BACKGROUND/RATIONALE:
The high prevalence and enormous cost of chronic heart failure (CHF) are well known. CHF affects 5 million Americans and is associated with high morbidity and mortality. It is especially common in the elderly, with 1 in every 10 persons carrying the diagnosis of CHF. Furthermore, almost one-half of CHF patients are readmitted to the hospital within 6 months of discharge. Additionally, the quality of life for patients with CHF has been reported to be poor, due to the common symptoms of fluid retention, shortness of breath and fatigue. A number of studies, usually in the form of single site studies, have demonstrated the benefit of a number of interventions mostly focusing on providing multidisciplinary case management in reducing readmission rates after an initial hospitalization for CHF. Thus, strategies that can improve the process of care for CHF patients are urgently needed.
OBJECTIVE(S):
The objectives of CHF QUERI are to: 1) Recommend to VA how best to use its existing research and administrative resources to close the important gaps in research and practice; 2) Recommend and influence the research portfolio of the Department of Veterans Affairs so that it covers the most pressing issues in clinical care and service delivery to patients with CHF as well as the best science; 3) Create and foster a network within VA of clinicians, researchers, policy-makers, managers, and information specialists who are deeply committed to improving care for patients with heart failure; 4) Monitor clinical practice (process and outcomes) in heart failure from the health system's perspective as well as the patient's in order to determine the extent to which the QUERI process is having its intended effects; 5) Create an information dissemination loop that ensures VA researchers, clinicians, managers, policymakers, information specialists, and patients are kept up-to-date with best practices in CHF and with the most pressing need for new knowledge in CHF; 6) Inventory ongoing data collection efforts pertaining to quality assessment and improvement in CHF throughout the VA system (e.g., performance agreements, the External Peer Review Program) and to advocate for improvements in these efforts; and 7) To be able eventually to compare and benchmark some VA data on process and outcomes in CHF with the non-VA sector.
METHODS:
1) Maintain and update the CHF QUERI Database Cohort - This database represents the backbone of the QUERI efforts because many of other studies utilize this data. Information collected includes hospital use (bed days of care in acute and extended care facilities, multi-stay ratio), outpatient use (total visits, as well as visits to 9 categories such as primary care, cardiology, urgent care and specialty care), cardiac surgery and diagnostic and therapeutic tests and procedures, 14-day and 90-day readmissions, and mortality. This information includes data from FY01 and FY02 and is updated annually.
2) Develop, test, implement and monitor various intervention projects with the purpose of improving the care of veterans with CHF.
3) Utilize CHF QUERI Database Cohort to develop a performance assessment system that compares VA facilities to similar types of VAs or other facilities within VISN
We are also using the CHF Cohort Database to analyze the existing practice patterns and outcomes of CHF care in the VA at a national, VISN and facility level. This data forms the basis for the Quality of Care Indicators (aka ‘report cards’) for CHF. The quality of care indicators are risk-adjusted data on the percentage of discharges among patients hospitalized with a Diagnosis Related Group (DRG) of heart failure, which resulted in a readmission for any diagnosis within 14 days or within 15 to 180 days of discharge. The CHF cohort can be used the examine the trends in the outcome measures over time within a facility, as well as comparisons to the network average and the average across the whole VA system.
The reports can be generated using data from the previous six months to allow facilities to closely monitor changes in rates. These reports also present the “achievable benchmarks of care” (attainable levels of excellence among facilities in the VISN) for each measure.
FINDINGS/RESULTS:
Refer to the IMPACT description
IMPACT:
Development of discharge instructions for CHF patients. Health Tips for Heart Failure - CHF QUERI collaborated with OQP to post on the OQP website “Heart Failure Tips” which was derived from the CHF QUERI patient education materials.
PUBLICATIONS:
Journal Articles
- Wilson EM, Gunasinghe HR, Coker ML, Sprunger P, Lee-Jackson D, Bozkurt B, Deswal A, Mann DL, Spinale FG. Plasma matrix metalloproteinase and inhibitor profiles in patients with heart failure. Journal of Cardiac Failure. 2002; 8(6): 390-8.
- Mann DL, Deswal A, Bozkurt B, Torre-Amione G. New therapeutics for chronic heart failure. Annual Review of Medicine. 2002; 53: 59-74.
- Greisinger A, Espadas D, Ashton C. Providing care to veterans with chronic heart failure. Federal Practitioner. 2000; 17: 10-19.
- Ashton CM, Bozkurt B, Colucci WB, Kiefe CI, Mann DL, Massie BM, Slawsky MT, Tierney WM, West JA, Whellan DJ, Wray NP. Veterans Affairs Quality Enhancement Research Initiative in chronic heart failure. Medical Care. 2000; 38(6 Suppl 1): I26-37.
- Krumholz HM, Baker DW, Ashton CM, Dunbar SB, Friesinger GC, Havranek EP, Hlatky MA, Konstam M, Ordin DL, Pina IL, Pitt B, Spertus JA. Evaluating quality of care for patients with heart failure [published erratum appears in Circulation 2000 Jun 27;101(25):2995]. Circulation. 2000; 101(12): E122-E140.
- Ashton CM. Care of patients with failing hearts: evidence for failures in clinical practice and health services research. Journal of General Internal Medicine. 1999; 14(2): 138-40.
DRA:
Aging and Age-Related Changes, Chronic Diseases, Health Services and Systems
DRE:
Quality of Care
Keywords:
Chronic heart failure, Decision support, Telemedicine
MeSH Terms:
none
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