Heart Failure Dashboard Design and Validation to Improve Care of Veterans

Foster, Marva; Albanese, Catherine L.; Chen, Qiang; Sethares, Kristen A.; Evans, Stewart; Lehmann, Lisa Soleymani; Spencer, James H.; Joseph, Jacob

doi:10.1055/s-0040-1701257

Cited by 15 publications

(14 citation statements)

References 31 publications

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“…Nearly all of the data currently collected for GWTG 33 can be derived from preexisting VA EHR data for all patients in the system without a registry and have been used to produce the VA Heart Failure Dashboard. 34 This innovative program provides a near real-time web-based display of 19 performance measures for all VA HF patients after discharge from a HF admission and is available to all VA providers. In addition to providing benchmarks for both established and emerging GDMT drugs, it tracks the use of specialty services, medications that may worsen HF, laboratory results, blood pressure, appointments, and identifies high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Inpatient Quality-of-Care Measures for Heart Failure: Treatment Gaps and Opportunities in the Contemporary Era

Warner

Ghaznavi

et al. 2022

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: Quality of care measures are vital tools to assess processes of care within and between health care systems. The 2020 American College of Cardiology/AHA performance measures for heart failure provide a new set of such measures. We evaluated the achievement of these and other performance measures within the Veterans Affairs hospital system in a contemporary cohort of patients hospitalized for heart failure. METHODS: Hospital discharges from January 2010 to February 2021 with a primary diagnosis of heart failure (n=289 810) were evaluated. Adherence to each measure was determined using the measure’s stated definition and by site. RESULTS: Among patients with reduced ejection fraction (53.0%), beta blocker use was high (89.0%), ACE (angiotensin-converting enzyme) inhibitor, angiotensin receptor blocker, or angiotensin receptor-neprilysin inhibitor (ARNI) use decreased over time (75.3% in 2010, 55.8% in 2020), and hydralazine/nitrate use in eligible Black patients (19.3%) was low. While 68.1% were eligible for ARNI, only 6.0% received them, reaching 17.2% by 2020. Mineralocorticoid receptor antagonists were used in 49.3% of those eligible; laboratory testing 7 days after their initiation was 73.0%, detecting hyperkalemia in 2.2%, although it occurred in 13.7% by 90 days. Achievement of ≥50% target dose was low (beta blocker 45.9%, ACE inhibitor/angiotensin receptor blocker 31.6%, ARNI 19.0%) and for ACE inhibitor/angiotensin receptor blocker/ARNI, decreased over time. Discharge appointments were 56.2% at 7 days and 78.8% at 14 days. Cardiac rehabilitation referral was low (10.5%) but increased. There were significant site-level differences, particularly for hydralazine, ARNI, devices, and cardiac rehabilitation. CONCLUSIONS: Important inpatient quality of care measures can be readily measured across the Veterans Administration health care system from electronic health records. Treatment gaps and site-level differences persisted into the contemporary era and will likely be exacerbated as newer treatments are added to this complex baseline. These measures and methods also offer the opportunity to target global, local, and individual processes of care for innovative quality improvement initiatives.

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Section: Discussionmentioning

confidence: 99%

Inpatient Quality-of-Care Measures for Heart Failure: Treatment Gaps and Opportunities in the Contemporary Era

Warner

Ghaznavi

et al. 2022

Circ: Cardiovascular Quality and Outcomes

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“…Many studies focused on the creation and evaluation of customized data displays. These customized data displays also focused on a diverse set of application areas, including integrated dashboards [ 10 , 61 , 124 ], critical care displays [ 96 ], opioid management [ 123 ], plan of care tools [ 125 ], and patient-focused communication [ 11 , 55 , 98 ]. A smaller number of studies addressed non-EHR integrated information systems [ 9 , 65 , 68 , 83 , 112 , 120 ], and EHR training design [ 46 , 59 , 135 ].…”

Section: Resultsmentioning

confidence: 99%

“…Mobile apps [105,113] [17,29,69,70,81,87,91,99,118,119,126,129,33,130,132,142, 34,36,37,49,50,53,67] [ 10,11,92,96,98,[123][124][125][50][51][52]55,61,66,72,84] [ 13,15,47,54,[56][57][58]63,75,85,108,110,23,[115][116][117]121,122,127,131,[25][26][27]30,35,40,41] Fig. 2 Relative weighting of HF/E outcomes by domain [1].…”

Section: Customized Data Displaysmentioning

confidence: 99%

Human Factors and Organizational Issues in Health Informatics: Innovations and Opportunities

Marquard

2021

Yearb Med Inform

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Objective: Human factors and ergonomics (HF/E) frameworks and methods are becoming embedded in the health informatics community. There is now broad recognition that health informatics tools must account for the diverse needs, characteristics, and abilities of end users, as well as their context of use. The objective of this review is to synthesize the current nature and scope of HF/E integration into the health informatics community. Methods: Because the focus of this synthesis is on understanding the current integration of the HF/E and health informatics research communities, we manually reviewed all manuscripts published in primary HF/E and health informatics journals during 2020. Results: HF/E-focused health informatics studies included in this synthesis focused heavily on EHR customizations, specifically clinical decision support customizations and customized data displays, and on mobile health innovations. While HF/E methods aimed to jointly improve end user safety, performance, and satisfaction, most HF/E-focused health informatics studies measured only end user satisfaction. Conclusion: HF/E-focused health informatics researchers need to identify and communicate methodological standards specific to health informatics, to better synthesize findings across resource intensive HF/E-focused health informatics studies. Important gaps in the HF/E design and evaluation process should be addressed in future work, including support for technology development platforms and training programs so that health informatics designers are as diverse as end users.

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“…Registries have demonstrated utility in the management of many health conditions. [13][14][15][16][17][18][19][20][21][22][23][24] We rapidly developed, implemented, and used EHR patient registries to manage the daily operations of one of the largest multistate group practices in the United States during the ongoing COVID-19 pandemic. The primary function of the COVID-19 registries was to equip our health system to process real-time data and to classify patients into the appropriate diagnostic category.…”

Section: Discussionmentioning

confidence: 99%

Digital Health Surveillance Strategies for Management of Coronavirus Disease 2019

Jose¹,

Warner²,

O’Horo³

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To describe the design, implementation, and utilization of electronic health record (EHR)e based digital health surveillance strategies used to manage the coronavirus disease 2019 (COVID-19) pandemic and to ensure delivery of high-quality clinical care, such as case identification, remote monitoring, telemedicine services, and recruitment to clinical trials at Mayo Clinic. Methods: The design and implementation work described in this report was performed at Mayo Clinic, a large multistate integrated health care system with more than 1.5 million annual patient visits that uses the Epic EHR system. Rule-based live registries were designed in the EHR system to classify patients who currently test positive for COVID-19, patients who test positive but have recovered from COVID-19, patients who are thought to have COVID-19 but do not yet meet clinical diagnostic criteria, patients who test negative for COVID-19, and patients who exceed a risk score for serious complications from COVID-19. Results: By use of registries, custom dashboards and operational reports were developed to provide a daily high-level summary for clinical practice use and up-to-date information to manage individual patients affected by COVID-19, including support of case identification, contact isolation, and other care management tasks. Conclusion: We developed and implemented a systematic approach to the use of EHR patient registries to manage the COVID-19 pandemic that proved feasible and useful in a large multistate group clinical practice. The key to harnessing the potential of digital surveillance tools to promote patient-centered care during the COVID-19 pandemic was to use the registry data, reports, and dashboards as informatics tools to inform decision-making.

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Heart Failure Dashboard Design and Validation to Improve Care of Veterans

Cited by 15 publications

References 31 publications

Inpatient Quality-of-Care Measures for Heart Failure: Treatment Gaps and Opportunities in the Contemporary Era

Inpatient Quality-of-Care Measures for Heart Failure: Treatment Gaps and Opportunities in the Contemporary Era

Human Factors and Organizational Issues in Health Informatics: Innovations and Opportunities

Digital Health Surveillance Strategies for Management of Coronavirus Disease 2019

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