From the 2019 HVPAA National Conference
Dr. Nisha Gilotra (Johns Hopkins School of Medicine), Ms. Diane Lepley (Johns Hopkins School of Medicine), Mrs. Sarah Riley (Johns Hopkins University School of Medicine), Mrs. Abby Cummings (Johns Hopkins School of Medicine), Ms. Kathryn Menzel (Johns Hopkins School of Medicine), Dr. Stuart Russell (Duke University Medical Center), Mrs. Kimberly Cuomo (Johns Hopkins University School of Medicine)
Background
Heart failure (HF) accounts for significant healthcare utilization and expenditure, with costs projected to reach $70 billion by 2030. HF is a leading cause for hospitalization, and 25% are readmitted within 30 days. With financial incentives in place, hospital systems have implemented various transitional care programs in an attempt to reduce readmission rates. HF guidelines suggest close post hospitalization outpatient follow up (within 7 days) in order to improve outcomes. The Johns Hopkins Heart Failure Bridge Clinic (HFBC) was established in 2012 to provide quality patient care by bridging the transition from hospital to home. The HFBC is a nurse practitioner managed outpatient clinic with ability to provide intravenous diuretics, laboratory assessments, medication management and heart failure education.
Objective
We aimed to study the impact of the Johns Hopkins Heart Failure Bridge Clinic (HFBC) on acute care utilization and healthcare expenditures.
Methods
Patients newly referred to the clinic between 7/1/15 and 12/31/15 were included (n=261). Chesapeake Regional Information System for our Patients (CRISP) reporting services and Health Services Cost Review Commission (HSCRC) data were accessed to identify number of acute care visits (defined as all-cause inpatient, emergency department and observation visit in the state of Maryland) along with associated charges in the 1, 3, 6, and 12 month pre- and post-index HFBC visit periods.
Results
261 patients (62.5±15.4 years old, 59% African American, 54% male) were seen 699 times over 3-month follow up. IV furosemide was administered at 73 visits (to 43 patients) and oral loop diuretic dose was adjusted at 261 visits. In the 1 month pre- compared to post-HFBC visit period, there was a significant decrease in percentage of patients with at least one acute care visit (83% to 25%) and total number of acute care visits (313 to 94), with differences maintained through 12-month pre- and post-period (Figure 1). During the 3-month pre- and post-period, total charges decreased from $9,658,446 to $2,980,161 ($15,311 reduction in charges/patient) (Figure 2).
Conclusions
A comprehensive post-hospitalization HF clinic effectively decreases subsequent acute care utilization and costs for HF patients, who are at high risk for readmission during the early post-hospitalization period.
Clinical implications
Implementation of an outpatient HF disease management clinic improved patient outcomes via reduction in acute healthcare utilization and expenditures. Such an intervention has tremendous potential to directly impact the quality of care in this vulnerable patient population, which is of particular interest in the current fiscal environment and with the burgeoning HF epidemic.
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