While effective chronic disease management remains one of the most promising ways to improve outcomes and lower unnecessary utilization, it is also one of the most elusive. Ensuring patients with chronic conditions like cardiovascular disease receive adequate care outside the hospital has long been a concern, magnified in recent years due to the advent of readmission penalties and other cost pressures introduced through legislation. However, studies suggest that providers have not yet developed a program to manage the care of heart attack and heart failure patients that consistently delivers strong results, leaving them to experiment with new approaches.
It’s widely accepted that interventions can improve outcomes and reduce utilization for heart failure and heart attack patients, but the best form an intervention should take is still being explored. An intervention can refer to many different types of interactions, ranging from a periodic phone call to in-person visits with a multidisciplinary care team. A 2013 literature review highlighted by the Agency for Healthcare Research and Quality determined that high-intensity efforts, or approaches that used more healthcare resources and required longer or more frequent patient contact, had the greatest impact on heart failure readmission and mortality. Of course, not every health system or provider group has the resources for an intensive post-discharge program, and neither do its good outcomes necessarily make it the most efficient method. Many providers have looked to the potential of self-management interventions, which rely more on the patient to adopt a disciplined approach to their care rather than a model that promotes better outcomes through greater clinical utilization.
The primary challenge behind a self-management intervention is matching a program to a patient. Many of those suffering from heart failure or who have had a recent heart attack tend to be elderly and may be afflicted with other ailments such as poor mobility, eyesight, and cognitive impairments that can complicate their ability to follow care guidelines without assistance. In addition, comorbidities like depression can limit the effectiveness of self-management even further. One analysis that studied a wide range of self-management intervention programs could not identify any specific characteristic common to the most successful approaches to improving heart failure outcomes, other than overall duration. The finding suggests that hospitals and providers might need to invest in a post-discharge management program that encompasses a wide variety of capabilities.
Median Hospital Statistics under CMS Readmissions Reduction Program
|30-Day Heart Attack Mortality Rate||14.0%|
|30-Day Heart Attack Readmission Rate||16.8%|
|30-Day Heart Failure Mortality Rate||12.1%|
|30-Day Heart Failure Readmission Rate||21.9%|
|Est Financial Penalty||$162,240|
*Based on Definitive Healthcare data
The recent spread of internet connectivity has led some providers and healthcare organizations to look at technology as the key to a viable intervention strategy. Technology, such as wearables and telemonitoring equipment, conceivably offers several advantages compared to standard methods. Far less expensive than long-term or home care, it also provides instant feedback of important patient information such as vital signs, weight, and even patient behavior. A recent study explored the effectiveness of technology in the form of advanced pill bottles on medication adherence and rehospitalization among patients discharged after a heart attack. The pill bottles used wireless technology to issue an alert when they were opened, allowing care managers to determine how often patients were taking their medications on schedule. Using the system, managers could identify patients in need of intervention, either through social support from a friend or family member chosen at the start of the trial or an employed advisor. Taking medication regularly also entered patients into a lottery with the chance to earn a financial reward. However, by the end of the study, the authors found that patients subject to monitoring and interventions did not have significantly better outcomes in terms of time before rehospitalization, rehospitalization rate, medication adherence, or overall costs than the control group. While acknowledging the negative results, one of the study’s authors did suggest in a later interview that the delay between each patient’s discharge and the start of the trial could have minimized the benefits of the intervention strategy. If true, then it’s possible that the monitoring technology could be useful if deployed earlier and carried out in coordination with the hospital provider.
The search for an effective heart failure intervention strategy to reduce readmissions and mortality mirrors other efforts in the broader picture of healthcare reform. Providers are still attempting to define and implement best practices in several aspects of care ranging from diagnosis, treatment, and population management. Given the seriousness of a heart failure diagnosis and its cost to the country and healthcare system, it’s likely to be an ongoing priority in the near future.
Definitive Healthcare has the most up-to-date, comprehensive and integrated data on over 7,700 hospitals, 1.4 million physicians, and numerous other healthcare providers. Our databases feature current and historical data on a variety of CMS initiatives and programs, including clinical and quality measures.
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