Amber E. Johnson, MD, MBA PGY-3 Johns Hopkins Bayview Medical Center Amber E. Johnson, MD, MBA PGY-3 Johns Hopkins Bayview Medical Center The Impact of Innovation on Heart Failure Care

Disclosures None

Background 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

Purpose 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?

Methods Multi-disciplinary working group Define Measure Analyze Improve Control Multi-disciplinary working group Define Measure Analyze Improve Control

Results 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

Results 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

Conclusions 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

Resources Roger VL et al. Heart Disease and Stroke Statistics 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: Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc Jun;82(6): Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30- day rehospitalization: a systematic review. Ann Intern Med Oct 18;155(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 Dec;36(12): Brown T. Design thinking. Harv Bus Rev. 2008;86(6): Ries E. The lean startup: How today's entrepreneurs use continuous innovation to create radically successful businesses. New York, NY: Crown Publishing; Roger VL et al. Heart Disease and Stroke Statistics 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: Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc Jun;82(6): Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30- day rehospitalization: a systematic review. Ann Intern Med Oct 18;155(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 Dec;36(12): Brown T. Design thinking. Harv Bus Rev. 2008;86(6): Ries E. The lean startup: How today's entrepreneurs use continuous innovation to create radically successful businesses. New York, NY: Crown Publishing; 2011.

Acknowledgements Kapil Parakh, MD Laura Winner, RN Carol Sylvester, RN Shaker M Eid, MD Robert Hody, MS Sharon Augustine, CRNP Tanya Simmons, RN Angel Sampedro, BS