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

ACC Continues Launch of Patient Navigator Program

John Gordon Harold, MD, MACC, president of the ACC attends the launch of the Patient Navigator Program at UCLA Medical Center.

John Gordon Harold, MD, MACC, president of the ACC attends the launch of the Patient Navigator Program at UCLA Medical Center.

The rollout of the ACC’s Patient Navigator Program continues with program launches this week at Ronald Reagan UCLA Medical Center in Los Angeles, CA, and Christiana Care Health Services in Wilmington, DE.

“The ACC Patient Navigator Program will serve as a test for innovative, patient-centered solutions to address issues that impact patient health and patient readmissions,” said ACC President John Gordon Harold, MD, MACC. “The [first participating] hospitals will serve as pioneers in a new approach to heart disease treatment and care that puts emphasis on meeting patients’ ongoing needs and helping patients make a seamless transition from the hospital to the home.” Continue reading

The ACC Patient Navigator Program Rollout Continues

With increased penalties in effect for hospitals with excessive readmissions for heart attack and heart failure, last year the ACC launched a program that applies a team approach to keeping patients at home and healthy after discharge.

The ACC created the Patient Navigator Program to support a team of caregivers at selected hospitals to help patients overcome challenges during their hospital stay and in the weeks following discharge when they are at most risk for readmission. Hospitals have been given funding to establish a program that supports a culture of patient-centered care that can potentially be implemented in other hospitals in the future. 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

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

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!

Heart Failure Performance Measures and Best Practices

This post was authored by Dick Kovacs, MD, FACC, former chair of the ACC Board of Governors and chair of the Best Practices and Quality Improvement Subcommittee, part of the College’s Clinical Quality Committee.

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The ACC, the American Heart Association, and the American Medical Association–Physician Consortium for Performance Improvement have released updated performance measures for adults with heart failure (HF) in order to provide further guidance to clinicians on the provision of optimal patient care.

Heart failure is a condition that occurs when the heart can no longer pump enough blood to meet the needs of the body. Because heart failure is often chronic, heart failure patients must work closely with their cardiovascular care team to not only slow the progression of the disease but also control symptoms and improve quality of life.

The newly released performance measures include care provided in both the outpatient and inpatient setting, emphasizing the need to measure care quality over time and across providers, while also focusing on functional outcomes.

The release of these performance measures are a timely reminder about the varied ACC resources to help manage heart failure patients, chief among them the new Heart Failure Practice Solutions “toolkit,” which provides easy access to nine tools (one for patients and eight for clinicians). This toolkit is intended to help cardiovascular professionals and others brush up on guideline recommendations for HF care; understand what to report for HF performance measures; prescribe appropriate drug therapies for HF patients; provide quality education and self-management strategies to patients; and assess performance improvement.

The Hospital to Home (H2H) Initiative led by the ACC and the Institute for Healthcare Improvement is another important resource for hospitals and cardiovascular care providers interested in improving heart failure patient transitions from hospital to “home.” Implementation of the H2H principles may help institutions avoid federal penalties associated with high readmissions rates. The H2H initiative challenges communities to better understand and tackle readmission problems through use of recommended tools and improvement strategies in three core concept areas: Early Follow-up, Post Discharge Medication Management, and Patient Recognition of Signs and Symptoms.

Beyond heart failure, the College has identified several other areas where the quality of care could be improved using recommended guidelines, appropriate use criteria and/or performance measures. I, working along with other ACC leaders and staff, am currently working to identify best practices for both atrial fibrillation and coronary revascularization. Similar to the Heart Failure toolkit, tools for each will range from web-based forms and check lists to pocket guidelines. It is our hope these tools will introduce real-time, easy-to-use solutions that cross the spectrum of quality, advocacy, and education and bring about real change.

For more details on the new Heart Failure Performance Measures as well as ACC resources, click here.

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.