Heart failure (HF) is the second most common inpatient diagnosis at hospitals across the US. HF patients who have frequent hospitalizations are at risk for poor outcomes. Those with multiple chronic medical problems have the highest rate of readmission. In 2012, Carolinas HealthCare System (CHS) piloted The Heart Success (HS) Transition Clinic at Carolinas Medical Center (CMC) Main and CMC NorthEast for patients with a primary diagnosis of HF. These clinics were designed to address the potential gap in care between the acute and ambulatory care settings. Patients enrolled in the program meet weekly for 4 to 6 weeks with a multidisciplinary team staffed by specialty trained advanced clinical practitioners (ACPs), a social worker, pharmacist, dietitian and registered nurse.
Both pilots have been successful in reducing readmission rates; however, early data also showed that approximately 25% of the patients being discharged from CMC Main were non-captured. The main reason for this was related to the patient’s home location and the travel distance to CMC Main.
To address these non-capture patients, CHS implemented a virtual model of the Heart Success Transition Clinic as a pilot. The pilot began in June 2013 at a regional facility located 55 miles from CMC Main. Following the same visit schedule, HF patients discharged from this facility meet with the HS team via telemedicine, using basic videoconferencing and a peripheral stethoscope.
The concept of using telemedicine to access specialty care, eliminating the need to travel to the center is innovative and cost effective. It is an efficient way to accomplish management of complex patients with a chronic illness. The plan manages across the patient’s continuum of care to decrease readmission rates and increase the patient’s ability to self-manage resulting in improved quality of life.
During the 6 month pilot June through December 2013, 60 new patients have been enrolled in the virtual clinic and 165 virtual encounters. The 30-day all cause readmission rate at CMC-L has decreased from 19.39 % in 2010 to 9.82 % in 2013. Patients have evaluated the experience with top box scores. The home health nurses have observed a new sense of accountability with the patients in the virtual visit. Unintentional variations in care have been addressed by centralizing staff education.
The Virtual Heart Success pilot is proving to be a best practice in chronic disease care at CHS. As outcomes continue with a positive trend, this model will be shared across service lines.
Dr. Sanjeev Gulati, (704) 373-0212, firstname.lastname@example.org; Debbie Fenner, (704) 355-8102, Debbie.Fenner@carolinashealthcare.org