Abstract P164: Reduction of Heart Failure Readmissions Through an Enhanced Internal Medicine Residency Curriculum

Abstract

Background: Heart failure (HF) carries a significant economic burden and hospitalizations account for 70% of the total costs of heart failure. Rehospitalizations are particularly costly and potentially avoidable. As part of the National Initiative for Alliance of Independent Academic Medical Centers, we aimed to decrease the HF readmissions by 5% through enhancements in the Internal Medicine Residency Curriculum. Methods: Between 7/10-2/11, we implemented a HF lecture series, multidisciplinary rounds, article and case reviews. Cardiac Rehabilitation, Information Systems, HF Team, Case Managers/Social Work and Nursing staff collaborated to develop better documentation and discharge protocols. To determine the impact of our intervention, the change in 30-day readmission and pre and post questionnaire about HF knowledge/attitudes were statistically analyzed. Results: The pre test questionnaire showed: 1) Residents felt more confident in treating/ counseling patients with HF and were not as confident in identifying precipitants of readmissions or applying core measures. 2) Most residents felt the key factors to preventing readmissions were close post-discharge follow up and patient education. Post intervention questionnaire showed: 1) More residents were confident about the core measures, quality indicators, appropriate documentation of HF. 2) More residents were satisfied with the Internal Medicine Residency Curriculum. The average HF readmission rate reduced from 24.6% to 20.9% between 7/10-11/10 (above goal). January - August 2010 (Before Intervention) September - November 2010 (After Intervention) All HF Admissions 1178 464 All HF Readmissions 292 (24.8 %) 103 (22.2%) Primary HF Admissions 167 63 Primary HF Readmissions 40 (24.0%) 12 (19.0%) Statistical comparison of All HF p=0.483, OR 1.339, 95% CI 0.656-2.727 Statistical comparison of Primary HF p=0.276, OR 1.155 95% CI 0.895-1.491 Conclusions: A 6-month resident-oriented multidisciplinary intervention improved patient care, documentation, and resident understanding of HF syndrome. This led to promising trends towards a significant decrease in 30-day HF readmissions. Further improvement in outcomes should be evident at the completion of 12-month follow-up.