scholarly journals Impact of Heart Failure Focused Follow-Up Care at the “Heart Success Clinic” on 30-Day Readmission Rates in Patients with Congestive Heart Failure

2020 ◽  
pp. 1-3
Author(s):  
Deepti Bhandare ◽  
Keyword(s):  
Heart Failure ◽  
Patient Outcomes ◽  
Readmission Rate ◽  
The United States ◽  
Hospital Data ◽  
Readmission Rates ◽  
Medication Reviews ◽  
Improve Patient

Nearly 6.2 million people in the United states are affected by heart failure, it is predicted that this number will rise to 8.5 million by 2030 Significant effort has been made to prevent heart failure and its exacerbations. The Hospital Readmission Reduction Program (HRRP), a Medicaare based program, was established to link payment to quality of care. Payment is reduced to hospitals when patients are readmitted within 30 days for heart failure The “Heart Success Clinic” is an outpatient clinic started to improve patient outcomes and reduce readmission rates. Patients are provided with heart failure focused visits which includes detailed medication reviews, diet modification, weight loss, disease education, etc. During the six months prior to the opening of the clinic, the readmission rate was 15.27% at AdventHealth Sebring hospital which is a community-based hospital. Data was collected on the patients who attended the “Heart Success Clinic” for six months. Zero patients from the clinic were readmitted, bringing the readmission rate down from 15.27% to 0%. This pilot study gives promising initial results. Further studies can be conducted over a longer period time as to gather more patients. Overall, the study demonstrates that there is value in providing heart failure focused follow up visits in improving patient outcomes and readmission rates.

scholarly journals The type of gastrectomy and modified frailty index as useful predictive indicators for 1-year readmission due to nutritional difficulty in patients who undergo gastrectomy for gastric cancer

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomohiro Osaki ◽  
Hiroaki Saito ◽  
Wataru Miyauchi ◽  
Yuji Shishido ◽  
Kozo Miyatani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Readmission Rate ◽  
Frailty Index ◽  
Partial Gastrectomy ◽  
Readmission Rates ◽  
Modified Frailty Index ◽  
Improve Patient ◽  
Predictive Indicators

Abstract Background Patients who undergo gastrectomy for gastric cancer (GC) are likely to have nutritional difficulty after surgery. Readmission due to nutritional difficulty is common in such patients. Thus, in this study, we aim to identify the predictive indicators for readmission due to nutritional difficulty in patients who underwent gastrectomy for GC. Methods We retrospectively reviewed surgical outcomes in 516 consecutive patients who underwent gastrectomy for GC. Results The readmission rate within 1 year was 13.8%. Readmission due to nutritional difficulty was observed in 20 patients (3.9%); it was determined as the second leading cause of readmission. Multivariate analysis revealed that the type of gastrectomy and the modified frailty index (mFI) were independent predictive indicators of readmission due to nutritional difficulty. Patients were assigned 1 point for each predictive indicator, and the total points were calculated (point 0, point 1, or point 2). The readmission rates due to nutritional difficulty were 1.2%, 4.7%, and 11.5% in patients with 0, 1, and 2 points, respectively (P = 0.0008). Conclusions The readmission rate due to nutritional difficulty was noted to be high in patients who underwent total or proximal partial gastrectomy with high mFI. Intensive follow-up and nutritional support are needed to reduce readmissions due to nutritional difficulty. Reduced readmission rates can improve patient quality of life and reduce medical costs.

scholarly journals Heart Failure: Novel and Emerging Therapies

2020 ◽  
Vol 15 (SP1) ◽  
pp. 22-26
Author(s):  
Shiva Nandiwada ◽  
Justin Ezekowitz ◽  
Nawaf Al-Majed
Keyword(s):  
Heart Failure ◽  
Patient Outcomes ◽  
Poor Prognosis ◽  
Large Scale ◽  
Novel Therapies ◽  
Efficacy And Safety ◽  
Emerging Therapies ◽  
Interventional Therapies ◽  
Improve Patient

Heart failure (HF) is increasing in prevalence and continues to have poor prognosis despite using up-to-date guideline-directed medical treatment and device intervention. There is a dire need for new therapies that can improve patient outcomes. New recently tested medical and interventional therapies have proven effective in reducing the morbidity, mortality and improving the quality of life for patients with HF and these therapies are discussed in details in this review. Ongoing large scale clinical trials are underway to determine the efficacy and safety of novel therapies of HF. Development of these medical and interventional therapies are improving our understanding of HF and paving the way to better clinical outcomes.

scholarly journals An Initiative to Improve 30-Day Readmission Rates Using a Transitions-of-Care Clinic Among a Mixed Urban and Rural Veteran Population

2021 ◽  
Author(s):  
Benjamin R Griffin ◽  
Neeru Agarwal ◽  
Rachana Amberker ◽  
Jeydith A Gutierrez Perez ◽  
Kelsi Eichorst ◽  
...  
Keyword(s):  
High Risk ◽  
Readmission Rate ◽  
The United States ◽  
Transitions Of Care ◽  
Relative Reduction ◽  
Health Administration ◽  
Readmission Rates ◽  
Care Clinic ◽  
Care Assessment

BACKGROUND/OBJECTIVE: Hospital readmissions in the United States, especially in patients at high-risk, cost more than $17 billion annually. Although care transitions is an important area of research, data are limited regarding its efficacy, especially among rural patients. In this study, we describe a novel transitions-of-care clinic (TOCC) to reduce 30-day readmissions in a Veterans Health Administration setting that serves a high proportion of rural veterans. METHODS: In this quality improvement initiative we conducted a pre-post study evaluating clinical outcomes in adult patients at high risk for 30-day readmission (Care Assessment Needs score > 85) discharged from the Iowa City Veterans Affairs (ICVA) Health Care System from 2017 to 2020. The ICVA serves 184,000 veterans across 50 counties in eastern Iowa, western Illinois, and northern Missouri, with more than 60% of these patients residing in rural areas. We implemented a multidisciplinary TOCC to provide in-person or virtual follow-up to high-risk veterans after hospital discharge. The main purpose of this study was to assess how TOCC follow-up impacted the monthly 30-day patient readmission rate. RESULTS: The TOCC resulted in a 19.2% relative reduction in 30-day readmission rates in the 12-month postimplementation period compared to the preimplementation period (9.2% vs 11.4%, P = .04). Virtual visits were more popular than in-person visits among both urban and rural veterans. There was no difference in outcomes between these two follow-up options, and both groups had reduced readmission rates compared to non-TOCC follow-up. CONCLUSIONS: A multidisciplinary TOCC within the ICVA featuring both virtual and in-person visits reduced the 30-day readmission rate. This reduction was particularly notable among patients with congestive heart failure.

scholarly journals Development and validity of the Korea psychiatric triage algorithm

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jeongmin Ha ◽  
Kyeongmin Jang ◽  
Misuk An
Keyword(s):  
Emergency Room ◽  
Patient Outcomes ◽  
Classification Algorithms ◽  
Clinical Validity ◽  
Psychiatric Emergencies ◽  
Emergency Room Nurses ◽  
Triage Algorithm ◽  
Improve Patient

Abstract Background Psychiatric emergencies require timely intervention because of the risk of harm to individuals and society, including others. The aim of the present study was to test the content validity of a psychiatric triage algorithm developed for use in South Korea. Methods The initial algorithm was developed through systematic literature review. Its validity was then verified by 10 experts. Based on results of expert validity, the algorithm was modified and the final algorithm was developed. Results Its clinical validity was then verified by 37 emergency room nurses who had used triage. Four questions of expert validity results with a CVI of 0.8 or less were revised to reflect expert opinion. The usefulness, adequacy, and convenience of the final modified algorithm was 2.98 ~ 3.53. Conclusion After sufficiently validated by follow-up studies, it is expected that the use of psychiatric classification algorithms in emergency room nurses will not only improve the quality of care, but also can improve patient outcomes and experience.

Abstract 328: Heart Failure Quality Improvement at the Las Vegas VA

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Awad Javaid
Keyword(s):  
Heart Failure ◽  
Quality Improvement ◽  
Healthcare System ◽  
Readmission Rate ◽  
Left Ventricular ◽  
Readmission Rates ◽  
Improvement Program ◽  
Southern Nevada ◽  
Patient Morbidity

Background: Recently there has been a push to prevent patients admitted with acute decompensated heart failure from being readmitted to the hospital within 30 days. At the VA Southern Nevada Healthcare System, we found that congestive heart failure was the most common cause of hospital admission from January 2017 to June 2018, as well as the diagnosis with the highest 30-day readmission rate to the hospital. Objective: The goal of this project was to research the cause of heart failure readmissions at the VA Southern Nevada Healthcare System and recommend solutions to reduce the readmission rate. Methods: We obtained a list of all patients at the VA who were documented as being readmitted within 30 days for heart failure from January 2017 to June 2018. We compared each patient’s hospital management to recommendations from the American Heart Association’s (AHA) “Get with the Guidelines” heart failure quality improvement program, which lays out a specific set of evidence-based benchmarks that should be achieved for patients with heart failure before hospital discharge. Results: We identified 36 patients and analyzed their hospital courses for compliance with AHA quality improvement measures. There were ten patients who did not receive pharmacologic guideline directed medical therapy for heart failure on discharge, who were not found to have any contraindications. There were eight patients who did not have a transthoracic echocardiogram performed in the previous six months who may have benefitted from repeat left ventricular function assessment. Importantly, 16 patients were not seen at a follow up appointment within one month of discharge from the hospital. Conclusion: We presented our findings to the Chief of Medicine, nursing staff, and residents at the VA Southern Nevada Healthcare System and worked with the Systems Redesign staff to determine how to improve adherence to guidelines and obtain close follow up for patients. An acute care transition clinic was created for patients at high risk for readmission on discharge, and a cardiology nurse practitioner was asked to make follow up appointments for all patients before discharge. We also created a heart failure order set in the electronic medical record, so that providers will be more likely to follow AHA recommendations from the beginning of each admission. We plan to conduct a follow up study to determine whether 30-day readmission rates improve after our recommended measures are instituted. Our objective is to reduce 30-day readmission rates and improve patient morbidity and mortality.ve patient morbidity and mortality.

Abstract 17142: Increased Adherence to Patient Follow-up Visits within 7 dDys in Heart Failure Patients are Associated With Reduced Readmission Rates in MI and WI

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Indermohan Thethi ◽  
Kathie Thomas ◽  
Lynn Mallas-Serdynski
Keyword(s):  
Heart Failure ◽  
Hospital Discharge ◽  
Cost Savings ◽  
Medicare Reimbursement ◽  
Readmission Rates ◽  
Patient Category ◽  
Quality Programs ◽  
Get With The Guidelines

Background & Objectives: Heart failure (HF) is the leading cause of hospitalization among adults aged 65 or older. Despite advancements in medical therapy, HF readmission rates remain high. The average cost of each HF readmission is about $13,000. High rates of readmissions can lead to penalties of up to 3% of Medicare reimbursement, the reduction of costs, & the improvement of quality of care and patient outcomes, which makes reduction vital to hospitals. Having a follow up visit within 7 days of hospital discharge may help reduce HF readmissions. The objective of the abstract is to quantify the change in 7 day follow up visits and 30 day readmissions as part of the Get With The Guidelines (GWTG) HF quality improvement (QI) initiative. Methods: GWTG HF is an in-hospital quality initiative designed to improve care by promoting adherence to the latest scientific guidelines. A retrospective review was conducted of HF discharges from 19 hospitals using GWTG HF in Wisconsin and Michigan from 2011-2014. Readmission rates were determined from Centers for Medicare and Medicaid Services data. Results: 19 hospitals demonstrated improvement in the percentage of HF patients undergoing a follow-up visit within 7 days of hospital discharge when using GWTG HF as a QI program. As the percentage of HF patients receiving a follow-up visit within 7 days of hospital discharge increases, the number of readmissions decreases by 3% or 413 discharges over 4 years, which resulted in $5,369,000 cost savings. Conclusions: An in-hospital QI program, such as GWTG HF, improves the percentage of HF patients receiving a follow-up visit with 7 days of hospital discharge. Adherence to patient follow up visits for HF patients within 7 days of discharge leads to reduction in readmission rates. This translates into significant healthcare cost saving directly related to readmission in this patient category. Larger studies using a higher number of hospitals participating in quality programs is recommended.

scholarly journals Booking the Appointment: A Strategy to Reduce Readmissions in Heart Failure Patients

2013 ◽  
Author(s):  
Lindsey Moran
Keyword(s):  
Heart Failure ◽  
Hospital Discharge ◽  
Acute Care Hospital ◽  
The United States ◽  
Primary Diagnosis ◽  
Care Hospital ◽  
Chart Audit ◽  
Readmission Rates ◽  
June July

Heart failure (HF) is a chronic condition that is the cause for many hospitalizations in the United States. Hospital readmission is a common problem in many chronic conditions, especially heart failure. The purpose of this research was to determine if scheduling a follow-up appointment with a primary care provider (PCP) or cardiologist prior to hospital discharge decreases 30-day readmission rates in patients with a primary diagnosis of HF. A quasi-experimental, two-group study was performed at The Miriam Hospital, a 247-bed acute care hospital, with a sample of 60 patients. A retrospective chart audit was performed to determine if 30-day readmission rates were lower in those HF patients who had a follow-up appointment booked prior to hospital discharge than those who did not have the appointment booked. Charts were reviewed for patients discharged during June, July, August and September 2012. Basic descriptive statistics were performed as well as differences between groups. Thirty-day readmission rates were lower for those who had a follow-up appointment booked (22.58%) compared those who did not have an appointment booked (31.03%). The 30-day readmission rate for those who had an appointment with a PCP was higher than those who followed up with a cardiologist (33.33% versus 7.69%). These findings suggest that booking a follow-up appointment for HF patients with a cardiologist prior to hospital discharge may help to decrease 30-day readmission rates. This simple intervention can be performed by nonclinical, administrative staff and could save hospitals money if even one HF readmission were prevented.

scholarly journals Trends in cause-specific readmissions in heart failure with preserved versus reduced and mid-range ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.T Cui ◽  
E Thunstrom ◽  
U Dahlstrom ◽  
J.M Zhou ◽  
J.B Ge ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Temporal Trend ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Readmission Rates ◽  
P Values ◽  
National Board ◽  
Over Time

Abstract Background It remains unclear whether the readmission of heart failure (HF) patients has decreased over time and how it differs among HF with preserved ejection fraction (EF) (HFpEF) versus reduced EF (HFrEF) and mid-range EF (HFmrEF). Methods We evaluated HF patients index hospitalized from January 2004 to December 2011 in the Swedish Heart Failure Registry with 1-year follow-up. Outcome measures were the first occurring all-cause, cardiovascular (CV) and HF readmissions. Results Totally 20,877 HF patients (11,064 HFrEF, 4,215 HFmrEF, 5,562 HFpEF) were included in the study. All-cause readmission was highest in patients with HFpEF, whereas CV and HF readmissions were highest in HFrEF. From 2004 to 2011, HF readmission rates within 6 months (from 22.3% to 17.3%, P=0.003) and 1 year (from 27.7% to 23.4%, P=0.019) in HFpEF declined, and the risk for 1-year HF readmission in HFpEF was reduced by 7% after adjusting for age and sex (P=0.022). Likewise, risk factors for HF readmission in HFpEF changed. However, no significant changes in cause-specific readmissions were observed in HFrEF. Time to the first readmission did not change significantly from 2004 to 2011, regardless of EF subgroup (all P-values>0.05). Conclusions Although the burden of all-cause readmission remained highest in HFpEF versus HFrEF and HFmrEF, a declining temporal trend in 6-month and 1-year HF readmission rates was found in patients with HFpEF, suggesting that non-HF-related readmission represents a big challenge for clinical practice. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The SwedeHF was funded by the Swedish National Board of Health and Welfare, the Swedish Association of Local Authorities and Regions.

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