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Catholic Healthcare Partners’ Closing the “GAP” for Heart Failure Don Casey MD, MPH, MBA, FACP* Chief Medical Officer and Principal Investigator Catholic Health Partners (Cincinnati, OH) June 28, 2006 *Currently Vice President, Quality & Chief Medical Officer Atlantic Health, Morristown, NJ
Components of Successful Healthcare Delivery Models for Heart Failure
Physician-directed care with assistance from nurse coordinators in patient management or nurse-managed care by experienced advanced practice cardiovascular nurses with access to a cardiologist for consultation
Intensive, comprehensive patient and family/caregiver education about heart failure with an emphasis on a low-salt diet, medications, symptoms that signal worsening heart failure, weighing, and management strategies for problems
Vigilant, frequent follow-up after hospital discharge
Optimization of medical therapy (ensuring patients are prescribed the appropriate drugs in appropriate doses) with published guidelines based on large-scale randomized, controlled clinical trials
Information systems that support effective point-of-care evidence-based clinical decision making (e.g. registries, patient records, laboratory information, prompts and reminders, self-management tools, etc.)
Components of Successful Healthcare Delivery Models for Heart Failure (Part II)
Increased access to healthcare professionals for problems by telephone or “walk-in” appointment
Early attention to signs and symptoms of fluid overload (ie, flexible diuretic regimen)
Supplementation of in-hospital education with outpatient education
Coordination with home health agencies where appropriate
Attention to behavioral strategies to increase compliance
Emphasis on addressing personal, financial, and social barriers to compliance
Assessment and assistance in management of social and financial concerns
Adaptable to communities without academic medical centers
Cost-effective and clinically relevant performance measurement systems
Many non-academic health systems do not have direct and ready access to nationally recognized clinical expertise for Heart Failure—such access can make a huge difference in quality improvement efforts
Appropriate organizational goals and incentives based upon standardized (ACC-AHA) quality measurements are powerful motivators for promoting and improving quality (Standardized “tools” are less important.)
Making the transition from focusing on acute hospital management to reducing hospital readmissions for HF is difficult and currently not profitable for most hospital systems; hospitals must now focus more on chronic care
Significant expertise in evidence-based HF care can be provided by well-trained “Heart Failure Advocates” without advanced-practice nursing training to improve quality of care and prevent readmissions for patients with chronic HF
Heart Failure Advocate: A Critical Link to Chronic Care Coordination Presented By: Barb Markward RN, BSN, CCRN Heart Failure Advocate St. Rita’s Medical Center, Lima, Ohio
CM-48 yr. old female, non-English speaking Hispanic with Hx of CHF, HTN, Diastolic Dysfunction with EF 45-50%. CM had 10 hospital admits from 1/04 to 6/04 R/T noncompliance issues. Daughters interpreted discharge instructions. Patient was referred to Medcare Clinic and CHF Clinic numerous times but never showed up for appointments.
• Referred patient to Medcare Clinic and attended apt with patient and caregiver.
• Intervened with physician and obtained referral to Home Health and the CHF Clinic.
• Visited home-no lasix, no scale. Educated Home Health RN, patient, and family and provided scale and pillbox.
• Integrated all services: CHF Clinic, Medcare Clinic, and Home Health.
• Patient and daughters reduced hospitalizations from 10 to 3 admissions 2 nd half 2004 R/T Renal Failure and 1 OBS stay in 2005.
• Patient was started on Hemodialysis 4/05 and moved to Columbus.
The National Heart Failure Training Program seeks to educate physicians and other healthcare professionals in best practices for treating heart failure by providing both didactic sessions and preceptorships through its network of heart failure centers across the country.