Study published in the British Medical Journal Quality & Safety suggests real-time, EMR based electronic risk stratification can reduce heart failure readmissions using fewer resources

Aug 01, 2013, 08:00 ET from PCCI

DALLAS, Aug. 1, 2013 /PRNewswire/ -- ( An EMR-enabled strategy that targets scarce care transition resources to high risk heart failure (HF) patients reduces readmissions, according to a new study in the British Medical Journal Quality & Safety.


"This is one of the first prospective studies to demonstrate how detailed data in EMRs can be used in real-time to automatically identify and target patients at the highest risk of readmission early in their initial hospitalization when there is a lot that can be done to improve and coordinate their care, so they will do well when they leave the hospital," said Ethan Halm, MD, MPH, senior author on the paper and Professor of Internal Medicine and Clinical Sciences and Chief of the Division of General Internal Medicine at UT Southwestern.

The study, conducted by investigators from PCCI, a non-profit research & development corporation based in Dallas, Texas, the University of Texas Southwestern Medical Center in Dallas and the Mayo Clinic (Jacksonville, Florida campus), provides evidence that technology platforms that allow for automated EMR data extraction, natural language processing-based disease identification and computerized risk stratification may substantially reduce readmissions in HF in conjunction with thoughtful care coordination and cardiac evaluation.

The study prospectively evaluated 1747 adult inpatients admitted with HF, acute myocardial infarction and pneumonia over two years at Parkland Memorial Hospital in Dallas, Texas. PCCI developed the software platform used in the study. The software sits above the EMR and stratifies patients admitted with HF on a daily basis by 30-day readmission risk, as defined by a published HF readmission reduction electronic model (Amarasingham, RA, et al, An Automated model to identify heart failure patients at risk for 30-day readmission or death using electronic medical record data. Med Care 2010;48(11):981-988.)

Although numerous studies have found that some combination of careful discharge planning, provider coordination and intensive counseling can prevent subsequent readmissions to hospitals, success has been difficult to achieve and sustain at the typical US hospital. Deploying high intensity care pathways for all patients regardless of risk can be expensive.

"This project was able to achieve the 'holy grail' of readmission reduction strategies. It reduced the population-based rate of readmission and saved the hospital thousands by redeploying limited, existing resources to the 25% of the patients at highest risk. It was so successful that what started as a research project is now part of the way the hospital does business," said Dr. Halm.

"These findings have important implications for the management of acute heart failure across large inpatient populations and health systems," said Parag C. Patel, MD, one of the study authors and an Assistant Professor of Medicine, Advanced Heart Failure/Mechanical Support, Department of Transplantation at the Mayo Clinic. "Patients with heart failure present to the hospital with different levels of readmission risk due to both physiologic and non-physiologic factors. Real-time electronic systems that capture this risk could significantly advance the way we manage these patients at a system level with greater efficiency and precision."

By using the real-time risk stratification program and concentrating intensive care management and cardiac resources on about one-quarter of the patients admitted with HF, study investigators found that the hospital was able to produce a 26% relative reduction in the odds of readmission (p=0.01) and an absolute reduction of 5.0 readmissions per 100 index HF admissions. Reference: Amarasingham, RA, Patel, PC, Toto, K, Nelson, L, Swanson, TS, Moore, BJ, Xie, B, Zhang, S, Alvarez, KS, Ma, Y, Drazner, MH, Kollipara, U, Halm, EA, Allocating scarce resources in real-time to reduce heart failure readmissions: a prospective controlled study. BMJ Quality & Safety. July 31, 2013 [Epub ahead of print].

This study was supported in part by grants from The University of Texas System Patient Safety Grant Award Program and The Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practices and policy.