Broadening Heart Failure Care Beyond Cardiology: Challenges and Successes Within the Landscape of Multidisciplinary Heart Failure Care

Olson, Michael F.; Thompson, Zachary; Xie, Lola; Nair, Ajith

doi:10.1007/s11886-023-01907-5

Cited by 3 publications

(1 citation statement)

References 68 publications

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“…31 Correspondingly, there has been a signi cant number of calls for increasing the number and types of nurse-led, multidisciplinary team con guration interventions in CHF care. [31][32] These ndings re ect the need to expand the responsibilities of hospitalized CHF patients beyond the responsibility the cardiologists. In fact, recent qualitative studies have highlighted the voices of cardiologists who have advocated for having multidisciplinary team con gurations help carry the workload of providing such highly intensive care.…”

Section: Discussionmentioning

confidence: 99%

The Association of Implemented Care Team Configuration Models with Length of Stay and Charges in Hospitalized Patients with Congestive Heart Failure: A Retrospective Analysis of EHR Data

Williams,

Crump,

Parker

et al. 2023

Preprint

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Background: Clinicians are the conduits of high-quality care delivery. Clinicians have driven advancements in pharmacotherapeutics, devices, and related interventions and improved morbidity and mortality in patients with congestive heart failure over the past decade. Yet, the management of congestive heart failure has become extraordinarily complex and has fueled recommendations from the American Heart Association and the American College of Cardiology to optimize the composition of the care team to reduce the health, economic, and health system burden of high length of stay and hospital charges. Therefore, the purpose of this study was to identify the extent to which care team configuration models of non-specialty clinicians were associated with high length of stay and high charges during the hospitalizations of patients with congestive heart failure. Methods: This study performed a retrospective analysis of EHR-extracted data on 3,099 patients and their encounters from the Arkansas Clinical Data Repository. The data was analyzed using binomial logistic regression in which adjusted odds ratios reflected the association of specific care team configuration models (i.e., combination of clinical roles) with length of stay and hospital charges. Results: Care team configuration models that included physicians, residents, and advanced nurse practitioners were generally associated with greater odds of a patient having a high length of stay or a high charge hospital encounter. Registered nurses were the only specific care team role found within all care team configuration models and has consistently been associated with decreased length of stay and decreased charges. Additionally, the study validated the Van Walraven Elixhauser Comorbidity Score by finding that its quartiles were statistically significantly associated with length of stay and charges. Conclusions: Cardiologists, alone, cannot shoulder the burden of caring for hospitalized patients with congestive heart failure. Care team configuration data within electronic health record systems of hospitals could be an effective method of isolating and tracking high risk patients. Within multidisciplinary care teams, registered nurses may be particularly effective in advancing real-time risk stratification by applying the Van Walraven Elixhauser Comorbidity Score at the point-of-care.

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Section: Discussionmentioning

confidence: 99%

The Association of Implemented Care Team Configuration Models with Length of Stay and Charges in Hospitalized Patients with Congestive Heart Failure: A Retrospective Analysis of EHR Data

Williams,

Crump,

Parker

et al. 2023

Preprint

View full text Add to dashboard Cite

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Clinical Importance of Protein Intake in Hospitalized Elderly Patients With Heart Failure

Miyata,

Matsumura,

Takase

et al. 2024

Circ Rep

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The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure

Williams,

Crump,

Parker

et al. 2024

Front. Health Serv.

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IntroductionClinicians are the conduits of high-quality care delivery. Clinicians have driven advancements in pharmacotherapeutics, devices, and related interventions and improved morbidity and mortality in patients with congestive heart failure over the past decade. Yet, the management of congestive heart failure has become extraordinarily complex and has fueled recommendations from the American Heart Association and the American College of Cardiology to optimize the composition of the care team to reduce the health, economic, and the health system burden of high lengths of stay and hospital charges. Therefore, the purpose of this study was to identify the extent to which specific care team configurations were associated with high length of stay and high-charge hospitalizations of patients with congestive heart failure.MethodsThis study performed a retrospective analysis of data extracted from the electronic health records of 3,099 patients and their hospitalizations from the Arkansas Clinical Data Repository. The data was analyzed using binomial logistic regression in which adjusted odds ratios reflected the association of specific care team configurations (i.e., combination of care roles) with length of stay and hospital charges.ResultsTeam configurations that included a nurse practitioner, registered nurse, care manager, and social worker were generally above the median length of stay and median charges when compared to team configurations that did not collectively include all of these roles. Patients with larger configurations (i.e., four or more different care roles) had higher length of stays and charges than smaller configurations (i.e., two to three different care roles). The results also validated the Van Walraven Elixhauser Comorbidity Score by finding that its quartiles were associated with length of stay and charges, an indicator of care demand based on patient morbidity.ConclusionsCardiologists, alone, cannot shoulder the burden of improving patient outcomes. Care team configuration data within electronic health record systems of hospitals could be an effective method of isolating and tracking high-risk patients. Registered nurses may be particularly effective in advancing real-time risk stratification by applying the Van Walraven Elixhauser Comorbidity Score at the point of care, improving the ability of health systems to match care demand with workforce availability.

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Broadening Heart Failure Care Beyond Cardiology: Challenges and Successes Within the Landscape of Multidisciplinary Heart Failure Care

Cited by 3 publications

References 68 publications

The Association of Implemented Care Team Configuration Models with Length of Stay and Charges in Hospitalized Patients with Congestive Heart Failure: A Retrospective Analysis of EHR Data

The Association of Implemented Care Team Configuration Models with Length of Stay and Charges in Hospitalized Patients with Congestive Heart Failure: A Retrospective Analysis of EHR Data

Clinical Importance of Protein Intake in Hospitalized Elderly Patients With Heart Failure

The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure

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