Reducing Readmission Rates in Heart Failure Patients Aged 60 and Older Through Education and Follow-Up Calls.

Implementation of Transitional Care Planning is Associated with Reduced Readmission Rates in Patients Undergoing Lower Extremity Bypass Surgery for Peripheral Arterial Disease

Accountable Care Organizations in the Medicare Shared Savings Program (MSSP) have financial incentives to reduce the cost and improve the quality of care delivered to Medicare beneficiaries that they serve. However, previous research about the impact of the MSSP on readmissions is limited and mixed. To examine the association between hospital participation in the MSSP during the 2012-2013 period and reductions in 30-day risk-standardized readmission rates for Medicare patients initially admitted for acute myocardial infarction, heart failure (HF), pneumonia, or any cause. Difference-in-differences estimation to compare the change in readmission rates for hospitals participating in the MSSP with that of other hospitals. Acute care hospitals that either participated in the MSSP or did not participate in any of Medicare Accountable Care Organization programs (for acute myocardial infarction, n=1631; for HF, n=1889; for pneumonia, n=1896; for any cause, n=2067). Compared with nonparticipating hospitals, MSSP-participating hospitals showed greater reductions in readmission rates for Medicare patients originally admitted for HF by 0.47 percentage points [95% confidence interval (CI), -0.76 to -0.17] and for pneumonia by 0.26 percentage points (95% CI, -0.49 to -0.03). MSSP-participating hospitals also showed more reductions in hospital-wide all-cause readmission by 0.10 percentage points (95% CI, -0.20 to 0.01), relative to nonparticipating hospitals during the first year of MSSP. MSSP-participating hospitals showed slightly greater reductions in readmissions during postimplementation years for Medicare patients initially admitted for HF or pneumonia, compared with other hospitals.

This study aimed to assess the effectiveness of postdischarge follow-up calls and patient education in reducing 30-day readmission rates for congestive heart failure (CHF) patients aged 60 and older. CHF is a common and debilitating condition, especially in older adults, leading to poor health outcomes and rising health care costs. As the number of CHF patients is projected to exceed 8 million by 2030, managing high readmission rates remains a major challenge in health care. The study took place in the cardiovascular unit of a hospital, focusing on patients who had recently been discharged following a CHF-related hospitalization. A quantitative design was used, with 12 CHF patients participating in the study. Participants received educational materials about managing their health, adhering to medications, and scheduling follow-up appointments. They also received follow-up calls to monitor progress and offer support. Data were collected before and after the intervention, and statistical analyses were performed to compare 30-day readmission rates between the two groups. The results indicated no statistically significant difference in readmission rates between the pre- and postintervention groups (p = .138). This lack of significance may be attributed to the small sample size or the limited effectiveness of the intervention. The study suggests that postdischarge follow-up calls and patient education alone may not be sufficient to reduce readmissions. Case management should focus on more comprehensive interventions, improved care coordination, and exploring alternative models of care, such as community-based or integrated care teams. Further research is needed to identify more effective strategies to address CHF readmissions.

Background/Objectives: With the global rise in chronic diseases among older adults, rehabilitation services have become essential, particularly for those with cerebrovascular and central nervous system (CNS) disorders, which lead to significant long-term disabilities. To determine the impact of designated rehabilitation medical institutions on the readmission rates of older patients with CNS disorders who receive surgical interventions. Methods: This was a population-based cohort study. Data was obtained from the National Health Insurance Service database (2002-2019). Fifteen designated institutions participated in the pilot project for convalescent rehabilitation. We analyzed the data of 1019 patients before and after the implementation of the designated rehabilitation institution. The study sample included (1) patients admitted to 15 designated institutions participating in the pilot project for convalescent rehabilitation and (2) patients diagnosed with conditions classified under the rehabilitation patient group, Rehabilitation Impairment Category 1 to 7. The intervention was the pilot project for designated rehabilitation institutions, launched in October 2017. The primary outcome of interest was the readmission rate of older patients with CNS disorders who received surgical interventions. Interrupted time series analysis with segmented regression was used to assess changes in the 30-day readmission rates. Results: Post-intervention, an 8% reduction in 30-day readmission rates (estimate, 0.9225; 95% confidence interval: 0.9129-0.9322, p < 0.0001) was observed. Subgroup analysis showed a significant decline in readmission rates across various patient groups, including those with disabilities, high Charlson Comorbidity Index scores, and extended hospital stays. The regions outside Seoul (capital city), particularly Gyeonggi/Incheon (areas around Seoul) and other areas (i.e., rural), also showed a significant decrease in readmission trends after the intervention. Conclusions: Designated rehabilitation medical institutions led to a significant reduction in readmission rates of older patients with CNS disorders, suggesting that these institutions effectively support recovery and reduce the burden of readmission for patients with severe conditions and those residing in non-capital cities.

A systematic review of the effectiveness of nurse coordinated transitioning of care on readmission rates for patients with heart failure

Review question/objective: The objective is to identify the best available evidence on effectiveness of nurse coordinated transitioning of care between hospital and home on all hospital readmission rates in hospitalized adult patients with heart failure. Inclusion criteria: Types of participants: This review will consider studies that include adult patients, 18 years of age or older, hospitalised with heart failure being discharged to home. Types of intervention(s)/phenomena of interest: This review will consider studies that evaluate all models of nurse coordinated transitioning of care from hospital to home, limited to inpatient care coupled with post-discharge home-based and/or telephone education and support by a nurse. Types of outcomes: This review will consider studies that include the following outcome measures: all hospital readmission rates with a focus on 30 day readmissions.

Objective To explore the impact of systematic management on the cardiac function and readmission rate in patients with chronic heart failure(CHF).Methods One hundred and sixty CHF patients in Beijing Shunyi Hospital Affiliated to China Medical University from Jul.2008 to Jul.2010 were selected as our subjects and random divided into intervention (79 cases) and control group(81 cases).Patients in intervention group were received systematic therapy based on heart function and clinical syndrome including therapy plan and guiding the application of angiotensin converting enzyme inhibitor and beta blockers,and in control group were received regular therapy.The cardiac function were evaluated by 6-minute walking test (6MWT) and echocardiography,and readmission rate was observed.Results (1)The result of 6MWT in the intervention group at 6 months and 12 months were (345.27 ± 123.95) m,(368.94 ± 121.62) m,significantly higher than that of 6MWT in the control group ((282.53 ± 94.63) m,(260.07 ± 86.13) m; F between groups =38.01,P ＜0.01 ;F inner group =19.26,P ＜ 0.01 ; F across group =48.36,P ＜ 0.01).(2) Left ventricular ejection fraction in the intervention group at 6 months and 12 months were (43.48 ± 8.42) ％,(41.21 ± 6.23) ％,significantly higher than that in the control group ((37.70 ±7.13)％,(37.15 ±6.83)％ ;P ＜0.001).(3)The readmission rate in the intervention group showed a decreased trend but did not reach statistically significant difference at 6 months,while the readmission times in the intervention group at 12 months was 26,significantly lower than that in the control group (36,P =0.024).Conclusion The systematic management might improve the heart function and reduce readmission rates in patients with CHF. Key words: Chronic heart failure; Systematic management; Cardiac function; Readmission rate

BackgroundUnhealthy behaviors of coronary heart disease (CHD) patients are closely related to the occurrence of major heart events, which increases the readmission rate and brings a heavy economic burden to families and society. Therefore, it is necessary for health care workers to take active preventive and therapeutic measures to keep or establish healthy behaviors of patients. Positive psychological intervention has been proved to be effective, but it has not been reported in the field of CHD in China. The purpose of this study is to explore the effects of positive event recording based on positive psychology on the healthy behaviors, readmission rate, and anxiety of patients with CHD, in order to provide new ideas for the development of secondary prevention strategies for CHD.MethodsThis is a prospective, single-center, randomized controlled trial (RCT). The subjects will be enrolled from the Department of Cardiology, the First Affiliated Hospital of Soochow University. There are 80 cases in total; according to the random number table, the subjects are randomly divided into the intervention group (n = 40) and the control group (n = 40). The patients in the intervention group will receive the intervention of recording positive events once a week for 3 months, while the patients in the control group receive conventional nursing. The primary outcomes will include healthy behaviors, readmission rate, and anxiety, and the secondary outcomes will include psychological capital, subjective well-being, and corresponding clinical laboratory indicators. The protocol was approved by the Medical Ethics Committee of Soochow University (approval no. SUDA20200604H01) and is performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. All participants provide written informed consent.DiscussionThis study will verify whether positive event recording based on positive psychology can make patients maintain healthy behaviors, reduce readmission rate, and improve anxiety after PCI. Then, this study will provide new ideas and references for the development of secondary prevention strategies for patients with CHD.Trial registrationChinese Clinical Trials Registry 2000034538. Registered on 10 July 2020.

Readmission rates for patients with heart failure are a major concern for hospitals worldwide. The importance of patient education and a structured care plan to ease the transition from hospital to home has been the focus of many intervention strategies to reduce readmission rates. The use of transitioning of care plans is believed to improve medication reconciliation, communication, patient education, and follow-up. To date, the evidence has not been systematically evaluated to support the effectiveness of a nurse coordinated transitioning of care for patients with heart failure in reducing readmission rates. The objective of the systematic review was to identify the best available evidence on the effectiveness of nurse coordinated transitioning of care between hospital and home on hospital readmission rates for all causes in adult patients hospitalised with heart failure. The search strategy aimed to find both published and unpublished studies in the English language from January 1975 through July 2010. A search of MEDLINE, CINAHL, PsycINFO, Healthsource Nursing/academic edition, EMBASE, the Cochrane Library, and the Joanna Briggs Institute Library of Systematic Reviews was conducted followed by a reference search of relevant studies. The initial key words searched were: heart failure, readmission, and transitional care. Randomised controlled trials that evaluated the effect of nurse coordinated transitioning of care from hospital to home in adult patients with heart failure on readmission rates were selected. The outcome was defined as hospital readmissions for all causes following an initial admission for heart failure. Studies selected for retrieval were critically evaluated by two independent reviewers for methodological validity using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted and analysed using the JBI-MAStARI program. A total of 16 randomised controlled studies were included. Ten of the 16 studies included in the review show that a nurse led transitioning of care intervention can reduce the rate of readmission for patients with heart failure. Interventions utilising home visits, or home visits coupled with telephone follow-up, show a more favourable reduction in readmission rates. Reduced readmissions occur when transitioning of care interventions are carried out by a heart failure trained nurse who conducts at least one home visit and follows the patient at least weekly for a minimum of 30 days post discharge with either additional home visits or telephone contact. This review supports the development of a nurse coordinated transitioning of care plan which will require improvements in communication, in addition to changes in health policy and payment systems that align incentives and performance measures in caring for patients with heart failure. Future research should evaluate the effect of the intensity and duration of the transitioning of care intervention on readmission rates in a large randomised control trial on an adult population with heart failure to determine the ideal frequency and duration of the post discharge interventions.

Studies show follow-up phone calls decrease readmission rates (RR) in trauma patients and social vulnerabilities may play a role as well. Minimal literature exists comparing RR of trauma patients who required an inpatient stay to those whose treatment was limited to the Emergency Department (ED), as they are at high risk of recidivism. We hypothesized post-trauma follow-up calls would show higher RR for ED patients than those requiring inpatient stay, as well as potentially differing outcomes for minorities. A retrospective analysis from 2019-2020 of 1328 trauma patients from UCI Medical Center, discharged from inpatient facilities or the ED. A questionnaire script read by a nurse practitioner to patients via phone call following discharge. Data associated with readmission were captured. Multivariable logistic regression analysis was performed, controlling for patient factors including severity of injury. Patients discharged from the ED were 47.4% less likely to be readmitted than those who required an inpatient stay (P < .01). However, ED patients were 88.7% less likely to receive a prescription than inpatient stay patients (P < .01). No difference between ED and inpatient discharge contact rates was noted (P < .99). Furthermore, no difference in readmission rates was noted for minorities. Post-trauma follow-up calls showed lower RR for index ED visit patients than those requiring inpatient stay, contrary to expectations. However, ED visit patients were also less likely to receive/fill prescriptions compared to those requiring inpatient stay. Ongoing analysis is warranted to further validate and improve follow-up call programs to ensure equitable health care.

Neuroaxial (i.e., spinal, regional, epidural) anesthesia has been shown to be associated with reduced readmission rate, decreased hospital stay, and decreased overall complication rate in orthopedic and gynecologic surgery. Our aim was to identify differences in intra- and postoperative complications, length of stay and readmission rates in open nephrectomy patients managed with neuroaxial anesthesia. Utilizing National Surgical Quality Inpatient Program (NSQIP) database, we identified patients who have undergone an open nephrectomy between 2014 and 2017. Patients were further subdivided based on anesthesia modality. We used the propensity score-matching (PSM) method to adjust for baseline differences among patients who received general anesthesia alone and those with additional neuroaxial anesthesia. Using step-wise multivariable logistic regression, we identified preoperative and intraoperative predictors associated with 30-day procedure-related readmission, complications, and postoperative length of stay. Out of 3,633 patients identified, 2346 patients met our inclusion and exclusion criteria. There was no difference in baseline characteristics after propensity score matching between general and additional neuroaxial anesthesia. Postoperative outcomes including: procedure-related readmission, rate of reoperation, operative time, all complications were similar between the groups. Adjuvant neuroaxial anesthesia group did experience a prolonged postoperative hospital stay that was statistically significant as compared to patients with general anesthesia alone [5.3 (3.5) days vs 4.8 (2.9) days, p = 0.007]. Compared to GA alone after multivariable logistic regression, neuroaxial anesthesia was not statistically significant for readmission (p = 0.909), any complication (p = 0.505), but did showed increased odds ratio of prolonged postoperative stay [aOR 1.107, 95% CI 1.042-1.176, p = 0.001] after adjusting for multiple factors. Using 2014-2017 NSQIP database, we were able to demonstrate no additional reduction in complication or readmission rate in patients with neuroaxial anesthesia as compared to general anesthesia alone. Furthermore, patients who did receive neuroaxial anesthesia experienced a longer postoperative course.

Background Patients with acute aortic dissection (AAD) usually require a restriction of physical activity during hospitalisation, which frequently causes difficulty returning to their daily life. Additionally, the increase in the number of older patients with AAD, especially those with frailty, is a crucial problem to worsen clinical outcomes after medical and surgical treatment. Conversely, outpatient cardiovascular rehabilitation is recognized to improve physical function and reduce readmission rates in patients with heart diseases. Although several studies have documented the safety of physical activity intervention after AAD, the relationship between outpatient cardiovascular rehabilitation and clinical outcomes has not been thoroughly evaluated. Purpose This study aimed to examine whether outpatient cardiovascular rehabilitation is associated with clinical outcomes, including readmission rates and mortality, in patients with AAD. Methods This was a single-centre cohort study. We included the patients admitted to a tertiary hospital for treatment of AAD and who received cardiovascular rehabilitation during hospitalisation. Patient characteristics during hospitalisation included age, sex, body mass index, type of AAD as the Stanford classification, treatment information, and comorbidities. We also reviewed whether or not the patients participated in outpatient cardiovascular rehabilitation after discharge. The primary and secondary endpoints were readmission due to cardiovascular disease and all-cause death, respectively. We compared the differences in patient characteristics between the participation in outpatient rehabilitation. The Kaplan–Meier method with log-rank test and multivariate Cox regression analysis were used to examine the association of outpatient rehabilitation participation with the incidences of readmission and death. Results Among the 323 studied patients, 163 participated in outpatient rehabilitation, and 160 did not in. Participants in outpatient rehabilitation showed rates of higher surgical treatment and lower diabetes mellitus as compared with non-participants. There was a significant association between participation in outpatient rehabilitation and lower readmission rates (log-rank: P = 0.045, Figure 1). However, this association was not observed in all-cause death (log-rank: P = 0.063). After adjusting for patient characteristics as confounders, outpatient rehabilitation was significantly associated with lower readmission rates (adjusted hazard ratio [aHR]: 0.63, 95% confidence interval [CI]: 0.41–0.97) and with a tendency of low all-cause death without statistical significance (aHR: 0.51, 95% CI: 0.23–1.10). Conclusions In patients with AAD, participation in outpatient cardiovascular rehabilitation may be beneficial to reduce readmission rates after hospital discharge. Our findings suggest outpatient cardiovascular rehabilitation is one of the treatment options to improve clinical outcomes in these patients.

Background Readmission rates for patients with heart failure are a major concern for hospitals worldwide. The importance of patient education and a structured care plan to ease the transition from hospital to home has been the focus of many intervention strategies to reduce readmission rates. The use of transitioning of care plans is believed to improve medication reconciliation, communication, patient education, and follow-up. To date, the evidence has not been systematically evaluated to support the effectiveness of a nurse coordinated transitioning of care for patients with heart failure in reducing readmission rates. Objective The objective of the systematic review was to identify the best available evidence on the effectiveness of nurse coordinated transitioning of care between hospital and home on hospital readmission rates for all causes in adult patients hospitalised with heart failure. Search strategy The search strategy aimed to find both published and unpublished studies in the English language from January 1975 through July 2010. A search of MEDLINE, CINAHL, PsycINFO, Healthsource Nursing/academic edition, EMBASE, the Cochrane Library, and the Joanna Briggs Institute Library of Systematic Reviews was conducted followed by a reference search of relevant studies. The initial key words searched were: heart failure, readmission, and transitional care. Inclusion criteria Randomised controlled trials that evaluated the effect of nurse coordinated transitioning of care from hospital to home in adult patients with heart failure on readmission rates were selected. The outcome was defined as hospital readmissions for all causes following an initial admission for heart failure. Data collection and analysis Studies selected for retrieval were critically evaluated by two independent reviewers for methodological validity using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted and analysed using the JBI-MAStARI program. Results A total of 16 randomised controlled studies were included. Ten of the 16 studies included in the review show that a nurse led transitioning of care intervention can reduce the rate of readmission for patients with heart failure. Interventions utilising home visits, or home visits coupled with telephone follow-up, show a more favourable reduction in readmission rates. Conclusions Reduced readmissions occur when transitioning of care interventions are carried out by a heart failure trained nurse who conducts at least one home visit and follows the patient at least weekly for a minimum of 30 days post discharge with either additional home visits or telephone contact. Implications for practice This review supports the development of a nurse coordinated transitioning of care plan which will require improvements in communication, in addition to changes in health policy and payment systems that align incentives and performance measures in caring for patients with heart failure. Implications for research Future research should evaluate the effect of the intensity and duration of the transitioning of care intervention on readmission rates in a large randomised control trial on an adult population with heart failure to determine the ideal frequency and duration of the post discharge interventions.

Although many hospital readmission reduction initiatives have been introduced globally, health care systems ultimately aim to improve patients' health and well-being. We examined whether the hospitals that report greater success in reducing readmissions also see greater improvements in patient-reported outcomes. We examined hospital groups (Trusts) that provided hip replacement or knee replacement surgery in England between April 2010 and February 2013. For each Trust, we calculated risk-adjusted 30-day readmission rates from administrative datasets. We also obtained changes in patient-reported health between presurgical assessment and 6-month follow-up, using general health EuroQuol five dimensions questionaire (EQ-5D) and EuroQuol visual analogue scales (EQ-VAS) and procedure-specific (Oxford Hip and Knee Scores) measures. Panel models were used to assess whether changes over time in risk-adjusted readmission rates were associated with changes over time in risk-adjusted health gains. Each percentage point reduction in the risk-adjusted readmission rate for hip replacement was associated with an additional health gain of 0.004 for EQ-5D [95% confidence interval (CI), 0.002-0.006], 0.39 for EQ-VAS (95% CI, 0.26-0.52), and 0.32 for Oxford Hip Score (95% CI, 0.15-0.27). Corresponding figures for knee replacement were 0.003 for EQ-5D (95% CI, 0.001-0.004), 0.21 for EQ-VAS (95% CI, 0.12-0.30), and 0.14 in the Oxford Knee Score (95% CI, 0.09-0.20). Reductions in readmission rates were associated with modest improvements in patients' sense of their health and well-being at the hospital group level. In particular, fears that efforts to reduce readmission rates have had unintended consequences for patients appear to be unfounded.

Hospitals participating in the Medicare Shared Savings Program (MSSP) share with the Centers for Medicare and Medicaid Services (CMS) the savings generated by reduced cost of care. Our aim was to determine whether MSSP is associated with changes in readmissions and mortality for Medicare patients hospitalized with ischemic stroke, and whether MSSP has a different impact on safety net hospitals (SNHs) compared to non-SNHs. This study was based on the CMS Hospital Compare data for risk-standardized 30-day readmission and mortality rates for Medicare patients hospitalized with ischemic strokes between 2010 and 2017. With a propensity score-matched sample, hospital-level difference-in-difference analysis was used to determine whether MSSP was associated with changes in hospital readmission and mortality as well as to examine the impact of MSSP on SNHs compared to non-SNHs. MSSP-participating hospitals had slightly greater reductions in readmission rates compared to matched nonparticipating hospitals (difference, 0.25 percentage points; 95% confidence interval [CI], -0.42 to -0.08). Mortality rates decreased among all hospitals, but mortality reduction was not significantly different between MSSP-participating hospitals and matched hospitals (difference, 0.06 percentage points; 95% CI, -0.28 to 0.17). Prior to MSSP, readmission rates in SNHs were higher compared to non-SNHs, but MSSP did not have significantly different impact on hospital readmission and mortality rates for SNHs and non-SNHs. MSSP led to slightly fewer readmissions without increases in mortality for Medicare patients hospitalized with ischemic stroke. Similar reductions in readmission rates were observed in SNHs and non-SNHs participating in MSSP, indicating persistent gaps between SNHs and non-SNHs.