Effect of Grand-Aides Nurse Extenders on Readmissions and Emergency Department Visits in Medicare Patients With Heart Failure
| Autor: | Arthur Garson, Robert A. Greevy, S. Craig Thomas |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Allied Health Personnel Nurses 030204 cardiovascular system & hematology Medicare Patient Readmission Medication Adherence Cohort Studies 03 medical and health sciences 0302 clinical medicine Medication Reconciliation Nursing Nursing Assistants House call Odds Ratio Medicine Humans 030212 general & internal medicine Propensity Score Aged Aged 80 and over Community Health Workers Heart Failure business.industry Odds ratio Emergency department Middle Aged medicine.disease United States House Calls Regimen Heart failure Cohort Propensity score matching Videoconferencing Female Cardiology and Cardiovascular Medicine business Emergency Service Hospital Cohort study |
| Zdroj: | The American journal of cardiology. 121(11) |
| ISSN: | 1879-1913 |
| Popis: | Numerous procedures have been tested to reduce hospital readmissions with varying success. The objective of this study was to evaluate all-cause readmissions and emergency department (ED) visits 30 days and 6 months after discharge with Grand-Aides (GAs): nurse extenders making frequent home visits under video direction by a nurse supervisor. Medicare patients with primary diagnosis of heart failure at the University of Virginia discharged January 1, 2013 to January 1, 2015 were included. A GA visited the patient's home within 24 to 48 hours with supervisor on video for medication reconciliation. Every visit, a GA completed a questionnaire for a supervisor who then had brief video conversation with the patient, reinforced adherence with medical regimen and danger signs, making 3 visits in the first week, 2 visits each in weeks 2 and 3, 1 visit in week 4, then a monthly visit supplemented by telephone. Outcomes were recorded for 108 GA and 854 controls. Statistical adjustment was performed through inverse probability of treatment weighting, with the distribution of covariates resembling a propensity score-matched cohort. Patients with GA had 2.8% 30-day all-cause readmissions versus 15.8% controls-82% reduction-(adjusted odds ratio [aOR] = 0.17; p = 0.0060); 6-month all-cause readmissions 13.0% versus 44.7% (aOR = 0.19; p 0.0001); ED 30-days 2.8% versus 45.1% (aOR = 0.03; p 0.0001); ED 6-months 12.0% versus 51.5% (aOR = 0.09; p 0.0001); and 6-month mortality 6.5% versus 8.8% (aOR = 0.73; p = 0.4698). At 30 days, 92% had "substantial medication adherence." Savings per $562,097, 7× return on investment. In conclusion, the GA approach to population health compares favorably in outcomes and expense 30 days and 6 months after discharge. |
| Databáze: | OpenAIRE |
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