Importance Of Congestive Heart Failure Management In Reducing Hospital Readmission

4. Joint Commission-required discharge instructions Heart failure patients receive discharge instructions in six areas: 1) Activity 2) weight (report increase to doctor) 3) Diet 4) Discharge medications 5) Follow-up appointment 6) Worsening of symptoms (report to doctor)

5. Heart failure results in one in eight deaths per year in United States (CDC, 2011) Progressive, chronic condition results from heart�s inability to effectively pump enough blood circulation to the body� organs Sign/symptoms include dyspnea, extreme fatigue and peripheral edema (untreated advances to generalize edema) Symptoms send patient back to hospital for readmission Significance of the Problem

6. Most common cause for hospital admissions Leading cause of death HF symptoms resulted in $17 billion in medical bills for the year 2007 (Joynt, 2007) By 2008 those costs had doubled to $34 billion (Esposito, 2009) National trend toward standardized discharge protocols strives to reduce readmission through disease management Impact of Problem

7. Joint Commission Core Measures National Patient Safety Goals with Core Measures Heart failure management included as one of the core measures Specific set of directives for patients to be given upon discharge Instructions include ACE-inhibitor prescription for left ventricular systolic pathology Smoking cessation education Comprehensive discharge summary that covers diet, exercise, daily weight, med regimen & Dr. appt

8. Beginning in 2013, required 1% of the hospital Medicare reimbursement be held back If hospital does not perform to goal it will not receive that reimbursement Amount withheld will increase to 2% by 2017 If hospital falls below performance benchmark, that money will be lost Since 2005, 2% of Medicare reimbursement has been tied to accurate data collection & reporting Patient Protection & Affordable Care Act of 2010

9. Measures adult inpatient perception of the quality of care that patients receive at an acute care hospital (Studer, 2007) Pay-for-performance will combine with pay-for-reporting requirements beginning in 2013 Requirements are geared to improving patient outcomes by rewarding hospitals that meet or exceed benchmarks HCAHPS is national standardized survey tool

10. Components of VBP monitor system include 17 categories, 4 of which apply to heart failure patients at discharge 1) ACE-inhibitor 2) Beta blocker 3) Smoking cessation counseling 4) written instructions/education materials Value Based Performance (VBP)

11. Impact of hospital reimbursement is massive 25% of heart failure patients are readmitted within thirty days Goal of performance directives: improvement of patient care by pinpointing area of weakness in hospital discharge process Hospitals motivated by financial consequences Improved hospital care & reduction of readmission rate=improved HCAHPS scores Impact of pay-for-performance

12. CDC-sponsored national health initiative lists improvement of heart failure care as one of health initiatives Target improvement goal: 10% reduction of heart failure rate by the year 2020 (Healthy People, 2011) Community nurse can include Healthy People guidelines in her patient teaching Community mental health to be alert for s/s of anxiety, depression and loss of control related to chronic heart failure Healthy People 2020

13. Literature review shows that discharge education and follow-up management of heart failure leads to reduced readmissions Standardized protocols and education at discharge is vital in improving outcome in heart failure (Paul, 2008) Joint Commission requires hospitals to assess quality using prescribed measures called core measures for specific disease, including heart failure Core measures are evidence-based Literature Review

14. Roy Adaptation Model (RAM) comprises domain concepts of person, health, and environment for implementation of teaching and promotion of self-care for the heart failure patient (Bakan, 2007) Studies of other chronic diseases have been based on the RAM and show approach is useful in promoting adaptation for patients (Bakan, 2007) Roy Adaptation Model (RAM)

15. Objective of nursing students to educate the Saint John Medical Center staff on the importance of CHF management Focus on the discharge education Decrease hospitalization in the HF patient population Educate the staff on HCAHPS HCAHPS results have proven to be tied to quality & clinical outcomes HCAHPS survey zeroes in on issues that impact core clinical quality Strategic approaches to problem

16. Hospital attention to improvement of HCAHPS scores will lead to improvement in care of heart failure patients Joint Commission�s National Patient Safety Goals with core measures guide heart failure management with set of specific set of directives for patient at discharge Press Ganey, healthcare performance improvement company assists hospitals in improvement of clinical outcomes SJMC staff attendance at 45-minute inservice with pre and post test for HF education and knowledge assessment (this method shown to improve learners� knowledge and clinical practice (Avillon, 2009) SJMC managers support mandatory inservice for staff Leadership Support

17. As the leading cause of death and doubling medical costs ($34 billion in 2008) heart failure is a major concern for hospitals that are required to bring readmission rates down to prevent loss of 1-2% of Medicare reimbursements Hospitals are motivated by monetary consequences to manage heart failure Standardized discharge protocols are required by Joint Commission Reduction of HCAHPS scores is viewed as way to assure better heart failure management Evaluation

18. HCAHPS patient satisfaction surveys will be made public This forces hospitals to focus on patient care Studer group (hospital monitoring company) claims that �if hospital fixes HCAHPS scores many problems, including readmission and hospital-acquired infection rates will fix themselves.� (Studer, 2011) 27-question survey for Medicare-reimbursed hospitals to provide consistency to measure quality and clinical outcomes Evaluation (continued)