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Hospitals that participated in the Southeast Michigan “See You in 7 Collaborative” experienced substantial reductions in 30-day readmission rates and Medicare payments related to heart failure (HF) care.
Increases in postdischarge 7-day follow-up were modest “but associated processes aimed at this goal may have improved the overall transition from inpatient to outpatient care,” Dr. Scott L. Hummel reported online Sept. 9 in JACC: Heart Failure. “Our study suggests that regional hospital collaboration to share best practices can be an effective strategy to reduce HF readmissions and associated costs.”
Established in 2011, the Southeast Michigan See You in 7 Collaborative is an effort by the Greater Detroit Area Council, the American College of Cardiology’s Michigan Chapter, the Michigan Peer Review Organization, and 11 previously nonaffiliated hospitals to increase 7-day postdischarge follow-up and reduce all-cause 30-day readmission rates in HF patients. Over a 1-year period, Dr. Hummel, a cardiologist at the University of Michigan, Ann Arbor, and his associates examined the rates of 7-day follow-up and 30-day readmissions in Medicare fee-for-service HF patients among the 10 collaborating hospitals, and compared the findings to trends in the state’s 82 nonparticipating hospitals. The preintervention period studied was May 2011-April 2012; the intervention occurred from May 2012-April 2013.
During the intervention period, the rates of 7-day postdischarge follow-up increased significantly but remained low in both groups (from 31.1% to 34.4% in collaborating hospitals, and from 30.2% to 32.6% in nonparticipating hospitals). At the same time, the rates of unadjusted readmissions significantly decreased in both groups (from 29% to 27.3% in collaborating hospitals and from 26.4% to 25.8% in nonparticipating hospitals). The researchers also found that the mean risk-standardized 30-day, all-cause readmission rates improved significantly among collaborating hospitals (from 31.1% to 28.5%), but significantly less so among nonparticipating hospitals (from 26.7% to 26.1%).
Finally, combined Medicare payments for inpatient and 30 days of postdischarge care decreased by an average of $182 per beneficiary in collaborating hospitals and by $63 in nonparticipating hospitals (JACC Heart Fail. 2015 Sept 9; [doi:10.1016/j.jchf.2015.06.007]).
The researchers acknowledged certain limitations of the study, including its observational design and the fact that administrative data sets were used to determine the outcomes of interest. “Given the observational nature of the study, we cannot confirm that improvements in 7-day follow-up or 30-day readmission rates directly resulted from See You in 7 Collaborative participation,” they noted.
The study was funded in part by the Robert Wood Johnson Foundation. Dr. Hummel disclosed that he is supported by a grant from the National Heart, Lung, and Blood Institute. The remaining study authors reported having no financial disclosures.
The investigators should be congratulated for a well-designed intervention that was multifaceted, allowing hospitals to experiment locally with the innovations that proved most useful to the individual health care environment. Unfortunately, the hospitals in the Collaborative were unable to significantly increase 7-day follow-up over the course of 1 year; 7-day follow-up rose from 31% to 34% only, compared with 32% to 34% in matched hospitals in Michigan. Even 14-day follow-up was less than 50% for various hospital groups in the study. These rates are consistent with other national data and are an important reflection of the current state of health care in the United States, yet it remains unclear why it is so difficult to move the needle.
Despite the lack of improvement in early follow-up, all-cause 30-day, risk-standardized readmission rates decreased more in Collaborative hospitals (31.1% to 28.5%), compared with other hospitals in Michigan (26.7% to 26.1%) during the 1-year study, including a cohort of hospitals matched for size, region, and demographics. Nevertheless, it is unclear which tools in the toolkit led to this improvement. Because of other changes noted in the environment, these results were possibly brought about by overall cultural or environmental attention toward readmission among more motivated hospitals. To address this important source of bias, future studies should consider randomization schemes of different interventions, such as cluster-randomized trials or embedded randomization.
There will undoubtedly be more opportunities to establish a better evidence base leveraging national, reusable research infrastructure such as the National Patient-Centered Clinical Research Network (PCORnet), which can serve as a platform for testing new health system delivery models.
Dr. Adrian F. Hernandez and Dr. Adam D. Devore are with the department of medicine at Duke University, as well as the Duke Clinical Research Institute, both in Durham, N.C. They made these comments in an accompanying editorial (JACC Heart Fail. 2015 Sept 9; [doi:10.1016/j.jchf.2015.07.004]). Dr. Hernandez reported receiving honoraria from Amgen, AstraZeneca, Janssen, Merck and Novartis; and research support from the Agency for Healthcare Research and Quality, American Heart Association, Amgen, AstraZeneca, Novartis, Merck, the National Heart, Lung, and Blood Institute, and the Patient Centered Outcomes Research Institute. Dr. Devore reported research funding from Amgen, AHA, Maquet, Novartis, and Thoratec; and consultant fees from Maquet.
The investigators should be congratulated for a well-designed intervention that was multifaceted, allowing hospitals to experiment locally with the innovations that proved most useful to the individual health care environment. Unfortunately, the hospitals in the Collaborative were unable to significantly increase 7-day follow-up over the course of 1 year; 7-day follow-up rose from 31% to 34% only, compared with 32% to 34% in matched hospitals in Michigan. Even 14-day follow-up was less than 50% for various hospital groups in the study. These rates are consistent with other national data and are an important reflection of the current state of health care in the United States, yet it remains unclear why it is so difficult to move the needle.
Despite the lack of improvement in early follow-up, all-cause 30-day, risk-standardized readmission rates decreased more in Collaborative hospitals (31.1% to 28.5%), compared with other hospitals in Michigan (26.7% to 26.1%) during the 1-year study, including a cohort of hospitals matched for size, region, and demographics. Nevertheless, it is unclear which tools in the toolkit led to this improvement. Because of other changes noted in the environment, these results were possibly brought about by overall cultural or environmental attention toward readmission among more motivated hospitals. To address this important source of bias, future studies should consider randomization schemes of different interventions, such as cluster-randomized trials or embedded randomization.
There will undoubtedly be more opportunities to establish a better evidence base leveraging national, reusable research infrastructure such as the National Patient-Centered Clinical Research Network (PCORnet), which can serve as a platform for testing new health system delivery models.
Dr. Adrian F. Hernandez and Dr. Adam D. Devore are with the department of medicine at Duke University, as well as the Duke Clinical Research Institute, both in Durham, N.C. They made these comments in an accompanying editorial (JACC Heart Fail. 2015 Sept 9; [doi:10.1016/j.jchf.2015.07.004]). Dr. Hernandez reported receiving honoraria from Amgen, AstraZeneca, Janssen, Merck and Novartis; and research support from the Agency for Healthcare Research and Quality, American Heart Association, Amgen, AstraZeneca, Novartis, Merck, the National Heart, Lung, and Blood Institute, and the Patient Centered Outcomes Research Institute. Dr. Devore reported research funding from Amgen, AHA, Maquet, Novartis, and Thoratec; and consultant fees from Maquet.
The investigators should be congratulated for a well-designed intervention that was multifaceted, allowing hospitals to experiment locally with the innovations that proved most useful to the individual health care environment. Unfortunately, the hospitals in the Collaborative were unable to significantly increase 7-day follow-up over the course of 1 year; 7-day follow-up rose from 31% to 34% only, compared with 32% to 34% in matched hospitals in Michigan. Even 14-day follow-up was less than 50% for various hospital groups in the study. These rates are consistent with other national data and are an important reflection of the current state of health care in the United States, yet it remains unclear why it is so difficult to move the needle.
Despite the lack of improvement in early follow-up, all-cause 30-day, risk-standardized readmission rates decreased more in Collaborative hospitals (31.1% to 28.5%), compared with other hospitals in Michigan (26.7% to 26.1%) during the 1-year study, including a cohort of hospitals matched for size, region, and demographics. Nevertheless, it is unclear which tools in the toolkit led to this improvement. Because of other changes noted in the environment, these results were possibly brought about by overall cultural or environmental attention toward readmission among more motivated hospitals. To address this important source of bias, future studies should consider randomization schemes of different interventions, such as cluster-randomized trials or embedded randomization.
There will undoubtedly be more opportunities to establish a better evidence base leveraging national, reusable research infrastructure such as the National Patient-Centered Clinical Research Network (PCORnet), which can serve as a platform for testing new health system delivery models.
Dr. Adrian F. Hernandez and Dr. Adam D. Devore are with the department of medicine at Duke University, as well as the Duke Clinical Research Institute, both in Durham, N.C. They made these comments in an accompanying editorial (JACC Heart Fail. 2015 Sept 9; [doi:10.1016/j.jchf.2015.07.004]). Dr. Hernandez reported receiving honoraria from Amgen, AstraZeneca, Janssen, Merck and Novartis; and research support from the Agency for Healthcare Research and Quality, American Heart Association, Amgen, AstraZeneca, Novartis, Merck, the National Heart, Lung, and Blood Institute, and the Patient Centered Outcomes Research Institute. Dr. Devore reported research funding from Amgen, AHA, Maquet, Novartis, and Thoratec; and consultant fees from Maquet.
Hospitals that participated in the Southeast Michigan “See You in 7 Collaborative” experienced substantial reductions in 30-day readmission rates and Medicare payments related to heart failure (HF) care.
Increases in postdischarge 7-day follow-up were modest “but associated processes aimed at this goal may have improved the overall transition from inpatient to outpatient care,” Dr. Scott L. Hummel reported online Sept. 9 in JACC: Heart Failure. “Our study suggests that regional hospital collaboration to share best practices can be an effective strategy to reduce HF readmissions and associated costs.”
Established in 2011, the Southeast Michigan See You in 7 Collaborative is an effort by the Greater Detroit Area Council, the American College of Cardiology’s Michigan Chapter, the Michigan Peer Review Organization, and 11 previously nonaffiliated hospitals to increase 7-day postdischarge follow-up and reduce all-cause 30-day readmission rates in HF patients. Over a 1-year period, Dr. Hummel, a cardiologist at the University of Michigan, Ann Arbor, and his associates examined the rates of 7-day follow-up and 30-day readmissions in Medicare fee-for-service HF patients among the 10 collaborating hospitals, and compared the findings to trends in the state’s 82 nonparticipating hospitals. The preintervention period studied was May 2011-April 2012; the intervention occurred from May 2012-April 2013.
During the intervention period, the rates of 7-day postdischarge follow-up increased significantly but remained low in both groups (from 31.1% to 34.4% in collaborating hospitals, and from 30.2% to 32.6% in nonparticipating hospitals). At the same time, the rates of unadjusted readmissions significantly decreased in both groups (from 29% to 27.3% in collaborating hospitals and from 26.4% to 25.8% in nonparticipating hospitals). The researchers also found that the mean risk-standardized 30-day, all-cause readmission rates improved significantly among collaborating hospitals (from 31.1% to 28.5%), but significantly less so among nonparticipating hospitals (from 26.7% to 26.1%).
Finally, combined Medicare payments for inpatient and 30 days of postdischarge care decreased by an average of $182 per beneficiary in collaborating hospitals and by $63 in nonparticipating hospitals (JACC Heart Fail. 2015 Sept 9; [doi:10.1016/j.jchf.2015.06.007]).
The researchers acknowledged certain limitations of the study, including its observational design and the fact that administrative data sets were used to determine the outcomes of interest. “Given the observational nature of the study, we cannot confirm that improvements in 7-day follow-up or 30-day readmission rates directly resulted from See You in 7 Collaborative participation,” they noted.
The study was funded in part by the Robert Wood Johnson Foundation. Dr. Hummel disclosed that he is supported by a grant from the National Heart, Lung, and Blood Institute. The remaining study authors reported having no financial disclosures.
Hospitals that participated in the Southeast Michigan “See You in 7 Collaborative” experienced substantial reductions in 30-day readmission rates and Medicare payments related to heart failure (HF) care.
Increases in postdischarge 7-day follow-up were modest “but associated processes aimed at this goal may have improved the overall transition from inpatient to outpatient care,” Dr. Scott L. Hummel reported online Sept. 9 in JACC: Heart Failure. “Our study suggests that regional hospital collaboration to share best practices can be an effective strategy to reduce HF readmissions and associated costs.”
Established in 2011, the Southeast Michigan See You in 7 Collaborative is an effort by the Greater Detroit Area Council, the American College of Cardiology’s Michigan Chapter, the Michigan Peer Review Organization, and 11 previously nonaffiliated hospitals to increase 7-day postdischarge follow-up and reduce all-cause 30-day readmission rates in HF patients. Over a 1-year period, Dr. Hummel, a cardiologist at the University of Michigan, Ann Arbor, and his associates examined the rates of 7-day follow-up and 30-day readmissions in Medicare fee-for-service HF patients among the 10 collaborating hospitals, and compared the findings to trends in the state’s 82 nonparticipating hospitals. The preintervention period studied was May 2011-April 2012; the intervention occurred from May 2012-April 2013.
During the intervention period, the rates of 7-day postdischarge follow-up increased significantly but remained low in both groups (from 31.1% to 34.4% in collaborating hospitals, and from 30.2% to 32.6% in nonparticipating hospitals). At the same time, the rates of unadjusted readmissions significantly decreased in both groups (from 29% to 27.3% in collaborating hospitals and from 26.4% to 25.8% in nonparticipating hospitals). The researchers also found that the mean risk-standardized 30-day, all-cause readmission rates improved significantly among collaborating hospitals (from 31.1% to 28.5%), but significantly less so among nonparticipating hospitals (from 26.7% to 26.1%).
Finally, combined Medicare payments for inpatient and 30 days of postdischarge care decreased by an average of $182 per beneficiary in collaborating hospitals and by $63 in nonparticipating hospitals (JACC Heart Fail. 2015 Sept 9; [doi:10.1016/j.jchf.2015.06.007]).
The researchers acknowledged certain limitations of the study, including its observational design and the fact that administrative data sets were used to determine the outcomes of interest. “Given the observational nature of the study, we cannot confirm that improvements in 7-day follow-up or 30-day readmission rates directly resulted from See You in 7 Collaborative participation,” they noted.
The study was funded in part by the Robert Wood Johnson Foundation. Dr. Hummel disclosed that he is supported by a grant from the National Heart, Lung, and Blood Institute. The remaining study authors reported having no financial disclosures.
FROM JACC: HEART FAILURE
Key clinical point: An interhospital collaborative approach was associated with substantial reductions in 30-day readmission rates and Medicare payments among heart failure patients.
Major finding: Over the course of 1 year, all-cause 30-day, risk-standardized readmission rates decreased more in collaborating hospitals (31.1% to 28.5%; P less than .001), compared with other hospitals in Michigan (26.7% to 26.1%; P = .02).
Data source: An observational study of Medicare heart failure patients discharged from 10 collaborating hospitals participating in the Southeast Michigan See You in 7 Collaborative.
Disclosures: The study was funded in part by the Robert Wood Johnson Foundation. Dr. Hummel disclosed that he is supported by a grant from the National Heart, Lung, and Blood Institute. The remaining study authors reported having no financial disclosures.
