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IMV 04-050 – HSR&D Study

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IMV 04-050
Implementation of Coordinated Care Program for HF in VHA
Rebecca J. Beyth MD MSc
Michael E. DeBakey VA Medical Center, Houston, TX
Houston, TX
Funding Period: January 2004 - June 2004

BACKGROUND/RATIONALE:
HF is prevalent and costly, and its impact is increasing annually. Although effective therapies are available, they are not applied appropriately or optimally. This leads to acute decompensation imposing burdens on emergency care, urgent care, primary care and specialists. For example, within the VA healthcare system there were 185,917 patients with an outpatient diagnosis of CHF in FY98 compared to 334,651 in FY02 (a 44% increase). Similarly, within VISN 16 there was a 42% increase over the same time period. Additionally, these 30,696 patients with an outpatient diagnosis of CHF had 26, 064 urgent care visits, 10, 870 cardiology clinic visits and 88,018 primary care visits in FY02. Furthermore, 2/3 of veterans with HF die within 5 years of their initial hospitalization. Efforts that implement known best practices aggressively and organize facilities and patients in a model of continuous management with just-in-time visits will likely improve clinical, fiscal and process related outcomes. We previously demonstrated in pilot work that a coordinated care program in HF did successfully decrease readmissions and costs in the Houston VAMC. We learned from our pilot project that in order to ensure sustainability, a HF program needed to be more specifically tailored to the existing organizational structure and work force of the targeted VA facility, as well as the patients’ needs.

OBJECTIVE(S):
To modify and refine a coordinated care program for HF using facilities with three distinct models of care within VISN 16. Our long-term goal is to develop an implementation model for HF that can be adopted throughout the VA healthcare system. The objectives of our six-month planning project are:
A. To facilitate implementation of known best practices for HF management using national guidelines in a coordinated care approach from acute decompensation to chronic care in representative VA facilities.
B. To generate knowledge that will facilitate a HF implementation plan, which will incorporate assessment and evaluation of educational needs (patients and providers), acute care needs, and chronic care needs (including telehealth) tailored to the organizational structures that support the care of VA HF patients and can be implemented across VA networks.

METHODS:
This is a planning grant to perform a cross-sectional assessment of HF treatment in 3 distinct healthcare models within VISN 16: (1) a tertiary care medical center with on-site cardiology support; (2) a community based outpatient clinic (CBOC) in both physical proximity and affiliation with a tertiary center; (3) a more remote CBOC that employs fee basis to private community facilities to support the care of its HF patients. Using 3 types of facilities with differing missions and staffing will provide us with knowledge and a process for implementing HF programs that can be generalized and exported to other VISNs. We will conduct focus groups of HF patients; one from each model of healthcare delivery, to assess how HF patients regard coordinated care in their facilities. Additionally, we will assess the current staff, training programs and telehealth capabilities at these 3 facilities and patients’ perceptions of them. Thus, we will obtain important information on providers, patients and their facilities that we will useful for tailoring HF coordinated care programs.

FINDINGS/RESULTS:
We have conducted the focus groups sessions, transcriptions and initial round of coding.

IMPACT:
The work from this planning grant will help us to develop a more integrated HF program that is acceptable to HF patients that can then be used to facilitate implementation of best management practices in HF.

PUBLICATIONS:
None at this time.


DRA: Health Systems
DRE: none
Keywords: Access, Implementation, Quality assurance, improvement
MeSH Terms: none

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