Readmission after Heart Failure Hospitalization: An Environmental Scan of Alberta Initiatives and Outcomes

This environmental scan aims to identify and describe initiatives implemented in Alberta, one of the few Canadian provinces with a unified health delivery system, to reduce heart failure (HF) readmissions. It also acknowledges the challenges in attributing direct benefits to these interventions. Using snowball sampling, we identified and recruited 11 employees and clinicians from Alberta Health Services (AHS) who possessed significant historical institutional knowledge about HF. Academic and grey literature were reviewed related to Albertas readmission reduction initiatives and reported outcomes. Unstructured, in-depth interviews were conducted to clarify timelines and provide detailed descriptions of these interventions. Our findings indicate substantial clinician efforts over 15 years to address all-cause readmissions post HF hospitalization in Alberta, encompassing a range of interventions from small-scale projects to large multi-city, multi-stakeholder initiatives. Assessing the impact of smaller interventions on provincial readmission rates proved challenging; however, five major initiatives collectively led to a 1.8% reduction in 30-day all-cause readmissions province-wide (from 22.2% to 20.4$, p=0.04). Key factors that appeared to support these efforts included utilization of the EMR system, stakeholder engagement in standardized care, effective communication practices, and appropriate resource allocation. Clinical teams are now integrating successful components from these initiatives into the province-wide clinical information system, Connect Care, to enhance care coordination and patient outcomes. This environmental scan highlights various comprehensive initiatives in Alberta aimed at improving patient care and reducing readmission after HF hospitalization. While an overall 1.8% reduction in readmission rates was observed over the 15 years, attributing this change directly to the interventions is challenging due to various implementation barriers and the complexity of healthcare delivery. Continued efforts towards personalized care and innovative EMR utilization hold promise for further improvement in HF readmission rates.