Hospital Pharmacy - July/August 2018 - 268

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Hospital Pharmacy 53(4)

Figure 1. Enrollment.

Note. ICD-9 = International Classification of Diseases, Ninth Revision; HF = heart failure; RED = Re-Engineered Discharge; LVEF = left ventricular ejection
fraction.

The primary outcome of this study was to assess the
unplanned hospital utilization for HF exacerbation within 30
days post discharge in patients who received Project RED
education versus those who did not. An unplanned hospital
utilization was determined by utilizing 2 parameters: ICD-9
codes as well as discharge summary notes. To minimize bias
from inappropriate coding errors, discharge summary notes
were reviewed to ensure patient had an unplanned hospital
readmission for HF exacerbation. The secondary outcomes
included assessing the all-cause mortality, primary care
appointment scheduled at discharge, attendance to a primary
care appointment within the recommended time frame post
discharge, and cost savings. Cost savings were calculated by
obtaining the difference between the total readmission cost
(hospital readmission cost + emergency room [ER] visit cost
+ PCP visit cost) between the 2 groups.
Baseline characteristics of race, gender, and housing status were compared between the pre-Project RED and post-
Project RED phases using Pearson's chi-square test. All
other baseline characteristics were compared using student's
t test. Primary outcome assessing unplanned 30-days hospital utilization for HF exacerbation was compared using chisquare test. All secondary outcomes were assessed using
Pearson's chi-square test except for cost savings for which
independent student t test was used. P values less than .05
were considered statistically significant. All data outcomes
collection and analysis were performed by primary author.

Results
A total of 1721 unique patient charts were extracted with the
above mentioned ICD-9 codes for HF; 741 patient charts
from February 1 to July 31, 2014, were reviewed to obtain
the first 100 patients who met the predefined inclusion and
exclusion criteria. For the post-Project RED phase, 337
patient charts from August 1 to November 30, 2014 were
reviewed to obtain the first 50 patients who met the predefined inclusion and exclusion criteria (Figure 1).
The baseline characteristics of patients in study groups,
pre-Project RED and post-Project RED phases, were similar
(Table 1). Overall, the mean age was 70.6 years and 72.1
years for the pre-Project RED and post-Project RED groups,
respectively. The majority of subjects were male and nonblack. Left ventricular ejection fraction was 35% and 32.05%
for the pre-Project RED and post-Project RED groups,
respectively. The average length of hospital stay was similar
between both groups.
There were 2 statistically significant differences noted
between the 2 groups. There was a significant reduction in
the all-cause mortality between the pre-Project RED and
post-Project RED patients (41% vs 24%, respectively; P =
.04). In addition, the post-Project RED group had a higher
rate of PCP appointments attended by patients based on their
postdischarge follow-up instructions (19% vs 40%, respectively; P = .006). There was a lower rate of 30-day hospital
readmission for the patient group that received Project RED

Table of Contents for the Digital Edition of Hospital Pharmacy - July/August 2018