Does Participation in the Community Integrated Healthcare Program Reduce Heart Failure Readmissions

Abstract

PURPOSE: Perform a program evaluation of the paramedicine transitional care program, the Community Integrated Healthcare Program, to determine its effectiveness in reducing heart failure 30-day readmissions compared to usual care. BACKGROUND: Heart failure is the leading cause of 30-day readmissions in the country with a rate of approximately 21.9%. Heart failure affects 6.2 million Americans and the incidence is expected to grow to 8 million by 2030. Additionally, the cost of treating heart failure is 30.7 billion dollars annually and is anticipated to double by 2030. The complexity of managing heart failure and high rate of complications has prompted the development of transitional care programs aimed at reducing readmissions. METHODS: This is a program evaluation using a quantitative, retrospective design. Data was gathered from the Zoll ® EMS Mobile Health EHR to describe the demographics of the Community Integrated Healthcare Program population and discover the 30-day heart failure readmission rate of participants. This was compared to the readmission rates of the two hospitals that refer to the program (obtained from the Center for Medicare and Medicaid Services) using a two-sample t-test of proportions. RESULTS: There were 13 females (48%) and 14 males (52%) with a mean age of 81.7  2.846. The 70-79-year age bracket represented 33.3% of the sample, the 80-89 year age bracket represented 37%, and the 90-99 year age bracket represented 22.2%. Days from discharge to the first home visit varied from 3 to 22 days (median 6.5), and the number of visits within 30-days ranged from 3 to 8 (median 5). Participation in the Community Integrated Healthcare Program significantly reduced heart failure readmissions compared to the total readmission rate of the referring hospitals (p= 0.0477). CONCLUSION: This project shows encouraging results as to the effectiveness of the Community Integrated Healthcare Program in reducing heart failure 30-day readmissions. The program evaluation was able to identify areas of success, and areas for improvement in the program. Additionally, a new role for the Doctor of Nursing Practice prepared nurse practitioner has been identified.