title: Hospital-to-Home: a hospital readmission reduction program for congestive heart failure.
abstract: OBJECTIVE
  To decrease the 30-day readmission rate following hospital stay for congestive heart failure, which in the United States approaches 30 percent nationally. In addition to indicating possible suboptimal care of patients with this condition, there are significant economic considerations.
  
  
  METHODS
  Prospective, non-randomized, two-center pilot project.
  
  
  METHODS
  General hospital and cardiac specialty hospital, both located in a community of 150,000 population in predominantly rural South Dakota.
  
  
  METHODS
  All patients admitted between June 7, 2010 and June 6, 2011 with a diagnosis of congestive heart failure.
  
  
  METHODS
  An intensive transitions of care program was implemented to ensure adequate self-management training of patients and appropriate out-patient follow-up and monitoring of the patient by the health care system.
  
  
  METHODS
  30-day all-cause readmissions.
  
  
  RESULTS
  A statistically significant 42 percent relative reduction in 30-day readmission rate was documented for those patients participating in the pilot program. This represented a net economic savings, even accounting for the added cost of the intervention.
  
  
  CONCLUSIONS
  An intensive transitions of care program decreases the 30-day readmission rate for patients with congestive heart failure in a non-urbanized Midwestern state like South Dakota.
authors.affiliation: Center for Family Medicine, Sioux Falls, USA.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Huntington
authors.forename: Aireen I
authors.initials: AI
authors.lastname: Guzman
authors.forename: Ann
authors.initials: A
authors.lastname: Roemen
authors.forename: Julie
authors.initials: J
authors.lastname: Fieldsend
authors.forename: Herbert
authors.initials: H
authors.lastname: Saloum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D019456:Health Transition; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010351:Patient Discharge / Q000639:trends*; D010359:Patient Readmission / Q000639:trends*; D010865:Pilot Projects; D011446:Prospective Studies; D013023:South Dakota / Q000453:epidemiology; D055815:Young Adult