The topic proposed is the way to reduce congestive heart failure (CHF) readmission rate. In healthcare, the readmission rate is hospital admission due to episodes of acute coronary infarction within a given period after discharge. CHF, which affects about 6.5 million Americans, is known to have multiple etiologies, including myocardial infarctions, high blood pressure, cardiac arrhythmias, myocardiopathy, and valvular heart disease (Pate & Deoghare, 2015).
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Its pathophysiology is linked to a cardiac dysfunction that results in the heart, not pumping an adequate amount of blood to meet the body’s metabolic needs. The healthcare spending per each readmission is estimated to be $13,000, a 118% increase over initial hospitalization costs (Pate & Deoghare, 2015). CHF treatment is multifaceted. It may involve heart surgery or pharmacological management, coupled with symptoms monitoring. CHF complications that lead to high readmission rates may be due to suboptimal post-discharge management. I would wish to explore possible interventions for improved outcomes of reduced 30-day CHF readmissions in hospitals.
Study Purpose and My Interest in this Topic
The nurse’s role in promoting positive self-care behaviors in cardiac critical care as an intervention to decrease hospital readmissions elicited my interest in exploring this topic. In particular, I am fascinated by the factors influencing patient compliance with self-care recommendations for improved post-discharge CHF outcomes. Non-adherence to therapy recommendations predisposes patients to avoidable CHF complications that warrant emergency hospitalization or prolonged length of hospital stay. Patient support to improve self-monitoring of symptoms before hospital discharge can help reduce the frequency of CHF readmissions.
The topic is relevant to today’s healthcare system that emphasizes continuous quality improvement by hospitals. Patient readmission is a key measure of quality improvement. Before 2012, facilities had no incentive to decrease readmissions. According to McIlvennan, Eapen, and Allen (2015), the Affordable Care Act (ACA) of 2012 instilled care quality by instituting hefty financial penalties on facilities with excessive 30-day readmissions for CHF, cardiomyocardial infarctions, and pneumonia, compared to national averages. In addition, the focus on reducing CHF readmission rate is meant to contain high costs related to re-hospitalizations and greater length of stay. In the US, an estimated 25% of 30-day hospital readmissions are attributed to CHF complications, contributing to high health care costs (about $40 billion annually) (Feltner et al., 2014). As a result, hospitals have a significant interest in addressing the factors that cause readmission for specific interventions. In particular, facilities now support aspects of transitional care, including post-discharge follow-ups, regular calls, and alliances with community-based clinics for healthcare continuity.
The purpose of a paper on this topic would be to improve CHF outcomes in adult patients 30 days after discharge, mainly through patient education. An exploration of the risk factors contributing to higher CHF readmission rates in hospitals can inform quality improvement interventions. In addition, higher CHF readmissions lead to lower Medicare disbursement related to financial penalties. Hospitals must find ways to achieve better CHF outcomes to avoid unnecessary readmissions. The strategies may include symptom monitoring, medical checkups, and medication adherence. My intended goal for exploring this topic is to evoke change geared towards reducing CHF readmission rates. The hospital change project will involve a two-pronged approach that includes improving nurses’ understanding of CHF management and patient self-care behaviors. This goal seems realistic as it focuses on CHF patients and specialty nurses in a single hospital.
Intended Target Audience
The specific target audience of this paper includes staff nurses caring for CHF patients. It encompasses experienced male and female specialty nurses with a BSN degree and from different socioeconomic classes and cultural backgrounds. Improving CHF outcomes requires adequate patient education by nurses before discharge. The efficient delivery of self-care knowledge to CHF patients is critical in reducing episodes that require hospitalizations. Nurses may be knowledgeable about CHF management guidelines, but still, fail to pass this information to patients. Nurses often underestimate the value of heart failure education in lowering CHF readmission rates. Thus, they may benefit from knowing about the link between inadequate patient education and higher readmission rates for CHF patients.
- In hospitalized CHF patients, does post-discharge medication use education by nurses through phone calls improve 30-day outcomes compared to no education?
- In CHF patients, what adverse events lead to emergency admissions within a 30-day period after discharge?
- What factors influence patient adherence to self-care guidelines and therapies taught by nurses after being discharged to recover at home?
- What is the knowledge base of the nursing staff caring for patients in relation to CHF management at home settings?
- In the critical care unit, what is the frequency of passing self-care knowledge to hospitalized patients by nurses?
Initial Problem Statement
Despite most hospitals adopting the recommended CHF management guidelines, a significant number of patients seek readmission for emergency care within a 30-day period following discharge.
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It is hypothesized that CHF patient education throughout the health care system (from admission to transition care) will decrease the 30-day readmission rates. The two variables expressed in this hypothesis are CHF management and readmission rates. The independent variable (CHF management) encompasses factors that affect CHF outcomes such as adherence levels and self-care behavior resulting from patient education. The effect of these factors is higher readmission rates of CHF populations. The hypothesis can be tested by comparing the readmission rates of CHF patients receiving self-care education before discharge and unprepared CHF populations within 30 days after discharge.
Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z., Sueta, C. A., Coker-Schwimmer, E. L.,…Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure: A systematic review and meta-analysis. Annals Of Internal Medicine, 160(11), 774-784. Web.
McIlvennan, C. K., Eapen, Z. J., & Allen, L. A. (2015). Hospital readmission reduction program. Circulation, 131(20), 1796-1803. Web.
Pate, C., & Deoghare, S. (2015). Heart failure: Novel therapeutic approaches. Journal Of Postgraduate Medicine, 61(2), 101-108. Web.