Readmission of Heart Failure Patients Re-Hospitalization and Heart Failure Patients

Heart failure is one of the top health problems in the United States leading to high rates of morbidity and mortality among people aged 60 years and above. The complications associated with health heart failure increases the readmission rates within 30 days of patients' discharges. In essence, the increase of readmission rate has been associated with high healthcare costs in the United States. Based on the correlation between high rates of readmission and its associated high costs, this paper argues that health education is an effective and essential tool that can reduce the rate of readmission. Techniques to carry out health education includes: pre-discharge planning, home visits, telephone calls, and tele-health to enhance a greater understanding of patients awareness, and how the implementation of strategies and effective self-care management can help their well-being.

PART 1

Clinical Question

Can health education reduce the readmission rates within 30 day for patients over the age of 60 years suffering from heart failure?

Background Information

As a nursing professional working in a long-term rehabilitation facility, I have been confronted with many challenges, but one of my core concerns is the need to reduce re-hospitalization of adult patients who are over 60 years of age with who are experiencing the markers for heart failure. My experience to date has revealed that, patients above 60 years suffering from heart failure are being re-hospitalized less than 30 days of discharge. This high rate of readmission for the identified group, have driven me to research and develop this paper based on evidence-based strategies to further understand and help reduce the rates of re-hospitalization among patients with heart failures.

Base on all the literature, heart failure is one of the major health problems in the United States, and more than 5.1 million people are suffering from heart failure. Based on a report by the Centers for Disease Prevention and Control (CDC) [2014], in 2010, approximately 7 million Americans were suffering from heart failure, and by 2030, an additional three million people are likely to suffer from chronic heart failure. Typically, heart failure happens when the heart is unable to pump sufficient oxygen and blood to support other organs of the body. Moreover, heart failure contributes to one out of 9 deaths in the United States. Additionally, the costs of heart failure increase the health budget in the U.S. by approximately $32 billion annually. The total costs of medications, and health services to treat heart failure and missed work days (CDC, 2014).

Literature Search Strategy

The purpose for this study is to review the clinical issues related to increase readmission rates with patients suffering with heart failure and implement effective health education to reduce readmission rates. The search strategy will include: MEDLINE, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, AHRQ, AHA, journal peer review articles. The study will also examine other databases on internet cohort studies between 1990 and 2014. The essential content for the literature search include: cause of readmission, cause of heart failure and influence of health education on readmission rate.

The conceptual framework, yet to be established, will provide the structure and content for the whole study based on literature review and personal experience. The search will carry out a literature review to reveal the rate of readmission of patients with heart failure. To date, the outcome of the search has reveal that the rate of readmission increases within 30 days after patients have been discharged, suggesting that health education is an effective tool to reduce the readmission rates.

Part II

Annotated Bibliography

Park, L., Andrade, A., Mastey, A., Sun, J., & Hicks (2014). Institution specific risk factors for 30 day readmission at a community hospital: a retrospective observational study. BMC Health Services Research,14-40. doi: 10.1186/1472-6963-14-40

The authors presented a strong case pertainig to the topic of this paper.

They conducted a retrospective observational study using administrative data from January 1, 2009 through December 31, 2010 on a 257 bed community hospital in Massachusetts. The study included inpatient medical discharges from the hospitals service with the primary diagnoses of congestive heart failure, where the outcome was a 30-day readmission rates. After adjusting for known factors that impact readmission, provider associated factors such as hours worked and census on the day of discharge and hospital associated factors such as floor of discharge, and season were compared. During the period of the study, they found that after 3774 discharges, within a 30-day time-frame there were 637 readmissions, of that number (448)-19.6% were...

These institution specific risk factors may be targets for interventions to prevent readmissions
Adib-Hajbaghery, M., Maghaminejad, F., & Abbasi, A. (2013). The role of continuous care in reducing readmission for patients with heart failure. Journal of Caring Science, 2(4), 255-267. doi: 10.5681/cs.2013.031

After conducting an extensive search of the database to identify clinical trial studies on post-discharge follow-up care for patients with heart failure between 1995 and 2013,much of the research results showed that a fifth of those patients were hospitalized within 30 days after discharge; most of readmitted, approximately 40 to 50% were in America. The researchers alluded to the fact that, with such numbers, this is costly for patients and the healthcare system. Therefore, emphasis should be oriented to preventing hospital readmission and improved prognosis for care and a new approach for heart failure cases.

It was concluded and suggested by the researchers that, nurses should be recognized and educated by the hospital organization and train them about appropriate care programs for the patients they encounter and treat with heart failures. In addition, nurses should be competently trained to educate heart failure patients about a change in life-style, diet, medications, activity, and sleeping patterns

Part III -- Integrated Summary

As previously mentioned, one of the major health problems in the United States for individuals aged 60 years and above is heart failure, which results in high rates of morbidity and mortality. The complications associated with this disease increase the rates of readmissions within 30 days of patients' discharges. Generally, heart failure contributes to more than 600,000 deaths in the United States on an annual basis. As a result, it has been considered as the leading cause of deaths for men and women though a huge percentage of deaths take place among individuals aged at least 60 years. Essentially, the increase in rate of readmissions of patients suffering from this condition within 30 days of patients' discharges is linked to high costs of health care in the United States. Therefore, there is a strong link or correlation between high readmission rates and high costs of healthcare in the country.

The increased morbidity and mortality rates because of heart failure incidents and the increase in the number of deaths has contributed to numerous studies being carried out to examine the issue. The existing studies have focused on different aspects relating to the disease including appropriate measures for reducing readmission rates for patients with the condition and evaluation of risk factors that contribute to increase in readmission of these patients. One of the studies conducted to identify measures for reducing readmission rates of heart failure patients is the research by Mohsen Adib-Hajbaghery, Farzaneh Maghaminejad and Ali Abbasi. These researchers examined the role of continuous care in lessening readmission for health failure patients. An example of a study carried out to examine specific factors contributing to readmission rates is the research by Lee Park, Danielle Andrade, Andrew Mastey, James Sun, and LeRoi Hicks. These researchers conducted a retrospective observational study to identify institution-specific risk factors that contribute to readmission of patients with heart failure at a community hospital.

One of the most important indicators for evaluating the quality of care is patient readmission a short time after discharge from a health care facility. According to the findings of studies and recent surveys, approximately one-fifth of patients will be readmitted to a hospital 30 days after discharge. This rate of readmission within a short period of time after discharge is particularly huge in the United States where it is reported to be between 40 and 50%. This high rate has partly contributed to the high costs in the country's health care system as well as generating additional costs for patients.

The high rates of hospital readmission in the United States is also evident in Medicare where one-fifth of beneficiaries are re-hospitalized within one month after discharge at a cost of $17.4 billion every year. This increased rate has forced Centers for Medicare and Medicaid Services (CMS) to penalize approximately 1% of reimbursement for inpatient services since the beginning of October 2012 and based on risk-adjusted ratio (Park et al., 2014, p.1).

The high rates of re-hospitalization implies that the basis for caring and developing new treatment measures for patients with heart failure is preventing readmission and enhancing prognosis. Moreover, individual hospitals are increasingly facing the need to patient and institutional risk factors that contribute to re-hospitalization within a short…