Amber E. Johnson, MD, MBAAmber E. Johnson, MD, MBAPGY-3PGY-3

Johns Hopkins Bayview Medical CenterJohns Hopkins Bayview Medical Center

Amber E. Johnson, MD, MBAAmber E. Johnson, MD, MBAPGY-3PGY-3

Johns Hopkins Bayview Medical CenterJohns Hopkins Bayview Medical Center

The Impact of The Impact of Innovation on Innovation on Heart Failure Heart Failure

CareCare

The Impact of The Impact of Innovation on Innovation on Heart Failure Heart Failure

CareCare

Disclosures

None

Disclosures

None

BackgroundBackground Heart failure is common

It is complicated to manage as an outpatient > 3 million ambulatory care and emergency department visits

annually

> 1 million hospitalizations annually

Heart failure is costly 25% readmitted in one month

$$$

Patient-centered care can help

Heart failure is common

It is complicated to manage as an outpatient > 3 million ambulatory care and emergency department visits

annually

> 1 million hospitalizations annually

Heart failure is costly 25% readmitted in one month

$$$

Patient-centered care can help

PurposePurpose

Because patients with heart failure have a high 30 day readmission rate, high costs, and poor quality of life…

we wanted to investigate:

What can we be doing better?

MethodsMethods

Multi-disciplinary working group

Define

Measure

Analyze

Improve

Control

Multi-disciplinary working group

Define

Measure

Analyze

Improve

Control

ResultsResults The most promising interventions were piloted as

improvements Scaled up based on success and patient interest

Examples: Patient education materials

Evidence-based provider order sets

Nursing and provider education

Teach back tools

Motivational interviewing training

Mechanisms for close outpatient follow up

Collaboration with home care and local nursing homes

The most promising interventions were piloted as improvements Scaled up based on success and patient interest

Examples: Patient education materials

Evidence-based provider order sets

Nursing and provider education

Teach back tools

Motivational interviewing training

Mechanisms for close outpatient follow up

Collaboration with home care and local nursing homes

ResultsResults No statistically significant differences in

pre- and post-intervention groups Rate of 30-day all cause readmissions for

HF declined from 28.4% to 18.9% (p<0.01)

This lead to an estimated reduction in charges of about $900,000 dollars

No statistically significant differences in pre- and post-intervention groups

Rate of 30-day all cause readmissions for HF declined from 28.4% to 18.9% (p<0.01)

This lead to an estimated reduction in charges of about $900,000 dollars

ConclusionsConclusions

An iterative innovations framework, has reduced 30-day readmission rates in heart failure

This approach included Identifying deficiencies in the processes of care Addressing the challenges patients face in caring for

themselves at home Customizing interventions to fit patients’ needs

Efforts are now focused on expanding the scale of this model

An iterative innovations framework, has reduced 30-day readmission rates in heart failure

This approach included Identifying deficiencies in the processes of care Addressing the challenges patients face in caring for

themselves at home Customizing interventions to fit patients’ needs

Efforts are now focused on expanding the scale of this model

ResourcesResources

Roger VL et al. Heart Disease and Stroke Statistics--2012 Update: A Report From the

American Heart Association. Circulation. 2012;125(1):e2-e220. Kociol RD, Peterson ED, Hammill BG, et al. National survey of hospital strategies to

reduce heart failure readmissions findings from the get with the guidelines-heart failure registry. Circ Heart Fail. 2012;5:680-687.

Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc. 2007 Jun;82(6):735-9.

Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011 Oct 18;155(8):520-8.

Glasgow JM, Scott-Caziewell JR, Kaboli PJ. Guiding inpatient quality improvement: a systematic review of Lean and Six Sigma. Jt Comm J Qual Patient Saf. 2010 Dec;36(12):533-40.

Brown T. Design thinking. Harv Bus Rev. 2008;86(6):84-92. Ries E. The lean startup: How today's entrepreneurs use continuous innovation to

create radically successful businesses. New York, NY: Crown Publishing; 2011.

Roger VL et al. Heart Disease and Stroke Statistics--2012 Update: A Report From the

American Heart Association. Circulation. 2012;125(1):e2-e220. Kociol RD, Peterson ED, Hammill BG, et al. National survey of hospital strategies to

reduce heart failure readmissions findings from the get with the guidelines-heart failure registry. Circ Heart Fail. 2012;5:680-687.

Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc. 2007 Jun;82(6):735-9.

Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011 Oct 18;155(8):520-8.

Glasgow JM, Scott-Caziewell JR, Kaboli PJ. Guiding inpatient quality improvement: a systematic review of Lean and Six Sigma. Jt Comm J Qual Patient Saf. 2010 Dec;36(12):533-40.

Brown T. Design thinking. Harv Bus Rev. 2008;86(6):84-92. Ries E. The lean startup: How today's entrepreneurs use continuous innovation to

create radically successful businesses. New York, NY: Crown Publishing; 2011.

AcknowledgementsAcknowledgements

Kapil Parakh, MDKapil Parakh, MDLaura Winner, RNLaura Winner, RNCarol Sylvester, RNCarol Sylvester, RNShaker M Eid, MDShaker M Eid, MDRobert Hody, MSRobert Hody, MSSharon Augustine, CRNPSharon Augustine, CRNPTanya Simmons, RNTanya Simmons, RNAngel Sampedro, BSAngel Sampedro, BS