Due to the Heart Success program, the 30-day readmission rate for heart failure patients at Carolinas Medical Center dropped from 19.7 percent to 13.9 percent. Patients can also be seen at Carolinas HealthCare System NorthEast, with plans to expand the program to other facilities in the future.
The Heart Success program, a Carolinas HealthCare System initiative, is a transitional care clinic to address the potential gap in care between the acute care (hospital setting) and the ambulatory care settings. The Heart Success team is a heart failure specialty trained, multi-disciplinary team including an advanced clinical practitioner, dietitian, pharmacist, social worker and RN working under the direction of board-certified heart failure specialists.
This team-based approach allows Sanger to:
Treat complex cases and identify better ways to manage high-risk patients
Engage patients and their families so they adhere to physician directions
Ensure that medications are maximized for optimal outcomes and patients understand their diagnosis and plan of care
Utilize virtual technology so advanced care is available to patients who live farther away
Build on patient and family education to better understand their diagnosis, self-management and ultimately improve quality of life
Carolinas HealthCare System's Sanger Heart & Vascular Institute recently piloted a virtual model of the Heart Success Program at a smaller regional facility, Carolinas HealthCare System Lincoln, located 55 miles outside of Charlotte. Once discharged, patients can connect with the Heart Success multi-disciplinary team at Carolinas HealthCare System Lincoln via telemedicine, using basic videoconferencing and a peripheral stethoscope. This model eliminates the need to travel to Charlotte for the same services. After introduction of this virtual model in 2013, the readmission rate at this facility dropped from 18.6 percent to 9.8 percent.*
The program also engages patients and their families, and provides psychological and social aid through a monthly support group. At these monthly meetings, patients can connect, share and work closely with Carolinas HealthCare System professionals to learn about stress management, nutrition, weight control and more.