title: Targeting heart failure rehospitalizations in a skilled nursing facility: A case report.
abstract: OBJECTIVE
  We report on a skilled nursing facility (SNF) that added designated heart failure (HF) beds and created a patient registry to track the number and reasons for rehospitalization.
  
  
  BACKGROUND
  Targeting the reduction of rehospitalizations from SNFs is an important goal and patients with HF are particularly vulnerable for rehospitalizations as HF disease management programs in SNFs are rare.
  
  
  METHODS
  A case study of a local quality improvement initiative.
  
  
  RESULTS
  The data from the registry revealed, that compared to patients without HF, patients with HF were more often rehospitalized for cardiopulmonary symptoms and less often for infection. In addition, patients with HF were most often rehospitalized during the first 7 days of their SNF stay and if they had a primary hospital discharge diagnosis of HF.
  
  
  CONCLUSIONS
  We highlight the benefits of a patient registry to guide future quality improvement initiatives to reduce patient rehospitalization rates.
authors.affiliation: Frances Payne Bolton School of Nursing, USA. Electronic address: mary.dolansky@case.edu.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Dolansky
authors.affiliation: Cleveland Clinic, Connected Care Program, USA.
authors.forename: Luann
authors.initials: L
authors.lastname: Capone
authors.affiliation: University of Colorado School of Public Health, Department of Biostatistics and Informatics, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Leister
authors.affiliation: University of Colorado School of Medicine, USA.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Boxer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000451:nursing*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D058996:Quality Improvement; D012866:Skilled Nursing Facilities / Q000592:standards*
keywords: Heart failure; Nursing; Quality improvement; Readmission; Skilled nursing facility