Going Low Tech Might Reduce Costly Hospital Admissions in Chronic Heart Failure

Lynne Weir, physical therapist and the Inova cardiac program's clinical coordinator who works with the program, says the patients answer five questions on the phone:

• Are they short of breath more than usual?


• Did they notice swelling or bloating more than usual?


• Did they wake up with shortness of breath?


• Did they have to sleep in a chair or propped up with pillows?


• Were they light-headed or dizzy?

If the patients don't call the designated number by noon, a case worker calls them back directly.  During the first six months of the program, 47 patients complied consistently.

Also, if they don't own a scale and don't have the means to buy one, Inova will take care of that too.

Compared with another set of patients who were not enrolled in the program or who were enrolled but for some reason dropped out, the CHF project reduced rehospitalizations as well as the cost of each hospitalization, from $10,305 to $6,536.

"We avoided a lot of panic calls to doctors offices, too," Weir says.

Also compared with another set of patients with CHF seen by the health system a year earlier, the hospital was able to reduce all-cause admissions by 31%.

The return on investment is favorable as well, Weir says. With an average cost of $50 per patient per month, the savings were worth it, even considering start-up costs, she says.

The program's cost was estimated at $74,300 for the first six months, with an estimated saving from avoided hospitalizations, or avoided more acute hospitalizations, of $99,291.

Now, the health system has expanded the program 150 patients.

Sherber says that for these patients, who tend to be older with multiple medical issues, taking the time to weigh themselves daily and monitor their symptoms may be something they otherwise would not want perform.

"This is an example of an implementation of a program that not only helps patients, but also helps physicians deliver care they want to give and helps the hospital to decrease unnecessary utilization at the same time," Sherber says. He adds that a similar call-in template is now being developed for patients with diabetes.

"A year from now, we'll be enrolling a lot more patients in this program," he says.