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Combining case management, pathways, and report cards for secondary cardiac prevention
L Levknecht1, J Schriefer, J Schriefer
1Heart and Vascular Network, Butterworth Health System, Grand Rapids, MI 49503, USA. llevknecht@bw.brhn.org
Insights
This study highlights a successful long-term cardiac prevention and rehabilitation program that integrates case management, clinical pathways, and outcome tracking. The program effectively modifies cardiovascular risk factors for secondary cardiac disease prevention.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Services Research
Background:
- Traditional cardiac rehabilitation often lacks long-term follow-up.
- Butterworth Hospital initiated a program in 1995 for sustained cardiovascular risk factor modification.
- This initiative shifted focus from treatment to prevention.
Purpose of the Study:
- To describe the development and components of a comprehensive cardiac prevention and rehabilitation program.
- To evaluate the program's integration into clinical practice and its impact on patient enrollment.
- To assess the program's effectiveness as a tool for secondary cardiac disease prevention.
Main Methods:
- Implementation of an outpatient extension of inpatient cardiovascular pathways, integrated into the electronic medical record.
- Utilized a "report card" system inspired by Dartmouth Medical Center, incorporating value compass and instrument panel approaches for quality improvement.
- Collected data on cost, utilization, patient satisfaction, functional health status, and clinical outcomes.
Main Results:
- Quarterly patient enrollment increased from under 15% to 32% of eligible patients since the program's inception in January 1995.
- Regularly issued internal "report cards" (June 1996, Sept 1996, Jan 1997) to track progress and drive improvements.
- The program demonstrated successful integration and growth in patient participation.
Conclusions:
- The integrated approach combining case management, clinical pathways, an outcomes database, and report cards proved effective.
- This model creates a marketable program for the secondary prevention of cardiac disease.
- The program successfully addresses the need for long-term cardiovascular risk factor management.
Background:
Many disease treatment tools can be shifted into prevention. Many cardiac rehabilitation programs have focused on a 12-week exercise plan with minimal long-term follow-up. In 1995 Butterworth Hospital established a cardiac prevention and rehabilitation program focusing on long-term modification of cardiovascular risk factors.
Clinical Pathway:
The pathway was created as the outpatient extension of three inpatient cardiovascular pathways. Unlike inpatient pathways, the outpatient pathway was integrated into the medical record as a major care planning and documentation tool.
Enrollment:
Since the entry of the first group of patients in January 1995, average quarterly enrollment has increased from less than 15% to 32% of eligible patients.
The Report Card:
Butterworth adopted Dartmouth Medical Center's (Hanover, NH) value compass and instrument panel approach under the rubric of report card. As an internal, clinical quality improvement tool, the report card is not used for public reporting, although prevention and rehabilitation report cards are provided to payers. Information on cost and utilization, patient satisfaction, functional health status, and clinical outcomes, as well as the current improvement activities, are covered. Report cards have been issued in June 1996, September 1996, and January 1997, each highlighting activities that drive program improvements.
Conclusion:
The combination of case management, pathways, an outcomes database, and report cards creates a marketable program for secondary prevention of cardiac disease.