CHF Longitudinal Workgroup. Addressing readmissions from SNFs and other PAC settings 3/2/17

Transcription

1 CHF Longitudinal Workgroup Addressing readmissions from SNFs and other PAC settings 3/2/17

2 Readmission Rate (%) Readmission Rate from SNF by Hospital (CHF) % Mean = 6.3% 0% Hospital

3 Top 10 Primary Readmission Diagnoses % Of Readmissions Primary Diagnosis 9.4% Unspecified septicemia 8.3% Acute on chronic diastolic heart failure* 7.0% Acute on chronic systolic heart failure* 4.8% Acute kidney failure 3.9% Acute on chronic combined diastolic/systolic heart failure* 3.6% Pneumonia, organism unspecified 3.3% Acute and chronic respiratory failure 3.1% Hypertensive heart and chronic kidney disease with heart failure* 2.8% Acute respiratory failure 2.4% Subendocardial infarction, Initial episode of care

4 Readmission Rate Readmission Rate from SNF 45% 40% 35% 30% 25% 20% readm_rate 15% 10% 5% 0% Skilled Nursing Facility (N=98)

5 Strategies to Reduce Readmissions from SNFs and other PAC settings Review for CHF Longitudinal Workgroup March 2 nd, 2017

6 General strategies Multicomponent interventions more likely to have sustainable success 1,2,3 Most successful multicomponent interventions include: 1. Attention to medication reconciliation and discontinuation of highrisk geriatric medications when not indicated 4 2. Elimination of safety hazards: minimize use of urinary catheters and other indwelling devices at time of discharge 4 3. Advanced care planning: include information about short and long term prognosis, expectations about PAC setting, discussion of goals of care 3

7 Examples of Successful Interventions Interventions to Reduce Acute Care Transfers (INTERACT) most rigorously studied of multicomponent PAC interventions 3 Project ReEngineered Discharge (RED) Both include 3 important components mentioned on previous slide, plus: Tools to enhance inter- and intra-facility communication Training to manage common medical conditions that may precipitate rehospitalization Enhanced follow-up procedures

8 INTERACT Model One study implemented model in 30 community-based nursing homes in Florida, Massachusetts and New York. Administrative support and an on-site champion required for participation. 2 Facilities required to implement the following tools: Stop and Watch Tool The Situation, Background, Assessment, Recommendation Communication Form The Resident Transfer Form and Transfer Checklist Quality Improvement Review Tools for residents transferred to acute hospital

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10 INTERACT Model Following six months of biweekly training by an experienced nurse practitioner: 17% reduction in self-reported hospital admissions compared to the same 6 month period from the year prior 2 24% reduction among the most engaged facilities 2 All tools freely available at:

11 Project ReEngineered Discharge (RED) Comprehensive transitions of care approach Creation and review of personalized care plan with patients and families Medication lists Follow-up appointments PCP contact information Advanced directives Project RED software integrated into electronic medical record of SNF One study conducted in a 50-bed subacute unit in Boston observed a 8.7% reduction in the rate of hospitalization during the intervention 5 More information here:

12 In Conclusion Effective interventions share certain features Having multiple components that span the inpatient and outpatient setting Delivery by dedicated transitional care personnel Use limited resources to focus efforts on patients at higher risk of readmission 6, 7, 8 : Advanced age Polypharmacy Decreased functional status

13 Sources 1. Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann. Intern. Med. 2011; 155: Google Scholar 2. Ouslander JG, Lamb G, Tappen R, Herndon L, Diaz S, et al. Interventions to reduce hospitalizations from nursing homes: Evaluation of the INTERACT II collaborative quality improvement project. J. Am. Geriatr. Soc. 2011; 59: Google Scholar 3. Kripalani S, Theobald CN, Anctil B, Vasilevskis EE. Reducing hospital readmission: Current strategies and future directions. Ann Rev Med. 2014; 65: Google Scholar 4. Borenstein J, Aronow H, Bolton L, Choi J, Bresee C, Braunstein GD. Early recognition of risk factors for adverse outcomes during hospitalization among Medicare patients: a prospective cohort study. BMC Geriatr. 2013:13. Google Scholar 5. Berkowitz RE, Fang Z, Helfand BKI, Jones RN, Schreiber R, Paasche-Orlow MK. Project ReEngineered Discharge (RED) lowers hospital readmissions of patients discharged from a skilled nursing facility. J. Am. Med. Dir. Assoc Google Scholar 6. Evans RL, Hendricks RD. Evaluating hospital discharge planning: a randomized clinical trial. Med. Care. 1993; 31: Google Scholar 7. Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, et al. Reduction of 30-day post discharge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J. Hosp. Med. 2009; 4: Google Scholar 8. Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999; 281: Google Scholar