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Date of Award

2016

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

Department

Nursing

Thesis Committee Chairperson

Lisa Ball, PhD, RN, FNP-BC

Second Reader

Vinay Mehta, MD

Keywords

heart failure, outpatient clinic, readmission, inpatient mortality, palliative care

Abstract

Background: A first to be established in the area, an outpatient heart failure clinic (HFC) was developed within a large private cardiology practice in Western New York to reduce 30 day allcause re-hospitalization and inpatient mortality.

Objectives: The purpose of this study was to analyze the process and patient outcomes of the first independent outpatient HFC in WNY. The specific aims were to (1) describe outpatient care strategies employed; and (2) determine whether the HFC reduced 30-day all-cause rehospitalizations and inpatient mortality by comparing HFC data to census data.

Methods: A retrospective chart analysis of 415 adults who were enrolled in the HFC after a HF hospitalization was conducted. Data were summarized using frequency comparisons and descriptive statistics. One-sample chi-square tests were conducted to test the observed values in the study sample against census data.

Results: Patients in the HFC were less likely to experience a readmission to hospital within 30 days of discharge (69% reduction within the study period, p < .001). Patients were seen acutely following discharge, had multiple medication adjustments, and received ongoing telephonic follow up. The HFC had statistically lower inpatient mortality rates (1.2% versus 11.6% national average) [p < .001], likely a result of the HFC care and referrals for palliative care (PC) (17%).

Conclusion: The results of this analysis highlight the importance of cultivating an outpatient HFC in collaboration with hospitals to coordinate inpatient and outpatient care of individuals with HF aimed at reducing 30-day all-cause readmissions and inpatient mortality with referral to PC when indicated.

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