A Transitional Care Model for Patients With Acute Coronary Syndrome | Page 3

This study suggests that the Bridging the Discharge Gap Effectively (BRIDGE) program can help decrease the number of hospital readmissions in patients with acute coronary syndrome that cause unnecessary and substantial healthcare systems costs.
Published Online: June 20, 2014
Sherry Bumpus*, PhD, FNP-BC; Barbara L. Brush*, PhD, ANP- BC, FAAN; Susan J. Pressler*, PhD, RN, FAAN; Jack Wheeler, PhD; Kim A. Eagle*, MD; and Melvyn Rubenfire*, MD *These authors contributed equally to this work
Optimal time to follow-up was another limitation of this study. When the BRIDGE program began (2008), postdischarge follow-up within 14 days was reasonable. However, this design was problematic for assessing 30-day outcomes, as the measurement period was not truly 30 days, but rather only the 14 days between BRIDGE appointments and the 30 days postdischarge date. A further limitation of this study was the use of self-report data for medication persistence. Information as to whether medication omissions or discontinuation were the result of a patient or provider decision was inconsistently documented. Thus, it is not possible to determine whether this over or underestimates the potential benefits of BRIDGE. A more formal study is needed to investigate these findings.


The general cardiology BRIDGE program is a novel and effective model for providing transitional care and lowering all-cause hospital readmissions for ACS patients. The NPs provide a high level of service in ensuring the health of their patients, providing education to the patients and their families, reconciling medications, and communicating with the patient’s discharge team and outpatient care provider. Even after adjustments for severity of illness and severity of event, patients who chose to attend their BRIDGE appointments had lower readmission rates at 30, 60, 90, and 180 days postdischarge than those with usual care. Furthermore, these reductions were not explained by better medication persistence. Though the relative value of this NP model of early postdischarge transitional care compared with a timely primary care or cardiology physician visit remains to be seen, models such as this should be developed and analyzed across institutions and patient types (diagnoses) to maintain patient safety at home after hospital discharge and reduce excessive and unnecessary health-system costs.

Acknowledgments: The authors would like to thank Eva Kline-Rogers, MS, RN, NP (University of Michigan, MCORRP), and Cydni A. Smith, BA (University of Michigan School of Pub- lic Health); Redah Mahmood, MD; Daniel Montgomery, MS; Ra- chel Sylvester, BS (MCORRP); and the student data abstractors who helped with this study.

Author Affiliations: Eastern Michigan University, Ypsilanti (SB); University of Michigan School of Nursing, Ann Arbor (BLB, SJP); University of Michigan School of Public Health, Ann Ar- bor (JW); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (KAE, MR).

Author Disclosures: The authors report no relationship or finan- cial interest with any entity that would pose a conflict of interest with the subject matter of this article. AHA Predoctoral Fellow- ship funded Sherry Bumpus to complete doctoral coursework and provided dissertation support. Dr Rubenfire had full access to all the data in the study and takes responsibility for the integri- ty of the data and the accuracy of the data analysis.

Address correspondence to: Sherry M. Bumpus, MCORRP, Domino’s Farms, 42 Frank Lloyd Wright Dr, Lobby A, Rm 3201, Ann Arbor, MI 48106. E-mail: sbumpus2@emich.edu.
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