Risk score–guided multidisciplinary team-based Care for Heart Failure Inpatients is associated with lower 30-day readmission and lower 30-day mortality - 18/12/19
, Colleen A. Roberts, RN, MS a, Kismet D. Rasmusson, DNP, FNP a, Jason Buckway, RN, MBA a, Rami Alharethi, MD a, Jalisa Cruz a, R. Scott Evans, PhD, MS a, c, James F. Lloyd, BS a, Tami L. Bair, BS a, Abdallah G. Kfoury, MD a, d, Donald L. Lappé, MD a, dAbstract |
Objective |
Using augmented intelligence clinical decision tools and a risk score-guided multidisciplinary team-based care process (MTCP), this study evaluated the MTCP for heart failure (HF) patients' 30-day readmission and 30-day mortality across 20 Intermountain Healthcare hospitals.
Background |
HF inpatient care and 30-day post-discharge management require quality improvement to impact patient health, optimize utilization, and avoid readmissions.
Methods |
HF inpatients (N = 6182) were studied from January 2013 to November 2016. In February 2014, patients began receiving care via the MTCP based on a phased implementation in which the 8 largest Intermountain hospitals (accounting for 89.8% of HF inpatients) were crossed over sequentially in a stepped manner from control to MTCP over 2.5 years. After implementation, patient risk scores were calculated within 24 hours of admission and delivered electronically to clinicians. High-risk patients received MTCP care (n = 1221), while lower-risk patients received standard HF care (n = 1220). Controls had their readmission and mortality scores calculated retrospectively (high risk: n = 1791; lower risk: n = 1950).
Results |
High-risk MTCP recipients had 21% lower 30-day readmission compared to high-risk controls (adjusted P = .013, HR = 0.79, CI = 0.66, 0.95) and 52% lower 30-day mortality (adjusted P < .001, HR = 0.48, CI = 0.33, 0.69). Lower-risk patients did not experience increased readmission (adjusted HR = 0.88, P = .19) or mortality (adjusted HR = 0.88, P = .61). Some utilization was higher, such as prescription of home health, for MTCP recipients, with no changes in length of stay or overall costs.
Conclusions |
A risk score-guided MTCP was associated with lower 30-day readmission and 30-day mortality in high-risk HF inpatients. Further evaluation of this clinical management approach is required.
Le texte complet de cet article est disponible en PDF.Abbreviations : HF, HRRP, MTCP, iHF, IMRS, MAWDS, CI
Plan
| Conflict of Interest: BDH is an inventor of clinical decision tools that are licensed to CareCentra. BDH is the PI of grants funded by Intermountain Healthcare's Foundry innovation program, the Intermountain Research and Medical Foundation, CareCentra, GlaxoSmithKline, Sysmex, and AstraZeneca for the development and/or clinical implementation of clinical decision tools. No other potential conflicts of interest exist. |
Vol 219
P. 78-88 - janvier 2020 Retour au numéro
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