Heart failure is the leading cause of hospitalization in older adults, and keeping these patients out of the hospital can be a significant challenge, requiring close follow-up. An in-person follow-up visit within 7 days after discharge from a heart failure hospitalization is associated with lower 30-day readmission, for example, yet too many patients never make it to their early post-discharge appointment.
Dr. Lee, who is also a clinical investigator at the KP Division of Research (DOR), wondered whether a telephone visit with a trained nurse or pharmacist within a week of leaving the hospital might be easier for patients and just as effective as seeing their physician in-person.
So with the support of a DOR Delivery Science grant, he designed a randomized trial that compared a structured telephone follow-up with nonphysician practitioners trained in heart failure to an in-person follow-up with their primary care physician. Telephone appointments included a structured protocol for medication titration, lab orders, and booking urgent clinic visits as needed, under physician supervision. The study compared the effect on 30-day readmission and death.
Among nearly 3,000 participants, Dr. Lee and his research team found no significant differences in 30-day heart-failure readmission, all-cause readmission, or all-cause death. In fact, 92% of patients who were randomized to telephone follow-up completed their 7-day visits, compared to 79% in those assigned to physician clinic follow-up. These findings show that remote care with trained non-physicians in an integrated healthcare system improves completion of follow-up and maintains effectiveness for preventing readmission and death, compared with in-person physician appointments.
“Dr. Lee’s success in designing and carrying out a pragmatic, rigorous, randomized trial that answers a fundamental, yet challenging question like how best to do follow-up care with heart failure patients is commendable,” says Betty Suh-Burgmann, MD, chair of the Central Research Committee. “Also commendable is the breadth of the study – the median age was 78 years old, and 41% were non-white, effectively demonstrating that it is indeed possible to recruit an inclusive, diverse population into research studies.”