Welcome to the Cardiovascular Clinical Program!
Intermountain Healthcare continues to be recognized as a national leader in research and provision of best practices in cardiovascular care. See how we monitor, measure, report, and improve these processes:
2014 CV Clinical Program Board Goal:
Heart failure is a chronic disease that is one of the leading contributors to morbidity, mortality, and cost. In the United States, the treatment of heart failure accounts for 5% to 7% percent of total healthcare costs, roughly thirty billion dollars per year. In addition, there are approximately 670,000 new cases diagnosed each year. Treatment of heart failure patients is a complex multidisciplinary process along the continuum of care. Reimbursement for these patients is decreasing. The Centers for Medicare and Medicaid Services (CMS) does not pay for heart failure patients readmitted within thirty days of their inpatient stay. There is much opportunity to improve. This is the second year of a two year goal that establishes a best practice strategy for the complex multidisciplinary process of care for heart failure patients.
In 2014, we continue our comprehensive approach to improving the treatment of heart failure patients along the continuum of care. We will further refine inpatient management of heart failure patients, provide more robust inpatient measures of clinical, service and cost outcomes, improve communication and management of outpatient services, focus initially on high blood pressure control as a key heart failure prevention strategy and focus on the transition of patients from the hospital to home with the engagement of telemedicine, palliative care and hospice resources.
- Goals will include detailed and specific milestones for each year. The Cardiovascular Clinical Program proposes to measure the overall completion of the Clinical Board Goal by producing a composite percentage of completion for each year to be reported at the end of the third quarter of 2013 and 2014 respectively.
- 72 Hours Follow Up Calls: It would be more sensible to make the goal to create a system to monitor and measure for 2014. Currently, we don't have the ability to measure.
- Follow-up Appointments: Site specific rate TBD.
- Discharge Medication Tool Usage: Require ninety (90) percent of patients with a primary diagnosis of heart failure to be discharged using the electronic discharge medication program.
The Cardiovascular Clinical Program in 2014 will improve the continuum of care for heart failure patients including prevention, detection, outpatient management, hospital management, transition-to-home strategies, home care, and caregiver education. The multi-faceted approach to treating hospitalized patients with a primary diagnosis of heart failure at all Intermountain Healthcare hospitals will be further advanced. The components of this section of the goal will serve to accurately identify patients with a primary diagnosis of heart failure within twenty-four hours of admission, and prioritize and apply a consistent care process model to be followed by caregivers in order to optimize clinical service and value outcomes across the continuum of care. This goal is comprised of the four elements listed below:
- Accurate and timely identification of patients coded with a primary diagnosis of heart failure.
- Implement the enhanced identification and risk stratification processes for hospitalized heart failure patients.
- Implement the care process pathways for risk adjusted management of hospitalized heart failure patients.
- Develop and distribute best practice guidelines to identify appropriate patients for advanced heart failure therapies including implantable cardioverter-defibrillators (ICD) and/or cardiac resynchronization therapy (CRT) to reduce hospitalizations and death rates among patients with heart failure. Additional advanced heart failure therapies include left ventricular assist device (LVAD) and/or transplant.
- Optimize the measurement and reporting systems for heart failure patients.
- Measure and report all-cause mortality rates within thirty days of hospitalization for patients with a primary diagnosis of heart failure.
- Measure and report readmission rates within thirty days of hospitalization for all causes for patients with a primary diagnosis of heart failure and for cardiac specific readmission rates for patients with a primary diagnosis of heart failure.
- Compare mortality rates and readmission rates to national benchmarks. Establish goals for these measures in 2014.
- Begin developing the ability to measure and report inpatient variable cost per case for heart failure patients.
- Standardize the entry and reporting of the post discharge phone call database.
- Achieve the 2013 Value Based Purchasing and Core Measure heart failure goals.
- Heart Failure-1 Discharge instructions (VBP) >98%
- Heart Failure 30-day mortality rate (VBP) <9.4%
- Heart Failure-2 Evaluation of left ventricular systolic function >98%
- Heart Failure-3 Angiotensin Converting Enzyme Inhibitor (ACE-I) or Angiotensin II Receptor Blocker (ARB) >98% and Beta Blocker for left ventricular systolic dysfunction >95%
- Heart Failure 30-day Risk Standardized Readmission Measure <19%
- Continuum of Care
- Optimize the transition phase from hospital to home to improve patient care readmission rates within thirty days of hospitalization.
- Develop a process for calling patients at high risk for readmission within seventy two (72) hours of discharge from each facility. Specific goal will be established in 2014.
- Improve patient medication communication prior to discharge.
- Implement a process for scheduling patients for a follow-up appointment within seven days of discharge. Establish measurement and a baseline for this process in the first quarter of 2013. Establish hospital specific goals for improvement in the third quarter of 2013. Achieve eighty five (85) percent compliance in 2014.
- Require ninety (90) percent of patients with a primary diagnosis of heart failure to be discharged using the electronic discharge medication program.
- Work collaboratively with Intermountain's Integrated Care Management Team and SelectHealth to enhance the care of discharged patients in the outpatient setting and identify process improvement goals for 2014.
- Develop strategies aimed to prevent the development of symptomatic Heart Failure in at-risk patients, with an initial focus towards hypertension management.
- Work collaboratively with the Emergency Department Development Team to develop strategies for the care of patients who present to the Emergency Department with Heart Failure.
Measurement Time Period: Third Quarter 2014
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