Regional Hospital Collaboration and Outcomes in Medicare Heart Failure Patients

Abstract

Background Early post-discharge follow-up after heart failure (HF) hospitalization is associated with lower 30-day readmission rates. Objectives Evaluate an inter-hospital collaborative approach to improve 7-day post-discharge follow-up (7dFU) rates and reduce 30-day readmissions in HF patients. Methods Observational analysis of Medicare HF patients discharged from 10 collaborating hospitals (CH) participating in the Southeast Michigan See You in 7 Collaborative. We compared pre-intervention (May 1, 2011–April 30, 2012) and intervention (May 1, 2012–April 30, 2013) 7dFU, unadjusted 30-day readmission, risk-standardized 30-day readmission (RSRR), and Medicare payments in CH and Michigan non-participating hospitals (NPH). Results 7dFU increased but remained low in both groups (CH: 31.1% to 34.4%, p<0.001; NPH: 30.2% to 32.6%, p<0.001). During the intervention period, unadjusted readmissions significantly decreased in both groups (CH: 29.0% to 27.3%, p<0.001; NPH: 26.4% to 25.8%, p=0.004); mean RSRR decreased more in CH than NPH (CH: 31.1% to 28.5%, p<0.001; NPH: 26.7% to 26.1%, p=0.02; p=0.015 for inter-group comparison). Findings were similar when CH was matched 1:1 with similar NPH. Combined Medicare payments for inpatient and 30 days of post-discharge care decreased by $182 in the CH and by $63 in NPH (per eligible HF discharge). Conclusions See you in 7 Collaborative participation was associated with significantly lower 30-day readmission and Medicare payments in HF patients. Increases in 7dFU were modest, but associated processes aimed at this goal may have improved the transition from inpatient to outpatient care. Regional hospital collaboration to share best practices could potentially reduce HF readmissions and associated costs.

Early Follow-Up After a Heart Failure Exacerbation

“…Given the recent report from the Michigan See You in 7 Collaborative about how difficult it is to significantly increase 7-day follow-up visits even with substantial investment, 28 our findings are important for clinicians and health system planners in both Canada and the United States. The second key finding is that such follow-up is best done by a physician familiar with the patient.…”

Clinical and Socioeconomic Predictors of Heart Failure Readmissions: A Review of Contemporary Literature

“…The study found that 7-day follow-up rates increased at both collaborating and noncollaborating hospitals but that 30-day readmission rates decreased significantly more in collaborating hospitals (2.6% vs 0.6%; P¼.015). 121 The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) is the largest national hospital-based program focused on improving institutional systems for managing HF in hospitalized patients. The program relies on a tool kit with items such as evidence-based best practice algorithms, discharge checklists, and pocket cards, along with quality of care reports and structured educational opportunities to facilitate improvement of quality of care.…”

Optimal Timing of Physician Visits after Hospital Discharge to Reduce Readmission

“…; Baker et al. ), and chronically ill patients (Misky, Wald, and Coleman ; Lin, Barnato, and Degenholtz ; Hubbard et al. ; Jackson et al.…”