Computerized discharge tool cuts readmissions for heart failure patients

Hospitals that used a computerized system for discharge of heart failure patients found 30-day readmission rates fell 2.5 percent compared with hospitals that did not use the system, according to research from Intermountain Healthcare. The study also found 10-fold increase in compliance with quality care measures.

In the study, researchers looked at whether the computerized tool made a difference, based on the records of heart failure patients discharged from 11 hospitals across Utah between January 2011 and September 2012, reports Cardiovascular Business

With the government fining hospitals for their readmission rates, attention has focused on how to best reduce them, including adopting standardized discharge orders. Little is known, however, about how standardized discharge orders affect clinical quality measures, according to an announcement. The research was presented yesterday at the American College of Cardiology's 62nd Annual Scientific Session in San Francisco.

"The tool was designed by our most skilled cardiovascular practitioners to mirror the workflow of the physician and provide evidence-based decision support for cardiovascular care," said lead investigator Jose G. Benuzillo, a senior outcomes analyst at Intermountain Healthcare in Salt Lake City. "Use of this tool reduces variation in practice between the most skilled and experienced specialists in cardiovascular care, and more general practitioners who see cardiovascular patients more infrequently."

The study also tracked adherence to three quality measures for best practices with heart failure patients: providing discharge instructions to patients; appropriate assessment of heart pumping ability; and the prescription of medications or documentation of contraindication.

Benuzillo said the tool also improved communication between physician and patient by providing a clear document outlining instructions and medications. 

Though the Centers for Medicare & Medicaid Services has ramped up efforts to reduce readmissions, a recent report from the Robert Wood Johnson Foundation found little progress between 2008 and 2010. Since October 2012, however, Medicare began penalizing hospitals that have higher-than-average rates of heart failure, pneumonia or heart attack readmissions.

A study of readmission rates for Medicare patients between 2005 and 2008, however, found no link between readmission and mortality rates. The authors urged hospitals to be tracking both.

Meanwhile, Marin General and Novato Community hospitals in California have focused on those at highest risk of readmission, with plans to hire nurses as transitional coaches who meet with patients before discharge, and again after they go home to help keep them on track. Glendale, Calif., hospitals also are taking patients' living situations into account, including whether they're homeless or foreign-born, which might affect their ability to care for themselves.

To learn more:
- find the announcement
- here's the Cardiovascular Business article

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