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Early Primary Care Provider Follow-Up for High Readmission Risk Native Hawaiian Health Project Patients at the Queen's Meidcal Center.

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Title:Early Primary Care Provider Follow-Up for High Readmission Risk Native Hawaiian Health Project Patients at the Queen's Meidcal Center.
Authors:Yokono, Yvonne K. Y.
Contributors:Nursing Practice (department)
Transitional Care
Discharge Planning
Date Issued:May 2018
Publisher:University of Hawaiʻi at Mānoa
Abstract:Hospitals within the United States are burdened by the steep costs associated with
preventable readmissions. With growing concern over high readmission rates among Native
Hawaiians, The Queen’s Medical Center implemented the Native Hawaiian Health (NHH)
Project. The author of the Doctor of Nursing Practice project partnered with the NHH Project to
develop, implement, and evaluate an evidence-based readmission reduction practice change. The
Iowa Model was selected as the conceptual framework to guide the project.
Following an analysis of NHH Project data, it was revealed that primary care provider
(PCP) follow-up for “high readmission risk” patients could be significantly improved. Following
a literature review on PCP follow-up timeliness, key recommendations were synthesized and
informed the development of the practice change innovation—an early (2 business days) PCP
follow-up visit guideline.
To operationalize the guideline, an interdisciplinary workflow process was implemented.
The workflow process utilized the NHH Project APRN’s risk assessment reports to substantiate
early PCP follow-up for high readmission risk patients at the Queen Emma Clinic. To evaluate
project outcomes, a “process” and “impact” evaluation was conducted.
All “process” measures improved following implementation, demonstrating guideline
adherence and workflow functionality. A post-pilot focus group identified that staff viewed the
project favorably; select staff unawareness of the practice change was perceived as a barrier. In
regard to “impact” measures, while the overall readmission rate remained unchanged, the
readmission rate increased for patients who did not receive PCP follow-up, and decreased for
patients who did receive PCP follow-up. These findings suggest the practice change may have
prevented an increase in overall readmission rate. An incidental finding was the high rates of
homelessness, substance use, and/or mental illness among patients who did not receive PCP
follow-up. This trend identified the need to explore innovative approaches to health maintenance
for these vulnerable populations.
As a quality improvement initiative, the project had several limitations. First, the practice
change was implemented in a fluid environment without controlled variables and conditions.
Second, the project’s marginal sample size limited the ability to draw reliable inferences from
evaluation data. Despite these limitations, practice change sustainment and expansion should be
Description:D.N.P. Thesis. University of Hawaiʻi at Mānoa 2018.
Rights:All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
Appears in Collections: D.N.P. - Nursing Practice

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