3 Must-Haves to Reduce Hospital Heart Attack Readmission Rates

Hospitals are being held more accountable for readmissions due to value-based purchasing, greater data transparency and other changes under healthcare reform. Many hospitals are focusing on heart attack care, as heart disease is the leading cause of death in the United States, according to the Centers for Disease Control and Prevention.

Tri-City Medical Center in Oceanside, Calif., had the fifth lowest 30-day heart attack readmission rate among U.S. hospitals based on CMS' Hospital Compare data submitted from July 2007 to June 2010. The hospital's rate was 15.6 percent compared to the national average of 19.8. Donald Dawkins, RN, MBA, vice president of strategic integration, and Chrisie Shand, data analyst for the Cardiovascular Institute at Tri-City Medical Center, share three factors that are key to achieving a low readmission rate for heart attack patients.

1. Collaborative leadership. Tri-City Medical Center opened the Cardiovascular Health Institute in the summer of 2010 and established a co-management structure. Under this structure, hospital administrators and physicians have a 50-50 partnership in which they regularly meet to discuss strategies and areas of focus for the institute. Through this partnership, CVHI decided to focus on improving heart attack care, among other areas.

"The co-management model of collaboration is key to focusing our attention on quality. Ninety to 95 percent of our collaborative work focuses on quality care delivery," says Mr. Dawkins, who is also secretary of CVHI's board of managers.

To ensure quality, CVHI followed CMS' key process indicators for cardiovascular care, such as administering aspirin and beta blockers to heart attack patients and coordinating patients' follow-up appointments. Providing physicians a leadership role helped CVHI standardize these evidence-based best practices. In addition, support from administrative leaders in the co-management model provided financial and other resources to enhance heart attack care.

2. Care coordinators. CVHI established care coordinators to guide patients through the different levels of their care — from admission to discharge to follow-up appointments. While other caregivers may change during a patient's hospital stay, the care coordinator remains with the patient to answer any questions and provide consistency. Care coordinators, in concert with physician leadership, are "the linchpin to the success of the program," Mr. Dawkins says of the heart attack readmission reduction initiative.

During patients' stay, care coordinators round on patients daily, communicate with their physicians and help schedule follow-up appointments. After discharge, care coordinators call patients to confirm they filled and are taking the correct medication. These last two responsibilities — setting up follow-up appointments and reconciling medication — directly address readmissions because readmissions are often caused by a lack of follow-up care and nonadherence to the prescribed medication regimen, according to Mr. Dawkins.

3. Data collection, analysis, application. A third essential element in reducing heart attack readmissions is collecting, analyzing and applying evidence-based data to patient care. Tri-City Medical Center collects heart attack patient-related data from various public databases and internal sources, such as its finance department and quality and performance improvement department. Data analysts study the data and provide analysis to CVHI leadership teams to help guide their decisions in improving care. "We routinely monitor patient data; if anything is concerning, we notify the clinicians, who use their medical discretion to address those issues," says Ms. Shand.

For example, data on the effects of post-discharge follow-up care led CVHI to establish a heart failure clinic to accommodate patients who were not able to schedule appointments within the targeted seven to 10 days post-discharge.

More Articles on Hospital Readmissions:

Advocate Points to Reduced Readmissions as Result of ACO
AF4Q Hospitals Improve Readmissions, Language Services and Other Quality Measures

Infographic: The Cost of Avoidable Admissions

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