National Survey of Hospital Strategies to Reduce Heart Failure Readmissions Findings From the Get With the Guidelines-Heart Failure Registry

1 Duke University School of Medicine, Durham, NC
Circulation Heart Failure (Impact Factor: 5.95). 08/2012; 5(6). DOI: 10.1161/CIRCHEARTFAILURE.112.967406
Source: PubMed

ABSTRACT BACKGROUND: -Reducing 30-day heart failure readmission rates is a national priority. Yet, little is known about how hospitals address the problem and whether hospital-based processes of care processes are associated with reductions in readmission rates. METHODS AND RESULTS: -We surveyed 100 randomly selected hospitals participating in the Get With the Guidelines-Heart Failure quality-improvement program regarding common processes of care aimed at reducing readmissions. We grouped processes into 3 domains (ie, inpatient care, discharge and transitional care, and general quality improvement) and scored hospitals on the basis of survey responses using processes selected a priori. We used linear regression to examine associations between these domain scores and 30-day risk-standardized readmission rates. Of the 100 participating sites, 28% were academic centers and 64% were community hospitals. The median readmission rate among participating sites (24.0%; 95% confidence interval, 22.6%-25.7%) was comparable to the national average (24.6%; 23.5-25.9). Sites varied substantially in care processes used for inpatient care, education, discharge process, care transitions, and quality improvement. Overall, neither inpatient care nor general quality-improvement domains were associated with 30-day readmission rates. Hospitals in the lowest readmission rate quartile had modestly higher discharge and transitional care domain scores (P = .03). CONCLUSIONS: -A variety of strategies are employed by hospitals in an attempt to improve 30-day readmission rates for patients hospitalized with heart failure. Although more complete discharge and transitional care processes may be modestly associated with lower 30-day readmission rates, most current strategies are not associated with lower readmission rates.

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