Date of Conferral

2021

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

Karin Polifko

Abstract

The United States consistently experiences the highest health consumption per capita, caused, in part, by the fragmented and inefficient care delivery within hospitals. Both excessive length of stay and undesirable readmission rates are prime opportunities for hospitals to correct inefficiencies and improve patient outcomes, as well as lower healthcare costs. The advent of the hospital-medicine specialty in 1996 began addressing these concerns, however, opportunity still exists to refine the medical model used by hospitalists caring for the high volumes of patients admitted to medical-surgical units. The purpose of this quantitative study was to compare the effect of open and closed models in medical-surgical units on length of stay and readmission rates. Both linear and logistic regression models were used to address a gap in the literature regarding whether the closed model would provide similar benefits previously seen in critical care. Donabedian’s triad structure-process-outcome model provided the theoretical framework. Retrospective data analysis of adult patient admissions to medical-surgical units at a two-hospital system in Naples, Florida, from June 2018 through January 2019 (n = 1547) indicated a significant relationship between the closed model and lower length of stay but did not result in increased readmission rates. Covariate analysis showed a clear link between patients’ comorbid/chronic conditions and both length of stay and readmission risk. Reducing length of stay and lowering readmission rates in medical-surgical units may improve hospital efficiency, cost-effectiveness, and quality of care leading to positive social change.

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