Effect of modified home palliative care on heart failure patients' hospital readmission rates

Abstract

Heart failure (HF) is the most common cause of hospital admissions among Medicare recipients, and readmission rates are disproportionately higher than in other chronic conditions. Over 20% of HF patients are readmitted within 30 days of discharge from the hospital. Various types of palliative care delivery programs have demonstrated positive outcomes for HF patients by decreasing emergency department visits, hospital days, physician visits, and medical costs. However, it appears that more frequent home visits early after hospital discharge may be the best combination to decrease hospital readmissions. Furthermore, research investigating the effect of an advanced practice nurse (APN) led home palliative care program on hospital readmissions in persons with HF is lacking. The purpose of this retrospective comparison study was to evaluate the difference in hospital readmissions between HF patients enrolled in a non-modified home palliative care program and a modified home palliative care program. Nonmodified palliative care is a service provided in the home by an APN that focuses on physical, emotional, social, and spiritual support. Services included with non-modified palliative care program include a 24-hour nurse phone line and monthly visits from the APN, as requested by the patient or primary care provider. Advanced practice nurse visits include evaluation, assessment, planning, care delivery, follow-up, monitoring, and reassessment, along with patient and family education. In addition to the services already described, modified home palliative care includes three APN home visits within the first month post-hospitalization and scheduled monthly visits thereafter. Neuman's Systems Theory provided the organizing framework. The sample consisted of 102 patients from one Midwest home palliative care agency. Data were collected through a retrospective chart review over two time periods; time one occurred during a non-modified home palliative care program, and time two occurred during a modified home palliative care program. Descriptive statistics were used to describe the sample, and group differences were evaluated using dependent test. The sample was predominantly female (73.5%), with a mean age of 82 years (SD = 4.69). Most resided within an assisted-living environment (66%), with the remainder living in a home or apartment. Nearly all subjects (98%) were Medicare recipients. The modified palliative care group demonstrated a significantly lower readmission rate (3.2%; m = 0.03; SD = 0.18) compared to the non-modified palliative care group (25%; m = 0.25; SD = 0.44) at p <0.05. The modified, APN led palliative care program, utilizing more frequent home visits after a hospitalization, significantly reduced hospital readmission rates in this sample. Lack of randomization and control over extraneous variables does not allow for causal inference in this study. However, the positive impact on HF hospital readmission rates in this type of palliative care program utilizing more frequent home visits by an APN should be further investigated. Future research studies are needed with larger, randomized sampling using a longitudinal design.