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Rockwell MS, Cox E, Locklear T, Hodges B, Mulkey S, Evans B, Epling JW, Stavola AR. Implementation of a Multimodal Heart Failure Management Protocol in a Skilled Nursing Facility. Gerontol Geriatr Med 2023; 9:23337214221149274. [PMID: 36755744 PMCID: PMC9900649 DOI: 10.1177/23337214221149274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/28/2022] [Accepted: 12/16/2022] [Indexed: 02/06/2023] Open
Abstract
Hospitals and skilled nursing facilities (SNFs) are incentivized to reduce hospital readmissions among patients with heart failure (HF). We used the RE-AIM framework and mixed quantitative and qualitative data to evaluate the implementation of a multimodal HF management protocol (HFMP) administered in a SNF in 2021. Over 90% of eligible patients were enrolled in the HFMP (REACH). Of the 42 enrolled patients (61.9% female, aged 81.9 ± 8.9 years, 9.5% Medicaid), 2 (4.8%) were readmitted within 30 days of hospital discharge and 4 (9.5%) were readmitted within 30 days of SNF discharge compared with historical (2020) rates of 16.7% and 22.2%, respectively (a potential savings of $132,418-$176,573 in hospital costs) (EFFECTIVENESS). Although stakeholder feedback about ADOPTION and IMPLEMENTATION was largely positive, challenges associated with clinical data collection, documentation, and staff turnover were described. Findings will inform refinement of the HFMP to facilitate further testing and sustainability (MAINTENANCE).
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Affiliation(s)
- Michelle S. Rockwell
- Carilion Clinic, Roanoke, VA, USA,Virginia Tech Carilion School of
Medicine, Roanoke, VA, USA
| | | | | | - Brandy Hodges
- Friendship Health and Rehabilitation
Center—South, Roanoke, VA, USA
| | - Stacey Mulkey
- Friendship Health and Rehabilitation
Center—South, Roanoke, VA, USA
| | - Brandon Evans
- Friendship Health and Rehabilitation
Center—South, Roanoke, VA, USA
| | - John W. Epling
- Carilion Clinic, Roanoke, VA, USA,Virginia Tech Carilion School of
Medicine, Roanoke, VA, USA
| | - Anthony R. Stavola
- Carilion Clinic, Roanoke, VA, USA,Friendship Health and Rehabilitation
Center—South, Roanoke, VA, USA,Anthony R. Stavola, Department of Family
& Community Medicine, Carilion Clinic/Virginia Tech Carilion School of
Medicine, 1 Riverside Circle, Suite 102, Roanoke, VA 24016, USA.
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Friedman DM, Goldberg JM, Molinsky RL, Hanson MA, Castaño A, Raza SS, Janas N, Celano P, Kapoor K, Telaraja J, Torres ML, Jain N, Wessler JD. A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: Retrospective Analysis. JMIR Cardio 2021; 5:e29101. [PMID: 34061037 PMCID: PMC8411436 DOI: 10.2196/29101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/04/2021] [Accepted: 05/16/2021] [Indexed: 12/12/2022] Open
Abstract
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, postconsultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc., a cardiovascular digital health company, to 11 SNFs (3510 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 was to assess whether a virtual cardiovascular care program could reduce the 30-day hospital readmission rate for patients with HF 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 or more telemedicine visit via smartphone, tablet, or laptop for cardiac patients identified by a SNF care team. Postconsult 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 or more virtual consultations compared with the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3510 patients admitted to SNF. A total of 185/3510 patients (5.27%) received virtual cardiovascular care via the Heartbeat Health 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 US $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.
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Affiliation(s)
- Daniel M Friedman
- Heartbeat Health, Inc., New York, NY, United States.,Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, United States
| | | | - Rebecca L Molinsky
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Mark A Hanson
- Heartbeat Health, Inc., New York, NY, United States.,Innovative Practice & Telemedicine Section, Department of Emergency Medicine, The George Washington University, Washington, DC, United States
| | - Adam Castaño
- Heartbeat Health, Inc., New York, NY, United States
| | | | - Nodar Janas
- Heartbeat Health, Inc., New York, NY, United States.,Cassena Care, LLC, Woodbury, NY, United States
| | - Peter Celano
- Heartbeat Health, Inc., New York, NY, United States
| | - Karen Kapoor
- Heartbeat Health, Inc., New York, NY, United States
| | | | | | - Nayan Jain
- Heartbeat Health, Inc., New York, NY, United States
| | - Jeffrey D Wessler
- Heartbeat Health, Inc., New York, NY, United States.,Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
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Chandra A, Rahman PA, Sneve A, McCoy RG, Thorsteinsdottir B, Chaudhry R, Storlie CB, Murphree DH, Hanson GJ, Takahashi PY. Risk of 30-Day Hospital Readmission Among Patients Discharged to Skilled Nursing Facilities: Development and Validation of a Risk-Prediction Model. J Am Med Dir Assoc 2019; 20:444-450.e2. [PMID: 30852170 DOI: 10.1016/j.jamda.2019.01.137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Patients discharged to a skilled nursing facility (SNF) for post-acute care have a high risk of hospital readmission. We aimed to develop and validate a risk-prediction model to prospectively quantify the risk of 30-day hospital readmission at the time of discharge to a SNF. DESIGN Retrospective cohort study. SETTING Ten independent SNFs affiliated with the post-acute care practice of an integrated health care delivery system. PARTICIPANTS We evaluated 6032 patients who were discharged to SNFs for post-acute care after hospitalization. MEASUREMENTS The primary outcome was all-cause 30-day hospital readmission. Patient demographics, medical comorbidity, prior use of health care, and clinical parameters during the index hospitalization were analyzed by using gradient boosting machine multivariable analysis to build a predictive model for 30-day hospital readmission. Area under the receiver operating characteristic curve (AUC) was assessed on out-of-sample observations under 10-fold cross-validation. RESULTS Among 8616 discharges to SNFs from January 1, 2009, through June 30, 2014, a total of 1568 (18.2%) were readmitted to the hospital within 30 days. The 30-day hospital readmission prediction model had an AUC of 0.69, a 16% improvement over risk assessment using the Charlson Comorbidity Index alone. The final model included length of stay, abnormal laboratory parameters, and need for intensive care during the index hospitalization; comorbid status; and number of emergency department and hospital visits within the preceding 6 months. CONCLUSIONS AND IMPLICATIONS We developed and validated a risk-prediction model for 30-day hospital readmission in patients discharged to a SNF for post-acute care. This prediction tool can be used to risk stratify the complex population of hospitalized patients who are discharged to SNFs to prioritize interventions and potentially improve the quality, safety, and cost-effectiveness of care.
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Affiliation(s)
- Anupam Chandra
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Parvez A Rahman
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Amelia Sneve
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | - Rozalina G McCoy
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | | | - Rajeev Chaudhry
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | - Curtis B Storlie
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Dennis H Murphree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Gregory J Hanson
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
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Fabbri M, Yost K, Finney Rutten LJ, Manemann SM, Boyd CM, Jensen D, Weston SA, Jiang R, Roger VL. Health Literacy and Outcomes in Patients With Heart Failure: A Prospective Community Study. Mayo Clin Proc 2018; 93:9-15. [PMID: 29217337 PMCID: PMC5756510 DOI: 10.1016/j.mayocp.2017.09.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/06/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the impact of health literacy on hospitalizations and death in a population of patients with heart failure (HF). PATIENTS AND METHODS Residents from the 11-county region in southeast Minnesota with a first-ever International Classification of Diseases, Ninth Revision code 428 or Tenth Revision code 150 (n=5121) from January 1, 2013, through December 31, 2015, were identified and prospectively surveyed to measure health literacy using established screening questions. A total of 2647 patients returned the survey (response rate, 52%); 2487 patients with complete health literacy data were retained for analysis. Health literacy, measured as a composite score on three 5-point scales, was categorized as adequate (≥8) or low (<8). Cox proportional hazards regression and Andersen-Gill models were used to examine the association of health literacy with mortality and hospitalization. RESULTS Of 2487 patients (mean age, 73.5 years; 53.6% male [n=1333]), 10.5% (n= 261) had low health literacy. After mean ± SD follow-up of 15.5±7.2 months, 250 deaths and 1584 hospitalizations occurred. Low health literacy was associated with increased mortality and hospitalizations. After adjusting for age, sex, comorbidity, education, and marital status, the hazard ratios for death and hospitalizations in patients with low health literacy were 1.91 (95% CI, 1.38-2.65; P<.001) and 1.30 (95% CI, 1.02-1.66; P=.03), respectively, compared with patients with adequate health literacy. CONCLUSION Low health literacy is associated with increased risks of hospitalization and death in patients with HF. The clinical evaluation of health literacy could help design interventions individualized for patients with low health literacy.
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Affiliation(s)
- Matteo Fabbri
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kathleen Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD
| | - Daniel Jensen
- Olmsted County Public Health Services, Rochester, MN
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Abstract
This study examines whether the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excess readmissions for certain conditions, has reduced hospital readmissions and led to unintended consequences. Our analyses of Florida hospital administrative data between 2008 and 2014 find that the HRRP resulted in a reduction in the likelihood of readmissions by 1% to 2% for traditional Medicare (TM) beneficiaries with heart failure, pneumonia, or chronic obstructive pulmonary disease. Readmission rates for Medicare Advantage (MA) beneficiaries and privately insured patients with heart attack and heart failure decreased even more than TM patients with the same target condition (e.g., for heart attack, the likelihood for TM beneficiaries to be remitted is 2.2% higher than MA beneficiaries and 2.3% higher than privately insured patients). We do not find any evidence of cost-shifting, delayed readmission, or selection on discharge disposition or patient income. However, the HRRP reduced the likelihood of Hispanic patients with target conditions being admitted by 2% to 4%.
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Arena R, Lavie CJ. Preventing Bad and Expensive Things From Happening by Taking the Healthy Living Polypill: Everyone Needs This Medicine. Mayo Clin Proc 2017; 92:S0025-6196(17)30121-0. [PMID: 28365096 DOI: 10.1016/j.mayocp.2017.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Ross Arena
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL.
| | - Carl J Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
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