Heart
patients’ mental state and thinking abilities may help predict whether
costly and potentially dangerous early hospital readmission will follow
their release after treatment, according to the results of a significant
new study by Henry Ford Hospital researchers.
The findings have important implications
for the health care industry as it struggles to contain unnecessary
costs, according to the study’s lead author, Mark W. Ketterer, Ph.D., a
psychologist and administrator for Henry Ford.
The study is published online in Psychosomatics.
“Wasted resources have become a central concern in American health
care, including readmission soon after a patient has been released from
hospital care,” Dr. Ketterer says.
“Because heart failure has one of the
highest readmission rates of all conditions that have been studied in
Medicare and Medicaid populations, we decided to focus on it and try to
identify predictors for early readmission.”
What was found, Ketterer explains, was
that a psychiatric history of depression, anxiety and other mood
disorders, as well as impairments in a patient’s ability to think,
remember and reason, may well be such predictors.
“Given both the exorbitant fiscal costs
and known health risks of hospitalization, including exposure to
drug-resistant infections and medical errors, it could be well worth
further study to test our findings.” he adds.
Currently, Medicare is penalising
hospitals for what it considers excessive readmission rates. Last month,
Medicare said it will access $227 million in fines against hospitals in
49 states as part of an initiative to reduce the number of patients
readmitted within a month. Medicare said that 2,225 hospitals will see
payments reduced for a year. Henry Ford Hospital is one of hospitals
that will see a reduction in payments starting from October 1.
In the study, the researchers chose 84
patients who were admitted to Henry Ford Hospital for treatment of acute
congestive heart failure. Each was interviewed for basic clinical and
demographic information and asked to complete several questionnaires
measuring depression, anxiety and spirituality.
Their medical risk factors — including
other illnesses and their severity — and behavioral risk factors —
including depression and such cognitive impairments as loss of
reasoning, planning, forgetfulness and other reduced mental functions —
as well as admissions during the past year and readmissions during the
previous 30 days were recorded.
The patient group was 62 per cent male
with an average age of 66. Central nervous system disorders — including
Alzheimer’s, dementia, closed-head injury and others — were present in
21 per cent. Nearly 70 per cent lived with a family member, 24 per cent
acknowledged a psychiatric history, 36 percent used or had used
antidepressants, 40 percent had coronary artery disease, 43 per cent had
diabetes, 86 per cent had hypertension, 20 per cent had chronic
obstructive pulmonary disease, 48 per cent had chronic kidney disease
and 24 per cent were alcohol or drug abusers.
The researchers found that depression, a
history of substance abuse, and a history of coronary artery disease
were related to hospital admissions during the previous year. Factors in
30-day readmission rates included immediate memory problems and a
history of psychiatric treatment and/or the use of an antidepressant.
The severity of congestive heart failure, however, was not a factor in
either admission or readmission rates.
“Our results agree with several recent
studies in finding an adverse impact of depression on admission and
readmission rates,” Ketterer says. “In addition, substance abuse and
chronic kidney disease may also adversely impact these rates in
congestive heart failure patients.
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