WGU D520 Capstone Task 2:
Prospectus Latest Update with
complete solutions.
KC
Student ID # XXXXXX
D520: Healthcare Leadership and
Administration Capstone Task 2:
Prospectus
Reducing Readmission Rates Due to AMA
Discharges
*This task received an Excellence Award
,A: Executive Summary
Over the past sixty years, the rates of patients who discharge
themselves from an inpatient hospitalization against medical advice
(DAMA) have increased (Haines et al., 2020). A recent study showed
that DAMA discharges account for over 338,000 inpatient
hospitalizations, with an average annual increase in prevalence of
1.9% (Haines et al., 2020). When a patient decides to leave before
their physician has approved a safe transition upon completion of
treatment for their acute care needs, the consequences for the
patient can be dire, including a higher risk of 30-day readmissions,
repeat DAMA events, and worsening of their clinical condition up
to and including potential death (Southern et al., 2012).
Readmissions due to a DAMA event can create up to a 56% higher
cost to treat than would be expected had the patient remained for
the initial hospitalization through to a physician-ordered discharge
(Alfandre, 2009). A study in 2020 found that readmissions for
patients who leave against medical advice accounted for more than
400,000 inpatient days at a total cost burden for healthcare of more
1
,than
$800 million annually (Tan et al., 2020).
Patients decide to leave before their acute care treatment is
completed, commonly due to personal or financial obligations
(Haines et al., 2020). In my own experience as both a former bedside
registered nurse and now as an inpatient medical coder, I daily see
patients who are willing to put their health in jeopardy to get home
as the sole caregiver of a dependent spouse, parent, or child. Other
reasons may include the need to return to work, or for others, once
the immediate acute needs are met and they feel better, they see no
point in continuing treatment (Haines et al., 2020), such as
additional days to complete a full course of IV antibiotics or
continued observation of a condition that the physician feels
remains clinically concerning. Still
2
, others may object to the non-smoking campus, or they have other
addictions that override their willingness to stay for a complete course
of treatment.
A solution for hospital organizations to mitigate DAMA events,
for whatever reason the patient is unwilling to stay, is to offer (for
patients who qualify) a patient-centered care model that fuses home
health care and hospital-quality acute care delivered in the patient’s
home. Acute care at home (ACH) is a program that bridges the gap
in care by providing the same physician-ordered medications,
supplies, equipment, clinical staff, and services that would have
been delivered in the hospital setting. This ensures that the patient
at risk for leaving against medical advice receives the full course of
required treatment to resolve their acute care issues while allowing
them to attend to their personal needs and obligations at home
without further risking their health and potentially their lives.
By removing the qualifying patients’ barriers to remaining
inpatient for care, an organization can better meet their patients’
needs by largely reducing or eliminating the risk of readmissions
3
Prospectus Latest Update with
complete solutions.
KC
Student ID # XXXXXX
D520: Healthcare Leadership and
Administration Capstone Task 2:
Prospectus
Reducing Readmission Rates Due to AMA
Discharges
*This task received an Excellence Award
,A: Executive Summary
Over the past sixty years, the rates of patients who discharge
themselves from an inpatient hospitalization against medical advice
(DAMA) have increased (Haines et al., 2020). A recent study showed
that DAMA discharges account for over 338,000 inpatient
hospitalizations, with an average annual increase in prevalence of
1.9% (Haines et al., 2020). When a patient decides to leave before
their physician has approved a safe transition upon completion of
treatment for their acute care needs, the consequences for the
patient can be dire, including a higher risk of 30-day readmissions,
repeat DAMA events, and worsening of their clinical condition up
to and including potential death (Southern et al., 2012).
Readmissions due to a DAMA event can create up to a 56% higher
cost to treat than would be expected had the patient remained for
the initial hospitalization through to a physician-ordered discharge
(Alfandre, 2009). A study in 2020 found that readmissions for
patients who leave against medical advice accounted for more than
400,000 inpatient days at a total cost burden for healthcare of more
1
,than
$800 million annually (Tan et al., 2020).
Patients decide to leave before their acute care treatment is
completed, commonly due to personal or financial obligations
(Haines et al., 2020). In my own experience as both a former bedside
registered nurse and now as an inpatient medical coder, I daily see
patients who are willing to put their health in jeopardy to get home
as the sole caregiver of a dependent spouse, parent, or child. Other
reasons may include the need to return to work, or for others, once
the immediate acute needs are met and they feel better, they see no
point in continuing treatment (Haines et al., 2020), such as
additional days to complete a full course of IV antibiotics or
continued observation of a condition that the physician feels
remains clinically concerning. Still
2
, others may object to the non-smoking campus, or they have other
addictions that override their willingness to stay for a complete course
of treatment.
A solution for hospital organizations to mitigate DAMA events,
for whatever reason the patient is unwilling to stay, is to offer (for
patients who qualify) a patient-centered care model that fuses home
health care and hospital-quality acute care delivered in the patient’s
home. Acute care at home (ACH) is a program that bridges the gap
in care by providing the same physician-ordered medications,
supplies, equipment, clinical staff, and services that would have
been delivered in the hospital setting. This ensures that the patient
at risk for leaving against medical advice receives the full course of
required treatment to resolve their acute care issues while allowing
them to attend to their personal needs and obligations at home
without further risking their health and potentially their lives.
By removing the qualifying patients’ barriers to remaining
inpatient for care, an organization can better meet their patients’
needs by largely reducing or eliminating the risk of readmissions
3
