Improved patient education reduces HF readmission rates

NEW ORLEANS — Major improvements in HF 30-day hospital readmission rates appear to correlate with increased 60-minute patient education programs, according to research presented at the American Association of Heart Failure Nurses annual meeting.

“We believe that education of the patients and providing 60 minutes of [HF] education in the inpatient population will help to decrease 30-day readmission rate,” Kimberly Arthur, MSN, APRN, ACNS-BC, of UC Health, Cincinnatti, Ohio, told Healio.com. “Our numbers actually show correlative data that we have decreased the readmission rate one-and-a-half fold.”

Arthur and a multi-disciplinary team selected 60 minutes of patient education as a target for quality improvement in its 692 bed medical center. The team instituted a bundle of strategies, but focused on a system change to improve the delivery of 60 minutes of patient education.

“Most of the data suggests education is among the top strategies to lower readmission rates,” Arthur said.

At the outset of the research, 9.6% of patients had received 60-minute patient education, and 30-day readmission rate for select Center for Medicare Services Codes averaged 29%. Only 12% of those readmitted had received the education.

After learning proper documentation processes for the new electronic medical records system, the HF coordinators and leaders worked together to identify patients with HF admitted to non-cardiology units, institute a 60-minute class for inpatients twice per week and revise the patient education booklet.

Staff nurses were taught the teach-back method, and were given information on available resources as well as written materials to increase competence in providing 60-minute patient education.

HF coordinators performed routine audits to ensure education was both provided and documented, with 48-hour telephone calls and 7-day follow-up appointments improved to reinforce inpatient education. For outpatients, monthly group visits offered another means for learning HF self-care.

At 1 year, 60-minute patient education improved to 62%, and the 30-day hospital readmission rate dropped to 21.9%. At 2 years, after further intensifying efforts to offer 81.4% of patients the 60-minute education, with a mean of 86.3% over 6 months, 30-day readmission rates decreased further to 19%.

The investigators observed an absolute improvement in 60-minute patient education of 71.8%, which translated to an eight-fold increase over 2 years. This corresponded with a 10% absolute reduction in 30-day hospital readmission rate, or a one-and-a-half fold reduction.

“Unfortunately, this is correlative data; we can’t really assume causality,” Arthur said. “There is always more research to be done.”

The team will likely focus its next round of research on motivational interviewing, she noted.

“We think we will see much better data with that than just education and employing the teach-back method.” – by Allegra Tiver

Reference:

Arthur K, et al. Poster 19P. Presented at: American Association of Heart Failure Nurses Annual Meeting; June 25-27, 2015; New Orleans.

Disclosure: Arthur reports no relevant financial disclosures.