Optimisation of diagnosis and treatment of heart failure in a primary care setting

[摘要] Background Heart failure (HF) is one of the leadingcauses of emergency department visits and hospitaladmissions in the USA. We identified a gap in the diagnosisand the use of guideline-directed medical therapy inpatients with HF at the internal medicine clinic.Aim To improve the diagnosis and treatment of HF, as wellas to reduce emergency department visits and hospitalisationover 12 months in patients aged 40–75 years.Methods The multidisciplinary quality improvement(QI) team performed a root cause analysis and identifiedbarriers to optimal guideline-directed medical therapy.Rates of patients on guideline-directed medical therapywith systolic HF diagnosis, emergency department visitsand hospital admissions were the outcome measures.The process measures included echocardiogram orderand completion rates, and rates of accurate classificationof HF from the baseline rate of less than 10%. Weused the focus, analyse, develop, execute and evaluate(FADE) model with five improvement cycles. The majorcomponents of interventions included (1) leveraging healthinformation technology; (2) optimising teamwork; and (3)providing education to patients, physicians and internalmedicine clinic staff. Data were analysed using statisticalprocess control and run charts.Results We observed a reduction in the total numberof emergency department visits (160 vs 108), hospitaladmissions (117 vs 114) and observation visits (22 vs 16)comparing the 1-year preproject and 1-year postprojectperiods. An increase in the use of ACE inhibitors orangiotensin receptor blockers occurred from the baselinerate of 20%–37% during the second half of the project andwas sustained at 71.4% (median) during 6 months of thepostproject period.Conclusions We achieved a sustainable increase in theaccurate diagnosis of HF and achieved 80% diagnosisduring the 6-month poststudy period.

[学科分类] 药学