Frequent Home Visits Reduce Heart Failure Readmissions, Improve Survival

Frequent home visits combined with multidisciplinary heart failure clinic interventions can reduce hospital readmission and improve survival for patients with heart failure, according to research from RTI International and the University of North Carolina at Chapel Hill.

The number and frequency of visits varied by program, but researchers said face-to-face contact was a common theme among the most effective programs. The multidisciplinary heart failure clinic interventions included contact with physicians as well as dieticians, pharmacists and nurses. The work, based on a report funded by the Agency for Healthcare Research and Quality (AHRQ), was published in the Annals of Internal Medicine.

According to data from AHRQ’s Healthcare Cost and Utilization Project, heart failure is a leading cause of hospitalization and healthcare expenditures in the United States. Nearly 25 percent of patients hospitalized with heart failure are readmitted to the hospital within 30 days of discharge, and readmission can lead to additional health complications and unnecessary costs for patients, insurers and hospitals.

The Centers for Medicare & Medicaid Services (CMS) began reducing reimbursements to hospitals with high readmission rates in 2012. All these factors have led hospitals, insurers, and other healthcare providers to create transitional care programs, which provide services, resources and education to reduce readmission. Heart failure is associated with the highest rate of hospital readmissions among Medicare patients, therefore many programs focus on this condition.

Researchers from the RTI-UNC Evidence-based Practice Center examined the comparative effectiveness and harms of transitional care programs for heart failure patients. They conducted a systematic evidence review of 47 randomized controlled trials of programs that included home visits, outpatient clinic visits, telemonitoring (monitoring physiological data remotely), telephone support, and educational programs.

Programs providing a series of home visits soon after hospital discharge can reduce 30-day readmission rates by 66 percent. Both home visit programs and multidisciplinary heart failure clinics visits can improve mortality and reduce all-cause readmission in the six months after hospitalization. Telephone support interventions do not appear to reduce all-cause readmission, but they can improve survival and reduce readmission related to heart failure. Programs focused on telemonitoring or providing only education did not appear to reduce readmission or improve survival.

Source: UNC Healthcare, May 26, 2014

Home Visits for High-Risk Patients: Tools, Timing and Outcomes

Home Visits for High-Risk Patients: Tools, Timing and Outcomes Stanford Community Care’s clinical nurse specialist, Samantha Valcourt describes the home visits program she developed and implemented for its care transitions initiative for high-risk patients.

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