Well now you see it...evidence is coming back that focusing on reducing hospital readmission rate for patients with heart failure has a terrible unintended consequence: an increased risk of death.
It's no surprise, really. After all, healthcare quality projects routinely have unintended consequences...unless we are very careful. Let's talk for a moment about how to decrease the chance that our quality project results in an unintended consequence that goes un-noticed and un-corrected.
Most Lean & Six Sigma projects I've facilitated include a data collection plan. Because of that important unintended consequence we now see from the focus on reducing heart failure readmissions, let me share some of the ways a good plan guards against issues like severe and persistent unintended consequences.
- A good data collection plan includes the name of each endpoint along with each of their operational definitions.
- A good plan includes whether the endpoint is a continuous or discrete endpoint.
- A good plan includes a sample size calculation. (Click here for how to do that.)
- A good plan includes secondary measures of unintended consequences.
Remember, as you build a data collection plan for your quality improvement project, take a minute to anticipate key issues that may arise when you're successful. What's the worst thing that could happen? Put it in your plan from the beginning and expect to track it as part of your new project.
Want to learn more about preparing a data collection plan and using it to avoid issues like the increased risk of death in the heart failure readmission situation? Look here.
Findings In this observational study of 115 245 fee-for-service Medicare beneficiaries hospitalized with heart failure at 416 sites across the United States, implementation of the Hospital Readmissions Reduction Program was associated with a subsequent decrease in 30-day and 1-year risk-adjusted readmissions and an increase in 30-day and 1-year risk-adjusted mortality. Meaning These findings support the possibility that the Hospital Readmissions Reduction Program has had the unintended consequence of increased mortality in patients hospitalized with heart failure.