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.