Hospital readmission is a common and costly problem, with an average 30‐day readmission rate of 20% for Medicare patients. HF is the most common reason for readmission. Inattention to care across transitions is a key factor in this problem. To improve care and reduce readmissions for HF patients, the Institute for Healthcare Improvement (IHI) recommends assessing patients' functional status and social resources in order to plan safe discharges, performing careful medication reconciliation, educating patients and/or caregivers using the teach‐back method, communicating in real time with patients' next providers of care, and arranging prompt postdischarge follow‐up visits. We developed a curriculum called the AHki Initiative for residents on the inpatient medicine service that emphasizes knowing patients as people in order to provide more patient‐centered care and improve care transitions. Curricular components overlap with IHI recommendations and include medication adherence review, phone calls to outpatient providers, posldischarge telephone contact, and a thorough assessment of a patient's social resources. We hypothesized that the Aliki curriculum would decrease HF read mission rates.
The general medicine service at Johns Hopkins Bayview Medical Center consists of 4 house staff teams (3 usual care teams and 1 Aliki team) and a hospitalist service, Each house staff team consists of 1 resident, 2 interns, 2 students, 1 attending, and a case manager. To allow time for completion of curricular activities, the Aliki team admits half the patients compared to usual care teams (5 patients on long call and 2 on short call, instead of 10 and 4 patients, respectively). The content of phone calls to patients and providers is not standardized, but the curriculum contains communication tools and guidelines. For patients initially admitted for HF, we analyzed rates of readmission for HF within 30 days to any service within our hospital. The Aliki curriculum began in October 2007. Data collection continued through August 2009.
For patients admitted for HF to the Aliki team between October 2007 and August 2009, there was a 6% 30‐day readmission rate for HF. For HF patients admitted to other house staff teams, the rate was 14%. The P value was 0.067; although this is not quite statistically significant because of the small sample size, a promising trend is indicated. For HF patients on the Aliki team, there were no 30‐day HF readmissions for the last 15 months of data collection. These improvements occurred despite significantly higher medical complexity and severity of illness of patients on the Aliki team, based on case‐mix index and severity scores.
The Aliki Initiative is a multipronged approach to teaching patient‐centered care and safe transitions that appears to decrease 30‐day HF readmissions. Our findings represent important quality and cost benefits.
J. Record, none; C. Rand, none; L. Hanyok, none; M. Federowicz, none; D. Hellmann, none; R. Ziegelstein, none.
To cite this abstract:Record J, Rand C, Hanyok L, Federowicz H, Hellmann D, Ziegelstein R. A Hospital‐Based Curriculum for Patient‐Centered Care and Safe Transitions: Effect on 30‐Day Heart Failure Readmissions. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 123. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/a-hospitalbased-curriculum-for-patientcentered-care-and-safe-transitions-effect-on-30day-heart-failure-readmissions/. Accessed July 21, 2019.