What have you done lately to reduce your acute care hospitalization rate? If you don’t do anything else this year, a campaign to educate your staff about Congestive Heart Failure may make an appreciable difference. In March of this year, the American College of Cardiology published updated research and guidelines on Congestive Heart Failure which can be found here. Found within the paper are common factors precipitating hospitalization. Many of these factors are easily addressed in the course of a home health visit. Please share with your staff.
• Noncompliance with medical regimen, sodium and/or fluid restriction
• Acute myocardial ischemia
• Uncorrected high blood pressure
• Atrial fibrillation and other arrhythmias
• Recent addition of negative inotropic drugs (e.g., verapamil, nifedipine, diltiazem, beta blockers)
• Pulmonary embolus
• Nonsteroidal anti-inflammatory drugs (Note: Ibuprofen worsens the risk of hospitalization in heart failure patients by 43 percent. Other NSAIDS increase risk even more!)
• Excessive alcohol or illicit drug use
• Endocrine abnormalities (e.g., diabetes mellitus, hyperthyroidism, hypothyroidism)
• Concurrent infections (e.g., pneumonia, viral illnesses)
Knowing that CHF patients have these risk factors prior to hospitalization is not enough. Addressing these conditions as they arise can prevent a hospitalization. Many agencies are using phone encounters between visits to assess weight fluctuations, new medications, control of diabetes and comorbidities. In reviewing charts, it is amazing how many patients with a diagnosis of CHF have NSAIDS ordered that probably can be replaced with other pain relievers.
It is rare that an agency is so large or has a hospitalization rate so high that avoiding even a couple of high risk hospitalizations a month for CHF patients won’t make a difference in reported outcomes. However, these efforts must be sustained and agencies must be patient to see their efforts reflected on the CMS reported outcomes.
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