Hospital Readmissions Less Likely for Discharged Heart Failure Patients Who Receive Combined Care

The chance of hospital readmission within 30 days of discharge is roughly 8 percent less for heart failure patients who receive early, intensive nursing services combined with at least one outpatient physician visit during the week following discharge, an AHRQ study concluded. Neither treatment used alone, however, had a significant effect on hospital readmission. The researchers examined almost 99,000 hospital stay records for Medicare patients admitted with heart failure who were discharged to home health care. “Reducing Readmissions Among Heart Failure Patients Discharged to Home Health Care: Effectiveness of Early and Intensive Nursing Services and Early Physician Follow-Up” appeared online July 28 in Health Services Research. Access the abstract.

2016 Jul 28. doi: 10.1111/1475-6773.12537. [Epub ahead of print]

Reducing Readmissions among Heart Failure Patients Discharged to Home Health Care: Effectiveness of Early and Intensive Nursing Services and Early Physician Follow-Up.

Murtaugh CM1, Deb P2,3, Zhu C4,5, Peng TR6, Barrón Y7, Shah S7, Moore SM8, Bowles KH7,9, Kalman J10, Feldman PH7, Siu AL4,5.

Author information

Abstract

OBJECTIVE:

To compare the effectiveness of two "treatments"-early, intensive home health nursing and physician follow-up within a week-versus less intense and later postacute care in reducing readmissions among heart failure (HF) patients discharged to homehealth care.

DATA SOURCES:

National Medicare administrative, claims, and patient assessment data.

STUDY DESIGN:

Patients with a full week of potential exposure to the treatments were followed for 30 days to determine exposure status, 30-day all-cause hospital readmission, other health care use, and mortality. An extension of instrumental variables methods for nonlinear statistical models corrects for nonrandom selection of patients into treatment categories. Our instruments are the index hospital's rate of early aftercare for non-HF patients and hospital discharge day of the week.

DATA EXTRACTION METHODS:

All hospitalizations for a HF principal diagnosis with discharge to home health care between July 2009 and June 2010 were identified from source files.

PRINCIPAL FINDINGS:

Neither treatment by itself has a statistically significant effect on hospital readmission. In combination, however, they reduce the probability of readmission by roughly 8 percentage points (p < .001; confidence interval = -12.3, -4.1). Results are robust to changes in implementation of the nonlinear IV estimator, sample, outcome measure, and length of follow-up.

CONCLUSIONS:

Our results call for closer coordination between home health and medical providers in the clinical management of HF patients immediately after hospital discharge.