DEVELOPMENT OF A LEARNING COMMUNITY TO IMPROVE SYSTEMWIDE EVIDENCE-BASED HEART FAILURE CARE

Document Type

Conference Proceeding

Publication Date

6-17-2022

Publication Title

Journal of General Internal Medicine

Abstract

STATEMENT OF PROBLEM/QUESTION: Reliable execution and coordination of evidence-based congestive heart failure (CHF) care across large healthcare organizations is highly complex. DESCRIPTION OF PROGRAM/INTERVENTION: Using principles from the National Academy of Medicine's Learning Health System (LHS) framework, we developed an organizational model to drive improvement and sustain organization-wide CHF care improvement. We formed seven interdisciplinary workgroups: inpatient, emergency medicine, primary care, palliative care, home-based care, pharmacy and analytics. Each contributed to a systemwide CHF care protocol. The leaders from each workgroup coordinated care between settings to improve experience and reduce readmissions. The analytics group created provider-level dashboards for accountability and regional dashboards for executive leaders. MEASURES OF SUCCESS: The LHS goal is to design, continuously improve, and drive adoption of a system-wide CHF care protocol. Process and outcome metrics are utilization rates of each of the protocol components and CHF readmission rates, respectively. FINDINGS TO DATE: Initial review identified 23 local pilot CHF care projects across our system. Workgroup members included those project leaders, other providers, heart failure experts and administrators to represent all system care settings (N=127). The groups selected five key care steps, executed in any care setting, for the initial CHF care protocol: 1) Optimization of guideline-directed medications; 2) Standard triggers for cardiology and palliative care referral of complex and end-stage patients, respectively; 3) Referral to hospital-level care at home; 4) Standard hospital discharge process and follow-up within 7 days; and 5) Standard patient-engagement materials. Structured feedback from front-line staff and patient representatives was used in selecting steps. Audit and feedback of provider-level process metrics by local leaders will enable accountability. The workgroups, enabled by regional and executive leaders, will monitor sustainability, spread and improvement. KEY LESSONS FOR DISSEMINATION: A front-line interdisciplinary learning community chose a focused care protocol to improve reliability and coordination of CHF care. Several generalizable lessons were learned. Workgroups focused on just 1-2 key care steps selected based on impact, evidence, and likelihood of local adoption. Structured meetings of the workgroup leaders aligned care goals and coordinated between care settings. Workgroup membership broadly selected by local opinion leaders represented the entire care continuum. They chose protocol steps that were feasible across the organization and could be flexible in how they were implemented. Patient representatives monitored patient- and family-centeredness of the protocol. Electronic medical record tools enabled ease of execution of the protocol steps. Similar learning communities may be created to work on other patient populations defined by disease states or common social determinants, for example.

Volume

37

Issue

Suppl 2

First Page

S598

Find It @ Sladen

Share

COinS