DECREASING READMISSIONS OF POST MYOCARDIAL INFARCTION PATIENTS Renee Robidart Nursing Theory IV March 4, 2015 Introduction “Each year, an estimated 785,000 American have a first acute myocardial infarction” (Dunlay, et al, 2012, p 11). Understanding the disease process of MI, providing quality collaborative care, and instituting treatment of comorbid conditions can significantly reduce the incidence of re-hospitalization for these patients. Psychobiological Finding of Myocardial Infarction “Myocardial infarction occurs when myocardial tissue is abruptly and severely deprived of oxygen. When blood flow is quickly reduced by 80% to 90%, ischemia develops. Ischemia can lead to injury and necrosis of myocardial tissue if blood flow is not restored” (Ignativicus & Workman, 2013, p 829). When the heart is hypoxic, the vessels vasodilate and catecholamines are released, in an effort to carry more hemoglobin rich red blood cells to the site of infarction. These protective mechanisms actually increase the oxygen demand of the heart by increasing the workload and cause further hypoxia of the myocardial tissues. In as little as six hours, ischemic myocardial tissue, necrotic tissue, and ventricular remodeling can occur. Ventricular remodeling is a permanent effect on the heart that can occur if the infarction is not treated quickly enough. Scar tissue forms in the left ventricle which affects its functionality. This condition is associated with a high risk of chronic
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This project was an observational study designed to evaluate the impact of Post-MI Transitional Care Program and Advanced Practice Provider Transitional Care Clinic on 30-day readmission rates, medication compliance and length of time to first office follow-up. Retrospective chart review was used to gather data. Prior to October 1, 2015, no formal Transitional Care Program or Advanced Practice Provider Transitional Care Clinic existed at Baptist Hospital. On October 1, 2015, Baptist began a Post-Myocardial Infarction Transitional Care Program and Advanced Practice Provider Transitional Care Clinic which incorporated multiple discipline inpatient education and structured post-discharge clinic which was managed by advanced practice providers who provide comprehensive patient care for the first 30 days after discharge with diagnosis of myocardial infarction.
Policy makers created the Medicare Hospital Readmissions Reduction Program (HRRP) in an attempt to improve quality of patient care and lower costs (James, 2013). In order to avoid these penalties, healthcare leaders must recognize that CMS has identified a correlation between readmissions and a lack of quality care. Therefore, the aim is not to focus solely on hospital readmissions, but to seek clinical excellence by investing in quality improvement (Silow-Carrol, Edwards & Lashbrook, 2011). However, reducing readmissions is a complex undertaking, because not all readmissions can or should be prevented. Indeed, some readmissions are planned as part of sound clinical care. Furthermore, while hospitals work to reduce readmissions caused
What factors contribute to multiple Chronic Obstructive admissions and how can the number of readmissions within 30 days be reduced? The Affordable Care Act added section 1886 to the Social Security Act. This section created the Hospital Readmission Reduction Program (HRRP). The purpose of HRRP is to reduce hospital spending and improve quality of care (Sjoding & Colin, 2014). HRRP requires Centers for Medicare and Medicaid Services (CMS) to reduce, or penalize, hospitals receiving payments from CMS for excessive admission of several chronic diseases, taking affect in October 2012 (CMS, 2018). Chronic Obstructive Pulmonary Disease was added in 2015 as one of these conditions.
Healthcare costs in the United States (U.S.) have escalated exponentially in recent years due to many factors. The Affordable Care Act was legislation passed in 2010 to attempt to change the delivery of healthcare in the U.S. and circumvent the continued rising healthcare costs. A major factor contributing to healthcare costs is the Medicare population and their readmission rates to the hospital within 30 days of discharge. This factor involves many layers of services and financial implications. This paper will discuss how healthcare quality results in hospital readmission, the fines that are imposed by the government through Health Readmission Reduction Program, the changes implemented by hospitals to decrease readmission
As we care for our patients in a hospital settings, our goal is to get them better so that they can be discharged. Most of the time recovery continues at home or at another facility. With shorter stays in the hospital setting, the recovery at home requires increased nursing and caregiver interventions. Based on statistics published by the Center for Medicare and Medicaid Services (CMS), the rate for readmission, within the first 30 days of discharge, in 2012, for Medicare FFS (Fee-for-service) beneficiaries, averaged 18.4 percent (Gerhardt et al., 2013). Throughout this paper, readmission refers to a “return hospitalization to an acute hospital following a prior acute admission within
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.
With heart failure, increasing in incidence in the United States, hospital readmission rates are being scrutinized to save money, especially for Medicare beneficiaries. Over 5 million people in the United States are living with heart failure, defined as “a condition in which the heart cannot pump enough blood and oxygen to support other organs in the body” (CDC, 2013). Heart failure affects 2.4% of the United States population with nearly 12% of both women and men 80 years and older having heart failure (Heidenreich, P. A., Albert, N. M., Allen, L. C., Bluemke, D. A., Butler, J., Morrow, G. C., Ikonomidis, J. S., et al., 2013). Heidenreich et al (2013) project that by 2030, heart failure will affect over 8 million Americans, with 2 million of those being ages 80 years and older. Heart failure is one of three conditions to be included in the Centers for Medicare and Medicaid Services (CMS) reimbursements that hospitals are penalized for if the hospital experiences an excess amount of readmissions within 30 days of the initial hospitalization due to the disease.
Hughes (2008) quoting from the , the Agency for Healthcare Research and Quality handbook stated that “many view quality health care as the overarching umbrella under which patient safety resides”. Friedman, Encinosa, Jiang & Mutter (2009) found that “safety events that result in hospital readmissions lead to hefty a financial burden on the institution”. In addition they believe that if more attention is given to address and “ assess the full extra cost of safety events and the factors influencing the rate of safety events, that strategies could be developed for health plans to improve incentives for safety” Friedman, Encinosa, Jiang & Mutter (2009). The Institute of Medicine (IOM) considers patient safety “indistinguishable from the
Health care spending in the United States has taken a toll on the federal financial budget (Minott, 2008; Stone & Hoffman, 2010). According to the National Center for Health Statistics, hospitalizations are costly, accounting for approximately 32 percent of total health care cost, additionally the total national health cost in 2014 was at $ 3 trillion (Center for Disease Control and Prevention (CDC), 2016). Reports generated by the Congressional Budget Office (2010), compared the Medicare spending between the dedicated funding and estimated an increase of $518.5 billion to $929.1 billion between 2010 and 2020 (as cited by Stone & Hoffman, 2010). According to the Centers for Medicare and Medicaid Services (CMS), approximately one in five
Hospital readmission is an avoidable healthcare issue. Pedersen, Meyer&Uhrenfeldt (2014) “defined hospital readmission as a return to hospital shortly after discharge from a recent stay”. When most patients leave the hospital, the intent is not for a reappearance in the hospital again soon. But, many discharged hospital inpatients get readmitted sooner than 30 days from their initial discharge. Some readmissions are projected or could be as a result of natural cause. Other patient readmissions due to lack of hospital quality care could be an avoidable readmission.
One of the leading concerns affecting the health care system is the high rates of unplanned hospital readmissions. While some readmissions are an appropriate part of treatment, many patients are admitted back into the hospitals due to avoidable factors that compromised their health. This critical issue, according to the Dartmouth Atlas Project, has now become a measure of the quality of hospital care. As a result, the Center for Medicaid and Medicare Services (CMS) currently penalizes hospitals with high rates of 30-day readmissions for certain conditions (PerryUndem Research & Communications, 2013). Aside from the governmental costs, those most affected are the patients, families, and their providers. Effective programs assessing the discharge plan and care coordination must be enforced to diminish the number of hospital readmissions and potential health complications.
As an individual who cares about health, including the Aspen Idea Festival and formerly employed at Prevention, I would like you to consider this thought, the way patients our educated before a hospital discharge must be reconsidered.
Research Question: Does contacting the primary care physician at the time of admission decrease readmission rates for patients admitted to the hospital?
Our market strategy will be direct contact with the target audience. Members of the Vision Casters will make appointments with hospital administrators, as well as health providers such as Cardiologists that practice at the targeted hospitals. There are 50 hospitals in the San Bernardino