Abstract 308: iHeart Failure: Using Innovative Methodologies From Technology And Manufacturing Companies To Reduce Readmissions

Abstract

Background: Heart failure patients have high 30-day readmission rates with high cost and poor quality of life. To address this issue, we created a framework using Lean Sigma (developed by Toyota and Motorola to improve efficiency and reduce defects), design thinking (championed by Apple and IDEO to improve user experience), and Lean Startup (pioneered in Silicon Valley to create technology companies). We assessed the impact of this approach on all-cause 30-day readmissions in heart failure. Methods: We used Lean Sigma’s Define Measure Analyze Improve Control or DMAIC framework to define the scope of the problem, measure key determinants and analyze root causes. A design thinking workshop held with support from IDEO augmented the improve phase to brainstorm possible interventions. A Lean Startup approach was also leveraged to create minimal viable products to test the promising interventions. The most viable interventions were piloted and scaled up including improvements in access to care, patient self-management, treatment algorithms, and patient education and provider training. Results: At baseline (fiscal year [FY] 2011), the readmission rate was 24.9% among 631 HF discharges (average age 70 (± 15) years, 53% women, length of stay 5.3 days (± 5) and 50% diabetes). Interventions were implemented in the second quarter of 2012, and the 30-day readmission rate declined to 19.3% in the subsequent three quarters (p<0.01). As a result, an estimated 35 readmissions prevented annually, saving payers about $419,000, much lower than the annual cost of implementation ($200,000, p<0.01). Further reductions in readmissions are expected in the coming quarters as more interventions move beyond the pilot phase. Conclusion: Methodologies from technology and manufacturing companies cost-effectively reduced 30-day readmissions in heart failure demonstrating their potential to improve chronic disease care.