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Analysis

NP Care Model Drastically Lowers Heart Failure Readmissions

By Jennifer Thew RN  
   February 23, 2016

After a new care model positively affected outcomes related to HF patients, Holy Name Medical Center in New Jersey expanded the use of advanced practice nurses inside and outside the medical center.

If you were given carte blanche to create a nursing care model, what would it look like?

Judith Kutzleb, RN, DNP, CCRN, CCA, APN-C, vice president of advanced practice professionals at Holy Name Medical Center, in Teaneck, NJ, had to answer that question when the organization 's CEO handed  her the opportunity a few years ago.

She easily could have forged ahead alone, but instead Kutzleb sought the input of others to develop the model.

"I don 't really like to do anything alone, " she told me. "My leadership style is one that enhances others to grow, so I designed a subcommittee of nurse practitioners and clinical nurse specialists in order to come up with a model that would be able to be implemented in the organization. "

 

Judith Kutzleb, RN, DNP, CCRN, CCA, APN-C

The group 's brainstorming sessions led to the creation of The NP Care Model, a patient-centered, collaborative-care approach intended to decrease readmissions and costs of care, and improve patient outcomes. The model 's details and outcomes were recently published in Nursing Economic$ .

"The model became the patient-centered model because the whole point is, if we 're meeting healthcare challenges, we need a collaborative team, " she says, "which means we 're not taking the place of anything. The model is not taking the place of anything. It 's going to enhance that which already being delivered. "

And enhance care it has.

A Win-Win Scenario
Evidence shows that APNs provide equal or better outcomes when compared to physicians, yet there is often still resistance to allowing APNs to function at the top of their licenses. 

In 2013, the New England Journal of Medicine published a study that reported "the Council of Medical Specialty Societies and the American Academy of Family Physicians strongly opposed broadening the scope of practice of nurse practitioners. "

But as Kutzleb points out, one provider doesn 't have to trump another.

"I don 't look at my place as a doctorally prepared nurse practitioner as taking a physician 's place, " she explains. "I look at it as a partnership. In a partnership, if I bring my best to the table, and the physician brings his best to the table, ultimately the patient 's going to win. "

As the results of the model show, when healthcare disciplines work collaboratively and APNs are given responsibilities that allow them use their administrative and clinical expertise, there can be big payoffs for patients, physicians, and the organization.

"The nurse practitioner is the conduit throughout the disciplines in order to make the patient experience and outcomes the very best, " Kutzleb says.

The program, which originally focused on heart failure patients, was implemented in January 2012.

Over a 12-month period, 30-day readmission rates dropped to 8% from 26%. Healthcare costs for the group of 312 patients receiving care via the NP Care Model was $311, 818 during 30-days after discharge. Prior to the model 's implementation, cost of care for this patient population during the 30-days post-discharge was $1,019,405.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


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