The Effect of Telehealth on 30-Day Readmissions in Medicare Beneficiaries Following Isolated Coronary Artery Bypass Graft Surgery
Cardiovascular disease (CVD) is the leading cause of death in 45.1% of Americans. Each year in the United States, 790,000 suffer myocardial infarction as end organ damage from coronary disease. Coronary artery bypass graft (CABG) surgery is a life-saving procedure for many patients with severe coronary artery disease. However, hospital readmissions for complications within 30 days after CABG discharge pose substantial burden to patients, families, and the healthcare system. This scholarly project examined the effect of a telehealth (TH) program in addition to usual discharge care on 30-day readmissions in Medicare isolated CABG patients. A retrospective case-controlled analysis of TH program data was conducted at a single project site. Medicare patients who participated in a TH program after discharge to a home setting following isolated CABG surgery from 5/1/17-4/30/18 were compared with a causal comparison group receiving usual care from 5/1/16-4/30/17. A total of 83 cases (51 control; 32 treatment) met inclusion criteria. No statistically significant differences were noted in 30-day all cause readmission (p=0.568), emergency room encounters (p=0.785) or readmissions specifically related to atrial fibrillation, heart failure, or pleural effusion. The treatment group showed a trend toward timely follow-up to cardiology appointments, with a reduction from 19.8 to 13.7 days (p= 0.062). The treatment group experienced no failures to show for surgical follow-up appointments. Treatment interventions due to TH primarily consisted of medication initiation and titration. Therefore, one practice recommendation is to incorporate a diuretic script into the discharge plan with instructions for use. A second recommendation is to remove barriers to surgical follow-up by utilizing nurse practitioners to evaluate these postoperative patients within one week of discharge. A final recommendation is to evaluate best practices for discharge care post isolated CABG surgery for incorporation into the American Hospital Association (AHA)/American College of Cardiology (ACC) guidelines. Reducing hospital readmissions from siloed care represents an opportunity to reduce cost and improve transitions of care practices.
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