Hospital readmissions cost Medicare alone more than $24 billion in 2011 (Hines, er al., 2014). Legislation embedded in the PPACA aimed at reducing readmissions levies penalties against hospitals with higher than average readmission rates. 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.
Through our research at MCORRP, we have found that most patients presenting to the clinic were referred due to acute coronary syndrome, congestive heart failure, or atrial fibrillation. 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).
Further, over the course of one year, BRIDGE demonstrated a significant cost savings as a result of avoided hospitalizations. On average, the utilization of this intervention translated into a $3,236 per-patient savings. Stated another way, BRIDGE saved $831,537 in annual healthcare costs at our health system. Not only were patients less likely to be readmitted if they attended, they were also less costly to manage.
The database is continually being updated to provide a more robust sample to measure the outcomes of this program. Over the 2016 summer, 600 cases were added to the dataset. BRIDGE also presented three abstracts at a national conference, and had a manuscript published in a medical journal. Through student projects in the past year alone, we explored readmissions amongst heart failure patients, variations in outcomes based on race and the presence or absence of diabetes, and summarized lessons learned over the last 7 years of the program. Past studies have examined readmissions amongst atrial fibrillation patients, reasons for BRIDGE clinic nonattendance, and evaluating how the Medicare case adjustment calculation would be effected by the inclusion of patients’ distance from the hospital. A qualitative analysis of what goes on during a BRIDGE visit has also been conducted to identify the “X-factor” that makes BRIDGE effective. Future studies aim to determine factors leading to early readmissions, 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