Review ArticleSkilled Nursing Facility Care for Patients With Heart Failure: Can We Make It “Heart Failure Ready?”
Section snippets
HF Hospital Admissions and Readmissions From SNFs Are Central to Policy Changes
Hospital readmissions have become a widely used metric by which suboptimal care is measured, and, as such, rehospitalization is now a key target of legislative efforts.15, 16 Although causes of readmissions from SNFs are often difficult to deconstruct, HF and/or HF symptoms are frequent triggers.17, 18, 19, 20 In the context of current measured quality metrics, HF is 1 of 13 conditions recognized by The Center for Medicare and Medicaid Services (CMS) as potentially preventable; in other words,
Transitional Care for Patients With HF Admitted to and Discharged From SNFs
Transitions of care (ie, transitional care) occur when patients are transferred between health care settings (ie, from hospital to SNF or from SNF to home) and actions (ie, medical reconciliation, discharge documentation, communication, coordinating patient follow-up, and postdischarge services) are taken to ensure coordination and continuity of care.26 Gaps in transitions contribute to poor outcomes,27, 28 and poor documentation, lack of attention to patient goals and geriatric conditions (eg,
HF Disease Management Approach
Processes to improve assessment and management of patients with HF during their SNF stay are critical determinants of quality and efficacy, but are inherently challenging. An undertrained and unstable SNF workforce, lack of standardized SNF disease management programs (DMP), and limited physician access all contribute to this challenge. Risk prediction tools, monitoring protocols, and DMPs have evolved, but still need to be adapted for SNF patients with HF (Table 1). Designation of disease
Facility Factors
A unique challenge in discharging patients to SNFs is that the facilities themselves lag behind hospitals in experience relevant to achieving quality improvement in HF. Navigating though complexities in care provision within individual facilities can be difficult for providers and families. More than 90% of Medicare beneficiaries live in a county with 3 or more SNFs; fewer than 1% live in a county without one.4 SNF placement is often based on geographic preferences, insurance coverage, or
Future Policy Considerations
Adding regulations on the federal level is a complex challenge; however, we advocate that federal policies are needed to both better assist SNFs in meeting their impending quality mandates, and improve the overall quality of care SNFs provide to the increasing number of patients with HF.
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Classification of SNFs as “HF Ready:” Under newer bundled payment models, hospitals will bear the burden of postacute care costs. Many hospitals currently have broad but weak relationships with postacute care
Conclusions
SNFs are moving to the forefront of care as a key component in the transitional pathway from acute care hospitalization to the community for older patients with HF; however, quality standards to optimize care are still lagging. Better understanding of factors that contribute to optimal care for older patients with HF, who tend to be inherently more complex than younger patients, is an area that requires ongoing investigation and management enhancements. The cardiology community has been
Acknowledgment
Supported by NIH grant R01 HL 113387.
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Cited by (0)
Dr. Forman is supported in part by NIA grants P30 AG024827 and 1R56AG051637-01A1, PCORI grant IH-1304678, and VA Office of Rehabilitation Research and Development grant F0834-R.