Investigating the Effects of a Pre‐ and Post‐Discharge Intervention on Access to Care and 30‐Day Readmission Rates of CHF Patients at the Phoenix VA Medical Center

Abstract

Significance: Cardiovascular disease represents the single most costly and common cause of hospitalizations in the US. More alarmingly, congestive heart failure (CHF) represents the largest cause of preventable hospitalizations. The 30‐day readmission rate after a hospitalization for CHF is an increasingly important measure of quality in the management of this chronic condition. Interventions targeted at CHF patients after discharge should address access to care and early follow‐up, and should be investigated as a means of decreasing 30‐day readmissions and improving patient outcomes. The Phoenix VAMC created a new early‐follow up clinic in 2011, and this study was the first investigation of outcomes from the intervention. Methods: Patients were selected who were admitted to the Phoenix VAMC with a primary diagnosis of heart failure (ICD‐9: 428.x). Patients referred to the early follow‐up clinic by their primary medicine team were our cohort of interest; patients which underwent standard care and served as our controls. A retrospective chart review was done to assess health status, compliance with the intervention, and 30‐day outcomes, the patient level outcomes. We also compared patients in two time periods, before and after the intervention was implemented, the hospital level outcome. Statistical analysis of this cohort study was done by identifying the relative risk of readmission and death. The RE‐AIM framework was used to determine the hospital‐level impact of the intervention. Results: 275 patients were divided into 116 control patients and 159 intervention patients. The RR of readmission in those referred to the clinic was 1.57 (p=0.09), and mortality was 0.78 (p=0.05). In those patients who were discharged in the post‐intervention time period, the RR of readmission was 0.57 (p=0.036) and 30d mortality was 0.72 (p=0.015). Time to follow‐up was reduced from 15 to 9 days (p<0.01) from the early time period to the late one. Conclusions: The use of care transition interventions have the potential to address issues of rehospitalization, especially in chronic diseases. Establishing a model which improves patient outcomes will have many long‐term benefits for our healthcare system. This intervention decreased mortality and increased readmissions on a patient level, while decreasing both mortality and readmissions on a hospital level, though other factors may be involved.