Reducing Readmissions of Patients with Heart Failure

In an article in the September issue of Nursing2010 Cheryl Burke,  director of quality at Mercy Hospital in Scranton, PA ,  ” …describes our hospital’s efforts to improve our care of patients with HF and reduce our readmission rates by focusing on patient discharge instructions.”

The Mercy Hospital heart failure performance improvement team used the PDCA cycle to develop a process that resulted a new HF patient education tool, as well as, a discharge sheet that included all elements required by CMS for discharge teaching.  

This HF PI process increased Mercy Hospital’s compliance with the six elements of CMS HF teaching from 30% in July 2006 to 100% in December 2008.

Burke CA.  Reducing readmissions of patients with heart failure.  Nursing 2010 Sep;40(9):12-13.

Lowering the Risk of Readmission for Heart Failure Patients

Decreasing the 30 day readmission rate for Medicare heart failure patients is  the target of both clinical research and quality improvement activities.   This observational analysis examined “…the association between outpatient follow-up within 7 days after discharge from a heart failure hospitalization and readmission within 30 days.”

Their findings support the hypothesis that “patients who are discharged from hospitals that have higher early follow-up rates have a lower risk of 30-day readmission.”   While recognizing the complexity of transitional care that  influences heart failure patient readmissions, this research provides an area for focusing efforts.

Hernandez AF, Greiner MA, Fonarow GC, Hammill BG, Heidenreich PA, Yancy CW,
Peterson ED, Curtis LH. Relationship between early physician follow-up and 30-day
readmission among Medicare beneficiaries hospitalized for heart failure. JAMA.
2010 May 5;303(17):1716-22. PubMed PMID: 20442387.

Medication Adherence in Cardiovascular Disease

Because medication nonadherence adversely affects patient outcomes and other hospital quality indicators, effectively addressing this problem is very important.  To facilitate an understanding of the problem and its possible solutions Steven Baroletti and Healther Dell’Orfano concisely describe:

• the patient outcomes associated with nonadherence
• the socioeconomic, communication-related and motivational causes of nonadherence
• strategies to address major causes of medication nonadherence

In conclusion Baroletti and Dell’Orfano state:

Nonadherence to medications remains a major problem for cardiovascular patients.  It leads to poor clinical outcomes, including rehospitalization, subsequent myocardial infarction, and increase mortality in various patient settings.  Clinicians need to use multiple approaches to simple solutions to improve their patients’ short and long-term medication adherence.

Baroletti S, Dell’orfano H. Medication adherence in cardiovascular disease.
Circulation. 2010 Mar 30;121(12):1455-8. PubMed PMID: 20351303.

 

Assessing Variations in Hospital Resource Use

In healthcare reform discussions many references have been made to the variations in hospital resource use  identified by the Dartmouth end-of-life analysis.    The Dartmouth Atlas analysis includes only individuals who have died.   However, researchers at some California hospitals, that have been identified as high users of resources, looked  at all patients with heart failure.   They discovered:  “when analyzing all patients hospitalized for heart failure, California teaching hospitals that used more resources had lower mortality rates” and “the variation in resource use among California teach hospitals was 27% to 44% less than the variations observed when analyzing only heart failure patients who died.”

This study illustrates the difficulty of finding the excess in health care.

Looking Forward, Looking Back: Assessing Variations in Hospital Resource Use and Outcomes for Elderly Patients With Heart Failure.  Circulation. Cardiovascular Quality and Outcomes 2009;2:548-557.

Focused Update 2009: Guidelines Heart Failure

This document is a limited update to the 2005 guidelines and based on a review of certain evidence, not a full literature review.

Features numerous tables comparing 2005  Guideline Recommendations and 2009 Focused Update Recommendations.

Link to full citation PMID 19324967.