Post-Discharge Heart Failure Management through Mobile Integrated Health Services
By
Meghan Reading Turchioe
Melani Ellison
Leah Shafran Topaz
Christina McGinnis
Jacky Choi
Yihong Zhao
Stacey Dai
Parag Goyal
Rohit Mukherjee
Erik Blutinger
Roland C. Merchant
Brock Daniels
Ruth Masterson Creber
August 21, 2026
Clinical Scorecard: Post-Discharge Heart Failure Management through Mobile Integrated Health Services
At a Glance
Category Detail
Condition Heart Failure Management Key Mechanisms Mobile Integrated Health (MIH) delivery model providing patient-centered, nonemergency services in home or community settings. Target Population Patients discharged following hospitalization for heart failure. Care Setting Community and home-based health care delivery.
Key Highlights
MIH programs may reduce emergency department transports and 30-day hospital readmissions. High patient and clinician satisfaction reported with MIH services. Substantial variation exists among MIH programs in clinical protocols and follow-up. Evaluation of MIH effectiveness is guided by the RE-AIM framework. Qualitative analysis involved interviews with patients and health care professionals. Guideline-Based Recommendations
Diagnosis
Management
Monitoring & Follow-up
Risks
Patient & Prescribing Data
Adults with heart failure discharged from hospitalization.
MIH programs incorporate telemedicine and interdisciplinary teams.
Clinical Best Practices
Utilize interdisciplinary teams for MIH implementation. Incorporate telemedicine in post-discharge care. Standardize evaluation of MIH program effectiveness. Related Resources & Content
