Large-scale policy changes fail to boost heart failure outcomes—what else is needed?
The Care Coordination Act, a nationwide quality improvement initiative introduced in Sweden, failed to make a significant impact on heart failure hospitalization trends, according to a new analysis published in Circulation: Heart Failure.[1]
The Swedish Care Coordination Act launched in 2018 with a goal of reducing hospital readmissions and shortening lengths of stay for all patients. Researcher described it as a "mandatory hospital discharge model, overseen by dedicated nurses in the hospital, primary care and social care."
The project was successful in a general sense, but was it an effective tool for improving the quality of care for heart failure patients? To learn more, researchers tracked data from more than 110,000 hospital admissions from 2015 to 2019. The mean age was 81.9 years old, and 45.2% were female.
Overall, the Care Coordination Act did not result in significant changes in all-cause unplanned readmissions after 30 days or lengths of stay among heart failure patients.
For example, the average length of stay for these patients was 8.4 days prior to the reform and 8.1 days following the reform. While technically an improvement, the difference was not statistically significant.
In addition, the mortality rate among heart failure patients was not impacted by this quality improvement initiative.
“The goal of the Care Coordination Act was to improve the discharge process by involving primary care and social care providers during the patient’s hospitalization and improving coordination between caregivers after discharge, resulting in lower readmissions as well as shorter lengths of stay,” wrote first author Robert S. Kristiansson, MD, a researcher with Uppsala University in Sweden, and colleagues. “However, we could not identify an effect on readmissions or mortality in our study. Focusing on the components of the Care Coordination Act, there might be several explanations to why the expected system effects were not achieved.”
The authors noted that it is possible this new system-wide initiative actually replaced helpful processes that were already in place. In addition, they added, the Care Coordination Act called for “postdischarge individual care planning conferences” that do not seem to actually take place. This would understandably lessen the impact of these new policies.
Finally, Kristiansson et al. wrote that “the incentives introduced by the reform may be misaligned with the responsibilities and interests of the actors intended to implement it.”
What can be done to truly help heart failure patients?
The authors concluded by pointing to some steps care teams could still take to improve care for patients hospitalized for heart failure symptoms. For example, they wrote, any policies put into place need to have the full support of the healthcare team. If there is no support, there is arguably no reason to even go forward with the reform. The group also noted that any future quality improvement initiatives should be more flexible and allow changes to be made during the implementation process.
“Primary care plays a crucial role in effecting the timely, coordinated ambulatory care needed to prevent hospital readmission, and must be included as part of the planning and execution of postdischarge heart failure care,” the authors concluded. “Nonetheless, the Care Coordination Act does not seem to have resulted in a system-wide reduction in hospital readmission rates for patients with heart failure.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.