Abstract 11098: Risk Score-Guided Team-Based Care for Heart Failure Inpatients is Associated With Lower 30-Day Readmission and 30-Day Mortality.

Introduction: Improved heart failure (HF) outcomes are needed due to patient health, utilization, and government penalty considerations. Previously we created clinical decision tools (CDT) and a CDT-guided multidisciplinary team care pathway (MTCP) for HF inpatients. Objective: This study evaluated outcomes of stepped wedge MTCP implementation in HF inpatient care across Intermountain Healthcare. Methods: HF inpatients (N=6,182) were studied at 19 Intermountain hospitals from January 2013 to November 2016. Starting February 2014, the MTCP intervention was implemented sequentially over 2.5 years in the 8 largest hospitals (accounting for 89% of HF inpatients). Where MTCP was implemented, CDT mortality and readmission risk scores were delivered electronically to clinicians within 24 hours of admission and repeated daily. MTCP was used for CDT "high risk" inpatients (n=1,221); lower risk patients received standard HF care (n=1,220). Controls were categorized retrospectively as high risk (n=1,791) and lower risk (n=1,950) at admission. Results: Patient age averaged 71.1±14.7 years; 45.5% were female. In CDT high-risk patients, the MTCP intervention was associated with 25% lower 30-day readmission (HR=0.75, CI=0.63, 0.88, p<0.001) and 48% lower 30-day mortality (HR=0.52, CI=0.37, 0.72, p<0.001). Cox regression adjustment for demographics, comorbidities, and medications retained both findings (readmission: HR=0.82, CI=0.69, 0.97, p=0.023; mortality: HR=0.54, CI=0.39, 0.76, p<0.001). CDT lower-risk patients in MTCP-implemented hospitals had no significant 30-day changes (readmission: adjusted HR=0.89, p=0.21; mortality: adjusted HR=0.86, p=0.51). LOS was not lower for MTCP recipients (4.5 days vs. controls: 4.6 days, p=0.65) or lower risk (3.8 days vs. controls: 3.9 days, p=0.35). Total variable cost (index stay & any 30-day readmission) was not different for MTCP (median $6,960 vs. controls: $6,741, p=0.08), but was higher in lower risk (median $6,258 vs. controls: $5,933, p=0.034). Conclusions: A CDT-guided precision medicine MTCP for high-risk HF patients was associated with lower 30-day readmission and mortality. Costs increased in lower risk patients where inpatient care was minimized but not higher-risk MTCP recipients. [ABSTRACT FROM AUTHOR]