Key result
Transitional care services linked to lower hospital readmission risk in high-risk heart failure.
Why the study?
New approaches to reduce hospital readmissions and high costs for clinically complex high-risk heart failure patients are supported by recent health reform provisions.
Cohort (n=447)
No
May support transitional care in high-risk HF to reduce readmissions; leaves open confirmation in randomized trials.
Provisions within the recently passed health reform law provide support for new approaches to reducing the high cost of care for clinically complex patients. This article describes the characteristics of a recent transitional care pilot initiative that aims to reduce hospital readmissions among high-risk heart failure patients. The program was designed and implemented through a joint collaboration between a Certified Home Healthcare Agency and regional hospital. As a preliminary assessment of the impact of this program on patient outcomes, we compare the odds of rehospitalization among patients who received the transitional care services (n = 223) and a similar group of patients who received usual home care services (n = 224). Analyses indicated that patients who received the transitional care services were significantly less likely to be readmitted to the hospital than the patients in the control group. Although preliminary, our findings suggest that providing transitional care services to high-risk heart failure patients can be an effective deterrent against patterns of rehospitalization. The opportunities and challenges associated with implementing this pilot program are discussed.
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Russell et al. (2011) conducted a cohort in High-risk heart failure (n=447). Transitional care services vs. Usual home care services was evaluated on Hospital readmission. Transitional care services significantly reduced the likelihood of hospital readmission among high-risk heart failure patients compared to usual home care.
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