Cardiac readmissions are an ever expanding burden spanning from patients, to hospitals, all the way up to the national healthcare system. Currently, there is a lack of consensus regarding appropriate inpatient screening tests for identifying patients at high risk for readmission, as well as peri-hospitalization disease management regimens aiming to prevent readmissions. Our clinical review examined cardiac patients and their risk of 7 day, all 30 day, and non-elective 30 day readmission rates, through the mini-cog mental examination as well as a set of ten peri-hospitalization interventions.
All cardiac admissions for a one year period from December 2014 to December 2015 at Regions Hospital, an urban tertiary center in Minnesota, were analyzed via EMR in a retrospective observational study. Each cardiac patient admitted during this time underwent mini-cognition evaluation with results recorded as either pass or fail. Additionally, each congestive heart failure patient’s chart was reviewed to assess which peri-hospitalization interventions he or she received. The ten interventions were: free weighing scales, MTM Pharmacist, complex disease management consultation, outpatient cardiology appointment within two weeks, community paramedic program, simplified heart failure booklet, heart failure refrigerator magnet, outpatient cardiac rehabilitation, inpatient cardiac rehabilitation, and a home health aide nurse. Chi square analysis was used to determine any association between mini – cog test and readmission. Similarly, a 2×2 contingency table was constructed for each of the 10 interventions vs. each of the 3 binary outcome measures (7 day, all 30 day, and non-elective 30 day readmissions); chi-square statistics and the associated p-value (at significant level of 0.05) was computed for each table to evaluate the correlation between each intervention and outcome measure.
The frequencies for all 7 day readmission rates, all 30 day readmission rates and non-elective 30 day readmission rates for all cardiac patients were 4.9%,12.9% and 11.2% respectively. The chi-square analyses indicated that there was no strong association between the result of the mini cog test and readmission rates in all categories. However, the average length of stay was shown to be statistically significant in affecting the all cause readmission rates
In review of interventions received by congestive heart failure patients, none of the 10 interventions were found to have lower rates of readmissions for 7 day , all 30 day, and non-elective 30 day readmissions. There were positive correlations shown between free scales and complex disease management programs in reducing readmissions.
A failed mini-cognition testing in all cardiac patients was not associated with higher readmission rates. However, in this analysis, it was found that a higher length of stay was statistically significant for higher readmission rates. In analyzing the CHF subset of cardiac patients, no one intervention received was found to have a statistically lower rate of readmission. Sharing these equivocal or negative results in quality improvement projects is crucial. Internally, institutions may learn lessons and make adjustments in their own practices and thus relieve burdens of otherwise wasted labor and resources. Similarly, other organzations facing these issues can also learn from these lessons as well.
To cite this abstract:Dohlen, AV; Boysen, N; Mathews, BK . THE VALUE OF NEGATIVE STUDIES IN QUALITY IMPROVEMENT: A CASE STUDY OF MINI-COG AND PERI-HOSPITALIZATION INTERVENTIONS TO REDUCE CARDIAC READMISSIONS. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 153. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/the-value-of-negative-studies-in-quality-improvement-a-case-study-of-mini-cog-and-peri-hospitalization-interventions-to-reduce-cardiac-readmissions/. Accessed April 4, 2020.