CHANGES IN HOSPITAL PERFORMANCE AND TRANSITION-CARE MEASURES 1-YEAR AFTER INITIATION OF THE PATIENT NAVIGATOR PROGRAM
Despite high rates of early readmission in patients with acute myocardial infarction (AMI) and heart failure (HF), little data exists regarding the impact of best practices on hospital-based transition-care measures. This project sought to evaluate early changes in AMI and HF program performance after implementing the American College of Cardiology Patient Navigator Program—a transition-care improvement initiative at 35 acute care hospitals.
Baseline and 1-year post intervention data from 3860 patients with AMI or HF were analyzed using Wilcoxon signed rank test for 17 care measures related to hospital processes (8), medication reconciliation (3), education delivery/documentation (2), HF patient identification prior to discharge (1), scheduling a follow-up appointment within seven days (1), and associated 30-day unadjusted rates of AMI and HF readmission (2).
Among Patient Navigator hospitals, 68.6% were urban and 77.1% were teaching. Baseline and 1-year assessments demonstrated wide variability in aherence for many measures. Compared with baseline, median (25th, 75th percentiles) performance improved for use of an evidence-based beta-blocker among patients with HF, from 91.6% (86.2%, 95.0%) to 93.8% (88.2%, 98.6%), p= 0.028; medication reconciliation at admission, discharge and both admission and discharge (all p≤ 0.05); scheduling of HF follow-up appointments (p= 0.004) and self-care education (p= 0.005). Post-AMI in-hospital mortality improved from 4.0% (4.0%, 5.0%) to 3.7% (3.3%, 4.3%), p= 0.015 and 30-day unadjusted HF readmission was non-significantly lower by 1.9%; from 19.0% (15.2%, 21.0%) to 17.1% (14.1%, 19.1%), (p= 0.09).
Transition-care interventions were associated with significant improvement in 6 processes of care and 1 outcome performance measure for patients with AMI or HF.