Data on number of, timing of, and reasons for hospital
readmissions, unscheduled acute care visits, and care
provided by visiting nurses or APNs and other healthcare
personnel were abstracted from patients’ records and bills
requested by the project manager via telephone calls and
letters to physicians, hospitals, and home care agencies. All
records from physicians’ offices and records from remote
hospitals and home care agencies were copied and mailed or
sent by facsimile to the research offices at the University of
Pennsylvania. RAs traveled to local hospitals and home care
agencies and copied records on-site. Two cardiologists
specializing in the treatment of heart failure blinded to
study group validated reasons for rehospitalizations and
categorized them as index related, comorbid (diagnoses
abstracted from medical record during index hospitalization),
or new health problem. Resource costs were
estimated using standardized Medicare reimbursements
for services used.22 The cost of the intervention,
including time devoted by APNs to the preparation of
patient education materials, was calculated by assessing
the intervention-related effort of APNs and multidisciplinary
team experts (from detailed logs) and applying
representative annual salaries for APNs and individual
team members plus benefits. Costs of pharmaceuticals,
over-the-counter drugs, other supplies, and indirect costs
were not collected.