Heart Failure 30-Day Readmissions: Causes, Prediction, Prevention in a Rural Hospital

Abstract

Readmissions of heart failure (HF) patients are a costly and potentially avoidable expenditure for our healthcare systems. In 2015, acute care facilities who exceed pre-determined benchmarks for 30-day HF readmission rates set by the Centers for Medicare and Medicaid Services (CMS) will see substantial penalties resulting in reductions in all Medicare reimbursement (Centers for Medicare and Medicaid Services [CMS], 2014). In an attempt to mitigate the financial burden associated with heart failure 30-day readmission rates, new techniques must be developed to identify the risk factors associated with this condition. The risk-standardized readmission rates (RSRRs) for heart failure have decreased from 23.4 % in July 2010 to 21.9% in June 2013 (CMS, 2013). Despite this decline, reducing readmission rates is a national priority in an effort to reduce rising healthcare costs (CMS, 2014). The purpose of this project was to identify trends of 30-day heart failure readmissions and evaluate the efficacy and feasibility of a discharge risk assessment implemented to stratify those at highest risk for 30-day readmission for heart failure. This discharge risk assessment for readmission was implemented at a North Carolina rural community hospital and targets an acute care population with a 30-day readmission rate higher than the current national median. The project design was a retrospective data analysis of all patients readmitted to the hospital within the first 30-days post discharge for treatment of heart failure as a primary diagnosis. Rogers’ Diffusion of Innovation provided the theoretical foundation for the project. Results of the retrospective chart review showed that neither age, nor time of follow up visits, nor medication regimens were predicting factors of 30-day heart failure readmissions. Heart failure 30-day readmissions are due to multiple factors. The prediction and prevention of 30-day heart failure readmissions requires an interprofessional approach to create robust strategies to address this issue.