A quality improvement approach to reducing hospital readmissions in patients with cancer and heart failure

Abstract

Background: The management of patients with cancer and concurrent heart failure (HF) is challenging. The increased complexity of treatment and the occurrence of multiple overlapping symptoms may lead to frequent hospital admissions, which may result in cancer treatment delays, a diminished quality of life, and an increased financial burden for the patient's family. To provide holistic care to oncology patients with HF, we implemented the Heart Success Program (HSP), a patient-centered, interprofessional collaborative practice, which decreased the 30day hospital readmission rate for HF diagnosis from 40 to 27%. However, this rate remains higher than that reported for Medicare beneficiaries. Aim: To identify the factors contributing to frequent readmissions, the HSP committee participated in the institution's Clinical Safety and Effectiveness and utilize quality improvement methodologies and tools to decrease hospital readmission for HF. Methods: The DMAIC (Define, Measure, Analyze, Improve and Control) method was used to guide this quality improvement. Areas considered as having high impact and requiring low effort to address were patient education barriers, lack of documentation clarity, and care provider knowledge gaps about the HSP. We implemented workflow changes, improved clarity with documentation of HF diagnosis, and increase provider knowledge about the HSP. Findings: After 6 months of implementing quality improvement techniques, the 30-day hospital readmission rate for HF patients fell by 23.43% (from 31.7% for the baseline period to 8.27%), exceeding the target project goal of 10%. Our quality improvement method may also be effective in improving the management of patients with cancer and other comorbid conditions.

Heart Failure Readmission in Patients With ST-Segment Elevation Myocardial Infarction and Active Cancer

“…Such monitoring can involve closer echocardiographic 39 or biomarker-based monitoring 40 as well as an enhanced focus on multidisciplinary cardiovascular risk factor modification. 11 Our current results also highlight the need for further studies to identify evidence-based treatment approaches for the care of cancer patients who present with myocardial infarction.…”

“… 1 , 9 Previous studies addressing HF risk post-STEMI in this patient group are limited, specifically concerning the evaluation of different cancer types and longer-term follow-up. 9 , 10 , 11 …”

Primary anastomosis with diverting loop ileostomy vs. Hartmann’s procedure for acute diverticulitis: what happens after discharge? Results of a nationwide analysis

“…In a retrospective analysis of 603 PADLI procedures, laparoscopic approach was independently associated with 30-day readmissions, the majority of which were due to dehydration. Readmission is of importance not only from the policy and healthcare system perspectives, but it also can negatively impact QoL [ 23 ], limiting the perceived benefits of PADLI. Future trials should include a patient-centered outcome, such as QoL, and qualitative studies may help determine how patients prioritize higher likelihood of ostomy closure with the higher risk of having to be readmitted to hospital.…”

Financial and Safety Impact of Simulation-based Clinical Systems Testing on Pediatric Trauma Center Transitions

“…[26][27][28] Simulation-based quality improvement initiatives are associated with reductions in readmissions from 12% to 50% below the baseline readmission rate. 29,30 Our calculation was based on the following assumptions derived from historical data: 450 trauma admissions/y with a 10% unplanned readmission rate. Reductions in readmissions were conservatively estimated between 15% and 25%.…”