Readmission of Heart Failure Patients

Re-Hospitalization and Heart Failure Patients

Heart failure is one of the top health problems in the United States leading to high rates of morbidity and mortality among people aged 60 years and above. The complications associated with health heart failure increases the readmission rates within 30 days of patients’ discharges. In essence, the increase of readmission rate has been associated with high healthcare costs in the United States. Based on the correlation between high rates of readmission and its associated high costs, this paper argues that health education is an effective and essential tool that can reduce the rate of readmission. Techniques to carry out health education includes: pre-discharge planning, home visits, telephone calls, and tele-health to enhance a greater understanding of patients awareness, and how the implementation of strategies and effective self-care management can help their well-being.

PART 1

Clinical Question

Can health education reduce the readmission rates within 30 day for patients over the age of 60 years suffering from heart failure?

Background Information

As a nursing professional working in a long-term rehabilitation facility, I have been confronted with many challenges, but one of my core concerns is the need to reduce re-hospitalization of adult patients who are over 60 years of age with who are experiencing the markers for heart failure. My experience to date has revealed that, patients above 60 years suffering from heart failure are being re-hospitalized less than 30 days of discharge. This high rate of readmission for the identified group, have driven me to research and develop this paper based on evidence-based strategies to further understand and help reduce the rates of re-hospitalization among patients with heart failures.

Base on all the literature, heart failure is one of the major health problems in the United States, and more than 5.1 million people are suffering from heart failure. Based on a report by the Centers for Disease Prevention and Control (CDC) [2014], in 2010, approximately 7 million Americans were suffering from heart failure, and by 2030, an additional three million people are likely to suffer from chronic heart failure. Typically, heart failure happens when the heart is unable to pump sufficient oxygen and blood to support other organs of the body. Moreover, heart failure contributes to one out of 9 deaths in the United States. Additionally, the costs of heart failure increase the health budget in the U.S. by approximately $32 billion annually. The total costs of medications, and health services to treat heart failure and missed work days (CDC, 2014).

Literature Search Strategy

The purpose for this study is to review the clinical issues related to increase readmission rates with patients suffering with heart failure and implement effective health education to reduce readmission rates. The search strategy will include: MEDLINE, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, AHRQ, AHA, journal peer review articles. The study will also examine other databases on internet cohort studies between 1990 and 2014. The essential content for the literature search include: cause of readmission, cause of heart failure and influence of health education on readmission rate.

The conceptual framework, yet to be established, will provide the structure and content for the whole study based on literature review and personal experience. The search will carry out a literature review to reveal the rate of readmission of patients with heart failure. To date, the outcome of the search has reveal that the rate of readmission increases within 30 days after patients have been discharged, suggesting that health education is an effective tool to reduce the readmission rates.

Part II

Annotated Bibliography

Park, L., Andrade, A., Mastey, A., Sun, J., & Hicks (2014). Institution specific risk factors for 30 day readmission at a community hospital: a retrospective observational study. BMC Health Services Research,14-40. doi: 10.1186/1472-6963-14-40

The authors presented a strong case pertainig to the topic of this paper.

They conducted a retrospective observational study using administrative data from January 1, 2009 through December 31, 2010 on a 257 bed community hospital in Massachusetts. The study included inpatient medical discharges from the hospitals service with the primary diagnoses of congestive heart failure, where the outcome was a 30-day readmission rates. After adjusting for known factors that impact readmission, provider associated factors such as hours worked and census on the day of discharge and hospital associated factors such as floor of discharge, and season were compared. During the period of the study, they found that after 3774 discharges, within a 30-day time-frame there were 637 readmissions, of that number (448)-19.6% were for congestive heart failure.

It was concluded by the researchers that, 30 day hospital readmissions may be associated with institution specific risk factors, even after adjustment for patient factors. These institution specific risk factors may be targets for interventions to prevent readmissions

Adib-Hajbaghery, M., Maghaminejad, F., & Abbasi, A. (2013). The role of continuous care in reducing readmission for patients with heart failure. Journal of Caring Science, 2(4), 255-267. doi: 10.5681/cs.2013.031

After conducting an extensive search of the database to identify clinical trial studies on post-discharge follow-up care for patients with heart failure between 1995 and 2013,much of the research results showed that a fifth of those patients were hospitalized within 30 days after discharge; most of readmitted, approximately 40 to 50% were in America. The researchers alluded to the fact that, with such numbers, this is costly for patients and the healthcare system. Therefore, emphasis should be oriented to preventing hospital readmission and improved prognosis for care and a new approach for heart failure cases.

It was concluded and suggested by the researchers that, nurses should be recognized and educated by the hospital organization and train them about appropriate care programs for the patients they encounter and treat with heart failures. In addition, nurses should be competently trained to educate heart failure patients about a change in life-style, diet, medications, activity, and sleeping patterns

Part III — Integrated Summary

As previously mentioned, one of the major health problems in the United States for individuals aged 60 years and above is heart failure, which results in high rates of morbidity and mortality. The complications associated with this disease increase the rates of readmissions within 30 days of patients’ discharges. Generally, heart failure contributes to more than 600,000 deaths in the United States on an annual basis. As a result, it has been considered as the leading cause of deaths for men and women though a huge percentage of deaths take place among individuals aged at least 60 years. Essentially, the increase in rate of readmissions of patients suffering from this condition within 30 days of patients’ discharges is linked to high costs of health care in the United States. Therefore, there is a strong link or correlation between high readmission rates and high costs of healthcare in the country.

The increased morbidity and mortality rates because of heart failure incidents and the increase in the number of deaths has contributed to numerous studies being carried out to examine the issue. The existing studies have focused on different aspects relating to the disease including appropriate measures for reducing readmission rates for patients with the condition and evaluation of risk factors that contribute to increase in readmission of these patients. One of the studies conducted to identify measures for reducing readmission rates of heart failure patients is the research by Mohsen Adib-Hajbaghery, Farzaneh Maghaminejad and Ali Abbasi. These researchers examined the role of continuous care in lessening readmission for health failure patients. An example of a study carried out to examine specific factors contributing to readmission rates is the research by Lee Park, Danielle Andrade, Andrew Mastey, James Sun, and LeRoi Hicks. These researchers conducted a retrospective observational study to identify institution-specific risk factors that contribute to readmission of patients with heart failure at a community hospital.

One of the most important indicators for evaluating the quality of care is patient readmission a short time after discharge from a health care facility. According to the findings of studies and recent surveys, approximately one-fifth of patients will be readmitted to a hospital 30 days after discharge. This rate of readmission within a short period of time after discharge is particularly huge in the United States where it is reported to be between 40 and 50%. This high rate has partly contributed to the high costs in the country’s health care system as well as generating additional costs for patients.

The high rates of hospital readmission in the United States is also evident in Medicare where one-fifth of beneficiaries are re-hospitalized within one month after discharge at a cost of $17.4 billion every year. This increased rate has forced Centers for Medicare and Medicaid Services (CMS) to penalize approximately 1% of reimbursement for inpatient services since the beginning of October 2012 and based on risk-adjusted ratio (Park et al., 2014, p.1).

The high rates of re-hospitalization implies that the basis for caring and developing new treatment measures for patients with heart failure is preventing readmission and enhancing prognosis. Moreover, individual hospitals are increasingly facing the need to patient and institutional risk factors that contribute to re-hospitalization within a short period after discharge. This tendency is influenced by the considerable impact of high rates of readmission on patients, health care facilities, and the overall health care system, especially in relation to costs.

Risk Factors Resulting in Readmission

There are several risk factors that contribute to increased rates of readmission of patients with heart failure. These risk factors can be classified as those relating to patients themselves as well as those related to the heath care facility or institution. Patient-related risk factors contributing to re-hospitalization of these patients include age, race, diagnoses, previous hospitalizations, insurance, disposition, and comorbidities associated with length of stay. The other patient-related risk factors for re-hospitalization are side effects of treatment, relapse of the condition, poor knowledge regarding heart failure symptoms, clinical course, and diet and drugs (Adib-Hajbaghery, Maghaminejad & Abbasi, 2013, p.256).

Despite these factors, the state of hospitals or health care facility themselves have also played a role in the high rates of patient readmission within 30 days after discharge. These institution-related risk factors are attributable to the fact that every facility has its own structure and processes, which have significant impact on delivery of patient care. In essence, the institutional risk factors contributing to increase re-hospitalization of heart failure are linked to the structure of the facility.

In addition to patient-related and institutional risk factors, the high rates of re-hospitalization have also been brought by issues that are not necessary linked to the patient or the hospital / health care facility. An example of these factors is season, particularly winter, which was associated with a high rate of re-hospitalization, unlike the other seasons. However, the reason for increased readmission of heart failure patients within one month after discharge during winter is largely unknown. Secondly, post-discharge home care has also been found to slightly contribute to these increased rates though the effect is relatively minimal as compared to the other factors.

Impact of High Readmission Rates

Recent studies have indicated that the United States has a high rate of hospital readmission of between 40 and 50% as well as nearly one-fifth for all beneficiaries of Medicare. This high rate is also evident among patients with heart failure, which has developed to become a major health issue in the country as reflected in the numerous annual deaths associated with it. Given this increased rate, hospital readmission has considerable impacts on patients, hospitals, and the overall health care system.

With regards to patients, re-hospitalization contributes to additional costs of care and consequently generates significant financial burdens. Generally, hospitalization is associated with high costs given the numerous challenges in the modern health care system. Patients with heart failure experience significant financial burdens in receiving treatments for their condition. These financial burdens are exacerbated by readmission to hospitals, which mostly occurs within 30 days after discharge. The nature of the patients’ conditions and current treatment interventions and measures imply that heart failure patients have to contend with increased hospitalization characterized by huge financial burdens. According to Adib-Hajbaghery, Maghaminejad & Abbasi (2013), the cost of readmission for heart failure patients is approximately over 400 billion Rials (p.255).

Apart from financial burdens, high rates of readmission to hospitals affect the quality of life of patients with heart failure. This is primarily because re-hospitalizations are considered as important factors in determining the quality of care. The increased readmission of these patients implies that current interventions are not effective in treating their conditions and improving their health and well-being. Consequently, these patients do not experienced improved health and well-being because of constant hospitalization for the condition. The quality of care for these patients is also attributable to side effects of treatment and relapse of the disease. These factors have forced investigators to search for effective preventative strategies and treatment interventions.

Similar to patients, high rate of readmission of heart failure patients generates high costs of operations because of the complexities involved in providing care services to patients suffering from this condition. Treatment of heart failure is characterized by complexities in interventions and processes utilized, which have significant costs. Despite significant need to lessen the rates of re-hospitalization, hospitals are forced to deal with seemingly ineffective treatment measures and prevention strategies. Recent findings have indicated that only a certain percentage of re-hospitalization of heart failure patients is preventable (Park et al., 2014, p.6). This implies that existing treatment measures and prevention strategies cannot effectively prevent readmission and generates considerable health care costs for hospitals. Moreover, current models that are designed to predict and help prevent re-hospitalization of these patients have been increasingly poor in addition to the widely unsuccessful interventions on a broad scale. Together with other stakeholders, hospitals continue to spend large amounts of money in research and development initiatives towards reducing the high rates of re-hospitalization. Furthermore, hospitals spend huge amounts of money in transforming their own structures and processes in attempts to reduce re-hospitalization of heart failure patients.

For the overall health care system, the high rates of readmission of heart failure patients are associated with huge costs. The annual cost of these high rates is $17.4 billion in the United States for all Medicare beneficiaries readmitted within the first 30 days after discharge. The health care system incurs huge costs relating to research and development initiatives, developing new treatment measures and prevention strategies, and providing coverage to these patients. The impact of high rates of readmission with regards to high costs in the overall health care system is reflected in the move by CMS to penalize nearly 1% of reimbursement for inpatient services, which will increase to 3% by the end of this financial year.

Measures towards Lessening Re-hospitalization of Heart Failure Patients

Given the significant impacts of high re-hospitalization rates of heart failure patients, the health sector has developed and utilized several measures towards reducing this rate and trend. The existing measures are developed and utilized based on the specific risk factors that contribute to readmission within the first 30 days upon discharge. Adib-Hajbaghery, Maghaminejad & Abbasi (2013), state that identifying institution specific risk factors for re-hospitalization of the patients provide an appropriate idea on where to focus efforts towards preventing readmission. The efforts developed from identification of these risk factors should focus on providers and hospital or health care facility’s processes instead of patients. This is primarily because such measures are more cost-effective to execute as compared to initiatives that are geared towards addressing the needs of the entire patient population. Through addressing factors related to hospitals and care providers, the efforts will contribute to better quality of care for heart failure patients during hospitalization, which will reduce readmission rates. The other important aspect of these efforts or measures is to generate mediators of early readmissions. In essence, the efforts should also incorporate effective strategies for predicting a patient’s likelihood for early readmission and initiatives that can be used to prevent it.

According to the findings of other studies, patient education and ongoing post-discharge follow-up interventions carried out by nurses are measures that could considerably decrease the rates of these patients’ readmission to the hospital or physician’s office (Park et al., 2013, p.265). The studies indicate that health education is not only an essential tool but also an effective mechanism for lessening the rate of re-hospitalization of patient with heart failure, which is a major problem in today’s health care system and sector. The cornerstone of heart failure management is conducting patient education during hospitalization and discharge phase or process. Patient education is important in reducing readmission because it gives patients necessary information on things they should follow. These things enable them to enhance compliance with advices from the health care team, lessen their concern, prevent probable complications, and promote effective recovery. Some of the major issues to address during patient education include food diet, lifestyle changes, measures for behavior change, medications, activity, and exercise. Additional techniques to conduct health education for these patients incorporate pre-discharge planning, telephone calls, home visits, and tele-health. These additional techniques improve a greater understanding of patients’ awareness and contribute to implementation of necessary strategies and self-care management practices for improved well-being.

Patient education can be combined with post-discharge follow-up strategies like home visits, telephone follow-up, and Internet follow-up. Home visits are essential and effective in reducing readmissions since they enable the health care team to constantly provide advices on medications, exercise, and dietary restrictions. During this process, care providers also monitor the patients’ blood pressure, ECG, weight, and heart rate, which are factors that contribute to heart failure. Moreover, home visits provide the health care team with an opportunity to address patients’ problems since discharge through proper examination, assessment and interventions.

Telephone and Internet follow-up are utilized as supplementary measures to home visits as part of constant post-discharge initiatives. Patients are encouraged to utilize their phones to call nurse managers in case of problems experienced during post-discharge from the hospital. Moreover, telephone contacts are used as tools for follow-up of patients with heart failure in relation to risk factors that contribute to the condition. Internet follow-up entails the use of Internet-based telemedicine system in which patients can easily communicate with the nurse on issues related to the disease. The Internet-based telemedicine system is utilized by patients to provide information regarding body weight, blood pressure, heart rate, and other symptoms relating to heart failure. On the other hand, nurses and the health care team utilize the system to provide educational materials to the patients.

Therefore, current literature shows that patient education and continuous care during post discharge are not only essential but also effective measures or tools for reducing the rate of readmissions of patients with heart failure issues. Techniques to carry out health education includes: pre-discharge planning, home visits, telephone calls, and tele-health to enhance a greater understanding of patients’ awareness, and how the implementation of strategies and effective self-care management can help their well-being. The effectiveness and essence of these strategies is attributed to the fact that they capitalize on patients’ motivation to promote health and well-being.

References

Adib-Hajbaghery, M., Maghaminejad, F., & Abbasi, A. (2013). The Role of Continuous

Care in Reducing Readmission for Patients with Heart Failure. Journal of Caring Science, 2(4), 255-267. doi: 10.5681/cs.2013.031

Park, L., Andrade, A., Mastey, A., Sun, J., & Hicks (2014). Institution Specific Risk

Factors for 30 day Readmission at a Community Hospital: A Retrospective Observational Study. BMC Health Services Research, 14-40. doi: 10.1186/1472-6963-14-40

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