Abstract P63: BRIDGE Clinic: A Novel Approach to the Hospital-to-Home Transition

Abstract

Background: Unplanned 30-day rehospitalization rates for AMI (19.9%) and CHF (24.4%) represent a huge health care burden for patients and providers. Delays in follow-up and lack of adherence to standardized guidelines, by providers and patients, contribute to these findings. The hospital-to-home transition is one area with the potential to effect changes in this complex problem. Specially trained outpatient cardiovascular nurse practitioners (NP) aim to “bridge” the transitional care gap in the Cardiovascular Medicine Bridge Program (BRIDGE). NPs, acting as an extension of the inpatient team, adjust treatments depending on patient status, educate patients, and ensure adherence to lifestyle and therapeutic guidelines. Purpose: To assess differences between patients who attended the BRIDGE clinic and those who did not. Methods: This was a retrospective study of all patients referred to BRIDGE, from June 2008 to February 2009. Univariate techniques were used to compare those who attended BRIDGE and those who did not, in terms of age, diagnoses, comorbidities, time to follow-up visit with a cardiologist, and unplanned readmission. Results: Of 359 patients, 239 (67%) attended BRIDGE, mean time from discharge to BRIDGE follow-up was 19.8 days. Mean age of attendees was 63.9, non-attendees M = 61.2, P = .110; 66.6% were male. Patients were more likely to attend BRIDGE if they had greater than two comorbidities (≤ 2 comorbidities 10.5% vs. > 2 comorbidities 18.3%, P = .046). Primary cardiac diagnoses accounted for 217 (60.6%) BRIDGE referrals (ACS 21.2%, CAD 13.7%, CHF 13.4%, other cardiac 12.3%); cardiac was a secondary diagnosis or complication for the remaining 39.4%. Mean days from discharge to first cardiology appointment was 73.0 for attendees and 53.6 for non-attendees, P = .018. BRIDGE attendees had significantly lower 30-day readmission and ED rates than those who did not attend (readmit: attend 8.7 % vs. not attend 21.7%, P = .001, ED visits: attend 13.5% vs. not attend 28.2%, P = .005). Conclusion: Individuals who attended the BRIDGE clinic had fewer unplanned readmissions, when compared to patients who did not take advantage of this opportunity. These preliminary findings suggest that this strategy can improve efficiency of acute cardiac care in the US.