Hospital readmissions cost Medicare alone more than $24 billion in 2011 (Hines et al., 2014). Legislation embedded in the PPACA aimed at reducing readmissions levies penalties against hospitals with higher than average readmission rates. These penalties were expected to increase to $528 million in 2017 (Boccuti and Casillas, 2017). Bridging the Discharge Gap Effectively (BRIDGE) is a nurse practitioner-led, transitional care cardiology clinic designed to reduce unnecessary hospitalizations.
BRIDGE strives to facilitate patients’ transition from hospital to home by serving as an extension of the in-patient care team. The clinic aims to schedule patients within fourteen days of hospital discharge. At these 60 minute visits, nurse practitioners assess each patient’s status and response to treatment, educate patients on cardiovascular disease and lifestyle modifications, and make evidence-based medication and therapy adjustments when necessary (Bumpus et al., 2017).
Through our research at MCORRP, we have found that most patients presenting to the clinic were referred due to acute coronary syndrome (ACS), congestive heart failure (CHF), or atrial fibrillation (AF). In a recent study of over 2400 cardiac patients, acute coronary syndrome patients who attended BRIDGE were significantly less likely to be readmitted within 30 days than those who did not attend (6.4% vs. 13.1%, p=0.006) (Bumpus et al., 2017). Further, over the course of one year, BRIDGE demonstrated a significant cost savings for ACS patients as a result of avoided rehospitalizations within 30 days of index discharge. On average, the utilization of this intervention translated into a $4,944 per-patient savings. Stated another way, BRIDGE saved $306,537 in annual healthcare costs at our health system for ACS patients alone. Not only were patients less likely to be readmitted if they attended, they were also less costly to manage (Bumpus et al., 2016).
The BRIDGE database is continually being updated to provide a more robust sample for measuring the outcomes of this program. During the summer of 2017, over 700 cases were added to the dataset. BRIDGE also presented four abstracts at a national conference, and had a manuscript published in a medical journal. Student projects from the past year explored the association of patient satisfaction, smoking, mental health, socioeconomic status, and cardiac rehab with outcomes, as well as “post-hospital syndrome” in the BRIDGE population. Future studies are focused on factors leading to early readmission, especially for patients with heart failure and atrial fibrillation.
Eva Kline Rogers, RN NP
Melvyn Rubenfire, M.D.
Sherry Bumpus, N.P., Ph.D.
Todd Koelling, MD
Eva Kline-Rogers, N.P.
American Heart Association- Acute Coronary Syndrome
Readmissions Reduction Program