title: Regional Hospital Collaboration and Outcomes in Medicare Heart Failure Patients: See You in 7.
abstract: OBJECTIVE
  The objective of this study was to evaluate an interhospital collaborative approach to improve 7-day post-discharge follow-up (7dFU) rates and reduce 30-day readmissions in heart failure (HF) patients.
  
  
  BACKGROUND
  Early post-discharge follow-up after HF hospitalization is associated with lower 30-day readmission rates.
  
  
  METHODS
  Observational analyses of Medicare HF patients discharged from 10 collaborating hospitals (CH) participating in the Southeast Michigan See You in 7 Collaborative were carried out. We compared pre-intervention (May 1, 2011 to April 30, 2012) and intervention (May 1, 2012 to April 30, 2013) 7dFU rates, unadjusted 30-day readmissions, risk-standardized 30-day readmissions (RSRR), and Medicare payments in CH and Michigan nonparticipating hospitals (NPH).
  
  
  RESULTS
  7dFU rates increased but remained low in both groups (CH: 31.1% to 34.4%; p < 0.001; NPH: 30.2% to 32.6%; p <0.001). During the intervention period, unadjusted readmissions decreased significantly in both groups (CH: 29.0% to 27.3%; p <0.001; NPH: 26.4% to 25.8%, p = 0.004); mean RSRR decreased more in CH than in NPH (CH: 31.1% to 28.5%; p < 0.001; NPH: 26.7% to 26.1%, p = 0.02; p = 0.015 for intergroup comparisons). Findings were similar when CH outcomes were matched 1:1 with similar NPH outcomes. Combined Medicare payments for inpatient and 30 days of post-discharge care decreased by $182 in CH and by $63 in NPH (per eligible HF discharge).
  
  
  CONCLUSIONS
  See You in 7 Collaborative participation was associated with significantly lower 30-day readmissions and Medicare payments in HF patients. Increases in 7dFU were modest, but associated processes aimed at this goal may have improved the transition from inpatient to outpatient care. Regional hospital collaboration to share best practices could potentially reduce HF readmissions and associated costs.
authors.affiliation: Michigan Peer Review Organization, Farmington Hills, Michigan.
authors.forename: Harolyn
authors.initials: H
authors.lastname: Baker
authors.affiliation: College of Nursing, Wayne State University, Detroit, Michigan.
authors.forename: Sandra
authors.initials: S
authors.lastname: Oliver-McNeil
authors.affiliation: Michigan Peer Review Organization, Farmington Hills, Michigan.
authors.forename: Lili
authors.initials: L
authors.lastname: Deng
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan. Electronic address: scothumm@med.umich.edu.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Hummel
mesh_terms: D000208:Acute Disease; D000368:Aged; D003299:Cooperative Behavior; D017046:Cost Savings; D016208:Databases, Factual; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D018570:Risk Assessment; D013997:Time Factors; D014187:Transportation of Patients / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States
keywords: care transitions; heart failure; outcomes; readmissions