Nearly one in four Americans needs to be readmitted to the hospital following a hospital stay for heart failure. However, Virginia Mason is working on a new way to knock that number down. In June 2015, it launched the program Heart to Heart with partner Kelley-Ross Pharmacy Group to do home visits with patients with moderate-to-severe heart failure once a month for three months after being discharged. The program is in addition to phone conversations and follow-up visits patients have with their care providers at the Virginia Mason Heart Failure Clinic.
During its pilot year, Heart to Heart worked with 30 patients after they were discharged, with pharmacists going to patients’ homes to explain medications and ensure patients have their questions answered and, most importantly, follow their medication schedules. The pharmacists make notes of these visits and conversations in the patient’s electronic medical record, which is also viewed by the patient’s cardiologists and other care team members at Virginia Mason. Only two of the 30 patients who participated in the pilot program’s first year needed to be readmitted to the hospital, putting the program’s readmission rate at just 6.6 percent.
The Cardinal Health Foundation, which helped fund the pilot, recently renewed its grant funding, providing $100,000 to help support the program through May 2018. Thanks to this funding, the program’s second year, which is now underway, will be expanded to a maximum of 100 patients.
Through the program, providers have identified and addressed 125 medication and therapy-related issues, providing 152 interventions — such as smoking cessation support and patient education and care coordination — to enhance the quality of care and improve patient safety.
Virginia Mason Heart Institute Director Anne Casey said patient education is a substantial part of the program, helping patients better understand when, why and how to take their medications, which helps them become more engaged in their well-being.
Home visits by health care providers are becoming more common, and with programs like Heart to Heart, they are proving successful at keeping more patients on track toward a healthy recovery. Click here to learn more about Heart to Heart. (Tim Pfarr)
