HCA 499 Module 2 Capstone Project Proposal Example

A Proposal to Reduce Heart Failure Readmissions: Scope, Objectives and Plan

Student Name

Health Care Administration Program, Aspen University

HCA 499: Senior Capstone

Instructor Name

Month Day, Year

A Proposal to Reduce Heart Failure Readmissions: Scope, Objectives and Plan

A project proposal turns a defined problem into an agreed plan. It tells the sponsor what the project will do, why, how, by when and with what resources, and it protects the project from drifting. This paper presents Dana's capstone proposal to reduce 30-day readmissions among patients discharged with heart failure from a composite 180-bed community hospital.

Background

Seventy-two of last year's 312 heart failure discharges were readmitted inside 30 days (23.1%), higher than the national average. The hospital received a payment reduction under the federal readmissions program, which has been associated with national declines in readmissions for targeted conditions (Zuckerman et al., 2016). Only about a third of heart failure patients left with a scheduled follow-up appointment.

Purpose

This project sets out to learn why heart failure patients return to the hospital within 30 days and to design, test and evaluate a practical change in the discharge and post-discharge process that reduces readmissions.

Objectives

The project has four SMART objectives. First, by the end of month two, analyze a year of readmission data and interview staff and patients to identify the main contributing factors. Second, by the end of month three, complete a focused literature review and options analysis and recommend an intervention. Third, by the end of month four, implement the intervention on one medical unit. Fourth, by the end of month six, reduce 30-day heart failure readmissions on the pilot unit to 19% or lower and report results.

Why Not Just Pick a Solution

It might seem efficient to adopt a popular intervention immediately. Yet when Hansen and colleagues sorted 43 studies, they could not find any lone intervention that dependably cut 30-day returns, and several common steps had only ever been tested as parts of bundles (Hansen et al., 2011). Analyzing the hospital's own causes first makes it more likely that the chosen intervention fits the problem.

Scope

The project includes adults with a principal diagnosis of heart failure discharged home from the two medical units, covering the period from planning the discharge to the end of the first post-discharge month. It excludes patients discharged to post-acute facilities, physician treatment choices and other diagnoses. The pilot will run on one unit, with the other serving as a comparison.

Methods

The project uses a quality improvement approach. Phase one analyzes data and processes. Phase two reviews evidence and options. Phase three implements a pilot using plan-do-study-act cycles. Phase four evaluates results with run charts and comparison to the other unit. Evidence suggests that interventions with more components and more people involved in care tend to be more effective (Leppin et al., 2014), which will guide option design.

Timeline

The table shows the six-month plan.

Stakeholders and Roles

The director of case management sponsors the project and approves changes. A cardiologist advises on clinical questions. The pilot unit's nurse manager leads unit staff. The quality department provides data. The outpatient cardiology clinic's scheduling lead handles appointment access. Dana leads analysis, coordination and reporting.

Resources

The project needs four hours a week of Dana's time, monthly data from quality, two hours of training time for pilot unit staff, electronic record changes such as an order set and possibly additional clinic appointment slots. No new staff are requested for the pilot; if the intervention requires them, a business case will be prepared.

Risks and Mitigation

Risks include limited clinic appointment availability, staff resistance to new steps at discharge, small numbers making results hard to interpret and competing priorities. Mitigations include early agreement with the clinic on reserved slots, involving unit staff in design, tracking process measures alongside outcomes and securing the sponsor's visible support.

Ethics and Privacy

The project is quality improvement, confirmed with the quality office. Data will be deidentified for analysis. Patient interviews will be voluntary and confidential. No patient will receive less care than current practice.

Approval

Dana presented the proposal to the sponsor and the pilot unit's manager in a 20-minute meeting. They asked her to add a balancing measure for emergency department visits that do not lead to admission, which she did. The sponsor signed the proposal, and the capstone instructor approved it.

Communication Plan

The proposal included a communication plan: a monthly update to the sponsor, a short report at each unit staff meeting, and a final presentation to hospital leadership. Stating how and when stakeholders will hear about the project reduces surprises and keeps support steady through the months when progress is less visible.

Measures Named in Advance

The proposal named measures before any data were collected: 30-day readmission rate as the outcome, appointment scheduling and post-discharge contact as process measures, and emergency visits without admission as a balancing measure. Naming measures early protects against choosing favorable ones later, and it tells the quality department exactly which data to prepare.

Budget

The pilot's direct costs were modest: informatics time to build an order set, training time for unit staff and printing of patient materials. Dana estimated them with the finance office and noted that any request for new positions would come later, with pilot data to support it. A small budget made approval easier.

Deliverables

The proposal lists five deliverables: a problem analysis report, a literature review, an options analysis with a recommendation, an implementation plan and a final report with presentation. Each is tied to a month and to a capstone module, which keeps academic and workplace timelines aligned and lets the instructor and sponsor review the same documents.

Conclusion

The proposal defines the purpose, four SMART objectives, scope, methods, timeline, roles, resources and risks for a six-month project to reduce heart failure readmissions. By analyzing causes before choosing a solution, as evidence advises, and piloting on one unit, the project balances ambition with feasibility and gives the sponsor a clear basis for approval.

References

Hansen, L. O., Young, R. S., Hinami, K., Leung, A., & Williams, M. V. (2011). Interventions to reduce 30-day rehospitalization: A systematic review. Annals of Internal Medicine, 155(8), 520-528. https://doi.org/10.7326/0003-4819-155-8-201110180-00008

Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., Wang, Z., Erwin, P. J., Sylvester, T., Boehmer, K., Ting, H. H., Murad, M. H., Shippee, N. D., & Montori, V. M. (2014). Preventing 30-day hospital readmissions: A systematic review and meta-analysis of randomized trials. JAMA Internal Medicine, 174(7), 1095-1107. https://doi.org/10.1001/jamainternmed.2014.1608

Zuckerman, R. B., Sheingold, S. H., Orav, E. J., Ruhter, J., & Epstein, A. M. (2016). Readmissions, observation, and the Hospital Readmissions Reduction Program. New England Journal of Medicine, 374(16), 1543-1551. https://doi.org/10.1056/NEJMsa1513024