Readmission Rates of Newly Diagnosed Congestive Heart Failure
Congestive heart failure (CHF) is a major public health problem that affects several families and communities all over the world. Approximately 5.7 million American have CHF disease, with a significant percentage of the newly reported cases being adults of age above sixty-five (American Heart Association, 2013). The reported annual number of hospitalization in the United States have been increasing over the past 25 years from 800,000 to over 1 million for primary diagnosis and from 2.4 to 3.6 million for secondary diagnosis and readmissions (Center for Disease Controls, 2013). In this case, readmission is defined as a hospitalization of CHF patients occurring shortly after discharge; “shortly” often describes a period of 30 days though it could be shorter or longer. A large number of readmission for CHF patients could be caused by issues related to noncompliance with the initial treatment given.
In spite of the recent advance in CHF-related medical care, increased readmission rates have raised concern, particularly when treating such patients. It is approximated that half of the newly diagnosed CHF patients are readmitted within six months of discharge from the hospital, with seventy percent of them reporting a worsening health condition (Hosenpud et al., 2007). The direct costs incurred by the newly admitted CHF patients were estimated to be at $39.2 billion in 2012 with additional unplanned readmissions costing $17.4 billion (Ross et al., 2010). Thus, lowering readmission rates is crucial in the provision of improved patient safety as well as lowering health care costs associated with such treatment.
Recently, greater emphasis has been placed on evidence-based practices. The Joint Commission on Accreditation of Healthcare Organization (JCAHO) now requires the use of core measures for specific diseases such as CHF (Hall et al., 2012). These actions include the assessment of the left ventricular function (LVF), provision of smoking cessation counseling and the prescription of angiotensin-converting enzyme inhibitor (ACEI). The patients have also been provided with discharge education that encompasses discharge medications as well as some prescribed activities including follow-up appointments (Linden & Butterworth, 2014). The knowledge on medication as well as discharging terms is quite significant in nursing practice.
Literature studies related to congestive heart failure and other cardiovascular diseases indicates that three-quarters of patients diagnosed with CHF are over the age of 65. Management and care of such patients provide a significantly more complex task since most of them suffer from multiple comorbidities. Such patients may also have some other functional limitations associated with their age, and may be involved in the consumption of the additional set of medication, thus, increasing their risk for CHF development and subsequent hospital admission and readmission (Ross et al., 2010).
There is no cure for CHF, but the condition can be managed through the use of heart failure medications as well as embracing lifestyle changes as advised by the physician. It is believed that patients would adopt lifestyle change if proper education related to their health condition is given to them. As from the year 2012 onwards, the Center for Medicare and Medicaid Services (CMS) in the United States reduced payments made to hospitals that reported excess readmission rates for patients diagnosed with various conditions, and by extension the congestive heart failure. The statistics derived from the US. Department of health indicates that CHF is the cause of greater than 250,000 deaths annually (Center for Disease Controls, 2013).
Although the admission rates for CHF patients increased from 2000 and 2010, the significant percentage of them are discharged to skilled nursing facility (SNF) while the rest are discharged to their homes. The readmission rates in patients discharged to their homes were found to be higher compared to those discharged to SNF, and this could be attributed to poor self-care management in their homes. Patients who are discharged to SNF facility reported a persistent readmission to hospital particularly within 30 days of discharge. This regular and frequent readmission of such patients was attributed to the failure of the facility’s health care personnel in providing continuous recommended follow-up (Rich et al., 2005).
Between the year 2000 and 2006, the patients discharged to SNF facility recorded an increased readmission by whopping 29% margin. For instance, 23.5% of all hospitals discharging CHF patients to SNF facility reported a direct readmission of all patients in a period of fewer than 30 days. Randomized control trials done in SNF facility showed that prevention of CHF readmission resulted in a promising reduction of readmission rates by a margin of 20% to 40%.
The threat to reduce and withhold a portion of medical reimbursements made some hospitals and researchers to resort to some frantic efforts aimed at examining their daily care practices. 43 studies were done by various researchers in different hospitals with the goal of analyzing some proposed intervention measures of reducing hospital readmissions. Only 16 of the measures proposed were found to be effective, though, none was found to be consistent in reducing readmission in CHF patients (In Rahko, 2014).
Another similar study examined the effect of evidence-based interventions on readmission rates in a community setting. The results of the study suggested that a stand-alone community hospital would find it difficult to reduce readmissions even after evidence-based interventions are made. Better collaboration between hospitals and other community healthcare providers was necessary to facilitate care and teaching long after the patients are discharged (In Rahko, 2014). A multi-disciplinary approach to interventions led by a nursing practitioner can improve the quality of life of patients while minimizing medical costs associated with the care process. On that note, some progress has been made particularly in determining patient education right after discharge. However, much of the research works on this subject lacks consistency. Therefore, it demands some further research to be conducted so as to determine the existing trends and map out solutions.
Readmission rates tend to be higher when psychosocial and/or economic factors limit adherence and compliance with medication, follow-ups, and self-monitoring. For instance, patience with these predisposing risk factors tends to cluster according to the geographical locality of their hospitals. Resource limitation also matters for healthcare institutions just as for individuals and thus influence the tendency for higher readmission of CHF patients in hospitals that are publicly owned. Local practice routines and patterns are also important in determining the readmission rates of patients with CHF. That is, hospitals that record high overall rates of admission tend to register significantly higher margin of readmission as compared to other hospitals with lower overall admission rates. Also, readmission rates are independent of the heart transplant capability of the healthcare facility, perhaps because transplant programs tend to concentrate on younger population with more severe cardiac disease but fewer comorbidities.
A special report focusing on whether to predict or prevent congestive heart failure suggests that early readmissions after hospital discharge could be assumed to indicate an incomplete treatment offered by the hospital, poor coordination and communication of services, and inadequate access to care in an early follow-up. The report further suggests that a comprehensive discharge planning that includes patient and caregiver education may reduce early readmission rates by as much as 25%. The special report thus recommends the exploitation of management opportunities across the full continuum of care from hospital to home, including the ambulatory clinic.
Emory University conducted a similar research with the aim of exploring the impact of incorporating family into patient teaching. The reflection of this research established that some family interventions were beneficial to the CHF patient. This research pointed to some other gray areas that require some further research including family functioning, problem-solving communication, and family support. All of the mentioned areas are important in conducting future research.
Some of the intervention measures that are currently in place to reduce CHF patient readmission rates come at both the policy level and as individual responsibility. Some of the policies feature change programs that are funded by the Center for Disease Control (CDC) within the state health department. These programs aim at monitoring the incidence of CHF diagnosis as well as encourage physical activity and healthy eating. Also, the American Heart Association (AHA) emphasizes on taking a personal responsibility through helping CHF patients acquire vital tools such as trackers and logs as well as tips to avoid contracting flu and pneumonia. The trackers could record everything ranging from blood pressure, weight, angina, and cholesterol among others.
The field of heart failure and particularly patient admission and readmissions have had little research in the recent times. Statistics concerning readmission of CHF rates have been mounting over time, and with that comes the demand to study and learn how to control them. As the studies are being put together, knowledge concerning care for individuals suffering from congestive heart failure will be made available, giving patients and hospitals a better chance to embrace and expect better outcomes from it.
Application of Knowledge on Rates of CHF Patients Readmissions to Nursing Practice
At a time when healthcare leaders are driven to reduce service inefficiency and a waste of time as well as money, elimination of unnecessary readmissions has been identified as a desirable and achievable target as evidenced by the extensive research content available. Both nursing practitioners and policymakers agree that such readmissions are often but not always related to a problem inadequately solved in the recent hospitalization, such as CHF (Rich et al., 2005). From the research information and data available on this field, nursing practitioners will learn that readmissions can be caused by deterioration in the patient’s health as a result of inadequate management of their condition, or lack of appropriate services and medication after discharge.
The knowledge on rates of CHF patients’ readmissions helps a nursing practitioner to develop interventions that will bring down the numbers of readmissions. Such efforts will improve the quality and safety of care as well as the transition to outpatient care. Such concerted efforts aim at ensuring continuity and coordination of healthcare providers and timely access to follow-up services. Redesigning the process of care for congestive heart failure patients is one such effort which a nurse will put in place to reduce high rates of readmissions. The new design of healthcare will feature close coordination of care in the post-acute period, enhance patient education, put in place a proactive counseling as well as offer clinical expertise available to CHF patients.
Also, the nursing practitioner will need to focus on post-discharge follow-up on CHF patients, so as to ensure that appropriate care is extended to them. Such intervention measures will guarantee that patients do not “fall off a cliff” after returning home. This means that the hospital will provide support services to such patients even after discharge regardless of an envisaged higher short-term costs. One of the simplest method used in conducting follow-ups will be through making telephone calls to the CHF patient, one week or so after discharge. Such action will ensure that the nurse will be in constant touch with the CHF patient and that any changes in medication or health status will be given the necessary attention at the earliest possible stage, thus preventing a case of patient readmission.
Collaboration with community providers to promote a continuum of care is another application of the rates of CHF readmissions. This will feature a close communication between inpatient and outpatient providers, thus, enhancing patient care transitions and ultimately reducing patient readmissions. The hospital can also acquire an outpatient heart clinic on site to which patients with CHF at discharge are referred to. Having such resource centers on the site will enable nurses to cure the patient, and in doing so, patient readmission will be avoided.
Both the hospital and the CHF patient are set to benefit if search intervention measures are rolled out in the healthcare sector. For example, setting up of patient follow-up services will ensure that patients are attended to in outpatient care facilities thus reducing readmission costs. It is also advantageous for the patients because care services will be within reach. High short-term cost proves to be a disadvantage if such change is to be implemented. For instance, the change will require the employment of additional care providers as well as the acquisition of extra facilities to handle community outpatient services. Thus, the barriers to change in reducing higher rates of readmissions may be attributed to higher short-term costs.
Implication for Future Research
The discharge teachings and lessons given to patients diagnosed with congestive heart failure needs to incorporate evidence-based practices which will reduce the risk to readmission to the hospital. This research study points to the fact that there is a missing link between the education that is delivered to the patients and what they are willing to incorporate into their lifestyles. Thus, future research should be directed to determining whether the problem lies in the information delivery or lack of CHF patient motivation. It is also recommended for the healthcare providers, particularly the nurses to understand the patient learning style before delivering some discharge instructions. This will ensure that the patient improves in the retention and implementation of the recommended practices.
Earlier detection of non-compliance with the information given could lower the level of readmission of patients with CHF. This is in support of the study and other published research on the topic. Thus, this study confirms that further research is needed in this area to determine the best plan to implement changes in the healthcare sector. Also, the gray areas exposing the trends and effect of family relationships and bonding in relation to patient compliance with instructions should be further researched so as to come up with a correct implication on the topic.
Congestive heart failure is an incurable chronic disease. The only available treatment for patients suffering from CHF includes the improvement of cardiac function, improving the quality of life as well as reducing the symptoms associated with it. The unplanned readmission rate of CHF patients within the period of 30 days is around 25%, with most of those readmitted being 65 years and above (Hall et al., 2012). However, from the research studies discussed in this paper, there exist several measures which if implemented could lead to an overall reduction of readmission rates in the United States. Such actions require a multi-disciplinary team approach and encompass giving the patient discharge instructions and some follow-up from the hospital which ensures that the patient is not left alone.
The study also sought to examine the elements of retention of the teachings by individual patients as well as their perception of adherence to the recommendation given to them. The study further puts a substantial burden on patients, families and care systems and illustrates that CHF patients may experience a declining health condition but may not necessarily be as a result of the previously treated condition.
The data provided in the literature review section, as well as the application of the knowledge on CHF patient readmission rates, provides evidence that the introduction of the current state-of-the-art technology in the health sector may help in changing and reducing the readmission rates of patients in hospitals.
American Heart Association. (2013). Coronary Artery Disease. Retrieved from http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Co ronary-Artery-Disease—Coronary-Heart-Disease_UCM_436416_Article.jsp
Center for Disease Controls. (2013). Heart failure fact sheet. Retrieved from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm
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