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Nurse practitioner home visits improved outcomes after CABG
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A transitional care program involving nurse practitioners was associated with lower rates of death and readmission after CABG at 30 days in a recent study.
Michael H. Hall, MD, MBA, and colleagues designed the Follow Your Heart program, in which hospital nurse practitioners make post-discharge visits to the patient’s home. The program was developed because “the factor that seems to have had the strongest effect for lower readmission rates has been an effort to provide continuity between inpatient and outpatient care, specifically including continuous strong medical management and a phased transition to allow appropriate long-term follow-up,” the researchers wrote.
Hall, of North Shore University Hospital in Manhasset, N.Y., and colleagues enrolled 401 patients undergoing CABG at a single medical facility in a study assessing the efficacy of the program. Between May 2010 and August 2011, 169 patients entered the Follow Your Heart program and 232 received usual care. The primary endpoint was death or readmission at 30 days after discharge.
Using binary logistic regression analysis, the researchers determined that the only evaluated variable independently associated with the composite outcome was participation in the Follow Your Heart program, which significantly reduced risk (OR=0.335; 95% CI, 0.139-0.809). Patients from the control group were 2.99 times more likely to be readmitted within 30 days of CABG than patients from the intervention group. The only variable with a higher OR was dialysis, with those on dialysis 3.11 times more likely to be readmitted than those not on dialysis, according to the researchers.
The researchers performed propensity matching of 156 patients from the intervention group and 156 patients from the control group. Among those patients, the incidence rate of the primary outcome was 3.85% for the intervention group vs. 11.54% for the control group (P=.023).
“More targeted resource allocation based on odds ratios of readmission may further improve results and be applicable to other patient groups,” Hall and colleagues wrote.
Face-to-face interaction appears to be a key to the success of the Follow Your Heart program, they added. “This model of face-to-face contact … empowers the cardiac surgical [nurse practitioner] to practice at an appropriate level of effectiveness. Physicians who are supervising the [nurse practitioners] are more likely to be engaged and more satisfied with this model because the [nurse practitioner] is responsible for being the communications hub for all appropriate stakeholders.”
Disclosure: The researchers report no relevant financial disclosures.
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