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Change in Readmissions and Follow-up Visits as Part of a Heart Failure Readmission Quality Improvement Initiative
Study Questions:
What is the impact of a quality improvement initiative that included mandatory 7-day follow-up visits in reducing 30-day readmission rates in patients discharged with a primary diagnosis of heart failure at the index hospitalization?
Methods:
This was a single-center, retrospective chart review of all heart failure discharges at the University of Connecticut before (2008) and after (2011) implementation of a quality improvement initiative. Eligible patients were discharged with a primary diagnosis of heart failure during the pre-initiative or post-initiative period. The initiative included pre-discharge education, timely follow-up visits, and coordination of services with community providers. It was mandatory for patients to have a scheduled visit within 7 days of discharge. The authors examined change in 30-day readmission rate after the initiative, frequency of 7-day follow-up visits in the University of Connecticut system (i.e., the authors could not determine follow-up visits with outside providers), and events at follow-up visits.
Results:
In a sample of 398 patients, the 30-day readmission rate decreased from 27.5% in 2008 to 19.1% in 2011, after implementation of the quality improvement initiative (p = 0.024). More than one half of the patients had follow-up with a cardiologist. The frequency of follow-up visits increased from 19.6% in 2008 to 46.9% in 2011 (p < 0.01). Interestingly, only 13% of patients had no discrepancy between the discharge and follow-up medication lists.
Conclusions:
A single-center quality improvement initiative, in which 7-day follow-up visits following a hospitalization for heart failure were mandatory, led to a decrease in 30-day readmission rates and an expected increase in 7-day follow-up visits. Often there were discrepancies between the discharge and follow-up medication lists.
Perspective:
The major limitations of this retrospective chart review aside, the authors presented promising results of a quality improvement initiative for patients discharged with heart failure. Although 7-day follow-up visits were mandatory following discharge and expectedly increased following implementation of this initiative, the study does not allow a determination of which component of the quality improvement initiative actually led to a decrease in readmission rates. Follow-up visits were one part of the three-pronged quality improvement initiative implemented in this study. Future research should continue to clarify initiatives and techniques that successfully reduce readmission rates and improve quality of care for patients with heart failure.
Keywords: Patient Readmission, Heart Failure
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