Annotated Bibliography : Annotated Bibliography

"Reducing 30-Day Readmissions for African Americans with Congestive Heart Failure by improving health literacy through a Comprehensive Context Oriented Discharge Plan”

In the UK, reports show that heart failure has been affecting up to 2% of the population, over 900,000 people are living with heart failure, with 63,000 new cases being diagnosed each year (BHF, 2015). It costs the NHS £625 million per year, as a result of the high portion of emergency admissions, readmission and long length of inpatient stay (NHS Improvement, 2010). DH (2000) confirmed that Heart failure accounts for all cardiac admissions and the readmission rate can be as high as 50% within 3 months; also, it further estimated 50% readmission might be preventable. Unfortunately, Heart Failure can’t be cured, but early

Heart Failure affects nearly 5.8 million people in the United States. The American Heart Association reports that the total economic cost of heart disease and stroke in 2011 was $320.1 billion. ("Efforts to Prevent Heart," 2015). More Medicare dollars are spent for the diagnosis and treatment of heart failure than for any other diagnosis (Schneider, O'Donnell, & Dean, 2011). Hospital admissions for heart failure are very common, especially among Medicare aged patients, and heart failure hospital readmissions are a major contributor to rising healthcare costs. Evidence suggests that factors influencing readmission rates for heart failure patients include knowledge deficits in nursing education, standardized patient education, and transitional

Hospital readmissions are potentially harmful, costly and often times an avoidable event. Between the provisions set forth under the Affordable Care Act and the penalties authorized by the Centers of Medicare and Medicaid Services, hospitals are forced to shift their focus towards the development of strategies to reduce and prevent avoidable hospital readmissions related to heart failure. It is estimated that of the 6 million individuals within the United States diagnosed with heart failure, 1 million of them are hospitalized each year with a primary diagnosis of heart failure, accounting for $17 billion dollars of Medicare expenditures (Sales et al, 2013). What is worse is the death rate associated with heart failure each year, accounting

As people get old a few of them will experience changes in cognition with age related capacity rather than intellectual capacity. There are some people who get both disparities of mentally and physically impaired that will led into depression due to aging process of their body. Even though, the forgetfulness is a common among older adults, we as healthcare providers must evaluate altered mental status of the patients. “The evaluation and management of altered mental status are broad and require careful history and physical examination to eliminate life-threatening situations”(Patti & Dulebohn, 2017). Therefore, it is very important to recognize the importance of difference between normal age-related symptoms and developing new health problems that can arise in this specific population. As elders get older their memory lapses it frustrating to them leading them to be more worried about changes in their memory. Nurses have a unique capability to promote a cognitive health and determine the possibilities of potential cases of the impairment in elders. The movie “On Golden Pond” Mr. Norman was a perfect example and showed that his symptoms were interfering with his everyday live when he almost burns down the house with fire, calling Bill by his daughter’s name Chelsea and getting lost in on the lake. Even though, Mr. Norman had heart and dementia problems his wife never discouraged him to do what he liked such as

Providing patients diagnosed with Congestive Heart Failure effective teaching can eliminate reoccurring hospitalizations. Patients are discharged with CHF and readmitted within 30 days. The information provided will examine the process of enhancing patient knowledge and provide additional resources essential for effective health care management. Research evidence provides data that proves patients who are diagnosed with CHF needs a variety of health care needs during admission and after discharge. The proposal will display an evaluation plan, implementation plan and a dissemination of the

Congestive heart failure is a growing chronic condition in the United States that accounts for over one million hospitalizations and is responsible for 27% of patients with heart failure on Medicare are readmitted with 30 days of discharge (Hines, Yu & Randall, 2010). The intensity of the disease process poses a financial strain on both the patient and the payers, especially Medicare, as 10 per 1000 population are 65 years or older and therefore a Medicare beneficiary (Mozaffarian et al., 2015). Consequently, in order to gain control over this chronic disease and its cost burden, the government and policy makers have shifted the responsibility to the health care facilities through the creation of policies that affect hospital reimbursement based on readmission rates. As a member of the quality team at my facility, the Hospital Readmissions Reduction Program deeply impacts my practice and encourages the hospital as a whole to focus on improving multidisciplinary collaboration in pursuit of quality patient care, resulting in better outcomes and decreased readmissions.

Each year the number of readmissions of the heart failure patient within 30 days of discharge has grown. The Medicare division in relation with the Affordable Care Act is reducing the amount of money they are willing to pay for readmissions to the hospital. Hospitals are now more than ever looking for ways to reduce the number of readmissions to the hospital for the heart failure patient. The purpose of this paper is take a look at a program designed with to reduce the readmission rates of one hospital to reduce the number of readmission through improved education and follow up of the heart failure patient.

Evaluation is the final and often the most critical step in evidence based research and practice. Evaluation of evidence based practice follows a pathway beginning with the selection of the area for improvement, synthesizing the research into a process improvement activity and evaluating both the implementation of the process improvement as well and the outcomes of the intervention (Titler, 2008). To measure the results of process change in the management of heart failure patients a retrospective analysis will be conducted comparing the readmission rates of a pilot and control population over a 6-month period. The pilot population will be evaluated with the LACE index readmission risk assessment upon admission and subsequently receive the recommended interventions based on the risk stratification. In comparison, the control group will receive the current process of telephonic contact only. The pilot group will include patients over the age of 18 residing in zip-codes 45402 and 45403,

According to the Centers for Disease Control and Prevention (CDC) there are an estimated 5.1 million adults suffering from heart failure (2013). As the prevalence of heart failure continues to rise, one out of every nine deaths occur as a result of this chronic condition. Studies conducted at Yale found in Medicare age patients with heart failure, there is a median 30-day mortality rate of 11.1% and 5-year rate of approximately 50% (Alspach, 2014). According to Desai & Stevenson (2012), rising costs of care are in direct correlation to the number of hospital admissions related to a primary diagnosis of heart failure especially among adults age 65 years or older. The national rate for readmissions within 30 days is approximately 24.7%, consequently having

Patient education is a must in this population, since many have limitations when it comes to lifestyle choices. An area I feel the heart team does an excellent job in addressing. As for their health literacy levels, since these clients have lived with their complex cardiac condition most of their lives, I believe their, or family’s, health literacy is relatively high. Most understand the severity of their disease and how it affects most other aspects of their lives. When it comes to an exercise regimen or planning a family, their cardiac health plays a key factor. Although, there are those minority with secondary mental disabilities that are at higher risk of errors in self-care, but what

Policy makers are constantly searching for new innovative ways to increase quality patient care and lower Medicare program spending. One indicator of inadequate quality that results in increased Medicare spending is the rate of readmissions to the hospital. Heart Failure patients are on the top of that list. Readmission refers to a patient’s being hospitalized within 30 days of an initial hosptial stay. This seems to be an indicator of inadequate quality of care in the hospital or a lack of appropriate coordination of postdischarge care.

Risk Factors: Before changes can be made to reduce readmission, an evaluation needs to be made to what is contributing to readmissions. In 2012, an average monthly readmission was 44 patients for every 1,000 FFS beneficiaries discharged (Gerhardt et al., 2013). Besides disease process, one of the risk factors, mentioned in the articles were lower cognitive functioning. Depression, which is common later in life, can effect cognitive functioning. To measure depression, the use of the Geriatric Depression Scale (GDS) has been tested to be a reliable tool (Greenberg, 2007). Poor clinical status, older age and poor health behaviors are also factors (Tao & Ellenbecker, 2013). Lower functional ability has be shown to contribute to increase risk for readmission. Functional ability can be measured by the scoring criteria in the Lawton Instrumental Activates of Daily Living Scale and the Katz Index of Independence in Activities of Daily Living (Graf, 2008a; Tao & Ellenbecker, 2013; Wallace & Shelkey, 2007). Communication breakdown and the lack of continuity between the hospital setting and the home setting also contributes to poorer patient outcome (Berry et al., 2011).

Heart failure readmissions remain a universal healthcare issue. Heart failure exacerbation is mostly the primary cause of admission for most hospitalizations (Retrum et al., 2017). These unnecessary readmissions cost the US healthcare billions of dollars annually and can significantly diminish patients’ quality of life. Management of chronic heart failure patients to prevent readmissions involves evidence-based interventions from a multidisciplinary team. The purpose of this paper is to critique an ethnography study conducted by Margaret Glogowska, et al., to explore the perceptions and experiences of health care practitioners working in multidisciplinary teams with specialized heart failure nurses and their impact on improving patient outcomes.

A great amount of time, money and resource is devoted to improving the transition to home from hospital in the heart failure patient (Qaddoura, Ashoori, Kabali, Thabane, Haynes, Connolly & Spall, 2015). With extensive research available on heart failure and readmission, this study will focus on four main categories. This four category approach allows the clinician to best formulate and prepare for practice in the outpatient setting. The four categories will include various articles based upon evidenced based practice approaches with ultimate goal of reducing admission by implementing successful outpatient care. The four categories are as follows: Frequent monitoring or reporting to the PCP; Medication and Diet compliance; Predictors of