This post was authored by William J Oetgen, MD, MBA, FACC, ACC's senior vice president of Science and Quality.

The Hospital to Home (H2H) initiative was launched in 2009 as a joint effort of the ACC and the Institute for Healthcare Improvement. Three years later, the goal of H2H continues to be a 20 percent reduction of hospital readmissions within 30 days for patients admitted with either acute myocardial infarction or heart failure. Three important activities that address core concepts have been identified as targets for improvement:

1. Medication Management Post-Discharge: Is the patient familiar and competent with his or her medications and is there access to them?
2. Early Follow-Up: Does the patient have a follow up visit scheduled within a week of discharge and is she or he able to get there?
3. Symptom Management: Does the patient fully comprehend the signs and symptoms that require medical attention and whom to contact if they occur?

In addition, H2H strives to create a learning community that shares expertise, experience and tools – and works together to improve the transition from hospital to home. The H2H community was developed to address these “challenges.” And, in a remarkable example of collegiality and cooperation, H2H members are collaborating and sharing information to help each other.

Over the past few years since H2H was established, individual and hospital participation in H2H has steadily increased. Currently, 2,294 individuals and 1,326 hospitals (39 percent of all U.S. hospitals) have united around the shared goal of lowering the risk of readmission.

Members of H2H have engaged in lively discussions of challenges and success strategies on the H2H listserv and on webinars designed to share experiences and best practices. We are continuously seeking ways to encourage participation and easier ways to access the tools and resources of the community.

During an ACC.12 session in Chicago, a panel of experts convened to discuss and identify tools and ideas to reduce hospital readmissions including a neighborhood watch solution that enlists trained volunteers from nearby universities to educate patients and make follow-up phone calls. We had several great ideas presented and the discussions underscored how the best way we can find the answer is by working together.

Reducing readmission rates is not straightforward and each institution must tailor its strategy to its particular setting and resources. Research in this area is still evolving, but with available knowledge it is now possible to make progress. In order to be successful and reach our goal, we must continue to learn from what we do – and from each other.

For more information on H2H visit www.H2Hquality.org.

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