3/20/2013

1

The following program is co-provided by the American Heart Association

and Health Care Excel, the Medicare Quality Improvement Organization for

Kentucky.

3/20/2013 ©2010, American Heart Association 1

3/20/2013

2

3/20/2013

3

3/20/2013 ©2011, American Heart Association 3

Presenter Disclosure InformationName: Bart Cox, MD, FACC

Title: Associate Professor of Medicine, Division of Cardiology,

Hospital: University of New Mexico School of Medicine, Albuquerque, NM

FINANCIAL DISCLOSURE: None

UNLABELED/UNAPPROVED USES DISCLOSURE: None

3/20/2013

4

3/20/2013 ©2011, American Heart Association 4

Presenter Disclosure InformationName: Diane M. Dodendorf, PhD

Title: Clinical Quality Manager/Anaylist, Internal Medicine

Hospital: University of New Mexico, Albuquerque, NM

FINANCIAL DISCLOSURE: None

UNLABELED/UNAPPROVED USES DISCLOSURE: None

3/20/2013

5

3/20/2013 ©2012, American Heart Association 5

3/20/2013

6

Target: Heart FailureUniversity of New Mexico School of Medicine

Division of Cardiology

Development of HF Performance Measures: Process, Barriers, and Spinoffs

3/20/2013

7

Objectives• Describe the individual components of our process for ascertainment,

clinical care, clinical follow-up (care transitions), data entry, and

monitoring of HF patients in the University of New Mexico Hospital

system.

• Demonstrate how these independent “parts” function together –

collaboration and cooperation and communication.

• Identify the early and late barriers and “spin-offs” with this process or

“What will get in your way!”

3/20/2013

8

Target: Heart Failure

• An AHA initiative launched in 2010 whose purpose is to improve quality, care

transitions, and outcomes for patients with heart failure with a targeted initiative and

leveraging the American Heart Association’s premier quality improvement suite of

resources including Get With The Guidelines-Heart Failure.

• Provide healthcare professionals with content-rich resources and materials designed to

help them advance heart failure awareness, prevention, treatment and recovery.

• Participants must demonstrate > 50% compliance on the following measures:

• Medication optimization

• Early follow-up and care coordination

• Enhanced patient education

3/20/2013

9

Target: Heart Failure• ACEI/ARB at discharge

• Evidence-based beta-blocker at discharge

• Aldosterone Antagonist at discharge

• Follow-up visit within 7 days

• Referral to disease management program

• Patient education (at least 60 min)

• Interactive workbook

3/20/2013

10

GWTG Target: HFUniversity of New Mexico Hospital

Performance

3/20/2013

11

3/20/2013

12

3/20/2013

13

3/20/2013

14

3/20/2013

15

3/20/2013

16

The “Why” and “How” of our Performance in 2012

3/20/2013

17

Barriers into Spinoffs

3/20/2013

18

LINE of VISIBILITY

3/20/2013

19

Real-time Activation = Clinical Alerts/Clinical Orders

Patient

Pharmacy

Cardiac Rehab

RN Education

HF Nurse Educator

Outpatient HF Clinic

Quality Outcomes

3/20/2013

20

Clinical efforts

3/20/2013

21

Medication Reconciliation

3/20/2013

22

Coding Issues

3/20/2013

23

Discharge Planning

3/20/2013

24

Transition in Care• The 7- day follow-up scheduled at discharge

• The 30-day visit data are ensured by use of dictation template (created by NP at HF

Clinic) and the use of dedicated database (clinical outpatient database)

• Medication reconciliation at each step

• Role of out-patient pharmacy services at HF Clinic

• Cardiac Rehabilitation

• Nurse Education at HF Clinic (1/2 day/week)

3/20/2013

25

Repeat Look at Process

3/20/2013

26

This process is like “braiding” 3 railroad tracks• First “railroad track”: Clinical Processes

• Second “railroad track”: Identification and Ascertainment of HF Patients

• Third “railroad track”: Chart Abstraction and Data Entry (EMR and Outcomes software)

• Build in redundancy and backups

• Expect barriers… actually they are a good thing!!

3/20/2013

27

Questions? Comments? Reactions?