Heart failure transitional care services: An APRN led clinic

Abstract

INTRODUCTION: Heart Failure (HF) is a debilitating disease, that doesn't let the heart muscle pump enough blood. HF effects 6.5 million, with costs over $30 billion annually in the US (Yancy, 2013) The coronavirus (Covid-19) pandemic re-enforced the importance of using telehealth to deliver care. Advanced Practice Registered Nurse (APRN) clinics have been found to reduce hospital admissions and costs (Rice, 2018). PURPOSE: This project compared the impact of an APRN-run and Medical doctor (MD) run clinic on hospital admission rates, Emergency Department (ED) visits and clinic costs at a metropolitan mid-western hospital. METHOD: This Quality Improvement project (a systematic approach to data collection) collected retrospective aggregated data through an electronic report. Data included HF patients age (18 yrs. and older), provider type (APRN or MD), insurance status, zip code, gender, race/ethnicity and diagnostic ICD-10 codes for 2019 and post implementation of telemedicine due to Covid-19 in 2020. RESULTS: Hospital admission and ED rates were not significantly different between the APRN and MD clinic in 2019. The findings were similar following implementation of telemedicine due to COVID19 in 2020. Median total costs (the middle cost) and direct costs (expenses) were found to be significantly higher, and direct contribution margin (how a product contributes to the overall profit of the company) significantly lower for the APRN clinic compared to the MD clinic. This changed in 2020, using telemedicine there was no longer a significant difference in direct contribution margin CONCLUSION: APRN and MD clinic HF patients had similar outcomes in hospital readmission rates and ED visits at one metropolitan hospital. The outcomes could be due to the APRN and MD providing similar patient care. Costs were expected to be lower for the APRN clinic because APRNs provide cost-effective outcomes through less expensive labor input that produce healthcare services with the desired clinical result (Rice, 2018). In this study the APRN clinic costs could be because the overhead costs for a hospital outpatient clinic (HOD) may be more than an outpatient clinic (OPC). This cost was negated with telemedicine. There is a need to assess additional HF patient outcomes other than just hospital admission rates (Yancy, 2013).