Why the study?
There was a gap in the diagnosis and use of guideline-directed medical therapy in patients with heart failure at an internal medicine clinic.
Does a multidisciplinary quality improvement intervention improve guideline-directed medical therapy and reduce emergency department visits and hospitalizations in patients aged 40-75 years with heart failure?
Does a multidisciplinary quality improvement intervention improve guideline-directed medical therapy and reduce emergency department visits and hospitalizations in patients aged 40-75 years with heart failure?
A multidisciplinary quality improvement intervention in a primary care setting successfully increased the accurate diagnosis of heart failure and the use of guideline-directed medical therapy, while reducing emergency department visits.
Supports multidisciplinary QI to boost GDMT and cut ED visits in HF; extends implementation evidence beyond trials.
BACKGROUND: Heart failure (HF) is one of the leading causes of emergency department visits and hospital admissions in the USA. We identified a gap in the diagnosis and the use of guideline-directed medical therapy in patients with HF at the internal medicine clinic. AIM: To improve the diagnosis and treatment of HF, as well as to reduce emergency department visits and hospitalisation over 12 months in patients aged 40-75 years. METHODS: The multidisciplinary quality improvement (QI) team performed a root cause analysis and identified barriers to optimal guideline-directed medical therapy. Rates of patients on guideline-directed medical therapy with systolic HF diagnosis, emergency department visits and hospital admissions were the outcome measures. The process measures included echocardiogram order and completion rates, and rates of accurate classification of HF from the baseline rate of less than 10%. We used the focus, analyse, develop, execute and evaluate (FADE) model with five improvement cycles. The major components of interventions included (1) leveraging health information technology; (2) optimising teamwork; and (3) providing education to patients, physicians and internal medicine clinic staff. Data were analysed using statistical process control and run charts. RESULTS: We observed a reduction in the total number of emergency department visits (160 vs 108), hospital admissions (117 vs 114) and observation visits (22 vs 16) comparing the 1-year preproject and 1-year postproject periods. An increase in the use of ACE inhibitors or angiotensin receptor blockers occurred from the baseline rate of 20%-37% during the second half of the project and was sustained at 71.4% (median) during 6 months of the postproject period. CONCLUSIONS: We achieved a sustainable increase in the accurate diagnosis of HF and achieved 80% diagnosis during the 6-month poststudy period.
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Bakhai et al. (2019) studied Heart failure. Multidisciplinary quality improvement intervention vs. Pre-intervention baseline was evaluated on Rates of patients on guideline-directed medical therapy, emergency department visits, and hospital admissions. A multidisciplinary quality improvement intervention reduced emergency department visits (160 to 108) and increased ACE inhibitor or ARB use from 20-37% to 71.4% in patients with heart failure.