scholarly journals A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: A Retrospective Analysis (Preprint)

2021 ◽  
Author(s):  
Daniel Max Friedman ◽  
Jana Marie Goldberg ◽  
Rebecca Lynn Molinsky ◽  
Mark Andrew Hanson ◽  
Adam Castaño ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
Care Program ◽  
Day Hospital ◽  
Skilled Nursing ◽  
Care Plans ◽  
The Impact ◽  
Cardiovascular Care

BACKGROUND Patients with heart failure (HF) in skilled nursing facilities (SNFs) have 30-day hospital readmission rates as high as 43%. A virtual cardiovascular care program, consisting of patient selection, initial televisit, post-consultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc. (HBH), a cardiovascular digital health company, to 11 SNFs (3,510 beds) in New York. The impact of this program on the expected SNF 30-day HF readmission rate is unknown, particularly in the COVID-19 era. OBJECTIVE The aim of the study is to assess whether a virtual cardiovascular care program could improve access to specialty care, thereby reducing the 30-day hospital readmission rate for HF patients discharged to SNF relative to the expected rate for this population. METHODS We performed a retrospective case review of SNF patients who received a virtual cardiology consultation between August 2020 and February 2021. Virtual cardiologists conducted ≥1 telemedicine visit via smartphone, tablet, or laptop device for cardiac patients identified by a SNF care team. Post-consult care plans were communicated to SNF clinical staff. Patients included in this analysis had a preceding index admission for HF. RESULTS We observed lower hospital readmission among patients who received ≥1 virtual consultation compared to the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3,510 SNF beds. 185 patients (7%) received virtual cardiovascular care via the HBH program, and 40 patients met study inclusion criteria and were analyzed, with 26 (65%) requiring 1 televisit and 14 (35%) requiring more than 1. Cost savings associated with this reduction in readmissions are estimated to be as high as $860 per patient. CONCLUSIONS The investigation provides initial evidence for the potential effectiveness and efficiency of virtual and digitally-enabled virtual cardiovascular care on 30-day hospital readmissions. Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations.

scholarly journals Impact of the Implementation of Project Re-Engineered Discharge for Heart Failure patients at a Veterans Affairs Hospital at the Central Arkansas Veterans Healthcare System

2017 ◽  
Vol 53 (4) ◽  
pp. 266-271 ◽  
Author(s):  
Pooja H. Patel ◽  
Kimberly W. Dickerson
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Primary Care Physician ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Cost Savings ◽  
Care Physician ◽  
Day Hospital ◽  
All Cause Mortality ◽  
The Impact

Background: Hospitalizations due to chronic diseases such as heart failure (HF) continue to increase worldwide. Fragmentation of care while transitioning from one care setting to another is an important factor contributing to hospitalizations. Fragmented discharge tools have been implemented; however, the impact of a comprehensive interdisciplinary discharge tool has not been previously studied. Objective: The goal of this study is to assess the impact of the implementation of Project Re-Engineered Discharge (RED) on the incidence of hospital readmissions, all-cause mortality, primary care physician follow-up rate, and cost savings for patients with HF. Methods: This was a single-center, retrospective, cohort study of patients admitted with HF exacerbation at the Central Arkansas Veterans Healthcare System (CAVHS). A random sample of 100 patients admitted prior to implementation of Project RED and 50 patients after Project RED intervention were included in the study. The primary end point was 30-day hospital readmission for HF exacerbation. The co-secondary end points were all-cause mortality, cost savings, and rate of primary care physician appointments scheduled as well as attended per postdischarge recommendations. Results: The 30-day hospital readmission rate was 28% in the pre–Project RED group, and it was 18% in the post–Project RED group ( P = .18). The all-cause mortality was significantly lower in the post–Project RED group as compared with the pre–Project RED group (18% vs 41%, P = .04). More patients in the post–Project RED group attended an outpatient primary care appointment as recommended per postdischarge instructions (40% vs 19%, P = .006). In addition, with the decrease in hospital 30-day readmission rate in the post–Project RED group, there was a cost savings of $1453 per patient visit for HF exacerbation. Conclusions: Coordination of care using a discharge tool like Project RED should be utilized in institutions to improve patient outcomes as well as patient safety while decrease the overall health care cost.

scholarly journals Using Telehealth to Reduce All-Cause 30-Day Hospital Readmissions among Heart Failure Patients Receiving Skilled Home Health Services

2016 ◽  
Vol 07 (02) ◽  
pp. 238-247 ◽  
Author(s):  
Melissa O’Connor ◽  
Mary Dempsey ◽  
Ann Huffenberger ◽  
Sandra Jost ◽  
Danielle Flynn ◽  
...  
Keyword(s):  
Heart Failure ◽  
Patient Outcomes ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
Health Agency ◽  
Home Health ◽  
Fiscal Year ◽  
Day Hospital ◽  
Home Health Agency

SummaryThe reduction of all-cause hospital readmission among heart failure (HF) patients is a national priority. Telehealth is one strategy employed to impact this sought-after patient outcome. Prior research indicates varied results on all-cause hospital readmission highlighting the need to understand telehealth processes and optimal strategies in improving patient outcomes.The purpose of this paper is to describe how one Medicare-certified home health agency launched and maintains a telehealth program intended to reduce all-cause 30-day hospital readmissions among HF patients receiving skilled home health and report its impact on patient outcomes.Using the Transitional Care Model as a guide, the telehealth program employs a 4G wireless tablet-based system that collects patient vital signs (weight, heart rate, blood pressure and blood oxygenation) via wireless peripherals, and is preloaded with subjective questions related to HF and symptoms and instructional videos.Year one all-cause 30-day readmission rate was 19.3%. Fiscal year 2015 ended with an all-cause 30-day readmission rate of 5.2%, a reduction by 14 percentage points (a 73% relative reduction) in three years. Telehealth is now an integral part of the University of Pennsylvania Health System’s readmission reduction program.Telehealth was associated with a reduction in all-cause 30-day readmission for one mid-sized Medicare-certified home health agency. A description of the program is presented as well as lessons learned that have significantly contributed to this program’s success. Future expansion of the program is planned. Telehealth is a promising approach to caring for a chronically ill population while improving a patient’s ability for self-care.

Impact of oral anticoagulants on 30-day readmission: a study from a single academic centre

2018 ◽  
Vol 24 (1) ◽  
pp. 10-14 ◽  
Author(s):  
Mukul Bhattarai ◽  
Tamer Hudali ◽  
Robert Robinson ◽  
Mohammad Al-Akchar ◽  
Carrie Vogler ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Risk Factor ◽  
Length Of Stay ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Warfarin Therapy ◽  
Oral Anticoagulants ◽  
Emergency Department Visits ◽  
Day Hospital ◽  
The Impact

Researchers are extensively searching for modifiable risk factors including high-risk medications such as anticoagulation to avoid rehospitalisation. The influence of oral anticoagulant therapy on hospital readmission is not known. We investigated the impact of warfarin and direct oral anticoagulants (DOACs) on all cause 30-day hospital readmission retrospectively in an academic centre. We study the eligible cohort of 1781 discharges over 2-year period. Data on age, gender, diagnoses, 30-day hospital readmission, discharge medications and variables in the HOSPITAL score (Haemoglobin level at discharge, Oncology at discharge, Sodium level at discharge, Procedure during hospitalisation, Index admission, number of hospital Admissions, Length of stay) and LACE index (Length of stay, Acute/emergent admission, Charlson comorbidity index score, Emergency department visits in previous 6 months), which have higher predictability for readmission were extracted and matched for analysis. Warfarin was the most common anticoagulant prescribed at discharge (273 patients) with a readmission rate of 20% (p<0.01). DOACs were used by 94 patients at discharge with a readmission rate of 4% (p=0.219). Multivariate logistic regression showed an increased risk of readmission with warfarin therapy (OR 1.36, p=0.045). Logistic regression did not show DOACs to be a risk factor for hospital readmission. Our data suggests that warfarin therapy is a risk factor for all-cause 30-day hospital readmission. DOAC therapy is not found to be associated with a higher risk of hospital readmission. Warfarin anticoagulation may be an important target for interventions to reduce hospital readmissions.

Abstract 15128: Clinical Outcomes in Heart Failure Patients With Concurrent Cocaine Use

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonah D Garry ◽  
Anjali Thakkar ◽  
Yifei Ma ◽  
Rebecca Scherzer ◽  
Priscilla Hsue
Keyword(s):  
Heart Failure ◽  
San Francisco ◽  
Hospital Readmissions ◽  
Safety Net ◽  
Chronic Obstructive ◽  
Day Hospital ◽  
Cocaine Use ◽  
Significant Difference ◽  
Safety Net Hospital ◽  
The Impact

Background: While cocaine use is associated with heart failure (HF) with reduced ejection fraction, the impact of cocaine use on HF outcomes including 30-day hospital readmission and survival has not been well described. Accordingly, this study evaluated the impact of cocaine use on 30-day hospital readmissions (heart failure and all cause) and mortality. Methods: We performed a case control study of HF patients with an index HF hospitalization at an academic safety net hospital in San Francisco between 2001-2019. 746 HF patients with history of cocaine use were matched to 746 HF patients without cocaine use, based on age, gender, and date of index hospitalization. We compared clinical characteristics, readmission rates, and mortality between these two groups. Results: Average age was 53 years and 79% were male. HF patients with cocaine use were more likely to be African American (69.6% vs. 29.8%, p<0.01), have hypertension, liver disease and concurrent use of methamphetamines and opioids. Rates of coronary artery disease, diabetes, chronic kidney disease, HIV, and chronic obstructive pulmonary disease were similar between the groups. There was no significant difference in prescription of guideline directed medical therapies at discharge. Within 30 days of index HF hospitalization, HF patients with cocaine use were more likely to attend follow up (91.8% vs 86.9%, p<0.01), but were more likely to be readmitted for HF (12.1% vs 7.4%, OR 1.75, p<0.01) or other causes (22.4% vs 14.7%, OR 1.67, p<0.01). Over the study period, cocaine use was associated with greater likelihood of death (27.9% vs 20.1%, p<0.01). Conclusions: HF patients with comorbid cocaine use were found to have higher likelihood of readmission or death following index HF hospitalization compared to HF patients without cocaine use. As cocaine use continues to grow it is critical to understand the mechanisms underlying cocaine induced cardiovascular pathophysiology, and to identify factors affecting readmission and mortality in this high risk group.

Abstract P315: The Impact Of Neighborhood Factors On Hospital Readmission Among Depressed Patients With Systolic Heart Failure.

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Emily Guhl ◽  
Julia P Holber ◽  
Kwonho Jeong ◽  
Kaleab Z Abebe ◽  
Amy Anderson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Systolic Heart Failure ◽  
Activity Level ◽  
Readmission Rates ◽  
Neighborhood Factors ◽  
Depressed Patients ◽  
Walk Score ◽  
The Impact

Introduction: Neighborhood factors such as walkability and proximity to stores, parks, and public transportation have been associated with obesity, diabetes, and physical activity level as well as hospital readmission rates. Among individuals with systolic heart failure (HF), reducing hospital readmissions is challenging, but little is known on the role of neighborhood factors on hospital readmissions in this population. Hypothesis: We hypothesized that better walk scores and less deprivation would be associated with a lower readmissions in HF patients. Methods: We screened hospitalized patients with systolic HF (EF≤45%) and NYHA class II-IV symptoms for depression at 8 Pittsburgh-area hospitals as part of the Hopeful Heart Study (R01 HL114016) and included patients who screened positive for depression and remained depressed when re-contacted by telephone 2 weeks after discharge. We classified neighborhoods using the validated neighborhood Walk Score®and Area Deprivation Index for each patient’s address at study entry (both 0-100 scales), and assessed readmissions for 12 months following each patient’s enrollment. We then compared the ADI and Walk Score of individuals who were readmitted vs. those who were not. Results: Final analysis included 629 depressed patients with systolic HF (43% female, 75% white, 86% HTN, 52% DM). Overall, 73.1% of individuals were readmitted at least once, and readmitted and not readmitted patients had similar walk scores (34.1±25.2 vs. 32.2±27.0, p = 0.40) and ADI (66.6±23.1 vs. 64.2±22.7, p=0.50) as those who were not readmitted. Table 1. Conclusions: Among depressed patients with systolic HF, Walk Score and ADI were associated with not associated with readmission rates. Further research is warranted to determine how neighborhood factors adversely impact individual with co-morbid depression and systolic HF. Further analyses are ongoing to determine if individual components of the Walk Score and ADI contribute to differences in readmission.

Abstract 15301: Skilled Nursing Facilities and 30-day Hospital Readmissions in Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheila M Manemann ◽  
Alanna M Chamberlain ◽  
Jennifer St. Sauver ◽  
Susan A Weston ◽  
Ruoxiang Jiang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmissions ◽  
Skilled Nursing Facility ◽  
International Classification Of Diseases ◽  
Revolving Door ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Classification Of Diseases ◽  
The Impact

Background: Referral to a skilled nursing facility (SNF) should contribute to reducing hospital readmissions; however, a “revolving door” phenomenon after admission to SNF has been hypothesized to drive readmissions. The urgent need to study the impact of SNF on readmissions in heart failure (HF) was recently emphasized, yet this has never been studied in the community. Objectives: To evaluate the association between discharge to SNF and 30-day readmissions in a community cohort of hospitalized incident HF patients. Methods: Olmsted County, MN residents hospitalized with first ever (incident) HF (International Classification of Diseases-9 th Revision code 428) from 1995 through 2010 were identified. HF was validated by Framingham criteria. Patients residing in a SNF prior to hospitalization were excluded from the analysis. Logistic regression was used to examine the association between discharge to SNF and 30-day readmissions. Results: Among 1360 HF patients (mean age 74±14, 47% male), 241(18%) were referred to a SNF. Overall, 296 (22%) patients were readmitted within 30-days after index hospitalization. The proportion of 30-day readmissions was greater among patients discharged to a SNF compared to patients discharged home (27% vs 21%, p=0.031). After adjustment for age and sex, patients discharged to a SNF had a 40% increase in the odds of having a hospital readmission within 30 days post HF compared to those discharged home (OR: 1.42, 95% CI 1.01-1.99). Further adjustment for year of HF diagnosis, ejection fraction, anemia, renal function, dementia and cancer did not alter the strength of the association (OR: 1.43, 95% CI: 0.99-2.09). Conclusion: Among community patients with HF, 30-day readmissions remain frequent and are more likely to occur among patients discharged to a SNF compared to those discharged home. These data provide new insight into the drivers of HF readmissions and suggest that interventions targeted to HF patients in SNFs may be warranted.

Impact of Pharmacist Involvement in Heart Failure Transition of Care

2019 ◽  
Vol 54 (3) ◽  
pp. 239-246 ◽  
Author(s):  
Rachel Neu ◽  
Melvin A. Leonard ◽  
Michelle L. Dehoorne ◽  
Samantha J. Scalia ◽  
Pramodini B. Kale-Pradhan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
Stage Iv ◽  
Dose Titration ◽  
Control Group ◽  
Transition Of Care ◽  
Medication Discontinuation ◽  
The Impact

Background: Heart failure (HF) transition of care (TOC) programs may improve continuity of care and coordination and decrease hospital readmissions. Objective: This study evaluated the impact of pharmacy-led HF TOC on HF readmission rate. Methods: This was a single-center, pre-post quasi-experimental study. Pharmacy TOC comprised admission and discharge medication reconciliations and patient education. Patients were included if they had a primary HF diagnosis. Patients were excluded if they were admitted for a non-HF diagnosis, admitted for <24 hours, had a stage IV cancer or dementia diagnosis, or were transferred to hospice care. The primary outcome was HF 30-day readmission rate. Results: A total of 663 patients were included in the study: 330 in the control group and 333 in the intervention group. The average age for both groups was 67 ± 16 years; 48.1% were female; 56.9% were African American; and 51.4% of patients had an ejection fraction ≤40%. In the control group, 57 (17.3%) patients had a HF 30-day readmission compared with 35 (10.5%) patients in the intervention group. After adjusting for age, the intervention group continued to show a difference in readmission (odds ratio = 0.578; 95% CI = 0.367-0.911; P = 0.018). The most common interventions were medication addition (11%), dose titration (7.5%), medication discontinuation (6.6%), and duplication avoidance (2.7%). Conclusion and Relevance: Pharmacy-led HF TOC, as a component of a targeted hospital-based initiative, significantly decreased HF 30-day readmission rate. Results from this study warrant further research to explore which interventions in TOC are most effective.

scholarly journals READMISSION RISK BY INSURANCE TYPE FOR PATIENTS WITH HEART FAILURE IN SKILLED NURSING FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S645-S645
Author(s):  
Andrea E Daddato ◽  
Edward A Miller ◽  
Pamela Nadash ◽  
Denise Tyler ◽  
Rebecca S Boxer
Keyword(s):  
Heart Failure ◽  
Hospital Discharge ◽  
Controlled Trial ◽  
Hospital Readmissions ◽  
Skilled Nursing Facilities ◽  
P Value ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Care Plans ◽  
Insurance Type

Abstract Heart failure (HF) is a leading cause of potentially preventable hospital readmissions for Medicare beneficiaries from skilled nursing facilities (SNFs). This research seeks to determine if a HF patient’s insurance type (Medicare Fee-for-Service (FFS) vs. Medicare Advantage (MA)) influences their risk for readmission within 30 days of hospital discharge to a SNF. MA beneficiaries receive benefits through managed care plans with restricted networks, but typically expanded benefits. This research is particularly timely in light of CMS’ new penalties under the Protecting Access to Medicare Act (PAMA) directed at SNFs for 30-day rehospitalizations. Outcomes data on readmissions from a randomized controlled trial of HF Disease Management in SNFs conducted from 2014-2017 were used to evaluate the risk of readmission. Patients with HF receiving SNF care were enrolled and followed for 30 days from SNF admission. Patients were recruited from 29 primarily for-profit (93%) SNFs that contracted with an average of 4.07 (±5.48) MA plans. Of the 340 study participants followed, 62% had FFS Medicare coverage (n=212) and 38% had MA (n=128). In total, 23% (n=79) of patients experienced at least one readmission within 30 days of hospital discharge. FFS patients had a higher risk of rehospitalization within 30 days of hospital discharge than MA patients (25% vs. 20%), but the association between insurance type and rehospitalization was not statistically significant (p-value=0.177). Findings suggest that insurance type may be an important risk factor for rehospitalizations for patients with HF from SNF; however, a larger sample will need to confirm this relationship.

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