Amber E. Johnson, MD, MBAAmber E. Johnson, MD, MBAPGY-3PGY-3
Johns Hopkins Bayview Medical CenterJohns Hopkins Bayview Medical Center
Amber E. Johnson, MD, MBAAmber E. Johnson, MD, MBAPGY-3PGY-3
Johns Hopkins Bayview Medical CenterJohns Hopkins Bayview Medical Center
The Impact of The Impact of Innovation on Innovation on Heart Failure Heart Failure
CareCare
The Impact of The Impact of Innovation on Innovation on Heart Failure Heart Failure
CareCare
Disclosures
None
Disclosures
None
BackgroundBackground Heart failure is common
It is complicated to manage as an outpatient > 3 million ambulatory care and emergency department visits
annually
> 1 million hospitalizations annually
Heart failure is costly 25% readmitted in one month
$$$
Patient-centered care can help
Heart failure is common
It is complicated to manage as an outpatient > 3 million ambulatory care and emergency department visits
annually
> 1 million hospitalizations annually
Heart failure is costly 25% readmitted in one month
$$$
Patient-centered care can help
PurposePurpose
Because patients with heart failure have a high 30 day readmission rate, high costs, and poor quality of life…
we wanted to investigate:
What can we be doing better?
MethodsMethods
Multi-disciplinary working group
Define
Measure
Analyze
Improve
Control
Multi-disciplinary working group
Define
Measure
Analyze
Improve
Control
ResultsResults The most promising interventions were piloted as
improvements Scaled up based on success and patient interest
Examples: Patient education materials
Evidence-based provider order sets
Nursing and provider education
Teach back tools
Motivational interviewing training
Mechanisms for close outpatient follow up
Collaboration with home care and local nursing homes
The most promising interventions were piloted as improvements Scaled up based on success and patient interest
Examples: Patient education materials
Evidence-based provider order sets
Nursing and provider education
Teach back tools
Motivational interviewing training
Mechanisms for close outpatient follow up
Collaboration with home care and local nursing homes
ResultsResults No statistically significant differences in
pre- and post-intervention groups Rate of 30-day all cause readmissions for
HF declined from 28.4% to 18.9% (p<0.01)
This lead to an estimated reduction in charges of about $900,000 dollars
No statistically significant differences in pre- and post-intervention groups
Rate of 30-day all cause readmissions for HF declined from 28.4% to 18.9% (p<0.01)
This lead to an estimated reduction in charges of about $900,000 dollars
ConclusionsConclusions
An iterative innovations framework, has reduced 30-day readmission rates in heart failure
This approach included Identifying deficiencies in the processes of care Addressing the challenges patients face in caring for
themselves at home Customizing interventions to fit patients’ needs
Efforts are now focused on expanding the scale of this model
An iterative innovations framework, has reduced 30-day readmission rates in heart failure
This approach included Identifying deficiencies in the processes of care Addressing the challenges patients face in caring for
themselves at home Customizing interventions to fit patients’ needs
Efforts are now focused on expanding the scale of this model
ResourcesResources
Roger VL et al. Heart Disease and Stroke Statistics--2012 Update: A Report From the
American Heart Association. Circulation. 2012;125(1):e2-e220. Kociol RD, Peterson ED, Hammill BG, et al. National survey of hospital strategies to
reduce heart failure readmissions findings from the get with the guidelines-heart failure registry. Circ Heart Fail. 2012;5:680-687.
Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc. 2007 Jun;82(6):735-9.
Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011 Oct 18;155(8):520-8.
Glasgow JM, Scott-Caziewell JR, Kaboli PJ. Guiding inpatient quality improvement: a systematic review of Lean and Six Sigma. Jt Comm J Qual Patient Saf. 2010 Dec;36(12):533-40.
Brown T. Design thinking. Harv Bus Rev. 2008;86(6):84-92. Ries E. The lean startup: How today's entrepreneurs use continuous innovation to
create radically successful businesses. New York, NY: Crown Publishing; 2011.
Roger VL et al. Heart Disease and Stroke Statistics--2012 Update: A Report From the
American Heart Association. Circulation. 2012;125(1):e2-e220. Kociol RD, Peterson ED, Hammill BG, et al. National survey of hospital strategies to
reduce heart failure readmissions findings from the get with the guidelines-heart failure registry. Circ Heart Fail. 2012;5:680-687.
Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc. 2007 Jun;82(6):735-9.
Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011 Oct 18;155(8):520-8.
Glasgow JM, Scott-Caziewell JR, Kaboli PJ. Guiding inpatient quality improvement: a systematic review of Lean and Six Sigma. Jt Comm J Qual Patient Saf. 2010 Dec;36(12):533-40.
Brown T. Design thinking. Harv Bus Rev. 2008;86(6):84-92. Ries E. The lean startup: How today's entrepreneurs use continuous innovation to
create radically successful businesses. New York, NY: Crown Publishing; 2011.
AcknowledgementsAcknowledgements
Kapil Parakh, MDKapil Parakh, MDLaura Winner, RNLaura Winner, RNCarol Sylvester, RNCarol Sylvester, RNShaker M Eid, MDShaker M Eid, MDRobert Hody, MSRobert Hody, MSSharon Augustine, CRNPSharon Augustine, CRNPTanya Simmons, RNTanya Simmons, RNAngel Sampedro, BSAngel Sampedro, BS
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