Date of Conferral



Doctor of Healthcare Administration, DHA




James E. Rohrer


Approximately 11% of patients diagnosed with a stroke or a transient ischemic attack are readmitted to the hospital, creating a cost burden of nearly $2 billion per year for Medicare beneficiaries. Because researchers and policy makers consider hospital readmission for patients with strokes or transient ischemic attack to be an indicator for the delivery of quality care, the Centers for Medicare and Medicaid Services has imposed financial penalties of up to 3% of a hospital's Medicare reimbursement in 1 year for excessive readmissions, potentially impacting the financial sustainability of various healthcare organizations. The ecological systems theory allows for the understanding of how microsystems, mesosystems, exosystems, macrosystems, and chronosystems impact the development, influence, and predictability characteristics of a specific population serviced in a healthcare setting. This quantitative study analyzed cross-sectional data from the 2016 National Hospital Ambulatory Care Survey, using cross-tabulations with chi-square followed by multiple regression analyses. Overall, this study addressed the gap in the existing literature by examining admission rates for patients with the diagnoses of strokes or TIA and the association between ancillary service use, insurance status, and provider level evaluation. The study concluded that few predictors that exist between the independent and dependent variables, with the exception of the amount of laboratory tests ordered. Maintaining the financial reasonability by avoiding penalties for stroke or transient ischemic attack unnecessary admission from value-based purchasing, the implication for social change is maintaining access to care for patients by avoiding hospital closures.