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. 2023 Feb 3:9:23337214221149274.
doi: 10.1177/23337214221149274. eCollection 2023 Jan-Dec.

Implementation of a Multimodal Heart Failure Management Protocol in a Skilled Nursing Facility

Michelle S Rockwell  1   2 , Emily Cox  1 , Tonja Locklear  1 , Brandy Hodges  3 , Stacey Mulkey  3 , Brandon Evans  3 , John W Epling  1   2 , Anthony R Stavola  1   3
Affiliations

Implementation of a Multimodal Heart Failure Management Protocol in a Skilled Nursing Facility

Michelle S Rockwell et al. Gerontol Geriatr Med. .

Abstract

Hospitals and skilled nursing facilities (SNFs) are incentivized to reduce hospital readmissions among patients with heart failure (HF). We used the RE-AIM framework and mixed quantitative and qualitative data to evaluate the implementation of a multimodal HF management protocol (HFMP) administered in a SNF in 2021. Over 90% of eligible patients were enrolled in the HFMP (REACH). Of the 42 enrolled patients (61.9% female, aged 81.9 ± 8.9 years, 9.5% Medicaid), 2 (4.8%) were readmitted within 30 days of hospital discharge and 4 (9.5%) were readmitted within 30 days of SNF discharge compared with historical (2020) rates of 16.7% and 22.2%, respectively (a potential savings of $132,418-$176,573 in hospital costs) (EFFECTIVENESS). Although stakeholder feedback about ADOPTION and IMPLEMENTATION was largely positive, challenges associated with clinical data collection, documentation, and staff turnover were described. Findings will inform refinement of the HFMP to facilitate further testing and sustainability (MAINTENANCE).

Keywords: 30-day readmission; hospital; quality improvement; remote dielectric sensing.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Heart failure management protocol. Note. HFMP = heart failure management protocol; BMP = basic metabolic panel; trigger = body weight change that initiates HFMP; SNF = skilled nursing facility; Pro-BNP = pro b-type natriuretic peptide; activate = HFMP proceeds to day 2; ReDs vest = remote dielectric sensing; Mg+ = magnesium; IV = intravenous; eGFR = estimated glomerular filtration rate; K+ = potassium.
See this image and copyright information in PMC

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