Chronic Heart Failure Management in Rural Primary Care

Background: Heart failure has been identified as a diagnosis associated with significant morbidity and mortality with inconsistent outcomes. As of October 1, 2012, the Centers for Medicare and Medicaid Services (CMS) began reducing payments to penalize hospitals for excessive heart failure readmissions and publicly reporting readmission rates. The rationale for the reduction in payments is that many heart failure-related admissions could have been prevented through improved outpatient management. In 2013, Medicare reimbursement cuts were applied to critical access hospitals. This most recent decrease in reimbursement to critical access hospitals paired with lack of reimbursement for heart failure related 30-day hospital readmissions provided the basis for implementing a heart failure management program. Participants: Thirteen adult patients, older than the age of 19 years, voluntarily participated in the heart failure management program in a rural primary care clinic located in the Midwest. Methods: The project was a quality improvement design. A chronic heart failure management program was implemented using the American Heart Association and the Institute for Health Care Improvement guidelines for heart failure management. Educational resources with monitoring logs for weights and symptoms were provided to each patient at the initial visit. Nursing staff filled out a heart failure flow sheet at each heart failure-related visit, and each patient who presented was then contacted 1 month from his or her initial visit date to discuss patient concerns. Results: Of the 13 individuals who presented for the initial visit, 11 had the flow record completed. One patient came in for subsequent visits because of changes in medications and follow-up. The flow record was filled out entirely on these 2 subsequent visits. There were 2 heart failure admissions during the 12-week implementation period, and neither were readmissions. Both patients followed up within 1 week of hospital discharge. There were no heart failure readmissions during the 12-week implementation period. Discussion: The findings of this project support the long-term feasibility of a chronic heart failure management program.