Abstract 96: Facilitation of the VA Hospital To Home (H2H) Initiative to Reduce Readmissions for Heart Failure: CHF QUERI

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Anju Sahay ◽  
Parisa Gholami ◽  
Nancy Oliva ◽  
Paul A Heidenreich
Keyword(s):  
Heart Failure ◽  
Diffusion Of Innovation ◽  
Symptom Management ◽  
Medication Management ◽  
Conference Calls ◽  
Provider Network ◽  
National Quality ◽  
Hospital To Home

Objective: Reducing readmission rates for heart failure (HF) patients is the primary goal of the VA and its' Chronic Heart Failure (CHF) QUERI. It is also the goal of Hospital to Home (H2H) national quality improvement (QI) which has 3 key focus areas: (a) medication management; (b) symptom management; and (c) early follow-up after discharge. According to Rogers’ Diffusion of Innovation Theory (2003) social networks significantly affect performance and innovation. Additionally, the Promoting Action on Research Implementation in Health Services(PARIHS, 2008) framework emphasizes the function of dynamic relationships among evidence, context and facilitation. The CHF QUERI formed the HF Provider Network consisting of 720+ providers (members) from 150 VA facilities to improve the quality of HF care. In January 2010 through the HF Network the “VA H2H” QI initiative was launched to facilitate the implementation of the national H2H initiative at the VA facilities with focus on H2H's 3 key focus areas. Through e-mails, web-based meetings and conference calls members were encouraged to (1) enroll own facility on national H2H website and (2) initiate and/or plan new projects focusing on the VA H2H initiative. Methods: A total of 122 VA facilities were identified with >100 discharges during 2007-2008. In Spring 2010 and then Spring 2011 members at all facilities were asked to complete surveys to find out (1) enrollment status and (2) number and description of projects initiated and/or planned for the VA H2H initiative, and other ongoing projects focusing on reducing HF readmissions. Results: Altogether 77 (63%) facilities enrolled on the national H2H website. With a survey response rate of 75% (92 facilities) altogether 529 projects were reported focusing on: Medication management=150 (29%); Symptom management=148 (27%); Early follow up=155 (30%); and Other areas=34 (14%). A total of 120 (22%) projects were initiated and another 93 (18%) are being planned based on the VA H2H initiative, and 316 (60%) are ongoing projects to reduce HF readmissions. Conclusions: Supporting the Rogers (2003) and PARIHS (2008) frameworks, these findings demonstrate the successful facilitation of the VA H2H initiative by the CHF QUERI through its HF Provider Network in terms of increased enrollment and significant number of initiated and/or planned VA H2H projects. Impact: Facilitation of non-mandated QI initiatives is crucial to improve the quality of care for HF patients.

Abstract P129: Building Capacity with Opinion Leaders to Implement the VA Hospital-to-Home Initiative: CHF QUERI

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Anju Sahay ◽  
Paul A Heidenreich
Keyword(s):  
Heart Failure ◽  
Diffusion Of Innovation ◽  
Opinion Leaders ◽  
Readmission Rates ◽  
Diffusion Of Innovation Theory ◽  
Provider Network ◽  
National Quality ◽  
Department Of Veteran Affairs ◽  
Survey Results ◽  
Hospital To Home

Objectives: Reducing readmission rates for heart failure (HF) patients is the primary goal of the Department of Veteran Affairs and its' Chronic Heart Failure (CHF) QUERI. It is also the goal of Hospital to Home (H2H) national quality improvement (QI) initiative cosponsored by the American College of Cardiology and the Institute for Healthcare. In January 2010 the CHF QUERI through its HF Provider Network launched the “VA H2H” QI initiative to implement the national H2H initiative at the VA facilities. Based on the PARIHS framework and Rogers Diffusion of Innovation Theory the specific aim was to identify local opinion leaders (OLs) at each facility to help facilitate the implementation of the VA H2H initiative at own facility. Methods: Prior to launching the VA H2H we used the sociometric method to identify OLs. HF Network members from 61 facilities were asked to nominate up to 2 providers at own facility (physician / nurse / other) including self as the local OL. Based on their nominations OLs were identified preferably with a physician and nurse team and they were asked to participate in the VA H2H. In Month 4 and Month 6 all members were asked to complete a survey providing information about the projects (or interventions) recently initiated based on the VA H2H, planned based on the VA H2H, or ongoing not based on VA H2H initiative. Results: 70% of the facilities (n=43) responded with 1-2 nominations for OLs (n=82) and the remaining 30% facilities had no identified OLs. Survey results show that among the facilities with OLs, 79% initiated/planned projects based on the VA H2H initiative; 9% did not initiate/plan project based on the VA H2H initiative; and 12% were non-responders. These facilities with OLs reported a total of 161 projects: 27 initiated planned based on the VA H2H, 52 planned based on the VA H2H, and 82 ongoing projects not related to VA H2H. Facilities without identified OLs reported having only a total of 6 projects. Conclusions: Most VA facilities were able to identify OLs and then successfully implement the VA H2H initiative. Impact: Use of OLs may be effective in implementing non-mandated QI initiatives to improve care for all VA HF patients.

Abstract P247: Facilitation of the VA Hospital-to-Home Initiative to Reduce Readmissions for Heart Failure Patients: CHF QUERI

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Anju Sahay ◽  
Paul A Heidenreich
Keyword(s):  
Heart Failure ◽  
Intervention Group ◽  
Control Group ◽  
Readmission Rates ◽  
Web Based ◽  
Provider Network ◽  
National Quality ◽  
Hospital To Home ◽  
Reported Data ◽  
And Control

Objectives: Reducing readmission rates for heart failure (HF) patients is the primary goal of the Department of Veteran Affairs (VA) and its’ Chronic Heart Failure (CHF) QUERI. It is also the goal of Hospital to Home (H2H) national quality improvement (QI) initiative cosponsored by ACC and the IHI. In January 2010 the CHF QUERI through its HF Provider Network (625 providers/members from 150 VA facilities) launched the “VA H2H” QI initiative by facilitating the implementation of the national H2H initiative at the VA facilities with focus on H2H’s 3 key areas. Methods: A total of 122 VA facilities were identified with >100 discharges during 2007-2008. Randomly, half of these facilities were assigned to the intervention group (n=61) and the remaining to the control group (n=61). From Month 1 through Month 6 via e-mails and web-based meetings HF Network members at the intervention facilities were encouraged to (a) enroll own facility on the national H2H website, and (2) initiate and/or plan projects focusing on 3 key areas. In Months 6 members of both the intervention and control facilities were asked to complete a survey to find out (1) enrollment status and (2) number of projects initiated and/or planned for the VA H2H initiative, and other ongoing projects focusing on reducing HF readmissions. Results: The survey response rate was 37% (intervention n=24, 59%; and control n=21, 34%). It was seen that 33 intervention and 6 control facilities enrolled on the national H2H website. Self-reported data indicated that the intervention facilities had a total of 163 projects: 73=initiated and/or planned VA H2H projects, and 90=other ongoing projects. In sharp contrast, the control facilities had a significantly less number of total 66 projects: 25=initiated and/or planned VA H2H projects and 41=other ongoing projects. Conclusions: The findings show that the facilitation of the VA H2H initiative through its HF Provider Network was very successful in terms of increased enrollment and significantly larger number of projects to reduce HF readmissions. Impact: Facilitation of non-mandated QI initiatives is crucial to improve the quality of care for HF patients.

scholarly journals Quality of life in patients with chronic heart failure and their carers: a 3-year follow-up study assessing hospitalization and mortality

2010 ◽  
Vol 12 (9) ◽  
pp. 1002-1008 ◽  
Author(s):  
Javaid Iqbal ◽  
Loraine Francis ◽  
Janet Reid ◽  
Scott Murray ◽  
Martin Denvir
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Follow Up Study

Abstract 282: Assessing Levels of Active Participation through a VA Provider Network to Improve Quality of Care for Veterans with Heart Failure

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Anju Sahay ◽  
Paul Heidenreich
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Active Participation ◽  
Teaching Hospitals ◽  
Evidence Based Practices ◽  
Provider Network ◽  
Participation Level ◽  
Level Data ◽  
Facility Level

Objective: The goal of the Dept. of Veterans Affairs (VA) Chronic Heart Failure (CHF) QUERI program is to improve the quality of care for heart failure (HF) patients and implement evidence-based practices throughout the VA system. One strategy to achieve this goal was to create a VA heart failure provider Network which occurred in 2006. We sought to characterize provider participation in this mature network. Method: We tracked all members of the HF Network including their title, location at one of 144 VA facilities; date joined and if applicable, date left the HF Network. We considered the following activities to be evidence of “active” participation: attended a web-based meeting or the annual in-person meeting, requested meeting materials, or completed a periodic survey of providers. Participation of all other members is considered “passive”. For this project we assessed each facility’s level of participation in the HF Network from July 2006 till June 2013 (7 years). Facility participation level was characterized as “None” (no member at that facility with active participation), “Low” (at least one member at that facility attended 1-2 activities) and “High” (at least one member at that facility participated in ≥3 activities). Data were linked to existing facility-level data that included presence of an HF clinic, cardiac cath lab, use of pharmacist, bed size, membership in Council on Teaching Hospitals (COTH), and presence of an Accredited Graduate Medical Education (ACGME) program. Results: Altogether, 1205 providers have participated in the HF Network. As of June 2013, 987 providers from 144 VA facilities participate in this network. They include VACO leadership (1%), VISN leadership (4%), facility leadership (9%), Chiefs of Cardiology (7%), staff physicians (32%), nurses (28%), pharmacists (5%) and others (14%). Participation at the facility-level has increased from 2008 (None=37, Low=43 and High=64) to 2013 (None=8, Low=16 and High=120, (p <0.001). High participating facilities were more likely to be classified as tertiary (p <.016), COTH members (p <0.001), having ACGME programs (p <0.001), and located in the West or Southeast United States (p =.03). High participating facilities are also more likely to have a HF clinic (p <0.001), a cardiac catheterization lab (<0.001), and use a pharmacist in routine HF care (p <.03). Conclusions: Involvement and active participation in the VA HF Network has grown and is more likely at academic facilities and those providing more intensive services.

Abstract 269: A Successful Blended Facilitation Approach with Internal and External Facilitators to Implement the VA Hospital-To-Home (H2H) Initiative: CHF QUERI

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Anju Sahay ◽  
Parisa Gholami ◽  
Paul A Heidenreich
Keyword(s):  
Diffusion Of Innovation ◽  
Opinion Leaders ◽  
Readmission Rates ◽  
Web Based ◽  
Diffusion Of Innovation Theory ◽  
Research Implementation ◽  
Healthcare Improvement ◽  
National Quality ◽  
Hospital To Home ◽  
Dynamic Relationships

A Successful Blended Facilitation Approach with Internal and External Facilitators to Implement the VA Hospital-To-Home (H2H) Initiative: CHF QUERI Objectives: Reducing readmission rates for heart failure (HF) patients is the primary goal of the VA and the CHF QUERI. It is also the goal of Hospital to Home (H2H) national quality improvement (QI) initiative cosponsored by the American College of Cardiology and the Institute for Healthcare Improvement. According to Rogers’ Diffusion of Innovation Theory (2003) social networks significantly affect performance and innovation. Additionally, the Promoting Action on Research Implementation in Health Services (PARIHS, 2008) framework emphasizes the function of dynamic relationships among evidence, context and facilitation. In January 2010 the CHF QUERI through its HF Network launched the “VA H2H” QI initiative to implement the national H2H initiative at the VA facilities. Blended facilitation approach was used with the HF Network's leadership being the “external” facilitators and the opinion leaders (OLs) at each facility being the “internal” facilitators. Methods: A total of 122 VA facilities were identified with >100 discharges during 2007-2008. Using the sociometric method OLs were identified to be “internal” facilitators. Members were to nominate up to 2 providers at own facility (physician/nurse/other/self) as the OL. Then OL teams were asked to participate in the VA H2H. As “external” facilitators the HF Network's leadership conducted web-based meetings and provided tool-kit and consultation to members at all 122 facilities. Periodic surveys were used to track projects (or interventions) recently initiated based on VA H2H, planned based on VA H2H, or ongoing to reduce HF readmissions not based on VA H2H initiative. Results: Members from 66% facilities (n=81) responded with 1-2 nominations for OLs. Members from the remaining 34% facilities (n=41) either responded with no nominations (n=3) or were non-responders (n=38). Overall, 47 facilities (39%) reported a total of 243 projects. Among them, 44 facilities had OLs (94%) with 234 projects (96%). In sharp contrast, the remaining 3 facilities (6%) with no OL had only 9 projects (4%). The 44 facilities with OLs reported 37 recently initiated VA H2H projects (versus 3 VA H2H projects at facilities without OL); 40 VA H2H projects being planned (versus 0 project at facilities without OL); and 149 projects ongoing not in response to VA H2H (versus 6 projects at facilities without OL). Conclusions: Facilities with OLs were very successful in implementing the VA H2H initiative. Impact: Use of OLs may be effective in implementing non-mandated QI initiatives to improve care for all VA HF patients.

Identifying Heart Failure Symptoms and Poor Self-Management in Home Healthcare: A Natural Language Processing Study

2021 ◽  
Author(s):  
Sena Chae ◽  
Jiyoun Song ◽  
Marietta Ojo ◽  
Maxim Topaz
Keyword(s):  
Heart Failure ◽  
Natural Language Processing ◽  
Natural Language ◽  
Language Processing ◽  
Symptom Management ◽  
Home Healthcare ◽  
Self Management ◽  
Clinical Notes ◽  
Patients With Heart Failure

The goal of this natural language processing (NLP) study was to identify patients in home healthcare with heart failure symptoms and poor self-management (SM). The preliminary lists of symptoms and poor SM status were identified, NLP algorithms were used to refine the lists, and NLP performance was evaluated using 2.3 million home healthcare clinical notes. The overall precision to identify patients with heart failure symptoms and poor SM status was 0.86. The feasibility of methods was demonstrated to identify patients with heart failure symptoms and poor SM documented in home healthcare notes. This study facilitates utilizing key symptom information and patients’ SM status from unstructured data in electronic health records. The results of this study can be applied to better individualize symptom management to support heart failure patients’ quality-of-life.

Quality of life of family caregivers 8 years after a relative's cancer diagnosis: follow-up of the National Quality of Life Survey for Caregivers

2015 ◽  
Vol 25 (3) ◽  
pp. 266-274 ◽  
Author(s):  
Youngmee Kim ◽  
Kelly M. Shaffer ◽  
Charles S. Carver ◽  
Rachel S. Cannady
Keyword(s):  
Quality Of Life ◽  
Family Caregivers ◽  
Cancer Diagnosis ◽  
National Quality

scholarly journals Effects of Oral Amino Acid Supplements on Functional Capacity in Patients with Chronic Heart Failure

2014 ◽  
Vol 8 ◽  
pp. CMC.S14016 ◽  
Author(s):  
Carlo Lombardi ◽  
Valentina Carubelli ◽  
Valentina Lazzarini ◽  
Enrico Vizzardi ◽  
Filippo Quinzani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
New York ◽  
Functional Capacity ◽  
Exercise Tolerance ◽  
Stress Test ◽  
Nyha Class ◽  
Heart Association

Amino acids (AAs) availability is reduced in patients with heart failure (HF) leading to abnormalities in cardiac and skeletal muscle metabolism, and eventually to a reduction in functional capacity and quality of life. In this study, we investigate the effects of oral supplementation with essential and semi-essential AAs for three months in patients with stable chronic HF. The primary endpoints were the effects of AA's supplementation on exercise tolerance (evaluated by cardiopulmonary stress test and six minutes walking test (6MWT)), whether the secondary endpoints were change in quality of life (evaluated by Minnesota Living with Heart Failure Questionnaire—MLHFQJ and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. We enrolled 13 patients with chronic stable HF on optimal therapy, symptomatic in New York Heart Association (NYHA) class II/III, with an ejection fraction (EF) <45%. The mean age was 59 ± 14 years, and 11 (84.6%) patients were male. After three months, peak VO2 (baseline 14.8 ± 3.9 mL/minute/kg vs follow-up 16.8 ± 5.1 mL/minute/kg; P = 0.008) and VO2 at anaerobic threshold improved significantly (baseline 9.0 ± 3.8 mL/minute/kg vs follow-up 12.4 ± 3.9 mL/minute/kg; P = 0.002), as the 6MWT distance (baseline 439.1 ± 64.3 m vs follow-up 474.2 ± 89.0 m; P = 0.006). However, the quality of life did not change significantly (baseline 21 ± 14 vs follow-up 25 ± 13; P = 0.321). A non-significant trend in the reduction of NT-proBNP levels was observed (baseline 1502 ± 1900 ng/L vs follow-up 1040 ± 1345 ng/L; P = 0.052). AAs treatment resulted safe and was well tolerated by all patients. In our study, AAs supplementation in patients with chronic HF improved exercise tolerance but did not change quality of life.

P6325Gas exchange improvements during exercise correlate with hemodynamic changes in heart failure patients with a left ventricular assist device

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Seuthe ◽  
M Morosin ◽  
H Smail ◽  
F Gerhardt ◽  
A Simon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Cardiopulmonary Exercise Test ◽  
Left Ventricular ◽  
Peak Oxygen Consumption ◽  
Ventricular Assist ◽  
Heart Failure Patients ◽  
Left Ventricular Assist

Abstract Background The implantation of left ventricular assist devices (LVAD) has established its role in therapy for patients with end stage heart failure. Benefits in survival as well as an improved quality of life, compared to optimized medical therapy (OMT) alone, has been proven. There are limited data in the literature on the metabolic changes during exercise in LVAD patients, and in most studies no increase in peak oxygen consumption on cardiopulmonary exercise test (CPET) could be shown early after surgery. However, recent data suggests an improvement in peak oxygen uptake (VO2) as a late effect after rehabilitation. To further investigate these findings we sought to analyse CPET data from patients before LVAD implantation as well as in the early and late follow up in correlation with hemodynamic changes at these times. Methods We collected and retrospectively analysed data of heart failure patients who had undergone LVAD implantation, and in whom a right heart catheterization, a cardiopulmonary exercise test and an echocardiography had been performed at time before, as well as 6 Months and 12 months after LVAD implantation, respectively. Results Data of 43 patients implanted with an LVAD between 2011 and 2017 were analysed. There was significant improvement in cardiac output (3,2 vs 4,3 L/min, p<0,001) and VE/VCO2 slope (46 vs 38, p=0,001) 6 months after LVAD implant as well as a significant reduction in PCWP (26 vs 11 mmHg, p<0,001), PAP mean (40 vs 22 mmHg, p<0,001), RA mean (12 vs 8 mmHg, p=0,002) and PVR (4,2 vs 2,5 WU, p<0,001). However, there was no significant increase in peak VO2 after 6 months. 12 months after LVAD implantation there were no further significant changes in cardiac output, intracardiac pressures or VE/VCO2 slope, which all remained similar to the 6 months follow up. However, at that point, a significant increase in peak VO2 was seen, compared to baseline (1060 vs 1410ml/min, p=0,001) and to 6 months after surgery (Figure 1). Conclusion Cardiac output increases in heart failure patients early after LVAD implantation. Consequently, permanent ventricular off loading results in the reduction of intracardiac pressures and improvement in the VE/VCO2 slope 6 months after surgery. However, a significant rise in peak oxygen consumption could only be noted 12 months after surgery, suggesting either a delayed long-term effect of improved hemodynamics or other causes such as enhanced mobility or training due to improved quality of life.

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