Transcript G) Adler - Heart Failure Progam

Hudson Valley Hospital Center
Heart Failure Project
A collaborative approach to
improving heart failure care
4/1/2016
Hospital to Home (H2H)
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A national quality improvement initiative
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Sponsored by the American College of Cardiology (ACC)
and the Institute of Healthcare Improvement (IHI)
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Purpose: to reduce cardiovascular-related hospital
readmissions & improve transitional care from hospital to
home
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Strategic partnerships are encouraged as a vehicle for
improving care and outcomes
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HVHC Heart Failure Task Force
Purpose: To improve
the care delivered to
heart failure patients
across the continuum
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Members of the HVHC HF Task Force
Myrna Cuevas RN, Esq
 William Higgins MD
 Maggie Adler RN-C
 Jennifer Fell RD
 Ann Marie Beall DPh
 Visiting Nurse Association of Hudson
Valley
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ACE Star Model
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ACE Star Model & EBP Process
PICO Question:
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What interventions for heart failure
patients help decrease their
rehospitalization and mortality rates?
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Knowledge Discovery & Evidence Summary
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Facts on Heart Failure
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50% readmission rate
within 6 months
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25% to 35%
incidence rate of
death at 12 months
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Facts on Heart failure
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The mortality rate for
women with breast
cancer is 1 in every
29 deaths, the
mortality rate for
women with
cardiovascular disease
is 1 in every 2.4
deaths
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Trends in Hospitalization for Heart
Failure by Age Group 1979-2004
(CDC, 2006)
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CMS Quality Measures:
Heart Failure (HF)
100% compliance with the following evidenced-based
guidelines:
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Discharge instructions
 diet
 MD f/u
 weight monitoring
 worsening s/s
 Medications with reconciliation
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Left ventricle systolic function evaluation
ACEI/ARB for LVSD
Smoking cessation counseling
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Heart Failure at HVHC
Heart failure is the second highest DRG
 Average costs per patient per day $2,000
 Average LOS is 6 days
 30 day readmission rate is 24.2%,
national rate is 24.5% (HHS, 2008)
 Mortality rate is 9.7%, nationally it is
11.1% (HHS, 2008)
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Translation into practice
Clinical Expertise to translate
your findings into practice
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How can we improve practice?
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Standardize treatment plans for heart failure
Standardize patient education for heart failure
Case Management referral for heart failure
patients to Telehealth program at VNA
Collaborate with the Visiting Nurse Association of
Hudson Valley (VNA)
Collaborate with community based physicians
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Integration
Integrating your findings into
practice
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Standardize Treatment
Evidenced-based
Recommendations
promote
a reduction in
rehospitalization and
mortality for patients
with heart failure
(IHI, AHRQ, ACC)
Physician Order Set
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LVSF assessment
ACEI or ARBs
Beta Blockers
Anticoagulants for atrial fibrillation
Diuretics
Lab assessment
Influenza & Pneumoccocal
vaccination
Diet and fluid restriction
Daily weights
Exercise/activity tolerance
Smoking cessation counseling
Patient education
Case management & Nutrition
referral
(ACCF/AHA, 2009; AHRQ, 2009)
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Considerations in Treatment of
Special Populations
Elderly patient's have an altered ability to
metabolize or tolerate medication therapy
 Isosorbide dinitrate and hydralazine is
recommended for African-Americans in addition
to standard heart failure treatment
 50% of Asian patients develop a ACEI induced
cough
 Majority of patient’s with heart failure are
women
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Standardize Patient Education
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Provide education literature from the AHA
Document education completed in EHR
Revise Discharge Instruction sheet to include HF
care instructions
HF education reinforced by VNA nurses
Future:
In CPOE create notification link from physician
order for HF education to nurses task list
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Heart Failure (HF) Screening Flow Chart
No Health Care
Services Provided
Present to ED
N
HF
symptoms w/i 1 year
and/or
present HF symptoms
and/or
R/A 31 days
with previous
HF diagnosis
N
Admit as Inpatient
Y
Case management
evaluates
patient/
Family/caregiver’s goals
Collaborates discharge
plan with patient and
health care team
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Case
Manager
assesses patient for
homecare or
skilled nursing need.
Y
Homecare or
skilled nursing
referral made
Telehealth Program
Screening for eligibility will be performed by the
VNA while the patient is hospitalized
 Remote home monitoring will include vital signs,
oxygen level assessment, and weight
 Patient education provided by VNA nurses will
reinforce education provided by HVHC nurses
 Telehealth visits are in addition to regular home
nursing visits
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Accomplishments & Outcomes of the
Heart Failure Project
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Interdisciplinary approach
Physician Order Set
Patient Education
Comprehensive discharge
instructions
Telehealth program
Collaboration across the
continuum of care
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Increase in patient selfmanagement skills
Increase in patient
satisfaction
Decrease variation in
care delivered
Decrease LOS from 6 to
4 days
Decrease 30 day
readmissions to 16%
Decrease mortality by
10%
Evaluation
HF Readmission & Mortality
rates
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Heart Failure Readmissions
Heart Failure Task Force Update:
 Total 27 HVHC patients referred to
Visiting Nurse Association Hudson
Valley in 10 months (9/09 – 06/10)
–Readmission rate: 11%
–HVHC Goal: 16%
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Future Opportunities for
Collaboration
15.89%
16.00%
13.25%
14.00%
10.62%
12.00%
9.67%
10.00%
8.08%
8.00%
6.00%
4.00%
2.00%
0.00%
RoutineHome/Self Care
To SNF
To Home Care
Service
Total for Three
Areas
Readmission Rate
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Total for All
Readmissions
Pinnacle Group:
- HVHC
- SSMC
- MVH
Improving Care at HVHC
At HVHC we are
dedicated to caring
for our patients
across the
continuum…….
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References

Academic Center for Evidenced-based Practice. (2004). ACE: Learn about EBP: ACE
Star Model of EPB: Knowledge Transformation. The University of Texas Health
Science Center at San Antonio. Retrieved July 8, 2009, from
http://www.acestar.uthscsa.edu
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Centers for Disease Control and Prevention. (2006). Heart Failure Fact Sheet.
Retrieved August 16, 2009, from the CDC on the World Wide Web:
http://www.cdc.gov/DHDSP/library/pdfs/fs_heart_failure.pdf
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Hunt, S.A., Abraham, W. T., Chin, M. H., Feldman, A. M., Francis, G. S., Ganiats, T.
G. et al. (2005). ACC/AHA 2005 guideline update for the diagnosis and
management of chronic heart failure in the adult: A report of the American
College of Cardiology/American heart Association Task Force on Practice
Guidelines. Retrieved August 10, 2009, from Circulation on the Wide World Web:
http://circ.ahajournals.org/cgi/reprint/112/12/1825?maxtoshow=&HITS=10&hits=10
&RESULTFORMAT=&fulltext=ACC%2FAHA+2005+Guideline+Update&searchid=1&FI
RSTINDEX=0&resourcetype=HWCIT
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Institute for Healthcare Improvement (2008). 5 Million Lives. Getting started kit:
Improved care for the patients with congestive heart failure. Retrieved July
19, 2009, from IHI on the World Wide Web: http://www.ihi.org
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References
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Jessup, M., Abraham, W. T., Casey, D. E., Feldman, A. M., Francis, G. S., Ganiats, T. G. et al.
(2009). 2009 Focused Update: ACCF/AHA guidelines for the diagnosis and
management of heart failure in adults: a report of the American College of Cardiology
foundation/American Heart Association Task Force on Practice Guidelines. Retrieved
August 10, 2009, from Circulation on the Wide World Web:
http://circ.ahajournals.org/cgi/reprint/119/14/1977?maxtoshow=&HITS=10&hits=10&RESULTFO
RMAT=&fulltext=2009+Focused+Update&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
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National Guideline Clearinghouse. (2007). Heart Failure in Adults. Retrieved July 20, 2009,
from NGC on the World Wide Web:
http://www.guideline.gov/summary/summary.aspx?doc_id=11531&nbr=005972&string=heart+A
ND+Failure
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Schroetter, S. A., & Peck, S. D. (2008, April). Women’s risk of heart disease: Promoting
awareness and prevention-a primary care approach. MEDSURG Nursing, 17(2), 107-113.
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U. S. Department of Health and Human Services. (2009). Hospital Compare-A quality tool
provided by Medicare. Retrieved July 19, 2009, from HHS on the World Wide Web:
http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp?version=default&browser=IE
%7C8%7CWinXP&language=English&defaultstatus=0&pagelist=Home
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