Multidisciplinary Impact on Heart Failure Readmissions

Abstract

Introduction HF related hospitalizations contribute significantly to health care costs. Consequently, the Hospitals Readmission Reduction Program (HRRP) was created to “support the national goal of improving health care for Americans by linking payment to quality of hospital care” including 30 day readmissions for HF hospitalizations. Many methods have been employed including patient centered (e.g. enhanced post-discharge monitoring) and non-patient centered (e.g. upcoding of disease severity) to reduce HF readmissions. Drivers of HF hospitalization vary and affect readmissions regardless of what patient centered or non-patient centered approaches are used. In this study, we used an inpatient multidisciplinary approach to find these drivers in patients at high risk for HF readmission and targeted these drivers in a specialized HF clinic. Hypothesis Use of a multidisciplinary assessment of patients admitted with HF will reduce readmissions. Methods Beginning Nov 2018, 6 patients (pts) were selected weekly using a health informatics database that identified pts admitted with HF. These pts were stratified by risk of readmission. They were included with the following criteria: presence of HF during hospitalization and mod-high risk of readmission. They were excluded for the following: ESRD requiring dialysis, severe COPD, advanced HF, location at ancillary site. These 6 pts were seen by the following entities: Supportive Palliative Care (SPC), Behavioral Health (BH), Physical Therapy and Cardiac Rehab, Pharmacy, a HF representative, and Case Management. A multidisciplinary meeting was held each Wednesday, and a focused discussion was held on the drivers of admission for HF. Issues pertinent to each pt were identified. Pts were discharged to a “bridge clinic” in which these issues were addressed with a) volume optimization using ReDS technology and an IV diuretic clinic, b) embedded BH/SPC, home PT as needed and a visiting nurse. Pts were seen weekly for 4 weeks and then followed with their Primary Physician or Cardiologist with continued management of issues identified in the multidisciplinary meeting. Readmission rate was followed subsequently. Results 101 pts were selected between Nov 5th 2018 and Feb 25th 2019. These pts accounted for 183 HF related admissions in the 6 months prior to initiation of this program. Of these 101 pts, 17 were readmitted within 30 days of which 9 were HF related. This accounted for a readmission rate of 16.8% of our selected pts. The overall readmission rate for index HF hospitalizations during this time was 16.6%. Conclusions Use of health informatics and a multidisciplinary team was associated with reduction in HF readmissions. Ongoing utilization of this program will be needed to assess whether this effect is persistent.