Document Type

Conference Proceeding

Publication Date


Publication Title

J Gen Intern Med


STATEMENT OF PROBLEM/QUESTION: After multistakeholder design of an inpatient, outpatient, and home heart failure (HF) care pathway, our regional health system needed implementation plans to drive uptake of key HF care steps. DESCRIPTION OF PROGRAM/INTERVENTION: Implementation plans are based on the AHRQ Learning Health System (LHS) framework and the Influencer change framework (Grenny, et al.). The LHS framework drives iterative care improvements via evidence application and ongoing learning from clinical performance data. The Influencer framework guides interventions that improve personal, structural, and social abilities and motivations to improve. The HF pathway included evidence-based interventions such as prescribing guideline directed medical therapy (GDMT), using universal healthliteracy appropriate patient education materials, and referring appropriate patients to cardiology, home-based care, or palliative care. Our implementation design team consisted of clinician-educators, residents, nurses, data analysts, an instructional designer, and a management engineer. Interventions include: 1) Driving buy-in by redesigning the pathway with facilitated teams of 100 clinicians and leaders from all disciplines and care venues; 2) Improving HF knowledge via education modules on our learning management system; 3) Audit and feedback of pathway uptake metrics; and 4) EMR tools to facilitate ordering of pathway steps. Education objectives are to update clinician knowledge on new HF nomenclature, GDMT, and descriptions of key steps in the HF care pathway. Rollout of these interventions is currently in progress. MEASURES OF SUCCESS: Clinician and executive qualitative feedback on content, usability, and design via unstructured interviews and our system wide HF governance structure. We will use the RE-AIM framework for evaluation of implementation. FINDINGS TO DATE: 1. The pathway design process engaged teams over 3 years despite competing priorities from COVID. 2. System wide education requires addressing differing resources across care settings and payors. 3. Defining which patients have HF by EMR data allowed real-time identification in hospitals, but challenges remain for outpatient and ED settings. 4. Specialty and location-based governance may be siloed, causing diffusion of ownership of implementation. KEY LESSONS FOR DISSEMINATION: Implementation plan design for the HF care pathway was successful due to: 1. Use of the AHRQ LHS and Influencer change frameworks facilitated more in-depth planning for spread and sustainability of clinical change. 2. Multi-stakeholder teams for sustained engagement across care siloes. 3. Executive sponsorship for system integration and local accountability. 4. Management engineer to coordinate multiple, diverse teams. 5. Instructional designer for effectiveness of education.




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