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Griffin BR, Agarwal N, Amberker R, Gutierrez Perez JA, Eichorst K, Chapin J, Schweitzer AC, Hagiwara M, Wu C, Eyck PT, Reisinger HS, Vaughan-Sarrazin M, Kuperman EF, Glenn K, Jalal DI. An Initiative to Improve 30-Day Readmission Rates Using a Transitions-of-Care Clinic Among a Mixed Urban and Rural Veteran Population. J Hosp Med 2021; 16:583-588. [PMID: 34424188 PMCID: PMC8494282 DOI: 10.12788/jhm.3659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/25/2021] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Benjamin R Griffin
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Corresponding Author: Benjamin R Griffin, MD; ; Telephone: 319-384-8197
| | - Neeru Agarwal
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Corresponding Author: Benjamin R Griffin, MD; ; Telephone: 319-384-8197
| | - Rachana Amberker
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jeydith A Gutierrez Perez
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Kelsi Eichorst
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Jennifer Chapin
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | | | - Mariko Hagiwara
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Chaorong Wu
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Heather Schacht Reisinger
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Mary Vaughan-Sarrazin
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ethan F Kuperman
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Kevin Glenn
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Diana I Jalal
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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