Date of Conferral

2016

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Deborah Lewis

Abstract

Cognitive impairment is commonly seen in the elderly population. It is unclear if cognitive deficit in heart failure (HF) patients is a primary factor for higher hospital readmission rates in this population. The Centers for Medicare and Medicaid Services have established strict guidelines for reimbursement on readmissions that occur within 30 days. It is imperative that organizations identify and rectify issues that impact readmissions. The aim of this project was to determine if there is a reduction in HF readmission after patients are screened for cognitive impairment. Orem's self-care model guided the project by providing a framework of inquiry regarding the impact of cognitive impairment on self-care deficits and the need for support for persons with heart failure. The project examined the hospital's 30-day readmission rate for the HF patients who received cognitive screening using a chi-square test; this analysis excluded HF patients who were not screened for cognitive impairment. Readmission rates for all patients during a 6-month period were examined. Two hundred sixty-eight patient records were reviewed; 48 patients were readmitted, and of those, 28 patients had completed the cognitive assessment, meeting the criteria for the project. The change in readmission rates was not significant (p = 0.196), suggesting that cognitive screening of patients is not associated with reduced readmission rates. Further research should examine the role of cognitive screening in addition to other resources on the 30-day readmission rate of HF patients. Social change will be improved as a result of the improved quality of life for HF patients and the reduced per-capita cost of health care in the United States.

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