Quality Improvement and Performance Monitoring Strategies

1. Partnering with other hospitals in the local area to reduce readmissions*

2. Tracking the percent of patients who were discharged with a follow-up appointment already scheduled for within 7 days

3. Tracking the proportion of patients readmitted to another hospital

4. Estimating risk of readmission in a formal way and using it to guide clinical care during hospitalization

Medication Management Strategies

5. Having electronic medical record or web-based forms in place to facilitate medication reconciliation

6. Using teach-back techniques for patient and family education

Discharge and Follow-up Strategies

7. At discharge, providing patients with heart failure (or their caregivers) written action plans for managing changes in condition*

8. Regularly calling patients after discharge to follow up on post-discharge needs or to provide additional education

9. Discharging patients with an outpatient follow-up appointment already scheduled*

*Use of these strategies has been associated with lower RSRR in prior cross-sectional studies¹⁹