Date of Award

8-2016

Degree Name

Nursing (D.N.P.)

Department

College of Nursing

First Advisor

Karen Burritt

Second Advisor

Barbara Hooper

Third Advisor

Raymond Higbea

Fourth Advisor

Tammy Awald

Abstract

The Affordable Care Act (ACA) of 2010 is transforming health care across the nation into a value-based system that emphasizes quality and continuity with reimbursement tied to patient outcomes. The shift in emphasis is best realized through the strategy of Population Health Management, a change from traditional episodic treatment of illness to management of the health needs of populations throughout the continuum of health. The goal of care is to ensure that patients, especially the chronically ill, receive effective attention to their health needs in order to improve outcomes, decrease costs, and provide a positive patient experience. An important component of coordinating care in Population Health Management is identifying those at risk for adverse outcomes or unplanned healthcare utilization, particularly at transitions of care. The purpose of this quality improvement project was to apply the LACE risk assessment tool in the emergency department (ED). Seventeen months of retrospective data was examined and Poisson regression used to examine and validate variables for use in the ED. The variables Length of Stay was modified to Length of Time between ED admissions, named Length of Stay Out of the ED (LOSO), and the Emergency Severity Index (ESI) scale of acuity was used. An ED-LACE score was calculated and validated using logistic regression. The model was found to have robust predictive ability with a with a c-statistic of 0.948.

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