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Gwtg hf williamsburg


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Gwtg hf williamsburg

  1. 1. HF Get With The Guidelines Heart Failure Program Tiffany D. McGhee RN, MS, MPH Director of Quality Improvement American Heart Association
  2. 2. HF Background on Heart Failure Population Hospital 1 Group Prevalence Incidence Mortality Discharges Cost Total $34.8 5,300,000 660,000 284,965 1,084,000 population billion • Heart failure (HF) is a major public health problem resulting in substantial morbidity and mortality • Despite recent advances a substantial number of patients are not receiving optimal care 1American Heart Association. 2008 Heart and Stroke Statistical Update. Dallas, TX: American Heart Association; 2008. 2Hunt SA et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult. 2001.
  3. 3. HF 10 Prevalence of HF Increases With Age Males 8 Population (%) Females 6 4 2 0 20–24 25–34 35–44 45–54 55–64 65–74 75+ Age (yr) US, 1988–1994 AHA. Heart Disease and Stroke Statistics 2004 Update
  4. 4. HF Heart Failure Hospitalizations The number of heart failure hospitalizations is increasing in both men and women CDC/NCHS: Hospital discharges include patients both living and dead. AHA, 1998 Heart and Statistical Update NCHS, National Center for Health Statistics AHA Heart and Stroke Statistical Update 2004
  5. 5. HF New Goal By 2020 improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular disease and stroke by 20%.
  6. 6. HF Bridge the Gap
  7. 7. HF Bridging the Gap Between Knowledge and Routine Clinical Practice AHA/ACC Clinical Guidelines Systems Practice I IIa IIb III • Implement evidence- based care • Improve communications • Clinical trial evidence • Ensure compliance • Improve quality of care • National guidelines • Improve outcomes Adapted from the American Heart Association. Get With The Guidelines; 2001.
  8. 8. HF Definition of Quality “Degree to which health care services increase the likelihood of desired health outcomes and are consistent with current professional knowledge” – Are you doing the right things? – Are your patients better off for it?
  9. 9. HF Building a Continuum of Care in the Inpatient Setting Create culture and Pilot resources Improved Assess new QI to Patient Quality programs ensure Outcomes & greater initiatives guideline adherence
  10. 10. HF Heart Failure Quality Improvement Program • Why have a QI program for HF? – Mortality from HF is high. – Major reason for readmission in the US. – Large cost to US healthcare economy. – Improved quality of life for HF patients and caregivers. – Hospital benefits by open bed space.
  11. 11. HF Why a Hospital-Based System • Patients for HF Management? – Patient capture point – Have patient’s/family’s attention: ―teachable moment‖ – Predictor of care in community • Hospital structure – Standardized processes/protocols/ orders/teams – Accrediting bodies for standards of care – Centers for Medicare and Medicaid Services—peer review organizations • JCAHO (in-hospital) • HEDIS (post-discharge) Fonarow GC et al. Am Heart J. 2004;148:43–51.
  12. 12. HF Hospital-based System in Heart Failure Reduces Readmissions P<.0001 and Mortality Pre-intervention (n=11,038) 95* Post-intervention (n=8045) Treatment Rates (%) HR 0.80 65 P<.0001 46 HR 0.77 38* P<.0001 23 18* ACEI Rx Readmissions 1-Year Mortality Intermountain Health Care: 10 hospitals 1/1996–12/1998 (n=11,038) to 1/1999–3/2000 (n=8045) Pearson RR et al. Circulation. 2001;104:II-838.
  13. 13. HF Since 2001 Over 1500 Hospitals Nationwide Over 2 Million Patient Records Over 625 Hospitals Receiving Recognition Almost 55 Peer Reviewed CONFIDENTIAL – American Heart Association 2009 Publications
  14. 14. HF CONFIDENTIAL – American
  15. 15. HF What is GWTG-HF? • The American Heart Association’s in- hospital quality improvement program aimed at ensuring every heart failure patient receives the best care possible.
  16. 16. HF GWTG-HF Program Objectives • Improve medical care and education of patients hospitalized with heart failure • Accelerate initiation of the HF evidence-based, guideline-recommended therapies by starting these therapies before hospital discharge in appropriate patients • Increase understanding of and overcome barriers to uptake of evidence-based therapies in this patient population
  17. 17. HF Get With The Guidelines: Elements of Success for Hospitals • Attend a GWTG workshop • Designate a champion from hospital • Recruit care team for implementation • Enter baseline data into the Patient Management Tool • Institute care paths, standing orders and discharge protocols that are consistent with the ASA/AHA guidelines • Utilize the Patient Management Tool to record and improve patient care. • Achieve Performance Award levels
  18. 18. HF GWTG Heart Failure Performance Measures Evidence Based Recommendations • Discharge instructions and HF patient education. • Measurement of left ventricular (LV) function in all eligible patients. • ACE inhibitor or ARB provided at discharge in eligible patients with LVEF of <40%, in the absence of documented contraindications or intolerance. • Beta-blocker provided to eligible patients at discharge with LVEF <40% in the absence of documented contrindications or intolerance. • Smoking cessation counseling provided to all eligible patients (current or recent smokers). ACC/AHA Clinical Performance measures for Adults with Chronic Heart Failure, Bonow, RO, et al. Circulation September 20, 2005
  19. 19. HF GWTG-HF Data Collection • Relevant medical history • Discharge Status • Smoking within the last 12 • If patient expired, primary cause months of death • HF History • Symptoms (closest to • Symptoms (closest to discharge) admission) • Vital Signs (closest to • Vital Signs discharge) • Exam (closest to admission) • Exam (closest to discharge) • Labs (closest to admission; • Labs (closest to discharge) peak to troponin) • Discharge medications • Admission medications (taken • Smoking cessation counseling prior to admission) • Discharge instructions • Parenteral therapies • Date of discharge • Procedures during this hospital • Process of care improvement stay • Ejection Fraction
  20. 20. HF GWTG-HF PMT Form
  21. 21. HF GWTG-HF PMT Special Features: Referral Note
  22. 22. HF GWTG-HF PMT Special Features: Patient Ed
  23. 23. HF GWTG-HF PMT Reporting Interface
  24. 24. HF Get With The Guidelines Works! Hospitals Participating in GWTG Provide Higher Quality Care with Better Clinical Outcomes than Other Hospitals
  25. 25. HF GWTG Gets Results:Performance - Heart Failure 100% 80% 60% 40% 20% 0% ACE or ARB at Smoking cessation Beta blockers at Discharge LV function Composite quality of discharge for counseling, current discharge for instructions measurement care measure patients w ith LVSD, smokers patients w ith LVSD, Baseline 69.60% 90.60% 83.30% 74.30% 86.50% 80.00% GWTG 79.40% 94.20% 85.90% 91.40% 89.40% 87.80%
  26. 26. HF Year All HF Patients 2003 6.02 (14252) 2004 5.79 (23533) 2005 5.72 (46928) 2006 5.62 (60147) 2007 5.62 (72268) 2008 5.6 (82769) 2009 5.57 (88706)
  27. 27. HF Year All HF Patients 2003 3.6% (547) 2004 3.7% (915) 2005 3.4% (1652) 2006 3.1% (1954) 2007 3% (2268) 2008 2.6% (2266) 2009 1.2% (1161)
  28. 28. HF
  29. 29. HF
  30. 30. HF AHA Get With The Guidelines is Award Winning • First hospital-based program to receive the prestigious Innovation in Prevention Award from U.S. Department of Health and Human Services. • Recipient of Inaugural eHealth Initiative (eHI) Award Honoring Leadership in Health Care Quality through Health IT for Transforming Care Delivery
  31. 31. HF GWTG-HF Recognition Program Performance Measures 1. HF Discharge instructions provided to all eligible patients 2. Measurement of LV function in all eligible patients 3. ACE inhibitor and/or ARB at discharge provided to eligible patients with LVEF < 0.40, in absence of documented contraindications or intolerance 4. Beta blocker at discharge provided to eligible patients with LVEF < 0.40, in absence of documented contraindications or intolerance 5. Smoking cessation counseling provided to all eligible patients (current or recent smokers)
  32. 32. HF Silver Performance Achievement Award Criteria Indicate compliance of applicable performance criteria in at least 85% of patients for 12 consecutive months
  33. 33. HF Silver Plus Performance Achievement Award Criteria Indicate compliance of applicable performance criteria in at least 85% of patients for 12 consecutive months and at least 12 consecutive months of 75% or higher compliance with 4 of 9 Get With The Guidelines Heart Failure Quality measures
  34. 34. HF Gold Performance Achievement Award Criteria Indicate compliance of applicable performance criteria in at least 85% of patients for two consecutive 12 month intervals
  35. 35. HF Gold Plus Performance Achievement Award Criteria Indicate compliance of applicable performance criteria in at least 85% of patients for consecutive 12 month intervals and at least 12 consecutive months of 75% or higher compliance with 4 of 9 Get With The Guidelines Heart Failure Quality measures
  36. 36. HF CONFIDENTIAL – American Heart Association 2009
  37. 37. HF Challenges to Implement a Heart Failure Performance Improvement System • This will not work in a community practice or hospital • The cardiologists will not agree to this • We can not get a consensus • The managed care organization will not pay for it • Patients do not want to be on a lot of medications • There is not enough time • It will cost too much • It may not be safe to start BB medications in heart failure patients • This will benefit the competition • The administration will not pay for it • What about the liability? • It will take too much time • All my patients are too complex for this • The patients should all be followed by someone else • It is too hard to get things through the practice committee • The physicians at my office do not like cookbook medicine • We do not have anyone to do this
  38. 38. HF Tools for Smooth HF Transitions • Should target both patient and providers • Improving transitional care – Better communication for transferring MD • Discharge summaries, EMR exchanges, etc – Closer follow-up care for those who need it • Minimizing “Door to clinic times” – Better patient education tools • Informing patients, family about disease, treatment – Tools to increase medication adherence • Pill boxes, pharmacist programs, disease management – Disease and risk management programs • Patient empowering, self management, multidisciplinary HF clinics, web based programs
  39. 39. HF Continuity of HF Care Reliable Care: Not Missing the Steps Hospital CCU DC Early Post Outpatient ED Telemetry DC • Oral •On right meds? •Diagnosis • IV Meds Meds • Right •On right dose? • Admit •Oral Meds • Other meds? •Volume status • CCU? •LV function Rx? •Titration •Re-assess EF •Acute Rx • Echo and/or •Other •Pt •Device? •Evaluation Cath? eval Education •Self Manage? •Other •Pt Ed Disease •Other Issues? Evaluation •F/U Manage •Tx to Floor •Disease •Continuity Manage Device? Fonarow GC Rev Cardiovasc Med. 2006;7:S3-11
  40. 40. GWTG-HF True Value HF Actual Cost Market Value GWTG-HF Patient Management Tool $1,195.00/year $10,000-$30,000/year Educational Programs $40 per person $10/hour/person -GWTG Workshop CEU/CME Teleconferences Free Free Patient Education Material Free $5,000-$10,000/year QI Consultative Services Free $250-$700/hour JC Advanced HF Certification Site Review *$500-$800 $5,000-$15,000 Technical Support Free $20-$50 charge per call Marketing Opportunities with AHA Free $20,000-$50,000/year Total $1,735-$2035/year $64,000-$154,000/year *Note: For HF Certification preparatory reviews we are including a stipend to cover costs for lodging, mileage and/or air fare, and meals for AHA staff.
  41. 41. HF GWTG-HF Cycle of Quality Improvement Find and Support a Champion Assess HF Treatment Rates Measure current treatment rates and process-of-care indicators Implement Refined Protocols Evaluate Assessment Hospital team coordinates Hospital team reviews implementation of refined summary reports and current protocols protocols Refine Protocols Hospital team identifies areas for improvement
  42. 42. HF What’s Next With Get With The Guidelines®?
  43. 43. HF Taking The Failure Out of Heart Failure Collection of content-rich resources for patients and professionals • Educational Tools • Prevention Programs • Treatment Guidelines • Quality Initiatives and Outcome-based programs
  44. 44. HF GWTG BEST PRACTICE TOOLKIT The best practice project demonstrates the American Heart Association’s continued commitment in providing the GWTG community the resources necessary to achieve quality goals. • Purpose of the project was to determine the best practices that could be instrumental in assisting other organizations in meeting and sustaining their quality goals. • Interviews, on line discussion sessions and focus groups were conducted with over 100 professionals representing GWTG silver and gold award winning hospitals. • A Best Practice multimedia on-line guidebook will be the result of this in depth market research. • The guidebook will initially contain 15 -17 best practices for HF and Stroke. Each best practice process is described in detail including supporting documents and educational programs. • Organizations will be able to adapt these best practices and tools to assist in meeting quality goals. CONFIDENTIAL – American Heart Association 2009
  45. 45. HF TJC Advance Certification in HF
  46. 46. HF HF
  47. 47. HF ―Knowing is not enough; we must apply. Willing is not enough; we must do.‖ Johann von Goethe
  48. 48. HF