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Family Education on Impaired Patient Care Lowers CHF Readmissions

DETROIT – Taking some extra time to involve family members and educate them on how to care for someone with memory loss can pay off in significantly reduced hospital readmissions.

That’s according to a new study in the American Journal of Accountable Care. Henry Ford Hospital researchers tested the strategy with 489 patients in its congestive heart failure (CHF) unit and found that 30-day readmission rates dropped 30%, from 23% to 16%.

Lead author Mark Ketterer, PhD, called the strategy "astonishing simplistic but effective."

"Patients with memory loss often don't do well with taking their medication on time, renewing their medication and just coping in their day-to-day surroundings," Ketterer said in a Henry Ford press release. "If they're in a medical setting such as a nursing home, a nurse or other provider is able to monitor them and make sure they're doing these things reliably and consistently.

"Assigning a nurse to at-home patients is simply not feasible for manpower and cost reasons. We found that involving and educating the family about the forgetfulness we frequently see in patients and having them more involved in overseeing the care at home proved to be really successful in keeping patients from returning to the hospital."

Taking into account the cost of readmissions and the care associated with them, Ketterer theorized that nearly $180,000 a month could be saved for every 100 patients benefiting from effective involvement and education of family members.

Patients and families were deemed eligible for psychoeducation if the patient met any of the following criteria:

  • was unable to repeat three simple nouns after the recruiter on the first try—assuming no environmental distractions and adequate hearing (immediate memory);
  • was unable to name the current month, year, and building they were in (orientation);
  • made two more mistakes on the clock-drawing test (executive function); or
  • could not remember at least two of the three items after 3 to 5 minutes of distraction (short-term memory).

For patients displaying baseline cognitive impairment, the entire patient treatment team -- attending physician, resident, fellow, nursing, and case manager – was encouraged to convey concern about the patient’s likely difficulty adhering to the complex medication regimens. Patients and/or families then were approached with “Destigmatized Cognitive-Behavioral Psychoeducation,” which educated them about the frequency and nature of cognitive impairment and enlisted their help in managing care for the illness.