What Strategies Reduce Readmission Rates for HF?

"The study shows the important results are out, linking actions by the hospitals with the outcome," said Harlan Krumholz, MD, FACC.

Combining several strategies is the key to lower risk-standardized 30-day readmission rates (RSRRs) for patients with heart failure (HF), according to new research published July 16 in Circulation: Cardiovascular Quality and Outcomes.  These findings underscore the importance of collaboration in tackling this crucial issue as health care professionals across the country are continuously working to reduce readmissions.

The study looked at survey data from 585 hospitals participating in either the ACC's Hospital to Home (H2H) national quality initiative  or the State Action on Avoidable Rehospitalizations Initiative. Approximately 30 hospital strategies were evaluated and organized into three categories: 1) quality improvement efforts and performance monitoring; 2) medication management; and 3) discharge and follow-up procedure. Results showed that the two most effective strategies for reducing RSRRs are partnering with local hospitals, which resulted in a 0.34 percent readmissions reduction (P=0.020), and partnering with community physicians or physician groups, which saw a 0.33 percent reduction (P=0.017). Other strategies that topped the list include 1) having staff follow up on test results that return post-discharge (0.26 percent reduction; P=0.049); 2) ensuring discharge papers or electronic summaries are sent directly to the patient's primary physician (0.21 percent reduction; P=0.004); 3) setting a follow-up appointment pre-discharge (0.19 percent reduction; P=0.037); and 4) having nurses take the lead on medication reconciliation (0.18 percent reduction; P=0.002).


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The authors note that their results show that "given the prevalence of HF, even relatively modest effects could improve transitions in care for >850,000 patients per year…" While the top six successful approaches reduced readmissions by less than one percentage point each, combining efforts resulted in significant reductions in RSRRs. "Our findings highlight the importance of the full system of care and underscore the potential value of greater coordination between hospital and other providers for addressing readmissions," they add.

Moving forward, future research "may need to use more mixed methods techniques, with qualitative studies of hospital organizations, to understand which complex interventions are influential and in which settings they are most effective," the authors add.

Meanwhile, a recently published study in the Medicare & Medicaid Research Review reported that national hospital readmission rates for Medicare fee-for-service beneficiaries significantly declined in 2012, nearly 20 percent of Medicare beneficiaries still return to the hospital within 30 days of discharge, resulting in a price tag of more than $15 billion per year. To address this growing issue, the Patient Protection and Affordable Care Act of 2010 initiated penalties for poor performing hospitals and Medicare reimbursement cuts are set to top off at 3 percent by 2015. As health care begins to shift from a quantitative to a qualitative system focused on improving quality and patient outcomes while achieving cost savings, readmissions are sure to remain a national priority.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Cooperative Behavior, Follow-Up Studies, Fee-for-Service Plans, Medicaid, Cost Savings, Patient Protection and Affordable Care Act, Patient Discharge, Prevalence, Quality Improvement, Patient Readmission, Heart Failure, Medication Reconciliation, Medicare, United States

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