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RRP 09-150 – QUERI Project

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RRP 09-150
Standardization of Heart Failure Assessments Using Home Tele-Health
Paul A. Heidenreich MD MS
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: September 2009 - January 2011

BACKGROUND/RATIONALE:
Care Coordination Home Telehealth (CCHT) is used by many VA providers to monitor and educate high-risk patients with different chronic diseases including heart failure. Several vendors provide home based devices and have different protocols for obtaining information. In addition, many VISNs have customized protocols. While this allows flexibility in the questions asked, there are no standard core questions that will allow pooling and comparisons across sites. As subject matter experts, the VA Office of Care Coordination (OCC) contacted the CHF QUERI to develop a standardized Disease Management Program(DMP) for Heart Failure (HF) which would be used by all vendors and implemented for all heart failure patients enrolled in the CCHT program.

OBJECTIVE(S):
The purpose of this project is to standardize a set of core questions for heart failure that would be asked of patients by all vendors for VA heart failure telehealth. Existing protocols will be examined by a Committee of clinicians and home telehealth experts. A core list of questions will be determined that allows for capture of appropriate symptoms, outcomes and other information while limiting the question burden on the patient to an acceptable level. Once selected, these questions will be pilot tested at two centers before a more widespread rollout occurs.


METHODS:
Existing questions provided by the Office of Care Coordination and proposed new questions were evaluated by a multidisciplinary committee of 11 members called the DMP for HF review Committee. Their names and discipline are provided in Appendix F, Executive Committee Subgroups Members. The members are physicians, cardiologists, nurses, a pharmacist, patient educator, social scientist and a consumer representative.

After creation of the first draft Standardized Disease Management Protocol (DMP) the vendors reviewed it for comments. A second draft was then created.

After creation of the second draft Standardized Disease Management Protocol (DMP) the Office of Care Coordination picked two VA sites to pilot test it.

Reviews from the sites were then used to revise the Disease Management Protocol.

The final Disease Management Protocol was then submitted to the Office of Care Coordination for implementation.

FINDINGS/RESULTS:
A standardized Disease Management Protocol was created with the help of a multidisciplinary committee of 11 members. The protocol was reviewed by vendors and two VA test sites. The test sites had suggestions for improvement but found that in general it was well received by patients and providers. The final version was submitted to the Office of Care Coordination for implementation.

The protocol quesitons include: 8 daily, 4 weekly, 3 monthly, 7 quartelry, and 1 semi-annually. Total question burden averages less than 9 questions each day.

The questions cover symptoms, weight, vital signs, medication use, diet, and related condisitons (e.g. depression, alcohol, sleep apnea).

There are up to 15 second line questions that may be asked based on the patient's response to the first question. After each answer the patient receives and informational/educational response.


IMPACT:
This project will result in a standardized telehealth product for the VA to offer to patients regardless of vendor. It will also allow pooling of patient data across all sites within the VA, thus contributing to improved quality of care and research into health status of patients with heart failure. It also serves as a starting point for combining Disease Management Protocols for different disease states (such as heart failure and diabetes).

PUBLICATIONS:
None at this time.


DRA: Health Systems, Cardiovascular Disease
DRE: Diagnosis, Technology Development and Assessment
Keywords: Assessment, Chronic heart failure, QUERI Implementation, Telemedicine
MeSH Terms: none