Improving the Heart Failure Readmission Rate at an Urban Medical Center

2012 ◽  
Vol 34 (8) ◽  
pp. 1066-1067 ◽  
Author(s):  
Carolyn Dickens ◽  
Karen Vuckovic ◽  
Maria Nehmer ◽  
Rob DiDomenico ◽  
David Kerbow ◽  
...  
Keyword(s):  
Heart Failure ◽  
Readmission Rate ◽  
Medical Center

Heart Failure: Improving the Continuum of Care

2006 ◽  
Vol 7 (2) ◽  
pp. 58-63 ◽  
Author(s):  
Dana Kay ◽  
Andrienne Blue ◽  
Patricia Pye ◽  
Adria Lacy ◽  
Catherine Gray ◽  
...  
Keyword(s):  
Heart Failure ◽  
Disease Management ◽  
Process Improvement ◽  
Readmission Rate ◽  
Administrative Support ◽  
Medical Condition ◽  
Medical Center ◽  
The United States ◽  
Continuum Of Care ◽  
Current Program

In the United States (US), heart failure (HF) is the leading medical condition resulting in hospital admission. Despite advances in treatment, the number of HF deaths has continued to increase. At Carolinas Medical Center (CMC), more than 950 annual HF admissions provided an opportunity to examine morbidity, mortality, and readmission rates. Within the facility there exist two HF disease management programs treating more than 1,500 patients annually. Through a systematic approach to identify the root causes of morbid and less severe complications, the facility addressed process improvement steps to positively impact HF treatment. Included in these strategies was a link to the outpatient continuum of care created for the HF patient.An examination of the HF program revealed the care to be fragmented, both organizationally and physically. A majority of readmissions could be prevented through closer patient follow-up and more aggressive therapy. Intensive education for staff about the disease management process, medication interventions, smoking cessation, and nutrition counseling was lacking. An interdisciplinary committee, with strong administrative support, was established to evaluate the current program and recommend changes. Delivery of patient care was changed to an integrated care management system model identifying the root causes of the most prevalent operational and clinical deficits. Process improvement steps were immediately implemented. The 30-day readmission rate (all causes) decreased from 18% to 6.1%, the readmission rate for HF decreased from 7.3% to 1.7%, mortality declined by 25%, and morbid complications decreased by 35%. Evaluation of processes and clinical outcomes are ongoing in order to develop strategies for even greater improvement within the HF program.

Abstract P33: Improving Heart Failure Metrics: A Multidisciplinary Team Approach

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Brittany L Cunningham ◽  
Zachary L Cox ◽  
Connie M Lewis ◽  
Daniel Lenihan
Keyword(s):  
Heart Failure ◽  
Multidisciplinary Team ◽  
Readmission Rate ◽  
Medical Center ◽  
Statistical Correlation ◽  
Demonstration Project ◽  
Initial Assessment ◽  
Team Approach ◽  
Positive Trend ◽  
Core Measures

Background: Quality of care has become a priority as heart failure (HF) core measures and readmission have been publically reported on the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website. In an effort to decrease readmissions Vanderbilt University Medical Center (VUMC) joined the H2H (Hospital to Home) initiative. Based on the CMS data for 2005 to 2008 the middle Tennessee region was in the 5 th Quartile of readmission scores (25.2%-29.0%). The 30-day HF readmission rate at VUMC (25.7%) was comparable to the national rate of 24.5%. Aim: The goal of this project was to decrease readmissions by 20% as suggested by the ACC through participation with the H2H initiative. Method: A multidisciplinary team, including Physicians, Pharmacist, Case Management, Nutrition, Nursing, and a Social Worker, was structured to round on the heart failure floor each morning to identify HF patients as part of a demonstration project. All identified patients were assessed by the multidisciplinary team for teaching needs and self care abilities based on their specialties. Based on their initial assessment, teaching was performed for newly diagnosed or reinforcement teaching. Education materials were updated for all patients and given to all heart failure patients regardless of status in the demonstration project. Results: Thirty day follow-up has been completed on 52 patients and 7 have been readmitted for any cause. This has decreased the readmission rate from 25.7% to 13.4%. There are 5 interventions which could have been completed. The most frequent, the Pharmacy intervention was completed on 76% of the patients; however there is not a statistical correlation between this intervention alone and readmission. Discharge instructions in core measures were also associated with a positive trend as evidence by quarter 4 2009 at 88.4% and quarter 4 2010 at 96.8%. Conclusions: Our project targeted recognizing the needs of the patient and matching them with the appropriate consult. This approach has been associated with reduction in readmission rates and in an increase in core measure compliance. Further data collection will be needed to confirm findings.

scholarly journals Clinical and echocardiographic trends in percutaneous balloon mitral valvuloplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ofir Koren ◽  
Asaf Israeli ◽  
Ehud Rozner ◽  
Nassem Darawshy ◽  
Yoav Turgeman
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Success Rates ◽  
Mitral Valvuloplasty ◽  
Percutaneous Balloon Mitral Valvuloplasty ◽  
Developing Heart ◽  
Percutaneous Balloon ◽  
Study Population ◽  
Procedural Success ◽  
Over Time

Abstract Background The prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years. Methods We conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019. Results Four hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p = 0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p = 0.02, p = 0.02, p = 0.001, p = 0.01, p = 0.02, and p = 0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p = 0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p < .0001 for all). The median time in these patients was 630 days compared to 4–5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA < 1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P < .0001). Conclusion Our research reveals trends over time in patients’ characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 cm2 were in-depended predictors for the time for surgery and heart failure hospitalization.

Impact of a pharmacy team–led intervention program on the readmission rate of elderly patients with heart failure

2018 ◽  
Vol 75 (4) ◽  
pp. 183-190 ◽  
Author(s):  
Pamela M. Moye ◽  
Pui Shan Chu ◽  
Teresa Pounds ◽  
Maria Miller Thurston
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Readmission Rate ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
Historical Control Group ◽  
Historical Control ◽  
Control Group ◽  
Patients With Heart Failure

Purpose The results of a study to determine whether pharmacy team–led postdischarge intervention can reduce the rate of 30-day hospital readmissions in older patients with heart failure (HF) are reported. Methods A retrospective chart review was performed to identify patients 60 years of age or older who were admitted to an academic medical center with a primary diagnosis of HF during the period March 2013–June 2014 and received standard postdischarge follow-up care provided by physicians, nurses, and case managers. The rate of 30-day readmissions in that historical control group was compared with the readmission rate in a group of older patients with HF who were admitted to the hospital during a 15-month intervention period (July 2014–October 2015); in addition to usual postdischarge care, these patients received medication reconciliation and counseling from a team of pharmacists, pharmacy residents, and pharmacy students. Results Twelve of 97 patients in the intervention group (12%) and 20 of 80 patients in the control group (25%) were readmitted to the hospital within 30 days of discharge (p = 0.03); 11 patients in the control group (55%) and 7 patients in the intervention group (58%) had HF-related readmissions (p = 0.85). Conclusion In a population of older patients with HF, the rate of 30-day all-cause readmissions in a group of patients targeted for a pharmacy team–led postdischarge intervention was significantly lower than the all-cause readmission rate in a historical control group.

Abstract 11906: Heart Failure Admissions to General Medicine Services are Associated With Increased 30-day Readmission Rate

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Parag Goyal ◽  
Madeline Sterling ◽  
Ashley N Beecy ◽  
Savira Kochhar ◽  
John T Ruffino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Readmission Rate ◽  
General Medicine ◽  
Structural Heart Disease ◽  
Multivariate Regression Analysis ◽  
Readmission Rates ◽  
Modifiable Factors ◽  
Patients With Heart Failure ◽  
Hospital Patients ◽  
Clinical Indices

Introduction: Hospitalists are increasingly caring for patients with heart failure (HF) at a time when there is need to identify modifiable factors associated with 30-day readmission rates. Hypothesis: Patients admitted to General Medicine services (GM) will have higher 30-day readmission rates than those admitted to Cardiology services. Methods: This retrospective cohort comprised patients with a principal diagnosis of HF discharged from GM or Cardiology services in 2013-2014 at an urban academic hospital. Patients discharged with hospice were excluded. Index hospitalizations and 30-day readmissions were identified via query of the electronic medical records. Demographics, clinical indices, and hospitalization characteristics were collected by chart review. Results: Among 926 patients admitted with HF, 40% were admitted to GM and 60% were admitted to a Cardiology service. Patients on GM were slightly older, more likely female, and more likely to have Medicare (Table). They also had higher LVEF, less RV dysfunction, and less ventricular tachycardia (VT). Rates of non-cardiac comorbidities were comparable between groups. Patients on GM experienced a 1.4-fold increased 30-day readmission rate compared to those on Cardiology services (32% vs. 23%, p=0.023). Multivariate regression analysis showed that admission to GM remained a predictor for 30-day readmission (OR 1.37, [1.01 to 1.87], p=0.048) after controlling for key differences between groups including age, sex, insurance, LVEF, RV dysfunction, VT, and admission blood pressure and hemoglobin. Conclusions: HF patients admitted to General Medicine have less structural heart disease, and yet have a higher rate of 30-day readmission compared to those admitted to Cardiology services. This underscores the importance of ensuring that hospitalists obtain adequate heart failure training (related to both inpatient care and optimization of discharge regimens), so as to avoid un-necessary readmissions.

Abstract 147: Hypertension-related Admission and Mortality at a Referral Hospital in Tanzania - A Call to Action

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Naomi Shike ◽  
Santosh Vardhana ◽  
Judith Briant ◽  
Robert Peck
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Tertiary Care ◽  
Sub Saharan Africa ◽  
Morbidity And Mortality ◽  
Hospital Death ◽  
Care Hospital ◽  
Common Cause ◽  
Related Disease ◽  
Reasonable Approach

Introduction The WHO has been increasingly emphasizing and calling for research on the vast unattended burden of non-communicable diseases in the developing world. Hypertension (HTN) in particular is thought to play a growing role in morbidity and mortality in these regions, but has yet to gain significant momentum in public health initiatives. Objective To determine what role HTN and comorbid diseases play in admission and mortality in Bugando Medical Center (BMC), a tertiary care hospital in Tanzania serving 13 million people. Methods We conducted a retrospective analysis of all patients admitted to the internal medicine service at BMC over 34 months between 2008 and 2011. Data on admission diagnoses and mortality had been collected prospectively by Tanzanian doctors in hand-written logs. For patients with heart failure or stroke, the ward logs specified if this was primarily related to hypertension or other risk factors. Data were copied into an Excel database and analyzed to determine the proportion of admissions and deaths primarily related to hypertension. Results In 34 months 8,037 patients were admitted and 1,508 died. HTN-related disease led to 1,997 admissions (25%), while HIV-related illness led to 2,076 (26%). Similarly, HTN led to 377 deaths (25%) and HIV to 579 (38%). HTN-related disease was second only to HIV-related disease as a cause of admission and death. Among hypertensives, the most common cause of admission was congestive heart failure (446; 27%) and of death was stroke (147; 49%). In non-hypertensives, HIV-related disease was the most common cause of both admission (2029; 32%) and death (566; 46%). Conclusions HTN-related disease was second only to HIV as a cause of admission to our hospital and in-hospital death. Better strategies for early diagnosis and treatment of HTN are desperately need in sub Saharan Africa to prevent this morbidity and mortality. Building HTN screening and treatment on top of the extensive infrastructure for HIV disease may be a reasonable approach.

MO759COMPERATIVE STUDY OF THE CARDIOVASCULAR SYSTEM IN PATIENTS WITH CKD ON HEMODIALYSIS IN URBAN AND RURAL POPULATIONS OF UZBEKISTAN

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Olimkhon Sharapov ◽  
Botir Daminov
Keyword(s):  
Heart Failure ◽  
Rural Areas ◽  
Rural Population ◽  
Urban Population ◽  
Medical Center ◽  
Women Patients ◽  
Urban Group ◽  
Rural And Urban ◽  
Ckd Stage ◽  
Rural Group

Abstract Background and Aims According to recently published WHO data, kidney disease has been the 10th leading cause of death in the world over the past 20 years. The lethality of dialysis patients with cardiovascular pathology is 3 times higher than that of patients without CVD. This is especially pronounced in developing countries. Uzbekistan is a country with a population of 34 million and has an equal urban and rural population. In this regard, it is of interest to comparatively study the structure of CVD in patients with CKD stage 5D of the rural and urban population of Uzbekistan. Method We examined 165 (90 men and 75 women) patients with CKD stage 5 receiving dialysis in urban and rural areas of Uzbekistan. The patients were divided into 2 groups depending on their permanent place of residence and the medical center where they receive hemodialysis. 104 (51 men and 53 women) patients were included in the Urban group and 61 (39 men and 22 women) patients were included in the Rural group. The average age of the urban population was 49.7 ± 1.38 years, the rural population was 45.5 ± 1.83 years. All patients underwent programmed hemodialysis according to the standard scheme for 4 hours 3 times a day (12 hours/week). The average duration of hemodialysis in the Urban group was 37.0 ± 4.77 months (M ± m) and 16.6 ± 2.4 months in the Rural group. The main causes of CKD 5D in both groups were glomerulonephritis (Urban-36.5%, Rural-62%) and type 2 diabetes (Urban-31.7%, Rural-18%). Results CVD comorbidity occurred in 55,8% (n=92) of all 165 examined patients, of which 52 were men and 40 were women. The most common CVDs in all groups were hypertension (51%, n=84), coronary heart disease, presented as angina (28%, n=47), heart failure (14%, n=23) and various types of arrhythmias (5%, n=8). 77% (n=127) of patients had anemia due ESRD. In the group Urban(n=104), 62.5% (n=65) had CVD. The main CVD was Hypertension. It was found in 92% (n=60) of patients with CVD in this group. Less (65%, n=42) were patients with angina. Heart failure was detected in 31% (n=20) of patients. Arrhythmia was diagnosed in only 5% (n=5). A large number of combined CVD have been identified. 69% (n=45) of all patients with CVD had a combined CVDs in different combinations. The most common combination was hypertension + angina (n = 26). It accounted for almost 58% of all combined cases. Only 28% (n=17) of all cases with hypertension had "isolated" hypertension. The main combination with hypertension was hypertension + angina (43%, n=26), 11% (n=11) of patients had hypertension + angina + heart failure, a combination in the form of hypertension + angina + arrhythmia had 3% (n=3) patients. Relatively fewer (n = 27, 44%) CVD were found in the Rural group. The most frequent CVD was also a hypertension. Patients with hypertension made up 89% (n = 24) of all patients with CVD in this group. The second place is occupied by angina, it was found in 18.5% (n=5) cases among patients with CVD. Combined CVS pathologies were less common in the rural group. A total of 8 patients (29.6% of all CVD cases) had several CVDs. Conclusion Сardiovascular diseases in the urban population (62.5%) occur almost one and a half times more often than in the rural population (44%). Combined CVD pathology occupies a leading place in the structure of CVD in patients with CKD 5D, both urban and rural.

Abstract P216: Heart Failure Readmission Rates: Experience of St John's Physician Group Practice Demonstration

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Joseph P Drozda ◽  
Donna A Smith ◽  
Paul C Freiman ◽  
Jeffrey A VanSlette ◽  
Timothy R Smith
Keyword(s):  
Heart Failure ◽  
Readmission Rate ◽  
Group Practice ◽  
Data Sets ◽  
Disease Registry ◽  
Readmission Rates ◽  
Annual Average ◽  
Physician Group ◽  
Period 2 ◽  
Artery Disease

Objective: The appropriateness of using readmission rates alone as markers of the quality of Heart Failure (HF) care has been questioned. The HF program of St. John's Health System's Physician Group Practice (PGP) Demonstration provided an opportunity to assess a number of outcomes that help to put readmission rates in context. The HF program included disease and case management and a disease registry in the PCP office. Methods: Several data sets were analyzed including the EHR, an inpatient database, the disease registry, and the Social Security Death Master File. Traditional Medicare patients admitted to St. John's Hospital from 2000 to 2010 with a diagnosis of HF, were included resulting in data for 5 years before (Period 1) and 5 years after (Period 2) the 2005 inception of PGP. Results: Total admissions were 3559 in Period 1 and 3514 in Period 2. The prevalence of 3 co-morbid conditions in admitted patients increased during Period 2 [diabetes 35.3% (1256/3559) to 42.7% (1499/3514), p<0.001; hypertension 54.8% (1952/3559) to 70.4% (2475/3514), p<0.0001; and coronary artery disease 62.7% (2253/3559) to 66.4% (2332/3514), p=0.015] indicating that patients were getting more complex. HF admissions trended down significantly from Period 1 (709 annual average) to 2009 (637, p=0.007). The 30 day all cause readmission rate dropped in 2005 [16.9% (137/809)] from Period 1 [annual average 18.8% (671 / 3559), p=0.04] and remained stable thereafter [annual average 16.9% (595/3514)]. The 30 day mortality rate was flat from 2000 to 2009 [2.7(15/550)-5.0% (30/597), p=0.3] and increased in 2010 [8.6% (28/327), p<0.0001]. The use of pacemakers and ICDs was unchanged during Period 2 but ACE inhibitor and beta blocker use increased in PGP practices during 2005 and was constant thereafter. Conclusions: The HF program implemented by this PGP project was associated with decreased HF admissions and with increased clinical complexity of admitted patients. Despite this increasing complexity, the 30 day all cause readmission rate dropped in the first year of the program and remained stable thereafter. Finally, 30 day mortality rates were not adversely affected until the last year of the program. The increased mortality in 2010 may be due to a change in case mix but remains unexplained.

Sign in / Sign up

Export Citation Format

Share Document