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ModelHeart: a resident-led implementation of metrics to reduce 30-day heart failure readmissions
  1. Sergey Kachur1,
  2. Patricia Kachur1,
  3. Tauseef Akhtar2,
  4. Elias Collado3,
  5. Martha Espinosa-Friedman4,
  6. Craig Asher5,
  7. Marlow Hernandez6
    1. 1 Ochsner Clinic Foundation, New Orleans, Louisiana, USA
    2. 2 Department of Internal Medicine, John H Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
    3. 3 Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
    4. 4 Department of Pharmacy, Cleveland Clinic, Weston, Florida, USA
    5. 5 Department of Cardiology, Cleveland Clinic, Weston, Florida, USA
    6. 6 Clinical, Cano Health, Miami, Florida, USA
    1. Correspondence to Dr Sergey Kachur, Ochsner Cardiovascular Institute, Ochsner Clinic Foundation, 1514 Jefferson Hwy, New Orleans, LA 70121; sergey.kachur{at}ochsner.org

    Abstract

    Hospitals have been penalised for excessive 30-day readmissions via Medicare payment penalties. As such there has been keen interest in finding ways of reducing readmissions. The basis for the study was a retrospective review of heart failure (HF) admissions at Cleveland Clinic Florida from 1 January 2010 to 31 December 2010. The result of this was a set of metrics associated with >30 day span between admissions: N-terminal pro-brain natriuretic peptide by at least 23%, fluid balance of ≤−1.3 L and sodium ≥135 mEq/L on discharge. The ModelHeart trial was a prospective resident-led validation of these criteria that consisted of education about and implementation of these metrics. A total of 200 patients carrying a diagnosis of HF, admitted between 1 November 2012 and 14 January 2014 were included in the trial. Of the 200 enrolled patients, 94% of discharged patients met at least one criteria, 58% met at least two criteria and 20% met all three. There were forty-eight all-cause 30-day readmissions. 30-day readmission rates between themore than equal to two criteria cohort and the remaining patients were not significantly different (p=0.71). Overall readmission rates were higher in the 2011–2012 retrospective patient pool (19%) versus the ModelHeart cohort (11%), and proportional differences were significant, (p<0.001). This may suggest that education provided sufficient awareness to alter discharge practices outside of the measured metrics. However, the lack of significant differences between groups with respect to discharge metrics suggests that further study is needed to refine the metrics and that reducing HF readmissions involves a continuum of care that spans the inpatient and outpatient setting.

    • heart failure
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    Footnotes

    • Contributors SK: primary contributing author, coordinated study, audited data entry and performed statistical analyses. PK: performed majority of data gathering and assisted with statistical analyses. TA: contributed to writing introduction and conclusions for the manuscript. EC: developed EMR templates and assisted with writing methods section. ME-F: enrolled patients for the study, and coordinated consent process and storage. CA: primary advisor on the study, oversaw IRB submission process, assisted with conclusions, and with data and manuscript review. MH: designed the study, initiated and completed IRB submission process, oversaw the project from start to finish, gathered preliminary data for retrospective dataset and oversaw statistical analyses.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval Cleveland Clinic Florida IRB.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Primary data are available. Each request would be evaluated on a case-by-case basis by the original institution.

    • Collaborators Stephen Tabaquin.

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