May 26, 2015Open Access

Hospital Readmissions of Patients with Heart Failure: The Impact of Hospital and Primary Care Organizational Factors in Northern Italy

VAVera Maria AvaldiUniversity of Bologna JLJacopo LenziUniversity of Bologna ICIlaria CastaldiniAzienda Unita' Sanitaria Locale di Parma

Structured PICO

Do specific organizational factors, such as a heart failure care pathway, reduce unplanned hospital readmissions in elderly patients discharged with heart failure?

Population

1,873 elderly patients resident in the Local Health Authority of Bologna (Northern Italy) discharged with a diagnosis of heart failure, median age 83, 55.5% female.

Intervention

Implementation of a specific heart failure care pathway at the primary care level, discharge from a cardiology department, and general practitioners' monodisciplinary organizational arrangement.

Comparator

Absence of the specific organizational factors (e.g., no specific HF care pathway).

Outcome

Unplanned hospital readmissions for any cause and for heart failure at 30, 90, 180, and 365 days.hard clinical

Implementation of a specific heart failure care pathway at the primary care level is associated with significantly lower rates of short- and long-term heart failure readmissions.

Abstract

BACKGROUND: Primary health care is essential for an appropriate management of heart failure (HF), a disease which is a major clinical and public health issue and a leading cause of hospitalization. The aim of this study was to evaluate the impact of different organizational factors on readmissions of patients with HF. METHODS: The study population included elderly resident in the Local Health Authority of Bologna (Northern Italy) and discharged with a diagnosis of HF from January to December 2010. Unplanned hospital readmissions were measured in four timeframes: 30 (short-term), 90 (medium-term), 180 (mid-long-term), and 365 days (long-term). Using multivariable multilevel Poisson regression analyses, we investigated the association between readmissions and organizational factors (discharge from a cardiology department, general practitioners' monodisciplinary organizational arrangement, and implementation of a specific HF care pathway). RESULTS: The 1873 study patients had a median age of 83 years (interquartile range 77-87) and 55.5% were females; 52.0% were readmitted to the hospital for any reason after a year, while 20.1% were readmitted for HF. The presence of a HF care pathway was the only factor significantly associated with a lower risk of readmission for HF in the short-, medium-, mid-long- and long-term period (short-term: IRR incidence rate ratio=0.57, 95%CI confidence interval=0.35-0.92; medium-term: IRR=0.70, 95%CI=0.51-0.96; mid-long-term: IRR=0.79, 95%CI=0.64-0.98; long-term: IRR=0.82, 95%CI=0.67-0.99), and with a lower risk of all-cause readmission in the short-term period (IRR=0.73, 95%CI=0.57-0.94). CONCLUSION: Our study shows that the HF care specific pathway implemented at the primary care level was associated with lower readmission rate for HF in each timeframe, and also with lower readmission rate for all causes in the short-term period. Our results suggest that the engagement of primary care professionals starting from the early post-discharge period may be relevant in the management of patients with HF.

AI에게 질문

Bookmark

View Full Paper