Reports From the Field

Implementing the AMI READMITS Risk Assessment Score to Increase Referrals Among Patients With Type I Myocardial Infarction

Journal of Clinical Outcomes Management. 2021 March;28(2):90-96 | 10.12788/jcom.0043

Author(s):

Nailya Muganlinskaya, DNP, MPH, ACNP-BC, MSN

Laurie Posey, EdD

Diane Vail Skojec, DNP, ANP-BC, MSN

Jon Rodney Resar, MD

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References

1. Why it is important to improve care transitions? Society of Hospital Medicine. Accessed June 15, 2020. https://www.hospitalmedicine.org/clinical-topics/care-transitions/

2. Tong L, Arnold T, Yang J, et al. The association between outpatient follow-up visits and all-cause non-elective 30-day readmissions: a retrospective observational cohort study. PloS One. 2018;13(7):e0200691.

3. Jackson C, Shahsahebi M, Wedlake T, DuBard CA. Timeliness of outpatient follow-up: an evidence-based approach for planning after hospital discharge. Ann Fam Med. 2015;13(2):115-22.

4. Health Research & Educational Trust. Preventable Readmissions Change Package. American Hospital Association. Updated December 2015. Accessed June 10, 2020. https://www.aha.org/sites/default/files/hiin/HRETHEN_ChangePackage_Readmissions.pd

5. Tung Y-C, Chang G-M, Chang H-Y, Yu T-H. Relationship between early physician follow-up and 30-day readmission after acute myocardial infarction and heart failure. Plos One. 2017;12(1):e0170061.

6. Kaplan RM, Koehler J, Zieger PD, et al. Stroke risk as a function of atrial fibrillation duration and CHA₂DS₂-VASc score. Circulation. 2019;140(20):1639-46.

7. Balan P, Zhao Y, Johnson S, et al. The Society of Thoracic Surgery Risk Score as a predictor of 30-day mortality in transcatheter vs surgical aortic valve replacement: a single-center experience and its implications for the development of a TAVR risk-prediction model. J Invasive Cardiol. 2017;29(3):109-14.

8. Smith LN, Makam AN, Darden D, et al. Acute myocardial infarction readmission risk prediction models: A systematic review of model performance. Circ Cardiovasc Qual Outcomes9.9. 2018;11(1):e003885.

9. Baker H, Oliver-McNeil S, Deng L, Hummel SL. See you in 7: regional hospital collaboration and outcomes in Medicare heart failure patients. JACC Heart Fail. 2015;3(10):765-73.

10. Batten A, Jaeger C, Griffen D, et al. See you in 7: improving acute myocardial infarction follow-up care. BMJ Open Qual. 2018;7(2):e000296.

11. Lee DW, Armistead L, Coleman H, et al. Abstract 15387: Post-discharge follow-up within 14 days reduces 30-day hospital readmission rates in patients with acute myocardial infarction and/or acutely decompensated heart failure. Circulation. 2018;134 (1):A 15387.

12. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction. Circulation. 2018;138 (20):e:618-51.

From The Johns Hopkins Hospital, Baltimore, MD (Dr. Muganlinskaya and Dr. Skojec, retired); The George Washington University, Washington, DC (Dr. Posey); and Johns Hopkins University, Baltimore, MD (Dr. Resar).

Abstract

Objective: Assessing the risk characteristics of patients with acute myocardial infarction (MI) can help providers make appropriate referral decisions. This quality improvement project sought to improve timely, appropriate referrals among patients with type I MI by adding a risk assessment, the AMI READMITS score, to the existing referral protocol.

Methods: Patients’ chart data were analyzed to assess changes in referrals and timely follow-up appointments from pre-intervention to intervention. A survey assessed providers’ satisfaction with the new referral protocol.

Results: Among 57 patients (n = 29 preintervention; n = 28 intervention), documented referrals increased significantly from 66% to 89% (χ2 = 4.571, df = 1, P = 0.033); and timely appointments increased by 10%, which was not significant (χ2 = 3.550, df = 2, P = 0.169). Most providers agreed that the new protocol was easy to use, useful in making referral decisions, and improved the referral process. All agreed the risk score should be incorporated into electronic clinical notes. Provider opinions related to implementing the risk score in clinical practice were mixed. Qualitative feedback suggests this was due to limited validation of the AMI READMITS score in reducing readmissions.

Conclusions: Our risk-based referral protocol helped to increase appropriate referrals among patients with type I MI. Provider adoption may be enhanced by incorporating the protocol into electronic clinical notes. Research to further validate the accuracy of the AMI READMITS score in predicting readmissions may support adoption of the protocol in clinical practice.

Keywords: quality improvement; type I myocardial infarction; referral process; readmission risk; risk assessment; chart review.

Early follow-up after discharge is an important strategy to reduce the risk of unplanned hospital readmissions among patients with various conditions.^1-3 While patient confounding factors, such as chronic health problems, environment, socioeconomic status, and literacy, make it difficult to avoid all unplanned readmissions, early follow-up may help providers identify and appropriately manage some health-related issues, and as such is a pivotal element of a readmission prevention strategy.⁴ There is evidence that patients with non-ST elevation myocardial infarction (NSTEMI) who have an outpatient appointment with a physician within 7 days after discharge have a lower risk of 30-day readmission.⁵

Implementing the AMI READMITS Risk Assessment Score to Increase Referrals Among Patients With Type I Myocardial Infarction

References

Abstract

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