Clinical question: What steps can hospitals take to reduce readmission rates in patients with heart failure?
Background: Evidence about various hospital strategies to decrease readmissions in patients with heart failure is limited.
Study Design: Cross-sectional study using a web-based survey.
Setting: Survey of 599 hospitals participating in quality initiatives to reduce readmissions.
Synopsis: Readmission of patients with heart failure is common and costly. Hospitals with high readmissions can lose up to 3% of their Medicare reimbursements by 2015.
This study found six strategies associated with lower risk-standardized 30-day readmission rates.
- Partnering with community physicians and physician groups (0.33%; P=0.017);
- Partnering with local hospitals (0.34%; P=0.020);
- Having nurses responsible for medication reconciliation (0.18%; P=0.002);
- Arranging follow-up visit before discharge (0.19%; P=0.037);
- Having a process in place to send all discharge summaries directly to the patient’s primary care physician (0.21%; P=0.004); and
- Assigning staff to follow up on test results after the patient is discharged (0.26%; P=0.049).
Individually, the magnitude of the effects was modest, but implementing multiple strategies was more beneficial (0.34% additional benefit for each additional strategy). Only 7% of the hospitals surveyed implemented all six strategies, highlighting substantial opportunities for improvement.
Bottom line: Implementing multiple strategies may help reduce readmission in patients with heart failure.
Citation: Bradley EH, Curry L, Horwitz LI, et al. Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circ Cardiovasc Qual Outcomes. 2013;6:444-450.