CardioExchange Archive

The CardioExchange Editors interview Joy Pollard about her research group’s findings in her recent paper studying the impact of regional collaboratives on improving heart-failure readmission rates. The article is published in the Journal of Nursing Care Quality.

CardioExchange Editors: Would you please summarize your findings for our readers?

Pollard: Using a focused, collaborative method concentrated on improving seven day post-discharge follow up and reducing 30-day heart failure readmissions, 10 hospitals in Southest Michigan showed improvement in both follow-up and readmission rates greater than non-participating hospitals in the same region. This Quality Improvement project was a year-long forum intended to bring hospitals together to learn from each other and share best practices and improvement strategies. Collaborative hospitals represented both urban and suburban hospitals and were affiliated with multiple health care systems. Each hospital had varying degrees of both supportive resources and maturity of their heart failure programs. Using aggregate claims data for Medicare fee-for-service beneficiaries provided by the Michigan Peer Review Organization, results showed overall 30-day readmission rates were reduced more in the collaborating hospitals than in non-collaborating hospitals (from 29.32% to 27.66% vs. from 27.66% to 26.03%; P=.008).

Editors: How did you establish the Southeast Michigan “See You in 7” Hospital Collaborative, and what was the role of ACC in this collaborative?

Pollard: The collaborative was a joint venture of the Greater Detroit Area Health Council in partnership with the American College of Cardiology (ACC) and the Michigan Peer Review Organization. The emphasis in this project was to implement strategies from the ACC Hospital to Home tool kit “See You in 7” challenge. Hospital to Home is a comprehensive Quality Improvement initiative of the ACC that provides evidenced-based tools for navigating the complexities of reducing readmissions for heart failure patients. Hospitals completed a “See You in 7” self-assessment before the collaborative as a gap analysis to identify individual areas of improvement. Each hospital then identified metrics from the toolkit on which to focus their process improvement. During the year-long project, hospitals tracked progress on their metrics and submitted quarterly process improvement reports that identified their successes and barriers in reaching their goals. Hospitals shared their quarterly reports in a round table format. Collaborative hospitals made modifications to their internal processes, established multidisciplinary teams to interview patients and families, improved their own data collection and tracking, streamlined availability of discharge summaries to follow up providers, identified key elements needed in discharge summaries, and created transportation guides to address patient barriers to follow up access.

Editors: What are the next steps? Have the hospitals sustained these efforts since this study was completed?

Pollard: Post-collaborative sustainability efforts by hospitals have focused on strategies that incorporate differing members of the care team into systematic improvement. One hospital now has every HF patient meet with a pharmacist (or pharmacy student) at their seven day follow up appointment for medicine reconciliation and teaching. Establishing support from the hospital administrative team has been another area of focus, with most utilizing a multidisciplinary approach of physicians and nurse champions meeting with administrators, quality management, and directors in tracking their progress. Overall, there was no mechanism for structured follow-up after the end of the year-long collaborative initiative. This limitation was due in part to ending of funding by the Robert Wood Johnson Foundation to the Greater Detroit Area Health Council, who supplied the collaborative with meeting space, electronic communication, and webinar support.

Next steps include extrapolating lessons learned from the MI collaborative to other regions and using a wider scope of the Hospital to Home toolkits in reducing heart failure readmissions.