Study: EMR-based risk stratification can reduce heart failure readmissions

A care transition intervention that directed largely existing resources to a smaller subgroup of patients with heart failure based on daily EMR-based risk stratification resulted in a reduction in overall readmissions, according to a study published in British Medical Journal Quality & Safety.

Researchers conducted a controlled before and after study of 1,747 adult inpatients admitted with heart failure, acute myocardial infarction and pneumonia between December 2008 and December 2010 at Parkland Memorial Hospital in Dallas, Texas.

An EMR-based software platform stratified all patients admitted with heart failure on a daily basis by their 30-day readmission risk using a published electronic predictive model. The EMR-enabled model extracted in real time 29 clinical, social, behavioral and utilization factors within 24 hours of admission for heart failure.

Patients identified as high risk received evidence-based interventions, including:

• A detailed inpatient clinical assessment, patient education and discharge planning starting early in the hospital course;
• A follow-up telephone call from a nurse within 48 hours of discharge to confirm medications and follow-up appointments;
• Outpatient case management for 30 days;
• A cardiology appointment with a heart failure specialist within seven days of discharge and subsequent cardiology follow-up for at least one month; and
• A primary care appointment scheduled according to the urgency of non-cardiac problems.

Study investigators found that the hospital was able to produce a 26 percent relative reduction in the odds of readmission and an absolute reduction of 5.0 readmissions per 100 index heart failure admissions, according to the report.

"This project was able to achieve the 'holy grail' of readmission reduction strategies. It reduced the population-based rate of readmission and saved the hospital thousands by redeploying limited, existing resources to the 25 percent of the patients at highest risk. It was so successful that what started as a research project is now part of the way the hospital does business," Ethan Halm, MD, MPH, senior author on the paper and chief of general internal medicine at University of Texas Southwestern, said in a statement on the findings.