Feature: Putting practices in place to curb HF readmissions

Despite recent efforts to reduce readmission rates in the U.S., results from a report by the Dartmouth Atlas Project showed a large regional variation in 30-day readmission rates, particularly for Medicare beneficiaries post-acute care. The average readmission rate in the U.S. currently stand at 16.1 percent, which shows that more needs to be done to close gaps in care. To help get a handle on readmissions, providers from Spectrum Health have developed cardiac care solutions for patients to try and reduce heart failure readmissions.

“Readmissions are a failure of the system and anything that we can do to stop them from happening will be helpful," Michael G. Dickinson, MD, director of advanced heart failure, ventricular assist device and heart transplant at Spectrum Health Frederik Meijer Heart & Vascular Institute in Grand Rapids, Mich., said in an interview.

Dickinson and colleagues developed and integrated the Ladder H20 project at Spectrum, which looks at the best transitions of care after patients leave the hospital. The staff at Spectrum set follow-up appointments within two to five days for all heart failure patients after a hospital discharge.

“With this program, we have the intent to make sure all of our heart failure patients are still stable,” Dickinson offered. At follow-up, staff answer patients' questions and ensure that patients’ prescriptions are properly refilled. Dickinson said that the program is cost-neutral because reimbursement is given to the hospital for seeing patients back in the office.

Additionally, Spectrum is using telehealth methods to try to reduce readmissions. The use of home health monitors are useful for high-risk patients who have limited resources and may not be able to get back to the hospital or doctor's office.

Spectrum also aimed to curb readmissions by developing a heart failure education class for patients recently discharged from the hospital. “Previous data have suggested that patients in the hospital retain less than 30 percent of the information relayed to them during a hospital admission,” Dickinson said. Therefore, the HF education class helps to educate patients on their medications, proper diet and proper care after being discharged for a heart failure admission.

Lastly, he said that Spectrum has integrated an HF observation unit in the hospital. “Some patients who are readmitted to the hospital within 30 days [in those cases] have just stumbled, not fallen. We can avoid readmission within 30 days,” Dickinson noted. 

Rather than readmitting a heart failure patient to the hospital, he or she will be put in the observational unit to be monitored. The cardiology-specific unit in the rehab setting is dedicated to the care of patients with the intent to stop a possible readmission.

“These types of programs must be done as a partnership between the physician group and the hospital,” Dickinson noted. “If one tries to drive it without the other it will not work because physician groups do not have the resources."

Tracking readmissions data is imperative, Dickinson concluded, because it enables the hospital to understand trends and patient populations where readmissions are increased.