Date of Conferral

6-13-2025

Degree

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

School

Health Services

Advisor

Matt Frederiksen-England

Abstract

Hospital readmissions for Medicare beneficiaries with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) contribute to increased healthcare costs and adverse outcomes. Evidence-based interventions, such as discharge planning, multidisciplinary care coordination, and patient education, have been implemented to reduce ambulatory care-sensitive admissions (ACSA), yet challenges in care continuity persist. This integrative review examined strategies adopted by healthcare organizations to reduce ACSA among Medicare beneficiaries with CHF and COPD. Guided by the utilization management framework, the review analyzed 19 studies and identified six primary themes: (a) integrated care models, (b) discharge and transitional care, (c) patient-centered interventions, (d) economic and resource efficiency, (e) technological innovations, and (f) cultural and operational challenges. While the first five themes represent effective intervention strategies, cultural and operational challenges were framed as factors organizations successfully navigated through context-specific alignment and adaptive implementation strategies. The 12 subthemes included multidisciplinary approaches, care pathways and bundles, early planning, structured education, tailored care, community engagement, cost-effective practices, hospital readmission reduction programs, telehealth, data-driven insights, generalizability, and bias and response issues. A key finding of this review is that tailoring interventions to organizational culture and workflows improves adoption and scalability. This review promotes positive social change by identifying scalable, evidence-based practices that enhance care coordination, improve patient self-management, reduce system burden, and advance health equity in chronic disease management.

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