Term of Award

Summer 2020

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Health Policy and Management (COPH)

Committee Chair

Samuel Opoku

Committee Member 1

Bettye Apenteng

Committee Member 2

Jeffery Jones


Background: Hospital readmissions account for a large part of healthcare costs, especially among stroke patients. Readmission is common among disabled stroke survivors because they often suffer some neurological deficits, functional impairment, and other preexisting cardiovascular conditions. Although previous studies have explored the relationship between hospital readmissions after initial hospitalization due to stroke and a set of predictors using various analytical models, it often remains uncertain which predictors are most influential or essential. This study aimed to assess the effect of patient and hospital-levels factors on 30-day readmission after initial hospitalization due to stroke using the Anderson model of healthcare utilization as a guide.

Methods: Data for this study was the 2014 National Readmissions Database. A generalized mixed-effect linear regression using a hierarchical modeling approach was run based on the Andersen model's main block to assess the predictive capabilities of both individual and hospital-level factors on 30-day readmission. Models also assessed geographic differences that may exist among stroke patients.

Results: Overall, the addition of variables blocks corresponding to the Anderson model of health utilization accounted for only a small variance in 30-day readmission. However, the addition of the enabling and need factors resulted in the most significant R2 change for hospitals in rural areas and urban areas, respectively.

Conclusion: The predictive powers of individual and hospital factors on readmission within 30 days of initial stroke-caused hospitalization is weak. The results of this study suggest a holistic approach should be the goal for policymakers and legislators when developing policies to reduce readmissions.

OCLC Number


Research Data and Supplementary Material