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Numerous procedures have been tested to reduce hospital readmissions with varying success. The objective of this study was to evaluate all-cause readmissions and emergency department (ED) visits 30 days and 6 months after discharge with Grand-Aides (GAs): nurse extenders making frequent home visits under video direction by a nurse supervisor. Medicare patients with primary diagnosis of heart failure at the University of Virginia discharged January 1, 2013 to January 1, 2015 were included. A GA visited the patient's home within 24 to 48 hours with supervisor on video for medication reconciliation. Every visit, a GA completed a questionnaire for a supervisor who then had brief video conversation with the patient, reinforced adherence with medical regimen and danger signs, making 3 visits in the first week, 2 visits each in weeks 2 and 3, 1 visit in week 4, then a monthly visit supplemented by telephone. Outcomes were recorded for 108 GA and 854 controls. Statistical adjustment was performed through inverse probability of treatment weighting, with the distribution of covariates resembling a propensity score-matched cohort. Patients with GA had 2.8% 30-day all-cause readmissions versus 15.8% controls-82% reduction-(adjusted odds ratio [aOR] = 0.17; p = 0.0060); 6-month all-cause readmissions 13.0% versus 44.7% (aOR = 0.19; p 0.0001); ED 30-days 2.8% versus 45.1% (aOR = 0.03; p 0.0001); ED 6-months 12.0% versus 51.5% (aOR = 0.09; p 0.0001); and 6-month mortality 6.5% versus 8.8% (aOR = 0.73; p = 0.4698). At 30 days, 92% had "substantial medication adherence." Savings per $562,097, 7× return on investment. In conclusion, the GA approach to population health compares favorably in outcomes and expense 30 days and 6 months after discharge.

Background Patient education is recommended to enhance self-care in all heart failure (HF) guidelines. The optimal method of educating HF patients is not known, but video education (VE) can provide a standardized and cost-effective method to deliver HF patient education. In addition, mobile technology can be an efficient and convenient way to deliver patient education as patients transition from hospital to home. Purpose The purpose of this study was twofold: 1) Evaluate whether HF knowledge, self-efficacy, self-care skills, and readmission rates improved after adding VE to usual care, and 2) Evaluate patient satisfaction with VE. Methods A convenience sample of adult HF inpatients was recruited over 11 weeks at an academic medical center. Participants received access via tablet, smartphone, or computer to 26 videos, each between 2-4 minutes in length, and lasting a total of 1.5 hours. The first video was shown while inpatient and subsequent videos were viewed at participants’ discretion while inpatient as well as after discharge. Participants received a “Managing Your Heart Failure With Video Education” booklet to aid accessing the videos. HF knowledge and self-care were measured before and after VE using the Atlanta Heart Failure Knowledge Test and the Self-care of Heart Failure Index. A patient log and satisfaction with each video was collected. Seventy participants enrolled and 30 completed the questionnaires. All-cause 30-day readmission data were compared to a randomly selected historical group from the previous months and year. Results Participants’ mean age was 66 years, 70% (21) were female, 67% (20) were Caucasian, 63% (19) high school educated or less, 83% (25) had hypertension, 73% (22) were New York Heart Association Class III-IV, and 43% (13) had HF with reduced ejection fraction. Mean Charlson Comorbidity Index scores was 6.2 ± 2.3. HF knowledge and self-maintenance scores increased (mean 1.7, + 3.2, p =.008, mean 13.96 + 20.99, p =.001 respectively). Participants’ scores improved by at least 5% on 20 of the 30 questions on the HF knowledge test. Self-efficacy (self-care confidence) and self-care management did not significantly improve (mean 1.67, SD 26.69, p = .735; mean 9.4, SD 22.7, p =.073 respectively). All-cause 30-day hospital readmissions did not significantly decrease (9 to 7, p= .276). HF patients were satisfied with the VE information (96%) and all would recommend the videos (100%). The videos rated most helpful were: Heart Failure Medications: Diuretics (71.4%), Managing Heart Failure: Limiting Sodium (65%), and Taking Your Heart Failure Medications (61.9%). Conclusion VE was associated with improved HF knowledge and self-maintenance with high patient satisfaction. HF Knowledge scores may further be used to tailor patient education based on identified knowledge gaps. Future work is needed to investigate whether self-efficacy and self-management improves with continued follow-up.

Dedicated heart failure (HF) clinics have been established to improve HF care. The Hospital-to-Home (H2H) program at our institution is a rapid clinic follow-up program for patients with recent HF admissions. We evaluated the real world costs of health care delivery with H2H after a HF admission

Heart failure (HF) readmissions are a quality measure for health outcomes. The Hospital-to-Home (H2H) program is an institutional rapid clinic follow-up program for patients with HF admission. We sought to determine the impact of this intervention on HF readmissions and mortality during the first 30