Advertisement

Journal of General Internal Medicine

, Volume 8, Issue 11, pp 585–590 | Cite as

Prevention of readmission in elderly patients with congestive heart failure

Results of a prospective, randomized pilot study
  • Michael W. Rich
  • Janice M. Vinson
  • Jane C. Sperry
  • Atul S. Shah
  • Lisa R. Spinner
  • Mina K. Chung
  • Victor Da Vila-Roman
Original Articles

Abstract

Objective: To determine the feasibility and potential impact of a non-pharmacologic multidisciplinary intervention for reducing hospital readmissions in elderly patients with congestive heart failure.

Design: Prospective, randomized clinical trial, with 2:1 assignment to the study intervention or usual care.

Setting: 550-bed secondary and tertiary care university teaching hospital.

Patients and participants: 98 patients ≥70 years of age (mean 79±6 years) admitted with documented congestive heart failure.

Interventions: Comprehensive multidisciplinary treatment strategy consisting of intensive teaching by a geriatric cardiac nurse, a detailed review of medications by a geriatric cardiologist with specific recommendations designed to improve medication compliance and reduce side effects, early consultation with social services to facilitate discharge planning, dietary teaching by a hospital dietician, and close follow-up after discharge by home care and the study team.

Measurements and main results: All patients were followed for 90 days after initial hospital discharge. The primary study endpoints were rehospitalization within the 90-day interval and the cumulative number of days hospitalized during follow-up. The 90-day readmission rate was 33.3% (21.7%–44.9%) for the patients receiving the study intervention (n=63) compared with 45.7% (29.2–62.2%) for the control patients (n=35). The mean number of days hospitalized was 4.3±1.1 (2.1–6.5) for the treated patients vs. 5.7±2.0 (1.8–9.6) for the usual-care patients. In a prospectively defined subgroup of patients at intermediate risk for readmission (n=61), readmissions were reduced by 42.2% (from 47.6% to 27.5%; p=0.10), and the average number of hospital days during follow-up decreased from 6.7±32 days to 3.2±1.2 days (p=NS).

Conclusions: These pilot data suggest that a comprehensive, multidisciplinary approach to reducing repetitive hospitalizations in elderly patients with congestive heart failure may lead to a reduction in readmissions and hospital days, particularly in patients at moderate risk for early rehospitalization. Further evaluation of this treatment strategy, including an assessment of the cost-effectiveness, is warranted.

Key words

hospital readmissions heart failure, congestive elderly prevention cost containment 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gooding J, Jette AM. Hospital readmissions among the elderly. J Am Geriatr Soc. 1985;33:595–601.PubMedGoogle Scholar
  2. 2.
    Rich MW, Freedland KE. Effect of Dregs on three-month readmission rate of geriatric patients with congestive heart failure. Am J Public Health. 1988;78:680–2.PubMedGoogle Scholar
  3. 3.
    Vinson JM, Rich MW, Shah AS, Sperry JC. Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc. 1990;38:1290–5.PubMedGoogle Scholar
  4. 4.
    Graham H, Livesley B. Can readmissions to a geriatric unit be prevented? Lancet. 1983;1:404–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Campion EW, Jette AM, Berkman B. An interdisciplinary geriatric consultation service: a controlled trial. J Am Geriatr Soc. 1983;31:792–6.PubMedGoogle Scholar
  6. 6.
    Andrews K. Relevance of readmission of elderly patients discharged from a geriatric unit. J Am Geriatr Soc. 1986;34:5–11.PubMedGoogle Scholar
  7. 7.
    Kennedy L, Neidlinger S, Scroggins K. Effective comprehensive discharge planning for hospitalized elderly. Gerontologist. 1987;27:577–80.PubMedGoogle Scholar
  8. 8.
    Townsend J, Piper M, Frank AO, Dyer S, North WRS, Meade TW. Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomized controlled trial. BMJ. 1988;297:544–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Smith DM, Weinberger M, Katz BP, Moore PS. Postdischarge care and readmissions. Med Care. 1988;26:699–708.PubMedCrossRefGoogle Scholar
  10. 10.
    Weinberger M, Smith DM, Katz BP, Moore PS. The cost-effectiveness of intensive postdischarge care: a randomized trial. Med Care. 1988;26:1092–102.PubMedCrossRefGoogle Scholar
  11. 11.
    Rich MW, Sperry JC, Vinson JM, Shah AS. Prediction of readmission of elderly patients with congestive heart failure [abstr]. Boston: Proceedings of the American Geriatrics Society 46th Annual Meeting, 1989;56.Google Scholar
  12. 12.
    Anderson GF, Steinberg EP. Hospital readmissions in the Medicare population. N Engl J Med. 1984;311:1349–53.PubMedCrossRefGoogle Scholar
  13. 13.
    Zook CJ, Moore FD. High cost users of medical care. N Engl J Med. 1980;302:996–1002.PubMedCrossRefGoogle Scholar
  14. 14.
    Lemrow N, Adams D, Coffey R, Farley D. The 50 most frequent diagnosis-related groups (DRGs), diagnoses, and procedures: statistics by hospital size and location. Rockville, MD: Agency for Health Care Policy and Research. DHHS Publication No. 90-3465;1990:1–12.Google Scholar
  15. 15.
    Ghali JK, Cooper R, Ford E. Trends in hospitalization rates for heart failure in the United States, 1973-1986. Evidence for increasing population prevalence. Arch Intern Med. 1990;150:769–73.PubMedCrossRefGoogle Scholar
  16. 16.
    Furberg CD, Yusuf S, Thom TJ. Potential for altering the natural history of congestive heart failure: need for large clinical trials. Am J Cardiol. 1985;55:45A-47A.PubMedCrossRefGoogle Scholar
  17. 17.
    Ghali JK, Kadakia S, Cooper R, Ferlinz J. Precipitating factors leading to decompensation of heart failure. Traits among urban blacks. Arch Intern Med. 1988;148:2013–16.PubMedCrossRefGoogle Scholar
  18. 18.
    Graves EJ. 1989 Summary: National Hospital Discharge Survey. Advance data from Vital and Health Statistics 1991;No. 199:1–12.Google Scholar
  19. 19.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9.PubMedGoogle Scholar
  20. 20.
    Folstein MF, Folstein SE, McHugh PF. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 1993

Authors and Affiliations

  • Michael W. Rich
    • 1
  • Janice M. Vinson
  • Jane C. Sperry
  • Atul S. Shah
  • Lisa R. Spinner
  • Mina K. Chung
  • Victor Da Vila-Roman
  1. 1.Geriatric CardiologyJewish Hospital at Washington University Medical CenterSt. Louis

Personalised recommendations