Introduction:
Safety net hospitals are more likely to be penalized for heart failure (HF) readmissions. There is limited evidence as to whether readmission reduction strategies are effective in this setting. We hypothesized that a discharge checklist would reduce readmissions in an urban safety net hospital.
Methods:
We implemented a novel HF discharge checklist in an academic safety net hospital in San Francisco from October 2018 to April 2019. The checklist included 1) achievement of euvolemia based on physical exam, 2) prescription of guideline-directed medical therapy, and 3) establishment of scheduled follow-up within 7 days of discharge. All HF patients who were discharged with the checklist in the 6 month study period were retrospectively compared to all HF patients discharged in the 6 months prior to the implementation of the checklist. The primary outcome was the 30-day readmission rate and multivariate modeling was used to assess the significance of each checklist component.
Results:
Demographics were similar between the intervention (n=118) and control (n=265) groups. Of all 383 patients, mean age was 60±13 years, 102 (27%) patients were women, 170 (44%) were black, 88 (23%) were latinx, 127 (33%) were not housed, 208 (54%) used illicit substances, and 289 (76%) had ejection fraction ≤ 40%. Use of the checklist was associated with a 13.3% absolute reduction in the 30-day readmission rate (33.6% vs 20.3%, p=0.009). The intervention group was more likely to be discharged on guideline-directed medical therapy (54% vs 25%, p<0.0001) including beta blockers (89% vs 71%, p<0.0001), ACEI/ARBs (88% vs 66%, p<0.0001) and MRAs (50% vs 23%, p<0.0001). The intervention group was also more likely to have scheduled follow-up within 7 days (70 vs 58%, p=0.02). There was no difference between the groups in achievement of euvolemia. In all patients, multivariate analysis adjusted for demographics and insurance status demonstrated that the prescription of guideline-directed medical therapy was associated with lower risk of readmission (OR 0.31, 0.15-0.64).
Conclusions:
A novel, inexpensive discharge checklist increased the prescription of guideline-directed medical therapy and significantly reduced 30-day HF readmissions in a safety net hospital.
A Focus Group Exploration of Automated Case‐Finders to Identify High‐Risk
Heart Failure Patients within an Urban Safety- Net Hospital
