Change in readmissions and follow-up visits as part of a heart failure readmission quality improvement initiative.
OBJECTIVE
The study objectives were to quantify the change in 7-day follow-up visits and 30-day readmissions as part of a hospital quality improvement initiative and to characterize events at 7-day follow-up visits. Some data suggest that outpatient assessments of patients with heart failure within 7 days of hospital discharge may prevent readmissions, although little is known about patient needs at 7-day follow-up visits.


METHODS
We performed a single-center, retrospective chart review of all heart failure discharges at the University of Connecticut Health Center (398 patients) the year before (2008) and the year after (2011) a quality improvement initiative that included mandatory 7-day follow-up visits. We quantified the change in 30-day readmission rate after the initiative, frequency of 7-day follow-up visits, and events at follow-up visits.


RESULTS
The average age of patients with heart failure was 79.9 years in 2011, with 45.9% having systolic heart failure. Thirty-day all-cause readmissions decreased from 27.5% to 19.1% after our quality improvement initiative (P = .024). Frequency of 7-day follow-up visits increased from 19.6% to 46.9% (P < .01). Eighty-one percent of 7-day visits occurred in the University of Connecticut Heart Failure Center with a cardiologist or heart failure nurse practitioner. Fifty-one percent of patients had blood work drawn, and 26% had a medication dose changed. Only 13% of patients had no discrepancy between the discharge and follow-up medication lists.


CONCLUSIONS
Our hospital's 30-day readmission rate for patients with heart failure decreased in parallel with an increase in 7-day follow-up visits. Patients with heart failure were complex and often had diagnostic testing and medication changes at follow-up visits.
University of Connecticut Health Center, Farmington. Electronic address: jaryan@uchc.edu.
Jason
J
Ryan
Sangwook
S
Kang
Steven
S
Dolacky
Joseph
J
Ingrassia
Raj
R
Ganeshan
D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015397:Program Evaluation; D058996:Quality Improvement; D012189:Retrospective Studies
Heart failure; Quality improvement; Readmissions