Cardiac Surgery Nurse Practitioner Home Visits Prevent Coronary Artery Bypass Graft Readmissions

BACKGROUND:

We designed and tested an innovative
transitional care program, involving cardiac surgery nurse
practitioners, to improve care continuity after patient discharge home
from coronary artery bypass graft (CABG) operations and decrease the
composite end point of 30-day readmission and death.

METHODS:

A
total of 401 consecutive CABG patients were eligible between May 1,
2010, and August 31, 2011, for analysis. Patient data were entered
prospectively into The Society of Thoracic Surgeons database and the New
York State Cardiac Surgery Reporting System and retrospectively
analyzed with Institutional Review Board approval. The “Follow Your
Heart” program enrolled 169 patients, and 232 controls received usual
care. Univariate and multivariate analyses were used to identify
readmission predictors, and propensity score matching was performed with
13 covariates.

RESULTS:

Binary logistic regression
analysis identified “Follow Your Heart” as the only independently
significant variable in preventing the composite outcome (p = 0.015).
Odds ratios for readmission were 3.11 for dialysis patients, 2.17 for
Medicaid recipients, 1.87 for women, 1.86 for non-Caucasians, 1.78 for
chronic obstructive pulmonary disease, 1.26 for diabetes, and 1.09 for
congestive heart failure. Propensity score matching yielded matches for
156 intervention patients (92%). The intervention showed a significantly
lower 30-day readmission/death rate of 3.85% (6 of 156) compared with
11.54% (18 of 156) for the usual care matched group (p = 0.023).

CONCLUSIONS:

A
home transition program providing continuity of care, communication
hub, and medication management by treating hospital nurse practitioners
significantly reduced the 30-day composite end point of
readmission/death after CABG. More targeted resource allocation based on
odds ratios of readmission may further improve results and be
applicable to other patient groups.