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The Impact of Innovation on Heart Failure Care

The Impact of Innovation on Heart Failure Care. Amber E. Johnson, MD, MBA PGY-3 Johns Hopkins Bayview Medical Center. Disclosures None. Background. Heart failure is common It is complicated to manage as an outpatient > 3 million ambulatory care and emergency department visits annually

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The Impact of Innovation on Heart Failure Care

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  1. The Impact of Innovation on Heart Failure Care Amber E. Johnson, MD, MBA PGY-3 Johns Hopkins Bayview Medical Center

  2. DisclosuresNone

  3. Background • Heart failure is common • It is complicated to manage as an outpatient • > 3 million ambulatory care and emergency department visits annually • > 1 million hospitalizations annually • Heart failure is costly • 25% readmitted in one month • $$$ • Patient-centered care can help

  4. Purpose Because patients with heart failure have a high 30 day readmission rate, high costs, and poor quality of life… we wanted to investigate: What can we be doing better?

  5. Methods • Multi-disciplinary working group • Define • Measure • Analyze • Improve • Control

  6. Results • The most promising interventions were piloted as improvements • Scaled up based on success and patient interest • Examples: • Patient education materials • Evidence-based provider order sets • Nursing and provider education • Teach back tools • Motivational interviewing training • Mechanisms for close outpatient follow up • Collaboration with home care and local nursing homes

  7. Results • No statistically significant differences in pre- and post-intervention groups • Rate of 30-day all cause readmissions for HF declined from 28.4% to 18.9% (p<0.01) • This lead to an estimated reduction in charges of about $900,000 dollars

  8. Conclusions • An iterative innovations framework, has reduced 30-day readmission rates in heart failure • This approach included • Identifying deficiencies in the processes of care • Addressing the challenges patients face in caring for themselves at home • Customizing interventions to fit patients’ needs • Efforts are now focused on expanding the scale of this model

  9. Resources • Roger VL et al. Heart Disease and Stroke Statistics--2012 Update: A Report From the American Heart Association. Circulation. 2012;125(1):e2-e220. • Kociol RD, Peterson ED, Hammill BG, et al. National survey of hospital strategies to reduce heart failure readmissions findings from the get with the guidelines-heart failure registry. Circ Heart Fail. 2012;5:680-687. • Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc. 2007 Jun;82(6):735-9. • Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011 Oct 18;155(8):520-8. • Glasgow JM, Scott-Caziewell JR, Kaboli PJ. Guiding inpatient quality improvement: a systematic review of Lean and Six Sigma. Jt Comm J Qual Patient Saf. 2010 Dec;36(12):533-40. • Brown T. Design thinking. Harv Bus Rev. 2008;86(6):84-92. • Ries E. The lean startup: How today's entrepreneurs use continuous innovation to create radically successful businesses. New York, NY: Crown Publishing; 2011.

  10. Acknowledgements Kapil Parakh, MD Laura Winner, RN Carol Sylvester, RN Shaker M Eid, MD Robert Hody, MS Sharon Augustine, CRNP Tanya Simmons, RN Angel Sampedro, BS

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