With only eight weeks before the Centers for Medicare and Medicaid Services (CMS) readmission penalty kicks in, hospitals and health care providers are scrambling to rein in high readmissions rates. A recent roundtable discussion hosted by the New England Healthcare Institute (NEHI) at ACC's Heart House explored the link between improving medication adherence and reducing readmissions. Pharmacists, researchers, providers, payers and other stakeholders came together to tackle these two crucial topics and discuss strategies for improving patient outcomes. 

 

The discussion follows on the tails of a study published in the Journal of the American College of Cardiology (JACC) that found substantial variability in hospital practices to reduce readmissions. The findings of the study suggest opportunities for further education around successful best practices, particularly in the areas of medication adherence and post-discharge management. More than 500 hospitals participating in Hospital to Home (H2H), a quality improvement initiative developed by the ACC and the Institute of Healthcare Improvement, were surveyed in order to gain insight into "key hospital practices." Overall, results of the study indicated that while most hospitals identify reducing readmissions as a key objective, efforts to meet this objective vary strikingly. In addition, efforts to help patients with medication management and discharge and follow-up processes – key elements identified by the H2H initiative as important to readmissions reductions – were particularly lacking. "Given the diversity of efforts to reduce readmission rates, establishing more definitive evidence about the effective hospital practices in this area is warranted," the authors concluded. They also noted that "the findings highlight a number of opportunities for continued improvement in communication and care coordination, which may assist in hospital efforts to reduce readmission rates."

Additional Resources Hospital to Home (H2H) Initiative Study Finds Substantial Variation in Hospital Efforts to Reduce Readmissions (JACC)  Hospital Readmissions and the Impact of Quality of Care (CardioSource WorldNews) CardioSmart Medication Adherence Resources CardioSurve Survey on H2H

During the roundtable discussion, Mary Anne Elma, director of quality innovation and implementation at ACC, built on the findings from this study and delved into additional lessons learned from the H2H initiative. According to Elma, medication adherence progress is stifled by the assumption that there is a magic recipe for success. As the H2H initiative has found, there is no "one size fits all" formula, and the abundance of information on the topic is often overwhelming for providers. The H2H program packages together proven readmissions reduction methods and breaks down the information overload. H2H Community members are challenged to implement simple and targeted strategies for improvement through three Challenge Projects. Elma described how the second challenge, "Mind Your Meds," acts as a "handshake" between patients and providers, addressing medication adherence using simple language and establishing specific goals for both parties.

 

Recent surveys of ACC’s CardioSurve panel and H2H Community members provide additional insight into the current readmissions landscape and how H2H resources are being utilized in hospitals nationwide.

The NEHI event also explored Million Hearts™, another ground-breaking initiative that has brought numerous agencies together around a singular condition. Janet Wright, MD, FACC, emphasized that the initiative's goal of preventing one million heart attacks and strokes by 2017 is not an aspirational goal, but a targeted, achievable goal that is based on predictive models. Wright stressed the importance of providers measuring their way to high performance on the ABCS (appropriate aspirin therapy, blood pressure control, cholesterol management and smoking cessation), centering the entire team around adherence and working in teams to effectively teach and reinforce. CMS, an integral participant in the Million Hearts campaign, has found that total disease-related health care costs decrease as medication adherence increases. With health care costs spiraling out of control, this connection is vital for CMS, the largest purchaser of health care in the world, to explore.

While a variety of improvement strategies were highlighted and various experiences were shared, the link between improved medication adherence and reduced readmissions was clear. With the CMS penalty going into effect in October, the pressure is on and these topics will remain in the spotlight. Stay tuned to The ACC Advocate and CardioSource.org for updates on penalty implementation.

CardioSmart has a comprehensive set of resources available for providers to help patients mind their meds. The new CardioSmart Med Reminder app, powered by Drugs.com, is a free and easy-to-use tool that helps patients take their medications as prescribed. Not only is it a medication and prescription refill reminder, but it also functions as a personal medication record to improve communications between patients and providers. Visit the ACC and CardioSmart Facebook pages for tips and tools to help your patients stay on track this summer. Also, the July/August issue of Cardiology magazine will explore the Script Your Future campaign, H2H at the local level and a readmission risk calculator.

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