Tennessee Medical Center Addresses Readmissions

JOHNSON CITY, Tenn. — One of the classic problems in medical and educational institutions is that many of the people the organizations serve have almost no other resources to get those services from. In education you see this in studies concerning summer break. Students with a lot of resources at home tend to come back to school more prepared than when they left. Conversely, students with few resources at home can actually regress, failing to even maintain the progress they made during the previous school year.

An analogous problem exists in medical care. Patients with few resources tend to be readmitted for previously treated problems at a much higher rate. A readmission is considered to be when a patient returns for the same problem within 30 days. A study by Mountain States Health Alliance (MSHA) found roughly one out of three congestive heart failure patients at its flagship hospital, Johnson City Medical Center (JCMC), returns, “due largely to socioeconomic reasons.” Congestive heart failure patients were used in the study because they are among the most likely to be readmitted within that time frame.

In an attempt to address this issue, MSHA has opened a new congestive heart failure clinic at JCMC, which will provide patients with education, consultations regarding interactions between various medications, and assistance in monitoring their condition. The clinic will also help patients find medication funding assistance programs that apply to their situation and connect them with other community resources. The clinic was opened within the existing structure of The Heart Hospital.

“There is a very big need for this in the community,” said Julia Bates, a nurse practitioner who helped create the care model for the clinic. “My job will first be to find out what kinds of social and financial issues they have, and if they understand about congestive heart failure. Many family practices don’t have enough time to focus on this, so we will provide as much education as the patient needs.”

“This is a service to the community, and our goal for the first year is to reduce our total congestive heart failure readmissions by 5 percent,” said Ed Stump, assistant vice president for cardiovascular and pulmonary operations at MSHA. “We want to help these patients transition from the hospital and learn to manage their disease.”

The positive news is that this appears to be the type of issue that can be substantially improved once identified, as CHF is primarily treated by medication and diet. According to MSHA, “Some patients may not have enough education about CHF; others don’t understand or follow through with their medication plans, or don’t know what is covered by their insurance.”

The hope is that offering highly visible free assistance will overcome many of these issues, bridging the gap between the cornucopia of services offered to those staying in the hospital and the relative lack of them at home.