Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for Heart Failure

Spall, Harriette G.C. Van; Lee, Shun Fu; Xie, Feng; Oz, Urun Erbas; Perez, Richard; Mitoff, Peter R.; Maingi, Manish; Tjandrawidjaja, Michael C.; Heffernan, Michael; Zia, Mohammad I.; Porepa, Liane; Panju, Mohamed; Thabane, Lehana; Graham, Ian D.; Haynes, R. Brian; Haughton, Dilys; Simek, K; Ko, Dennis T.; Connolly, Stuart J.

doi:10.1001/jama.2019.0710

Cited by 216 publications

(293 citation statements)

References 30 publications

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“…A study of an inpatient geriatric consultation service similar to one of the major components of our intervention showed positive effects on several measures, but did not reduce 30‐day readmissions . A recent randomized trial of another intervention similar to the STAR program in patients with heart failure with a mean age of 78 years also failed to demonstrate an effect on 30‐day readmissions and returns to the ED …”

Section: Discussionmentioning

confidence: 74%

“…37 A recent randomized trial of another intervention similar to the STAR program in patients with heart failure with a mean age of 78 years also failed to demonstrate an effect on 30-day readmissions and returns to the ED. 38 We learned several lessons that may be valuable for implementing care transition interventions in the high-risk geriatric population. First, the intervention was not as robust as it could have been.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of a Multicomponent Care Transitions Program for High‐Risk Hospitalized Older Adults

Huckfeldt

Reyes

Engström

et al. 2019

J American Geriatrics Society

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OBJECTIVES To test the effectiveness of a multicomponent care transition intervention targeted at hospitalized patients, aged 75 years and older, at high risk for hospital readmissions, return emergency department (ED) visits, and related complications. DESIGN Implementation as a quality improvement program with propensity‐matched preintervention and concurrent comparison groups over a 12‐month period. SETTING A 400‐bed community teaching hospital. PARTICIPANTS Patients, aged 75 years and older, admitted to non–intensive care unit beds who met specific high‐risk criteria. The intervention group included 202 patients, and the concurrent and preintervention comparison groups included 4142 and 4592 patients, respectively. MEASUREMENTS Primary outcomes were 30‐day hospital readmissions and returns to the ED; 7‐day readmissions and ED visits were secondary measures. RESULTS Among the 202 patients enrolled in the “Safe Transitions for At‐Risk Patients” (“STAR”) program, 37 (18.3%) were readmitted within 30 days, in contrast to 14.3% and 14.6% in the concurrent and preintervention comparison groups, respectively. Rates for 30‐day return ED visits that did not result in hospitalization were 10.9% in the intervention group, and 7.2% and 7.9% in the comparison groups. STAR patients had greater 30‐day ED use than patients in the preintervention comparison group (5.0 percentage points; 95% confidence interval = 0.8‐9.3 percentage points; P = .020). Implementation challenges included suboptimal involvement of the participating hospital and post–acute care organizations and a relatively high proportion of patients who did not receive the intervention as planned, despite agreeing to participate before leaving the hospital. CONCLUSION A multicomponent care transitions intervention targeting high‐risk patients, aged 75 years and older, admitted to a community teaching hospital was not effective in reducing 30‐ or 7‐day readmissions or return ED visits. Our implementation experience offers many lessons for future programs for similar high‐risk geriatric populations. J Am Geriatr Soc 67:2634–2642, 2019

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Evaluation of a Multicomponent Care Transitions Program for High‐Risk Hospitalized Older Adults

Huckfeldt

Reyes

Engström

et al. 2019

J American Geriatrics Society

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“…In total, 17 of the 25 studies were conducted in North America [17-22, 24-27,29,31,34,37-40], three in Europe [23,30,35], three in China [16,28,32], and two in Iran [33,36]. Thirteen of the 25 studies did not report racial ethnicity [16,20,21,23,24,26,28,30,32,33,35,36,38]. The sample size ranged from 38 [24] to 3462 [19], and the average patient age was between 65 [36] and 82 years [27,30].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Subjects presented with various HF types: two studies reported on end-stage HF [28,32], three on chronic HF [16,23,33], two on congestive HF [21,37], one on decompensated HF [29], and the remaining 17 on HF [17][18][19][20]22,[24][25][26][27]30,31,[34][35][36][38][39][40]. To identify HF severity, we considered the New York Heart Association (NYHA) class and left ventricle ejection fraction (LVEF).…”

Section: Type and Severity Of Hfmentioning

confidence: 99%

Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

Son

Lee

et al. 2020

IJERPH

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Heart failure (HF) is a life-limiting illness and presents as a gradual functional decline with intermittent episodes of acute deterioration and some recovery. In addition, HF often occurs in conjunction with other chronic diseases, resulting in complex comorbidities. Hospital readmissions for HF, including emergency department (ED) visits, are considered preventable. Majority of the patients with HF are often discharged early in the recovery period with inadequate self-care instructions. To address these issues, transitional care interventions have been implemented with the common objective of reducing the rate of hospital readmission, including ED visits. However, there is a lack of evidence regarding the benefits and adverse effects of transitional care interventions on clinical outcomes and patient-related outcomes of patients with HF. This integrative review aims to identify the components of transitional care interventions and the effectiveness of these interventions in improving health outcomes of patients with HF. Five databases were searched from

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“…Although early post-discharge follow-up is recommended following HF hospitalization, such transitional care strategies have not conclusively improved clinical outcomes. 6,9 These inconsistent results may stem from the difficulty and variability in the assessment of congestion by clinicians. 5 Haematocrit represents a widely available and inexpensive laboratory test that can be easily ordered in the outpatient clinic.…”

mentioning

confidence: 99%

Post‐discharge haemodilution, congestion, and clinical outcomes among patients hospitalized for heart failure with reduced ejection fraction: results from the EVEREST trial

Bhatt

Vaduganathan

Patel

et al. 2019

European J of Heart Fail

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Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for Heart Failure

Abstract: Health care services that support the hospital-to-home transition can improve outcomes in patients with heart failure (HF). OBJECTIVE To test the effectiveness of the Patient-Centered Care Transitions in HF transitional care model in patients hospitalized for HF.

Cited by 216 publications

References 30 publications

Evaluation of a Multicomponent Care Transitions Program for High‐Risk Hospitalized Older Adults

Evaluation of a Multicomponent Care Transitions Program for High‐Risk Hospitalized Older Adults

Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

Post‐discharge haemodilution, congestion, and clinical outcomes among patients hospitalized for heart failure with reduced ejection fraction: results from the EVEREST trial

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