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Published on: August 1, 2019
Quality improvement in heart failure: a randomized educational intervention to change provider behavior
Ileana L Piña1, David Bruckman, Craig Lance
1Montefiore-Einstein Medical Center, Bronx, NY 10467, USA. ilppina@aol.com
Congestive Heart Failure (Greenwich, Conn.)
|June 19, 2012
Summary
A training program for primary care providers (PCPs) on heart failure (HF) showed modest practice changes. While not significantly improving guideline adherence, it led to more appropriate diuretic use in HF patients.
Area of Science:
- Cardiology
- Medical Education
- Health Services Research
Background:
- Heart failure (HF) management requires adherence to evidence-based guidelines.
- The impact of provider education on HF treatment practices remains under-reported.
- The NHeFT (Network-based Heart Failure Training) program was developed to optimize HF care through didactic and experiential training for primary care providers (PCPs).
Purpose of the Study:
- To evaluate the effectiveness of the NHeFT program in changing PCP practice patterns for heart failure (HF) management.
- To assess whether didactic and experiential training improves adherence to HF treatment guidelines among PCPs.
Main Methods:
- A randomized controlled trial was conducted in Cleveland VA clinics, assigning PCPs to either the NHeFT training (T) or a control group (C).
- The primary endpoint was the proportion of patients with ejection fraction (EF) < 40% treated with ACEI/ARB and Beta Blocker, +/- diuretic, post-training versus pre-training.
- Secondary endpoints included changes in ACEI/ARB use or diuretic dose post-training.
Main Results:
- Of 641 patients, 216 had EF < 40%. At baseline, 85% did not meet the primary endpoint.
- After training, similar proportions of patients in the control (64.2%) and training (74.4%) groups met the primary endpoint (P = 0.14).
- Patients seen by trained PCPs were more likely to have diuretic doses decreased without increasing ACEI/ARB (P < 0.03).
Conclusions:
- The NHeFT didactic and preceptorship program resulted in modest changes in PCP practice for heart failure management.
- The training did not significantly increase the odds of patients meeting the primary guideline-based treatment endpoint.
- Future studies should investigate provider readiness for change and self-efficacy in adhering to evidence-based HF care.
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