Impact of a model of care for heart failure in‐patients to reduce variation in care – a quality improvement project

Ingrid Hopper, Kellie Easton, Ilona Bader, James Campbell, Lucy Busija, Peter Markey, Peter J. Bergin, David M. Kaye

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Abstract

Background: We identified variation in delivery of guideline recommended care at our institution, and undertook a project to design a HF model of care. Aim: To maximize time patients with HF spend well in the community by delivering best practice guidelines to reduce variation in care improving overall outcomes. Method: 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 hours, and a nurse-pharmacist early follow-up clinic. Outcomes were assessed using interrupted time series analyses. Results: The pre-intervention group comprised 1,585 patients, and post-intervention 1,720 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 with significant step-down of 7.8% (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 re-presentations, 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 ED representations, mortality and length of stay. This model will be adapted to the electronic medical record at our institution.
Original languageEnglish
Number of pages29
JournalInternal Medicine Journal
DOIs
Publication statusAccepted/In press - 11 Feb 2020

Keywords

  • continuous quality improvement
  • care bundle
  • variation
  • transitional care
  • heart failure toolkit

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