Specialized Care from Hospital to Home Improves the Health of Elderly with Heart Failure, Cuts Costs to the Health Care System
A new study shows that when elderly heart-failure patients receive
specialized nursing care throughout their hospital stay and at home
following hospital discharge, the patients have a better quality
of life and have fewer hospital readmissions. Instead of costing
more money for this specialized care, the study showed that the
care resulted in a nearly 38% savings in Medicare costs. The
study, funded by the National Institute of Nursing Research, one
of the National Institutes of Health, appears in the May, 2004 issue
of the Journal of American Geriatrics Society.
The study, conducted by researchers at the University of Pennsylvania
and led by Professor of Nursing Mary Naylor, PhD, RN, demonstrates
a model of care that has important implications for the nation's
health care system. Elders with heart-failure typically have the
highest rate of hospitalization, at a cost exceeding $24 billion
annually. Further, the study points out that this patient group
is representative of a growing segment of the U.S. population. Americans
are living longer with chronic health problems and experiencing
breakdowns in care during multiple transitions from hospital to
home that affect their quality of life and consume substantial health
care resources.
Six Philadelphia academic and community hospitals participated
in the study the first multi-site assessment of a transitional
care intervention targeting the serious health problems and risk
factors common among elders throughout an acute episode of heart
failure on a spectrum of clinical and economic outcomes. Advanced
practice nurses (APNs, nurses with Master's degrees) coordinated
the care provided by the patients' physicians, pharmacists, social
workers, RNs, and other health team members for high risk older
adults throughout an episode of acute illness.
The study found that while the total costs of providing this level
of care for patients in the APN group was nearly double that provided
to patients receiving routine care, this increase was more than
offset by cost savings from fewer hospital readmissions. The higher
level of care actually saves taxpayers an average of $4,845 per
patient, the researchers found a 37.6 percent savings over 12
months.
As a result of these findings, a major health insurer has launched
a $1 million pilot program to test Dr. Naylor's research in practice.
Participating APNs were given specialized training that emphasized
application of educational and behavioral strategies in the home
to address patients' and caregivers' unique learning needs. "The
goal was to provide these chronically ill patients and their families
with the knowledge and management skills necessary to prevent poor
outcomes and avoid the need for acute care," said Dr. Naylor.
"Working with a major insurer means the nation's elders will
immediately reap the benefits of our research, she added.
A randomized sample of 239 patients 65 years or older with a diagnosis
of heart failure were assigned to either the group receiving transitional
care or a control group that received routine care. Patients in
the transitional care group were visited by advanced practice nurses
within 24 hours of hospital admission and, upon discharge, the nurses
conducted home visits within 24 hours of discharge and were available
by telephone. Patients were followed for one year after hospital
discharge.
"To date, transitional care programs such as this have typically
not been adopted because of lack of Medicare reimbursement, the
system's focus on acute versus chronic care, and the organization
of care into distinct silos such as hospitals or home care without
a safety net to connect them," said Dr. Naylor. The Penn researchers
report that a major health insurer will begin to implement the Penn
team's model of care in New Jersey, Delaware and Pennsylvania this
summer. Older adults at high risk for poor outcomes will participate
in the test marketing to verify the researchers' quality of care
and cost findings in the commercial marketplace. The Commonwealth
Fund and the Jacob and Valeria Langeloth Foundation will fund marketing
strategies and product development for the translation of this research
into practice and evaluation of the pilot testing in the mid-Atlantic
region.
"With Americans living longer, chronic health issues affecting
the elderly are overtaking acute illnesses as a major concern. It
is becoming increasingly important to develop and test strategies
that will help these vulnerable, at-risk populations live healthier,
more independent lives," said NINR Director Dr. Patricia A.
Grady, PhD, RN, FAAN. It is heartening to see a public-private partnership
that facilitates translating research results to practice. The success
of the insurance company's pilot program will mean better quality
of care and improved health for many, with the added benefit of
reducing costs," noted Dr. Grady.
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