Thomas Vasko

Date Approved

2013

Date Posted

1-23-2014

Degree Type

Open Access Senior Honors Thesis

Department or School

Nursing

First Advisor

Sherry Bumpus

Abstract

Purpose and Background

Heart disease is the leading cause of death in the U.S. and costs and estimated $6 to $26 billion annually largely due to hospitalizations. Bridging the Discharge Gap Effectively (BRIDGE) is an NP-driven transitional care program for cardiovascular patients. BRIDGE has demonstrated lower rates of readmission for patients with acute coronary syndrome who participated but not for atrial fibrillation (Afib) patients. We sought to assess differences between Afib patients who participated in the BRIDGE program and those who did not.

Conceptual Framework

The BRIDGE program is based on the Bumpus Integrated Client-Focused Transitional Care Model that posits that there exists a dynamic relationship between systems and clinicians that simultaneously influences individual behaviors and health outcomes.

Methods

This was a retrospective study of all patients referred to BRIDGE with a primary discharge diagnosis of Afib. Equal numbers of BRIDGE attendees were randomly matched to non-attendees. Uni-variate techniques were used to compare groups.

Results and interpretation of results

Of 148 Afib patients referred to BRIDGE, 84 (56.8%) attended BRIDGE, 36 (24.3%) saw cardiologists or primary care providers and 28 (18.9%) saw other providers or were unknown. There was no significant difference in median time to follow up. In total 17 (11.5%) patients were readmitted within 30 days. Non-attendees were more likely (71.4%) to be readmitted with afib/related diagnoses whereas attendees were less likely (40%). There was no significant differences in incidence of comorbid CAD, HTN, CHF or vascular disease between groups. However, of patients readmitted there was a trend toward BRIDGE attendees having more comorbidities.

Conclusion

This study helps us to better understand readmission patterns of Afib patients. While there was no difference in readmission rates between groups, patients who were readmitted from BRIDGE had more comorbid conditions and were often readmitted for non-Afib conditions while those readmitted by cardiologists had fewer comobidities but were more often readmitted with Afib/related issues. A larger sample is needed to better understand this dichotomy and to determine what measures can be taken to enhance the BRIDGE program for Afib patients.

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