The ACC Corner: National Quality Initiative Looks to Reduce Readmission Rates

	Mary Norine Walsh, MD, FACC

Treating cardiovascular disease, in particular those patients with heart failure (HF) and myocardial infarction (MI), is costly. Studies show that HF and MI patients are particularly vulnerable in the 30-day post discharge period for hospital readmission. Therefore, changes in care strategies during this period of time could greatly improve outcomes.

In an effort to address this issue, the American College of Cardiology (ACC) has partnered with the Institute for Healthcare Improvement (IHI) in the H2H (Hospital to Home) initiative, which has a goal of reducing all-cause readmission rates for patients discharged with HF and MI by 20 percent by December 2012.

The H2H initiative aims to reduce readmission in the first 30 days by helping participating hospitals and clinicians make reducing readmissions a priority in their organizations, and by supporting all members of the cardiovascular care team to implement change. This support comes in the form of access to a steering committee composed of physicians and nurses who are nationally recognized for their expertise, connection with an active online community that shares best practice tools and strategies, educational webinars and surveys to make sharing information easy.

Readmission rates for HF and MI are publicly reported by CMS, and participants are encouraged to become familiar with their own readmission statistics to better determine what implemented changes have a positive impact. The H2H initiative focuses on three specific areas for improvement:

1. Post-discharge medication management. Patients must not only have access to the proper medications, but also be properly educated on how to use them.
2. Early follow-up. Discharged patients should have a follow-up visit scheduled within one week of discharge, as well as the means of getting to that appointment.
3. Symptom management. Patients must recognize the signs and symptoms that require medical attention, as well as the appropriate person to contact if those signs/symptoms appear.

H2H is built on the lessons learned from the ACC's quality improvement communities. The initiative benefits from the leadership of ACC member volunteers, national experts and organizational partners. Thousands of participants and more than 35 strategic partners have joined the initiative. Participants from across the healthcare continuum include hospitals, office practices, community healthcare practitioners, home health agencies, skilled nursing facilities and community leaders.

H2H connects hospitals and clinicians and their experiences with other hospitals that are struggling with similar issues. Identifying patients, data collection, gaining administrative and physician buy-in and coordinating care between inpatient and outpatient clinicians have all been topics of extensive discussion on the web portal and list serve. The H2H tools, webinars and other resources have been tailored to bring a focus to specific areas of improvement. The first such project, called the "See You in 7" challenge, focuses on improving the early follow-up process with the goal that all HF and MI patients are discharged with a follow-up appointment within seven days of leaving the hospital. The message to H2H participants: If you can't figure out where to start—do this first and get the ball rolling.

Though there is an abundance of research on readmissions, no single strategy has been demonstrated to be universally successful. However, there are straightforward improvements in the transition from inpatient to outpatient status that can reduce risk and improve quality of life for patients. The success of the H2H initiative will depend on the College's ability to provide simple, clear recommendations, practical tools and an environment that fosters learning across institutions.

A 20 percent reduction in hospital readmission for patients with HF and MI by 2012 is an ambitious goal. Success will impact the lives of thousands of patients and decrease cost by millions of dollars. Through national quality improvement initiatives such as H2H, cardiovascular clinicians are impacting both patient care as well as the bottom line.

Dr. Walsh is a member of the steering committee of H2H and medical director of HF and cardiac transplantation at St. Vincent Heart Center of Indiana in Indianapolis. For more information on H2H, visit www.h2hquality.org.