Risk score-guided multidisciplinary team-based Care for Heart Failure Inpatients is associated with lower 30-day readmission and lower 30-day mortality.
Am Heart J
; 219: 78-88, 2020 01.
Article
em En
| MEDLINE
| ID: mdl-31739181
ABSTRACT
OBJECTIVE:
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.BACKGROUND:
HF inpatient care and 30-day post-discharge management require quality improvement to impact patient health, optimize utilization, and avoid readmissions.METHODS:
HF inpatients (Nâ¯=â¯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 (nâ¯=â¯1221), while lower-risk patients received standard HF care (nâ¯=â¯1220). Controls had their readmission and mortality scores calculated retrospectively (high risk nâ¯=â¯1791; lower risk nâ¯=â¯1950).RESULTS:
High-risk MTCP recipients had 21% lower 30-day readmission compared to high-risk controls (adjusted Pâ¯=â¯.013, HRâ¯=â¯0.79, CIâ¯=â¯0.66, 0.95) and 52% lower 30-day mortality (adjusted Pâ¯<â¯.001, HRâ¯=â¯0.48, CIâ¯=â¯0.33, 0.69). Lower-risk patients did not experience increased readmission (adjusted HRâ¯=â¯0.88, Pâ¯=â¯.19) or mortality (adjusted HRâ¯=â¯0.88, Pâ¯=â¯.61). Some utilization was higher, such as prescription of home health, for MTCP recipients, with no changes in length of stay or overall costs.CONCLUSIONS:
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Equipe de Assistência ao Paciente
/
Readmissão do Paciente
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Insuficiência Cardíaca
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Female
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Humans
/
Male
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article