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

Abstract

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.

Referral and access to heart function clinics: A realist review

“…Contextual factors such as the lack of funding and capacity problems play a significant part in influencing how narrowly clinics set their referral criteria. One way to addressing this might be utilizing the strategy set out by Ontario, Canada, which is to treat HF through an integrated and collaborative strategy called the spoke‐hub‐node model 5,51 . This strategy aims to efficiently distribute HF care across all tiers of healthcare service delivery, by applying a risk model which assigns patients to different tiers based on their status.…”

Optimal Usage of Sacubitril/Valsartan for the Treatment of Heart Failure: The Importance of Optimizing Heart Failure Care in Canada

“… 3 Wait times for access to specialists or regional HF clinics can vary by region and may impact uptake of sacubitril/valsartan prescription, as specialists are more likely to prescribe newer HF medications than generalists. 46 , 47 At present, most patients with HF are cared for by primary care physicians and general internists. 46 , 48 …”

The Status of Specialized Ambulatory Heart Failure Care in Canada: A Joint Canadian Heart Failure Society and Canadian Cardiovascular Society Heart Failure Guidelines Survey

“…18 Patient-centred and seamless care requires integration of services and collaboration between care providers, as defined by the shared-care model. 18,19 A substantial proportion of patients, attending the HFCs represented in this survey, do not have a PCP. In fact, less than half of all clinics identified a PCP for >75% of their patients.…”