Transitional care programs reduce HF rehospitalization rate
MedWire News: Transitional care programs reduce the 30-day readmission rate for patients with heart failure (HF), say US researchers.
But payment reforms need to be made before this intervention is financially sustainable in hospitals, note Brett Stauffer (Baylor Health Care System, Dallas, Texas) and colleagues in the Archives of Internal Medicine.
The prospective study examined the effects of an advanced practice nurse-led program on 56 patients with HF, aged 65 years or older, who were discharged from Baylor Medical Center Garland (BMCG) from August 2009 through April 2010.
The 30-day all-cause readmission rate, length of stay, and 60-day direct cost for BMCG from admission was calculated for all patients, and compared with the same outcomes in 84 patients from other hospitals within the Baylor Health Care System who were not enrolled in the program.
The transitional care program was led by advanced practice nurses who educated patients and their families about symptom management, improved patient-healthcare provider communication, and maximized patient adherence to treatment plans.
The results revealed that the program significantly reduced 30-day readmission rates to BMCG by 48%, a greater reduction than was seen at other facilities within the Baylor Health Care System (11.0-42.9%).
However, it had little effect on the length of stay and mean total 60-day direct cost for BMCG.
In a budget impact analysis using the current payment system, the transitional care program reduced the hospital financial contribution margin by an average of US$ 227 (€ 158) for each Medicare patient with HF.
However, editorialist Mitchell Katz (Los Angeles County Department of Health Services, California, USA) calculated that under current reimbursement formulas, the hospital actually lost an average of US$ 751 (€ 522) in revenue for each program participant.
"Global payments with quality incentives are needed to improve America's healthcare system and reduce its cost," he wrote.
Nonetheless, he concluded: "It is comforting to read about successful real-world translations of interventions shown to be effective in reducing hospitalizations."
By Piriya Mahendra