Transitional Care Interventions To Prevent Readmissions for People With Heart Failure - Policymaker Summary | AHRQ Effective Health Care Program

Transitional Care Interventions To Prevent Readmissions for People With Heart Failure - Policymaker Summary | AHRQ Effective Health Care Program

Policymaker Summary – Aug. 9, 2016

Transitional Care Interventions To Prevent Readmissions for People With Heart Failure

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Table of Contents

• Key Issue
• Background
• Summary of Evidence from the Systematic Review
• Considerations for Programs and Policies†
• Source

Key Issue

Readmissions for people with heart failure (HF) are common, costly, and potentially preventable. Targeting preventable HF readmissions is a potential strategy for reducing overall health care costs from both societal and payer perspectives. This is a summary of a systematic review evaluating the evidence regarding the efficacy, comparative effectiveness, and harms of transitional care interventions (defined in Table 1) that aim to reduce readmissions and mortality for adults hospitalized with HF. The systematic review included 47 studies published from 1990 to October 29, 2013.

Background

Heart failure (HF) is a major clinical and public health problem and a leading cause of hospitalization and health care costs in the United States. Despite a decline in HF-related hospitalizations during the past decade, readmission rates for patients with HF have not decreased. Up to 25 percent of patients hospitalized with HF are readmitted within 30 days.

A preventable readmission is defined as one occurring within 30 days of discharge and is clinically related to the previous admission if there was a reasonable expectation that it could have been prevented by providing quality care in the initial hospitalization, adequate discharge planning, adequate postdischarge followup, or improved coordination between inpatient and outpatient health care teams. Beginning in 2012, the Centers for Medicare & Medicaid Services implemented the Hospital Readmissions Reduction Program (HRRP), which reduces payments to hospitals with excess readmissions for HF.

The rate of preventable readmissions may be reduced by transitional care interventions, which are defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer from the inpatient setting to alternative care (see Table 1). Some transitional care interventions may be used in combination with each other.

The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) Guideline for the Management of Heart Failure focuses on the importance of optimizing HF pharmacotherapy and providing HF education before discharge and recommends a followup visit within 7 to 14 days of discharge. This guideline also recommends initiating multidisciplinary-HF disease-management programs for patients at high risk for readmission. This systematic review adds to our understanding about components of transitional care interventions that improve outcomes in patients with HF.