effectiveness and cost of a transitional care program for heart failure arch intern med....
TRANSCRIPT
Effectiveness and Cost of a Transitional Care Program for Heart Failure
Arch Intern Med. 2011;171(14):1238-1243
September 11, 2012
Brett Stauffer MD MHSDirector of Clinical Decision SupportCenter for Clinical InnovationBaylor Health Care System
© 2005 Baylor Health Care System
Baylor’s Transitional Care Program
• Readmission increasingly the focus for evaluating the quality of care provided by hospitals, especially by CMS.
• Heart failure the largest contributor to readmissions for Medicare patients.
• BHCS felt implementation of a pilot program to reduce readmission was necessary to gain experience on methods of reducing readmission.
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Evaluation of Programs for Pilot
Several different programs had been show to be efficacious in controlled research studies
Previous studies had shown the most effective care coordination programs had 2 crucial features: Care coordinators interacted in person with patients
and did not simply educate or assist them by telephone
Care coordinators collaborated closely with patients’ physicians to influence care
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© 2005 Baylor Health Care System
Implementation of Modified Naylor Transitional Care Model
Decision made to go with a transitional care model developed by Dr. Naylor at University of Pennsylvania
Uses Advance Practice Nurses to bridge care after discharge
Includes visits in the hospital, an initial home visit within 72 hours, and at least 8 home visits over a 3 month period
Telephone support is available 7 days a week
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Analysis of Intervention
Intervention performed at Baylor Garland from August 2009 to April 2010
Study was a prospective observation study with concurrent controls
Analysis was intention to treat with outcome of interest being readmission within 30-days of discharge
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Analysis of Intervention
Attempts were made to enroll all patients admitted with heart failure Some patients were not
identified while hospitalized to be enrolled
Some patients declined to participate in the program
Patients discharged to skilled nursing facilities or nursing homes
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© 2005 Baylor Health Care System
Analysis of Intervention
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Analysis of Intervention
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© 2005 Baylor Health Care System
Financial Analysis
Since current payment based on episodes of care (including readmission) and little reimbursement exists for costs associated with the program, the intervention -- while effective in the real world -- may not be financially sustainable long term without modifications to how hospitals are reimbursed for their care.
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QUESTIONS?
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