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CHF QUERI VA Heart Failure Trends

CHF QUERI VA Heart Failure Trends. 8/18/2009 Paul Heidenreich MD, MS VA Palo Alto. Outline. Trends in VA HF Hospitalization Heart Failure Network Facility Survey Non-VA Cardiology Use. CHF QUERI. Mission Partner with VA offices/organizations (e.g. OQP, PCS)

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CHF QUERI VA Heart Failure Trends

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  1. CHF QUERIVA Heart Failure Trends 8/18/2009 Paul Heidenreich MD, MS VA Palo Alto

  2. Outline • Trends in VA HF Hospitalization • Heart Failure Network • Facility Survey • Non-VA Cardiology Use

  3. CHF QUERI • Mission • Partner with VA offices/organizations (e.g. OQP, PCS) • Define current VA practice patterns • Determine gaps in care • Identify interventions that will improve quality of care • Understand and assist in the implementation of these interventions

  4. Trends in VA HF Admissions

  5. Trends in HF Mortality

  6. Trends in HF Readmission

  7. Discharge

  8. Severity of Illness P<0.001 P<0.001

  9. Severity of Illness P<0.001 P<0.001

  10. Procedures P<0.001 P<0.001

  11. HF Network Membership • 450+ providers • 155 facilities • 1-12 members at each facility

  12. Table: Provider Categories

  13. Facility Survey % of VAs

  14. Standardized Orders % of VAs

  15. Clinical Reminders % of VAs

  16. Have Patients Been Told They Have Heart Failure? % of Respondents

  17. Outside MD Managing Heart Failure? % of Respondents

  18. Outside MD Managing Heart Failure? % of Respondents

  19. Patient Interest in Services % of Respondents

  20. Facility % of Respondents

  21. Outcome % of Respondents 1 YEAR OUTCOME

  22. MD Location and Outcome % of Respondents 1 YEAR OUTCOME

  23. High Risk for VA Hospitalization • VA Provider • Moderate or greater edema • Moderate or greater dyspnea on walking • 16% had all of these

  24. Use of the Survey • Identification of patients for services • Note to provider let to care coordination referral in 15-20%. • Identification of patients at risk for hospitalization • Candidates for local HF programs • More powerful if it can be combined with existing VA datasets (medication, lab)

  25. Summary • Heart failure readmission rates flat despite improved mortality • Heart Failure Network is a promising mechanism for improving care, spreading innovation. • Wide variation in facility heart failure programs • Dual care has a significant influence on VA hospitalization

  26. Screening Survey • One page • Sent to all patients at Palo Alto VA with one icd9 diagnosis of heart failure in the last 12 months (N=2503) • Asks general questions • Heart Disease • Symptoms • Interest in services

  27. Response • 2503 mailed • 190 found to died • 1799 surveys received (78% response)

  28. Patient Survey Offer • CHF QUERI will identify and survey heart failure patients at other facilities • Customized lists will be returned based on local need • Contact Paul.Heidenreich@va.gov or Anju.Sahay@va.gov if interested

  29. Facility Survey • 144 • 88% cardiologist • 93 reported data on fulltime cardiologists (mean 3.3)

  30. Home Monitoring % of VAs

  31. Home Monitoring Enrollment Number of VAs

  32. Follow Up % of Facilities

  33. Follow-up Time for Clinic Visit % of Facilities 1 YEAR OUTCOME

  34. Follow-up Time for Telephone Call % of Facilities 1 YEAR OUTCOME

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