Heart failure: improving the continuum of care

In the United States (US), heart failure (HF) is the leading medical condition resulting in hospital admission. Despite advances in treatment, the number of HF deaths has continued to increase. At Carolinas Medical Center (CMC), more than 950 annual HF admissions provided an opportunity to examine morbidity, mortality, and readmission rates. Within the facility there exist two HF disease management programs treating more than 1500 patients annually. Through a systematic approach to identify the root causes of morbid and less severe complications, the facility addressed process improvement steps to positively impact HF treatment. Included in these strategies was a link to the outpatient continuum of care created for the HF patient. An examination of the HF program revealed the care to be fragmented, both organizationally and physically. A majority of readmissions could be prevented through closer patient follow-up and more aggressive therapy. Intensive education for staff about the disease management process, medication interventions, smoking cessation, and nutrition counseling was lacking. An interdisciplinary committee, with strong administrative support, was established to evaluate the current program and recommend changes. Delivery of patient care was changed to an integrated care management system model identifying the root causes of the most prevalent operational and clinical deficits. Process improvement steps were immediately implemented. The 30-day readmission rate (all causes) decreased from 18% to 6.1%, the readmission rate for HF decreasedfrom 7.3% to 1.7%, mortality declined by 25%, and morbid complications decreased by 35%. Evaluation of processes and clinical outcomes are ongoing in order to develop strategies for even greater improvement within the HF program.