Guideline-Appropriate Care and In-Hospital Outcomes in Patients With Heart Failure in Teaching and Nonteaching Hospitals

Patel, Dhavalkumar; Shah, Rakibuzzaman; Bhatt, Deepak L.; Li, Liang; Schulte, Phillip J.; DeVore, Adam D.; Hernandez, Adrian F.; Heidenreich, Paul A.; Yancy, Clyde W.; Fonarow, Gregg C.

doi:10.1161/circoutcomes.115.002542

Cited by 25 publications

(18 citation statements)

References 24 publications

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“…While not everyone returned within 7 days, nearly all of the eligible patients had a follow‐up visit within 14 days. These rates are an increase from prior years and may be higher than what has been reported in the literature; however, are not necessarily comparable 46‐51 …”

Section: Introductioncontrasting

confidence: 55%

“…These rates are an increase from prior years and may be higher than what has been reported in the literature; however, are not necessarily comparable. [46][47][48][49][50][51] Historically, social and health care services are funded by different systems and have not been integrated. 12 We focus on a cost analysis of GHFP to answer the following question: What does it cost annually for a safety-net hospital to advance health equity by using a health care intervention that integrates social needs activities into clinical care?…”

Section: What This Study Addsmentioning

confidence: 99%

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The implementation cost of a safety‐net hospital program addressing social needs in Atlanta

MacLeod

Chapel

McCurdy

et al. 2021

Health Services Research

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Objective: To describe the cost of integrating social needs activities into a health care program that works toward health equity by addressing socioeconomic barriers. Data Sources/Study Setting: Costs for a heart failure health care program based in a safety-net hospital were reported by program staff for the program year May 2018-April 2019. Additional data sources included hospital records, invoices, and staff survey. Study Design:We conducted a retrospective, cross-sectional, case study of a program that includes health education, outpatient care, financial counseling and free medication; transportation and home services for those most in need; and connections to other social services. Program costs were summarized overall and for mutually exclusive categories: health care program (fixed and variable) and social needs activities.Data Collection: Program cost data were collected using a activity-based, microcosting approach. In addition, we conducted a survey that was completed by key staff to understand time allocation.

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Section: Introductioncontrasting

confidence: 55%

Section: What This Study Addsmentioning

confidence: 99%

The implementation cost of a safety‐net hospital program addressing social needs in Atlanta

MacLeod

Chapel

McCurdy

et al. 2021

Health Services Research

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“…Registry data suggest variations in performance measures in teaching vs. nonteaching hospitals with greater adherence to standard guidelines for cardiovascular diseases, such as coronary artery disease and heart failure in teaching vs. nonteaching hospitals [12,13]. However, recent registry data suggest no significant association between hospital teaching status and adherence to guidelines among hospitals enrolled in the "Get With The Guidelines"-Heart Failure program [14].…”

Section: Discussionmentioning

confidence: 99%

Hospital teaching status and trascatheter aortic valve replacement outcomes in the United States: Analysis of the national inpatient sample

Telila

Akintoye

Ando

et al. 2017

Cathet Cardio Intervent

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“…Our results are concordant with recently published findings from the American Heart Association’s comprehensive Get With The Guidelines-HF programme, which used a combination of educational approaches, multidisciplinary teams and public hospital performance reporting to improve care. 71 The intervention was carefully adapted and introduced at each hospital site through collaborative discussions of barriers and solutions, and iterative plan-do-study-act cycles prior to the intervention phase. 72 …”

Section: Discussionmentioning

confidence: 99%

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review

et al. 2018

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BackgroundThe uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success.MethodsWe searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction. Primary outcomes included: proportion of eligible patients offered guideline-recommended pharmacotherapy, self-care education, left ventricular function assessment and/or intracardiac devices. We reported clinical outcomes when available.ResultsWe included 38 studies. Provider-level interventions (n=13 studies) included audit and feedback, reminders and education. Organisation-level interventions (n=18) included medical records system changes, multidisciplinary teams, clinical pathways and continuity of care. System-level interventions (n=3) included provider/institutional incentives. Four studies assessed multi-level interventions. We could not perform meta-analyses due to statistical/conceptual heterogeneity. Thirty-two studies reported significant improvements in at least one primary outcome. Clinical pathways, multidisciplinary teams and multifaceted interventions were most consistently successful in increasing physician uptake of guidelines. Among randomised controlled trials (RCT) (n=10), pharmacist and nurse-led interventions improved target dose prescriptions. Eleven studies reported clinical outcomes; significant improvements were reported in three, including a clinical pathway, a multidisciplinary team and a multifaceted intervention. Baseline assessment of barriers, staff training, iterative intervention development, leadership commitment and policy/financial incentives were associated with intervention effectiveness. Most studies (n=20) had medium risk of bias; nine RCTs had low risk of bias.ConclusionOur study is limited by the quality and heterogeneity of the primary studies. Clinical pathways, multidisciplinary teams and multifaceted interventions appear to be most consistent in increasing guideline uptake. However, improvements in process outcomes were rarely accompanied by improvements in clinical outcomes. Our work highlights the need for improved research methodology to reliably assess the effectiveness of implementation interventions.

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Guideline-Appropriate Care and In-Hospital Outcomes in Patients With Heart Failure in Teaching and Nonteaching Hospitals

Abstract: Background-Despite increasing awareness regarding evidence-based guidelines, considerable gaps exist for heart failure (HF) quality of care at teaching hospitals (TH) and nonteaching hospitals (NTH

Cited by 25 publications

References 24 publications

The implementation cost of a safety‐net hospital program addressing social needs in Atlanta

The implementation cost of a safety‐net hospital program addressing social needs in Atlanta

Hospital teaching status and trascatheter aortic valve replacement outcomes in the United States: Analysis of the national inpatient sample

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review

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