In a recent study [i] from the Henry Ford Health System focusing on identifying predictors for early readmission in Medicare and Medicaid patients with heart failure, researchers found 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.” The possible implications are that early screening for depression, anxiety and other mood disorders among CHF patients can offer a means to identify risk of early readmissions and provide effective behavioral and educational interventions.
The Henry Ford study’s lead investigator, Mark W. Ketterer, Ph.D., indicated that “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.” While the study size was relatively small (84 patients who were admitted to Henry Ford Hospital for treatment of acute congestive heart failure) its results seem to reinforce earlier research from 2001 in the European Journal of Heart Failure that “depression is relatively common in this population, with a reported prevalence between 24 and >40% in patients with stable heart failure.”[ii]
The European study reported that:
“Our findings emphasise the importance of depression, along with clinically relevant prognostic indicators of severity of myocardial disease and comorbidity, as risk factors for mortality and hospital readmission in patients with dilated cardiomyopathy. The findings also support published data showing that psychosocial intervention deserve consideration as a potentially important component of prevention programmes…”
Dr. Mark Moore, Director of Psychological Services, Abramson Cancer Center at Pennsylvania Hospital, wrote that the Henry Ford study’s findings;
“(The findings) are intriguing and noteworthy, and it lends support to clinical observations that early readmissions in CHF patients are often related more to psychosocial factors than the presenting medical problem. Tellingly, the severity of CHF was not a factor in readmission, while memory problems, history of psychiatric treatment and use of an antidepressant were. If this finding can be replicated by others it would open up how we think about reducing readmissions and shift the focus onto a wider range of factors that are often ignored at great cost to the system.”
As health systems struggle to comply with Medicare’s readmission requirements, the use of psycho-social evaluations as part of a “high risk assessment” to identify patients with the greatest risk for readmission can be a cost-effective strategy. Considering that for 2013 Medicare has penalized 2,225 hospitals $227 million for “excessive readmission rates” and that these penalties will rise over time and include additional diagnoses, these results, while preliminary, should be viewed as an opportunity for the significant integration of a psycho-social ‘toolbox’ into discharge planning and post-acute care.
[i] Behavioral Factors and Hospital Admissions/Readmissions in Patients With CHF.Mark W. Ketterer, Cathy Draus, James McCord, Usamah Mossallam, Michael HudsonPsychosomatics – 09 September 2013 (10.1016/j.psym.2013.06.019)
[ii]Clinical Depression is Common and Significantly Associated with Reduced Survival in Patients with Non-Ischaemic Heart Failure.R. Farisa, H. Purcella, M.Y. Heneina and A.J.S. CoatsEuropean Journal of Heart Failure, Volume 4, Issue 4, Pp. 541-551