Healthday News — A transitional program involving cardiac surgery nurse practitioners may reduce a composite end point of 30-day readmission and death for patients discharged home after coronary artery bypass graft operations, according to research published in Annals of Thoracic Surgery.
Average statewide 30-day coronary artery bypass grafting (CABG) readmission rates from 1999 to 2007 increased from 15.3% to 16.5%, with 87.3% stating the primary reason for readmission being factors related to the initial CABG operation.
Of the 401 patients eligible for a transitional care program involving cardiac surgery nurse practitioners (“Follow Your Heart”) led by Michael H. Hall, MD, MBA and colleagues from the North Shore University Hospital, 169 were enrolled in the intervention, whereas 232 controls received usual care.
Readmission predictors were identified and propensity scores matching with 13 covariates were performed.
“Follow Your Heart” program admission was the only independent significant variable in preventing the outcome of 30-day readmission and death (P=0.015) in binary logistic regression analysis.
The likelihood of readmission was increased for dialysis patients, Medicaid recipients, women and non-Caucasians (odd ratios for readmission 3.11, 2.17, 1.87, 1.86, respectively), and for patients diagnosed with chronic obstructive pulmonary disease, diabetes and congestive heart failure (OR=1.78, 1.26, and 1.09, respectively).
In a propensity score matching analysis for 156 intervention patients, 30-day readmission was significantly lower for the intervention compared with the matched usual care group (3.85% vs. 11.54%, P=0.023).
“A home transition program providing continuity of care, communication hub, and medication management by treating hospital nurse practitioners significantly reduced the 30-day composite end point of readmission/death after CABG,” wrote the authors.