There are multiple reasons why a heart failure patient may require readmission shortly after their initial heart failure hospitalization. This document helps your team to identify potential gaps in transitional care that contribute to potentially preventable readmissions. 

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This new form was designed to help make early follow up on recently discharged heart failure patients easier.  Studies have proven that early follow up with patients significantly reduces readmission rates and improves overall quality of life for the patient.  This quality improvement tool makes it simple to perform a comprehensive follow up that is comprehensive enough to use on its own or flexible enough to incorporate any addition or deletion of questions as deemed appropriate by the provider.

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This document is intended to provide a brief rationale as to each of the measures that are measured under Target: Heart Failure for each of the three key categories: (1) Medication Optimization, (2) Early Follow-up Care Coordination, and (3) Enhanced Patient Education. To qualify for the Target: Heart Failure Honor Roll, hospitals must demonstrate 50% or greater compliance on the following measures within those key areas for at least one calendar quarter.

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