Reasons why readmission of CHF patients is high in local setting

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Table of Contents

Abstract
Introduction
Problem Statement
Literature Review
Methodology
Findings
Conclusion
References

Abstract

CHF is a health condition that affects normal operations of the body of a human person by interfering with the supply of blood to other body parts leading to the impairment of their normal functioning. The condition affects many people in different countries throughout the world. The U.S. is one of the developed countries that are affected by the CHF patients. It is estimated that about 5.3 million Americans suffer from this condition.

Due to the critical nature of the condition and other factors, this study seeks to establish reasons for increased number of CHF patient readmission in a local setting (Nasif & Alahmad, n.d.). Using the quantitative research method, the study will examine readmission patients in a local hospital that has a 300-bed capacity. From the study findings, CHF patient readmissions are caused by various factors such as non-compliance to medication, smoking, drinking alcohol and lack of diet modification (Pitt, et al. 2000).

Introduction

Chronic Heart Failure is a medical condition in which the heart of an individual is unable to pump enough blood to other parts of the body in order to enable them function as required. The condition is serious and could lead to other medical complications affecting patients if the condition is not detected and treated early.

CHF condition is prevalent in all countries throughout the world. Using quantitative research method, this study examines reasons for the readmission of CHF patients in the local setting. Some of the established reasons for CHF patient readmissions were smoking, medical noncompliance, dietary changes and drinking (Brophy, et at. 2001).

Problem Statement

CHF is an issue affecting many people and public health systems in different countries across the world. More than 20 million people worldwide are affected by CHF while 2% of prevalent patients are reported in developed countries. Nasi & Alahmad (n.d.) note that the American Heart Association has reported that there are 5.3 million Americans suffering from the CHF condition with 660,000 new patients being reported annually.

The occurrence of the condition is about 10 people per 1000 persons in the U.S. population. Due to health implications brought about by the CHF condition, about 287,000 people die every year.

In spite of increased infection rates of CHF, the success rate of treating the conditions has also increased (Georgiou, et al. 2001). On the contrary, the problem remains high in rural settings that are characterized by high readmissions of CHF patients. Therefore, this study investigates reasons for high CHF patient readmission in a local setting (Jong, et al. 2002).

Literature Review

The condition affects both individuals and the economy. The public health sector is forced to spent large amounts of money on the treatment of CHF patients every year. According to Nasif & Alahmad (n.d.), the U.S. spent about $34.8 billion in 2009 whose large part went to hospital readmissions.

The centers for Disease control and prevention indicate that African American population in the U.S. contracts CHF at the rate of 70% compared to other population groups that have lower levels. In addition, many of the reported patients involve individuals aged between 45 and 65 (Centers for Disease Control and Prevention, 2004).

Short breaths characterize the CHF condition with early symptoms being exertion. Dyspnea, the sudden development of severe short breaths at night that awaken patients is experienced by CHF patients as the condition progresses to the critical situation over time (Hernandez, et al. 2007).

According to Yancy (2004), pulmonary congestion is one of the related conditions to other initial symptoms of the disease. The pulmonary congestion occurs due to the interstitial and alveolar spaces that are caused by pulmonary edema. The two common conditions of CHF are the systolic heart failure and diastolic heart failure that is characterized by impaired relaxation phase of the cardiac muscle.

McKelvie et al. (1995) note that the coronary artery disease, stroke and the peripheral artery disease that form the risk factors for contracting the disease contribute to the development of CHF disease during the mature stages of the disease that when not treated early, may cause death.

Following the occurrence of the disease, rural settings have been reported to have increased rates of readmissions for patients with the CHF condition. The high readmission rates of the disease in these areas is attributed to many factors some of which include patients not complying to medication, lack of modification of the diet, intake of alcohol, smoking and lack of community follow up (Elixhauser, et al. 2000).

Methodology

A research can be either quantitative or qualitative in nature depending on the research method undertaken by the researcher. This study employed a quantitative research method with a quantitative research design that involved the researcher collecting numerical data using quantitative data collection tools such structured questionnaires (Quinn, 2002). The researcher used purposive sampling technique to select a sample comprising of 65 and above year old patients suffering from CHF condition from a large population of CHF patients in a local setting. The researcher did not group the sampled population any further based on other factors such as race, color, ethnicity or point of origin in order to ensure validity and reliability of the study. The variables for the study included readmission that is the dependent variable while independent variables were many and included factors such as non-compliance to medication, smoking, drinking alcohol and lack of diet modification (Saunders, Lewis & Thornhill, 2007).

Findings

The findings of the study indicate that the level of CHF patients in the rural setting fluctuated over the period from January 2010 to March 2011. The patients were as high as 17 in January 2010 (Piepoli, et al. 2004). They declined to a low level of 5 patients during the month of May 2010 before beginning to increase gradually to 16 patients during the month of March 2011 as indicated in the figure below.

The increase in the level of CHF readmissions was attributed to be various factors such as non-compliance to medication, smoking, drinking alcohol and lack of diet modification as illustrated and explained below.

January 2010

From the figure below, it is revealed that the cause of readmissions for CHF patients was all the factors listed above. However, the composition differed. It is clear that the highest cause of CHF patient readmissions was lack of community support while the lowest causes for CHF patient readmissions were smoking and lack of diet modifications.

February 2010

The month of February 2010 saw some decrease in the total number of CHF patients readmitted to the hospital with the total number declining by 5 CHF patients.

The causes remained the same with different compositions. Lack of community support remained the main cause of CHF patients’ readmissions with increased number of CHF patients being readmitted. Smoking led to increased patient readmissions from 3 patients in the month of January to 5 patients in the month of Feruary. The lowest cause for CHF patient readmission was lack of dietary modifications.

March 2010

This month was a different in the hospital because there were changes in the composition of causes for CHF patient readmissions. Total patients readmissions reduced to 9 patients. However, the main cause of readmissions was lack of dietary modifications that had the rate of 6 patients being readmitted while the lowest reason for patients being readmitted was smoking.

April 2010

This period saw the increase in the number of CHF patient readmissions to 10 patients from 9 in the previous month. The highest cause of patient readmission for this period was smoking that had the rate of 7 patients being readmitted followed by lack of community support. However, the lowest causes remained lack of dietary modifications followed by lack of follow up on PCP as illustrated below.

May 2010

This period saw a decline in CHF patient readmission to 7 patients. The causes remained the same while the highest cause was lack of dietary modifications at the rate of 6 patients followed by medication non-compliance. On the contrary, the lowest cause of CHF patient readmission during this month was smoking at the rate of 2 patients.

June 2010

During this period, CHF patient readmissions in the local hospital increased to 15 patients. The increase in the number of readmissions can be attributed to the increase in the number of readmissions caused by lack of dietary modifications. This factor increased the number of readmissions from 6 to 8. The next causes of readmission were medication noncompliance. On the contrary, the lowest cause of CHF patient readmission in the month as the smoking that had the rate of 2 patients.

July 2010

Readmissions in the course of this month dropped by 2 patients to remain at 13 patients. The cause of the drop in patient readmission was lack of dietary modifications followed by medical non-compliance (Smedley, Stith & Nelson, 2003). The rest of the causes remained at the rate of 2 patients as illustrated below.

August 2010

CHF patient readmission increased to 14 patients following the increase in the number of patients that were readmitted due to non-medication compliance that was the highest cause of readmission. The factor led to an increase in patient readmission from 3 patients to 7 patients.

Similarly, lack of dietary modifications was responsible for 7 readmitted patients hence being another highest reason for patient readmission. On the lower side, other causative factors remained low at the rate of 2 patients except for lack of community support that led to three patients being readmitted.

September 2010

During this period, readmitted patients increased to 16 following an increase in the patients caused by all other factors except medical non-compliance and lack of dietary modifications (Wang, et al. 2003). However, the highest causative agents were medical noncompliance and lack of dietary modifications.

October and November 2010

December 2010 and January 2011

February and March 2011

Conclusion

From the findings of the study, it is evident that readmission patients in the rural setting fluctuated over the period of study. The reasons for readmissions of CHF patients were non-compliance to medication, smoking, drinking alcohol and lack of diet modification. Others were lack of follow up to PCP and lack of community support.

The highest causative factors for CHF patient readmissions were medical non-compliance, lack of dietary modifications and lack of community support. On the contrary, the lowest causative factors of CHF readmissions were lack of follow up on PCP and alcohol intake.

The months of January 2010, September 2010 and March 2011 recorded the highest CHF patient readmissions while the lowest rates of patient readmissions were recorded during the months of May 2010, March 2010 and April 2010. It is therefore evident that the rates of CHF readmission patients in the rural setting are high with causative factors being as indicated above.

References

Brophy, J.M.e at. (2001). Beta-blockers in congestive heart failure. A Bayesian meta-analysis. Ann Intern Med, 134(550), 135-151.

Centers for Disease Control and Prevention, (2004). The Burden of Heart Disease and Stroke in the United States: State and National Data, 1999. Atlanta: Centers for Disease Control and Prevention.

Elixhauser, A, et al. (2000). Table 4. Most Common reasons for hospitalizations by age groups, in Hospitalization in the United States, 1997, Rockville Agency for Healthcare Research and Quality, HCUP Fact Book. New York: AHRQ publication.

Georgiou, D. et al. (2001). Cost-effectiveness analysis of long-term moderate exercise training in chronic heart failure. Am J Cardiol, 87, 984.

Hernandez, A.F. et al. (2007). Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. JAMA, 298,1525-1532.

Jong, P. et al. (2002). Angiotensin receptor blockers in heart failure: Meta-analysis of randomized controlled trials. Journal of Am Coll. Cardiol, 39, 463.

McKelvie, R.S. et al. (1995). Effects of exercise training in patients with congestive heart failure: A critical appraisal. J Am Coll Cardiol, 25:789.

Nasif, M. & Alahmad, A. (n.d.). Congestive Heart Failure and Public Health.

Piepoli, M.F. et al. (2004). Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ, 328, 189.

Pitt, B. et al. (2000). Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial–the Losartan Heart Failure Survival Study, Lancet: ELITE II. 355:1582.

Quinn, M. (2002). Qualitative Research & Evaluation Methods, 3 Ed. Thousand Oaks, NJ: Sage Publications.

Saunders, M., Lewis, P. & Thornhill, A. (2007). Research Methods for Business Studies. Fourth Edition. Boston, MA: Pearson Education.

Smedley, B.D., Stith, A.Y. & Nelson, A.R. (2003). Unequal Treatment: confronting racial and ethnic disparities in healthcare. Institute of Medicine, National Academy of Sciences. p. 43–4.

Wang, T. et al. (2003). Natural history of asymptomatic left ventricular systolic dysfunction in the community. Circulation, 108, 977–982.

Yancy, C. (2004). The prevention of heart failure in minority communities and discrepancies in health care delivery systems. Clin N Am, 88, 1347–1368

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