Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Reducing 30-day hospital readmissions for chronic obstructive pulmonary disease in southwest Montana: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Brumbach, Kevin Christopher; Chairperson, Graduate Committee: Lindsey Davis; This is a manuscript style paper that includes co-authored chapters.Chronic obstructive pulmonary disease (COPD) recently joined the leading causes of hospital readmission. Readmissions range from 7% up to 82.2% with the highest rate amongst home-bound patients. Post-discharge programs demonstrate varied impacts on 30-day COPD readmission rates. Home health provides evaluation and treatment management opportunities for the most at-risk population and the literature lacks studies evaluating patient outcomes with a home health nurse-driven COPD protocol. At the project site, the hospital COPD 30-day readmission rate for patients > or = 65 years averaged 28.8% from 2018 to 2021. The clinic stakeholders recorded two 30-day readmissions during calendar year 2023. To reduce 30-day COPD hospital readmissions and identify home health qualifying patients a COPD Home Health Protocol and participant qualifying identification tool were created and evaluated with descriptive statistics. Two interventions were initiated: a provider approved, nurse-driven home health protocol managing COPD symptoms; an electronic health record .dotphrase identifying home-bound patients qualified for home health and the COPD nurse-driven protocol. The project aims were partially achieved with a 75% utilization rate of the home health qualifying .dotphrase and successful identification of one possible home health candidate who refused home health services. No patients received the COPD home health protocol during the eight-week study period. The project successfully identified participants qualifying for home health but lacked sufficient opportunity to evaluate the COPD home health protocol. Expanding age inclusion criteria to participants > or = 50 years will more effectively evaluate the at-risk population.Item Implementation of Lean management in family practice to decrease overall clinic visit time(Montana State University - Bozeman, College of Nursing, 2020) Quist, Rochelle Eileen; Chairperson, Graduate Committee: Angela JukkalaVariations in the patient rooming process have created inefficient practices for staff in a clinic setting. Negative impacts from these variations have been correlated with increased patient wait times, delayed patient care and decreased patient satisfaction. Through patient complaints with frustrations in delayed care and wait times, this scholarly project found discrepancies in the patient flow process. Variations existed within several primary care patient settings based on individual provider training and personal habits, style, and preferences. Utilizing Lean Management ideals to improve rooming and throughput were strongly indicated within recent healthcare journals as a means to reduce waste and improve efficiency in patient care processes. Developing interventions based on Lean Management principles discovered in the literature review will be outlined for execution. Following implementation of interventions, a follow up time study will be completed to compare to the original data, as well as repeat patient satisfaction surveys. This scholarly project expands nursing knowledge by addressing the gaps in past studies by examining throughput in an outpatient clinic setting, potentially decreasing patient wait times, delays in care and increasing patient and provider satisfaction.Item Post-sepsis syndrome: improving morbidity & mortality following hospitalization(Montana State University - Bozeman, College of Nursing, 2020) Woods-Tatarka, April Ann; Mauws, Amanda Frances; Chairperson, Graduate Committee: Angela JukkalaSepsis is the life-threatening organ dysfunction caused by a dysregulated host response to infection. Globally, statistics are grim with 19 million cases diagnosed annually. Each year in the United States (US) there are over 1.6 million people diagnosed with sepsis; over 250,000 of these will not survive. Currently, it is a leading cause of morbidity, mortality, and hospital readmissions in the US. The population of focus was those residing within the north-central Montana region. The purpose of this project was to explore the topic of post-sepsis syndrome (PSS) and its occurrence following a primary diagnosis of sepsis. The goal of this project was the development of a quality improvement initiative focused on establishing a care-management program for patients diagnosed with sepsis. Ultimately, maximizing patient health and healthcare organization outcomes. An interprofessional team was convened to develop an evidence-based quality-improvement plan to decrease the human and financial costs of sepsis and PSS. The purposed evaluation of the quality-improvement project includes monthly PDSA cycles with project goals reviewed bi-annually.Item Attention deficit hyperactivity disorder treatment for pediatrics(Montana State University - Bozeman, College of Nursing, 2018) Brewer, John Mikkel; Chairperson, Graduate Committee: Tracy HellemAttention deficit, hyperactivity disorder (ADHD) is commonly diagnosed in children, and the frequency of this disorder being diagnosed and treated continues to rise each year. The research regarding treatment for pediatric ADHD has shown varied results ranging from pharmacological and behavioral therapies producing positive effects when combined to standalone behavioral therapy or medication producing positive effects with no therapeutic intervention. There are two published guidelines on the management of pediatric ADHD. The American Academy of Pediatrics and the National Collaborating Centre for Mental Health each created a guideline for evaluating, diagnosing, and treating pediatric patients with ADHD. This project analyzed ADHD treatments for children ages 4 to 18 years in an acute, inpatient psychiatric setting, and in an inpatient, residential-treatment-care setting. A comparison of these treatments with the national guidelines was conducted. This scholarly project compared pediatric ADHD treatment in an inpatient, acute-care unit versus a residential-care unit of a psychiatric children's hospital. Readmission rates within 30 days of discharge from a psychiatric children's hospital have been analyzed, and care practices have been compared with the national guidelines. Data was extracted from electronic medical records from the psychiatric children's hospital's healthcare record system. The types of data that were extracted included demographics, such as age, comorbid diagnoses, and concomitant medications; in addition to types of treatment, readmission rates, and treatment setting. Type-of-treatment data included type of medication versus treatment setting. The findings suggest that medications other than methylphenidate may have similar efficacy as methylphenidate for treating pediatric ADHD. The inpatient psychiatric unit is not necessarily following the National Clinical Guidelines for treating pediatric and adolescent ADHD, but the results reveal that methylphenidate versus non-methylphenidate treatment for ADHD does not demonstrate a statistically significant difference with respect to inpatient readmission rates. The research identified that patients receiving residential care for ADHD had a higher likelihood of being readmitted to the hospital than patients receiving acute care, and patients' readmission rates were not statistically significantly different regarding methylphenidate versus non-methylphenidate medication-treatment regimens. Overall, this research identified that medications other than methylphenidate can be effective in treating patients with ADHD.Item Implementation of a quality-improvement project to improve identification of patients at high risk for psychiatric hospitalization(Montana State University - Bozeman, College of Nursing, 2018) Shomate, Heath; Chairperson, Graduate Committee: Susan LuparellReadmission to a psychiatric hospital within 30 days is a common problem. Worldwide, nearly one in seven individuals hospitalized for psychiatric reasons are readmitted within 30 days of discharge. Frequent readmissions in individuals with a psychiatric cause are also problematic in the Western United States. The aim of this DNP project was to use the READMIT tool to determine if it can predict psychiatric readmission within 30 days of hospital discharge. The cohort included in the project were adults 18-years-old and older diagnosed as having a psychiatric disorder that caused them to be admitted to an inpatient psychiatric treatment unit. Data were collected from a 'healthcare organization in a western state' using a retrospective chart review of 50 electronic medical records (EMRs) that were at least one year old. The data were collected on the retrospective dates of 06/24/17, 7/01/17, and 7/08/17. The dates were selected close together so that treatments, providers, and cares would be relatively similar, thus having less of a chance to skew the data. Each of the 50 patient charts was examined and each was given its own separate score generated by the READMIT tool. The READMIT tool's scores ranged from 0 to 41, with higher scores indicating an increased probability for readmission. The mean READMIT score for patients that were readmitted was 23.21 compared with a mean of 17.78 for the group of patients that were not readmitted. Of the charts examined for this study, 14 (28%) of them were readmitted within 30 days. The READMIT index did show that the higher an individual scores, the more likely he or she would be readmitted. The READMIT tool has the potential to enhance psychiatric treatment as it can identify individuals more likely to be readmitted.Item Cost-effective strategies to minimize heart failure readmission rates(Montana State University - Bozeman, College of Nursing, 2018) Herring, Russel Ryan; Chairperson, Graduate Committee: M. Jean Shreffler-GrantThe purpose of this project was to identify and analyze the potential costs and benefits associated with the inclusion of a certified heart-failure nurse responsible for inpatient education and outpatient follow-up services for heart-failure patients. Admission and avoidable readmission data for a representative, Eastern Montana, inpatient healthcare facility were obtained and analyzed as the standard care model, and then compared against a care model utilizing a specialist heart-failure nurse responsible for inpatient education and outpatient, post-discharge follow-up care. A five-year pro forma was constructed, presenting a five-year cost versus savings forecast, in which a positive savings trend was estimated over the course of a five-year period.Item Getting fixed : perceptions of rural and urban patients who have experienced total knee or hip replacement surgery and their discharge planners in a Montana hospital(Montana State University - Bozeman, College of Nursing, 1991) McIntosh, Allison MarieItem Psychiatric patient needs assessment as it pertains to discharge planning(Montana State University - Bozeman, College of Nursing, 1982) Necker, Elaine AudreyItem What are the attitudes of nurses employed by small, rural hospitals toward discharge planning?(Montana State University - Bozeman, College of Nursing, 1983) Sorenson, Dianna Lee SpiesItem Predictive models for 30-day patient readmissions in a small community hospital(Montana State University - Bozeman, College of Engineering, 2013) Lovejoy, Matthew Walter; Chairperson, Graduate Committee: David ClaudioPresently, national healthcare initiatives have a strong emphasis on improving patient quality of care through a reduction in patient readmissions. Current federal regulations created through the Patient Protection and Affordable Care Act (PPACA); focus on the reduction in readmissions to improve patient quality of care (Stone & Hoffman, 2010). This legislation mandates decreased reimbursement for services if a facility has high 30-day patient readmissions related to the core measures Congestive Heart Failure (CHF), Acute Myocardial Infarction (AMI) and Pneumonia (PNM). This research focuses on building predictive models to aid Bozeman Deaconess Health Services (BDHS), a small community hospital, reduce their readmission rates. Assistance was performed through identification of patient characteristics influencing patient readmission risk, along with advanced statistical regression techniques used to develop readmission risk prediction models. Potential predictor variables and prediction models were obtained through retrospective analysis of patient readmission data from BDHS during January 2009 through December 2010. For increased prediction accuracy seven separate readmission dataset types were developed: General population, and ICD-9 code related populations for AMI, CHF, PNM, Alcoholic Psychoses (291), Cardiac Dysrhythmias (427) and Disorders of the Function of the Stomach (536). For the greatest benefit from readmission reduction, analysis focused on readmissions categorized as Potentially Preventable Readmissions (PPR); defined as unplanned, medically related readmissions within 30-days of a patient's previous inpatient visit. General exploratory analysis was performed on the PPR patient data to discover patterns which may indicate certain variables as good predictors of patient readmission risk. The prediction model methods compared were binary logistic regression, and multivariate adaptive regression splines (MARS). Usable binary logistic regression models for 536 (Nagelkerke R 2=0.676) and CHF (Nagelkerke R 2=0.974) were achieved. MARS developed usable models for 427 (Naïve Adj. R 2=0.63288), 536 (Naïve Adj. R 2=0.77395), AMI (Naïve Adj. R 2=0.76705), CHF (Naïve Adj. R 2=0.99385) and PNM (Naïve Adj. R 2=0.82615). Comparison of the modeling methods suggest MARS is more accurate at developing usable prediction models, however a tradeoff between model complexity and predictability is present. The usable readmission risk prediction models developed for BDHS will aid BDHS in reducing their readmissions rates, consequently improving patient quality of care.