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Transitional Care Interventions to Prevent HF Readmissions

Transitional Care Interventions to Prevent HF Readmissions

According to published research, heart failure (HF) is a leading cause of hospitalization and healthcare costs in the United States. Current estimates show that up to 25% of patients hospitalized with HF are readmitted within 30 days. Early hospital readmissions following an initial hospitalization for HF are related to a variety of conditions. About one-third can be attributed to HF, whereas the rest are related to other conditions, such as renal disorders, pneumonia, and arrhythmias. In an effort to reduce readmission rates for HF, CMS began decreasing reimbursements to hospitals with excessive risk-standardized readmissions in 2012. With this policy in place, hospitals have been incentivized to develop programs to reduce HF readmission rates. “Although significant advances have occurred with regard to the quality of how acute and chronic HF are managed, hospital readmissions in this population continue to be a problem,” says Cynthia Feltner, MD, MPH. She adds that there is uncertainty about the effectiveness of interventions to support the transition of care for people with HF. Transitional care interventions are designed to prevent readmissions among patients transitioning from one care setting to another. Several models have been created, with the goal of avoiding poor outcomes caused by uncoordinated care. “These interventions focus on patient or caregiver education, medication reconciliation, and coordination among healthcare professionals involved in the transition,” Dr. Feltner says. A Systematic Review In a systematic review published in Annals of Internal Medicine, Dr. Feltner and colleagues examined transitional care interventions for people with HF as part of AHRQ’s Effective Health Care Program. The authors reviewed a broad range of intervention types that aimed to prevent readmissions...
Depression, Clinical Inertia, & Uncontrolled Hypertension

Depression, Clinical Inertia, & Uncontrolled Hypertension

Depression has been identified as a risk factor for a poor prognosis among patients with cardiovascular disease. Few studies, however, have investigated the association between depression and clinical inertia, which has been defined as the lack of intensifying treatment for those who are not meeting evidence-based goals for care. In addition, data are lacking as to whether a diagnosis of depression is connected to clinical inertia in patients with uncontrolled hypertension. Examining the Connection To address this research gap, Ian M. Kronish, MD, MPH, and colleagues had a study published in JAMA Internal Medicine that examined data from 158 older adults with uncontrolled hypertension. The study patients also had blood pressures (BPs) that were above goal, defined as at least 140/90 mm Hg for most patients or at least 130/80 mm Hg for those with diabetes or chronic kidney disease. Depression was noted in the electronic medical record for 45% of patients in the study. “Among patients with uncontrolled hypertension, those with depression were less likely to have their treatment intensified to achieve BP goals,” says Dr. Kronish. Clinical inertia occurred in 70% of patients with depression and 51% of those without depression, according to results. This difference remained significant even after excluding depressed patients who had at least one documented home or clinic systolic BP reading below goal and after adjusting for patient-reported medication non-adherence. Assessing the Implications “Clinical inertia may be one mechanism by which patients with depression have worse cardiovascular outcomes,” says Dr. Kronish. “That said, there may be cases in which clinical inertia is appropriate. More qualitative studies are needed to explore the reasons why...

Adverse Events in California Hospitals: Look at the Data

According to a Bay Area television station’ s investigative exposé, California hospitals reported 6,282 adverse events to the state over the last 4 fiscal years combined. It sounds like a lot until you realize that there are 410 hospitals in California. That means the average number of adverse events per hospital is only 15.3—fewer than 4 per year. A brief summary of this story appeared on a website called California Healthline. Its lede mentioned the total number and followed it with possibly the understatement of the year “but the number of actual adverse events could be higher.” Ya think? Analyzing data by calculating averages sometimes can be misleading. For example, Stanford Hospital reported a total of 211 adverse events, and the UCSF Medical Center reported 169. That means some hospitals must have reported far fewer than the average number. The NBC article has a handy interactive tool that enables the user to click on the name of any hospital in northern California to see its total number and types of reported adverse events. Use it and note that several hospitals reported only one adverse event over the entire 4-year period. Another interesting statistic is that 3,959 or 63% of the adverse events reported were bedsores. Although bedsores can be serious problems and in most cases preventable, they pale in comparison to death or serious disability associated with the use of restraints or bed rails, operating on the wrong body part, or leaving a foreign body in a patient after surgery. Surgery performed on the wrong body part occurred 140 times. Even one is too many. One California hospital managed...
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