Reducing rates of readmission and development of an outpatient management plan in pulmonary hypertension: lessons from congestive heart failure management

Abstract

AIM: Pulmonary Hypertension (PH) currently has minimal guidelines for outpatient disease management. Congestive heart failure (CHF) studies however have shown effectiveness of disease management plans in reducing all-cause mortality and all-cause and CHF related hospital readmissions. Heart failure exacerbation is a common reason for readmission in both PH and CHF. Our aim was to review individual studies and comprehensive meta-analyses to identify effective CHF interventions that can be used to develop similar disease management plans for PH. METHODS: A comprehensive literature review from 1993 to 2019, including original articles, systematic reviews and meta-analyses. We reviewed topics of outpatient CHF interventions to decrease CHF mortality and readmission and patient management strategies in CHF. RESULTS: The most studied interventions included case management (CM), multidisciplinary Intervention (MI), structured telephone strategy (STS) and tele-monitoring (TM). CM showed decreased all-cause mortality (ACM) at 12 months, all-cause readmission (ACR) at 12 months and CHF readmission at 6 and 12 months. MI resulted in decreased ACR and CHF readmission. There was some discrepancy on effectiveness of TM programs in individual studies, however meta-analyses suggest TM provided reduced ACM and risk of CHF hospitalization. STS had similar results to TM including decreased risk of CHF hospitalization, without effect on mortality. CONCLUSIONS: Extrapolating from CHF data, it seems strategies to improve the health of PH patients and development of comprehensive care programs (CCP) should include structured telephone strategy and/ or tele-monitoring, case management strategies and multi-disciplinary interventions.

A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States

“…This brought the total down to 136 articles for full-text review. Following the full-text review, articles that duplicated the insights already gained were excluded, leaving a final total of 53 articles for inclusion in the review across the six medical specialties [ 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 ]. Table 2 (below) summarizes the key themes and insights that emerged from the narrative review and synt...…”

“…Within this context, among specialties with lower telehealth use, hospitals and health systems have historically provided limited support for telehealth use in allergy-immunology [ 46 , 49 ]. On the other hand, hospitals organizations have been able to develop a ‘business case’ for telehealth use in other specialties, e.g., using telepsychiatry to grow revenues by attracting younger patients, using telecardiology to reduce costs, and earning ‘pay-for-quality’ incentives [ 72 , 78 ]. In family medicine, physicians based in large health systems with an integrated EHR system were more likely to use telemedicine [ 64 ].…”

“…Among specialties with higher telehealth use, in cardiology, telehealth’s applications are extensive, and can be used before, during, and after hospitalization. Telecardiology can be leveraged for real-time, remote diagnosis, and treatment of heart disease as well as the evaluation of congestive heart failure, cardiac arrest, and arrhythmias [ 72 , 73 , 78 ]. In psychiatry, studies have shown that telemedicine has been used more for certain diagnoses like post-traumatic stress disorder, depression, and anxiety, more than others [ 82 ].…”

Specialty-level Factors Historically Influencing Telehealth Use Can Provide Implications for Sustainability in a Post-Pandemic Era: A Systematic Review and Narrative Synthesis

“…[39] On the other hand, hospital organizations have leveraged other specialties to cash in on the 'business case' for telehealth, e.g., attracting younger patients through telepsychiatry, and using telecardiology to improve outcomes (e.g., reduce readmissions for heart failure), reduce costs, and earn pay-for-quality incentives. [62,68,93] In Family Medicine, studies show that FPs who were integrated with health systems and used an EHR, were more likely to use telemedicine. [54] Likewise, in Gastroenterology, physicians a liated with large integrated health systems have undertaken initiatives to establish Specialty-PCMHs for IBD care.…”

“…Telecardiology's applications are extensive and can occur before, during and after hospitalization, giving it the power to increase access to cardiovascular care not only in rural regions but also within cities' underserved areas. [62,63,68] Importantly, telecardiology can be used for remote patient monitoring. In Psychiatry, although telepsychiatry has been used clinically for most diagnoses, research studies have emphasized certain diagnoses more than others.…”