The primary goal of the VA Chronic Heart Failure (CHF) QUERI is to improve the quality and outcomes of care for Veterans with heart failure (HF). One strategy to achieve this goal was to develop a social network (Community of Practice) to facilitate (1) knowledge exchange and collaboration among VA HF providers, and (2) efficient dissemination of evidence-based practices (EBP) and tools to guide HF care processes. In July 2006 the CHF QUERI formed the VA Heart Failure Provider Network (HF Network) inviting VA providers to join a bi-directional social network for sharing successful HF programs and to collaborate, discuss and exchange ideas and share resources to improve HF care. Over 1200 multi-disciplinary/multi-level providers from throughout the VA have participated as members of the HF Network. The goals of the HF Network are (1) sharing evidence-based HF programs and updates in HF care; (2) understanding the context of HF care (e.g., facility, culture, leadership style, HF program); (3) learning about barriers and facilitators to improving care; (4) establishing collaborations/network among members of the HF Network; and (5) providing opportunities to identify/involve local champions at facilities.
This RRP proposal describes a comprehensive formative evaluation, using mixed methods, to guide ongoing improvement of the HF Network and decisions regarding expansion of the concept within VA.
Aim 1. To document the structure, features and operation of the VA HF Network and assess its effectiveness in facilitating information exchange and implementation of evidence-based practices among VA providers.
a. Determine what percentage of VA HF clinicians are familiar with the VA HF Network.
b. Identify facility and clinician characteristics associated with variations in clinician participation in the HF Network over time.
c. Determine if Network members have initiated collaborations through the HF Network.
d. Determine if Network members receive new information and knowledge through the HF Network, and if they value the information and knowledge received.
e. Determine if members share HF innovations and QI projects through the HF Network, and if they value this benefit of the HF Network.
f. Determine if the VA HF Network has helped members identify and address barriers and facilitators to implementation of effective practice and if the Network has led to enhanced implementation and quality improvement.
g. Determine if attitudes toward the HF network and reported benefits (sub-aims c-f above) vary across types of Network members, such as key opinion leaders in HF care versus other members.
Aim 2. To document awareness, use and impacts of a key component of the HF Network, the HF e-Toolkit.
a. Determine what percentage of VA HF clinicians are familiar with the HF e-Toolkit.
b. Assess ways in which the HF e-Toolkit has been used by different clinicians and staff and in different types of settings.
c. Determine what parts of the HF e-Toolkit are most and least used and most and least valued.
d. Evaluate users' views about the relevance, accuracy, comprehensiveness and format of the HF e-Toolkit.
e. Determine barriers and facilitators to use and benefits of the HF e-Toolkit.
We used an exploratory mixed methods approach to explore perceptions of VA providers and gathered data from:
a) Sample 1 - cross-sectional surveys from all eligible current members of the HF Network (n=878) with a response rate of 24.9%.
b) Sample 2 - brief cross-sectional surveys from non-members (providers) of the HF Network (n=31) with a response rate of 67.7%.
c) Sample 3 - conduct semi-structured phone interviews of selected HF Network members from facilities (n=25).
d) Study logs from existing database of HF Network participation and facility characteristics.
HF Network: The survey respondents (n=219) included leaders from Central Office, VISNs and facilities (11.9%), Chiefs of Cardiology (9.6%), staff physicians (22.8%), nurses (34.2%) and others (14.5%). Almost half of them (43.3%) started providing HF care before 2006 and majority of them (69.1%) were involved with QI projects/programs at their own facility. Their participation in the HF Network's bi-monthly web-based meetings and conference calls ranged from none (n=15, 6.8%) to low (n=159, 72.6%) and high (n=45, 20.5%) levels.
In terms of reported helpfulness of HF Network's activities no significant differences were observed among members participating at low and high levels. Most members self-reported that their participation in the HF Network helped them establish collaborations and/or to network among other members (90%), validated their own current practice in taking care of HF patients (93.6%), encouraged an evidence-based (EB) change in their own practice (89%); and attending bi-monthly live meetings and/or conference calls helped them learn about barriers and facilitators in setting up or running HF program (94.1%). Qualitative analysis strongly supported these above quantitative findings.
Non-members (n=31) responding to the survey included leaders from Central Office, VISNs and facilities (14.4%), staff physicians (19.0%), nurses (57.1%) and others (9.5%). Among them 95.2% were involved with QI projects/programs at their own facility. Among all non-members, 23% had heard about the HF Network and one non-member had joined the HF Network's bi-monthly web-based meeting and/or conference call. All non-members expressed very high interest in the goals of the HF Network ranging from 76.2% - 90.5%.
HF e-Toolkit: 133 member respondents (61.3%) were aware of the HF e-Toolkit and had accessed it 1-9 times. Among them 60.9% had recommended and/or sent the link for the HF e-Toolkit to non-members. They perceived the e-Toolkit very positively in terms of its usability to manage HF patients (96.6%) and comprehensiveness of topics (98.3%), and felt the e-Toolkit helped provide EB care for HF patients (98.0%) and can be used by providers in primary care and PACT teamlets (98.0%) in all types of facilities (98.0%). Supportive qualitative findings showed 75% of the members had heard about the HF e-Toolkit, and 57% of them mentioned specific components as being extremely useful.
Among non-members 19% (n=4) reported being aware of the HF e-Toolkit and 75% of them had accessed this toolkit.
Facility Characteristics: Data from the study logs shows that participation of members in the HF Network was higher in academic facilities (p <.001), those that have a HF clinic (p <.001) and cardiac cath lab (p <.001). Bed size, tertiary/non-tertiary and region were not found to be significant factors influencing participation levels of the HF Network members.
With its focus on the HF Network and the HF e-Toolkit, this project directly addresses all goals of the CHF QUERI discussed in its Strategic Plan. The findings of the project will be directly relevant to others (within and outside VA) interested in starting a provider network or developing a provider toolkit.
None at this time.