Effect of implementing a heart failure admission care bundle on hospital readmission and mortality rates: interrupted time series study.
| Autor: | Woodcock, Thomas, Matthew, Dionne, Palladino, Raffaele, Nakubulwa, Mable, Winn, Trish, Bethell, Hugh, Hiles, Stephen, Moggan, Susan, Dowell, Jackie, Sullivan, Paul, Bell, Derek, Cowie, Martin R. |
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| Předmět: |
EVALUATION of human services programs
HOSPITALS THERAPEUTICS ECHOCARDIOGRAPHY CONFIDENCE intervals RESEARCH methodology PATIENTS PATIENT readmissions REGRESSION analysis HOSPITAL admission & discharge HOSPITAL mortality QUALITY assurance TIME series analysis DESCRIPTIVE statistics RESEARCH funding PATIENT care PEPTIDE hormones LOGISTIC regression analysis DATA analysis software ACUTE diseases HEART failure POISSON distribution |
| Zdroj: | BMJ Quality & Safety; Jan2024, Vol. 33 Issue 1, p55-65, 17p |
| Abstrakt: | This study aimed to evaluate the impact of developing and implementing a care bundle intervention to improve care for patients with acute heart failure admitted to a large London hospital. The intervention comprised three elements, targeted within 24 hours of admission: Nterminal pro-B-type natriuretic peptide (NT-proBNP) test, transthoracic Doppler two-dimensional echocardiography and specialist review by cardiology team. The SHIFTEvidence approach to quality improvement was used. During implementation, July 2015--July 2017, 1169 patients received the intervention. An interrupted time series design was used to evaluate impact on patient outcomes, including 15 618 admissions for 8951 patients. Mixed-effects multiple Poisson and log-linear regression models were fitted for count and continuous outcomes, respectively. Effect sizes are slope change ratios preintervention and post-intervention. The intervention was associated with reductions in emergency readmissions between 7 and 90 days (0.98, 95% CI 0.97 to 1.00), although not readmissions between 0 and 7 days post-discharge. Improvements were seen in in-hospital mortality (0.96, 95% CI 0.95 to 0.98), and there was no change in trend for hospital length of stay. Care process changes were also evaluated. Compliance with NT-proBNP testing was already high in 2014/2015 (162 of 163, 99.4%) and decreased slightly, with increased numbers audited, to 2016/2017 (1082 of 1101, 98.2%). Over this period, rates of echocardiography (84.7-98.9%) and specialist input (51.6-90.4%) improved. Care quality and outcomes can be improved for patients with acute heart failure using a care bundle approach. A systematic approach to quality improvement, and robust evaluation design, can be beneficial in supporting successful improvement and learning. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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