UAB’s clinic that helps keep heart failure patients out of the hospital

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The University of Alabama at Birmingham’s Heart Failure Transitional Care Services for Adults Clinic is keeping heart failure patients out of the hospital.

The clinic uses a transitional care model to see referred patients in the hospital, clinic and at home. Its team includes nurse practitioners, clinical nurse leaders, social workers, registered nurses, pharmacists, behavioral health counselors and a collaborating physician. Its goals are to coordinate care, improve quality of life and reduce 30-day readmissions. 

So far, it’s served more than 1,950 patients since 2014 and continues to serve between 25 and 35 patients a month. The clinic’s patients are among the hardest to keep out of the hospital. Eighty-seven percent are uninsured or underinsured, 79% are unemployed, 40% have no income and 29% live on less than $10,000 a year. More than 58% face food insecurity and have trouble getting life-sustaining medications.

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