Abstract 13864: A Novel Patient Reported Outcome Questionnaire for Reduction in Heart-Failure Readmissions: Protocol for Usability Assessment Study

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A13864-A13864
• Main Authors: Aggarwal, Rashmi, Okoh, Alexis K, Shreiber, Matthew
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.13864

IntroductionEmerging evidence suggests that para-medical reasons may account for a proportion of re-hospitalization rates and poor quality of life in patients with heart failure (HF).HypothesisWe developed a patient reported outcome questionnaire for patients with HF to better understand challenges they face and identify those at highest risk for readmission secondary to para-medical reasons.MethodsWe implemented a HF readmission initiative at a community medical center over a 4-year period. The program identified demographic and clinical factors associated with HF readmission. Pre-specified parameters were vigorously interrogated at multiple levels and their efficacy were tested. A group of patients whose readmission rates weren’t affected by the initial intervention were identified and enrolled for the development of a patient reported outcome questionnaire. Individual home visits and phone calls were used to query patients on factors they believed contributed to their readmission. A questionnaire was developed based on these responses.ResultsOver a 4-year period, a Preventing Avoidable Readmission, Improvement Strategy (PARIS) program led to a significant reduction in overall 30-day readmission rates from 20.8% (2015) to 15% (2019). This change was consistent across all insurance categories including Medicare and Medicaid beneficiaries. About 16% of patients readmitted were enrolled into a protocol for the development of a patient reported questionnaire. Most common reasons for readmission were lack of access to transportation, food, insecurity in neighborhoods of living and financial challenges. A 15-point questionnaire was developed to identify patients at increased risk for readmission for non-medical reasons. The questionnaire is currently being utilized in a prospective fashion, applicable to all patients admitted for heart failure.ConclusionsThe main contribution of this project is the development of a patient-reported outcome survey, which may support traditional risk models in identifying HF patients’ at risk for readmission. For low-income patients with HF, this user-centered outcome will help physicians better understand factors associated with readmission.