Processes and Outcomes of Congestive Heart Failure Care by Different Types of Primary Care Models

Kuo, Yong–Fang; Adhikari, Deepak; Eke, Chiemeziem; Goodwin, James S.; Raji, Mukaila

doi:10.1016/j.cardfail.2017.08.459

Cited by 13 publications

(9 citation statements)

References 34 publications

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“…18,19,23,26,33,34 The Canadian, American and European HF Guidelines all recommend multidisciplinary HFCs. 32,38,39 Recently a review confirmed a lower incidence of HF hospitalizations and all-cause mortality associated with specialized HFCs. 35 However, only patients with a minimum of 3 months follow-up benefit (OR 0.52; P=0.0009), while those followed less than 3 months do not (OR 0.91; P=0.70).…”

Section: Spoke-hub-and-node (Shn) Model Of Carementioning

confidence: 98%

The Spoke-Hub-and-Node Model of Integrated Heart Failure Care

Huitema

Harkness

Heckman

et al. 2018

Canadian Journal of Cardiology

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Heart failure (HF) is a significant public health concern. Specialized HF clinics provide the optimal environment to address the complex needs of these patients and improve outcomes. The current and growing population of patients with HF outstrips the ability of these clinics to deliver care. Integrated care is defined as health services that are managed and delivered so that people receive a seamless continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services. This approach requires coordination across different levels and sites of care within and beyond the health sector, according to changing patient needs throughout their lives. The spoke-hub-and-node (SHN) model represents an organization of care that works collaboratively with the primary care sector and is highly integrated with community-based multidisciplinary teams of health care professionals and specialty care. The purpose of this article is to analyze the requirements for successful implementation of SHN models. We consider the respective roles of HF clinics, HF nurse specialists, pharmacists, palliative care teams, telemonitoring, and solo practitioners. We also discuss levels of care delivery and the importance of patient stratification and patient flow. The SHN approach has the potential to build on and improve the chronic care model (CCM) to deliver centralized services to preserve high-quality patient-centred care at affordable costs.

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Section: Spoke-hub-and-node (Shn) Model Of Carementioning

confidence: 98%

The Spoke-Hub-and-Node Model of Integrated Heart Failure Care

Huitema

Harkness

Heckman

et al. 2018

Canadian Journal of Cardiology

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“…However, all of these studies were conducted in highly selected populations. To get real world evidence, we previously performed an observational study to compare quality of care provided by PCPs only or NPs only vs. a shared care model involving both [ 9 ]. The main limitation of this study was that we did not know the extent to which the share care model was actually shared care.…”

Section: Introductionmentioning

confidence: 99%

Processes and outcomes of diabetes mellitus care by different types of team primary care models

et al. 2020

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Background Team care improves processes and outcomes of care, especially for patients with complex medical conditions that require coordination of care. This study aimed to compare the processes and outcomes of care provided to older patients with diabetes by primary care teams comprised of only primary care physicians (PCPs) versus team care that included nurse practitioners (NPs) or physician assistants (PAs). Methods We studied 3,524 primary care practices identified via social network analysis and 306,741 patients ≥66 years old diagnosed with diabetes in or before 2015 in Medicare data. Guideline-recommended diabetes care included eye examination, hemoglobin A1c test, and nephropathy monitoring. High-risk medications were based on recommendations from the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Preventable hospitalizations were defined as hospitalizations for a potentially preventable condition. Results Compared with patients in the PCP only teams, patients in the team care practices with NPs or PAs received more guideline-recommended diabetes care (annual eye exam: adjusted odds ratio (aOR): 1.04 (95% CI: 1.00–1.08), 1.08 (95% CI: 1.03–1.13), and 1.10 (95% CI: 1.05–1.15), and HbA1C test: aOR: 1.11 (95% CI: 1.04–1.18), 1.11 (95% CI: 1.02–1.20), and 1.15 (95% CI: 1.06–1.25) for PCP/NP, PCP/NP/PA, and PCP/PA teams). Patients in the PCP/NP and the PCP/PA teams had a slightly higher likelihood of being prescribed high-risk medications (aOR: 1.03 (95% CI: 1.00–1.07), and 1.06 (95% CI: 1.02–1.11), respectively). The likelihood of preventable hospitalizations was similar among patients cared for by various types of practices. Conclusion The team care practices with NPs or PAs were associated with better adherence to clinical practice guideline recommendations for diabetes compared to PCP only practices. Both practices had similar outcomes. Further efforts are needed to explore new and cost-effective team-based care delivery models that improve process, outcomes, and continuity of care, as well as patient care experiences.

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“…It has been strongly advocated to design newer models of care, likely led by primary care provider (PCP) or generalist and inclusive of other health care providers, to close care gaps and improve continuity and effectiveness of care for such patients in the ambulatory settings. 16 Innovation in provision of care should not only address HF and its risk factor therapies but also offer better coordinated and integrated services/programs to optimize chronic disease management. For example, shared care models including both nurse practitioners and PCPs for more complicated patients with HF likely need better clinical resources and increased frequency of encounters with clinicians and other health care multidisciplinary members, including dieticians, physical therapists, and pharmacists.…”

mentioning

confidence: 99%

“…Newer collaborative cardio-geriatric clinics are being tested. 16 These clinics are designed to meet the needs of older patients with HF and their caregivers by providing teaching support and comprehensive care focusing on improving QoL and functional independency. If managed adequately in a multidisciplinary ambulatory care setting, we can potentially prevent most of the unnecessary HF decompensations and hospital readmissions.…”

mentioning

confidence: 99%

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Opportunities for Care Optimization and Hospitalization Reduction for Older Persons With Heart Failure

Azad

2019

Clin Med Insights Cardiol

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Processes and Outcomes of Congestive Heart Failure Care by Different Types of Primary Care Models

Abstract: The delivery of CHF care mirrors the severity of comorbidity in these patients. The high rate of hospitalization and ER visits in the shared care model underscores the need to design and implement more effective chronic disease management and integrated care programs.

Cited by 13 publications

References 34 publications

The Spoke-Hub-and-Node Model of Integrated Heart Failure Care

The Spoke-Hub-and-Node Model of Integrated Heart Failure Care

Processes and outcomes of diabetes mellitus care by different types of team primary care models

Opportunities for Care Optimization and Hospitalization Reduction for Older Persons With Heart Failure

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