What is Intermountain Healthcare doing for patients with heart failure?
“Clinical Programs” are organizational structures that span the entire set of 24 hospitals to look at disease-specific processes of care. The Cardiovascular Clinical Program consists of a group of experts who lead the process decisions for all cardiac conditions, including heart failure. This group includes physicians, nurses, administrators, and statisticians who meet regularly to work on reviewing reports on how care is delivered, and work to continuously improve care.
Goals on care delivery are set each year by Intermountain Healthcare. During the years 2002-2009, the corporate goal included measuring heart failure care that was delivered during the hospitalization. These heart failure goals are based on the best evidence on providing care to patients with this diagnosis. The heart failure goals include:
- Measuring heart function,
- Prescribing appropriate medications,
- Teaching patients how to manage their heart failure at home (MAWDS),
- Encouraging smoking cessation for smokers.
What is the impact Intermountain Healthcare has on heart failure care?
Since 2000, the above mentioned experts have worked together to better understand heart failure.
- Evidence-based protocols were established and disseminated to providers to update them on how to deliver the best care to heart failure patients.
- Patient education tools were developed to teach patients how to live with heart failure, using a video, manual, and diary to track symptoms.
- Information systems were established to track the delivery of care, and to work on areas that need improvement.
In 2004, we published data from our hospitals, which showed that by improving the prescribing rates of a heart failure medication called an ACE inhibitor during hospitalization provided a significant reduction in readmissions to the hospital, deaths, and costs. This showed the tremendous impact that one class of medications alone had on heart failure care. Intermountain Healthcare supported the process by which nurses, physicians and pharmacists work together to prescribe ACE inhibitors to heart failure patients. Learn more.
In 2005, we showed that patients who had documented education about their diagnosis and how to care for themselves at home before discharge from the hospital had a 21% reduction in their chance of death when compared to patients with the same diagnosis who did not receive this education. This was a profound finding. It showed that bedside education by nursing staff, using standardized educational tools throughout Intermountain Healthcare, could improve patient outcomes. Learn more.
In 2007, we showed that heart failure patients had better chances of survival the more we adhered to the heart failure goals while those patients were in the hospital. This data was published in the Journal of Cardiac Failure. Again, the conclusion was that fewer patients die when evidence-based care is followed. Learn more.
In 2010, we showed that heart failure patients in our original study from 2005 continued to show a survival benefit 5 years after their initial hospitalization. This study suggests that our heart failure educational process using MAWDS has a meaningful impact on heart failure patients cared for within Intermountain Healthcare. Learn more.
Intermountain Healthcare continues to focus on heart failure care throughout all hospitals.
Each patient with heart failure admitted to the hospital is identified as such and a process of care begins, ensuring that all of the heart failure goals are addressed during their stay. This takes coordination between teams to ensure that adequate care is provided. For this process to be delivered in a standardized approach each hospital has a designated 'heart failure liaison;' this individual directly interfaces with heart failure experts who are part of the Cardiovascular Clinical Program. Liaisons help monitor heart failure processes of care at their hospital and they are in contact with the healthcare providers providing clinical care to the patients. The goal is to provide ongoing updates on evidence-based care, tools to enable better adherence to goals, and to improve processes of care. One such example is an educational update called Heart Failure Clinical Pearls that are emailed out to healthcare providers each month.
Not only is Intermountain Healthcare supportive of providing the best possible clinical care, but it also supports heart-related research. By participating in clinical trials we actively contribute to learning about and providing the best care. We have participated in many heart failure clinical trials at our facilities spanning medical therapy, pacemakers (device therapy) and mechanical circulatory support (ventricular assist devices).
Intermountain Healthcare is in a unique position as they have been included as one of eight national centers to participate in the Heart Failure Clinical Research Network. The Network consists of eight hospitals across the United States which were chosen to participate collaboratively and collectively in large-scale clinical trials funded by the National Institutes of Health (NIH). These trials are designed to help answer important clinical questions such as optimizing diuretic use in hospitalized heart failure patients, how to best utilize ultrafiltration to help certain patients who are volume overloaded remove excess fluid, and studying whether or not Sildenafil improves activity tolerance in heart failure patients.
Goals of the NIH Heart Failure Clinical Research Network are to establish a knowledge base that will improve therapeutic decision making by testing approaches to manage acute and chronic heart failure. The Network plans to establish this knowledge base in these ways:
- Develop methods to predict individual responses to interventions
- Evaluate and correlate various measures of quality of life and cost-effectiveness for heart failure interventions
- Establish collaborations between the practice community and regional clinical centers
- Disseminate findings to the medical community
- Train physicians in heart failure clinical investigations