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Improving Heart Failure Management in Skilled Nursing Facilities

Improving Heart Failure Management in Skilled Nursing Facilities. AMDA Foundation/Pfizer Quality Improvement Award. Rebecca S. Boxer, MD Assistant Professor of Medicine. Heart Failure is the Most Common Reason for 30-Day Rehospitalization. Jencks N Engl J Med 2009.

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Improving Heart Failure Management in Skilled Nursing Facilities

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  1. Improving Heart Failure Management in Skilled Nursing Facilities AMDA Foundation/Pfizer Quality Improvement Award Rebecca S. Boxer, MD Assistant Professor of Medicine

  2. Heart Failure is the Most Common Reason for 30-Day Rehospitalization Jencks N Engl J Med 2009

  3. Hospital Discharges for Heart Failure by Age and Sex (FHS: 1980-2003). Source: NHLBI. * HF based on physician review of medical records and strict diagnostic criteria.

  4. Discharge Status from the National Hospital Discharge Survey 1980-2004 % *LTC includes NH and SNF Fang JACC 2008;52:428–34

  5. Hospital to Home(does not include SNF) A national quality improvement initiative of the American College of Cardiology and the Institute for Healthcare Improvement Goal Reduce 30 day, all-cause readmission rates for patients discharged with cardiac conditions by 20 percent by December 2012.

  6. The Bridge Project • Assess the HF Management in 4 SNF in Greater Cleveland area And then • Identify needs of SNF • Create HF disease management program for SNF

  7. Results from 4 Facilities • No HF disease management programs • No tracking of patients with HF • Inadequate dietary flexibility • Poor symptom recognition • No medication titration protocols or flexible diuretic regimens Boxer et. al. JAMDA 2011 in press

  8. AMDA Foundation/Pfizer Quality Improvement Award Preparing the SNF for change in HF Management • Program to Educate all Staff • Train the Trainer • Develop multi-media tools to teach both staff and patients

  9. Results from HF Educational Program Boxer et. al. JAMDA 2011 in press

  10. Development of HF Teaching Videos • Nurse teaching STNA to manage HF • STNA teaching Patient to manage HF • Nurse teaching family to manage HF - Focus Group Assessment – Motivational Interviewing Techniques added STNA = State Tested Nurses Aide

  11. Thanks to: Ileana Piña MD, MPH Mary Dolansky RN, PhD Jeanne Hitch Med, MA Peter Degolia MD Matthew Wayne MD Megan Frantz, BA Regina Prosser RN-BNC AMDA Foundation/Pfizer Quality Improvement Award The McGregor Foundation CWRU/Mt Sinai Skills and Simulation Center Case/Cleveland Clinic Multidisciplinary Clinical Research Training Program; 1KL2RR024990 The Bridge Project a Collaboration

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