MDNews - Long Island

" Most patients do not appreciate how severe [heart failure] is in terms of both the intensity of required therapy and limitation of survival. It has been called the 'cancer of cardiology,' although the prognosis is worse than for most cancers." • LYNNE WARNER STEVENSON, MD, DIRECTOR OF THE HEART FAILURE PROGRAM AND PROFESSOR OF MEDICINE AT THE CENTER FOR ADVANCED HEART DISEASE IN THE‰HEART AND VASCULAR CENTER AT BRIGHAM AND WOMEN'S HOSPITAL IN BOSTON Section of the Cardiovascular Division at Brigham and Women's Hospita l and Assistant Professor at Harvard Medical School. " Broad ly spea king, [drivers of HF readmissions] include medica l factors, chiefl y incomplete treatment of congestion; patient factors, includ- ing willing ness to adhere to therapy and dietary recommendations, such as sodium and fl uid restrictions; physician factors that have to do with how quickly we see patients [after discharge]; system factors that have to do with resources a nd coordination of ca re across the continuum; and socia l factors that are env ironmenta l a nd have to do w it h patients' access to care and limitations." REDUCING READMISSIONS THROUGH EDUCATION According to Dr. Desai, the primar y obstacle to reducing HF rehospitaliza- tions is a paucity of information about what prevention strategies are eƒ ective. He notes that the literature suggests pre-discharge patient education, prompt post-discharge contact with an ancil- lary provider and timely follow-up with a clinician are keys to preventing rehospi- talization. A recent UCSF study published in Cardiology Research underscores these points and may provide a reproducible, cost-eƒ ective model for hospitals. A team of providers at UCSF created TEACH-HF, an intervention that includes four components: inpatient Teaching and patient Education from two nurse coordinators, follow-up Appointments within seven days of hospital discharge, Consultation for additional medical and support services, and Home follow-up phone calls within seven days of dis- charge. To educate patients about HF, the nurse coordinators use teach-back, a method that asks patients to convey information they learn from the coordina- tors back to the providers to improve comprehension. The researchers imple- mented TEACH-HF in 2009. T h e U C S F t e a m d e s i g n e d t h e TE ACH-H F i nter vention ba sed on proven transition-of-care models and tools developed by the Institute for Healthcare Improvement, according to Teresa De Marco, MD, FACC, Professor of Medicine and Surgery, Director of the Advanced Heart Failure Therapies Program, Director of the Adult Pulmonary Hy per tension Comprehensive Ca re Center, and Medical Director of Heart Transplantation at UCSF. Dr. De Marco was involved in the TEACH-HF study. "It was clear from the beginning that there would be no one factor that would be successful [in reducing HF readmissions]; rather, a comprehensive program had to be developed utilizing components that were realistic within our medical system²...," she says. "All components [of TEACH-HF] are interrelated and essential to achieve success. In-depth interviews of patients and caregivers carried out by the dedicated HF nurses to assess health literacy, cognition and likely barriers to successful outcomes so as to design an eƒ ective individualized pla n within the overa ll TEACH-HF intervention were subjectively deemed to be highly valuable. The teach-back method in hospital and with outpatient reinforcement was subjectively deemed by the nurses to facilitate patient and caregiver education." Dr. De Marco and co-investigators tested the e¬ cacy of TEACH-HF by com- paring readmission rates and inpatient costs for a group of patients who received the intervention from 2010 to 2012 with those of a cohor t who received ca re from 2007 to 2008, before the program was instituted. Patients who received TEACH-HF had a 30-day readmission rate of 12² percent; non-TEACH-HF patients had a 19 percent 30-day readmis- sion rate. Nineteen percent of TEACH-HF patients were rehospita lized within 90²days, compared with 30 percent of pre- TEACH-HF patients. Non-TEACH-HF patients were 1.5 times more likely to be readmitted than patients who received the intervention. TEACH-HF saved 649 bed days in two years and $640,000 per year in operating costs. " T E ACH-H F ca n be ef fect ive i n reducing readmission for HF patients," Dr. De Marco says. "The personnel costs of providing this comprehensive disease management program can be oƒ set by reducing CMS penalties and savings in hospital bed days ... . At our institution, the program paid for itself. [Hospitals may wish to] consider instituting a similar pro- gram within the context of their unique HF patient population and resources." ■ SPECIAL CLINICAL SECTION: CARDIOLOGY M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 016 1 9

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