information..


Technology,..2019),..which..is..mandatory..for..a..successful..ACH..program..in..order..to..ensure..coo

rdinated..communication..and..sharing..of..patient..information,..clinical..decision..support,..clinical

order..management,..and..to..support..remote..patient..monitoring..(RPM)..devices..for..data..collection

...A..robust..EHR..system..will..support..all..aspects..of..safe,..efficient,..and..effective..patient-

centered..care..delivery..(HealthIT,..n.d.).

Implementing..an..ACH..program..will..require..that..an..organization..has..the..resources..to..

utilize..technology-

driven..solutions..to..ensure..that..patients..are..closely..monitored..at..home,..with..the..ability..to..prov

ide..immediate..patient..connection..to..hospital..personnel..24-

hours..a..day,..including..the..provision..of..telehealth..equipment..for..virtual..check-

ins...The..success..of..the..ACH..program..will..require..the..use..of..RPM..devices..that..will..monitor..a

nd..report..in..real-
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, time..the..patient’s..clinical..data..to..medical..staff;..these..devices..may..include..blood..pressure..mo

nitoring,..glucometers,..pulse..oximetry,..Bluetooth..thermometers..and..weight..scales,..biometric..m

onitoring..devices..such..as..electrocardiograms..and..stethoscopes,..and..wearables..such..as..activity..

trackers..and..continuous..monitoring..(Muller,..n.d.)...These..technologies..do..not..replace..medical..

staff,..who..must..assess..the..patient..daily..with..in-

person..and/or..virtual..visits,..but..they..will..provide..continuous..clinical..data..in..the..same..way..tha

t..monitoring..in..the..hospital..would..be..achieved.

Organizational..considerations..for..dedicated..staffing..will..require,..at..minimum,..a. . physi

cian..to..act..as..the..program’s..medical..director,..adviser,..and..liaison..to..senior..leadership;..nurse..pr

actitioners..to..lead..the..ACH’s..patient-

care..teams..and..assess..the..patient..daily..through..to..an..ordered..discharge;..registered..nurses..to..m

ake..at-

home..visits..for..all..nursing..care..(dressing..changes,..IV..medications,..other..nursing..treatments..as

..ordered,..and..unscheduled..visits..as..necessary..to..assess..changes..of..condition);..and..ancillary..se


rvices..staff..to..include..respiratory,..physical,..occupational,..and..speech..therapies,..along..with..nec

essary..oxygen..and..durable..medical..equipment..(DME)..such..as..bedside..commodes,..walkers,..an

d..the..like.

Service..considerations..for..an..ACH..program..to..deliver..hospital-

quality..care..must..include..pharmacy..services,..diagnostics..(labs,..radiology),..transportation..(for..

a..patient..that..may..require..a..service..or..procedure..that..can..only..be..accomplished..in-

hospital,..such..as..an..MRI,..endoscopy..or..other..procedure),..and..food..services,..especially..for..pa

tients..who..have..specific..nutritional..requirements..while..they..are..recovering...Social..workers..w

ill..be..required..to..provide..care..coordination..and..discharge..transition,..whether..the..disposition..is

..home,..a..skilled..nursing..facility,..a..rehabilitation..facility,..or..traditional..home..health..care.

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