National Survey of Hospital Strategies to Reduce Heart Failure Readmissions: Findings From the Get With the Guidelines-Heart Failure Registry.
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.
- JACC: Heart Failure. 01/2014;
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ABSTRACT: Limited data exist regarding baseline characteristics and management of heart failure with reduced ejection fraction (EF) in tertiary care facilities.Clinical Research in Cardiology 07/2014; 103(12). · 4.17 Impact Factor
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ABSTRACT: Objective: To provide an up-to-date review of current care transitions in elderly heart failure (HF) patients and assess the role of the pharmacist in improving patient care.Data Source: A PubMed search of articles in the English language published between 1995 and May 2013 was done using a combination of the following words: discharge counseling, elderly, heart failure, multidisciplinary team, pharmacist, pharmacy, readmission, transition of care.Study Selection/Data Extraction: Relevant original studies, review articles, and guidelines were assessed for current practices in HF transitions of care. References from the above literature were also evaluated for relevance. Articles were selected for inclusion based on relevance to the topic, detailed methods, and clear, comprehensive results. Data Synthesis: The incidence of HF is rapidly increasing, and emphasis has been placed on reducing readmissions. Although present practices are primarily nurse-led, pharmacists are in a key position to educate patients through multidisciplinary teams, discharge counseling, and medication reconciliation. Because of concerns about pharmacist provider status and reimbursement, pharmacists should identify areas in their practices where they can intervene and improve patient care to reduce readmissions.Conclusion: Pharmacists are an integral part of the multidisciplinary team in optimizing care for elderly HF patients to prevent readmissions.The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists 03/2014; 29(3):179-90.