Heart failure (HF) is a major cause of death associated with extensive morbidity and impaired quality of life. The incidence and prevalence of HF has also increased dramatically in the past three decades (Whitaker-Brown et al., 2017). HF now affects approximately 5.7 million people in the United States and is the cause of more than 55,000 deaths annually (Whitaker-Brown et al., 2017). Consequently, readmission rates of HF patients are an area of great concern. The purpose of this benchmark project is to decrease HF readmission rates in adults who had a recent HF related hospitalization by providing comprehensive transitional care interventions. According to the Centers for Disease Control and Prevention (CDC), HF costs the nation an estimated $30.7 billion annually (CDC, 2020). In patients with HF, use of 30-day readmission rates as a healthcare metric and increased pressure to provide value-based care compel healthcare providers to improve efficiency and to use an integrated care approach (Albert et al., 2015). As a solution, transition of care programs are being used to achieve goals.

Date of publication

Winter 12-9-2020

Document Type

MSN Capstone Project



Persistent identifier



Masters in Nursing Administration