A Look at Trends in Cardiovascular Hospitalizations and Outcomes

This post was authored by Harlan M. Krumholz, MD, SM, FACC, member of the ACC Board of Trustees.

In cardiology we need to measure our achievements by what we have done for patients and populations. It is not enough to brag about new programs provided or treatments delivered. In the end we need to know the results we have achieved.

Such information, however, is not easy to obtain. We do not have the type of integrated national data that would provide a surveillance system. However, the Medicare Fee-for-Service system does have records stretching back more than a decade that can be accessed and analyzed to determine trends in hospitalization rates and outcomes. Continue reading

Fine-Tuning Readmission Reduction Strategies to Improve Patient Care

This post was authored by Scott Hummel, MD, FACC, from the VA Ann Arbor Healthcare System.

With heart failure (HF) readmissions for Medicare patients in southeast Michigan surpassing the national average of 24.4 percent in 2010, the ACC’s Michigan Chapter decided to take the problem head on by joining together with Michigan’s  Quality Improvement Organization, MPRO, and the Great Detroit Area Health Council to form the  Southeast Michigan “See You in 7” Hospital Collaborative. The goal: increase the number of follow-up appointments scheduled within seven days of discharge by implementing lessons learned from ACC’s Hospital to Home (H2H) early follow-up challenge, “See You in 7.” This post is part of a series on H2H at the local level. Continue reading

Overcoming Challenges to Reduce Readmissions

This post was authored by Marie Boyle Reinman, RN, director of heart and vascular services and critical care nursing at Beaumont Hospital in Grosse Pointe, MI; and Sarine John-Rosman, MD, FACC.

With heart failure (HF) readmissions for Medicare patients in southeast Michigan surpassing the national average of 24.4 percent in 2010, the ACC’s Michigan Chapter decided to take the problem head on by joining together with Michigan’s  Quality Improvement Organization, MPRO, and the Great Detroit Area Health Council to form the  Southeast Michigan “See You in 7” Hospital Collaborative. The goal: increase the number of follow-up appointments scheduled within seven days of discharge by implementing lessons learned from ACC’s Hospital to Home (H2H) early follow-up challenge, “See You in 7.” This post is part of a series on H2H at the local level.

Beaumont Grosse Pointe is a 280 bed community hospital and it was felt we might have an easier time getting our arms around the HF readmission issue due to our size.  We chose the metrics we thought would have the biggest impact: Continue reading

Lessons Learned From Implementing a Readmissions Reduction Program

This post was authored by Jacqueline Jones, MSN, APN-BC, CEN-CEN, manager of NP/PA cardiovascular services at Crittenton Hospital Medical Center; Jill Klaver, JD, RHIA, medical staff quality specialist at Crittenton Hospital Medical Center; and Samer Kazziha, MD, FACC, executive medical director, cardiovascular program at Crittenton Hospital Medical Center.

With heart failure (HF) readmissions for Medicare patients in southeast Michigan surpassing the national average of 24.4 percent in 2010, the ACC’s Michigan Chapter decided to take the problem head on by joining together with Michigan’s  Quality Improvement Organization, MPRO, and the Great Detroit Area Health Council to form the  Southeast Michigan “See You in 7” Hospital Collaborative. The goal: increase the number of follow-up appointments scheduled within seven days of discharge by implementing lessons learned from ACC’s Hospital to Home (H2H) early follow-up challenge, “See You in 7.” This post is part of a series on H2H at the local level. Continue reading

Integrated Care: The Writing is on the Great Wall

This post was authored by Shal Jacobovitz, CEO of the ACC.

ACC staff joined me for a great meeting with the Chinese Society of Cardiology.

ACC staff joined me for a great meeting with the Chinese Society of Cardiology.

Last week I joined ACC President John Gordon Harold, MD, MACC, and other College leaders at the 24th Great Wall International Congress of Cardiology (GW-ICC). It was truly an honor to be a part of this remarkable event. For me, the meeting’s focus on “Integrated Medicine” was particularly opportune given that it fits nicely under the theme of “Transformation of Care” – one of the five main themes the College is addressing as part of its strategic planning process.

Continue reading

Reducing Readmissions: A Success Story

This post was authored by Joy A. Pollard, PhD, RN, ACNP-BC, Southeast Michigan “See You in 7” Hospital Collaborative planning committee member.

With heart failure readmissions for Medicare patients in southeast Michigan surpassing the national average of 24.4 percent in 2010, the ACC’s Michigan Chapter decided to take the problem head on by joining together with other local organizations to form the  Southeast Michigan “See You in 7” Hospital Collaborative. The goal: increase the number of follow-up appointments scheduled within seven days of discharge by implementing lessons learned from ACC’s Hospital to Home (H2H) early follow-up challenge, “See You in 7.”  Continue reading

H2H “See You in 7” Tools Updated for Cardiac Rehab Awareness Week

This post was authored by Marjorie King, MD, FACC, MAACVPR, past president and chair of the Professional Liaison Committee of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).

The ACC and American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) have a longstanding relationship, and as a result, have developed a variety of tools for physicians and their patients to use to encourage participation in cardiovascular rehabilitation (cardiac rehab).

As clinical practice guidelines highly recommend cardiac rehabilitation after cardiac events such as a myocardial infarction to improve mortality, quality of life and functional capacity, the ACC’s Hospital to Home (H2H) program stresses that it is important for a patient to have a referral for a cardiac rehab program within 7 days following discharge after a myocardial infarction. This recommendation is not by chance – there is now good evidence showing that the sooner a patient enrolls in cardiac rehab, the better their likelihood of attending regularly, which will then lead to better outcomes.  There is also evidence that participation in cardiac rehabilitation improves adherence with preventive medications and decreases depression and anxiety.

Just in time for Cardiac Rehabilitation Awareness Week, the ACC and AACVPR worked together to update the cardiac rehab resources in the “See You in 7” toolkit available on the H2H website. The resources allow for managers, nurses, and others working on care coordination to appropriately incorporate cardiac rehabilitation into patients’ treatment to help decrease readmissions related to misconceptions about medications or symptoms.

In order to emphasize the importance of cardiac rehab, the ACC and the AACVPR have developed multiple resources for several of the success metrics of the H2H “See You in 7” challenge, including highlights of the 2010 ACC Foundation (ACCF)/ American Heart Association/ AACVPR Cardiac Rehabilitation Performance Measures. In addition, CardioSmart.org has a great overview of cardiac rehab on its newly redesigned website, in addition to a cardiac rehab fact sheet developed by AACVPR available in both English and Spanish, and a CardioSmart Video: Journey Back to Heart Health, about cardiac rehab that can be used in office or hospital settings.

Smart cardiac rehab teams will be making sure that others working on hospital readmissions in their community are aware of H2H and of the materials within the H2H website that can be used to promote cardiac rehab enrollment. It’s time for ACC and AACVPR colleagues within local communities to meet to figure out how and when to use this information, in order to break down barriers to participation in cardiac rehab and improve patients’ health outcomes.

Brace for Impact: The Unintended Consequences of Readmission Penalties

By: Judy Tingley, MPH, RN, member of the ACC’s Clinical Quality Committee.

The Centers for Medicare and Medicaid Services (CMS) readmission payment penalties went into effect on Oct. 1.  Mandated by the Patient Protection and Affordable Care Act, this quality improvement initiative imposes financial penalties on more than 2,200 hospitals with Medicare readmission rates above the national averages.  The unintended consequence of these penalties is yet to be determined.

This new crackdown will have the greatest impact on the “safety net” hospitals that treat our poorest patients.  Current studies demonstrate that much of the variance in readmissions is due to factors beyond the hospital’s control.  Many of these community hospitals have limited resources, antiquated medical records systems, serve late presenting and/or underinsured clients, and are at greatest risk for financially failing.  This reality reaffirms that quality metrics identification and measuring outcomes has never been more important.  As we move toward data driven reimbursement models, it is critical that the implementation of “patient centric quality metrics” does not get lost in the quagmire of financial and regulatory demands.  Quality needs to remain the focus of “quality metrics.”

Of late, safety measure techniques used by the airline industry have been meaningfully translated to health care delivery systems.  Pre-operative checklists (modeled after pre-flight checklists) have significantly improved patient safety.  Just as regular and consistent communication between the crew and air traffic control helps thwart potential problems and keep the skies friendly, so should regulators, payers, hospitals, patients and practitioners communicate to keep patient safety at the forefront.  If not, we should brace for the impact of the unintended consequences of making worse a system that is very much in need of patient centric reform.

Our population is changing and if you’ve seen one patient, you’ve seen one patient.  There will never be a one-size-fits-all model to eliminate readmission.  Therefore, the impact of demographic characteristics, co-morbidities, socioeconomic parameters, post-discharge environmental factors and regional health care delivery disparities all must be considered in strategically planning meaningful cost efficient care.  As our patient population ages the economic impact of this reality is yet to be seen:

  • Half of older women 75+ live alone
  • Persons reaching age 65 have an average life expectancy of 18.1 additional years
  • The 85+ population is projected to increase to 9.6 million in 2030

Improved efficiency and reduction in avoidable readmissions is imperative.  Methods to better identify patients at risk for readmission, reduction of hospital complications, improvement in transitional care and overall communication between providers and patients are important ways of improving quality care.

There remains much work to be done in order to transform today’s health care into the efficient quality centric delivery system needed for the future.  The ACC has taken the lead in providing tools to help practitioners review and provide a transition of care plan.  Specifically, Hospital to Home (H2H) is a national quality improvement initiative developed to help hospitals reduce all-cause readmissions among patients with heart failure or acute myocardial infarction.  As health care providers, we must continue striving toward a coordinated multi-disciplinary strategy to effectively address improving quality of care in a fiscally responsible way.  If we fail, brace for impact!

Collaborative Efforts to Target Poor Medication Adherence

Medication non-adherence is a growing public health concern because there is evidence that this is prevalent problem which is associated with adverse outcomes and higher costs of care. Addressing the problem is especially critical as the number of Americans affected by a chronic condition requiring medication therapy is expected to grow from 133 to 157 million by 2020. Nearly three out of four Americans admit that they do not always take their medication as directed, a problem that causes more than one-third of medicine-related hospitalizations, nearly 125,000 deaths in the U.S. each year, and adds $290 billion in avoidable costs to the health care system annually.

One of several ways the College is working to encourage medication adherence is through the Script Your Future campaign led by the National Consumers League (NCL), a 113-year-old Washington, DC-based consumer advocacy organization. The campaign addresses the need for tools and resources to support medication adherence across the country and opens dialogue between health care professionals and patients about the health consequences of non-adherence. Advocates have found that the messages about the importance of adherence need to come from a variety of places in order for patients to absorb them, and the campaign faces that challenge head-on by partnering with diverse groups, and working to reach patients in a variety of places, and via a variety of relationships – through open dialogue with doctors, pharmacists, nurses, caregivers, and other health care professionals.

This spring marked the first anniversary of the three-year campaign that targets those who suffer from three chronic conditions: cardiovascular, diabetes and respiratory. Script Your Future is operating at both the national level and in six regional target markets across the country – Baltimore, Birmingham, Cincinnati, Providence, Raleigh, and Sacramento – hosting local, grassroots efforts on the ground in these communities to educate patients and their loved ones about the importance of taking medication as directed and to initiate new conversations between patients and their healthcare professionals.

Moving forward, Script Your Future offers several opportunities for Chapters, both in the target markets and nationally as part of the Million Hearts campaign, to increase patient education around the benefits of medication adherence as it relates to the treatment and prevention of heart disease. It also affords opportunities to promote CardioSmart tools, such as the new CardioSmart Med Reminder app. This app is free to iPhone and iPad users and is intended to serve as a medication and prescription refill reminder, as well as a personal medication record, to help patients communicate with health care providers about the medications they are taking.

This summer the ACC and CardioSmart are promoting a “Don’t Take a Vacation from Your Medication” campaign on our social media channels to curb the trend of medication non-adherence and to encourage patients to not forget about taking their medication. Get all of the tips and tools on ACC and CardioSmart’s Facebook pages. Also be sure to follow @ACCinTouch and @CardioSmart on Twitter. You can also learn more about medication adherence in the July/August issue of Cardiology magazine, hitting newsstands later this month, and in the July issue of CardioSource WorldNews. The College’s Hospital to Home (H2H) campaign also has medication adherence as a key component of reducing unwarranted hospital readmissions. You can learn more and take part in the H2H “Mind Your Meds” Challenge at h2hquality.org.

Reducing Readmissions through the H2H Initiative

This post was authored by William J Oetgen, MD, MBA, FACC, ACC’s senior vice president of Science and Quality.

The Hospital to Home (H2H) initiative was launched in 2009 as a joint effort of the ACC and the Institute for Healthcare Improvement. Three years later, the goal of H2H continues to be a 20 percent reduction of hospital readmissions within 30 days for patients admitted with either acute myocardial infarction or heart failure. Three important activities that address core concepts have been identified as targets for improvement:

  1. Medication Management Post-Discharge: Is the patient familiar and competent with his or her medications and is there access to them?
  2. Early Follow-Up: Does the patient have a follow up visit scheduled within a week of discharge and is she or he able to get there?
  3. Symptom Management: Does the patient fully comprehend the signs and symptoms that require medical attention and whom to contact if they occur?

In addition, H2H strives to create a learning community that shares expertise, experience and tools – and works together to improve the transition from hospital to home. The H2H community was developed to address these “challenges.” And, in a remarkable example of collegiality and cooperation, H2H members are collaborating and sharing information to help each other.

Over the past few years since H2H was established, individual and hospital participation in H2H has steadily increased. Currently, 2,294 individuals and 1,326 hospitals (39 percent of all U.S. hospitals) have united around the shared goal of lowering the risk of readmission.

Members of H2H have engaged in lively discussions of challenges and success strategies on the H2H listserv and on webinars designed to share experiences and best practices. We are continuously seeking ways to encourage participation and easier ways to access the tools and resources of the community.

During an ACC.12 session in Chicago, a panel of experts convened to discuss and identify tools and ideas to reduce hospital readmissions including a neighborhood watch solution that enlists trained volunteers from nearby universities to educate patients and make follow-up phone calls. We had several great ideas presented and the discussions underscored how the best way we can find the answer is by working together.

Reducing readmission rates is not straightforward and each institution must tailor its strategy to its particular setting and resources. Research in this area is still evolving, but with available knowledge it is now possible to make progress. In order to be successful and reach our goal, we must continue to learn from what we do – and from each other.

For more information on H2H visit www.H2Hquality.org.