Heart Failure Disease Management: Impact on Hospital Care, Length of Stay, and Reimbursement

Abstract

Congestive heart failure (CHF) is a major medical problem with significant hospital costs. The authors developed an inpatient disease management program for CHF in a community hospital setting to determine if it is possible to: 1) increase implementation of Agency for Health Care Policy and Research criteria for CHF; 2) improve the quality of patient care, while lowering length of stay and treatment cost for CHF; and 3) maintain nursing staff satisfaction. The program encompassed a clinical pathway incorporating Agency for Health Care Policy and Research criteria for CHF, CHF education, and patient educational materials. When compared to "unmanaged" patients (n=197) not participating in the algorithm due to physician choice, "managed" patients (n=396) had significantly increased documentation of left ventricular dysfunction and of angiotensin-converting enzyme inhibitor use. In contrast to unmanaged patients, managed patients had a significantly lower length of stay (3.9+/-2.2 vs. 6.1+/-2.8 days; p<0.0001) with a significant reduction in cost per patient ($4404+/-$1989 vs. $6828+/-$3347; p<0.0001). These changes were sustained in follow-up over 1 year and were associated with an improvement in nursing staff education and nursing care. Thus, a disease management program for CHF can be successfully implemented in a general community hospital setting, achieving improved compliance with Agency for Health Care Policy and Research treatment criteria and enhancing patient care, while reducing length of stay and cost.

Effects of care pathways on the in-hospital treatment of heart failure: a systematic review

“…Among 46 studies identified, only 7 publications met the study inclusion criteria [5,10,22,23,28-30] and they were included in the systematic review for a total sample of 3,690 patients, as shown in Figure 1. This systematic review consists of three randomised controlled trials [11,22,23] one interrupted time series [5] and three controlled studies [28-30]. …”

“…Examining the effect of CPs on the length of stay, out of five studies [5,10,28-30] three studies showed a significantly shorter LOS in the care pathway group [5,28,30]. The overall results of the random-effects model showed that care pathway provided a positive reduction in LOS when compared with the standard care (WMD  = − 1.89, 95%CI  =  (−2.44-(−)1.33 days, P  < 0.001) (Figure 4).…”

“…Three of the included studies (one randomised controlled, two controlled), representing a study population of 1776 patients, reported costs during hospitalisation [10,28,30]. Two of the CCTs [28-30] found significantly high hospitalisation costs for the care pathway groups.…”

Remote Physiological Monitoring: Clinical, Financial, and Behavioral Outcomes in a Heart Failure Population

“…Numerous studies of HF DM programs have demonstrated improvements including decreased hospitalizations, improved prescribing patterns (improved use and dose of betablockers and ACE-I), decreased costs, and shorter lengths of stay. [9][10][11] Certain HF DM programs have enhanced their interventions by incorporating remote physiological monitoring (RPM). Studies citing use of remote monitoring yield ambiguous results; some have reported improved outcomes such as reduced mortality, decreased utilization, and lower hospital charges, [12][13][14] while others have found no differences when the RPM component is taken into account.…”

Does the Collaborative Model Improve Care for Chronic Heart Failure?

“…Nurse-or case manager-based CHF disease management programs have shown great promise but focus on controlling costs and reducing readmission rates as much as improving processes and outcomes. [11][12][13] Facility-or physician-based audit/feedback strategies have failed to improve quality indicators 14 and at best have modestly improved 30-day mortality rates. 15 In any case, CHF disease management programs are not commonly used among physician organizations.…”