Hospital Pharmacy - July/August 2018 - 266

749925
research-article2017

HPXXXX10.1177/0018578717749925Hospital PharmacyPatel and Dickerson

Article

Impact of the Implementation of Project
Re-Engineered Discharge for Heart
Failure patients at a Veterans Affairs
Hospital at the Central Arkansas Veterans
Healthcare System

Hospital Pharmacy
2018, Vol. 53(4) 266-271
© The Author(s) 2017
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https://doi.org/10.1177/0018578717749925
DOI: 10.1177/0018578717749925
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Pooja H. Patel1 and Kimberly W. Dickerson2

Abstract
Background: Hospitalizations due to chronic diseases such as heart failure (HF) continue to increase worldwide.
Fragmentation of care while transitioning from one care setting to another is an important factor contributing to
hospitalizations. Fragmented discharge tools have been implemented; however, the impact of a comprehensive
interdisciplinary discharge tool has not been previously studied. Objective: The goal of this study is to assess the impact
of the implementation of Project Re-Engineered Discharge (RED) on the incidence of hospital readmissions, all-cause
mortality, primary care physician follow-up rate, and cost savings for patients with HF. Methods: This was a single-center,
retrospective, cohort study of patients admitted with HF exacerbation at the Central Arkansas Veterans Healthcare System
(CAVHS). A random sample of 100 patients admitted prior to implementation of Project RED and 50 patients after Project
RED intervention were included in the study. The primary end point was 30-day hospital readmission for HF exacerbation.
The co-secondary end points were all-cause mortality, cost savings, and rate of primary care physician appointments
scheduled as well as attended per postdischarge recommendations. Results: The 30-day hospital readmission rate was
28% in the pre-Project RED group, and it was 18% in the post-Project RED group (P = .18). The all-cause mortality was
significantly lower in the post-Project RED group as compared with the pre-Project RED group (18% vs 41%, P = .04).
More patients in the post-Project RED group attended an outpatient primary care appointment as recommended per
postdischarge instructions (40% vs 19%, P = .006). In addition, with the decrease in hospital 30-day readmission rate in
the post-Project RED group, there was a cost savings of $1453 per patient visit for HF exacerbation. Conclusions:
Coordination of care using a discharge tool like Project RED should be utilized in institutions to improve patient outcomes
as well as patient safety while decrease the overall health care cost.
Keywords
cardiovascular, cost effectiveness, disease management, transition of care, outcomes research

Hospital readmission has been a long-standing concern in
health care. Since October 2012, the Centers for Medicare
and Medicaid Services initiated the Readmission Reduction
Program. With the implementation of the program, there are
reduced payments to hospitals that have more 30-day readmissions compared with an established standard based on a
3-year national average, for heart attack, heart failure (HF),
and pneumonia.1 A recent study showed that 20% of
Medicare beneficiaries who were discharged from a hospital
were readmitted within 30 days' post discharge. Of those
readmitted patients, 50% of patients did not have a bill for a
visit to a physician's office between the time of discharge
and rehospitalization. The study estimated the cost of
unplanned rehospitalization in 2004 was $17.4 billion.2
According to the Centers for Medicare and Medicaid

Services, approximately 2.6 million older adults are readmitted to a hospital within 30 days of being discharged. The
estimated cost exceeds $2.6 billion every year or more than
$1000 per readmission. The Medicare Payment Advisory
Commission estimates that more than three-quarters of
30-day readmissions may be preventable. Fragmentation of
care while transitioning from one care setting to another is
1

Texas A&M University, Houston, USA
Central Arkansas Veterans Healthcare System, Little Rock, USA

Corresponding Author:
Pooja H. Patel, Clinical Assistant Professor, Department of Pharmacy
Practice, Irma Lerma Rangel College of Pharmacy, Texas A&M University,
2121 W Holcombe Blvd, Rm 1107, Houston, TX 77030, USA.
Email: phpatel@pharmacy.tamhsc.edu

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