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From Knowledge to Practice Translation
A Multidisciplinary Intervention to Reduce 30 day Heart Failure
Readmissions
Context
• Rehospitalization ≤30 days marker of poor quality – Reduction of unnecessary rehospitalization is a way to
improve quality and decrease cost
• Limited data re: patterns of rehospitalization in U.S.
• Jencks et al. (2009) NEJM– What is the frequency of rehospitalization of
Medicare patients within 30 days after discharge?– How long does the risk of rehospitalization persist?– What is the frequency of outpatient followup after
hospitalization?
Jencks S et al. (2009) NEJM 360(14): 1418-1428
30 day rehospitalization
• 19.6% of all Medicare patients rehospitalized within 30 days of discharge– Medical diagnoses – 21.1%• Heart failure – 26.9%
– Surgical diagnoses – 15.6%• No record of outpatient follow-up visit for 50.1%
of patients rehospitalized within 30 days after discharge
• No outpatient follow-up visit for 52% of those rehospitalized within 30 days after discharge for heart failure
Jencks S et al. (2009) NEJM 360(14): 1418-1428
Heart failure readmission and HLOS relationship
Winslow R, Wall Street Journal, June 2, 2010
The Allen Hospital Project
Graham et al., 2006
28.3%
The population
Strategy
Teambuilding
Preparatory work
Intervention components
Practice change
Effect on 30 day readmission
Would improvement have happened anyway?
Core measure improvement
Lessons Learned
But the story doesn’t end here…..
Ongoing Monitoring 2012
• Rise in readmission rates • Characteristics of those
readmitted analyzed• Chronic kidney disease• Dementia• Respiratory diseases• Poor social support• Medication discrepancies
• Review of meds by pharmacist prior to discharge
• Need for palliative care team