Document Type

Dissertation

Title

A Propensity-Matched, Mortality-Adjusted Study of Palliative Care Consult to Reduce 90-day Hospital Readmission in a Heart Failure Cohort

Authors

Janice Shirley, Nova Southeastern University

Degree Name

Doctor of Philosophy (PhD) in Health Science

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences – Health Science Department

First Advisor

Sarah Ransdall

Second Advisor

Peter Holub

Third Advisor

Charles Lambert

Publication Date / Copyright Date

2021

Publisher

Nova Southeastern University

NSUWorks Citation

Janice Shirley. 2021. A Propensity-Matched, Mortality-Adjusted Study of Palliative Care Consult to Reduce 90-day Hospital Readmission in a Heart Failure Cohort. Doctoral dissertation. Nova Southeastern University. Retrieved from NSUWorks, College of Health Care Sciences – Health Science Department. (21)
https://nsuworks.nova.edu/hpd_hs_stuetd/21.

Abstract

Centers for Medicare and Medicaid Services (CMS) instituted the Hospital Readmission Reduction Program (HRRP) to reduce the frequency of heart failure (HF) 30-day hospital readmissions. To meet the needs of patients with end-stage HF, palliative care (PC) is promoted to provide additional support to patients and reduceunnecessary hospital readmission. While PC is a plausible and logical intervention, effectiveness in achieving reductions in readmissions has not been assessed ina HF population with adequate controls to assess confounding.

The goal of this research was to assess the effectiveness of Palliative care for HF (HFPC) consult to effect change in 90-day hospital readmissions in apropensity-matched model that adequately controls for mortality at a single-site 526-bed tertiary-care facility. Index hospitalization for live HF discharges: Oct 1 - Dec. 31, 2019, n= 250. Propensity matching helped to achieve a more homogeneous population with less variability ensuring a greater likelihood of observing an accurate and valid assessment of the outcome of interest.

Results were statistically significant for a strong association between HFPC consult and 90-day hospital readmission in a propensity-matched population. Logistic regression found a statistically significant association between HFPC and 90-d hospital readmission, p< .001. The logit transformation of the HFPC factor, OR 4.3, 95% CI [1.8 - 10.6] . Survival analysis demonstrates that time to readmission happens more frequently in patients who have a HFPC consult, readmissions occur earlier inthe post-discharge period and are strongly skewed to the immediate 30d post-discharge period. >50% of HF patients who have a HFPC consult experience a hospitalreadmission within 30 days of discharge. >75% of HF patients who have a HFPC consult will have a hospital readmission within 90 days of discharge.

This study demonstrates that while HFPC may be an important aspect of continuity of care and care planning for HF patients, it has a strong negative association with the objective of reducing hospital readmissions. HFPC consult predicts earlier hospital re-admissions in this HF population with high morbidity, approaching end-of-life.

Disciplines

Other Medicine and Health Sciences

Keywords

Heart failure, Hospital readmission, Palliative care, Propensity-matching