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Hospital to Home (H2H) National quality initiative.

As soon as patients are admitted to the hospital, physicians, nurses, case managers, and discharge planners initiate plans for discharge. The plan is designed to help prepare the patient for discharge, set up home care needs, if applicable, improve outcomes, and decrease hospital readmission rates. A new quality improvement initiative by the American College of Cardiology (ACC) and the Institute for Healthcare Improvement (IHI) called Hospital to Home (H2H) was developed to help in this endeavor. The program was designed to improve patient outcomes and decrease readmission rates for cardiovascular patients, specifically heart failure (HF) and acute myocardial infarction (AMI) patients. The goal of the H2H initiative is to decrease HF and AMI readmission rates by 20% by the year 2012.

A study by Freidman, Jiang, and Elixhauser (2008) found that congestive heart failure patients had a 33.8% probability of readmission (21.0% within one month) and acute myocardial infarction patients had a 23.8% probability of readmission (15.2% within one month). A second study cited on the H2H webpage from the Commonwealth Fund entitled "Why Not the Best? Results from a National Scorecard on U.S. Health System Performance" listed hospital readmission rates as high as 14-22%. Another study cited on the H2H webpage from Dr. Krumholz et al, reported the median 30-day readmission rate was 19.9% for AMI and 24.4% for HF (http://h2hquality.org).

Participants in the H2H program will receive support from the ACC and IHI in the form of readmission-related legislative updates, literature based exploration of the issues that impact readmission rates, tools and strategies to decrease HF and AMI patient readmissions, tactics to help execute the initiative, support, and access to educational programs. Participants will also receive assistance in addressing several issues that impact hospital readmission rates including:

1. Post-discharge medication management. Is the patient familiar and able to fulfill his/her mediation regime?

2. Follow-up care. Does the patient have a follow up appointment and is he/she committed to keep it?

3. Symptom management. Is the patient aware of the signs/symptoms that require immediate medical attention and know who he/she needs to contact to receive that care? (http://h2hquality.org).

Who should enroll? Anyone who is interested in decreasing readmission rates including hospitals, private practice personnel, home health care agencies, nurses, hospitalists, pharmacists, and other front line health care providers should participate. While more than one person from any organization can enroll, it is recommended that each institution assign one individual to ensure prompt communication and access to the H2H list serv and discussion boards. Participation in the H2H initiative is voluntary and free. To enroll, visit http://www.acc.org/h2h/Enrollment/RequestForInfo.aspx. Currently nine hospitals in the state of Wisconsin are signed up and already receiving benefits of this program

References:

Friedman, B., Jiang, H., & Elixhauser, A. (Winter 2008/2009). Costly Hospital Readmissions and Complex Chronic Illness. Inquiry, 45, 408-421.

H2H FAQS. Retrieved March 14, 2010 from http://h2hquality.org.

By Margaret A. Kuehl, MSN, RN, CNOR and WNA Liaison to Wisconsin Node

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Author:Kuehl, Margaret A.
Publication:STAT Bulletin
Geographic Code:1USA
Date:Apr 1, 2010
Words:510
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