Improving Heart Failure Care: Integrating Lessons Learned From Patient & Provider Perspectives

Kismet Rasmusson, DNP, FNP-BC, FAHA, CHFN

I will not discuss off label use or investigation use in my presentation

I have no financial relationships to disclose

Improving Heart Failure Care: Integrating Lessons Learned From Patient & Provider Perspectives

Background/Purpose

• Heart failure (HF) is a chronic condition that requires high levels of both patient and provider engagement in their care.

• Healthcare reform includes a shift to engage patients to improve care, outcomes and the patient experience.

• Hospital systems often develop processes of care without direct patient input.

• Thus the purpose of this work is to demonstrate how Heart Failure (HF) care can be transformed through integrating patient/caregiver and provider perspectives.

Research Design

• Qualitative research

• Conducted focus groups (FG) and telephone interviews (TI)

• Patients with a primary diagnosis of HF and their caregivers and

• FG with providers who care for patients with HF

• Results were categorized in themes

Study Population/Sample

• Patients with a HF-related hospitalization across Intermountain’s hospitals within the prior year were invited to participate in 2 separate Focus Groups or Telephone Interviews.

• Internists with Intermountain’s Medical Group in the Salt Lake Valley and cardiovascular hospitalists at Intermountain Medical Center were invited to participate in 2 separate provider Focus Groups.

Results

• 78 participated

• 51 completed the PI (average age 63.2 years, 51% female)

• 27 (including 11 caregivers) attended the FGs (average age 52.8 years, 31% female)

• The majority of patients had outpatient management by cardiologists (70%), the minority were in a HF clinic (22%)

Patients

Results

• 75% of patients received the Patient Education folder and who reviewed contents with provider/nurse felt more prepared to manage their care at home.

• 71% of respondents expressed being very confident that they could manage their care when leaving the hospital, however, almost all experienced challenges once at home, particularly with diet, activity-level, and feelings of stress about their diagnosis.

• 47 % of respondents reported that they were very consistent in following their discharge instructions, yet many reported feeling overwhelmed and wish they had been told more candidly by their provider about symptoms and self-care management.

• 84% of respondents received some type of follow-up after their hospitalization, with in-office visits that took place within two weeks of discharge being the most helpful to patients

Patients

Results

Receive

d Ed Materia

l

Confident in fo

llowing plan

Consistency

with fo

llowing d/c

instructi

ons

Had hospital f/

u appt0

20

40

60

80 75 71

47

84Focus Group & Phone Calls

Series 1

Patients

Learning from HF PatientsLearning from Heart Failure Patients to Improve Patient Centered Care

Recommendations Focus Group (n=27) Phone Interview Group (n=51)D/C Instructions • Include caregivers

• Start education earlier• Personalize instruction• Create support group• Honestly discuss disease & severity

• RN to provided detailed instruction from Ed packet• Watch DVD • Provide instruction/tips to manage congestion• Allow time to practice tracking weights: prep for d/c• Time to recover from the “shock”, prior to education

Dietary Recommendations

• Provide simple/ detailed meal plans• Consider comorbid conditions to

personalize meal planning

• Enhance diet, meal planning and sodium restriction instructions

Medication Management

• Provide new med list• Provide pill box, mobile App • Coordinate with pharmacy for

partial refills

• Provide guidance on medications, costs, refills, potential interactions

Coordination of Care

• Provide close f/u in month after d/c• Personalize home care instructions• Improve care coordination with PCP

• Enhance communication from hospital to PCP• Provide consistent communication: d/c & diet plan • Suggest ways to manage stress• Suggest ways to be their own advocate, negotiate

health care system

Results

• 12 physicians participated in 2 separate FGs

• 6 cardiovascular hospitalists and 6 internists

• Providers

• were busy

• had limited time for education (relied on others)

• wanted easy tools to guide discussions

Providers

Results:

Implications

• The patient/caregiver perspective provides valuable insights not commonly considered in process improvement.

• HF patients want early and personalized education, consistency and coordination amongst providers, and assistance with medications and home care.

• Providers are often too busy to offer complete education to patients, relying on other team members. They want simple tips to offer patients and a guide for their discussions.

• By utilizing patient-and provider -identified themes for improvement and recommendations, the patient experience can be enhanced and care processes more effective and outcomes may be improved.

Fulfilling Intermountain’s MissionHelp people live the healthiest lives possible

• Patient and Family Advisory Council (PFAC)

• Patient pool from Intermountain’s heart failure research Plans

• Ongoing patient & provider tools

• Coupling patients’ and providers’ perspectives in process improvement activities is essential

• Patients need meaningful assistance in living with heart failure

• Busy providers need useful tools

Conclusion

KISMET RASMUSSON- Intermountain Heart Institute, Salt Lake City

KATY JO STEVENS- Intermountain Healthcare, Salt Lake City

SEAN MEEGHAN- Intermountain Healthcare, Salt Lake City

STEPHANIE CROASDELL- Intermountain Healthcare, Salt Lake City

DEBORAH BUDGE- Intermountain Heart Institute, Salt Lake City

COLLEEN ROBERTS-Intermountain Healthcare, Salt Lake City

DONALD L. LAPPÉ - Intermountain Heart Institute, Salt Lake City

Authors & Collaborators:

Thank you!