A UCLA-led consortium of five University of California medical schools and Cedars-Sinai Medical Center has received a $9.9 million grant from HHS's Agency for Healthcare Research and Quality to investigate the use of wireless and telephone care management to reduce hospital readmissions for heart failure patients.

The project will be a three-armed, randomized controlled trial examining the effect of two interventions: managing the transition from inpatient to outpatient care via telephone, and managing the transition from inpatient to outpatient care via wireless remote monitors and telephone. These will be compared to the standard care for heart failure patients.

"Heart failure patients have high rates of hospital readmissions, and a critical window for preventing readmissions is as the patient transitions from the inpatient to outpatient setting," said Michael Ong, assistant professor of medicine at the David Geffen School of Medicine at UCLA and the grant's principal investigator. "This project compares two approaches designed to help patients make a smooth transition from inpatient to outpatient care. We will compare whether each approach reduces readmissions among heart failure patients at six different medical centers."

The three-year grant, "Variations in Care: Comparing Heart Failure Care Transition Intervention Effects," is funded under the AHRQ's Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE) program. It is part of $473 million in AHRQ grants and contracts that support projects to help people make healthcare decisions based on the best evidence of effectiveness. The funding, announced Sept. 30, covers all of the AHRQ's allocation and $173 million administered for the HHS Secretary by the AHRQ.

"This funding is critical if we're to learn how to reinvent healthcare in the United States," said Tom Rosenthal, chief medical officer for Ronald Reagan UCLA Medical Center.

"Our goal is to improve quality and reduce cost of care and, most importantly, to identify approaches that are applicable in every community, not only large academic centers."

Given that this research involves not just healthcare but technology, the project will take a "team science" approach, among the six institutions and within UCLA.

"This is a marvelous example of the leadership that UC can offer to all Americans as we collaborate with one another and significant partners like Cedars–Sinai to study interventions that most efficiently help patients navigate transitions from the hospital so that they can avoid preventable readmissions," said. John Stobo, UC senior vice president for health sciences and services. "UC is committed to developing innovations and a new paradigm of healthcare delivery that creates a culture of deliberate improvement."

This project builds on a study of variations in healthcare resource use and outcomes among heart failure patients from the five UCs and Cedars–Sinai that was led by Ong and published last year in the journal Circulation: Cardiovascular Quality and Outcomes. That study found that six-month mortality rates were lower for elderly Medicare heart failure patients hospitalized at centers that used more healthcare resources, compared with those at hospitals that used fewer resources. These findings suggested that more resource-intensive care may improve outcomes among certain patients with heart failure, the most frequent cause of hospitalization and death among Medicare beneficiaries.

"The new Variations in Care project seeks to improve those outcomes with innovations that require less intensive care resources," Ong said.