title: Variability in Implementation of Interventions Aimed at Reducing Readmissions Among Patients With Heart Failure: A Survey of Teaching Hospitals.
abstract: OBJECTIVE
  To highlight teaching hospitals' efforts to reduce readmissions by describing interventions implemented to improve care transitions for heart failure (HF) patients and the variability in implemented HF-specific and care transition interventions.
  
  
  METHODS
  In 2012, the authors surveyed a network of 17 teaching hospitals to capture information about the number, type, stage of implementation, and structure of 4 HF-specific and 21 care transition (predischarge, bridging, and postdischarge) interventions implemented to reduce readmissions among patients with HF. The authors summarized data using descriptive statistics, including the mean number of interventions implemented and the frequency and stage of specific interventions, and descriptive plots of the structure of two common interventions (multidisciplinary rounds and follow-up telephone calls).
  
  
  RESULTS
  Sixteen hospitals (94%) responded. The number and stage of implementation of the HF-specific and care transition interventions implemented varied across institutions. The mean number of interventions at an advanced stage of implementation (i.e., implemented for ≥ 75% of HF patients on the cardiology service or on all services) was 10.9 (standard deviation = 4.3). Overall, predischarge interventions were more common than bridging or postdischarge interventions. There was variability in the personnel involved in multidisciplinary rounds and in the processes/content of follow-up telephone calls.
  
  
  CONCLUSIONS
  Teaching hospitals have implemented a wide range of interventions aimed at reducing hospital readmissions, but there is substantial variability in the types, stages, and structure of their interventions. This heterogeneity highlights the need for collaborative efforts to improve understanding of intervention effectiveness.
authors.affiliation: E.E. Vasilevskis is assistant professor of medicine, Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, and staff physician, Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Health Care System, Nashville, Tennessee. S. Kripalani is associate professor, Center for Clinical Quality and Implementation Research, Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee. M.K. Ong is associate professor of medicine, Department of Medicine, University of California, Los Angeles, and the VA Greater Los Angeles Health Care System, Los Angeles, California. J.T. Rosenthal is chief medical officer, University of California, Los Angeles Health System, Los Angeles, California. D.E. Longnecker is professor of anesthesiology and critical care emeritus, University of Pennsylvania, Philadelphia, Pennsylvania, and executive director, Coalition to Transform Advanced Care, Washington, DC. B. Harmon is a quality and safety data consultant, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota. S.F. Hohmann is a principal consultant for comparative data and informatics research, University HealthSystem Consortium, and assistant professor, Department of Health Systems Management, Rush University, Chicago, Illinois. K. Wright is program coordinator, Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee. J.T. Black is manager, Health Policy and Program Evaluation, Cedars-Sinai Health System, Los Angeles, California.
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Vasilevskis
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.forename: Michael K
authors.initials: MK
authors.lastname: Ong
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Rosenthal
authors.forename: David E
authors.initials: DE
authors.lastname: Longnecker
authors.forename: Brian
authors.initials: B
authors.lastname: Harmon
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Hohmann
authors.forename: Kelly
authors.initials: K
authors.lastname: Wright
authors.forename: Jeanne T
authors.initials: JT
authors.lastname: Black
mesh_terms: D003266:Continuity of Patient Care; D006333:Heart Failure / Q000628:therapy*; D006784:Hospitals, Teaching; D006801:Humans; D010359:Patient Readmission; D010360:Patient Transfer; D058996:Quality Improvement; D011795:Surveys and Questionnaires