Abstract 12565: Transitional Care Model Decreases Readmission in the Left Ventricular Assist Device Patients

Abstract

Decreasing 30-day readmission rates is critical to minimizing penalties from Medicare and Medicaid. Hospital readmission rates in the Left Ventricular Assist Device (LVAD) programs are 26% to 76% and are highly contingent on successful transitions to home. A Transitional Care Model (TCM) approach is comprehensive, holistic and involves collaboration between the patient and their caregiver. The efforts guided by the TCM, in managing symptoms, education of self-management, coordinating care, and maintaining relationships, are patient and caregiver focused. The principles of the TCM involve patient screening to evaluate for their risk for readmission. The purpose of this pilot study is to evaluate the effectiveness of an intervention based on the TCM in reducing readmission rate. This pilot of the TCM was conducted at a single major medical center which places approximately 60 LVADs yearly. A total of ten participants were enrolled using convenience sampling between June and August of 2015. The eight-week program consisted of an individualized self-management care plan and a combination of weekly follow-up home visits or phone calls. Medical records were reviewed in addition to obtaining participant satisfaction surveys. Pilot evaluation is based on the 30-day readmission rate, participant satisfaction, and program costs. Of the ten participants, six completed the program. The 30-day readmission rate for the six was 16.7%, as compared to the hospital’s readmission rate of non-enrolled participants at 32.1%. The participants expressed overall satisfaction with the program and would willingly use the program if needed; they also said they would recommend the program to family and friends. The total program costs were estimated at $125,444. The cost of readmission at the 32.1% rate and 16.7% are $674,100 and $350,700 respectfully; with a potential cost avoidance of the TCM program of $248,356. Patients with an LVAD experience compounding stressors of managing a chronic illness, an acute surgical intervention, and a life-sustaining device. The TCM pilot was able to achieve successful outcomes in the midst of these stressors. Further inquiry in interventions consistent with TCM is needed to advance care and transitions in the LVAD patient population.