Patient-Identified Factors Related to Heart Failure Readmissions

Retrum, Jessica H.; Boggs, Jennifer M.; Hersh, Andrew; Wright, Leslie; Main, Deborah S.; Magid, David J.; Allen, Larry A.

doi:10.1161/circoutcomes.112.967356

Cited by 102 publications

(105 citation statements)

References 23 publications

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“…This 18 and many readmissions are not easily attributable to a single cause. 1,19 Therefore, even if the three domains of the CTM-3 were addressed equally for patients with PCI and CABG, their post transition experiences and ultimate reasons for readmission could vary greatly. Although our study generally supports the association between the CTM-3 score and readmission, it should be interpreted with caution, and the association should be validated on a large scale, at the hospital level in future studies.…”

Section: And Readmissionmentioning

confidence: 99%

Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center

et al. 2016

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BACKGROUND: It is widely hypothesized that improvement in transitions of care will reduce unplanned hospital readmissions. However, the association between the Care Transitions Measure, the national quality metric for transitions of care and readmission risk, has not been established. OBJECTIVE: We aimed to determine the association between the Care Transition Measure and readmission. DESIGN: This was a single-center, prospective cohort study. PARTICIPANTS: Convenience sample of 2,963 patients enrolled in the BBridging the Divides^program, a longitudinal care management program for patients with coronary revascularization, from 2013 to 2014. Of these, 1594 (54 %) patients completed a post-discharge Care Transition Measure questionnaire. INTERVENTION: Care Transition Measure scores were collected by trained research staff blinded to study hypothesis, by telephone, within 30 days of discharge. Higher Care Transition Measure scores reflect a higher quality transition of care. MAIN MEASURES: 30-day readmission was measured. KEY RESULTS: Of the1594 patients that completed the Care Transition Measure survey, 1216 (76 %) received percutaneous coronary intervention and 378 (24 %) received coronary artery bypass grafting. Mean Care Transition Measure scores were significantly lower among patients who had a prior admission (77.2 vs. 82.1, p < 0.001) and those with ≥ 5 comorbidities (77 vs. 82.6 vs. 81.6, p < 0.001). Mean scores were significantly lower among patients who were readmitted within the percutaneous coronary intervention subgroup (73 vs. 80.9, p < 0.001) and the total study population (74.6 vs. 81.1, p < 0.001) compared to those who were not readmitted. This was not the case in the coronary artery bypass grafting subgroup (78.5 vs. 81.7, p = 0.29). After multivariable adjustment, every ten-point increase in the Care Transition Measure score was associated with a 14 % reduction in readmission risk (adjusted odds ratio 0.86, 95 % CI 0.78-0.95). CONCLUSIONS: The Care Transition Measure is strongly associated with readmissions, which strengthens its validity. However, its association with patient variables linked with readmission and its inconsistent association with readmission across clinical groups raises concerns that scores may be influenced by patient characteristics.

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Section: And Readmissionmentioning

confidence: 99%

Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center

et al. 2016

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“…Patients often did not seek care until symptoms became intolerable [55,51,67,59,56,72,74]. Frightening attacks of acute breathlessness were the most common reason patients sought professional care [51,49,56,74].…”

Section: "I Don't Know Really; I'm So Used To It Now" [71]mentioning

confidence: 99%

“…In other cases, patients perceived the ability of local physicians was inadequate for HF specific management [56]. Many noted a preference for doctors in the ER, with specialist HF knowledge.…”

Section: Perceived System and Provider Barriers To Accessing Carementioning

confidence: 99%

Care-seeking decisions for worsening symptoms in Heart Failure: a qualitative metasynthesis

Ivynian

DiGiacomo

Jha

et al. 2015

Heart, Lung and Circulation

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Purpose: Over 50% of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF.Methods: Electronic databases searched were Medline, EMBASE and CINAHL. Studies were included if they were peer reviewed journal articles written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas and Harden. Leventhal's self-regulatory model (SRM) was used to organise the literature.Results: Much of the literature fit within the SRM, however this model did not account for all factors that influence patients' care-seeking for worsening symptoms. Factors not accounted for included patients' appraisals of previous care-seeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in the model, such as misattribution of symptoms, not identifying with HF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients' decision-making was revealed.Implications: This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients' responses to worsening symptoms, and target those most at risk of delay.

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“…Prior studies suggest that, in general, patients and caregivers attribute failed transitions to a lack of preparedness for discharge, [14][15][16][17] a sense of exclusion from discussions of the care plan, 14,18 abandonment by the health care system after discharge 15,19 and lack of adherence to discharge recommendations. 20,21 Despite the fact that low-SES patients are at higher risk for poor outcomes, few prior studies specifically explore the perspectives of these patients. 22 One qualitative study of 21 patients served in lowincome community health centers suggested that low-SES patients knew their diagnoses, medications and discharge instructions, but faced other non-knowledge barriers to recovery such as stress, difficulty paying for home care and lack of transportation.…”

Section: Introductionmentioning

confidence: 99%

Challenges Faced by Patients with Low Socioeconomic Status During the Post-Hospital Transition

et al. 2013

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BACKGROUND:Patients with low socioeconomic status (low-SES) are at risk for poor outcomes during the posthospital transition. Few prior studies explore perceived reasons for poor outcomes from the perspectives of these high-risk patients. OBJECTIVE: We explored low-SES patients' perceptions of hospitalization, discharge and post-hospital transition in order to generate hypotheses and identify common experiences during this transition. DESIGN: We conducted a qualitative study using indepth semi-structured interviewing. PARTICIPANTS: We interviewed 65 patients who were: 1) uninsured, insured by Medicaid or dually eligible for Medicaid and Medicare; 2) residents of five low-income ZIP codes; 3) had capacity or a caregiver who could be interviewed as a proxy; and 4) hospitalized on the general medicine or cardiology services of two academically affiliated urban hospitals. APPROACH: Our interview guide investigated patients' perceptions of hospitalization, discharge and the posthospital transition, and their performance of recommended post-hospital health behaviors related to: 1) experience of hospitalization and discharge; 2) external constraints on patients' ability to execute discharge instructions; 3) salience of health behaviors; and 4) self-efficacy to execute discharge instructions. We used a modified grounded theory approach to analysis. KEY RESULTS: We identified six themes that low-SES patients shared in their narratives of hospitalization, discharge and post-hospital transition. These were: 1) powerlessness during hospitalization due to illness and socioeconomic factors; 2) misalignment of patient and care team goals; 3) lack of saliency of health behaviors due to competing issues; 4) socioeconomic constraints on patients' ability to perform recommended behaviors; 5) abandonment after discharge; and 6) loss of self-efficacy resulting from failure to perform recommended behaviors.CONCLUSIONS: Low-SES patients describe discharge goals that are confusing, unrealistic in the face of significant socioeconomic constraints, and in conflict with their own immediate goals. We hypothesize that this goal misalignment leads to a cycle of low achievement and loss of self-efficacy that may underlie poor post-hospital outcomes among low-SES patients.

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Patient-Identified Factors Related to Heart Failure Readmissions

Cited by 102 publications

References 23 publications

Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center

Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center

Care-seeking decisions for worsening symptoms in Heart Failure: a qualitative metasynthesis

Challenges Faced by Patients with Low Socioeconomic Status During the Post-Hospital Transition

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