Abstract
Heart Failure (HF) is one of the leading hospital readmission diagnoses in the United States. It is a major challenge in today’s healthcare environment to reduce hospital readmissions for HF and much of the expenditure on HF is on in-hospital treatment. In the USA, risk factors for readmission with HF include being African American, low-socioeconomic status, Medicare, Medicaid, self-pay/no insurance and drug abuse. The Transitional Care Clinic (TCC) model established at our institution integrated multiple facets of chronic HF management, including early post-discharge follow-up, phone call reminders as well as clinical pharmacists and nurse practitioner’s integration into the treatment team.Of 488 HF admissions to our institution from March 2015 until May 2017, mean age = 65 years (SD 13.03), 262 patients were males (53.6%) and 463 patients (94%) were Blacks. There was a total of 121 readmissions within 30 days after discharge (24.8%) and 43 readmissions 7 days after discharge (8.81%) during our study period. 159 patients (32.58%) followed up in our TCC, while 329 patients (67.41%) did not at TCC. Within 7 days post discharge, there was 3 (1.9%) Vs 40 (12.2%) readmissions for TCC and non-TCC groups respectively, P<0.01. There was 18 (11.32%) Vs 103(31.31%) readmissions within 30 days post discharge for TCC and non-TCC groups respectively P<0.01.Among high readmission risk and predominantly black population with HF, TCC resulted in significantly lower hospital readmission rate within 7 days and within 30 days of initial discharge. These data help inform policy makers regarding the effectiveness of TCC model for resource allocation and broader implementation, particularly among high risk population with the potential of cost saving and better patient outcomes.
Highlights
In the United States, Heart Failure (HF) is one of the leading chronic illnesses with a prevalence of 5 million patients [1]
In the US, much of the aforementioned expenditure in HF treatment is spent in hospital readmissions, as approximately 25% of initial HF admissions will be followed by a second admission [1]
Χ2 tests were used to determine statistical significance among groups, which was set at P
Summary
In the United States, Heart Failure (HF) is one of the leading chronic illnesses with a prevalence of 5 million patients [1]. In the US, much of the aforementioned expenditure in HF treatment is spent in hospital readmissions, as approximately 25% of initial HF admissions will be followed by a second admission [1]. These challenges led to the initiation of the Hospital Readmissions Reduction Program (HRRP) of the Patient Protection and Affordable Care Act. Beginning in 2012, institutions with unacceptably high 30day readmission rates for several conditions, including HF, were faced with financial penalties under this legislation [4]
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