Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Susan Dean-Baar


Nancy Magnuson


Brian Hokamp




As healthcare spending continues to increase and overall quality lags in comparison to other developed countries, hospital readmission has been targeted to increase quality while decreasing cost. Components of the Affordable Care Act (ACA) have placed an emphasis on preventative and transitional care which has created programs aimed at reducing readmission, including the Community Health Access Programs (CHAP). One program in St. Louis, Missouri consisted of advanced practice paramedics and an occupational therapy assistant that performed discharge follow-up through in-home, in-office, and telephone visits. An in-depth program evaluation can create a foundation to build other programs in communities suffering similar care gaps.


A retrospective, program evaluation was performed. Data compilation revealed 22 patients who received services from the CHAP at Christian Hospital after a hospitalization. Age, race, gender, length of stay, number of secondary diagnoses. number of CHAP visits, and days to readmission from discharge were provided. A group of 22 patients not receiving CHAP services was then formed.


The mean LOS for the CHAP group was 5.95 days and for the non-CHAP group was 5.36 days. There was no significant difference in the two groups for LOS. For days to readmission the average was 17.41 days for the CHAP group and 12.18 days for the non-CHAP group which approached statistical significance (p = 0.056). A linear regression comparing number of CHAP visits found that the number of CHAP visits was associated with more days before the next admission.

Implications for Practice

Findings suggest the CHAP was able to improve readmission rates as the number of patient visits increased. This suggests patients need more connection with providers than is typically occurring in areas without a transitional care program in place. Further analysis is needed to determine implications across in other communities and across other diagnoses.