Protecting Hearts

Patients often leave the hospital uneducated and confused about how to care properly for themselves at home, ultimately causing them to be readmitted. The 4.4 million potentially preventable trips to the hospital add $30 billion to US healthcare spending each year. The Aligning Forces for Quality initiative in Maine, led by Maine Quality Counts, is addressing the problem of avoidable readmissions, particularly in heart failure patients, by taking steps to help patients get the care they need through a collaborative approach.
Eight Maine hospitals in the Hospital Quality Network focused on reducing readmissions and avoided 19 readmissions within 30 days of hospital discharge during a reported 18-month period. Among Maine hospitals, the average 30-day readmission rate was better than the national and state average throughout the entire collaborative. Across the Alliance, Maine hospitals exceeded the goal of meeting and sustaining 95 percent adherence to the Measure of Ideal Care for the five quarters of the initiative and consistently performed above the AF4Q average of 93 percent.

“To meet these goals, Maine hospitals targeted several specific areas for improvement, including putting systems in place to ensure that heart failure patients are discharged with the appropriate medications and a clear plan for post-discharge follow up: conducting telephone follow up to ensure that patients understand their medicines; and making referral to community-
based organizations, such as Area Agencies on Aging, to ensure that patients have access to needed social services and supports,” said Lisa Letourneau, MD, MPH, executive director of Maine Quality Counts.

One participating organization, Fairview General Hospital in Skowhegan, examined trends among heart failure patients to determine how to recognize those at higher risk for readmission. The hospital implemented the “LACE” assessment, which calculates a risk score based on length of stay, acute admission through the emergency department, comorbidities, and emergency department visits in a six month period. Redington- Fairview tested the system by assigning LACE scores to each patient upon admission. If a patient had a high score, care transition nurses closely monitored the patient and provided more comprehensive education. During the 18-month trial, 30-day readmission rates for heart failure patients decreased from 6.9 percent to zero percent.