Document Type

Article

Publication Date

3-20-2020

Abstract

Background:

The CDC reports 6.5 million adults in the US have Heart failure (HF) with yearly costs topping 30 billion. HF patients admitted to Valley Baptist (VB) are readmitted 26% of the time, which is close to the national average of 23% [1]. Standard of care for HF patients is remote nursing care for 30 days from discharge. A hospitalization for any reason within 30 days is considered a “readmission”. On October 1, 2019 at VB remote nursing care changed from weekly house visits to weekly phone calls. The aim of the study is to evaluate the effectiveness of this policy change on readmission rates.

Methods:

We performed a retrospective chart review using all patients admitted with HF from August 1, 2019 to January 31, 2020 at VB. A final sample of 170 patients was collected. Variables considered for the study were readmission, time to readmission (days), age (yrs), length of stay (LOS), in hospital education and follow up care (FU). Descriptive statistics [mean (SD) and n (%)] were created overall and stratified by readmission. Binary logistic regression was used to assess the association with readmission and time to admission. Final adjusted ORs are reported to explore how FU care is associated with readmission.

Results:

The average age of patients was 68.8 (yrs) with the mean LOS 5.5 days. During hospital stay, 54.1% (92/170) of all patients received education; 29.3 % (27/92) of them received it through a skilled nurse in the Progressive Coronary Care Unit (PCCU) while 70.7% received it from the primary nurse. Readmission rates were 31.7 % before nursing care changed from weekly house visits to weekly phone calls and 19.3% afterwards (p = 0.0633). There was no evidence FU Care produces a disparity in readmission rates after adjustment (in-home visits vs phone calls) OR = 1.75 (95% CI 0.84 – 3.66, p = 0.1363).

Conclusions:

Our study supports the change in FU care produced no disparity in readmission rates, which may result in lower costs to FU care with new policy. In-home visits were more prevalent with readmissions than phone calls; As a limitation for our analysis, we were unable to determine if CHF severity determined what patients received hospital education from skilled nursing staff which could have introduced selection bias.

1. Khera, R., et al., Evaluation of 30-day hospital readmission and mortality rates using regression-discontinuity framework. Journal of the American College of Cardiology, 2019. 74(2): p. 219-234.

Academic Level

resident

Mentor/PI Department

Internal Medicine

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