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Tackling Heart Failure Readmissions

Tackling Heart Failure Readmissions

According to recent estimates, heart failure (HF) currently affects about 6 million adults in the United States, and the prevalence is projected to increase 25% by 2030. When HF patients are hospitalized, it represents a turning point in the natural history of their disease. “About 25% of HF patients who are discharged from the hospital are readmitted within 30 days,” says Clyde W. Yancy, MD, MSc, FACC. HF patients often need to be readmitted because the underlying cause of HF worsens. Hospitalizations are responsible for the majority of the nearly $40 billion that is spent annually for HF care in the U.S. As a result, these hospitalizations have become a focal point for quality improvement efforts and initiatives aimed at reducing costs. In an effort to improve outcomes, CMS has mandated that hospitals report their 30-day readmission rates for HF and acute myocardial infarction (AMI). The problem with this approach, according to Dr. Yancy, is that public reporting of outcomes is not effective as a hospital performance indicator. “Readmission rates, particularly for HF, are not a good marker of quality of care,” he says. “The emphasis on 30-day readmissions is misguided because the primary driver of these events is often patient population and the community that is served by hospitals.” Clinical investigations have also suggested that public reporting does not provide effective incentives for improvement and has had only minor effects on outcomes. Widespread Concern The changing paradigm to deny payment for HF readmissions within 30 days of discharge has led to widespread concern across hospitals. “Implementing HF programs and readmission reduction strategies are undertakings that require significant analysis,...
A Look at Recidivism in COPD Management

A Look at Recidivism in COPD Management

COPD is a group of progressively debilitating respiratory conditions, including emphysema and chronic bronchitis, and it ranks as the third leading cause of death in the United States, according to the CDC. About 16 million Americans are currently diagnosed with COPD, but another 14 million or more remain undiagnosed. In addition, COPD accounts for nearly 2 million ED visits each year, but much of this data is confounded by asthma admissions. “COPD patients who require ED attention or hospitalization are those with the most severe disease,” explains Reynold A. Panettieri, Jr., MD. “Furthermore, hospitalization and ED visits for COPD are more often clustered in the winter. They are associated with exposure to viruses and bacterial pathogens.” People aged 50 and older are more likely than others to get COPD, but the damage starts years before these individuals are diagnosed and can progress even after smoking cessation. Since the disease occurs and is diagnosed later in life, the risk of COPD is especially high for patients older than 45 with a smoking history. Healthcare Utilization & Readmission for COPD Most patients with diagnosed COPD report that symptoms of their disease impair their quality of life, but only about half take at least one daily medication for COPD. The healthcare utilization rate for COPD patients is also substantial. About one in five COPD patients visits an ED or is admitted to a hospital for care within a year. “The bottom line is that patients, providers, and the healthcare system cannot afford recidivism for COPD hospitalization.” Recidivism in healthcare has been defined as the tendency by ill patients to relapse or return...
Predicting Avoidable 30-Day Readmissions

Predicting Avoidable 30-Day Readmissions

Throughout the United States, readmission rates are increasingly being used for benchmarking across hospitals. Some hospital readmissions may be avoidable, which in turn has led to the levying of financial penalties on hospitals with high risk-adjusted rates. Recent studies have estimated that the 30-day readmission rate for Medicare beneficiaries is almost 20%, and these occurrences cost the U.S. healthcare system as much as $17 billion annually. Several prediction scores have been developed, but few accurately and efficiently predict 30-day readmission risk in general medical patients, explains Jacques Donzé, MD, MSc. “The models that are currently available often do not distinguish between avoidable and unavoidable readmissions, have poor discriminatory power, or use complex scores that aren’t calculable before hospital discharge. Interventions to reduce readmissions are often expensive to implement. To improve efficiency, the highest intensity interventions should be targeted to patients who are most likely to benefit.” A New Prediction Model for 30-Day Readmission In JAMA Internal Medicine, Dr. Donzé and colleagues had a study published that derived and validated a prediction model for potentially avoidable 30-day hospital readmissions in medical patients. The model used administrative and clinical data that was readily available prior to discharge. “Our purpose was to help clinicians target transitional care interventions most efficiently,” Dr. Donzé says. “The goal was to develop a score to predict potentially avoidable readmissions. In other words, we wanted to predict which patients may be most likely to benefit from intensive interventions.” The HOSPITAL score is able to indicate readmission risk before a patient is discharged. This allows clinicians to target a timely transitional care intervention. In their retrospective analysis, Dr....

Avoiding Readmission After CABG

Researchers from New York suggest that readmissions after CABG may be reduced through careful postoperative surveillance for risk factors and frequent causes of readmission. The study team found that cardiac and pulmonary complications, including pleural effusions, were frequent reasons for readmission. Abnormal discharge serum creatinine was also associated with increased readmission rates. Abstract: Journal of the American College of Surgeons, March...

Hospital Nursing & 30-Day Readmissions

Improvements in nurses’ work environments and staffing may help prevent readmissions for patients with heart failure, acute myocardial infarction, and pneumonia. A study found that each additional patient per nurse was associated with 7% to 9% higher odds of readmission. Good work environments were associated with 6% to 10% lower odds of readmission. Abstract: Medical Care, January...
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