Improved quality interventions for heart failure patients linked to reduced readmissions, varying costs

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Patients who are hospitalized once are likely to be hospitalized again, but patients with heart failure are at an even greater risk. Plus, it’s costly.

But new research, led by Teryl K. Nuckols, MD, director of the division of general internal medicine at Cedars-Sinai Medical Center in Los Angeles, shows how quality improvement (QI) interventions could reduce readmissions, particularly among heart failure patients. QI interventions were described as assessing a patient's risks and needs, engaging the patient and their caregivers, reconciling medication and connecting patients to familiar clinicians.

In 2013, 3.9 million 30-day readmissions occurred in the U.S., of which 183,000 were for heart failure patients. In total, readmissions added up to about $52.4 billion. Most readmissions are linked to heightened self-care needs, new medication and impaired function.

“Our objective was to systematically evaluate the clinical effectiveness and incremental net costs of QI interventions for the prevention of readmission to acute care hospitals, including within 30 days and over longer periods,” the authors wrote in the study. “We searched peer-reviewed and non–peer-reviewed literature. We then examined the types of interventions studied, clinical effectiveness, associated costs, and the quality of the economic evaluations. Finally, we examined factors associated with effectiveness and costs.”

In the study, published May 30 in JAMA, researchers found that hospital readmissions were reduced by 12.1 percent among those with heart failure and by 6.3 percent among general populations when QI interventions were implemented.

However, little changed in terms of cost savings. Results varied among patients and were not consistently lower across the board. Mean net savings to the health system per patients with heart failure was about $972 and $169 among general patient populations.

The data is based off economic evaluations on more than 16,700 patients pulled from several research databases, including PubMed, EconLit, the New York Academy of Medicine’s Grey Literature Report and Worldcat.

“Multicomponent QI interventions can be effective at reducing readmissions relative to the status quo, but net costs vary,” the authors wrote in the study. “Interventions that engage general populations of patients and their caregivers may offer greater value to the health system, but the implications for patients and caregivers are unknown.”