HOSPITAL SISTERS HEALTH SYSTEM
Research has shown congestive heart failure to be the most common reason the elderly are hospitalized, and patients with this condition are at increased risk for rehospitalizations too. The American College of Cardiology estimates that about one in five patients with cardiovascular conditions is readmitted within 30 days of discharge.
Clinicians believe that many of the hospital readmissions could be prevented with better patient education and symptom management. With this in mind, the American College of Cardiology and the Institute for Healthcare Improvement launched Hospital-to-Home, or H2H, a nationwide campaign aimed at improving patient care after discharge. In a new phase of the initiative to be unveiled this year, H2H will focus on the importance of early follow-up care.
Amy Murphy, director of media relations for the American College of Cardiology, says H2H is a framework for quality improvement and a platform for H2H participants to share information and tools. Since its launch in the fall of 2009, H2H has enrolled thousands of participants including individuals, hospitals, office practices, home health agencies and skilled nursing facilities. Participants have a collective goal of cutting readmission rates of Medicare patients discharged with heart failure or following a heart attack by 20 percent by December 2012.
The Prairie Heart Institute at St. John's Hospital in Springfield, Ill., was one of the early H2H sites, and it long has been at the forefront of work to improve the post-discharge quality of life for patients with congestive heart failure and other forms of heart disease, Murphy says.
In its H2H program, Prairie Heart offers congestive heart failure patients as well as patients who have suffered acute myocardial infarctions a consultation with a nurse seven to 14 days after being released from the hospital — usually well before their follow-up visit with the physician.
"Hospital to Home is a transitional, educational clinic designed to help answer patients' questions about medications and dietary changes so they can better manage their disease and avoid readmission to the hospital," explains Claire Call, manager of the Heart Failure Support Clinic at St. John's Hospital.
Readmission rates for congestive heart failure patients average 24.5 percent within 30 days nationwide. (Heart attack patients don't fare much better, with a readmission rate of 19 percent within a month.)
"Our stats at St. John's were 21.2 percent, which we thought were horrendous," says Call, who watched a webinar on H2H pilot projects before launching H2H at Prairie Heart in November, 2009.
The Prairie Heart educational clinic is held each Monday and Thursday for half a day, with two cardiac rehab nurses able to spend an hour one-on-one with each of eight patients and their families or caregivers. They conduct physical exams, monitor food diaries and medications, review symptoms that require calls to physicians, and answer questions about general lifestyle changes.
"It's been an eye-opening experience — there are so many misunderstandings patients have that affect their well-being," says Call. Many patients, for example, know that they are supposed to reduce salt intake but are completely unaware how much salt a hot dog or Chinese meal may contain, she says. Others find it hard to follow doctors' orders for a variety of unanticipated reasons.
"We find we often need to refer patients to social services to help them comply with medical directives. Some are homeless, so we need to help them find shelter and access to medication. Others cannot afford glasses, so they cannot read prescription labels," Call says.
The private counseling offered through H2H already has improved patient health and impacted hospital readmission rates. From January to March of 2010, St. John's readmission rate for congestive heart failure was 13.1 percent — compared to a 22 percent average for large teaching hospitals across the U.S. during the same period.
"We are very encouraged by the results — so much so that the hospital is considering similar patient education programs for populations such as coronary bypass patients and diabetics," says Call. "We hope we can help reform health care at the local level by developing more effective programs like this for our patients."
Strategies: Make sure the patient understands the Rx
Medication management: Is the patient familiar and competent with their medication? Can they fill the prescriptions?
Early follow-up: Does the patient have a follow-up visit scheduled within a week of discharge? Can he or she get there?
Symptom management: Does the patient understand signs that require medical attention? Do they know who to call if such symptoms occur?
Source: American College of Cardiology
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