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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3039 — Using a Heart Failure Provider Network to Implement the Hospital to Home (H2H) Initiative: Results from a Randomized Trial

Heidenreich PA (VA Palo Alto), Sahay A (VA Palo Alto), Gholami P (VA Palo Alto), Oliva N (VA Palo Alto), Rumsfeld J (VA Denver), Massie BM (VA San Francisco)

The Hospital to Home (H2H) is a national quality improvement (QI) initiative cosponsored by the American College of Cardiology (ACC) and the Institute for Healthcare Improvement (IHI) and joined by the VA. Individual hospitals are asked to join and implement QI projects related to the transition of care for hospitalized patients with heart disease. We sought to determine if the existing VA Heart Failure (HF) Network created by CHF QUERI can be activated to increase H2H enrollment and implementation of QI interventions.

We randomized 122 VA facilities with at least 20 discharges for HF in 2008 to HF network activation (intervention, 61) or no activation (control, 61). All facilities were made aware of H2H through national calls with Chiefs of Staff and VISN Chief Medical Officers. VA HF Network members from intervention facilities were invited to periodic teleconferences describing H2H and received several reminder emails. At 4-6 months HF network members from both intervention and control facilities were contacted to determine ongoing QI projects. The primary outcome was facility enrollment in the national H2H program (results supplied by ACC/IHI). Secondary outcomes were presence and number of heart failure QI projects in response to H2H at 6-months following randomization.

Intervention and control VA facilities had similar HF discharge volume (mean 266 per year for both). Among the 61 facilities randomized to HF Network activation 33 (54%) enrolled in H2H, compared to 6 of 61 (10%) in the control arm (p < 0.001) at 6-months after randomization. Of the 38 intervention facilities responding to a follow-up survey, 13 facilities stated they had initiated 22 QI projects as a result of the H2H campaign. Another 7 facilities had planned H2H projects. Of the 20 control facilities that responded, 5 had initiated 9 projects as a result of H2H and none had plans to do so.

Activation of the VA Heart Failure Network was successful in increasing enrollment in the H2H initiative and appeared to increase the number of quality improvement projects.

Provider networks are a potentially valuable tool for implementation of national quality improvement campaigns.

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