Collaborative program lowers HF readmission rates
Hospitals that participated in a collaborative program designed to increase 7-day follow-up rates after discharge for HF reported significantly lower readmission rates and reduced Medicare payments, despite only modest improvements to follow-up rates.
The study included data collected from Medicare beneficiaries with HF discharged from 10 hospitals in southeast Michigan participating in the American College of Cardiology’s “See You in 7” program. The program is part of the ACC’s Hospital-to-Home quality improvement initiative, which was developed to reduce readmissions due to heart disease and ease patients’ transition to home after discharge, according to a press release.
Participating hospitals selected one or more care process goals to improve follow-up rates within 7 days of discharging a patient with HF. During a 1-year intervention period, hospitals submitted assignments and participated in quarterly meetings, telephone and Web-based conferences.
Researchers evaluated follow-up rates within 7 days before the program (May 1, 2011-April 30, 2012) and during the program (May 1, 2012-April 30, 2013). Readmissions within 30 days and Medicare payments were also evaluated and compared between the 10 participating hospitals and 82 nonparticipating hospitals throughout Michigan, with additional analyses comparing participating hospitals with 10 1:1-matched nonparticipating hospitals.
Compared with the pre-intervention period, follow-up rates within 7 days increased after implementation of the program at participating hospitals (31.1% vs. 34.4%; P < .001) and nonparticipating hospitals (30.2% vs. 32.6%; P < .001). However, researchers noted that the rates remained low both before and after implementation.
Compared with the pre-intervention period, the unadjusted 30-day readmission rate decreased at participating hospitals (29% vs. 27.3%; P < .001) and nonparticipating hospitals (26.4% vs. 25.8%; P = .004). Similar results were observed between participating hospitals and the 10 matched nonparticipating hospitals (P = .06).
The mean decrease in risk-standardized readmissions at 30 days was greater at participating hospitals (from 31.1% to 28.5%; P < .001) compared with nonparticipating hospitals (from 26.7% to 26.1%; P = .02). The risk-standardized readmission rate was not decreased at the matched nonparticipating hospitals (P = .32).
Overall, the total reduction in Medicare payments between the evaluated time periods was $4.5 million at participating hospitals ($451,000 per hospital). Medicare payments for inpatient care and 30-day postdischarge care decreased by $182 among eligible patients discharged from participating hospitals after HF treatment vs. a $63 decrease at nonparticipating hospitals.
“Our study clearly shows there are challenges in coordinating early follow-up care, since increases in 7-day post-discharge follow-up were modest,” Sandra Marie Oliver-McNeil, DNP, ACNP-BC, assistant professor of nursing at Wayne State University, said in the release. “However, despite this, hospitals in the program stepped up to address deficiencies in post-hospital care and reduce 30-day admissions. Through collaboratively addressing the ‘See You in 7’ goals, hospitals participating in this program learned from each other when helping their patients transition from hospital to home, and they should serve as an encouraging example for other regional hospitals to share best practices.” – by Adam Taliercio
Disclosure: The Robert Wood Johnson Foundation partially funded the study. One researcher reports receiving grant support from the NHLBI, Novartis, Pfizer and PurFoods LLC.