Preventing Chf Readmission Rates : A Multi Factorial Approach That Involves Careful Monitoring And Patient Participation

Nearly 5.1 million people in the United States have been diagnosed with heart failure. Yet so many people don’t have a clue what it is until they have been diagnosed with it. Congestive Heart Failure, or CHF, is a disease that has many symptoms, can be tested and treated, has several causes, and can be avoided.

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.

I liked this article, it did give me some new information, like the improvement of adherence to dietary restrictions and appropriate use of pharmacological therapy. The fact that all the literature points to CHF patients benefitting from advanced care and outpatient follow-up, seals my notions of the need for a CHF clinic. Increasing quality of life was also another important finding gained from this study.

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.

High readmission rates of patients present challenges within the healthcare industry. Nearly one third of the United States health expenditures are associated with preventable readmissions and an estimated 20% of patient readmissions occur within 30-days (Cloonan, Wood, & Riley, 2013). As costs and penalties associated with high readmission are expected to increase, the development and

Hospital readmission rate has gained attention over the last few years because it reveals the

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).

Readmission is defined as “an admission to subsection hospital within 30 days of a discharge from the same or another subsection hospital” for the same diagnosis or for a complication related to the initial diagnosis (American College of Emergency Physicians, 2015). According to the Robert Wood Johnson Foundation (2014) report, the annual cost of hospital readmission in the nation is about $41 billion. More importantly, hospital readmission disrupts patient’s life and decreases the quality of life (Padhukasahasram, Reddy, Li, & Lanfear, 2015). Consequently, due to the human and economic burden of hospital readmission, the Center for Medicare and Medicaid (CMS), in 2012 implemented penalty on hospitals that exhibit a high readmission for diagnoses of Heart Failure, Pneumonia and Septicemia. This action has resulted in the reduction of readmissions to hospitals specifically associated with

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.

Individuals with end stage decompensated congestive heart failure (CHF) will often be admitted to the hospital when complications arise. This is often the case because treatments (such as intravenous medications) needed to deal with the various complications of CHF require interventions that need to be administered by a team of medical staff with close monitoring of the patient. According to the CDC website report Hospitalizations for Congestive Heart Failure: United States 2000 -2010, 5.8 million people suffer from CHF in the United States, and hospitalization rates for individuals under the age of 65 with CHF increased significantly from 23% to 29% with rates for men higher compared to women. Fluid retention that is unresponsive to oral diuretic treatments is one of the most common situations that lead to a hospital admission (Austin, Hockey, Williams, & Hutchison, 2013). Detecting early signs of decompensated heart failure could help reduce the need for a hospital admission and improve the quality of life for those with end stage CHF by allowing treatment to occur in the home setting that might normally be provided in the hospital

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.

Nurses should take care to select the proper outcomes to ensure optimum care is provided to patients with CHF. The plan of care is dependent on the nursing diagnosis and the desired nurse-sensitive outcomes. The priority NOC outcome for the diagnosis of CHF is Fluid Balance and Fluid Overload Severity. Other related NOC outcomes are Knowledge: Cardiac Disease Management, Knowledge: Energy conservation, Knowledge: Medication, Knowledge: Prescribed Activity, Knowledge: Treatment, and Knowledge: Weight Management (Johnson et al., 2012). These are only a select few of the multiple outcomes available; care should be modified as the disease progresses through the problems which evolves over the lifetime of patients diagnoses with CHF. Once all these determinants are established, the nurse will be prepared to determine which level of NOC is essential to effectively manage the disease.

Diagnosed with Congestive cardiomyopathy implies that the patient’s heart muscle has been debilitated by ailment and cannot sufficiently pump blood through the heart, which can lead to heart failure (“Columbia University Medical Center”, 2016). In this case study, the current situation of a male patient Mr. P., who is 76 years old, and frequently hospitalized with CHF is given. The purpose of this paper is to describe an approach to care with treatment plan recommendation, provide education to both the patient and his family, and a teaching plan.

Finding ways to decrease readmission for patient with a chronic disease process has brought about change with the use of technology. As of October 2012 hospital are penalized 1% from Medicare for every patient who have excessive readmission for certain chronic disease such as pneumonia, acute myocardial infarct (AMI), and chronic heart failure (CHF) in addition to the amount increase by 1% for the following two years (ACEP, n.d.). Engaging and monitoring patients with chronic disease outside the hospital include supplying a patient with CHF with an I Pad, blood pressure monitor, digital scale, pulse oximetry, and hand held heart monitor provides data. The patient checks in daily from home and the data is analyzed to determine if any intervention