Background & Objectives: Nearly 1 in 4 heart failure (HF) patients are readmitted within 30 days of discharge and nearly half readmitted in 6 months. HF prevalence is projected to continue increasing resulting in over 8 million adults with HF by 2030. Rising prevalence and poor outcomes provide significant improvement opportunities. Health system participation in a quality improvement (QI) initiative promoting adherence to evidence-based scientific clinical practice guidelines informs high quality care and improves patient outcomes. IMPLEMENT-HF, an American Heart Association (AHA) multi-site QI collaborative across inpatient and outpatient settings, uses implementation science and data analysis to improve guideline adherence across the HF care continuum. Methods: The IMPLEMENT-HF program targets the transformation of HF care in seven national regions. Organizations across the care continuum collect baseline and 30-day follow-up HF data and contribute to learning collaboratives. Data sources include HF measures in the AHA Outpatient Pilot Registry and Get With The Guidelines®-Heart Failure (GWTG-HF) inpatient and post-acute data. In addition to quantitative data, qualitative data including needs assessments, model sharing queries, and evaluation surveys are assessed. After establishing benchmark data, performance is evaluated continuously to identify care gaps. Opportunities for HF QI from this analysis emanate from 1:1 site meetings, regional, and initiative-wide learning collaboratives. AHA staff monitor data to recommend improvements, provide consultation, and deliver targeted training and resources to address common guideline adherence barriers. Intended Analyses: Demonstrate improved guideline adherence across the currently participating 60 sites; benchmark clinical outcomes, esp., mortality, against prevailing community norms with a goal absolute reduction in cardiovascular mortality of 5%; and use multi-site collaboration to develop and promulgate implementation strategies. Conclusions: This three-year multi-region QI initiative connects sites to share challenges and strategies, develop resources, and analyze data to foster continuous guideline adherence improvement across the HF care continuum.
Background: Heart Failure (HF) is projected to impact over 8 million people by 2030. Guideline-Directed Medical Therapy (GDMT) reduces mortality and morbidity, but many eligible patients are not receiving the recommended medications. The 2022 ACC/AHA/HFSA Guideline for the Management of HF highlight the importance of SGLT2i and ARNi, which continue to be underused in eligible HFrEF patients. Methods: IMPLEMENT-HF (I-HF), a national HF quality improvement initiative focusing on early adoption of GDMT, aims to improve use of SGLT2i and ARNi for HFrEF patients. I-HF creates a transformative learning collaborative and resource repository across seven U.S regions to promote education and adherence to GDMT, that includes sharing models of clinical care, targeted training, resource development, and quality improvement consultation. Participation in a learning collaborative allows for sharing of interventions, such as adding SGLT2i on formulary, optimizing EHR tools for GDMT (best practice alerts, disease-specific order sets, dot phrases), provider education, and patient resources to address medication affordability. Sites receive educational materials, including webinars, pocket guideline booklets, and guideline reminder cards to reinforce GDMT. Participating hospitals collect GDMT data in Get With The Guidelines®-Heart Failure (GWTG-HF). ARNi and SGLT2i at discharge was analyzed from baseline (Q1 & Q2 2021 aggregate) through Q1 2022. Results: Data from 62 sites (16,533 HF patient records) showed that use of ARNi at hospital discharge increased from baseline 46% to 58% in Q1 2022, +12%, p value <0.001. SGLT2i use at discharge increased from 8% to 26%, +18%, p value <0.001 (Figure 1). Conclusions: Among centers participating in the I-HF initiative, early findings suggest there has been a rapid increase in use of SGLT2i and ARNi at discharge for HFrEF patients. Further study is needed to assess post-discharge GDMT use, adherence, and clinical outcomes.
Background & Objectives: Stroke is the fifth leading cause of death and the leading cause of disability in the U.S. Timely administration of IV alteplase, can lead to reduction in the severity of disability and improve patient outcomes. The American Heart Association and the American Stroke Association have focused community awareness efforts on the importance of calling 9-1-1 when stroke symptoms are present. Our objective is to determine if arrival mode, specifically arriving by Emergency Medical Services (EMS) vs. privately owned vehicle (POV), impacts timely administration of IV alteplase. Methods: Get With the Guidelines (GWTG) -Stroke is a quality improvement initiative to improve care by promoting adherence to scientific guidelines. A retrospective review was conducted of 10,948 stroke patients from 261 hospitals using GWTG-Stroke in the Midwest from 2013 through 2015. Arrival mode, as well as IV alteplase administration times were analyzed. Results: In 2013, the median arrival to IV alteplase administration (admin) time was 58 minutes (min) when arriving by EMS vs. 64 min when arriving by POV. In 2014, patients arriving by EMS had a median arrival to admin time of 54 min in comparison to 59 min when arriving by POV. In 2015, patients arriving by EMS had a median door to admin of IV alteplase time of 51 min, whereas patients arriving by POV arrival to IV alteplase median time was 58 min. Conclusions: Midwest Stroke patients arriving by EMS received treatment of IV alteplase more timely than those that arrived by POV. Throughout the three years of this study, an average of 64.6% of patients arriving by EMS received IV alteplase within 60 min of hospital arrival in comparison to 52% of patients when arriving by POV. This demonstrates the collaboration, communication, and systems of care work being done by hospitals and EMS. With less than 40% of patients arriving by EMS, this data also identifies the continued need for community education regarding the importance of calling 9-1-1.
Background and Objectives: Healthcare systems are under increasing pressure to deliver a high quality care. To assist with this delivery, hospitals often participate in data registries. The American Heart Association’s Get With The Guidelines® modules are an in-hospital suite of programs designed to improve quality of care, adhere more closely to evidence-based guidelines, and improve patient outcomes. The objective of this study was to determine factors that influence the adoption of GWTG or other quality improvement registries in Midwest (IA, IL, IN, KS, MI, MN, MO, ND, NE, SD, WI) hospitals. Methods: Data was collected via an online survey tool. The tool consisted of 8 questions, consisting of 6 rank order or fill in the blank and 2 demographic questions. Communication about the survey and a link to it was distributed via email to 1100 participants at 726 facilities across the Midwest. The survey was available to hospitals for 1 month. Results: The survey was completed by 260 individuals, giving a response rate of 23.6%. Quantities of returned surveys were proportional to the population in each surveyed state. Job titles of respondents were predominantly Administrative Service Line Directors, Nurses, C-Suite Personnel, Quality Improvement Personnel and Physicians. Questions focused on the following: elements considered during the purchase of a registry, reasons for the retention and continued use of a data registry, Full Time Equivalent (FTE) and other operational costs tied to Return on Investment (ROI), and the identification of which department is responsible for the final approval and acquisition of a data registry. Calculations clearly demonstrated three primary factors influenced the selection and continued use of a data registry - (1) Cost of acquiring and operating the tool, (2) Ease of use and tool functionalities, and (3) Registry purchasing decisions are typically made at the C-Suite level. Conclusions: This survey was designed to examine hospital motivations, barriers and deterrents when considering data registry implementation. Ease of use, data mapping capabilities and reporting functions were consistently ranked highest in importance from most respondents. It is evident as well that the cost of acquiring and operating a registry are primary concerns of hospitals and the final decision to engage in a registry rests with C-Suite personnel. This correlates closely to the desire to lower operating costs and larger ROI through efficient and effective tool usage. Resultingly, building strategies to address financial returns on investment is imperative to engage hospitals. Specific strategies towards addressing the needs and concerns of C-Suite personnel are critical if quality improvement data registry implementation is to occur.
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