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Hospital Collaboration and Heart Failure Outcomes
Study Questions:
What is the impact of an interhospital collaborative approach on 7-day post-discharge follow-up (7dFU) rates, and does it reduce 30-day readmissions in heart failure (HF) patients?
Methods:
The study authors conducted observational analyses of Medicare HF patients discharged from 10 collaborating Southeast Michigan hospitals (CH) participating in the “See You in 7 Collaborative.” They compared pre-intervention (May 1, 2011 to April 30, 2012) and intervention (May 1, 2012 to April 30, 2013) 7dFU rates, unadjusted 30-day readmissions, risk standardized 30-day readmissions (RSRR), and Medicare payments in CH and Michigan nonparticipating hospitals (NPH). A 7dFU visit was defined as claims identified for any physician outpatient visit within 7 days of discharge for HF patients regardless of provider type.
Results:
The authors found that 7dFU rates increased, but remained low in both groups (CH: 31.1% to 34.4%; p < 0.001; NPH: 30.2% to 32.6%; p <0.001). During the intervention period, unadjusted readmissions decreased significantly in both groups (CH: 29.0% to 27.3%; p < 0.001; NPH: 26.4% to 25.8%, p = 0.004); mean RSRR decreased more in CH than in NPH (CH: 31.1% to 28.5%; p < 0.001; NPH: 26.7% to 26.1%, p = 0.02; p = 0.015 for intergroup comparisons). Unadjusted 30-day readmission rates for patients with 7dFU were significantly higher than those who did not attend 7dFU appointments. They found that the findings were similar when CH outcomes were matched 1:1 with similar NPH outcomes. Total Medicare payments for acute HF care and post-discharge outpatient care decreased substantially between the pre-intervention and intervention periods at the 10 CH, with overall reduction of $4.5 million ($451,000 per hospital). In the much larger group of 82 NPH, Medicare payments decreased $5.8 million ($70,000 per hospital) over the same time period. Combined Medicare payments for inpatient and 30 days of post-discharge care decreased by $182 in CH and by $63 in NPH (per eligible HF discharge).
Conclusions:
The authors concluded that regional hospital collaboration to share best practices could potentially reduce HF readmissions and associated costs.
Perspective:
This is an important study because it suggests that early follow-up of HF patients is associated with decrease in 30-day readmission rates. As the national burden of HF continues to increase, such collaborative efforts should significantly reduce readmission rates and reduce costs. Further studies are needed to determine the impact of collaborative studies on the overall outcome in HF.
Keywords: Ambulatory Care, Heart Failure, Medicare, Geriatrics, Patient Discharge, Patient Readmission
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