Karen Bush

Author: Karen S. Bush, MSN, FNP, BC, NCRP is a Transition Coach for Covenant Health Care and President of SelfCare Solutions

We know that the clinical status of a heart failure patient is negatively impacted by non-adherence to the self-care demands of this disease. Engaging heart failure patients with proper tools to manage their disease and understand changes in body weight and symptoms, allows these items to be addressed at home, therefore avoiding clinical deterioration and potential hospitalization.  At Covenant HealthCare we created a heart failure toolkit called Balancing Your Daily Fluid© and studied the effectiveness of the kit in improving heart failure maintenance, management and confidence on patients hospitalized with a heart failure diagnosis.   This toolkit with the education and follow up by the transition coaches has offered patients the opportunity to engage in their care and manage their disease, which has resulted in  significantly lower readmission rates and improved maintenance, management and confidence with patients’ heart failure.

What Covenant did

As a result of the above activities, we began looking for other opportunities for utilization of this model.  After looking at the Key Insights page on the Michigan Value Collaborative website we could see that patients with an index admission for acute myocardial infarction (AMI) demonstrated opportunities not only for readmission, but also for cost reduction.  Additionally, in our work with heart failure patients, we noted that often the index heart failure diagnosis followed an admission for AMI. To further investigate this theory and to better understand how to approach the readmission issue, we downloaded our site specific data for these 2 diseases separately and noted the following.  Under the diagnosis of AMI we had 1,451 data points with a higher unadjusted mean cost per episode compared to MVC all.  When we filtered for patients who had co-morbid condition of CHF there were 26 patients with a mean unadjusted cost per episode that was almost $10,000.00 higher than our non-comorbid CHF group.   This is a significant cost increase on patients who are admitted with AMI, who also have CHF. 

In looking at the readmissions on our key insights page we noted that our readmission rate for AMI at this time was at 17% which was higher that the MCV all which is 15.6%.  In looking at the drill down for the readmitted population, we were able to review 31 charts.  We applied a filter for patients who had co-morbid condition of CHF which gave us a list of 5 patients.  The mean cost per episode and readmission costs were significantly higher on these 5 patients. This did not however, indicate if our problem with readmissions was related to the heart failure or another issue.  To investigate this further we entered the individual patient’s billing record to identify the first diagnosis listed on the readmission record following the index admission.  We also looked to see if heart failure was listed as any diagnosis on the readmission.  In 13% of the cases heart failure was listed as the first diagnosis and in 36% of the cases it was listed as one of the diagnosis on readmission. 

In conclusion

In light of the current data we have expanded our use of the heart failure toolkit to patients admitted with diagnosis of CHF and AMI who have EF of less than 50%.  We will also be looking to expand this to our CABG patients as well to assist those patient’s in proactively managing their heart failure as there is similar evidence to support this expansion.  Additionally, we are assigning a transition coach to all high risk patients who fall under the diagnosis of CHF, AMI or CABG.

Questions or comments?  We’d love to hear from you.  You can comment on this article, or use the form at the bottom of this page. 

If you’d like to learn more about what Covenant Health did, please contact Karen Bush here.