Heart failure is a growing health burden and a leading cause of hospital readmissions. Small gains have been realized over the past five years although about 20% of patients are still readmitted every month and the rate could rise to 50% within six months (O’Connor, 2017). Although it is difficult to predict who could be readmitted, much remains unexplained. According to O’Connor (2017), hospitals play a critical role in heart failure readmissions. The health system is made up of a network of hospitals providing both primary and tertiary care. Skilled nursing facilities, ambulatory centers, transitional care systems, and subspeciality groups are all part of the complex system (Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013). With some factors at play, the first is the fact that admission of heart failure patients is controlled by the admission criteria in the health system. The availability of emergency room services and same day access clinics are influential in establishing whether a patient is readmitted. Therefore, it is essential to establish factors responsible for re-hospitalization of heart failure patients and possible strategies to improve the situation. The information on the topic was obtained from peer reviewed journal articles, which are perceived to be reliable sources of information.
Research Question
The study seeks to answer the question: Are the readmission rates for congestive heart failure improving? What can be done to improve the situation?
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Heart Failure Readmissions
A large number of Americans are living with the problem of congestive heart failure. A study by Bergethon, Christine, DeVore, Hardy, Fonarow, Yancy, et al. (2016) indicates that about 5.7 million Americans have the condition and the number could increase by 46% between 2012 and 2030 whereby an estimated 8 million Americans will have the condition. Heart failure is among the leading causes of hospitalization in the U.S. In 2012 alone, the cost of heart failure hospitalization was about $30.7 billion with Medicare median risk-standardized 30-day readmission being 23.0% (Ziaeian & Fonarow, 2016). Researchers and policymakers are usually interested in the readmissions since they can help diagnose a solution for poor quality of care and excessive medical expenditures. The Affordable Care Act (ACA) established a financial penalty for excessive readmissions rates for hospitals, a value that was capped at 3% of total Medicare payments beginning 2015 and beyond. The law had initially not provided any disincentive to reduce the readmissions rates. The Centers for Medicare and Medicaid Services are currently assessing adjusted 30-day readmission rates for heart failure, pneumonia, and acute myocardial infections among other conditions. The objective is to improve quality, patient interventions foe effective prevention, and reduction of readmissions.
The causes of congestive heart failure readmissions have been attributed to several factors. A study by O’Connor (2017) notes that hospitals play a critical role since the establishment of whether to admit a patient or not is based on the emergency room teams’ decisions and availability of same access clinics. Hospitals having low cases of heart failure cases also report low readmission rates thereby implying that the organizations structure of the health facility is important (O’Connor, 2017). The other determinant is the course and care of heart failure patients through the hospital. Other causes are the responsibilities of the hospital such as implementation of evidence-based therapy, patient education, and socio-economic barriers.
The burden of heart failure hospitalization is noteworthy over the years. The management of the condition has improved over the decades with health facilities enhancing provided medical therapies and interventions that have enabled patients to live with the disease for long. Improvements include reduced period of hospital stay and 30-day mortality, though rates and discharges to skilled nursing care facilities have also been on the rise. Readmission risks include the length of stay and the degree of decongestion within a health facility. Bergethon et al. (2016) reported that the daily risk of readmission was highest on day 3 after discharge and lowest after 38 days after discharge. Patients with an index heart failure admission have elevated risks of readmission for at least once annually. Besides, index heart failure is a significant pointer toward increased morbidity and mortality extending beyond 30 days and shows the severity of the illness as well as the importance of close evaluation and management.
The solution to the problem of congestive heart failure 30-day readmissions rate can be found by addressing the causative issues. O’Connor (2017) began by advising hospitals to maintain the patients in the hospital for longer periods. Having the patients take a longer period in the hospital ensures that they are well taken care of and are fully healed before being discharged. When the patient stays longer at the hospital, he or she will be educated and be informed about the condition, the causes, and care. Besides, staying longer in the hospital allows physicians and nurses to optimize medical therapy and improve outcomes thereby minimizing re-hospitalization.
The 30-day risk adjusted readmission rates can also be attributed to other two factors. First is the management program at the hospital followed by education levels. According to Ambrosy et al. (2014), hospitals that referred patients to heart failure disease management programs reported low relative adjusted readmission rates compared to those that did not. Besides, findings from a study by Gheorghiade, Vaduganathan, Fonarow, and Bonow (2013) reported that teaching hospitals had reported higher risk-adjusted readmission rates compared to nonteaching hospitals. The reason is that nonteaching hospitals were more likely to refer patients to heart failure disease management programs compared to teaching hospitals.
The findings are supported by a report by Bradley, Curry, Horwitz, Sipsima, Wang, Walsh, et al. (2013) who argued that patient education or information about the condition affects the healing process, thereby resulting in low readmissions. A smooth transition of the patient from the hospital to clinics and allowing him or her to gain access to health services up to 7 days after discharge can further reduce readmission. At the hospital, the patient should be allowed to see familiar physicians in a follow-up network. Furthermore, the hospital should implement several transition strategies to allow patients move from hospitals to nursing care centers.
Conclusion
The essay investigated the problem of high hospital readmission rates for congestive heart failure patients. It is evident that the 30-day readmission rate for the condition is still high despite the efforts to solve the problem. Hospitals, emergency room services, and availability of skilled nursing facilities are some of the factors responsible for the persistence of the problem. Hospitals that are likely to have high harm rates for their patients have often been penalized after the ACA introduced the penalty in 2015. The ability of health facilities to implement bundled care initiatives and coordination of care with skilled nursing facilities can play a critical role in minimizing heart failure readmissions rates.
References
Ambrosy, A., Fonarow, G., Butler, J., Chioncel, O., Greene, S., Sato, N. et al. (2014). The global health and economic burden of hospitalizations for heart failure: Lessons learned from hospitalized heart failure registries. Journal of the American College of Cardiology, 63 (12), 1124-1133. DOI: 10.1016/j.jacc.2013.11.053.
Bergethon, K., Christine, J., DeVore, A., Hardy, C., Fonarow, G., Yancy, C. et al. (2016). Trends in 30-day readmission rates for patients hospitalized with heart failure: Findings from the GWTG-HF registry. Circulation: Heart Failure, 9 (6). Doi: 10.1161/CIRCHEARTFAILURE.115.002594. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928632/
Bradley, E., Curry, L., Horwitz, L., Sipsima, H., Wang, Y., Walsh, M. et al. (2013). Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circulation: Cardiovascular Quality and Outcomes, 6 (4), 444-450. Originally published1 Jul 2013 https://doi.org/10.1161/CIRCOUTCOMES.111.000101
Gheorghiade, M., Vaduganathan, M., Fonarow, G., & Bonow, R. (2013). Rehospitalization for heart failure problems and perspectives. Journal of the American College of Cardiology, 61 (4), 391-403. Retrieved from http://www.onlinejacc.org/content/61/4/391.abstract
O’Connor, C. (2017). High heart failure readmission rates: Is it the health system’ s fault? JACC: Heart Failure , 5 (5), 393.
Ziaeian, B., & Fonarow, G. (2015). The prevention of hospital readmissions in heart failure. Prog. Cardiovascular Dis. 58 (4), 379-385. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783289/
