Solara Medical Group 

 

It is estimated that 5.8% of the 300 million Americans suffer from heart failure.  The American Heart Association reports that in the U.S., congestive heart failure (CHF) is the leading cause of hospitalization in people over the age of 65.  After discharge from hospital, HF patients are at high risk for re-hospitalization or death with a three month rate of death and readmission close to 14 and 25% respectively.  The disease puts a significant financial burden on patients, their families.

In the United States the estimated annual cost of heart failure in 2010 is estimated to be 39 .2 billion or approximately 2% of the total US healthcare budget.  In hospital care is responsible for 60% of heart failure related costs.

A study published in the Journal of cardiology, in 2005 indicated that about one-third of patients still have signs and symptoms of congestion at discharge, which puts them at heightened risk for re-hospitalization.

The costs for optimal HF treatment would appear to be a reasonable use of health-care resource, with improved survival and well-being of a large patient population. Strategies to reduce costs should primarily focus on the reduction of hospitalization that represents the largest part of treatment costs and the identification of which patients are most likely to benefit from the range of interventions available.

Optimal management of patients with chronic HF typically requires regular and frequent visits to carefully monitor the patients clinical status, improve patient education, and enhance the use of evidence-based therapies

Surveillance by monitoring of blood pressure, heart rate, ECG, body weight, symptom response, patient compliance, and other parameters are increasingly used for the management of HF patients

Increases in body weight is associated with hospitalization for heart failure and begins at least one week before admission. Daily information about patients’ body weight identifies a high-risk period during which interventions can be implemented to avert decompensated heart failure

Extensive evidence demonstrates that medications can be used to effectively treat and manage CHF by slowing disease progression, allaying symptoms, and reducing use of medical services such as hospitalizations.

The complexity of interventions that these patients may require and the high mortality and rehospitalization rates suggest that cardiologist and advanced practice nurses with expertise in cardiovascular and complex long-term care can supervise or deliver interventions.

Acute care hospitals have been the focus of many systematic investigations to improve HF outcomes, but much less is known about SNFs. Reducing mortality and rehospitalization and improving quality of life for patients with HF discharged to SNFs may require engaging SNF employees as partners in care.

Improving the effectiveness of care for residents with a chronic disease requires changing our approach and accompanying systems. Instead of reacting and intervening when a resident becomes ill, Solara health care practitioners proactively focus on keeping residents as healthy as possible and preventing unnecessary hospital and emergency room admissions. Chronic disease management requires knowledge and implementation of disease-specific, evidence-based practices for care and monitoring that actively involve residents and their families in care decisions as well as integration and coordination among all of the resident’s care providers.

Effective management and monitoring of a chronic disease, and preventing hospitalization are vital steps in ensuring that care is resident-centered and effective. Preventing unnecessary hospitalizations for patients in skilled nursing facilities (SNFs) is also a focus of health care reform legislation. MedPac data indicates that in 2009, hospitalized patients discharged to a SNF had higher percentages of hospital readmissions than discharges to other post-acute care settings.   Solara can help in decreasing this by providing ongoing, closely monitored care, of high risk patients. 

​In addition to CHF, patients with other cardiac illness are also seen and managed.