Communication, Patient Navigator Resources May Lead to Lower AMI, HF Readmissions; Process Improvements

Hospitals participating in ACC's Patient Navigator Program: Focus MI that implement team communication methods and use Patient Navigator resources may be more likely to improve care processes and have lower readmission rates for patients with acute myocardial infarction (AMI) and heart failure (HF), according to two abstracts presented April 6 at the 2019 Quality of Care and Outcomes Research Scientific Sessions in Arlington, VA.

For the first abstract, Nancy M. Albert, PhD, RN, et al., completed surveys of 35 hospitals that participated in Patient Navigator to assess whether five types of communication – sharing meeting minutes, regular team meetings, conference calls with team leaders, a shared checklist, and communication via electronic health records (EHRs) – supported Patient Navigator implementation. The researchers looked at associations between each communication type and 30-day unadjusted readmission for AMI and HF; in-hospital risk-adjusted mortality for AMI; and 14 care processes.

According to the results, EHR-directed communication was associated with a greater likelihood of discharge medication reconciliation (100 percent vs. 68.4 percent) and prescribed medication documentation (100 percent vs. 66.7 percent). In addition, hospitals that used at least two communication types were more likely to identify HF patients before discharge, perform discharge medication reconciliation, and document patient education and medication instruction. The researchers concluded that EHR-directed communication and the use of at least two communication methods could lead to process improvements.

For the second abstract, Albert et al., looked at the survey results from the 35 hospitals that participated in Patient Navigator to assess hospital structure, system and process changes; number of site-initiated technologies; and the perceived value of Patient Navigator features, such as webinars, data reports and quality-focused site visits. The researchers analyzed associations between these factors and 30-day unadjusted readmission for AMI and HF patients, risk-adjusted in-hospital AMI mortality, and 14 process metrics.

The results show that hospitals with higher rates of structure, system and process changes were more likely to reduce 30-day HF readmissions (p=0.014). Sites that valued Patient Navigator calls and webinars were more likely to improve documentation of self-care education for AMI and HF patients (p=0.049). A higher value on quality-related site visits was associated with improved 30-day unadjusted readmissions for AMI patients (p=0.021) and HF patients (p=0.007). In addition, sites that highly valued Patient Navigator data reports were more likely to have improved 30-day readmission rates (p=0.033). The researchers concluded that hospitals that implemented changes in structure, systems and process and valued Patient Navigator resources were more likely to improve 30-day HF readmission rates and implement process improvements after two years.

Keywords: Patient Readmission, Quality Improvement, Patient Navigation, Patient Discharge, Hospital Mortality, Electronic Health Records, Heart Failure, Myocardial Infarction, Registries, Chest Pain, Documentation, National Cardiovascular Data Registries, Chest Pain MI Registry

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