Implementation of a Multimodal Heart Failure Management Protocol in a Skilled Nursing Facility

Abstract

Hospitals and skilled nursing facilities (SNFs) are incentivized to reduce hospital readmissions among patients with heart failure (HF). We used the RE-AIM framework and mixed quantitative and qualitative data to evaluate the implementation of a multimodal HF management protocol (HFMP) administered in a SNF in 2021. Over 90% of eligible patients were enrolled in the HFMP (REACH). Of the 42 enrolled patients (61.9% female, aged 81.9 ± 8.9 years, 9.5% Medicaid), 2 (4.8%) were readmitted within 30 days of hospital discharge and 4 (9.5%) were readmitted within 30 days of SNF discharge compared with historical (2020) rates of 16.7% and 22.2%, respectively (a potential savings of $132,418–$176,573 in hospital costs) (EFFECTIVENESS). Although stakeholder feedback about ADOPTION and IMPLEMENTATION was largely positive, challenges associated with clinical data collection, documentation, and staff turnover were described. Findings will inform refinement of the HFMP to facilitate further testing and sustainability (MAINTENANCE).

Implementation Science to Achieve Equity in Heart Failure Care: A Scientific Statement From the American Heart Association

“…62,63 Last, for individuals residing in a skilled nursing facility, an HF management protocol focused on weight management, diuretic use, and a noninvasive volume overload detection decreased readmission rates to the hospital. 55 Few implementation interventions were designed for patients with stage D or advanced HF (Table 2). One trial showed that a left ventricular assist device decision aid improved patient knowledge and decision quality, although adjusted rates of left ventricular assist device implantation were not affected.…”

“…62,63 Last, for individuals residing in a skilled nursing facility, an HF management protocol focused on weight management, diuretic use, and a noninvasive volume overload detection decreased readmission rates to the hospital. 55…”