HLTH 4913 Module 1 Capstone Problem Proposal Example

Forty-One Percent Seen Within a Week: A Capstone Problem Proposal on Missed Follow-Up Visits After Heart Failure Discharge and the Rides Behind Them

Student Name

American College of Education

HLTH4913: Senior Capstone Experience: Healthcare Administration

Module 1 Assignment

Instructor Name

October 5, 2026

The Problem

At a composite 240-bed nonprofit community hospital, about 760 patients a year are sent home after a heart failure admission. The hospital's own discharge standard calls for each of them to see a primary care clinician or cardiologist within a week. Over the past fiscal year, only 41% of those patients were seen within that window, and 23.8% of those patients were back in the hospital within 30 days. When care coordinators called 180 patients who had missed their follow-up appointment, the most common reason given, by about a third, was that they had no way to get there.

This capstone addresses that gap. Its problem statement is this: most patients discharged home after heart failure hospitalization at the hospital are not seen by a clinician in the first seven days after they leave, and lack of transportation is the most frequently reported barrier. The capstone will examine the problem, the evidence on solutions and a feasible plan the hospital's administration could adopt.

Significance for Patients

The first week after discharge is when heart failure patients are most fragile. Medications are often changed during the hospital stay, weight and fluid status can shift quickly, and small problems that a clinician could correct in the office become emergencies if they go unnoticed. Hernandez et al. (2010) followed more than 30,000 older Medicare patients sent home from 225 hospitals and found that the typical hospital saw fewer than two in five of them within a week, and that patients from the hospitals doing the least early follow-up came back within a month more often than patients from any other group of hospitals. The study was observational, so it does not prove that follow-up visits prevent readmissions, but it links hospital systems that deliver early follow-up with better outcomes, and the hospital's own figures sit squarely in the weakest group.

Transportation barriers are not a minor inconvenience either. Pulling together 61 U.S. studies, Syed et al. (2013) judged lack of transportation a meaningful block to ongoing care, heaviest for people with low incomes or thin insurance, and traced it to missed and rescheduled visits, delayed care and skipped medicines.

Significance for the Organization

The problem also has direct financial consequences. Under the Hospital Readmissions Reduction Program, Medicare reduces payments to hospitals with excess readmissions for several conditions, including heart failure, with the reduction capped at 3% of payments (Centers for Medicare & Medicaid Services, 2026). The hospital's reduction last year, across all included conditions, was 0.58% of its base Medicare inpatient payments, about $390,000. Each avoidable readmission also consumes a bed during the hospital's busiest months and adds to emergency department boarding. For an administrator, missed follow-up visits are a quality problem, a financial problem and a capacity problem at once, which is why the capstone is framed as an operational issue that administration can act on, not only a clinical one.

Significance for the Community

The hospital serves a county where many older residents no longer drive, bus service ends at 6 p.m. and does not reach several rural townships, and adult children often work during the day. Among the heart failure patients discharged home, about 14% are dually eligible for Medicare and Medicaid, a group with a Medicaid transportation benefit that many do not know how to use, and many others have Medicare Advantage plans, some of which include rides to medical appointments. The community therefore has partial transportation resources that are not connected to the moment of discharge. A solution designed at the hospital could make better use of benefits that already exist.

What the Hospital Already Does

The hospital is not starting from nothing, which matters for a realistic capstone. For about 58% of heart failure patients sent home, the unit secretary books a follow-up appointment before discharge and prints it on the discharge papers; the others are told to call their doctor's office, which many never do. A care coordinator attempts a phone call within 48 hours of discharge, but reaches only about 60% of patients because many phone numbers in the record are outdated. Discharge nurses hand out a county transit brochure, but no one asks whether the patient actually has a ride or helps book one. In other words, each piece of a transition process exists, but none is reliable, and none connects the appointment to the means of reaching it. The capstone will therefore look first at strengthening and linking what exists before proposing anything new, since changes that build on current roles are cheaper and easier for staff to adopt.

Confirming the Problem With Data

The figures above come from a quality report and a set of phone calls, and before the capstone recommends changes, the problem needs a firmer baseline. With the quality department's help, the capstone will draw twelve months of electronic health record data for heart failure patients sent home: whether an appointment was booked before discharge, whether it was kept within seven days, whether the patient was readmitted within 30 days, and the patient's payer, distance from the clinic and whether a caregiver was listed. Those data will show whether missed follow-up is concentrated among particular groups, such as dual-eligible patients or those living farther away, and whether patients with a booked appointment really do better. The phone survey will be repeated with a structured question list, so that transportation can be compared fairly with other reasons, such as not knowing about the appointment or feeling too unwell to go.

Scope, Stakeholders and Questions

The capstone is limited to adults discharged home after a heart failure hospitalization, excluding patients discharged to skilled nursing facilities, hospice or other hospitals, whose follow-up is managed differently. It covers the twelve months after implementation. Stakeholders include patients and caregivers, hospitalists and discharge nurses, care coordinators, the hospital's outpatient cardiology and primary care practices, the finance and quality departments, Medicaid transportation brokers, Medicare Advantage plans and the county transit authority.

Three questions will guide the work. What does the evidence show about interventions that improve early follow-up and reduce transportation barriers? What causes, beyond transportation, explain missed follow-up at this hospital? And what combination of options is feasible, affordable and measurable for the hospital to implement? A capstone that fixes rides but ignores why patients did not know about their appointment would solve a third of the problem.

Why This Problem Suits a Healthcare Administration Capstone

The problem draws on the whole healthcare administration curriculum. It involves quality measurement, finance through the readmissions program, operations through scheduling and discharge processes, human resources through care coordinator roles, law and policy through Medicaid and Medicare transportation benefits, and community health through the barriers patients face after they leave. It is also realistic in scale: the hospital can change its own processes and partnerships without new construction or major capital. The following modules will review the literature, analyze causes and options, build an implementation and evaluation plan, and present a final recommendation to administration.

References

Centers for Medicare & Medicaid Services. (2026, September 21). Hospital Readmissions Reduction Program (HRRP). https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp

Hernandez, A. F., Greiner, M. A., Fonarow, G. C., Hammill, B. G., Heidenreich, P. A., Yancy, C. W., Peterson, E. D., & Curtis, L. H. (2010). Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA, 303(17), 1716-1722. https://doi.org/10.1001/jama.2010.533

Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013). Traveling towards disease: Transportation barriers to health care access. Journal of Community Health, 38(5), 976-993. https://doi.org/10.1007/s10900-013-9681-1