Appendix B: Summaries
of PFQ Grantee Activities (continued)
PFQ Grant Summary: CalNOC Partners for Quality TRIP to Reduce Patient Falls Project
Lead Organization: Association of California Nurse Leaders and California Nursing
Outcomes Coalition (CalNOC)
Partner Team: UCSF, Cedars-Sinai Research Institute, American Nurses
Association\California, California State University at Fullerton
Title: CalNOC Partners for Quality TRIP to Reduce Patient Falls Project
Topic Area: Reduction of patient falls in hospitals
Principal Investigators: Nancy E. Donaldson, DNSc
AHRQ Project Officer: Denise Burgess (formerly Marge Keyes)
Total Cumulative Award: $1,160,856
Funding Period: 9/2002–9/2006
Project Status: Completed 9/29/2006
1. Project
Description
Goals. The aim of the four-year project was to use evidence on effective practices
and data from the California Nursing Outcomes Coalition (CalNOC) statewide data
repository to support interventions to reduce the incidence of patient falls
and the severity of fall-related injuries in California hospitals. The project
builds on CalNOC's efforts to engage acute care hospitals in voluntarily
reporting standardized data for nurse staffing, patient falls, and fall-related
injuries based on American Nursing Association (ANA) quality indicators. This
project was designed to advance CalNOC's efforts to use its quality
benchmarking infrastructure to expedite the transfer of evidence-based
knowledge into practice and so improve patient care quality and safety.
The
project planned to recruit hospitals from CalNOC's membership network and help
them set an agenda for reducing patient falls. Rather than select a standard
intervention for all participating hospitals, the project helped each facility
choose an intervention for decreasing patient falls that fit with its
organizational strategic priorities. To support these interventions, the
project would pair a "Coach" from the Project Team with a "Linker" in each
hospital. The project also assisted hospital nursing staff in accessing
research-based evidence to support their strategic falls reduction efforts.
Activities and
Progress
Year
1. The project held a strategic planning retreat with the Project Team—a
core research group of individuals/organizations—and 20 statewide stakeholders
to discuss strategic planning and designate subgroups to implement its plan.
The project staff aggregated falls-related data from CalNOC's data repository
and synthesized information to identify opportunities for improvement in falls
risk assessment, prevention, and injury reduction. The Project Team issued a
call to CalNOC's member hospitals to participate, received interest from 32 of
them, and began collecting baseline data from these hospitals, which they
planned to use to compare indicators from participating and non-participating
units. The Project Team developed role descriptions for Coaches and Linkers,
with key competencies and expectations, project orientation content and
strategies, and coaching documentation tools. Project staff provided coaching
for the hospital Linkers by six Coaches from the Project Team of investigators,
and a staff coaching coordinator for the state's southern region.
Year
2. The project recruited 92 medical/surgical patient care units in 32
CalNOC hospitals to participate in the three-year demonstration (the total was
91 after one unit dropped out later). The medical/surgical units conducted
self-assessments on patient falls, and the Project Team engaged sites in a
comprehensive review of the CalNOC falls data. The project initiated its
telephone-based educational and supportive coaching intervention by identifying
Linkers in each hospital and pairing them with one of the project's Coaches.
The Coaches scheduled telephone meetings with their Linkers about once a month
to discuss each hospital's strategic plans, follow their progress, and discuss
Linkers' needs. The roles of the Linkers and the hospitals' strategic plans
varied to match individual organizational needs, since some hospitals already had
strategic initiatives for patient falls in place and others did not. Telephone
contacts were complemented by site visits when requested, and evolved to
included multi-site conference calls for regional networking.
The
project funds also partially supported the creation of the CalNOC Web site,
which went live in August 2003. It provides general information about CalNOC
member hospitals and representatives and contact information for CalNOC's
committee members. It also has tools specifically designed for members involved
in the falls reduction project, such as a bulletin board for posting questions
and responses, and an eReserve library that posts curriculum materials.
Year
3. The project Coaches continued to support Linkers' efforts to implement
evidence-based interventions for reducing the incidence and injury associated
with patient falls in medical-surgical units. Hospitals set their own agendas
and areas of focus; some hospitals developed general strategies, while others
focused on one or two focal areas for improvement. The project provided
hospitals with self-assessment tools in Years 1 and 4 to document their
progress.
The
six project Coaches and the coaching consultant, Dr. Kristin Geiser, held
monthly conference calls to learn from each other and optimize the
effectiveness of individual and collective efforts. The Falls Medication
Assessment Fact Sheet emerged from one of these conference calls, and was
distributed to Linkers to help them integrate emerging concepts related to
medication assessment into their fall risk assessment activities. Dr. Patricia
Quigley RN, PhD, an expert in falls based at the VA Tampa, joined the team as a
consultant and participated in calls with the coaches to discuss the impact of
medication assessment on falls risk assessment/prevention. Coaches documented
the monthly contacts with Linkers using a coaching documentation worksheet,
which will inform the descriptive analysis of the Coaching intervention.
Year
4. The last year of the PFQ grant focused on completing a formative
evaluation of the project, with pre- and post-analyses comparing data from
participating and non-participating units in participating hospitals. The
project also sought evaluation feedback from Chief Nursing Officers at these
hospitals. The project uses the CalNOC Web site to provide ongoing updated
"drill down" reports to assist sites in using their own performance as the
basis for guiding ongoing efforts. The project began exploring ways to
disseminate its work through a web-based version of the intervention via ANA's
NDNQI Web site.
2. Partnership
Structure/Function
The
PFQ project was spearheaded by CalNOC, a coalition of nursing organizations in
California, founded in 1995 by the Association of California Nurse Leaders
(ACNL)—which serves as the PFQ grantee—and the American Nurses Association of
California (ANA\C). CalNOC was formed to develop clinical outcome quality
indicators for hospital-based nursing processes and conduct research on efforts
to improve them. The PFQ project structure was built around the existing CalNOC
governance and committee structure and had three levels of partnerships. The
first level of partnership is between the core Project Team, comprised of the
individuals in CalNOC's Operations and Research teams3 and outside consultants brought in for their expertise. The second
partnership occurs between the project and the 32 participating hospitals. A
third level of partnership exists between the Project Team and the national
experts and stakeholders that make up the Advisory Council, which helps to
shape the project's methods, measures, and strategies.
For the core Project Team, frequent meetings were held
between Principal Investigator Dr. Donaldson with UCSF and the grant recipient
ACNL's Executive Director, Patricia McFarland, to discuss grants
administration, since this was ACNL's first federal grant. The core Project
Team, led by the PI and her two co-investigators at Cedars Sinai Research
Institute and California State University at Fullerton, had weekly phone calls
and met in person about five times a year. Strategy meetings with other
project collaborators—including the investigative and coaching teams—occurred
every four to six weeks via conference calls during the implementation of the
Coaching/Linker intervention. These meetings continued after the intervention
was underway, although less frequently.
At the hospital-project team partnership level, the
Linkers at hospitals spoke with their Coaches about once a month to discuss
strategic plans, update Coaches on hospital activities, and seek guidance. The
larger group of Coaches and Linkers convened meetings every four to six months
to promote cross-facility learning.
The core Project Team and the project Advisory Council
attended a Strategic Planning Retreat in January 2003 to plan and launch the
project's partnership activities. The retreat led to the development of working
groups that continue to operationalize the strategic plan. The PI, Dr.
Donaldson, maintains ongoing collaborative contact with co-investigators and
working groups.
Table 1. Major Partner Organizations and Roles in the Project
|
Organization |
Role in Project |
Lead Organization (grant recipient) |
Association of California
Nurse Leaders (ACNL)
|
Refine processes and procedure to assure compliance and
efficient administration of the business aspects of the
project; manage sub-contracts
Recruit and retain hospitals for the project
|
Key
Collaborators |
Project Team in
addition to ACNL:
University of
California, San
Francisco (UCSF)
Cedars-Sinai Research
Institute
California State
University Fullerton
(CSUF)
CalNOC Advisory
Council—All organizations
above (except CSUF) and:
ANA National Database for
Nursing Quality Indicators
(NDNQI),
VA NOD, MilNOD,
Gorden and Betty Moore
Foundation
AHRQ
|
The PI, Nancy Donaldson from UCSF, and two coinvestigators
lead project activities
The core Project Team works on strategic planning and
evaluation for the project and are Coaches to Linkers in
hospital sites to facilitate implementation
Cedars-Sinai oversees data management for the data
received from participating hospitals
The consultant from CSUF, Dana Rutledge, is the only
member of the Project Team who also is not part of the
CalNOC's Operations and Research teams; Dr. Rutledge
developed the role of the Linker and has worked to keep
Linkers engaged
Provide advice on methods, measures, and strategies
ANA's NDNQI may help to implement the Coach-Linker
intervention nationwide
|
Target Organizations |
91 medical-surgical patient
care units in 32
participating CalNOC
hospitals statewide
|
Implement falls risk assessment on admission; patients atrisk
receive prevention interventions; provide feedback on
effective improvement strategies and barriers faced
|
3. Project Evaluation and Outcomes/Results
The evaluation of the project consisted of tracking
and analyzing the project's effect on falls-related outcomes indicators, e.g.,
falls per 1000 patient days and injury falls per 1000 patient day. It compared
falls-related outcomes in the 91 participating units (called TRIP or
Translating Research into Practice units) in the 32 hospitals before and after
the intervention, and with non-participating units (non-TRIP units) in the
same hospitals. The project collected monthly data on these indicators for
each participating medical-surgical unit. Pre-intervention data came from the period
2001 to the first quarter of 2003, and post-intervention data was from 2005.
The analysis examined data from all the units with pre- and post-data available—89 TRIP and 260 non-TRIP units.
The analysis found that the mean changes in falls and
falls with injury were not significantly different between the pre- and
post-data period for TRIP/participating units. In addition, the mean changes in
falls and falls with injury were not significantly different for TRIP versus
non-TRIP units. Despite the lack of statistically significant change, the
project did find that falls per 1000 patient days for TRIP units were trending
in the right direction—decreasing slightly between pre and post periods. The
lack of a statistically significant drop in falls in the TRIP hospitals was
attributed to convergent impact of JCAHO's 2004 focus on falls rates and the
resulting range of organizational and clinical activities to reduce falls
implemented in participating hospitals. In addition, the fact that the outcome
variable (falls) is relatively rare and annual rates are highly variable may
have affected the power of the interventions to achieve results. The
statistically significant increase in injury falls in the TRIP units
from the pre to post time period may be due to improved reporting. The
coaching team was exploring further the reasons for these findings at the time
this summary was prepared.
Other outcomes include informal learning about the
process of implementing evidence-based interventions in hospitals. For example,
the three-year time horizon for this project may be too long in view of
hospitals' single-year budgeting cycles, suggesting that the improvement
process may need to adopt the rapid cycle model. In addition, the
sustainability of the interventions can be compromised by the turnover of
Linkers—nurse champions in each hospital—and Chief Nursing Officers, who
are the principal administrative sponsors of the programs.
4. Major Products
- Presentations at
2002, 2004, and 2006 CalNOC conferences; 2003 National Association of
Healthcare Quality Meeting; 2004, 2005, and 2006 ANCL conferences; 2004 ANA
Convention; VA Tampa 2004; and 2005 Patient Safety Conferences.
- Donaldson,
Rutledge, and Ashley "Outcomes of Adoption: Measuring Evidence Uptake by
Individuals and Organizations." Worldviews on Evidence-Based Practice
Journal (Suppl; Sept. 2004).
- Expanded CalNOC
Web site to include information for sites with bulletin board, library, and project-specific
drill-down reports available to participating hospitals on an ongoing basis.
- Self-Assessment
Tools (Organizational and Unit Level); Fact Sheet; Miles Stone is Falls
Improvement; Falls Rater-to-Standard Training Tutorial.
5. Potential for Sustainability/Expansion after PFQ
Grant Ends
The Project Team has executed an agreement with the
American Nurses Association to use the ANA NDNQI Web site for transforming
"live" coaching at sites into a self-directed online process; this could help
to sustain this activity. CalNOC received a follow-up grant from the Gordon and
Betty Moore Foundation, which supported CalNOC in continuing some of this work
as part of the foundation's efforts to evaluate the impact of its multifaceted
$110 million nursing initiative in the San Francisco Bay Area, designed to
improve nursing-related quality and safety in acute care hospitals. This
partnership with the Gordon and Betty Moore Foundation also has supported
increased collaboration between CalNOC, ANA, and NDNQI.
3. The CalNOC Operations Team consists of staff
from the UCSF Center for Research and Innovation in Patient Care, the
Association of California Nurse Leaders (ACNL), the Cedars-Sinai Research
Institute, and representatives of the CalNOC User Members. Key CalNOC
personnel (Dr. Donaldson at UCSF, Dr. Aydin at Cedars-Sinai
Research Institute, and Ms. McFarland with ACNL) coordinate and manage the work
of CalNOC with the policy direction and advice of the Governance and Advisory
Council. The CalNOC Research Team, under the leadership of Co-Principal
Investigators Drs. Donaldson and Brown, is accountable for the integrity of
CalNOC methods, studies, and reports. The CalNOC Governance and Advisory
Council engages CalNOC stakeholders as strategic partners in shaping CalNOC
methods, measures, and strategies.
Return to Appendix B Contents
PFQ Grant Summary: CHP Heart Failure GAP (Guidelines Applied
in Practice)
Lead Organization: Catholic Healthcare Partners (CHP)
Partner Team: CHP HF GAP Partnership, Ohio State University, Case Western
University, National Heart Failure Training Program, American Heart
Association, and others
Title: CHP's Closing the "GAP" for Heart Failure (GAP=Guidelines Applied
in Practice)
Topic Area: Quality improvement for patients with chronic congestive heart failure
Principal Investigators: Donald Casey, Jr., MD (was Chief Medical Officer at CHP but remained
PI after his move to Atlantic Health System, NJ in 2005)
AHRQ Project Officer: Margaret Coopey
Total Cumulative Award: $1,278,719
Funding Period: 9/2002–9/2006
Project Status: Request for no-cost extension through September 29, 2007, under review
1. Project
Description
Goals. The purpose of this project was to improve health outcomes for patients
with heart failure (HF) by promoting the consistent use of evidence-based
guidelines in the treatment of such patients, i.e., narrowing the gap between
clinical evidence and clinical practice. It sought to motivate quality
improvements for such patients throughout Catholic Healthcare Partners (CHP), a
large health system comprised of 31 hospitals and other health care facilities
located in 9 regional health systems in 5 states. The project tried to develop
and demonstrate CHP's ability to improve chronic illness care for patients with
HF through the effective use of standardized quality measurement systems for
the treatment of HF patients. These improvements were designed so that all hospitals
in the CHP system could sustain effective, broad-based national and local
partnerships to support and sustain this work on an ongoing basis after the end
of the grant period.
Activities
and Progress. The project initially planned to adapt evidence-based heart
failure interventions and develop standardized HF "tools" for all 31 CHP
hospitals. However, after an initial planning period, project leadership
decided instead to encourage CHP hospitals to adopt nationally endorsed quality
interventions through explicit alignment with the health care system
organizational structure, culture, and capacity. The project selected six
community hospitals in six of the nine regional CHP systems to participate in
the project and convinced hospital CEOs to support or adopt existing HF quality
improvement interventions and tools that were evidence-based and met their
system's needs.
In 2003, 21CHP
hospitals chose to report nationally developed quality measurement for HF to
CMS and JCAHO as a part of the Hospital Quality Alliance (HQA): (1) ACE
inhibitor prescribed at discharge, (2) left
ventricular function (LVEF) assessment, (3) smoking cessation counseling, and
(4) appropriate discharge instructions. The CHP hospitals regularly collected
data for these measures through the MIDAS system, a national proprietary data
warehouse with patient outcomes and treatment information that permits
comparisons among hospitals using benchmarks set by top performing hospitals.
CHP initially set a goal of achieving a minimum score for each measure at or
above 75 percent of all HF patients, or in the top 25th percentile in the MIDAS
system, whichever was greater. During this time, CHP also developed an
organizational goal of reducing the system's 30-day all-cause readmission rates
for patients with an index admission for HF. To create strong incentives for
CHP regional health systems to improve HF care quality, CHP evaluated
performance for all CHP home office staff, regional CEOs, and other senior
management, contingent on successful achievement of these performance targets
for chronic HF. Moreover, CHP added an HF readmission metric to the evaluation
of regional health systems by the CHP national and regional boards.
The
project encouraged all CHP regional systems to select evidence-based HF quality
improvement tools and plans that best fit their needs. The project team also
decided to develop one common intervention for six specially selected
hospitals. They created a staff position called the "Heart Failure Advocate"
(HFA) to facilitate the implementation of quality improvement tools and plans.
The project recruited and trained HFAs, all of whom were nurses, from each of
these six hospitals in the second project year. The HFA job was designed to
manage and coordinate care more effectively for HF patients at high risk for
readmission or death, and also to implement broader quality improvement
initiatives for HF within each of the six hospitals. The HFAs also conducted
intensive followup for the high-risk patients after discharge. The HFAs
generally spent 50 percent of their time managing individual HF patients and 50
percent improving the system of HF care. The project funded the HFA position
salaries in the first year with the understanding that the hospitals would transition
to providing 50 percent salary support and eventually would fully cover the
cost of the staff positions. At the end of the project, one of the
participating hospitals decided not to continue to fund its HFA position, but
additional HFA positions were created for implementation in four other CHP
hospitals.
The
HFAs participated in several types of training to cover a variety of critical
skills identified for the project, such as communication, management, and
technical and clinical expertise. They also attended a two-day training
session provided by the National Heart Failure Training Program (N-HeFT) to
further develop and refine their skills. They were encouraged to attend
individual sessions throughout the project period to refine improvement strategies
for achieving highest performance on the HF quality measures, as well as to
enhance their abilities to better provide care coordination, medication
management, and patient/provider education. To build organizational support for
quality improvement, the HFAs also recruited physician champions to support the
project. These physicians accompanied the HFAs to a special training session
provided by N-HeFT and The Ohio State University that focused on disease
management strategies, effective communication between nurses and physicians,
developing strategies for setting up an effective HF program, and managing
change.
To
diffuse the adoption of evidence-based guidelines for the treatment of patients
with HF in the community, the project provided HF education to physicians,
nurses, and other clinicians in the CHP system, as well as other personnel from
organizations external to CHP. To accomplish this, the project created
CME-accredited HF education programs for community physicians and hospital
staff. These were presented through several teleconferences at participating
hospitals to explain the project and its progress to the larger HF community
and other large "observer" health systems.
2. Partnership
Structure/Function
The
CHP project was run by a core project team led by Dr. Donald Casey and other
CHP staff, as well as some members of non-CHP partner organizations (see table
below). The core project team included seven co-investigators and their
respective teams. National HF experts Dr. Abraham (Ohio State University) and
Dr. Piña (Case Western University and N-HeFT) were involved directly in the
project, providing training to HFAs and developing and personally presenting
education sessions for community physicians at several HFA hospitals. Other co-investigators
provided strategic advice and promoted physician participation in project
activities. Although the project included monthly conference calls between
co-investigators, HFAs, and supervisors, some co-investigators communicated
more frequently.
The
project established four sets of partnerships: (1) between CHP and the
individuals or organizations that comprised the core project/research team; (2)
between the project team and the CHP HF GAP Partnership, comprised of local and
national expert cardiologists, advanced practice cardiac care nurses, regional
CEOs, and advisors from outside of CHP, who provided multidisciplinary
expertise, helped convene/recruit local participants, disseminated the model,
and provided feedback on project results; (3) among the project team, HFAs, and
the hospitals/regional health systems they represented; (4) between the project
team and the "observer" organizations that the project hoped would adopt or
endorse the model, (e.g., other large Catholic health systems such as Catholic
Health Initiatives, Catholic Healthcare East, or Trinity Health), and the
Greater Cincinnati Health Council.
Table 1. Major Partner Organizations and Roles in the Project
|
Organization |
Role in Project |
Lead Organization (grant recipient) |
Catholic Healthcare Partners
|
Provided the quality improvement leadership and
oversaw the project's activities
|
Key
Collaborators |
Core Project/Research Team:
Ohio State University
Case Western Reserve University
N-HeFT
Xavier University
North Ohio Heart Center
Applied Health Services
|
William Abraham MD, from Ohio State
University (co-PI), one of the HF GAP major
clinical expert leaders, provided advice for
program design/execution and design of program
assessment
Ileana Piña MD, from Case Western and N-HeFT
(co-PI), another major clinical expert leader,
provided training and technical support to
Advocates and advice for program design and
assessment
John Schaeffer MD, from North Ohio Heart
Center, a clinical expert, provided advice for
program design/execution and program
assessment
Liu Guo, PhD, from Xavier University conducted
the program's evaluation
Rick Snow, DO from Applied Health Services
|
CHP HP GAP Partnership:
Cardiologists from CHP regions,
CHP Regional HF Experts, American
Heart Association
HF GAP Observers: Catholic
Healthcare East, St Joseph Health
System, Catholic Health Initiatives,
Greater Cincinnati Health Council |
Provided multidisciplinary expertise
Helped convene/recruit local participants
Evaluated and provided feedback on project
results
Participated in communication/dissemination
(particularly AHA) by including the Advocates in
its new 'Get With The Guidelines' program |
Target Organizations |
Six CHP regional health systems,
with one hospital from each system
hosting an advocate
|
Heart Failure Advocates managed high-risk
patients and implemented quality improvement
interventions; hospital executives monitored and
managed QI improvements
|
3. Project Evaluation and Outcomes/Results
Project Evaluation. The evaluation of the project will assess (1) the CHP HF GAP
Partnership, based on eight dimensions, such as partnership synergy,
partnership involvement, and others; (2) the degree of implementation of HF
care interventions; (3) improvement in the process of care delivery; and (4) the impact of improved practices on clinical and
cost outcomes. The performance measures include:
- Four national HF
inpatient performance measures collected for JCAHO and CMS (ACE inhibitor
prescribed at discharge, LVEF assessment, smoking cessation counseling, and
appropriate discharge instructions).
- 30-day all-cause
(not just for HF) readmission rates for patients with an index admission for
DRG 127.
- Appropriate
identification and referral of chronic HF patients to palliative or hospice
care at or near the end of life.
- Effectiveness of
CHP HF Advocates in influencing the above measures.
- Effectiveness of
the CHP HF GAP Partnerships (system-wide and regional).
- Financial impacts
of the initiative, with special attention to the effects of pay-forperformance
and other monetary and non-monetary incentives on all of the above.
Data for these measures will be derived primarily from
existing data already collected by regional CHP organizations, e.g., through
the MIDAS system. The methodology uses a quasi-experimental study, comparing
patients with versus without interventions, and comparing the same cohort of
patients between the pre- and post-intervention periods.
To determine the effect of interventions, such as
training, on HFAs, a survey or focus group will be conducted to determine if
the partnership met their needs, how it could better address their needs, and
which non-partnership interventions were implemented that affected HFA
performance. The project intends to use the tool created by the Partnership
Subcommittee in AHRQCoPs to measure the success of its Partnership.
Outcomes/Results. Although final data analysis was not complete at the time this
summary was written in October 2006, initial analysis of the evaluation data
showed that patients under the care of the HFAs have experienced fewer
readmissions and a longer time between readmissions than those patients not
enrolled in the program (i.e., those with "usual care"). Further analysis
indicates that patients experienced a 66 percent reduction of hospitalizations
after they were enrolled in the HFA program. Their 30-day readmissions were
reduced by 41 percent in the post-enrollment period. Their days elapsing
without readmissions were doubled in the post-enrollment period (469 days),
compared to the pre-enrollment period (211 days). Early results also show that
30-day all-cause readmission rate for HF patients cared for by the HFAs
consistently ranged from 1 percent to 10 percent on a quarterly basis, compared
to the CHP hospitals' average readmission rates. HF readmission rates for the
21 CHP hospitals decreased to 18.3 percent in the third quarter of 2005 from
22.0 percent in the same quarter of 2003. The CHP system as a whole also has
been highly successful in improving its performance on the four national HF
quality measures, all of which have improved since 2002. For example, the LVEF
assessment measure rose from 77 percent in the third quarter of 2002 to 95
percent in the second quarter of 2006. The most recently available composite
score of 95 percent for the four HF quality measures put CHP as a single entity
in the top decile of performance within the CMS-Premier Hospital Quality
Incentive Demonstration Program.
One lesson learned from the project is that
organizational goals and incentives based on standardized quality measures
(e.g., the HF measures developed by the American College of Cardiology and the
American Heart Association) are more important motivators of quality
improvement than standardized tools. The project's experience also highlights
the difficulty of motivating hospitals to adopt a program that is not
profitable, since reducing hospital readmissions may lower total revenue. We
were told by some interviewees that while the individual HFAs have been
effective change agents, a larger number of HFAs would make a bigger difference
in reducing global hospital readmission rates for patients with HF.
4. Major Products
- HFA training
program developed by N-HeFT.
- Special video-DVD
recording from April, 2005 highlighting the key elements of the CHP HF GAP
initiative, presented to CHP Governance Academy, Tucson, AZ.
- Publications.
- Presentations at
meetings of the Heart Failure Society of America, American Heart Association,
and American College of Cardiology.
5. Potential for Sustainability/Expansion after PFQ
Grant Ends
Five of the six participating CHP hospitals have made
a commitment to continue funding the Advocate positions on their own. One of
the hospitals found the HF Advocate position so useful that they are interested
in creating an Advocate position for diabetes as well. Moreover, two new
HF Advocates began in May 2006 in Cincinnati, Ohio as part of a pilot to see if
the Advocates role can be adopted in other CHP hospitals. A hospital in New Jersey and one in Pennsylvania have also expressed interest in setting up an HF
advocate position.
In 2005-06, the CHP HF GAP Partnership began efforts
to create a broad coalition of stakeholders committed to improving HF care in Ohio. The Ohio Heart Failure Coalition (OHFC) was formed in September 2005, made up of
organizations such as the national and regional offices of the American Heart
Association, the Ohio Department of Health, the Ohio Hospital Association,
several large health systems (CHP, University Hospitals of Cleveland, Ohio
State, and Christ Hospital in Cincinnati), Ohio KePRO (the QIO in the region),
and third party payers, notably Anthem Blue Cross of Ohio. The OHFC will
attempt to gain the support and participation of more organizations for HF
quality improvement activities based on the CHP HF GAP initiative. The mission
of the OHFC is "to achieve transformational change across the continuum of
heart failure care through an innovative collaborative dedicated to sharing
best practices and resources."
The CHP HF GAP also is trying to disseminate its
approach by collaborating with the American Heart Association's "Get With the
Guidelines" project for HF, a quality improvement program available for
purchase by hospitals that supplies a data collection tool and materials,
including a full patient education program, methods for communicating with
physicians, and patient education materials. CHP's HFAs are presenting at
regional and national AHA workshops. It was during one such workshop that one
of the organizations now involved with the OHFC heard about the HF GAP program,
prompting its participation in the OHFC. One grant partner indicated that some
people who attended the AHA workshop were impressed by the HFA's message and
have taken their "lessons learned" back to their own hospitals.
6. Publication References
Guo L, Chung ES, Casey DE,
Snow R. Redefining Hospital Readmissions to Better Reflect Clinical Course of
Care for Heart Failure Patients. American Journal of Medical Quality.
Accepted for publication in an upcoming issue in 2006.
Snow R, Guo L, Barrow L,
Grossbart S, Miller K, Chung E, Casey D. The Effect of Heart Failure Trained
Advocates on 30 and 60 Day Readmissions. To be presented at the American Heart
Association Scientific Sessions 2006, Chicago, Illinois, November 12-15, 2006
and subsequently referenced in Circulation.
Guo L, Chung ES, Snow R,
Miller KL, Grossbart S, Casey D. Redefining Readmissions to Better Reflect the
Clinical Course of Heart Failure Patients. To be presented at the American
Heart Association Scientific Sessions 2006, Chicago, Illinois, November 12-15,
2006 and subsequently referenced in Circulation.
Markward BA, Glesser RR, Kaiser D, Baird T, Reinhardt
S, Zite G, Piña II, Casey DE, Hitch JA, Blum K. Development and Evaluation of
the Heart Failure Advocate Role in the Care of Patients with Chronic Heart
Failure. Journal of Cardiac Failure, August 2006 (Vol. 12, Issue 6
(Supplement), page S123).
Guo L, Chung ES, Snow R,
Miller KL, Grossbart S, Casey D. Redefining Readmissions to Better Reflect the
Clinical Course of Heart Failure Patients. Journal of Cardiac Failure,
August 2006 (Vol. 12, Issue 6 (Supplement), page S110).
Snow R, Guo L, Barrow L,
Grossbart S, Miller K, Chung E, Casey D. The Effect of Heart Failure Trained
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