Author + information
- Received February 17, 2015
- Revision received June 1, 2015
- Accepted June 4, 2015
- Published online October 1, 2015.
- Harolyn Baker, MPH∗,
- Sandra Oliver-McNeil, DNP†,
- Lili Deng, MD, MS∗ and
- Scott L. Hummel, MD, MS‡,§∗ ()
- ∗Michigan Peer Review Organization, Farmington Hills, Michigan
- †College of Nursing, Wayne State University, Detroit, Michigan
- ‡Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
- §Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan
- ↵∗Reprint requests and correspondence:
Dr. Scott L. Hummel, Department of Medicine, University of Michigan Frankel Cardiovascular Center, 1500 East Medical Center Drive, SPC 5853, Ann Arbor, Michigan 48109-5853.
Objectives The objective of this study was to evaluate an interhospital collaborative approach to improve 7-day post-discharge follow-up (7dFU) rates and reduce 30-day readmissions in heart failure (HF) patients.
Background Early post-discharge follow-up after HF hospitalization is associated with lower 30-day readmission rates.
Methods Observational analyses of Medicare HF patients discharged from 10 collaborating hospitals (CH) participating in the Southeast Michigan See You in 7 Collaborative were carried out. We compared pre-intervention (May 1, 2011 to April 30, 2012) and intervention (May 1, 2012 to April 30, 2013) 7dFU rates, unadjusted 30-day readmissions, risk-standardized 30-day readmissions (RSRR), and Medicare payments in CH and Michigan nonparticipating hospitals (NPH).
Results 7dFU rates increased but remained low in both groups (CH: 31.1% to 34.4%; p < 0.001; NPH: 30.2% to 32.6%; p <0.001). During the intervention period, unadjusted readmissions decreased significantly in both groups (CH: 29.0% to 27.3%; p <0.001; NPH: 26.4% to 25.8%, p = 0.004); mean RSRR decreased more in CH than in NPH (CH: 31.1% to 28.5%; p < 0.001; NPH: 26.7% to 26.1%, p = 0.02; p = 0.015 for intergroup comparisons). Findings were similar when CH outcomes were matched 1:1 with similar NPH outcomes. Combined Medicare payments for inpatient and 30 days of post-discharge care decreased by $182 in CH and by $63 in NPH (per eligible HF discharge).
Conclusions See You in 7 Collaborative participation was associated with significantly lower 30-day readmissions and Medicare payments in HF patients. Increases in 7dFU were modest, but associated processes aimed at this goal may have improved the transition from inpatient to outpatient care. Regional hospital collaboration to share best practices could potentially reduce HF readmissions and associated costs.
This study was funded in part by the Robert Wood Johnson Foundation. Dr. Hummel is supported by U.S. National Institutes of Health/National Heart, Lung, and Blood Institute grant K23HL109176; and has received grant support from PurFoods, LLC, Pfizer, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 17, 2015.
- Revision received June 1, 2015.
- Accepted June 4, 2015.
- American College of Cardiology Foundation