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Case Study

How UPMC Harrisburg improved heart failure care and outcomes

15 Minute Read

Overview

The challenge

Nation-wide, heart failure (HF) has a 30-day all-cause readmission rate of 20 to 25%. High HF readmission rates are associated with many factors, including poor adherence to follow-up care and inconsistent inpatient care. Generalist hospitalists often manage admitted HF patients, even if HF is listed as the primary condition. General hospitalists are less likely to use consistent, guideline recommended HF care protocols, exacerbating a patient’s already high risk of readmission.

The organization

University of Pittsburg Medical Center (UPMC) is a 36-hospital health system in Central Pennsylvania. UPMC Harrisburg is a 409-bed urban hospital within the system that is known for its top cardiology care at UPMC Heart and Vascular Institute.

The approach

UPMC Harrisburg hospital developed a dedicated Congestive Heart Failure (CHF) hospitalist team to follow HF class 1 guideline-directed medical therapies in a high-touch care model. The team also focuses on patient and family education to improve treatment plan adherence and created structures for continued patient engagement outside of the original inpatient visit.

The result

The CHF hospitalist program achieved a heart failure order set usage of >98%, resulting in a lower length of stay (LOS) and reduced cost per case for program patients. Most importantly, UPMC reduced all-cause readmissions among HF patients from the national average in 2017 to an impressive 6.95% in 2021 for patients treated by the HF hospitalist program.

 

Approach

How UPMC Harrisburg used CHF hospitalist team members to decrease HF readmissions

In 2015, UPMC Harrisburg’s HF LOS, readmission rate, and cost were around the national average – and the hospital wanted to improve these numbers. UPMC noted that while many health systems pursued outpatient and urgent-care based HF programs, few were investing in inpatient strategies. Realizing their hospitalized HF patients were seeing up to eight providers per day, UPMC decided to develop an inpatient CHF hospitalist program to streamline care and improve patient outcomes.

 

The three strategies

In the five years since UPMC Harrisburg Hospital implemented the CHF hospitalist program, three strategies have led to its success:

  • Strategy

    Develop consistent care protocols

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  • Strategy

    Routinely educate patients and caretakers

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  • Strategy

    Tailor follow-up plans for ongoing engagement

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Results

How we know it’s working

Between September 2017 to July 2021, 29% of HF patients at UPMC Harrisburg, West Shore, and Community General Hospitals received consistent care from the seven-person CHF hospitalist team and achieved superior outcomes.

  • Standardization of care: CHF hospitalists have a greater than 98% order set usage, which ensures that care is evidence-based and consistent.
  • Decreased length of stay: HF patients treated by the CHF hospitalist team have an average length of stay of 5.6 days, compared to 6.5 days for HF patients treated by general hospitalists and cardiologists at UPMC Harrisburg, West Shore, and Community General.
  • Readmission rate reduction: Prior to the CHF hospitalist program, UPMC had an average readmission rate for HF that was around the national 30-day all cause readmission rate of 20 to 25%. After the program started, HF patients treated by the CHF hospitalist team have dropped below 10%, with the 30-day all cause readmission rate for CHF team patients being 6.95% in 2021.

As HF readmissions have grown from 1,100 to 1,500 in the past four years among HF patients treated by generalist hospitalists, the CHF hospitalist team is relying on APPs to help see the greater number of patients. In January of 2022, the CHF Hospitalist program expanded to UPMC West Shore hospital and plans to expand to Community General Hospital by summer of 2022. The HF hospitalist team credits their early success to their high-touch care model.

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