Objectives
Heart failure (HF) is increasing in prevalence in the VA. Best processes of care have been identified that can markedly affect the outcomes. This effort was to examine how facilities with formal HF programs varied in terms of providing care for HF patients at all the facilities at the Department of Veterans Affairs (VA).
Method
The Chronic Heart Failure (CHF) Quality Enhancement Research Initiative (QUERI) conducted a survey of all the VA facilities to examine the processes of care for HF patients. From a total of 144 facilities the Chiefs of Cardiology or the Chiefs of Medicine completed the survey with focus on the facility's current processes of care for HF. 100% response rate was obtained for these surveys.
Results
Data was analyzed for 144 facilities. Of them 64 facilities (45%) reported having a clinic with special focus on heart failure. Comparison of processes of care for the facilities with and without HF clinics consistently showed that facilities with HF clinics have more HF focused structure and processes of care. They have cardiologists with a special focus on HF (86% vs. 14% p<.001), protocol for diuretic titration by provider (64% vs. 36% p<.05), protocol for diuretic titration by patient (73% vs. 27% p<.001), provided HF related patient education program (64% vs. 36% p<.001), used pharmacists (60% vs. 40% p<.001) and inpatients at their facility were routinely seen by practitioner affiliated with HF program (80% vs. 20% p<.001). Regarding standardized HF orders no significant difference was observed between inpatients and outpatients.
Conclusions
Facilities which have clinics with special focus on HF programs with standardized programs and activities that have been associated with improved care for patients with heart failure
Impact
Formal heart failure clinics are associated with improved process of care for patients with heart failure
Learning from the U.S. Department of Veterans Affairs Quality Enhancement Research Initiative: QUERI Series