Front Loading Visits: A Best Practice Measure to Decrease Rehospitalization in Heart Failure Patients

Abstract

Home care agencies are under pressure to deliver high-quality care with outcomes that demonstrate reduced patient rehospitalization. One approach found to be successful in reducing rehospitalization of heart failure patients is front loading visits. Our recent study showed front loading was effective for patients with heart failure, dramatically decreasing rehospitalization by more than one half (30.4% to 16%). Other methods utilized to enhance front loading are supplementation of visits with telehealth and/or telemonitoring and the use of established care paths. This article discusses the many challenges home care agencies face in implementing redesign and these best practice measures.

A comparison of in-person home care, home care with telephone contact and home care with telemonitoring for disease management

“…In response to national quality improvement efforts, agencies have instituted many interventions to decrease readmissions making it difficult to show a difference when these events are already low due to other successful interventions such as front loading visits. 31 (This means that the nurse visits most often early on in the episode when the patient is most unstable.) The national average for rehospitalization from home care is currently 29% by 60 days.…”

1RM Living

“…Frontloading provides the opportunity to build positive expectations around physical activity and encourage our patients early in the course of care. Positive expectations relating to physical activity have been shown to demonstrate physiological benefits (decreased weight, blood pressure, body fat, waist-to-hip ratio, and body mass index) despite no change in physical activity levels 12. It can be helpful to build positive expectations with patients by discussing how exercise and physical activity will help them reach their goals and desires.…”

“…Positive expectations relating to physical activity have been shown to demonstrate physiological benefits (decreased weight, blood pressure, body fat, waist-to-hip ratio, and body mass index) despite no change in physical activity levels. 12 It can be helpful to build positive expectations with patients by discussing how exercise and physical activity will help them reach their goals and desires. We can also discuss how exercise can ultimately improve pain levels and can help people become more resilient.…”

Pilot Testing of the Home Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities Intervention

“…20 Based on evidence that many readmissions occur before ambulatory follow-up, there has been a significant push for follow-up with primary care physician, ideally in collaboration with a cardiac specialist, within 7 to 14 days maximum following hospital discharge. 21…”

“…20 Based on evidence that many readmissions occur before ambulatory follow-up, there has been a significant push for follow-up with primary care physician, ideally in collaboration with a cardiac specialist, within 7 to 14 days maximum following hospital discharge. 21 Within home care settings, close follow-up strategies typically include frequent skilled nursing visits particularly during the first couple of weeks following admission to home care. One study found that increasing the nursing visit frequency within the first 2 weeks of admission to home care, known as front loading, was effective in decreasing rehospitalization by more than one half (30.4% to 16%).…”