From North Mississippi Health Services, Tupelo, MS (Drs. Greer and Fagan), and the University of Colorado, Denver, CO (Dr. Coleman).
Abstract
- Objective: To describe the self-care college, an innovative initiative designed to reduce hospital readmissions for congestive heart failure (CHF) patients.
- Methods: CHF patients at North Mississippi Medical Center are asked to participate in a “self-care college” prior to discharge. Participants rotate through 3 learning stations: weight, diet and medications. At each station, they are asked to perform the tasks they will be required to do at home. By engaging patients in the learning process, they are activated to assume responsibility for their care. This approach has the added advantage of providing a feedback loop, allowing the health care team to “road test” the proposed care plan to determine the likelihood that the patient (and family caregivers) will be able to execute following discharge.
- Results: Since the self-care college was implemented in 2011, the 30-day readmission rate for CHF patients at NMMC has been reduced from 16.8% to 12.85%. There has also been a reduction in the observed to expected CHF readmissions ratio, from 0.90 to 0.71.
- Conclusion: Although the self-care college targets CHF patients, it is likely that this type of initiative could be applied for rural patients with other chronic illnesses, such as asthma, COPD, and diabetes. It is a relatively simple and inexpensive program (approximately $30,000 per year, primarily in personnel expenses, or roughly the cost of 3 hospital readmissions) that does not require sophisticated technology or equipment, and could easily be replicated in health care settings across the country.
Congestive heart failure (CHF) is a chronic and costly condition that affects approximately 5.1 million people in the United States, with an additional 670,000 diagnosed yearly [1]. Heart failure is the most common cause of hospitalization among adults over 65. Nearly 25% of patients hospitalized with heart failure are readmitted within 30 days [2].
Medical management of people living with CHF and other chronic illnesses presents a challenge for health care providers. Due to their often complex medical conditions and limited opportunities to learn self-management skills, patients in rural areas with CHF are at increased risk for complications and hospital readmission [3]. Many approaches have been considered to reduce heart failure readmissions, including efforts to improve self-management skills. Initiatives that engage patients in the process of learning to self manage their illness may activate them to assume responsibility for their care.
North Mississippi Health Services (NMHS) is an integrated regional health care organization with over 5000 employees that serves more than 700,000 residents of 24 primarily rural counties in north Mississippi and northwest Alabama. The flagship of the NMHS system is North Mississippi Medical Center (NMMC), a 650-bed regional referral center in Tupelo. NMHS is one of the largest rural health systems in the United States, and the statistics for its service area reflect these challenges: the prevalence and age-adjusted mortality rates for most chronic illnesses exceed those for the nation as well as for Mississippi, which itself historically ranks at or near the bottom of almost all health status indicators [4–6]. On average, 800 patients with CHF are discharged annually from NMHS’s hospitals, and more than 2900 patients diagnosed with CHF are active NMMC clinic patients.