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.

Conclusions

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.
1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6- e245.

2. Fye WB. Cardiology workforce: a shortage, not a surplus. Health Aff (Millwood). 2004;(suppl):W4-64-W66.

3. Smith SC, Benjamin EJ, Bonow RO, et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and other Atherosclerotic Vas- cular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124(22):2458-2473.

4. Report to the Congress: Promoting Greater Efficiency in Medicare. Washington, DC: Medicare Payment Advisory Commission; June 2007.

5. Jencks S, Williams M, Coleman E. Rehospitalizations among patients in the Medi- care fee-for-service program. N Eng J Med. 2009;360(14):1418-1428.

6. Coleman E, Parry C, Chalmers S, Min S. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822-1828.

7. Naylor M, Brooten D, Campbell R, Maislin G, McCauley KM, Schwartz JS. Tran- sitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004;52(5):675-684.

8. Sinclair A, Conroy S, Davies M, Bayer A. Post-discharge home-based support for older cardiac patients: a randomised controlled trial. Age Ageing. 2005;34(4):338-343.

9. Stewart S, Pearson S, Luke C, Horowitz J. Effects of home-based interven- tion on unplanned readmissions and out-of-hospital deaths. J Am Geriatr Soc. 1998;46(2):174-180.

10. Hernandez AF, Greiner MA, Fonarow GC, et al. Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospital- ized for heart failure. JAMA. 2010;303(17):1716-1722.

11. Naylor M, Aiken L, Kurtzman E, Olds D, Hirschman K. The importance of transitional care in achieving health reform. Health Aff (Millwood). 2011;30(4):746- 754.

12. Goldfield NI, McCullough EC, Hughes JS, et al. Identifying potentially prevent- able readmissions. Healthcare Finance Rev. 2008;30(1):75-91.

13. Outcome measures. CMS website. http://www.cms.gov/Medicare/Quality-Ini- tiatives-Patient-Assessment-Instruments/HospitalQualityInits/OutcomeMeasures. html. Published 2013. Accessed February 2, 2013.

14. Conrad DA, Christianson JB. Penetrating the “Black Box”: financial incentives for enhancing the quality of physician services. Med Care Res Rev. 2004;61:37S-68S.

15. Albert NM. Improving medication adherence in chronic cardiovascular disease. Crit Care Nurse. 2008;28:54-64.

16. Charlson M, Pompei P, Ales K, MacKenzie C. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron- ic Dis. 1987;40:373-383.

17. Needham D, Scales D, Laupacis A, Pronovost P. A systematic review of the Charlson comorbidity index using Canadian administrative databases: a perspective on risk adjustment in critical care research. J Crit Care. 2005;20(1):12-19.

18. Charlson M, Szatrowski T, Peterson J, Gold J. Validation of a combined comor- bidity index. J Clin Epidemiol. 1994;47(11):1245-1251.

19. Eagle K, Lim M, Dabbous O, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month post-discharge death in an international registry. JAMA. 2004;291(22):2727-2733.

20. Elbarouni B, Goodman S, Yan R, et al. Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute myocardial coronary syndrome in Canada. Am Heart J. 2009;158(3):392- 399.

21. Ramsay G, Podogrodzka M, McClure C, Fox K. Risk prediction in patients presenting with suspected cardiac pain: the GRACE and TIMI risk scores versus clinical evaluation. QJM. 2007;100(1):11-18.

22. Eagle K, Kline-Rogers E, Goodman S, et al. Adherence to evidence-based ther- apies after discharge for acute coronary syndromes: an ongoing prospective, obser- vational study. Am J Med. 2004;117(2):73-81.

23. Brown SA, Grimes DE. A meta analysis of nurse practitioners and nurse mid- wives in primary care. Nurs Res. 1995;44(6):332-339.

24. Horrocks S, Anderson E, Sallisbury C. Systematic review of whether nurse practitioners in primary care can provide equivalent care to doctors. BMJ. 2002;324(7341):819-823.

25. Margulis AV, Choudhry NK, Dormuth CR, Schneeweiss S. Variation in initiating secondary prevention after myocardial infarction by hospitals and physicians, 1997 through 2004. Pharmacoepidemiol Drug Saf. 2011;20:1088-1097.

26. Simpson E, Beck C, Richard H, Eisenberg MJ, Pilote L. Drug prescriptions after acute myocardial infarction: dosage, compliance, and persistence. Am Heart J. 2003;145:438-444.

27. Vasaiwala S, Nolan E, Ramanath VS, et al. A quality guarantee in acute coronary syndromes: the American College of Cardiology's Guidelines Applied in Practice program taken real-time. Am Heart J. 2007;153:16-21.
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