Review of Literature Regarding Heart Failure Efficient Transition Care Models
Criteria of inclusion and exclusion of studies
The purpose of this project focuses on reducing the rates of hospital readmission for patients discharged after heart failure care by utilizing the proper and efficient transition care models. In backing up the intervention, it is essential to review relevant scholarly articles from databases as one of the competencies in relying on the best possible available evidence justified through research.
In a bid to obtain the research articles for this section, a systematic approach got adopted chronologically in steps. The process involved considering and selecting a topic which was, ‘Transition of Care in Heart Failure.’ The next step entailed literature searches using PubMed, BMJ Quality & Safety, Springer Link, BMC Public Health, Academic Medicine, and the American Journal of Preventive Medicine search engine databases. Keying in relevant critical words for the topic was significant, and they included ‘heart failure,’ ‘transition care,’ ‘post-discharge care’ and ‘readmissions.’
Besides, articles published with other languages other than English got excluded. Studies with randomized controlled trials and systematically reviewed studies met my inclusion criteria because of their high levels of evidence. Articles met the inclusion criteria considering that one of their dependent variables was reducing the readmissions following the implementation of one or many transitional care interventions. Materials were also excluded if their only response focused on patient education only. Also, those published earlier than 2014 got excluded.
Broader Relevant Scholarly Literature
In a systematic review conducted by Vedel and Khanassov, 41 randomized control trials got evaluated and assessed on their level of effectiveness on Hear Failure care transition in reducing hospital readmissions; Emergency Department visits, and associated mortality rates. All the 41 randomized controlled trials had a total of 43 transition care interventions. Provision of transition care interventions to discharged patients with chronic heart failure indicated an overall mean reduction of 8% and 29% on hospital readmission and emergency department visits, respectively. Each of the forty-one articles included at least one transitional care intervention or a combination of TCIs and made a comparison with conventional care.
Some of the transition care interventions utilized were the provision of patient and carer education before and after discharge, in-person home visits and follow-ups, scheduling outpatient clinic seven days post-discharge, using a case manager, and employing systematic telephone support. Most importantly, there was stress on relying on combining multidisciplinary health care providers in clinic visits, home visits, and telephone follow-ups. Low-intensity transitional care interventions, including only follow-ups in outpatient clinics, however, proved not useful.
The results from an integrative study by Stamp, Machado, and Allen (2014) are consistent with finding from the previous research. Results from the twenty articles included in the review echo the necessity to use transitional care programs in minimizing readmission rates while improving the quality of life. Further, the study illustrates the significant reduction in the overall cost of care in nurse-led transition care programs. The clinical implications of increased heart failure readmissions and ED visits are reduced rates of reimbursement by the Patient Protection and Affordable Care Act (ACA).
Moreover, the American Heart Association provided a scientific statement regarding quality care coordination strategies requiring a multidisciplinary healthcare approach that relies on effective communication. Post-discharge policies were put forward since they associated positive outcomes in patients with chronic heart failure (Albert, Barnason, Deswal, et al., 2015). Nurse-led transition care models should be integrating technology in facilitating the effectiveness of the model. Emerging technology ought to be utilized remotely to assess patient progress as per Chan, Lin & Wong (2016). Based on their study, they identify the existing gap in the formal augmentation of Heart Failure delivery care models. Notably, there exist no clear guidelines on the application of the current research Heart Failure transition care models to be part of the interventional strategies.
Significance of Literature to the Problem
Overall, health care providers must strive to deliver quality care to their patients by adopting multiple care delivery models. Concerning the reviewed evidence, utilization of transition care programs for the management of discharge patients with Heart Failure is essential. It is worth considering the inclusion of advanced practice nurses to act as leaders and managers of the heart failure transition care program alongside other interventions (Garcia, 2017; Vedel, I., & Khanassov, 2015).
Most importantly, Advanced practice nurses who always remain at the front foot and leaders of the continuum of care ought to coordinate care plans by using a multicomponent transition care program. Among the elements that have been included best practices in transitional care models include home visits after discharge, patient, and caregiver education provision before and after discharge. Also, telephone follow-ups, outpatient multidisciplinary clinic visits within seven days post-discharge, and use of a case manager have proved effective.
Conclusively, research evidence has resulted in the need to embrace the transition care programs in various care models. Therefore, the multicomponent transition of care in heart failure should be the center of the care continuum in care coordination. Advanced nurse practitioners ought to demonstrate their competencies in continued education and research undertakings to improve the care delivery to clients in different care delivery settings. Multidisciplinary coordination of care should be based on evidence-based interventions for quality improvement, reduce care costs, thus, increasing on ACA’s reimbursement rates.
References
Albert, N. M., Barnason, S., Deswal, A., Hernandez, A., Kociol, R., Lee, E., … & White-Williams, C. (2015). Transitions of care in heart failure: a scientific statement from the American Heart Association. Circulation: Heart Failure, 8(2), 384-409.
Chan, W. X., Lin, W., & Wong, R. C. C. (2016). Transitional care to reduce heart failure readmission rates in South East Asia. Cardiac failure review, 2(2), 85.
Garcia, C. G. (2017). A literature review of heart failure transitional care interventions. The American Journal of Accountable Care, 5(3), 21-25.
Stamp, K. D., Machado, M. A., & Allen, N. A. (2014). Transitional care programs improve outcomes for heart failure patients: an integrative review [published online ahead of print January 23, 2013]. J Cardiovasc Nurs. doi, 10.
Vedel, I., & Khanassov, V. (2015). Transitional care for patients with congestive heart failure: a systematic review and meta-analysis. The Annals of Family Medicine, 13(6), 562-571.
Ziaeian, B., & Fonarow, G. C. (2016). The Prevention of Hospital Readmissions in Heart Failure. Progress in Cardiovascular Diseases, 58(4), 379–385. https://doi.org/10.1016/j.pcad.2015.09.004