Care delivery team composition effect on hospitalization risk in African Americans with congestive heart failure

Abstract

The care delivery team (CDT) is critical to providing care access and equity to patients who are disproportionately impacted by congestive heart failure (CHF). However, the specific clinical roles that are associated with care outcomes are unknown. The objective of this study was to examine the extent to which specific clinical roles within CDTs were associated with care outcomes in African Americans (AA) with CHF. Deidentified electronic medical record data were collected on 5,962 patients, representing 80,921 care encounters with 3,284 clinicians between January 1, 2014 and December 31, 2021. Binomial logistic regression assessed associations of specific clinical roles and the Mann Whitney-U assessed racial differences in outcomes. AAs accounted for only 26% of the study population but generated 48% of total care encounters, the same percentage of care encounters generated by the largest racial group (i.e., Caucasian Americans; 69% of the study population). AAs had a significantly higher number of hospitalizations and readmissions than Caucasian Americans. However, AAs had a significantly higher number of days at home and significantly lower care charges than Caucasian Americans. Among all CHF patients, patients with a Registered Nurse on their CDT were less likely to have a hospitalization (i.e. 30%) and a high number of readmissions (i.e., 31%) during the 7-year study period. When stratified by heart failure phenotype, the most severe patients who had a Registered Nurse on their CDT were 88% less likely to have a hospitalization and 50% less likely to have a high number of readmissions. Similar decreases in the likelihood of hospitalization and readmission were also found in less severe cases of heart failure. Specific clinical roles are associated with CHF care outcomes. Consideration must be given to developing and testing the efficacy of more specialized, empirical models of CDT composition to reduce the disproportionate impact of CHF.

The Association of Implemented Care Team Configuration Models with Length of Stay and Charges in Hospitalized Patients with Congestive Heart Failure: A Retrospective Analysis of EHR Data

“…Prior research has demonstrated that patients with the severest cases of CHF and CHF patients with signi cant comorbidity are heavy utilizers of health care systems as evident by their large combinations of clinical roles on their care teams during hospitalization, when compared to patients with other chronic conditions. 3,8,14 CHF patient care team con gurations generally include an array of general practitioners with broad care expertise and those with specialize expertise in CHF. 25 Overall, this study found no speci c care team con guration models (i.e., combination of clinical roles) consistently found to be statistically signi cant among both all patients and when strati ed by heart failure severity.…”

“…This was consistent with the prior research demonstrating the vast and highly engaged role of the registered nurse in high quality CHF care delivery (e.g., immediate triage, ongoing monitoring, discharge planning, end-of-life care). 8,14,26 Furthermore, a recent study of 5,962 CHF patients found that CHF patients with a registered nurse providing care delivery was associated with an 88% decreased risk of having a hospitalization and 50% decreased risk of having a high of readmissions over a seven year period. 14 These ndings also demonstrate that the highly engaged role of registered nurses provide a signi cant opportunity for increased nurse-led solutions for reducing LOS and charges in CHF patients, as the ACC and AHA have called for care team recon guration.…”

“…For example, patients with the severest cases of CHF (i.e., left ventricular ejection fraction of less than 40%) who had a registered nurse on their care delivery team during a hospital encounter were 88% less likely to have a subsequent hospitalization over the seven-year study period. 14 However, patients with other clinical roles providing care during an encounter were more likely to be hospitalized: a physician (i.e., 2.97 times more likely) and a care manager (i.e., 119.09 times more likely). 14 CHF patients with a social worker on their care delivery team were 3.32 times more likely to have a high charger encounter.…”

“…14 However, patients with other clinical roles providing care during an encounter were more likely to be hospitalized: a physician (i.e., 2.97 times more likely) and a care manager (i.e., 119.09 times more likely). 14 CHF patients with a social worker on their care delivery team were 3.32 times more likely to have a high charger encounter. 14 Patients with an advanced nurse practitioner on their care team were found to signi cantly reduce the care encounter charges.…”

Summer undergraduate biomedical research program for underrepresented minority students in a rural, low-income state

“…At the University of Arkansas for Medical Sciences (UAMS), <7% of the faculty are minorities, which constrains efforts to engage URM communities using URM faculty for direct advocate-to-community engagement. In particular, it constrains biomedical research domains with a focus on cardiovascular and blood disorders, as heart disease is the leading cause of death in the United States, including individuals of most racial and ethnic groups ( 24 , 25 ). African Americans in Arkansas with reduced cardiovascular function have a significantly higher number of hospitalizations and readmissions than White Americans ( 26 , 27 ).…”