Process-of-care / performance improvements
The CHF QUERI demonstrated the improved use of
beta-blockers in appropriate patients with heart
failure within the VA Palo Alto Health Care System
and VISN21. Our randomized trial conducted at three
sites within the VA Palo Alto Health Care System
demonstrated an absolute increase of beta-blocker
use by 8%. This reminder has now been implemented
within the Palo Alto Health Care System. In addition,
as part of our trial of national implementation
five other sites have indicated they will start
using this reminder following a single email. A
previous intervention (nurse based initiation and
titration of beta-blockers) has been implemented
at several sites within VISN 21 over the last 3
years. During this time recommended beta-blocker
use (carvedilol or metoprolol succinate) in VISN21
has increased from 54% in 2003 to 81% in 2006.
Morbidity performance improvements
Meta-analyses indicate that treatment of 100
patients with beta-blockers for one year prevents
11 hospitalizations. We estimate that between 55
and 110 hospitalizations have been prevented during
2006 in VISN21 due to increased beta-blocker use.
Mortality performance improvements
Meta-analyses indicate that treatment of 100 patients
with beta-blockers for one year prevents 2 deaths.
We estimate that between 10 and 20 deaths have
been prevented during 2006 in VISN21 due to increased
beta-blocker use.
Quality of life improvements
None documented though other studies have demonstrated
improved quality of life with beta-blocker use.
Cost/utilization savings
Economic analyses from randomized trials indicate
that treatment of 1 patient with beta-blockers
for one year saves $300. We estimate that $300,000
has been saved during 2006 in VISN21 due to increased
beta-blocker use.
Other patient and system impacts
- Heart Failure Provider Network: CHF QUERI has
continued to grow the network of Heart Failure
Providers representing all VISNs and 157 VA centers.
This network is a forum for providers consisting
of clinicians, nurses, researchers, administrators,
physician assistants, etc. to discuss successes,
best practices, facilitators and barriers to better
care. It also serves as conduit for implementing
new interventions aimed at improving the quality
of heart failure care. This forum has been partnering
with Patient Care Services' Cardiology Systems
Redesign to promote and implement IHI's Save 5
Million Lives Campaign with the VA.
- An example of the Heart Failure Network's success
is the development of a patient medication sheet
with pictures of the medications. This implementation
effort started as a suggestion from one of the
Heart Failure Network members. The rationale is
that many patients are not aware of the appearance
of their medications and working through existing
online databases (e.g. Physician Desk Reference)
is time consuming. We worked with Pharmacy Benefits
Management and the Consolidated Mail Outpatient
Pharmacy to modify an existing program. Early January
2008 a new option will be available to all VAs
that will allow the creation of patient specific
lists of mailed prescriptions with medication images.
- Reviewed, selected and posted heart failure-related
patient education materials on CHF QUERI's website.
These are materials developed at the various VA
facilities.
- My Health E-Vet Heart Failure education materials
created by CHF QUERI are now available for patients
on My Health E-Vet and on the CHF QUERI Website.
