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Improving Heart Failure Management in Skilled Nursing Facilities

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Presentation on theme: "Improving Heart Failure Management in Skilled Nursing Facilities"— Presentation transcript:

1 Improving Heart Failure Management in Skilled Nursing Facilities
AMDA Foundation/Pfizer Quality Improvement Award Rebecca S. Boxer, MD Assistant Professor of Medicine

2 Heart Failure is the Most Common Reason for 30-Day Rehospitalization
Jencks N Engl J Med 2009

3 Hospital Discharges for Heart Failure by Age and Sex
(FHS: ). Source: NHLBI. * HF based on physician review of medical records and strict diagnostic criteria.

4 Discharge Status from the National Hospital Discharge Survey 1980-2004
% *LTC includes NH and SNF Fang JACC 2008;52:428–34

5 Hospital to Home (does not include SNF)
A national quality improvement initiative of the American College of Cardiology and the Institute for Healthcare Improvement Goal Reduce 30 day, all-cause readmission rates for patients discharged with cardiac conditions by 20 percent by December 2012.

6 The Bridge Project Assess the HF Management in 4 SNF in Greater Cleveland area And then Identify needs of SNF Create HF disease management program for SNF

7 Results from 4 Facilities
No HF disease management programs No tracking of patients with HF Inadequate dietary flexibility Poor symptom recognition No medication titration protocols or flexible diuretic regimens Boxer et. al. JAMDA 2011 in press

8 AMDA Foundation/Pfizer Quality Improvement Award
Preparing the SNF for change in HF Management Program to Educate all Staff Train the Trainer Develop multi-media tools to teach both staff and patients

9

10

11 Results from HF Educational Program
Boxer et. al. JAMDA 2011 in press

12 Development of HF Teaching Videos
Nurse teaching STNA to manage HF STNA teaching Patient to manage HF Nurse teaching family to manage HF - Focus Group Assessment – Motivational Interviewing Techniques added STNA = State Tested Nurses Aide

13 The Bridge Project a Collaboration
Thanks to: Ileana Piña MD, MPH Mary Dolansky RN, PhD Jeanne Hitch Med, MA Peter Degolia MD Matthew Wayne MD Megan Frantz, BA Regina Prosser RN-BNC AMDA Foundation/Pfizer Quality Improvement Award The McGregor Foundation CWRU/Mt Sinai Skills and Simulation Center Case/Cleveland Clinic Multidisciplinary Clinical Research Training Program; 1KL2RR024990

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