Allocating scarce resources in real-time to reduce heart failure readmissions: A prospective, controlled study

Ruben Amarasingham, Parag C. Patel, Kathleen T. Toto, Lauren L. Nelson, Timothy S. Swanson, Billy J. Moore, Bin Xie, Song Zhang, Kristin S. Alvarez, Ying Ma, Mark H. Drazner, Usha Kollipara, Ethan A. Halm

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Objective To test a multidisciplinary approach to reduce heart failure (HF) readmissions that tailors the intensity of care transition intervention to the risk of the patient using a suite of electronic medical record (EMR)-enabled programmes. Methods A prospective controlled before and after study of adult inpatients admitted with HF and two concurrent control conditions (acute myocardial infarction (AMI) and pneumonia (PNA)) was performed between 1 December 2008 and 1 December 2010 at a large urban public teaching hospital. An EMR-based software platform stratified all patients admitted with HF on a daily basis by their 30-day readmission risk using a published electronic predictive model. Patients at highest risk received an intensive set of evidence-based interventions designed to reduce readmission using existing resources. The main outcome measure was readmission for any cause and to any hospital within 30 days of discharge. Results There were 834 HF admissions in the pre-intervention period and 913 in the postintervention period. The unadjusted readmission rate declined from 26.2% in the pre-intervention period to 21.2% in the post-intervention period (p=0.01), a decline that persisted in adjusted analyses (adjusted OR (AOR)=0.73; 95% CI 0.58 to 0.93, p=0.01). In contrast, there was no significant change in the unadjusted and adjusted readmission rates for PNA and AMI over the same period. There were 45 fewer readmissions with 913 patients enrolled and 228 patients receiving intervention, resulting in a number needed to treat (NNT) ratio of 20. Conclusions An EMR-enabled strategy that targeted scarce care transition resources to high-risk HF patients significantly reduced the risk-Adjusted odds of readmission.

Original languageEnglish (US)
Pages (from-to)998-1005
Number of pages8
JournalBMJ Quality and Safety
Volume22
Issue number12
DOIs
StatePublished - Dec 2013

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Heart Failure
Prospective Studies
Electronic Health Records
Patient Transfer
Pneumonia
Myocardial Infarction
Numbers Needed To Treat
Public Hospitals
Urban Hospitals
Teaching Hospitals
Inpatients
Software
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Health Policy
  • Medicine(all)

Cite this

Allocating scarce resources in real-time to reduce heart failure readmissions : A prospective, controlled study. / Amarasingham, Ruben; Patel, Parag C.; Toto, Kathleen T.; Nelson, Lauren L.; Swanson, Timothy S.; Moore, Billy J.; Xie, Bin; Zhang, Song; Alvarez, Kristin S.; Ma, Ying; Drazner, Mark H.; Kollipara, Usha; Halm, Ethan A.

In: BMJ Quality and Safety, Vol. 22, No. 12, 12.2013, p. 998-1005.

Research output: Contribution to journalArticle

Amarasingham, R, Patel, PC, Toto, KT, Nelson, LL, Swanson, TS, Moore, BJ, Xie, B, Zhang, S, Alvarez, KS, Ma, Y, Drazner, MH, Kollipara, U & Halm, EA 2013, 'Allocating scarce resources in real-time to reduce heart failure readmissions: A prospective, controlled study', BMJ Quality and Safety, vol. 22, no. 12, pp. 998-1005. https://doi.org/10.1136/bmjqs-2013-001901
Amarasingham, Ruben ; Patel, Parag C. ; Toto, Kathleen T. ; Nelson, Lauren L. ; Swanson, Timothy S. ; Moore, Billy J. ; Xie, Bin ; Zhang, Song ; Alvarez, Kristin S. ; Ma, Ying ; Drazner, Mark H. ; Kollipara, Usha ; Halm, Ethan A. / Allocating scarce resources in real-time to reduce heart failure readmissions : A prospective, controlled study. In: BMJ Quality and Safety. 2013 ; Vol. 22, No. 12. pp. 998-1005.
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T1 - Allocating scarce resources in real-time to reduce heart failure readmissions

T2 - A prospective, controlled study

AU - Amarasingham, Ruben

AU - Patel, Parag C.

AU - Toto, Kathleen T.

AU - Nelson, Lauren L.

AU - Swanson, Timothy S.

AU - Moore, Billy J.

AU - Xie, Bin

AU - Zhang, Song

AU - Alvarez, Kristin S.

AU - Ma, Ying

AU - Drazner, Mark H.

AU - Kollipara, Usha

AU - Halm, Ethan A.

PY - 2013/12

Y1 - 2013/12

N2 - Objective To test a multidisciplinary approach to reduce heart failure (HF) readmissions that tailors the intensity of care transition intervention to the risk of the patient using a suite of electronic medical record (EMR)-enabled programmes. Methods A prospective controlled before and after study of adult inpatients admitted with HF and two concurrent control conditions (acute myocardial infarction (AMI) and pneumonia (PNA)) was performed between 1 December 2008 and 1 December 2010 at a large urban public teaching hospital. An EMR-based software platform stratified all patients admitted with HF on a daily basis by their 30-day readmission risk using a published electronic predictive model. Patients at highest risk received an intensive set of evidence-based interventions designed to reduce readmission using existing resources. The main outcome measure was readmission for any cause and to any hospital within 30 days of discharge. Results There were 834 HF admissions in the pre-intervention period and 913 in the postintervention period. The unadjusted readmission rate declined from 26.2% in the pre-intervention period to 21.2% in the post-intervention period (p=0.01), a decline that persisted in adjusted analyses (adjusted OR (AOR)=0.73; 95% CI 0.58 to 0.93, p=0.01). In contrast, there was no significant change in the unadjusted and adjusted readmission rates for PNA and AMI over the same period. There were 45 fewer readmissions with 913 patients enrolled and 228 patients receiving intervention, resulting in a number needed to treat (NNT) ratio of 20. Conclusions An EMR-enabled strategy that targeted scarce care transition resources to high-risk HF patients significantly reduced the risk-Adjusted odds of readmission.

AB - Objective To test a multidisciplinary approach to reduce heart failure (HF) readmissions that tailors the intensity of care transition intervention to the risk of the patient using a suite of electronic medical record (EMR)-enabled programmes. Methods A prospective controlled before and after study of adult inpatients admitted with HF and two concurrent control conditions (acute myocardial infarction (AMI) and pneumonia (PNA)) was performed between 1 December 2008 and 1 December 2010 at a large urban public teaching hospital. An EMR-based software platform stratified all patients admitted with HF on a daily basis by their 30-day readmission risk using a published electronic predictive model. Patients at highest risk received an intensive set of evidence-based interventions designed to reduce readmission using existing resources. The main outcome measure was readmission for any cause and to any hospital within 30 days of discharge. Results There were 834 HF admissions in the pre-intervention period and 913 in the postintervention period. The unadjusted readmission rate declined from 26.2% in the pre-intervention period to 21.2% in the post-intervention period (p=0.01), a decline that persisted in adjusted analyses (adjusted OR (AOR)=0.73; 95% CI 0.58 to 0.93, p=0.01). In contrast, there was no significant change in the unadjusted and adjusted readmission rates for PNA and AMI over the same period. There were 45 fewer readmissions with 913 patients enrolled and 228 patients receiving intervention, resulting in a number needed to treat (NNT) ratio of 20. Conclusions An EMR-enabled strategy that targeted scarce care transition resources to high-risk HF patients significantly reduced the risk-Adjusted odds of readmission.

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