Comprehensive Heart Failure Improvements Lead to Reduced Readmissions, Mortality, and Costs

Despite having an in-depth, individualized heart failure (HF) program, Billings Clinic’s 30-day readmission rate was higher than desired and negatively impacted the costs of care. The organization leveraged comprehensive data and analytics to create an analytical approach for evaluating and caring for patients with HF, successfully enhancing HF care and improving clinical outcomes.

HIGH COST OF HEART FAILURE

In the U.S., nearly 6.5 million adults are diagnosed with HF every year. Annually, HF accounts for one out of every eight deaths and costs an estimated $30.7 billion.¹此外，全国心衰患者的30天再入院率为23%，使其成为医疗保险“减少医院再入院计划”(HRRP)和基于价值的购买计划中的六个高优先条件之一。^2,3

REDUCING HEART FAILURE READMISSIONS

Despite having a comprehensive HF program designed to provide education and care coordination for managing the individualized needs of patients with HF, Billings Clinic’s 30-day HF readmission rate was higher than desired, resulting in less than desirable patient experiences while increasing the costs of care. Billings Clinic lacked the deep analytics insight necessary to identify opportunities to improve the care delivered to these patients and the costs associated with delivering this care, resulting in missed opportunities to implement evidence-based interventions and care coordination during the hospital stay, at discharge, and post-discharge.

A lack of knowledge of exactly which patients in the hospital had HF led to missed or delayed opportunities to implement the appropriate care and follow-up. A lack of standard orders and workflows led to substantial variation in the care delivered to patients with HF diagnoses, leading to a lower-than-desired adherence related to the provision of evidence-based inpatient care and discharge planning. Billings Clinic desired a data-driven approach for the early identification of patients with HF to ensure the delivery of standardized and optimized patient care to improve clinical outcomes and reduce the cost of care.

EFFICIENTLY IDENTIFYING PATIENTS WITH HEART FAILURE

Leveraging and analyzing data

Billings Clinic’s HF program convened an outcomes improvement team, led by a physician specializing in HF, charged with improving care across the continuum to improve outcomes for patients with HF and reduce 30-day readmission rates. To enhance the skills of the improvement team, members attended the Health Catalyst^®Accelerated Practices (AP) Program, an immersive and project-based experiential course that incorporates real-world application of the tools and knowledge required to achieve significant outcomes improvement.

Billings Clinic understood that success begins with leveraging data from multiple systems to identify improvement opportunities—and then implementing and monitoring targeted interventions to improve performance. It leveraged the Health Catalyst^®数据操作系统(DOS™)平台和一套强大的分析应用程序，包括世界杯厄瓜多尔vs塞内加尔波胆预测心力衰竭分析加速器，以更容易地访问数据和分析。使用分析加速器，组织可以在一个易于使用的一页摘要中快速可视化结果和过程指标，其中包括临床相关的、标准的、跨领域有意义的患者队列、定义和过程测量——消除了心力衰竭患者队列或心力衰竭严重程度定义的耗时开发。

The analytics accelerator includes process measures, such as documentation of ejection fraction and adherence with evidence-based guidelines and care transitions, and outcome measures including mortality, readmission rate, length of stay, and cost per case.

改进团队使用分析加速器来支持一种严格的、数据驱动的方法来评估和护理心衰患者，帮助推动和维持临床和财务结果的显著改善。比林斯诊所第一次能够有效地识别心衰住院患者，从而为这些患者提供循证护理，并能够对其表现进行全面分析。

Closing Care Gaps

The improvement team utilized the analytics accelerator to identify and address gaps in compliance with evidence-based guidelines. The data demonstrated two distinct areas in need of additional focus, including:

• 出院后一周内尽早再入院。
• 出院后7至30天内再入院。

利用这一信息，改进团队在实践中雇用提供者来制定标准工作流程，以指导临床决策，以改善住院病人护理，并采用标准工作流程来改善护理和门诊护理活动的过渡。

Registered nurses with HF expertise receive a list of admitted patients with HF, allowing purposeful rounding, enhanced case management, improved patient education, and a refined method of ensuring patients receive care that is consistent with the most recent evidence-based guidelines.

Billings Clinic developed and implemented a discharge checklist embedded within the EMR to facilitate evidence-based activities during the discharge process. The discharge checklist pulls information such as ejection fraction, lab results, and medications into one location so clinicians can easily determine if the evidence-based recommendations are being correctly followed. Each patient receives a follow-up phone call within 48 hours of discharge and is scheduled for a follow-up appointment with an HF specialist or, in some cases, a primary care provider, within seven days of discharge from the hospital.

Provider Training and Feedback

所有诊所的提供者都接受了关于HRRP测量要求、最新的循证指南、新的标准工作流程以及如何使用分析加速器的教育，使提供者能够自我监测患者的结果。

The improvement team meets bi-monthly to refine workflows and share performance data obtained from the analytics accelerator regarding compliance. Providers receive personalized feedback describing their compliance with the discharge form and the diuretic protocol.

RESULTS

Billings Clinic successfully improved HF care, which has resulted in improved clinical outcomes and substantial cost savings, including:

• $544K in cost savings, the result of a:
  • 18.6 percent relative reduction in the HF 30-day readmission rate in one year—with the current readmission rate 13.6 percent lower than the national average.
  • 10.9 percent relative reduction in the cost of care for patients with HF.
• 37.3 percent relative reduction in the hospital mortality rate for patients with HF.
• Avoided HRRP payment reductions.

比林斯诊所的数据驱动的标准改进努力使该组织能够参与风险共享的储蓄计划。The organization also received national recognition for its improvement efforts and was a recipient of the American Heart Association’s Get With the Guidelines Silver Plus Award.

“We are no longer simply reacting to problems. The Heart Failure Analytics Accelerator has enabled us to be a data-driven organization.”

– Sherrie Fuller-Benge, BSN, Director of Quality Resources, Billings Clinic

WHAT’S NEXT

比林斯诊所计划实施一项住院患者利尿方案，并正在制定具体的、有针对性的改善措施，支持心衰患者出院90天，以避免急诊，防止心衰再次入院，并降低护理成本。

REFERENCES

1. Centers for Disease Control and Prevention. (2019).心力衰竭。Retrieved fromhttps://www.cdc.gov/heartdisease/heart_failure.htm
2. Khera, R., Wang, Y., Nasir, K., Lin, Z., & Krumholz, H. M. (2019). Evaluation of 30-day hospital readmission and mortality rates using regression-discontinuity framework.Journal of the American College of Cardiology.Retrieved fromhttps://www.acc.org/latest-in-cardiology/journal-scans/2019/07/10/09/53/evaluation-of-30-day-hospital-readmission
3. Centers for Medicare & Medicaid Services. (2020).Hospital readmissions reduction program (HRRP).Retrieved fromhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program