Initiative at Massachusetts General reduces readmissions following PCI

An initiative at Massachusetts General Hospital helped reduce readmissions after PCI from 9.6 percent in 2011 to 5.3 percent in 2015.

The hospital’s leaders implemented several programs to decrease readmissions, including assessing patients’ readmission risk, ensuring they receive appropriate medications, following up on a regular basis and providing them with patient education videos.

Lead researcher Varsha K. Tanguturi, MD, of Massachusetts General Hospital and Harvard Medical School, and colleagues published their results online in Circulation: Cardiovascular Quality and Outcomes on Aug. 23.

They mentioned that readmission rates after PCI typically range from 8 percent to 15 percent and depend on patient characteristics and clinical factors such as sex, race, discharge to a nursing home, longer length of stay, comorbidities, lack of insurance, Medicare or Medicaid use and periprocedural and postprocedural complications.

To improve the quality and value of care for PCI patients, Massachusetts General Hospital developed an initiative to reduce preventable readmissions with interventions during the index hospitalization, the post-discharge and outpatient visits and any visits to the emergency department.

Massachusetts General Hospital has 950 inpatient beds and performs 1,000 PCIs per year. It is the largest hospital in the Partners Healthcare network, the largest healthcare system in the state.

Before patients undergo PCI, the hospital creates a risk for each patient that includes age, sex, admission status, insurance status and comorbidities such as previous CABG, peripheral arterial disease, renal dysfunction and lung disease.

When patients are discharged, they are given a checklist that addresses previous research on the causes and preventability of PCI readmissions. The checklist includes a sublingual nitroglycerin prescription and confirmation of insurance coverage of prescribed antiplatelet agents and recommends timely follow-up.

Patients also receive short videos that explain chest discomfort, provide contact information for outpatient cardiologists, discuss the role of anxiety after PCI and tell patients how to manage heart failure symptoms and use nitroglycerin to treat angina.

The hospital encourages cardiology providers to see patients within two weeks of discharge. It has also set up an urgent access clinic to give patients access to busy outpatient providers and provide them with care after acute cardiovascular events.

If patients visit the emergency department within 30 days after PCI, their cardiologists are notified. The program has allowed patients to be seen more quickly and have their problems resolved in a more timely manner.

The researchers said they worked for a year with nurses, medical residents, pharmacists and information technology specialists to create and implement the programs. Physicians are incentivized to improve the quality of care and reduce inappropriate and unnecessary utilization.

The index hospital readmission rate decreased from 9.6 percent in 2011 to 5.3 percent in 2015. The researchers mentioned that they plan on assessing readmissions on the state level and noted that many patients who have their index PCI at Massachusetts General Hospital may be readmitted to local, non-network hospitals.

“At our hospital, we have seen an improvement in readmissions after PCI subsequent to the implementation of these initiatives,” the researchers wrote. “If successful, this program could potentially provide evidence-based tactics that can be implemented in other healthcare centers, to both reduce the cost of care and improve the quality of care for patients after PCI.”