Hospital Pharmacy - July/August 2018 - 269

269

Patel and Dickerson
Table 1. Baseline Characteristics.
Characteristics
a

Age, years (SD)
Gender, n (%)b
Male
Female
Race, n (%)b
Black
Nonblack
LVEF, %a
Length of hospital staya

Pre-Project RED (N = 100)

Post-Project RED (N = 50)

P value

70.6 ± 10.8

72.12 ± 8.88

.37

99 (99)
1 (1)

49 (98)
1 (2)

.62

31 (31)
69 (69)
35
5.61

14 (28)
36 (72)
32.05
5.85

.71
.71
.66

Note. RED = Re-Engineered Discharge; LVEF = left ventricular ejection fraction; SD = standard deviation.
a
Statistical test: Independent Student t test.
b
Statistical test: Pearson's chi-square test.

Table 2. Cost analysis.
Parameter
Length of hospital stay
Hospital readmission cost per day, $
Hospital readmission cost per visit, $
(Hospital readmission cost per day × Length of hospital stay)
Hospital readmissions, %
Hospital readmission cost per 100 visits, $
(Hospital readmission cost per visit × % Hospital readmissions × 100)
PCP cost per visit. $
PCP follow-up visits, %
PCP cost per 100 visit, $
(PCP cost per visit × % PCP visits × 100)
ER cost per visit, $
ER visits, %
ER cost per 100 visits, $
(ER cost per visit × % ER visits × 100)
Total cost per 100 visits, $
(Total hospital cost + PCP visit cost + ER visit cost for 100 visits)
Cost savings per 100 patients, $
(Pre-Project RED cost - Post-Project RED cost)
Cost savings/visit, $

Pre-Project RED (N = 100)

Post-Project RED (N = 50)

5.61
2937
16 476.57

5.85
2937
17 181.45

28
461 343.96

18
309 266.10

298
19
5662

298
40
11 920

516
1
516

516
2
1032

467 521.96

322 218.10
145 303.86
1453

Note. RED = Re-Engineered Discharge; PCP = primary care physician; ER = emergency room; CAVHS = Central Arkansas Veterans Healthcare System.
Utilized CAVHS average cost of hospital visit broken down by treating specialty-Cardiology-information as provided by CAVHS Facility Revenue
Manager.10

education intervention (post-Project RED phase) versus
those who did not (pre-Project RED phase) (28% vs 18%,
respectively; P = .18). The number of PCP appointments
scheduled at the time of discharge between pre-Project RED
and post-Project RED groups were slightly different (6% vs
2%, respectively; P = .274). With the decrease in 30 days'
hospital readmission rate post-Project RED education intervention, there was a cost savings of $1453 per patient visit
for HF exacerbation (Table 2).

Discussion
Overall, all baseline characteristics were very similar in both
groups. The increase in percent of primary care appointments

attended by patients, based on postdischarge instructions,
reiterates that the Project RED intervention provides a better
transition for patients post discharge and they are more likely
to attend their primary care appointment. The study excluded
patients with left ventricular ejection fraction >55% to avoid
a potential bias to select healthier patients. All unplanned
hospital readmissions for HF exacerbations were included
(emergency department and readmission). A majority of the
patients did not have a PCP appointment scheduled at discharge. This might be a reason for the lack of statistical significance in the 30-day hospital readmission rate for HF
exacerbations post discharge in both groups, as the patients
were not followed-up in a timely fashion post discharge.
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