Rationale and design of the comparison of outcomes and access to care for heart failure (COACH) trial: A stepped wedge cluster randomized trial

Lee, Douglas S.; Straus, Sharon E.; Austin, Peter C.; Mohamed, Shanas; Taljaard, Monica; Chong, Alice; Fang, Jiming; Prasad, Treesa; Farkouh, Michael E.; Schull, Michael J.; Mak, Susanna; Ross, Heather J.

doi:10.1016/j.ahj.2021.05.003

Cited by 10 publications

(6 citation statements)

References 43 publications

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“…This finding is important because we know that discharging patients from emergency departments without early follow-up leads to poorer outcomes. 25,26 We have been able to show that if patients become engaged in their ongoing care, readmissions can be reduced. 12…”

Section: Discussionmentioning

confidence: 98%

Interprofessional Collaborative Practice Improves Access to Care and Healthcare Quality to Advance Health Equity

et al. 2022

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Healthcare disparites exist in cardiovascular care, including heart failure. Care that is not equitable can lead to higher incidence of heart failure, increased readmissions, and poorer outcomes. The Heart Failure Transitional Care Services for Adults Clinic is an interprofessional collaborative practice that provides guideline-directed medical therapy and education to underserved patients with heart failure. Little is known regarding healthcare equity and quality metrics in relation to interprofessional teams. Thus, the purpose of this study was to examine if an interprofessional collaborative practice care delivery model can affect access to care and healthcare quality outcomes in underserved patients with heart failure. As evidenced by control charts over a two and a half year period, the Heart Failure Transitional Care Services for Adults Clinic was able to show improvements in access to care and quality metrics results without variation. An interprofessional collaborative practice can be an effective delivery model to address health equity and quality of care outcomes.

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Section: Discussionmentioning

confidence: 98%

Interprofessional Collaborative Practice Improves Access to Care and Healthcare Quality to Advance Health Equity

et al. 2022

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“…It is also possible that patients may require follow-up earlier than 7 days. Randomized clinical trials are underway to evaluate whether early 43 Most importantly, early physician visits are only 1 component of a large set of collaborative efforts required for better patient care. In our study, patients with early follow-up also had higher rates of collaborative care, visits with a relevant specialist, guideline-directed medical therapy, and medication reconciliation, and patients with CHF had higher rates of cardiac functional assessment and evaluation for myocardial ischemia, all of which may have been associated with improvement, suggesting that early physician visits may provide the opportunity to develop a plan of care and ongoing chronic disease management.…”

Section: Discussionmentioning

confidence: 99%

“…It is also possible that patients may require follow-up earlier than 7 days. Randomized clinical trials are underway to evaluate whether early (72-hour) cardiology follow-up, risk stratification, and systematized outpatient care can reduce readmissions among patients with CHF who present to the emergency department …”

Section: Discussionmentioning

confidence: 99%

Association of Early Physician Follow-up With Readmission Among Patients Hospitalized for Acute Myocardial Infarction, Congestive Heart Failure, or Chronic Obstructive Pulmonary Disease

et al. 2022

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“…Accurate risk stratification of ED patients with AHF is challenging due to the medical and social complexity of these patients. Studies demonstrate the challenge of optimal alignment of resource intensity with patient risk, with many lower-risk patients being admitted to hospital, higher-risk patients being discharged [ 5 , 6 ], and high rates of adverse events among discharged patients [ 5 , 6 , 7 , 8 , 9 ]. These significant discrepancies between patient risk and hospital admission decisions highlight the impetus for development and testing of risk prediction tools.…”

Section: Introductionmentioning

confidence: 99%

Barriers and Opportunities Regarding Implementation of a Machine Learning-Based Acute Heart Failure Risk Stratification Tool in the Emergency Department

et al. 2022

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Hospital admissions for patients with acute heart failure (AHF) remain high. There is an opportunity to improve alignment between patient risk and admission decision. We recently developed a machine learning (ML)-based model that stratifies emergency department (ED) patients with AHF based on predicted risk of a 30-day severe adverse event. Prior to deploying the algorithm and paired clinical decision support, we sought to understand barriers and opportunities regarding successful implementation. We conducted semi-structured interviews with eight front-line ED providers and surveyed 67 ED providers. Audio-recorded interviews were transcribed and analyzed using thematic analysis, and we had a 65% response rate to the survey. Providers wanted decision support to be streamlined into workflows with minimal disruptions. Most providers wanted assistance primarily with ED disposition decisions, and secondarily with medical management and post-discharge follow-up care. Receiving feedback on patient outcomes after risk tool use was seen as an opportunity to increase acceptance, and few providers (<10%) had significant hesitations with using an ML-based tool after education on its use. Engagement with key front-line users on optimal design of the algorithm and decision support may contribute to broader uptake, acceptance, and adoption of recommendations for clinical decisions.

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Rationale and design of the comparison of outcomes and access to care for heart failure (COACH) trial: A stepped wedge cluster randomized trial

Cited by 10 publications

References 43 publications

Interprofessional Collaborative Practice Improves Access to Care and Healthcare Quality to Advance Health Equity

Interprofessional Collaborative Practice Improves Access to Care and Healthcare Quality to Advance Health Equity

Association of Early Physician Follow-up With Readmission Among Patients Hospitalized for Acute Myocardial Infarction, Congestive Heart Failure, or Chronic Obstructive Pulmonary Disease

Barriers and Opportunities Regarding Implementation of a Machine Learning-Based Acute Heart Failure Risk Stratification Tool in the Emergency Department

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