Risk score-guided multidisciplinary team-based Care for Heart Failure Inpatients is associated with lower 30-day readmission and lower 30-day mortality
| Autor: | James F. Lloyd, Rami Alharethi, Colleen Roberts, Jalisa Cruz, Benjamin D. Horne, Abdallah G. Kfoury, Jason Buckway, Donald L Lappe, Kismet Rasmusson, R. Scott Evans, Tami L Bair |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors MEDLINE 030204 cardiovascular system & hematology Lower risk Patient Readmission Risk Assessment Decision Support Techniques 03 medical and health sciences 0302 clinical medicine Cause of Death Health care medicine Humans 030212 general & internal medicine Precision Medicine Cause of death Aged Heart Failure Patient Care Team Inpatients Framingham Risk Score Cross-Over Studies Inpatient care business.industry medicine.disease Quality Improvement Heart failure Emergency medicine Female Cardiology and Cardiovascular Medicine business Risk assessment |
| Zdroj: | American heart journal. 219 |
| ISSN: | 1097-6744 |
| Popis: | Using augmented intelligence clinical decision tools and a risk score-guided multidisciplinary team-based care process (MTCP), this study evaluated the MTCP for heart failure (HF) patients' 30-day readmission and 30-day mortality across 20 Intermountain Healthcare hospitals.HF inpatient care and 30-day post-discharge management require quality improvement to impact patient health, optimize utilization, and avoid readmissions.HF inpatients (N = 6182) were studied from January 2013 to November 2016. In February 2014, patients began receiving care via the MTCP based on a phased implementation in which the 8 largest Intermountain hospitals (accounting for 89.8% of HF inpatients) were crossed over sequentially in a stepped manner from control to MTCP over 2.5 years. After implementation, patient risk scores were calculated within 24 hours of admission and delivered electronically to clinicians. High-risk patients received MTCP care (n = 1221), while lower-risk patients received standard HF care (n = 1220). Controls had their readmission and mortality scores calculated retrospectively (high risk: n = 1791; lower risk: n = 1950).High-risk MTCP recipients had 21% lower 30-day readmission compared to high-risk controls (adjusted P = .013, HR = 0.79, CI = 0.66, 0.95) and 52% lower 30-day mortality (adjusted P .001, HR = 0.48, CI = 0.33, 0.69). Lower-risk patients did not experience increased readmission (adjusted HR = 0.88, P = .19) or mortality (adjusted HR = 0.88, P = .61). Some utilization was higher, such as prescription of home health, for MTCP recipients, with no changes in length of stay or overall costs.A risk score-guided MTCP was associated with lower 30-day readmission and 30-day mortality in high-risk HF inpatients. Further evaluation of this clinical management approach is required. |
| Databáze: | OpenAIRE |
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