An innovative program for heart failure patients at the University of Virginia Health System has reduced costs for both patients and the hospital and improved patient outcomes, researchers have determined.
The program costs roughly the salary of two nurse practitioners but reduces costs by about 75 percent per patient within the first 30 days of discharge from the hospital.
Benefits of H2H
The Hospital to Home program was implemented at UVA specifically for patients with heart failure in July of 2010, after the implementation of the Affordable Care Act. The researchers examined its effects retrospectively, looking at approximately 5,000 patients. After 30 days of being discharged from the hospital, patients enrolled in the program had a readmission rate that was 7.3 percent lower than patients not enrolled in the program. This reduced the average cost for program participants by $15,976 compared with patients not enrolled.
“The study looked at all the patients who had been followed here. The clinic is called H2H, Hospital to Home, and it’s based off the premise that when people leave the hospital after an admission for heart failure, it’s very likely that they may be readmitted, and the more they’re readmitted, their mortality and costs go up,” said Timothy Welch, MD, lead author of the study. “This program is so important to our heart failure patients because heart failure is the No. 1 reason for admission and readmission to the hospital. The H2H program helps to improve their lives and reduce the chance that they will be readmitted.”
How It Works
Essentially, the program consists of two nurse practitioners who have access to numerous resources such as dieticians, exercise physiologists and social workers. These nurse practitioners meet with patients within 4 to 7 days of the patients’ discharge from the hospital to help answer questions and adjust medications, if necessary.
“Patients and family members are grateful for the hour-long appointment with us and have their questions answered,” explained Nita Reigle, NP, one of the nurse practitioners. “In the hospital, education may occur in a sporadic way, and, often, family members aren’t present because they are working during the day. Family members frequently come with patients to the H2H appointments and can ask questions that they didn’t get to ask while their loved one was in the hospital. Also, when patients and family members are home in a more comfortable and familiar setting, new questions can arise.”
The Impact It’s Made
Jason Dent, a patient enrolled in the program, spent two weeks in the hospital, one in the Intensive Care Unit and another in the step-down unit to undergo monitoring before returning home. After being discharged, he began the program, which helped him not only to keep track of his medications and doctor’s appointments, but also helped him emotionally recover from the incident. “Having to stay in the hospital for two weeks is difficult with the probing and exams and day-to-day bloodwork and X-rays. You get antsy and want to return home,” he said. “But everyone was supportive and treated me with respect and everything. … I’ve been blessed by the UVA family. From nurses to doctors to complete strangers, they’ve been there for me. From the CNAs to the RNs to the surgeons, everyone has treated me with respect.”
“It’s amazing the support that I’ve gotten from UVA staff, and I’m blessed to be alive and grateful that I picked UVA hospital,” he said.
As a result of the program’s care, Dent was able to participate in Liberty University’s graduation commencement exercises via wheelchair on May 14, receiving his master’s in human services counseling.
Future Plans
The study was a collaborative effort among Welch; Reigle; Sula Mazimba, MD; and Kenneth Bilchick, MD. The research team is submitting its findings for publication in a scientific journal after presenting two abstracts at an American College of Cardiology meeting in Chicago.
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