Background: In the current policy environment hospital readmissions are receiving considerable attention due to a provision in the Affordable Care Act (2010), that penalize hospitals through reduced payments for excess readmissions (the hospital readmissions reduction program (HRRP)). This program primarily holds hospitals accountable, although a multitude of factors not directly in control of hospitals can be contributory to readmissions. Of these, whether or not patients are discharged to an appropriate post-discharge care setting can be one contributory factor, and, this study evaluated the association between post-discharge care setting and hospital revisits. Methods: A retrospective analysis of the 2008 Medicare Current Beneficiary Survey (MCBS) was conducted. Three post-discharge care settings were evaluated: 1) routine discharge to home; 2) home with home healthcare; and 3) skilled nursing facility. Two outcomes were assessed: 1) 30-day all-cause hospital readmissions; and 2) 30-day all-cause hospital revisits (combination of inpatient admissions and emergency department visits). Analyses were carried out among patients with hospitalizations for any reason, as well as among a subgroup that were hospitalized for one of seven priority conditions identified in the HRRP. Weighted logistic regression analyses that incorporated information on the complex survey design were conducted. Results: Of the MCBS sample representing 46,048,125 Medicare beneficiaries (unweighted N=11,723), 4.9 percent (N= 2,293,629; unweighted N=670) contributed at least one index hospitalization to the analysis. Among hospitalization for any reason, 30-day all-cause hospital readmissions and revisits was 12.3 percent and 17.8 percent, respectively. The subgroup consisted of 31.8 percent of hospitalizations for any reason (N=730,174; unweighted N=216). Readmissions and revisits in the subgroup were 17.8 percent, and 24.5 percent, respectively. Post-discharge care setting was not significantly associated with either readmissions (P=0.966) or revisits (P=0.728) for hospitalizations for any reason. Findings for the subgroup were similar with no significant association between post-discharge care setting with either readmissions (P=0.850) or revisits (P=0.483). Conclusion: Absence of a difference in readmissions and revisits by post-discharge care setting suggests that the choice of discharge status might be appropriate following an inpatient admission. However, further research with larger sample sizes for conditions in the subgroup both together and separately is recommended.

No / In 2005, the UK Department of Health recommended that a new role, the arrhythmia care coordinator (ACC), be created to guide patients through the diagnosis and treatment for arrhythmia. The belief was that this would improve the efficiency of care and improve their quality of life. The British Heart Foundation provided funding for 32 such posts, all of which were filled by arrhythmia specialist nurses, and commissioned an evaluation of the new service to assess its impact on patients. This paper focuses on the impact of the ACCs on their patients’ levels of anxiety and depression, hospital readmissions and costs to the National Health Service (NHS). From 2008 to 2010, using questionnaires, we conducted a longitudinal audit of the psychological status of the patients referred to the ACCs; we also assessed the ACCs’ impact on readmissions and cost benefits to the NHS using UK Hospital Episode Statistics. We found high levels of anxiety and depression amongst patients. Nearly one-third were at the ‘borderline’ or ‘clinically anxious’ and 18% were at the ‘borderline’ or ‘clinically depressed’ level at their first assessment with small changes at follow-up. In arrhythmia specialist nurse sites, readmission rates were reduced by half. After deducting the cost of the ACCs and their support, the estimated annual saving was £29,357 per ACC. This evaluation has shown that the NHS saves £29,357 per year over and above the costs of employing a British Heart Foundation ACC and that all arrhythmia centres should be encouraged to employ an appropriate number of such specialists.

Each year in the United States, thousands of people are readmitted within 30 days of being discharged from a hospital. Current research indicates that at least one-third of these rehospitalizations are preventable. The purpose of this project was to examine patient and environmental characteristics of those who were readmitted within 30 days of discharge for commonalities that may explain the gap in practice for a specific health care organization. The project was undertaken in response to the organization's need to improve a 50th-percentile ranking with the goal of reaching the top 10th percentile. A plan-do study-act framework was used as a guide to ensure no steps in the process were missed and the logical progression of the project was clear. Three fiscal quarters of data, including 515 readmissions, were examined. A data analytics cube on hospital-wide readmissions provided patient and environmental characteristics that were charted using common language for sorting purposes. Data analysis revealed that 77% of patients were admitted within 30 days of discharge with a diagnosis that differed significantly from the index admission. Potential gaps in practice identified were a need for more patient and family engagement and education by nursing during the inpatient stay in regard to the primary admitting condition, the management of comorbidities, and potential posthospital complications. Need exists for more intense whole-patient monitoring, communication, and education following the transition from hospital to home. A reduction in 30-day readmissions can reduce the psychological and physical burden on patients and families, on health care resources that could be used for other purposes, and on society in the form of financial costs that continue to rise.

In the United States, congestive heart failure (CHF) is a cardiac condition with increasing hospitalization and rehospitalization burden to patients, families, and the healthcare system. This chronic condition is expected to affect more than 8 million people by 2030; however, not much is known about the relationship between risk factors and hospital readmissions once CHF patients are discharged to a skilled nursing facility (SNF). Applying a systems theory unbounded systems thinking, coupled with a systems-thinking approach the purpose of this quantitative, retrospective cohort study was to examine CHF hospital readmissions from SNFs within a 90-day period using a secondary data set of gender, age, race, SNF geographic location, length of SNF stay, and home health use risk factors. A binary logistic regression analysis revealed that out of 238 episodes, 99 patients were readmitted; however, no statistically significant relationship between the risk factors and readmission was found. Findings suggest that CHF readmissions from the SNF are not attributed to only quantifiable risk factors. Based on these findings, further research can support social change through multifaceted quantitative and qualitative systemic analyses to identify and inform how healthcare organizations can better assist the elderly population with CHF and improve future post-acute community-based health education and prevention programs.

BACKGROUND:The Affordable Care Act of 2010 proposed maximum penalty equal to 1% of regular Medicare reimbursements which prompted change in how hospitals regard 30-day readmissions. While several hospital to home transitional care models demonstrated a reduction in readmissions and cost savings, programs adapted to population needs and existing resources was essential.METHODS:Focusing on process and outcomes evaluation, a retrospective analysis of a modified community based care transitions program was conducted.RESULTS:In addition to high levels of patient satisfaction with the care transitions program, participants' confidence with self care was significantly improved. Further, the program evaluation demonstrated a 73% reduction in readmissions and an actual Medicare cost savings during the 9-month study period of $214,192, excluding the cost to administer the program.CONCLUSIONS:While there are several transitional care programs in existence, a customized approach is desirable and often required as the most cost effective way to manage care transitions and employ evidence based policy making. This study established some of the pitfalls when implementing a community-based transitional care program and demonstrated encouraging outcomes.

Patients who have chronic diseases are often readmitted to the hospital within 30 days of being discharged. In the United States preventable hospital readmissions cost approximately $12-$17.4 billion annually. The Institute of Healthcare Improvement [IHI] has identified one key measure for reducing preventable readmissions and that is a timely post hospital follow-up visit. Although this seems to be a simple task, studies have revealed that as many as one-third of patients discharged from the hospital are not following up with their primary care provider. In North Dakota the percentages of patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, type 2 diabetes, and pneumonia have steadily increased over the last several years. A North Dakota critical access hospital report revealed a high percentage of patients with a chronic disease are being readmitted within 30 days. Identifying barriers to care in North Dakota can help to reduce the rate of readmission within the state. This study seeks to identify perceived barriers as observed by primary care nurse practitioners to improve patient outcomes and reduce hospital readmission rates.

Heart failure (HF) is a clinical syndrome associated with high morbidity and mortality with a large economic burden, and is the leading cause of hospitalizations among Medicare beneficiaries in the United States. Healthcare reform has focused on strategies to reduce HF readmissions, including outpatient HF clinics. Purpose: The purpose of this DNP Project was to answer the following question: In adult patients diagnosed with HF, how does enrollment in the HF clinic, compared to non-enrollment affect hospital admission and readmission rates? Methods: A retrospective analysis of 767 unique patients and their 1,014 respective admissions and readmissions was conducted. Continuous and categorical data was analyzed and presented as a mean (M), standard deviation (SD), absolute number (N) and percentage (%). A Pearson Chi Square test was used for categorical variables and Analysis of Variance was used for age and ejection fraction (EF). Results: Study sample demographics (N=767); age (M=79.72, SD=7.48); gender (57.6 % male) and EF (M=0.43, SD=0.16) were evaluated. The No HF clinic (No HFC) and HF clinic (HFC) enrollment groups (N=573) were compared for age (M=79.49, SD=7.65) (M=80.39, SD=6.94), male gender (54.6%, 66.5%) and EF (M= 0.44, SD=0.17) (M=0.42, SD=0.15), respectively. Each sample patient had at least one admission for HF during 2015; of which 573 (46.2%) were in the No HFC group and 194 (8.4%) were in the HFC group (p<0.001). There was no difference in all-cause readmissions between the No HFC group [n=95(14.5%)] and the HFC group [n=37(16.2%)] (p=0.534) and no difference in HF-related readmissions between the No HFC group [n=72(11.0%)] and the HFC group [n=23(10.0%)] (p=0.700). Conclusions: This DNP project demonstrated a significant difference in HF admission rates in favor of the HFC group. While no differences were found in all-cause or HF-related readmission rates in No HFC and HFC groups, the rates are less than the national average. Unintended findings were that datasets can be very poorly constructed and populated, resulting in large amounts of unusable data. Recommendations are for more rigor in the organization of datasets to assure accurate comparisons between admission and readmission rates based on enrollment in HF clinics.

In 2011, Medicare patients represented the largest share of total readmissions and health costs when compared to all other patient categories. Because patient-centered care drives the use of health services, the U.S. Patient Protection and Affordable Care Act outlined improving the patient experience to reduce readmission rates; however, the relationship between patient experience and readmissions is not well understood. Grounded in systems theory, the purpose of this correlational study was to determine if the relationship between patient experience and readmission rates in Medicare Shared Savings Program accountable care organizations. Data from the Consumer Assessment of Healthcare Providers and Systems survey were gathered from the Centers for Medicare and Medicaid datasets to analyze patient experience measurements and readmission rates, while accounting for variation among Medicare service regions, number of assigned beneficiaries, and performance year. Using multiple linear regression to analyze the data, the model was used to predict Medicare's all-condition readmission rate (per 1000), R-²= .242, F (13, 634) 15.59, p < .001. The research question was answered partially; variation in the patient experience domain did not support all hypotheses. Because the Medicare population represents the fastest growing patient population within the U.S. health care system, continuous evaluation of policy and performance provides an evidence-based analysis to health administrators and providers who have pivotal roles in the creation of positive social change. Findings may be used to improve quality and service while reducing costs, which contributes to the sustainability of the U.S. Medicare program and its beneficiary population.

Hospital readmissions within 30 days of discharge result in significant multimillion-€dollar penalties to thousands of Medicare-€eligible hospitals throughout the United States and are indicators of suboptimal patient healthcare leading to less than ideal health outcomes for previously hospitalized patients. The purpose of this correlation study was to examine the relationship between medication reconciliation, nursing workforce competency, timely and effective care, and Medicare-€eligible hospital 30-€day readmission rates. The sample of 269 hospitals came from the population of Medicare-€eligible hospitals throughout the United States. Complexity theory and the general model of readmission were theoretical frameworks grounding this study. Secondary data were from publicly available governmental databases. The reporting of the F statistic resulted in rejection of the null hypothesis in this study, based on evidence of the existence of a significant correlation between the variables. Findings shows a statistically significant relationship between nursing workforce competency, timely and effective care, and Medicare-€eligible hospital 30-€day readmission rates. Medication reconciliation, as measured in this study, was not a significant predictor of 30-€day readmission rates. Implications of this study for positive social change include an understanding of factors related to hospital 30-€day readmission rates to help leaders take action to enhance patient care, reduce inpatient care expenses, and decrease Medicare-€imposed hospital penalties.

Heart Failure readmissions (HFR) significantly contribute to all cause hospital readmissions rates. Current evidence on the effectiveness of interventions for reduction of HFR is inconclusive. Recent research suggests that nurses’ emotional intelligence (EI) may be associated with better patient outcomes. The purpose of this study was to examine if nurses’ EI is significantly related to HFR and if that relationship is mediated through patient satisfaction with care. One hundred and thirty six Registered Nurses were recruited from 11 in-patient units at a large teaching hospital in the south eastern United States. Two surveys were mailed to eligible participants; the Bar-On Emotional Quotient Inventory 2.0 and a demographic survey. Patient satisfaction was measured with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The unit of observation for the analysis of the current study was the individual nursing unit with monthly measures for 14 months. Nurses EI was assessed at a single point in time and served as the basis for the data collected. Results of one-way ANOVA showed a non-significant small trend of higher total EI being associated with lower rates of HFR. The generalized estimating equation model was used to account for correlated observations and revealed a greater non-significant likelihood for higher total EI to translate to no HFR. Results of Pearson’s correlations found non-significant positive correlations between nurses total EI and the patient satisfaction items of rate hospital, nurses’ courtesy and respect, nurse listening, nurse explaining, and nurse communication. The linear mixed model to account for correlated observations showed small non-significant trends for total nurse EI and all patient satisfaction items. Results of one-way ANOVA showed no association between patient satisfaction and HFR. When accounting for correlated observations, increases in total nurse EI were not significantly associated with the predicted odds of no HFR. In conclusion, the examination of the aims in this study demonstrated results that were in the expected direction but not at the level expected. The findings of this study indicate that there is a need to further examine how nurses’ EI may influence patient outcomes.