Strategies to reduce heart failure readmissions vary widely, study finds

January 3, 2013 – DCRI researchers, including Adrian Hernandez, MD, MHS, analyzed discharge processes and other patient care initiatives at 100 hospitals.

Hospitals’ inpatient care processes, discharge processes, and quality improvement methodologies for heart failure patients vary widely, and no single process is associated with improved 30-day heart failure readmission rates. That is the conclusion of a recent study by DCRI researchers.

The study was conducted by the DCRI’s Robb D. Kociol, MD; Eric D. Peterson, MD, MPH; Bradley G. Hammill, MS; Kathryn E. Flynn, PhD; Barbara L. Lytle, MS; Lesley H. Curtis, PhD; Adrian F. Hernandez, MD, MHS; and researchers from California and Ohio. Kociol was first author and Hernandez served as senior author. The study was published in the November 2012 issue of the journal Circulation: Heart Failure.

As many heart failure patients are readmitted to hospitals within 30 days of discharge, reducing readmission rates has been a major priority for hospitals across the country. However, efforts to reduce readmissions have been largely unsuccessful, and readmission rates have remained steady during the past 20 years, even though heart failure hospitalizations in the United States have declined almost 30 percent in the past decade. In an effort to understand why heart failure readmission rates remain high, the researchers surveyed 100 randomly selected hospitals participating in the Get With The Guidelines—Heart Failure quality improvement program. That program is a voluntary initiative sponsored by the American Heart Association.

The researchers conducted telephone interviews with personnel at each hospital, including nurse coordinators, nurse administrators, midlevel providers, and physicians. The interviews focused on readmission rates, patient education efforts, discharge processes, transitions of care to general practitioners or other medical professionals, and quality improvement initiatives. The researchers then grouped all of these processes into three domains (inpatient care, discharge/transitional care, and general quality improvement) and scored hospitals based on survey responses. They used linear regression to examine associations between these domain scores and 30-day risk-standardized readmission rates.

The results of the survey revealed that of the 100 participating sites, 28 percent were academic centers and 64 percent were community hospitals. The median readmission rate among participating sites (24 percent) was comparable with the national average (24.6 percent). Sites varied substantially in processes for inpatient care, education, discharge, care transitions, and quality improvement. Overall, neither inpatient care nor general quality improvement domains were associated with 30-day readmission rates. Hospitals in the lowest readmission rate quartile had modestly higher discharge and transitional care domain scores.

The researchers concluded that additional research is needed to determine whether increased attention to discharge and transitional care processes might result in reduced readmissions.