Published by: Diane Gauthier on 2/1/2011 10:58:09 AM
As a nurse practitioner in the cardiomyopathy program at Boston Medical Center (BMC), I know firsthand that my patients have been dealt a serious blow to their health. Current treatment for cardiomyopathy, which literally means “weak heart muscle,” relies on a complex medical regimen that includes taking at least five pills several times a day, frequent visits to a medical professional and following a series of strict dietary and lifestyle recommendations.
For those patients who live within the downtown Boston neighborhood where BMC resides, following the recommendations of their healthcare providers presents various challenges, which include:
• access to public transportation to get to and from visits, including money for fares
• having enough money to afford generic medication co-pays
• proximity to a market that sells healthy (i.e. low salt) foods, not a “convenience store”
Patients who are diagnosed with cardiomyopathy and heart failure are prone, by the nature of the disease, to frequent readmissions. This takes a huge bite out of our healthcare budgets. The mandate from the Centers for Medicare & Medicaid Services (CMS) may result in hospitals not being eligible to receive payment for readmissions for heart failure that occur within 30 days of the initial event.
In order to be proactive and cut down on our cardiomyopathy readmission rates, we initiated a project aimed at educating our patients about diet, medications and lifestyle changes before they leave the hospital and continuing to help them once they return home. We have also started to incorporate very early outpatient visits to our clinic with either a doctor or nurse practitioner for necessary blood tests and follow-up of their medical status.
By underscoring the importance of adhering to their medication regimens and following the nutrition and activity guidelines that we have provided them, our patients are making a better transition from the hospital to their home.
Also important is that we are following up with them to ensure that they have access to the medication and care they need. Connecting with many of these patients is not easy. Some live in homeless shelters while others don’t have an answering machine or their phone line is disconnected.
However, we have discovered that the following are important methods of engaging our patients as they begin caring for themselves and managing a complex disease at home:
• face-to-face educational interaction, which begins in the hospital
• simple telephone follow-up calls within 48-hours of discharge
• early visits to our Cardiomyopathy Clinic within seven to ten days
While this project is still in its infancy, we have begun to see a reduction in our re-admission rates within our complex and challenged population.
By combining a commitment to uncompromising excellence with a commitment to caring for those most in need, BMC has become a national model of care, and caring, for all.
The Cardiomyopathy Program at BMC offers services to patients with cardiomyopathy and/or congestive heart failure of all etiologies, including idiopathic and ischemic cardiomyopathy, valvular heart disease and hypertension. For more information about the program, please visit http://www.bu.edu/myopathy/program/program.html.
Diane Gauthier, MS, ANP-BC
Boston Medical Center