Dallas Campus (Online)
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Doctor of Education
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Third Committee Member or Committee Reader
Navigating the complex, fragmented U.S. healthcare system presents patient challenges that result in increased utilization and consequent increases in the cost of care. This program evaluation was conducted to determine the impact of ambulatory assigned continuity of care nurses (COCN) on patient outcomes in terms of length of stay, return visits to the emergency department, and readmissions to the hospital within 30 days of discharge. Between June 1, 2020, and May 31, 2022, there were 26,912 admissions with general risk scores between 1 and 100. Undersampling technique was conducted to create a 1:2 balance of 3,502 patients admitted with an assigned COCN and 7,004 patients admitted without a COCN assigned. After adjusting for 534 deaths, the sample for return visits to the emergency department within 30 days of discharge was n = 3502 in the experimental group and n = 6471 in the control group. There were 1,043 patients labeled “not eligible for readmission” who were excluded from the sample when analyzing readmissions within 30 days of hospital discharge sample, resulting in an experimental group n = 3,106 and a control group n = 5,823. Because the independent variable violated normal distribution assumption, nonparametric tests were used to compare the differences between the experimental and control groups. The non-parametric Mann-Whitney U test revealed a statistically significant difference in the median LOS, U = 117, z = -3.749, p < .001, between patients with an assigned COCN (median rank = 5097.65, n = 3502, p < .001) compared to patients without a COCN (median rank = 5331.42, n = 7004, p < .001). The effect size was minimal (d = .091), indicating no practical impact. The non-parametric Pearson chi-square analysis revealed no significant impact of the COCN on the rate of return visits to the emergency department (X2(1)= 1.84, p = .177) and no significant impact on the rate of readmissions to the hospital (X2(1)= 1.784, p = .182).
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Lunsford, Lura Cynthia, "Do Metrics Improve When Continuity of Care Nurses Follow Chronic Disease Patients in the Ambulatory Setting?" (2023). Digital Commons @ ACU, Electronic Theses and Dissertations. Paper 669.