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Published on May 09, 2017

A Trifecta of Cardiac Care Improves Patient Outcomes, Experience

Michael W. Farrar, MD, FACC, FASE

Dr. Farrar earned his medical degree from the University of Missouri-Kansas City, School of Medicine. He completed his residency in internal medicine, where he was later chief resident in internal medicine, and his fellowship in cardiology at the University of Cincinnati Medical Center.

The combination of North Kansas City Hospital’s Heart Care Clinic, Home Health department and remote patient monitoring program gives patients with heart failure a trifecta of comprehensive cardiovascular care services. The result: low hospital readmission rates and additional services to help this patient population remain at home.

Low HF Readmissions

Although HF is the primary reason patients return to a hospital following discharge, North Kansas City Hospital’s HF patient readmission rate is well below the national average. In 2016, NKCH’s average 30-day all-cause HF readmission rate was 15.6%, while the national average was 21.9%.

“These are sick patients by and large,” said Michael W. Farrar, MD, FACC, FASE, a cardiologist with Meritas Health Cardiology. “By their very nature, their readmission rates are going to be substantial. The key to successfully taking care of heart failure is to see these patients frequently.”

Complementary Services

Investigations into the treatment of HF, hypertension and other chronic cardiac conditions prove that quality improvement initiatives, such as those offered through NKCH’s Heart Care Clinic, home health services and remote patient monitoring program help reduce readmissions. For Dr. Farrar and his colleagues, it’s a team effort that focuses on the patient.

“Using these services helps me keep my patients out of the hospital and their heart failure under control,” Dr. Farrar said.

Patients with HF can be treated concurrently by the Heart Care Clinic and the Home Health department, and still be covered by their insurance.

“We’ll get Home Health and the Heart Care Clinic involved. They go hand in hand. A lot of these patients are going to need both, and they complement each other,” Dr. Farrar said. “Most patients like the fact that they will be seen frequently and that they may be in the hospital less frequently.”

A Connection to Care

With remote patient monitoring, patients receive
a scale, blood pressure cuff, and pulse oximeter
to record their weight, blood pressure, heart
rate and oxygen levels.

Because patients with HF can experience more hospital admissions than other patients, Home Health not only provides in-home expert nursing care, but also remote patient monitoring.

In addition to a scale, blood pressure cuff and pulse oximeter, Home Health will be adding spirometry to its RPM technology so nurses can follow patients with chronic obstructive pulmonary disease and asthma. RPM is provided at no additional cost to individuals who receive Home Health care.

Patients electronically report each day to Home Health nurses, who monitor their status and determine if follow-up care is needed from Home Health, the Heart Care Clinic or a cardiologist. If a patient does not check in, a Home Health nurse follows up with the patient.

Heart Failure Readmission Rates

21.9%

National Average

15.6%

NKCH

Average 30-day all-cause heart failure readmission rates

NKCH physicians also can now order RPM through the electronic medical record. RPM reports for patients with HF also are available for the entire healthcare team to review.

“Remote patient monitoring is one of the best things we’ve developed at North Kansas City Hospital,” Dr. Farrar said. “It makes a significant impact for HF patients with reduced ejection fraction — the systolic heart failure patients.”

If such a patient’s volume is up, the team will intervene before the patient is symptomatic and before heart failure develops. They can increase diuretics and adjust medications, thereby avoiding hospitalization.

Home Health and the Heart Care Clinic keep an open line of communication that extends to referring physicians who work closely with primary care and specialty physicians to manage and coordinate care during acute phases of heart failure.

Cardiologists, nurse practitioners, physician assistants, registered nurses, nurse technicians, social workers, dietitians, pharmacists and case managers comprise the Heart Care Clinic, which sees patients with HF on a regular basis to administer diuretics and provide other services. Clinic visits are an adjunct to a patient’s regular cardiology appointments. Home Health nurses, social workers, therapists and aids are specially trained to care for patients with heart failure.

“The Heart Care Clinic and Home Health staffs do a great job,” Dr. Farrar said. “They treat some of the most difficult cases — chronically ill patients — and they are dedicated to their work.”