Value of a post-discharge multidisciplinary heart failure clinic with pharmacist and nurse practitioner collaboration
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Background: Studies have shown that pharmacists can play a valuable role in decreasing 30-day heart failure readmission rates while improving hospital and post-discharge care effectively. However, existing literature does not address the cost-benefit of a pharmacist based heart failure clinic with or without a nurse practitioner. Since health care resources are limited and cost containment, along with quality, is of primary concern, administrators who make resource allocation decisions must base them on cost-benefit analysis. Methods: The study is a retrospective cohort study with a time series analysis of patients with a primary diagnosis of heart failure between January 2010 and December 2012. Data on 30-day all-cause heart failure readmissions (all-cause readmissions after a prior admission with a primary diagnosis of heart failure) were collected from an existing heart failure clinic at Memorial Hermann Texas Medical Center (MHTMC) and compared to all heart failure patients discharged from hospitals within the Memorial Hermann Health System. The difference in 30-day heart failure all cause readmissions analysis was used to build a cost-benefit model for justification of heart failure clinic services at a community hospital. Results: The study included 192 visits for the clinic cohort with 26 all-cause heart failure readmissions (13.5%) and the Memorial Hermann Health System cohort including 10,028 admissions with 1625 readmissions (16.2%). The non-statistically significant absolute difference in all-cause readmissions was 2.66%. The relative risk reduction of 16.41% formed the basis of the cost-benefits analysis. The cost benefit analysis for the pharmacist and nurse practitioner clinic showed a revenue/cost ratio of 1.7. Conclusion: Our study results showed a significant trend towards decreased 30-day all-cause readmissions rate with pharmacist and nurse practitioner run post-discharge heart failure clinic intervention. The clinic services will be cost-effective to health care organizations and are applicable to both community as well as academic institutions.