Disease Management Programs and Hospital Readmission

Discuss About The Hospital Readmission Heart Failure Patients.

A systematic literature review including randomized control trials that identified disease management programs which help reduce heart failure patient hospital readmission. The study included a comprehensive search of online databases such as EBSCOHost, Medline, and Cochrane Library. Selection was mainly based on the Cochrane Handbook guidelines which led to a collection of randomized studies with a minimum of 50 participants and reported on heart failure disease management programs. The randomized trials were only those that compared the mortality rates related to interventions and usual care or control, as well as outcomes related to hospital readmissions. Data was analyzed by both thematic analysis and meta-analysis, where themes on heart failure disease management programs were discussed to identify the most likely program to reduce heart failure patient hospital readmission. Among in-home care, outpatient visits, telemonitoring (invasive and non-invasive) and structured telephone support interventions, the study found no specific program with a consistent benefit to heart failure and ability to reduce hospital readmission. Ultimately, the study concluded that there are inconsistent results associated with the efficacy of heart failure disease management programs; although this should not be interpreted to mean that disease management programs for heart failure are ineffective. Rather, applying one approach to a large number of patients may be erratic and therefore it is important to tailor interventions to the health status of each patient.

to enhance adherence to medications in patients with heart failure: A systematic review. Circulation Heart Failure, 5, 126-133. https://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.964569

A systematic literature review that identifies summarizes and examines the effectiveness of various interventions to promote adherence to medication among heart failure patients. The review included randomized control trials comparing a control group with usual treatment. Eligible studies were those that included adult (18 years and above) diagnosed with heart failure. Self-administered medications were of major interest, and outcomes were measured through self-reported data, prescription or refill data, electronic monitoring and pill count. The systematic literature review was majorly based on the Cochrane Collaboration guidelines and the reviewed articles were sourced from online databases including Medline, Cochrane, CINAHL, Embase, and PsychInfo. Data was majorly collected by two researchers from the 16 selected studies to eliminate bias of selection and to promote credibility. Quality was further ensured by following the guidelines provided by Cochrane Reviewers Handbook, which included blinded outcome assessment. Data was analyzed by grouping the main components of each intervention. As a result, 8 of the 16 selected studies found that it is possible to enhance adherence to medication among heart failure patients. It was also found that intensive patient care by pharmacists is effective in ensuring adherence to medication. The study concluded that intensive patient care is an effective intervention to promote adherence to medication by heart failure patients.

Interventions to Promote Medication Adherence

(2003). Nurse-led heart failure clinics improve survival and self-care behavior in patients with heart failure: Results from a prospective, randomized trial. European Heart Journal, 24, 1014-1023. https://dx.doi.org/10.1016/S0195-668X(03)00112-X

This study is a randomized control trial where a total of 106 patients were assigned to usual care or follow-up at a heart failure health facility. The main aim of the study was to explore the effects of follow-up on morbidity, mortality and self-care behaviors of heart failure patients. The study involved qualified cardiac nurses who visited heart failure patients and assessed their status, provided education about heart failure and gave social support to the patients and their families. The nurses had to be qualified cardiac nurses with experience in cardiac-related medications and the protocols related to changing such medications. The study found fewer admissions and death events among the intervention group as compared to the control group. The intervention group also had fewer days in hospital and fewer admission cases. It was concluded that follow-up interventions after hospitalization can reduce the days spent in the hospital, number of readmissions and number of heart failure events experienced by heart failure patients.

The case study at hand involves a 75-year old man who is readmitted into the hospital two years after being diagnosed with chronic heart failures triggered by hypertension and ischemic cardiomyopathy. The patient complains of feeling increasingly unwell and is seeking medical attention. While hospital readmission has largely been associated with heart failure complications, studies by Gorthi et al 2014, Molloy et al 2012 and Stromberg et al 2003 give incredible insights into the management heart failure and prevention of hospital readmission. The following section will justify the relevance and importance of these studies to the case study.

Against this backdrop, Gorthi et al initiated a systematic literature review to explore various disease management programs that can be implemented to reduce cases of heart failure hospital readmission. The findings of this study give important details that can assist in delivering proper care to Charlie. For instance, the study suggested that patients should be subjected to care strategies that are unique to their prevailing health status to improve the effectiveness of such interventions and reduce hospital readmission. These findings are similar to assertions by Vecchione (2017) and Thompson et al (2016) that interventions such as home visits and telemonitoring are effective ways of managing heart failure complication at low costs although caution must be taken to choose the right intervention that responds to the patient’s conditions. While the study may have been subject to various limitations, it displays reliable quality based on the methodology applied. For example, the study relied on strict inclusion and exclusion criteria which saw it select journals written in English language and only those that included a minimum of 50 participants. Similarly, the study relied on the Cochrane Handbook guidelines. According to Salerno (2017), these guidelines are known for establishing a higher threshold of quality that studies have to attain to be considered valid and reliable.

Effectiveness of Nurse-led Heart Failure Clinics

Poor adherence to hospital medication is among the major reasons for hospital readmission among most HF patients (Gu et al 2014; Mcllvennan et al 2015; and Lau et al 2017). Indeed, Charlie’s health deterioration and readmission could have been triggered by him failing to adhere to his prescribed medications. To give further insights into this matter, Molloy and colleagues launched a study to explore the interventions that could enhance adherence to medication by HF patients. This study is relevant to Charlie’s case because it provides a detailed and up-to-date review of previous research on interventions for medication adherence that could help reduce cases of hospital readmission among HF patients. According to Drincic et al (2017), failure to take medicine as prescribed may lead to further complications which may need hospital readmission to ensure patient safety. Thus, the fact that this study (Molloy et al 2012) evaluates and outlines various interventions to promote adherence to medications makes it an important piece of study that adds to the available knowledge on heart failure management. The study’s quality level is assured by its research methodology, which is based on Cochrane Collaboration guidelines and it concludes that for example, patient education and consistent support from pharmacists are essential interventions that can promote Charlie’s adherence to medication and thus a reduction in readmission cases.

Charlie’s hospital readmission could have been triggered by poor self-care behavior. According to Nuckols (2015), failure to adopt proper self-care behavior and lack of proper follow-up by their health caregivers increases chances of hospital readmission among heart failure patients. Against this backdrop, Stromberg and colleagues launched a study to explore the effectiveness of nurse-led heart failure clinics and self-care behaviors in reducing hospital readmission among heart failure patients. This study is relevant to the case of Charlie because its findings illustrate how being assigned to a qualified nurse responsible for protocol-led medications and other follow-up activities such as patient education on heart failure, social support, and regular status evaluation could reduce chances of him being readmitted. Despite the informative findings, the study had several limitations including the fact that most participants were over 75 years old.  Boesen et al (2015) argued that a majority of patients at this age may be at the last stage of heart failure and may therefore not be able to adopt proper self-care behavior. This affects the generalizability of the study.

All in all, the findings of Stromberg et al (2003) imply that exposing Charlie to consistent follow-up from a cardiac specialist nurse at the nearest health clinic could minimize chances of him being readmitted. Similarly, the follow-up can promote self-care and survival behaviors that improve Charlie’s health condition and reduce chances of hospital readmission. Similarly, the findings by Gothi et al (2014) imply that different interventions can be applied to reduce hospital readmission among heart failure patients but care must be taken to use only the methods that resonate with the patient’s health conditions. Charlie’s case of hospital readmission is not unique to him because many patients experience the same. Inadequate disease management programs, lack of nurse-led heart-failure follow up interventions and poor adherence to HF medications could have been the major risk factors for Charlie’s situation. Addressing these risk factors through establishing proper disease management programs, establishing frequent nurse-led heart failure follow up and promoting adherence to HF medications may reduce the chances of Charlie being readmitted again in the hospital. We recommend that hospital leaders should ensure that nurses are provided with adequate resources to promote HF disease management programs and establish frequent follow-up on nurses. it is also recommendable that HF patients should be exposed to education and training on the sensitivity and importance  of adhering to the prescribed medications.

Case Study: Applying Literature Findings to Charlie’s Condition

Reference

Boesen, K. G., Leal, S., Sheehan, V. C., & Sobolik, R. (2015). Hospital Readmissions Reduction

Program: Implications for pharmacy. American journal of health-system pharmacy, (3). 237.

Drincic, A., Pfeffer, E., Luo, J., & Goldner, W. S. (2017). The effect of diabetes case

management andDiabetes Resource Nurse program on readmissions of patients with diabetes mellitus. Journal Of Clinical & Translational Endocrinology, 829-34. doi:10.1016/j.jcte.2017.03.003

Gu, Q., Koenig, L., Faerberg, J., Steinberg, C. R., Vaz, C., & Wheatley, M. P. (2014). The

Medicare HospitalReadmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations. HEALTH SERVICES RESEARCH -CHICAGO-, (3). 818.

Gorthi, J., Huntera, C. B., Mooss , A. N., Alla, V. M., & Hilleman, D. E. (2014). Reducing heart

failurehospital readmissions: A systematic review of disease management programs. Cardiology Research, 5, 126-138. https://dx.doi.org/10.14740/cr362w

Lau, C. S., Siracuse, B. L., & Chamberlain, R. S. (2017). Readmission After COPD Exacerbation

Scale:determining 30-day readmission risk for COPD patients. International Journal Of Chronic Obstructive Pulmonary Disease, 1891. doi:10.2147/COPD.S136768

McIlvennan, C. K., Eapen, Z. J., & Allen, L. A. (2015). Hospital Readmissions Reduction

Program.Circulation, 131(20), 1796-1803. doi:10.1161/CIRCULATIONAHA.114.010270

Molloy, G. J., O’Carroll, R. E., Witham, M. D., & McMurdo, M. E. T. (2012). Interventions to

enhanceadherence to medications in patients with heart failure: A systematic review. Circulation Heart Failure, 5, 126-133. https://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.964569

Nuckols, T. K. (2015). County-Level Variation in Readmission Rates: Implications for the

HospitalReadmission Reduction Program’s Potential to Succeed. HEALTH SERVICES RESEARCH -CHICAGO-, (1). 12.

Salerno, A. M., Horwitz, L. I., Ji Young, K., Herrin, J., Grady, J. N., Zhenqiu, L., & .

Bernheim, S. M. (2017).Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015. BMJ Open, 7(7), 1. doi:10.1136/bmjopen-2017-016149

Sagar, V. A., Davies, E. J., Briscoe, S., Coates, A. J. S., Dalal, H. M., Lough, F., … Taylor, R. S.

(2015). Exercise-based rehabilitation for heart failure: Systematic review and meta-analysis. Open Heart, 2, 1-12. Retrieved from https://openheart.bmj.com/content/openhrt/2/1/e000163.full.pdf

Strömberg, A., Mårtensson, J., Fridlund, B., Levin, L-A., Karlsson, J-E., & Dahlström, U.

(2003). Nurse-ledheart failure clinics improve survival and self-care behaviour in patients with heart failure: Results from a prospective, randomised trial. ******opean Heart Journal, 24, 1014-1023. https://dx.doi.org/10.1016/S0195-668X(03)00112-X

Thompson, M. P., Kaplan, C. M., Cao, Y., Bazzoli, G. J., & Waters, T. M. (2016). Reliability of

30-dayreadmission measures used in the Hospital Readmission Reduction Program. Health Services Research, (6). 2095. doi:10.1111/1475-6773.12587.

Vecchione, A. (2017). Readmissions Program Has Unintended Consequences: The federal

HospitalReadmission Reduction Program, introduced a few years ago by CMS, was designed to urge hospitals to reduce their readmission rates of Medicare patients by penalizing them if they didn’t achieve results. But a new study has raised a red flag. Drug Topics, (12). 29.