Date of Conferral

2020

Degree

Doctor of Nursing Practice (DNP)

School

Health Services

Advisor

Barbara A. Niedz

Abstract

Heart failure (HF) affects over 5.5 million adults in the United States with a prevalence of 10%'€“20% in older adults and accounts for 3% of all hospital admissions with a readmission rate as high as 25% within 1 month of discharge. Patients with HF account for approximately 42% of the doctor of nursing practice project site's patient population, and the health system has a 30-day readmission rate of 35% for patients with HF in 2 large hospitals. Thus, the health system loses almost $13 million per year in Medicare penalties. This retrospective quality improvement project reviewed the effectiveness of care for HF patients, as measured by quality-adjusted life years (QALY) in a home-based primary care (HBPC) practice over 3 years guided by a health economics framework, using cost-benefit (CBA) and cost-utility (CUA) analyses. Sources of evidence that were used to address the practice-focused question included patient frailty score, years since HF diagnosis, patient days of hospital admission and readmission, use of the emergency department (ED), and patient satisfaction results. The CBA of patients (N = 119) revealed a 46% decrease in inpatient days after enrollment in HBPC. Hospital admissions decreased by 49% and readmissions decreased 40%. The estimated overall total cost savings was 48% or $434,752 (N = 119, M = $35,897.85). ED encounters decreased 28% (N = 119, M = $557.97). An overall increase in QALY from start of care (N = 119, M = .96) to 2019 (N = 119, M = 3.23) demonstrated the effectiveness of HBPC on increasing quality of life (QOL) for home bound HF patients. By providing HBPC, elder patients can maintain their self-worth and dignity that is often lost in a long-term care facility and improve their QOL, in turn promoting positive social change.

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