According to research presented last week at the American College of Cardiology's 61st Annual Scientific Session, the likelihood of heart failure patient readmission can be drastically lowered when using a simple checklist before patients leave the hospital.
The inexpensive checklist, which can also improve the quality of care patients receive, was developed by Abhijeet Basoor at St. Joseph Mercy Oakland Hospital in Pontiac, Mich., where he practices Internal Medicine and Cardiology.
[See also: American College of Cardiology sues HHS secretary over physician payment cuts]
Clinicians who used this one-page, 27-question checklist at discharge were able to cut the percentage of patients who were readmitted to the hospital within one month of a cardiac event from 20 percent to just 2 percent. The readmission rate continued to be lower six months after discharge. If broadly adopted, it could translate into billions of Medicare dollars saved each year. While other studies have shown that home care and patient education can reduce readmissions, this is the first to evaluate the use of such a unique one-page, in-hospital checklist that requires no extra cost.
Heart failure, which is the heart's inability to pump enough blood to the body, costs $29 billion each year in treatment and carries a relatively high 30-day readmission rate, which can cost hospitals an average of $2,084 per patient per day. Under the Affordable Care Act, hospitals may not be reimbursed for readmissions occurring within a 30-day period.
"In addition to lowering 30-day and six-month readmissions and the associated costs, we also showed that more patients in the checklist group were likely to be on correct medications and had appropriate drug doses than patients in the control group," said Basoor in a press release.
The checklist was developed and used after approval of the hospital Cardiovascular Quality Integration Board. Basoor said that everything on the checklist is derived from and reinforces evidence-based practices for managing heart failure and lowering the likelihood of another cardiac event. It is divided into three parts: medications and their appropriate dose modification; counseling and monitoring intervention; and follow-up instructions. The average heart failure patient will need 12 to 15 of the total 27 interventions listed, so using the checklist can help remind both patients and doctors about the various steps that can be taken to manage the condition.
[See also: Hospital readmission rate tied closely to overall hospital admissions]
"The checklist provides simple reminders to instruct patients about things like diet, weight, blood pressure monitoring and appropriate drug dose up titration," said Basoor in a written statement. "The physician or nurse practitioner working with the patient uses the checklist, so hospitals don't have to pay for additional nursing staff or home care follow-up."
According to the Kaiser Family Foundation, heart failure readmission costs $12 billion in Medicare spending each year and approximately 25 percent of Medicare patients with heart failure are readmitted to the hospital within 30 days of an event. Previous studies have shown 50 percent of these heart failure readmissions can be prevented. When the Affordable Care Act takes effect in 2014, Medicare will begin to penalize hospitals with high readmission rates by refusing reimbursements.
Follow HFN Associate Editor Kelsey Brimmer on Twitter @kbrimmerhfn.
[See also: Readmissions increase at Pennsylvania hospitals, but mortality declines]