|
BACKGROUND/RATIONALE:
A main goal of our Chronic Heart Failure Quality Enhancement Research Initiative (CHF-QUERI) is to increase use of care known to prolong survival while maintaining or improving quality of life. Studies have indicated that these treatments are not used as frequently as they should be both within and outside the VA system. The reasons for non-optimal use are not clear but may be due to organizational and provider factors. VA centers likely vary in their use of disease management, cardiology heart failure clinics, and use of clinical reminder systems among other structural characteristics.
OBJECTIVE(S):
The immediate objectives are to determine the variation in organizational characteristics for VA cardiology sections that treat heart failure patients. We also plan to determine if this variation explains variation in guideline compliant care for heart failure.
METHODS:
Variation in organizational characteristics of cardiology care delivery is being obtained from a survey of each VA facility. Outcome (guideline recommended care) is being obtained from EPRP data.
Survey data: Data are being gathered using 2-page cross-sectional surveys focusing on organizational characteristics. Our survey has been sent as a joint IHD-CHF QUERI survey to each Cardiology Section Chief, and if none exists to each Medical Service Chief (non-tertiary care centers). The following questions have been asked: presence of existing heart failure clinics, heart failure programs, capability to implant devices (defibrillators, biventricular pacemakers) and number implanted, use of standardized heart failure order, use of clinical reminders for specific drugs or patient education, and physician feedback programs.
EPRP data: We already have an accepted data use agreement with the Office of Quality and Performance (OQP) to use heart failure data from the External Peer Review Program (EPRP). Data from Jan 1, 2005 to Dec 31, 2005 is being sent for the VA inpatients (100%) sample and all available outpatients confirmed as having heart failure by OQP. We will obtain patient level data for OQP’s performance measures: dietary instruction, smoking cessation, measurement of left ventricular ejection fraction (LVEF) and use of angiotensin converting enzyme (ACE) inhibitors in those with an LVEF,40%. In addition guideline recommended treatment with beta-blockers (for patients with LVEF < 40%) and aldosterone antagonists (for patients with LVEF < 40% and severe symptoms).
FINDINGS/RESULTS:
Variation in structural aspects of heart failure care and variation in quality indicators (guideline compliance) will be determined. Logistic regression analysis will be used to establish relationships between structural characteristics of heart failure care VA and quality indicators for heart failure.
.
IMPACT:
If variation in the structure of heart failure care can be identified and correlated to use of guideline recommended care, then it may be possible to identify organizational characteristics associated with the best care that can be implemented through the VA system.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases
DRE:
none
Keywords:
none
MeSH Terms:
none
|
