Christine Thompson

An Electronic Medical Record Report Improves Identification of Hospitalized Patients With Heart Failure

BACKGROUNDnEarly identification of inpatients with heart failure (HF) may help to reduce readmissions. We found that many patients identified by our coding team as having a primary diagnosis of HF were not identified by our clinical team. We hypothesized that an electronic medical record (EMR)-based report would improve identification of hospitalized patients eventually diagnosed with HF.nnnMETHODS AND RESULTSnWe constructed an automated EMR-based tool to allow our team to identify patients with HF more quickly and accurately. We selected criteria that could potentially identify the cohort as patients with an exacerbation of HF. We performed monthly reconciliations, comparing the list of patients identified by our coding team as having a primary diagnosis of HF versus the patients identified by our team as having HF. We reduced a baseline 17% discrepancy of patients coded as HF but not identified by our team to 9.5% in the year after implementation of our screening tool (Pu2009=u2009.006), and to 5.4% in the next year (Pu2009=u2009.03); 56% of patients that were identified as having HF by our CNS team were coded as having HF, versus 49% in the 2 years after implementation (Pu2009=u2009.15). Thirty-day readmission rates to our hospital decreased from 16% to 11% (Pu2009=u2009.029).nnnCONCLUSIONSnAn EMR-based approach significantly improved identification of patients discharged with a primary diagnosis of HF. Future investigations should determine whether early identification of inpatients with HF can independently lower readmissions, and whether this strategy can successfully identify outpatients with HF.

An informatics-based approach to reducing heart failure all-cause readmissions: the Stanford heart failure dashboard.

BackgroundnReduction of 30-day all-cause readmissions for heart failure (HF) has become an important quality-of-care metric for health care systems. Many hospitals have implemented quality improvement programs designed to reduce 30-day all-cause readmissions for HF. Electronic medical record (EMR)-based measures have been employed to aid in these efforts, but their use has been largely adjunctive to, rather than integrated with, the overall effort.nnnObjectivesnWe hypothesized that a comprehensive EMR-based approach utilizing an HF dashboard in addition to an established HF readmission reduction program would further reduce 30-day all-cause index hospital readmission rates for HF.nnnMethodsnAfter establishing a quality improvement program to reduce 30-day HF readmission rates, we instituted EMR-based measures designed to improve cohort identification, intervention tracking, and readmission analysis, the latter 2 supported by an electronic HF dashboard. Our primary outcome measure was the 30-day index hospital readmission rate for HF, with secondary measures including the accuracy of identification of patients with HF and the percentage of patients receiving interventions designed to reduce all-cause readmissions for HF.nnnResultsnThe HF dashboard facilitated improved penetration of our interventions and reduced readmission rates by allowing the clinical team to easily identify cohorts with high readmission rates and/or low intervention rates. We significantly reduced 30-day index hospital all-cause HF readmission rates from 18.2% at baseline to 14% after implementation of our quality improvement program ( P u2009=u2009.045). Implementation of our EMR-based approach further significantly reduced 30-day index hospital readmission rates for HF to 10.1% ( P for trendu2009=u2009.0001). Daily time to screen patients decreased from 1 hour to 15u2009minutes, accuracy of cohort identification improved from 83% to 94.6% ( P u2009=u2009.0001), and the percentage of patients receiving our interventions, such as patient education, also improved significantly from 22% to 100% over time ( P u2009<u2009.0001).nnnConclusionsnIn an institution with a quality improvement program already in place to reduce 30-day readmission rates for HF, an EMR-based approach further significantly reduced 30-day index hospital readmission rates.

COMMUNITY COLLABORATION IMPROVES CARE AND REDUCES REHOSPITALIZATIONS FOR HEART FAILURE PATIENTS

Background HF is a leading cause of hospitalization for adults, with highest readmission rates occurring 30 days post-discharge. Hospitals are instituting evidence-based strategies to improve patient transitions from hospital to home and reduce 30-day all-cause readmissions. Impacting 90-day readmissions poses a greater challenge. Incorporating community partners into care transitions is critical for successful outcomes, particularly considering new bundled payment models. Patients discharging to skilled nursing facilities (SNFs) or with home health agency (HHA) services are often more vulnerable and at heightened risk. Objectives Create a collaborative partnership between one medical center and local SNFs and home health agencies (HHA) to improve sustained HF patient outcomes and reduce hospital readmissions. Methods Monthly multidisciplinary meetings were held with local SNF and HHA participants. Collaborative goals included identifying gaps in patient transitions between care settings and creating an evidence-based community standard for HF patient care. Corollary aims were to align quality care practices, share outcomes data and create solutions for identified barriers to optimal care transitions. Results Comparing baseline data (476 HF discharges) to a year post-implementation of our intervention bundle (412 discharges), overall 30-day readmissions reduced from 19% to 9% while 90-day readmissions improved from 31% to 19%. 30-day rehospitalizations for SNF patients declined from and were decreased for patients who discharged with home health services by 26%. Conclusions Building relationships fostering communication and collaboration among community partners is a key strategy to reduce avoidable rehospitalizations and sustain improved patient outcomes. Figure 1 Primary Diagnosis HF Patient Readmissions by Index Disposition (pre/post interventions).