Abstract P33: Improving Heart Failure Metrics: A Multidisciplinary Team Approach

Abstract

Background: Quality of care has become a priority as heart failure (HF) core measures and readmission have been publically reported on the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website. In an effort to decrease readmissions Vanderbilt University Medical Center (VUMC) joined the H2H (Hospital to Home) initiative. Based on the CMS data for 2005 to 2008 the middle Tennessee region was in the 5 th Quartile of readmission scores (25.2%-29.0%). The 30-day HF readmission rate at VUMC (25.7%) was comparable to the national rate of 24.5%. Aim: The goal of this project was to decrease readmissions by 20% as suggested by the ACC through participation with the H2H initiative. Method: A multidisciplinary team, including Physicians, Pharmacist, Case Management, Nutrition, Nursing, and a Social Worker, was structured to round on the heart failure floor each morning to identify HF patients as part of a demonstration project. All identified patients were assessed by the multidisciplinary team for teaching needs and self care abilities based on their specialties. Based on their initial assessment, teaching was performed for newly diagnosed or reinforcement teaching. Education materials were updated for all patients and given to all heart failure patients regardless of status in the demonstration project. Results: Thirty day follow-up has been completed on 52 patients and 7 have been readmitted for any cause. This has decreased the readmission rate from 25.7% to 13.4%. There are 5 interventions which could have been completed. The most frequent, the Pharmacy intervention was completed on 76% of the patients; however there is not a statistical correlation between this intervention alone and readmission. Discharge instructions in core measures were also associated with a positive trend as evidence by quarter 4 2009 at 88.4% and quarter 4 2010 at 96.8%. Conclusions: Our project targeted recognizing the needs of the patient and matching them with the appropriate consult. This approach has been associated with reduction in readmission rates and in an increase in core measure compliance. Further data collection will be needed to confirm findings.