Abstract 16357: Standardization of Care Transitions Including Early Cardiology Consultation in the Emergency Department is Associated With Reduced Risk for Readmission in Patients Hospitalized With Acute Decompensated Heart Failure
Background: Hospitalization for Acute Decompensated Heart Failure (ADHF) carries a high rate of All-Cause Readmission (ACR). While isolated interventions may reduce HF-related readmission, methods to reduce ACR remain elusive and are rarely cost-efficient. We hypothesized that support of two critical transitions of care, Hospital to Home and Home to Emergency Department, could reduce ACR and cost of care.
Methods: Patients admitted in 2015 with a diagnosis of ADHF received standardization of care transitions including a scripted phone call by a nurse within 3 days of discharge, a Cardiology appointment within 7 days, and a PCP appointment within 14 days. Patients at high risk for readmission also received weekly phone calls for 30 days and a second Cardiology appointment. If a patient returned to the ED, the ED team notified the on-call cardiologist familiar with each patient who provided immediate recommendations. Unplanned 30-day ACR in the intervention group was compared with risk-matched historical controls treated on the same floors the prior year who received usual care. HF symptoms were quantified using the Minnesota Living with HF Questionnaire (MLHFQ) at the time of discharge and 30 days post-discharge. Healthcare cost was calculated by query of our center’s billing data and marginal cost was calculated using Time-Driven Activity-Based Costing.
Results: 391 patients received the intervention compared with 391 risk-matched historical controls from 2014. Groups were similar in age, sex, race, LVEF, and NYHA class. Patients who received the intervention had significantly lower risk of 30-day ACR (15.1% vs. 23.8%, RRR=37%, p<0.01) as well as ED visits. This effect persisted through 90 days post-discharge. MLHFQ scores were similar in both groups at the time of discharge and 30 days afterward with both groups experiencing a non-significant improvement in HF-related symptoms. Total healthcare expenditure was 40% lower in patients receiving the intervention compared with controls after factoring in the cost of the intervention (p<0.01).
Conclusion: Standardization of two critical transitions of care including early cardiology consultation in the ED reduces ACR in a cost-efficient manner. Further study is needed to assess longer-term outcomes.
Author Disclosures: C.E. Tabit: None. M.J. Coplan: None. C.F. Alcain: None. T. Spiegel: None. J.K. Liao: None. K.T. Spencer: None. R.M. Sanghani: None.
- © 2016 by American Heart Association, Inc.