Healthcare News & Insights

New readmissions study stirs up controversy in the hospital

Which group do you think is better at treating patients with congestive heart failure (CHF) and preventing readmissions — cardiologists or hospitalists?

Cardiologists is the correct answer, according to a recent trial conducted by the Minneapolis Heart Institute (MHI).

However, this study is bound to stir up a bit of controversy, since the latest trend has been toward hospitalist-led care and discharge processes.

Congestive heart failure readmissions

CHF is the most common cause for hospital readmission in patients over the age of 65. That’s why MHI began establishing protocols to improve heart failure readmission rates five years ago.

“We were concerned about providing better patient care, which would then by design have an impact on decreasing preventable readmissions,” explained Dr. Casey Lawler, a cardiologist at the institute, in an announcement.

Initially, MHI healthcare professionals found that one in five patients didn’t understand their diagnosis and even fewer patients understood their medication regimen. That led the researchers to focus more heavily on post-discharge care. So to combat the confusion MHI healthcare professionals:

  • contacted patients by phone within 24 hours of discharge
  • established provider follow-up within three to five days post discharge, and
  • had a nurse practitioner follow up with patients identified as high risk.

Researchers also wanted to discover whether treatment within the facility had an impact on patient care and readmission rates.

They looked at 2,311 patients, 65% of whom were treated by a hospitalist and 35% who were treated by a cardiologist. They analyzed patient demographics, length of stay, time to readmission, all patient refined diagnosis related groups, hospital attending at the time of discharge and total hospital costs.

Here’s what they found:

  • readmission rates were significantly lower when the attending physician was a cardiologist vs. a hospitalist (16% vs. 27.1%)
  • cardiologists were treating more severe cases, and
  • median length of stay was similar for both patients who were treated by cardiologists and hospitalists (4.8 days vs. 4.2 days).

However, the final result of the study may give cause for pause, as the mean costs for patients treated by a cardiologist were substantially higher than those treated by a hospitalist ($9,850 vs. $7,741).

Hospitalists for the prevention of readmissions

Don’t count your hospitalists out just yet. A study conducted by Pennsylvania’s PinnacleHealth System cut readmissions with its hospitalists team.

In the study, hospitalists cared for 70% of the inpatient volume. The hospitalists were  regularly trained in preventive measures such as:

  • clear communication of discharge plans
  • identification of a person who can answer questions once the patient has been discharged, and
  • ensuring the necessary arrangements have been made for follow-up care.

According to a report on Hospital, Pinnacle’s hospitalist program has made a positive difference in its readmission rates.

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