Meeting News

Quality improvement campaign helps hospitals identify readmission risk in MI, HF

Hospitals that participated in a 2-year national quality improvement campaign improved their ability to identify patients with acute MI and HF and to assess their readmission risk, according to data presented at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions.

“By participating in a national quality improvement initiative focused on reducing early readmission after myocardial infarction and heart failure, notable improvements in care transition processes can be achieved,” Ty J. Gluckman, MD, FACC, FAHA, medical director of the Center for Cardiovascular Analytics, Research and Data Science (CARDS) at Providence Heart Institute in Portland, Oregon, adjunct member of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and a Cardiology Today’s Next Gen Innovator, said in an interview. “Identification of goals for improvement, sharing of transition-care best practices and display of performance on a quarterly basis represent important steps to achieve success.”

Researchers analyzed the effect of the American College of Cardiology’s Patient Navigator Program on 18,736 patients from 35 acute care hospitals, which were selected based on local setting, diversity, hospital provider type, national geographic representation and mean number of acute MI and HF discharges per year.

Hospitals were assessed on 36 performance measures and received quarterly performance reports. Personnel received reports and transition-care best practices through a learning network, online dashboard, one-on-one support from ACC quality leaders and in-person educational forums. Each hospital’s quality and service line leaders established three transition-care goals with the ability to add more over time.

Performance measure comparisons were performed within each hospital and across all hospitals in the study at baseline, 1 year and 2 years after goals were implemented.

During the study, up to 14,388 patients were assessed at baseline and up to 4,348 patients were evaluated at 2 years.

At baseline, 31% of hospitals were unable to identify patients with acute MI prior to discharge for transition-care purposes, which was reduced to 8% at 2 years. The percentage of hospitals that were unable to identify patients with HF prior to discharge for transition-care purposes decreased from 23% at baseline to 3% at 2 years.

The ability to assess readmission risk for patients with acute MI increased from 26% at baseline to 80% at 2 years. The ability to assess readmission risk for patients with HF rose from 31% to 86% during that time.

“It remains to be determined whether improvements in processes to identify patients at risk for early readmission and assessment of their readmission risk leads to improvement in 30-day readmission or other important outcomes,” Gluckman told Cardiology Today. “In addition, it remains to be determined whether such performance could be replicated beyond the 35 hospitals participating in the Patient Navigator Program. Further research is needed to address these questions and determine ways in which this quality improvement program could be effectively scaled.” – by Darlene Dobkowski

Reference:

Gluckman TJ, et al. Presentation 186. Presented at: American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions; April 6-7, 2018; Arlington, Va.

Disclosures: Gluckman reports he receives modest support from the ACC.

Hospitals that participated in a 2-year national quality improvement campaign improved their ability to identify patients with acute MI and HF and to assess their readmission risk, according to data presented at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions.

“By participating in a national quality improvement initiative focused on reducing early readmission after myocardial infarction and heart failure, notable improvements in care transition processes can be achieved,” Ty J. Gluckman, MD, FACC, FAHA, medical director of the Center for Cardiovascular Analytics, Research and Data Science (CARDS) at Providence Heart Institute in Portland, Oregon, adjunct member of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and a Cardiology Today’s Next Gen Innovator, said in an interview. “Identification of goals for improvement, sharing of transition-care best practices and display of performance on a quarterly basis represent important steps to achieve success.”

Researchers analyzed the effect of the American College of Cardiology’s Patient Navigator Program on 18,736 patients from 35 acute care hospitals, which were selected based on local setting, diversity, hospital provider type, national geographic representation and mean number of acute MI and HF discharges per year.

Hospitals were assessed on 36 performance measures and received quarterly performance reports. Personnel received reports and transition-care best practices through a learning network, online dashboard, one-on-one support from ACC quality leaders and in-person educational forums. Each hospital’s quality and service line leaders established three transition-care goals with the ability to add more over time.

Performance measure comparisons were performed within each hospital and across all hospitals in the study at baseline, 1 year and 2 years after goals were implemented.

During the study, up to 14,388 patients were assessed at baseline and up to 4,348 patients were evaluated at 2 years.

At baseline, 31% of hospitals were unable to identify patients with acute MI prior to discharge for transition-care purposes, which was reduced to 8% at 2 years. The percentage of hospitals that were unable to identify patients with HF prior to discharge for transition-care purposes decreased from 23% at baseline to 3% at 2 years.

The ability to assess readmission risk for patients with acute MI increased from 26% at baseline to 80% at 2 years. The ability to assess readmission risk for patients with HF rose from 31% to 86% during that time.

“It remains to be determined whether improvements in processes to identify patients at risk for early readmission and assessment of their readmission risk leads to improvement in 30-day readmission or other important outcomes,” Gluckman told Cardiology Today. “In addition, it remains to be determined whether such performance could be replicated beyond the 35 hospitals participating in the Patient Navigator Program. Further research is needed to address these questions and determine ways in which this quality improvement program could be effectively scaled.” – by Darlene Dobkowski

Reference:

Gluckman TJ, et al. Presentation 186. Presented at: American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions; April 6-7, 2018; Arlington, Va.

Disclosures: Gluckman reports he receives modest support from the ACC.

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