Abstract
Problem: Heart failure is an increasingly common and costly disease affecting nearly 5 million American adults. A significant percentage of these individuals are hospitalized, treated, and discharged to the community, skilled nursing facilities (SNF), or other living arrangements, with a lack of coordination of interim care between the provider, clinic, and patient. Subsequently, many heart failure patients are readmitted to acute care hospitals within 30 days, related to symptoms of instability due to poor follow up and management of their disease.|Purpose: The purpose of this study is to explore the processes of care and interventions and determine if there is a benefit of post acute services delivered by a Nurse Practitioner, on a weekly basis at a SNF in rural SW Iowa in a heart failure population.|Subjects: Individuals age 19 and older, with heart failure as their primary diagnosis, who reside in a skilled nursing facility/nursing home in rural SW Iowa.|Methods: Data collection was conducted initially by the medical records department who generated a list of ICD-9 codes for all patients (n=176) for the calendar years 2012 and 2013. The researcher perused the list for the ICD-9 code of 428.00, heart failure as the primary diagnosis. Medical records were asked to retrieve the paper charts for n=7 patients. The researcher then performed a retrospective chart review collecting the variables of: age, gender, ethnicity, number of hospitalizations, number of 30 day hospital readmissions, number of NP or provider visits, BNP labs ordered, electrolyte labs ordered, blood pressure measurements and frequency obtained, weights and frequency obtained, diet, ADL ability, reports of dyspnea and/or fatigue, adventitious lung sounds, medications used, and co-morbidities. Data from Pre-NP 2012 rounds was then compared to Post-NP 2013 rounds.