Date of Conferral

2-11-2025

Degree

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

School

Public Policy and Administration

Advisor

Donna Clews

Abstract

Hospitals with high readmission rates face financial penalties due to the Medicare Hospital Readmissions Reduction Program (HRRP). The purpose of this quantitative, retrospective, quasi-experimental study was to determine the relationship between pre- and post-implementation of an Acute Care for Elders (ACE) Unit in a critical access hospital (CAH) and length of stay (LOS) and readmission rates within 30 days. The theoretical framework used for this study was Donabedian’s theory of evaluating the quality of medical care delivered. Donabedian’s theory of quality care delivery is composed of three elements, structure, process, and outcome. For the purpose of this study, structure consists of the CAH, the process is represented by the implementation of the ACE unit, and the outcomes are the LOS and readmission rates within 30 days. The relationship between pre- and post-implementation of ACE unit in a CAH and LOS with controls for age and gender was analyzed using a multiple linear regression, which showed a statistically significant difference between pre- and post-implementation groups and LOS (p < .001). The study revealed that the implementation of the ACE unit decreased LOS by 0.48 days (B = -0.48, 95% CI [-0.76, -0.21]). The relationship between pre- and post-implementation of ACE unit in a CAH and readmission rates within 30 days with controls for age and gender was analyzed using a binomial logistic regression with findings that showed no statistically significant difference between the pre- and post-implementation groups (p = .166). This study has the potential to contribute to positive social change by adding to the existing body of knowledge regarding ACE units and patient outcomes.

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