Improving the Management of Patients with Heart Failure

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Improving the Management of Patients with Heart
Failure

• Joseph J. Benich III, MD
• Trident/MUSC Family Medicine Residency Program

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Heart Failure (HF)

• Common problem in primary care
• Prevalence - 4.9 million people in US
• Incidence - 550,000 people each year in US
• Guidelines established
• American College of Cardiology and the American
  Heart Association
• Many clinic patients are not receiving optimized
  treatment regimens in accordance with these
  guidelines

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I3 Collaborative

• A Practice Innovations Collaborative for Family
  Medicine Educators in North and South Carolina
• Trident/MUSC FM Program participating
• Purpose
• To monitor and improve the care being provided by
  FM Residencies in NC and SC, especially focusing
  on the care being provided to patients with
  diabetes and HF

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Trident/MUSC Family Medicine

• Purpose
• Are the chronic care model and quality
  improvement initiatives effective approaches to
  managing patients with HF in the Trident/MUSC FM
  Residency Practice?

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Measures

• Process measures
• Percentage of patients with ejection fraction
  (EF) measured
• EF lt40 on ACE-inhibitor or angiotensin receptor
  blocker (ACEI/ARB)
• EF lt40 on beta blocker (BB)
• Outcome measures
• Hospital admission and readmission rates

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Methods

• Patient registry
• Adults with HF based on ICD-9 codes and either
  outpatient or inpatient contact
• Baseline chart review to evaluate process and
  outcome measures
• Updated quarterly with patients seen in the past
  6 months
• Approved as exempt research by the MUSC IRB

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Methods

• Interventions
• Delivery system redesign - case management
• Additional clinic appointments scheduled at least
  once in every 3 month block to allow for desired
  changes to be made to current treatment regimens
• Collaboration with I3 programs
• Monthly conference calls to share data and senior
  leader reports

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Results Demographics
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Results Process measures

• Percentage of patients on ACE/ARB, BB therapy
  with EF lt 40
• Best Practice EF measured on ACE/ARB BB

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Results Outcome Measures
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Discussion

• Goals are being met for the percentages of
  patients who have EF measured and who are taking
  ACEI/ARB and BB
• Hospitalization and re-hospitalization rates are
  decreasing

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Future Direction

• Decision support
• Redesigning electronic health record templates to
  embed point of care reminders from HF guidelines
• Self management plans need to be created and
  implemented
• Monitoring weights at home is the next step, once
  electronic health record revised

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Conclusion

• HF is a serious condition with high morbidity and
  mortality commonly managed in primary care
• Applying the principles of the chronic care model
  and quality improvement are effective approaches
  to the management of patients with HF
• I3 collaborative is an effective organization for
  optimizing the care of patients

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