Disease Management in Skilled Nursing Facilities Improves Outcomes for Patients With a Primary Diagnosis of Heart Failure.

Abstract

Skilled nursing facilities (SNFs) are common destinations after hospitalization for patients with heart failure (HF). Our objective was to determine if patients in SNFs with a primary hospital discharge diagnosis of HF benefit from an HF disease management program (HF-DMP). This is a subgroup analysis of multisite, physician and practice blocked, cluster-randomized controlled trial of HF-DMP vs usual care for patients in SNF with an HF diagnosis. The HF-DMP standardized SNF HF care using HF practice guidelines and performance measures and was delivered by an HF nurse advocate. Patients with a primary hospital discharge diagnosis of HF discharged to SNF. Composite outcome of all-cause hospitalization, emergency department visits, and mortality were evaluated at 30 and 60days post SNF admission. Linear mixed models accounted for patient clustering at the physician level. Of 671 individuals enrolled in the main study, 125 had a primary hospital discharge diagnosis of HF (50 HF-DMP; 75 usual care). Mean age was 79 ± 10years, 53% women, and mean ejection fraction 46% ± 15%. At 60days post SNF admission, the rate of the composite outcome was lower in the HF-DMP group (30%) compared with usual care (52%) (P= .02). The rate of the composite outcome at 30days for the HF-DMP group was 18% vs 31% in the usual care group (P= .11). Patients with a primary hospital discharge diagnosis of HF who received HF-DMP while cared for in an SNF had lower rates of the composite outcome at 60days. Standardized HF management during SNF stays may be important for patients with a primary discharge diagnosis of HF.