Improving Heart Failure Care: Integrating Lessons Learned from Patient & Provider Perspectives. Kismet Rasmusson, DNP, FNP-BC, FAHA, CHFN Intermountain Healthcare Presented at the 11th Annual HSR/ PCOR Conference: Partnering for Better Health: Bringing Utah's Patient Voices to Research 2016

1. Improving Heart Failure Care:
Integrating Lessons Learned
From Patient & Provider
Perspectives
Kismet Rasmusson, DNP, FNP-BC, FAHA, CHFN

2. I will not discuss off label use or investigation use in my
presentation
I have no financial relationships to disclose
Improving Heart Failure Care: Integrating Lessons
Learned From Patient & Provider Perspectives

3. Background/Purpose
• Heart failure (HF) is a chronic condition that requires high levels of
both patient and provider engagement in their care.
• Healthcare reform includes a shift to engage patients to improve
care, outcomes and the patient experience.
• Hospital systems often develop processes of care without direct
patient input.
• Thus the purpose of this work is to demonstrate how Heart Failure
(HF) care can be transformed through integrating patient/caregiver
and provider perspectives.

4. Research Design
• Qualitative research
• Conducted focus groups (FG) and telephone interviews (TI)
• Patients with a primary diagnosis of HF and their caregivers and
• FG with providers who care for patients with HF
• Results were categorized in themes

5. Study Population/Sample
• Patients with a HF-related hospitalization across
Intermountain’s hospitals within the prior year were invited to
participate in 2 separate Focus Groups or Telephone Interviews.
• Internists with Intermountain’s Medical Group in the Salt Lake
Valley and cardiovascular hospitalists at Intermountain Medical
Center were invited to participate in 2 separate provider Focus
Groups.

6. Results
• 78 participated
• 51 completed the PI (average age 63.2 years, 51% female)
• 27 (including 11 caregivers) attended the FGs (average age
52.8 years, 31% female)
• The majority of patients had outpatient management by
cardiologists (70%), the minority were in a HF clinic (22%)
Patients

7. Results
• 75% of patients received the Patient Education folder and who reviewed contents
with provider/nurse felt more prepared to manage their care at home.
• 71% of respondents expressed being very confident that they could manage their
care when leaving the hospital, however, almost all experienced challenges once
at home, particularly with diet, activity-level, and feelings of stress about their
diagnosis.
• 47 % of respondents reported that they were very consistent in following their
discharge instructions, yet many reported feeling overwhelmed and wish they
had been told more candidly by their provider about symptoms and self-care
management.
• 84% of respondents received some type of follow-up after their hospitalization,
with in-office visits that took place within two weeks of discharge being the most
helpful to patients
Patients

8. Results
75
71
47
84
0
10
20
30
40
50
60
70
80
90
Received Ed Material Confident in following plan Consistency with following
d/c instructions
Had hospital f/u appt
Focus Group & Phone Calls
Series 1
Patients

9. Learning from HF Patients
Learning from Heart Failure Patients to Improve Patient Centered Care
Recommendations Focus Group (n=27) Phone Interview Group (n=51)
D/C Instructions • Include caregivers
• Start education earlier
• Personalize instruction
• Create support group
• Honestly discuss disease & severity
• RN to provided detailed instruction from Ed packet
• Watch DVD
• Provide instruction/tips to manage congestion
• Allow time to practice tracking weights: prep for d/c
• Time to recover from the “shock”, prior to education
Dietary
Recommendations
• Provide simple/ detailed meal plans
• Consider comorbid conditions to
personalize meal planning
• Enhance diet, meal planning and sodium restriction
instructions
Medication
Management
• Provide new med list
• Provide pill box, mobile App
• Coordinate with pharmacy for
partial refills
• Provide guidance on medications, costs, refills,
potential interactions
Coordination of
Care
• Provide close f/u in month after d/c
• Personalize home care instructions
• Improve care coordination with PCP
• Enhance communication from hospital to PCP
• Provide consistent communication: d/c & diet plan
• Suggest ways to manage stress
• Suggest ways to be their own advocate, negotiate
health care system

10. Results
• 12 physicians participated in 2 separate FGs
• 6 cardiovascular hospitalists and 6 internists
• Providers
• were busy
• had limited time for education (relied on others)
• wanted easy tools to guide discussions
Providers

11. Results:

12. Implications
• The patient/caregiver perspective provides valuable insights not commonly
considered in process improvement.
• HF patients want early and personalized education, consistency and
coordination amongst providers, and assistance with medications and
home care.
• Providers are often too busy to offer complete education to patients,
relying on other team members. They want simple tips to offer patients
and a guide for their discussions.
• By utilizing patient-and provider -identified themes for improvement and
recommendations, the patient experience can be enhanced and care
processes more effective and outcomes may be improved.

13. Fulfilling Intermountain’s Mission
Help people live the healthiest lives possible
• Patient and Family Advisory
Council (PFAC)
• Patient pool from
Intermountain’s heart failure
research Plans
• Ongoing patient & provider
tools

14. • Coupling patients’ and providers’ perspectives in process
improvement activities is essential
• Patients need meaningful assistance in living with heart failure
• Busy providers need useful tools
Conclusion

15. KISMET RASMUSSON- Intermountain Heart Institute, Salt Lake City
KATY JO STEVENS- Intermountain Healthcare, Salt Lake City
SEAN MEEGHAN- Intermountain Healthcare, Salt Lake City
STEPHANIE CROASDELL- Intermountain Healthcare, Salt Lake City
DEBORAH BUDGE- Intermountain Heart Institute, Salt Lake City
COLLEEN ROBERTS-Intermountain Healthcare, Salt Lake City
DONALD L. LAPPÉ - Intermountain Heart Institute, Salt Lake City
Authors & Collaborators:

16. Thank you!