Reducing Hospital Readmissions in Upstate New York: Teasing Out the Effective Programs

PURPOSE OF STUDY

The study's purpose was to identify hospital programs, organizational characteristics, and levels of nursing involvement in hospital programs that contribute significantly to reductions in readmission rates and reimbursement penalties for hospital systems in upstate New York.

PRIMARY PRACTICE SETTING

Hospitals located in upstate New York.

METHODOLOGY AND SAMPLE

No sampling technique was employed because the cohort included hospitals located in upstate New York. Hospitals in upstate New York were selected (N = 94), representing 53 counties ranging between metropolitan and rural status. Using an ex post facto design within the framework of the ecological and synergy models, organizational characteristics of hospital systems and educational levels of nursing involvement in hospital programs were analyzed and coded. Independent-samples t tests, analysis of variance, and Pearson correlation tests were conducted.

RESULTS

Organizational programs that reduce various hospital readmission rates and reimbursement penalties for hospitals in upstate New York are (1) certified home health agencies; (2) telehealth; (3) house calls; (4) advanced practice nurses on care management interdisciplinary discharge teams; and (4) increasing the number of hospital readmission reduction programs (HRRPs) utilized.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Hospitals should.

Congestive heart failure disease management program: 1-Year population experience from a tertiary center heart failure registry in Saudi Arabia

Aims

We aimed to evaluate congestive heart failure (CHF) multidisciplinary disease management program (DMProg) impact on mortality, readmission rates, length of stay (LOS), and gender health characteristics.

Methods and results

This was a quasi-observational, pre- and post-trial with a parallel nonequivalent group. We enrolled 174 inpatients having CHF with reduced ejection fraction and New York Heart Association (NYHA) Class II–IV, and a total of 197 hospital admissions. A comparative follow-up was performed from 15 December 2014 to 15 December 2015. Among 197 consecutive hospital admissions, 76 (39%) were included in the preintervention or usual care group and 121 (61%) were assigned to the postintervention group. After 1 year, in comparison with the preintervention group, the postintervention group had shorter average LOS in days (7.6 days vs. 11.1 days, p < 0.002), lower 1-year readmission rate (36% vs. 57%, p < 0.003), and lower in-house mortality (1.6% vs. 7.8%, p = 0.03), but similar baseline mortality scores (38.2 vs. 38.6, p = 0.7), 30-day and 90-day readmission rates (15% vs. 18.3%, p = 0.62 and 27.6% vs. 30%, p = 0.65), and 30-day readmission risk score (24.9% vs. 26.2%, p = 0.09). By regression analysis, the DMProg intervention was an independent factor for 1-year readmission reduction (p = 0.001). Kaplan–Meier survival analysis favored the postintervention group (log-rank, p < 0.001).

Conclusion

DMProg significantly decreased 1-year readmission rates, LOS, and in-house mortality.

Case management for heart failure in the emergency department

Heart failure affects approximately 5 million individuals in the United States and is the most common discharge diagnosis among the elderly. The number of individuals diagnosed with heart failure will continue to rise as the population of the United States ages. The natural course of the disease is characterized by periods of stability interrupted by periods of symptom exacerbation. These periods of exacerbation often require emergency intervention or hospitalization for management. Once an individual is hospitalized, they are at a greater risk for rehospitalization. The causes of rehospitalizations are multifactorial and many are preventable. Case managers are in a position to have a positive impact on the readmission rate. Interventions include adherence to medication guidelines, increasing patients' knowledge of self-care measures, assessing discharge readiness and needs, and increasing the frequency of symptom monitoring for early intervention. Case management begins in the emergency department and facilitates care throughout the patient's stay by fostering communication among all caregivers and the patient and family. Case managers also affect the quality of care patients receive by instituting processes that streamline care and ensure that quality care is provided to the patients. They also serve as mentors and resources for other members of the healthcare team. Most of the information about case management comes from inpatient and outpatient programs; however, the emergency department nurse can adapt these models to support their role. More research is needed as to what specific portions of the case manager's role are most appropriate for the emergency department.

Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes

AIMS

Disease management programmes (DMPs) have evolved as an innovative clinical practice system to enhance the discharge outcomes of older people with heart failure. Yet, clinical trials which have examined their effectiveness have reported inconsistent findings. This may be explained by variations in the design of DMPs. The aim is to identify the characteristics of DMPs which are crucial to reducing hospital readmission and/or mortality of older people with heart failure.

METHODS AND RESULTS

A systematic computerized search was conducted to identify randomized controlled trials of the last 10 years, which examined the effects of DMPs on hospital readmission and mortality of older people with heart failure. The identified DMPs were classified as effective and ineffective, according to statistically significant changes in discharge outcomes. Twenty-one trials were identified, 11 (52.4%) of which reported DMPs improving the discharge outcomes of older people with heart failure. The results indicate that an effective DMP should be multi-faceted and consists of an in-hospital phase of care, intensive patient education, self-care supportive strategy, optimization of medical regimen, and ongoing surveillance and management of clinical deterioration. Cardiac nurse and cardiologist should be actively involved and a flexible approach should be adopted to deliver the follow-up care.

CONCLUSION

This study defines precisely the characteristics of the care team and the organization content and delivery method of the DMP which are crucial to enhance the discharge outcomes of older people with heart failure.