The History and Future of the SDA: Sustaining and Expanding the Role of an Open Access Clinic
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The document discusses the history and future of the Duke Heart Failure Same Day Access (SDA) Clinic. It began in 1998 as a Heart Failure Disease Management program and transitioned in 2012 to the SDA Clinic in response to penalties for hospital readmissions. The SDA Clinic provides an alternative to the emergency room for HF patients, using tools like IV diuretics and frequent monitoring to safely treat patients and avoid unnecessary hospital stays. Going forward, the document discusses expanding SDA services using remote monitoring, wearables, telehealth, hospital-at-home programs, and HF titration clinics to better serve patients wherever they receive care.
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The History and Future of the SDA: Sustaining and Expanding the Role of an Open Access Clinic
- 1. The History and Future of the SDA: Sustaining and Expanding the Role of an Open Access clinic Midge Bowers DNP, FNP-BC,AACC, FAANP, FAAN Nurse Practitioner Duke HF Same Day Access clinic Associate Professor Duke University School of Nursing
- 2. Objectives • Discuss the history of the Heart Failure Disease management program as a foundation for the Same Day Access Clinic • Describe opportunities for innovative HF delivery models/practices
- 3. Timeline 1998 Heart failure Disease management program launched 2012 Same Day Access Clinic 2017 HF consults in LTC and rehabilitation
- 5. Heart Failure Disease Management Who were the patients? Whellan et al, 2001
- 6. Heart Failure Disease Management Whellan et al, 2001 What were the priorities?
- 7. Transition from Disease Management to Acute Treatment • 2012- CMS announced financial penalties for facilities with readmissions for HF, within a 30-day timeframe. • Same Day Access Clinic established – Alternative to the emergency room to avoid unnecessary hospital stays. – Patients are taught self-management and given tools to promote successful transitions from hospital to home. – Clinicians provide follow-up care consisting of phone calls 24-48 hours post-discharge and frequent office visits until the patient is stable.
- 9. Key Components of SDA clinic • Clinical focus • Utilization of IV diuretics bolus • Monitoring and Titration of evidenced base therapies • Treating and evaluating acute and chronic medical illnesses • Address Social Drivers of Health • Coordination of care • Transportation, housing, financial and medication insecurity
- 10. SDA Stable patient Patient decompensates Lack of availability with primary cardiologist Appointment with SDA provider scheduled IV Lasix and electrolyte supplementation Returns to SDA as scheduled in 3 days Primary cardiologist notified Medication regimen adjusted Return care to primary provider
- 11. Adapted from the 2013 ACCF/AHA Guideline for the Management of Heart Failure Duke Heart Center
- 12. Greene, SJ, et al, Journal of Cardiac Failure 27(1) 2021.
- 13. Now and in the Future • Remote monitoring • Wearables • Telehealth • Hospital at home • Titration clinic
- 14. Remote monitoring • Invasive – CardioMEMS™ • Non-invasive – Talking scales, BP monitor, pulsox
- 15. Wearables • Apple Watch ECG Key is seamless integration with electronic health record and parameters for notification
- 16. Teleheath • Opportunity to include skilled nursing and rehabilitation facilities • Beyond the video visit- off site personnel using tools for clinician to complete exam virtually Thinklabs Digital Stethoscope
- 17. Hospital at home • November 2020, CMS launched the Acute Hospital Care At Home program to provide hospitals expanded flexibility to care for patients in their homes. • Mount Sinai launched its program in 2014 after receiving a $9.6 million grant from the CMS Innovation Center. – Hospitalization at Home program had an 8.6 percent 30-day readmission rate, compared to 16.1 percent for similar hospitalized patients, according to a case study from the American Hospital Association. – Patients who received home-based care also had fewer ED visits (5.8 percent versus 11.9 percent) and reported a better patient experience (67.8 percent versus 45.6 percent). Duke Raleigh Hospital (NC) - January 13, 2021
- 18. HF Titration Clinic • 12 week program • Virtual and face to face visits • RN medication titration by protocol every 2 weeks • 4 billable provider visits • Disease management teaching with RN phone calls.
- 19. Summary Rethink how we deliver HF care Meet the patient/family where they are Margaret.bowers@duke.edu
Editor's Notes
- Patient and family education
- Hospital at Home model dates to 1995 and is the brainchild of John Burton, MD, former director of geriatric medicine and gerontology at Johns Hopkins School of Medicine in Baltimore. New York City-based Mount Sinai Health System and Albuquerque, N.M.-based Presbyterian Healthcare Services were both early adopters of Johns Hopkins' Hospital at Home model.