TY - JOUR
T1 - Impact of a model of care for heart failure in-patients to reduce variation in care
T2 - a quality improvement project
AU - Hopper, Ingrid
AU - Easton, Kellie
AU - Bader, Illona
AU - Campbell, James
AU - Busija, Lucy
AU - Markey, Peter
AU - Bergin, Peter
AU - Kaye, David
N1 - Funding Information:
Victorian Department of Health and Human Services. I. Hopper is supported by a National Health and Medical Research Council fellowshipWe thank the Victorian Department of Health and Human Services for funding the project, the Heart Foundation Victoria for providing central support and co-ordination, the Victorian Cardiac Clinical Network and the Heart Failure Model of Care Collaborative for the opportunity of working together and sharing experiences. We are also grateful to Tamzin Dimmock from Alfred Health Redesigning Care, and Suzanne Shaw for assisting with the IT design. Thanks also to the many dedicated staff and patients at Alfred Health who assisted with the redesign process.
Funding Information:
We thank the Victorian Department of Health and Human Services for funding the project, the Heart Foundation Victoria for providing central support and co‐ordination, the Victorian Cardiac Clinical Network and the Heart Failure Model of Care Collaborative for the opportunity of working together and sharing experiences. We are also grateful to Tamzin Dimmock from Alfred Health Redesigning Care, and Suzanne Shaw for assisting with the IT design. Thanks also to the many dedicated staff and patients at Alfred Health who assisted with the redesign process.
Publisher Copyright:
© 2020 Royal Australasian College of Physicians
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - Background: We identified variation in delivery of guideline recommended care at our institution, and undertook a project to design a heart failure (HF) model of care. Aim: To maximise time patients with HF spend well in the community by delivering best practice guidelines to reduce variation in care improving overall outcomes. Methods: This quality improvement project focused on reducing variation in process measures of care. The HF model of care included electronic HF care bundles, a patient education pack with staff training on delivering HF patient education, referral of all HF patients to the Hospital Admissions Risk Program for phone call within 72 h, and a nurse–pharmacist early follow-up clinic. Outcomes were assessed using interrupted time series analyses. Results: The pre-intervention group comprised 1585 patients, and post-intervention 1720 patients with a primary diagnosis of HF admitted under general cardiology and general medicine. Interrupted time series analysis indicated 30-day readmissions did not change in overall trend (−0.2% per month, P = 0.479) but a significant immediate step-down of 7.8% was seen (P = 0.018). For 90-day readmissions, a significant trend reduction over the time period was seen (−0.6% per month, P = 0.017) with a significant immediate step-down (−9.4%, P = 0.001). Emergency department representations, in-patient mortality and length of stay did not change significantly. Improvements in process measures were seen at audit. Conclusion: This model of care resulted in overall trends of reductions in 30- and 90-day readmissions, without increasing emergency department representations, mortality and length of stay. This model will be adapted as the electronic medical record is introduced at our institution.
AB - Background: We identified variation in delivery of guideline recommended care at our institution, and undertook a project to design a heart failure (HF) model of care. Aim: To maximise time patients with HF spend well in the community by delivering best practice guidelines to reduce variation in care improving overall outcomes. Methods: This quality improvement project focused on reducing variation in process measures of care. The HF model of care included electronic HF care bundles, a patient education pack with staff training on delivering HF patient education, referral of all HF patients to the Hospital Admissions Risk Program for phone call within 72 h, and a nurse–pharmacist early follow-up clinic. Outcomes were assessed using interrupted time series analyses. Results: The pre-intervention group comprised 1585 patients, and post-intervention 1720 patients with a primary diagnosis of HF admitted under general cardiology and general medicine. Interrupted time series analysis indicated 30-day readmissions did not change in overall trend (−0.2% per month, P = 0.479) but a significant immediate step-down of 7.8% was seen (P = 0.018). For 90-day readmissions, a significant trend reduction over the time period was seen (−0.6% per month, P = 0.017) with a significant immediate step-down (−9.4%, P = 0.001). Emergency department representations, in-patient mortality and length of stay did not change significantly. Improvements in process measures were seen at audit. Conclusion: This model of care resulted in overall trends of reductions in 30- and 90-day readmissions, without increasing emergency department representations, mortality and length of stay. This model will be adapted as the electronic medical record is introduced at our institution.
KW - continuous quality improvement
KW - care bundle
KW - variation
KW - transitional care
KW - heart failure toolkit
UR - http://www.scopus.com/inward/record.url?scp=85104652293&partnerID=8YFLogxK
U2 - 10.1111/imj.14783
DO - 10.1111/imj.14783
M3 - Article
C2 - 32043694
AN - SCOPUS:85104652293
VL - 51
SP - 557
EP - 564
JO - Internal Medicine Journal
JF - Internal Medicine Journal
SN - 1444-0903
IS - 4
ER -