Abstract 13582: A Quality Improvement Project to Increase Primary Care Follow Up After Congestive Heart Failure Exacerbation in an Academic Medical Center Using a Quality and Safety Award

Abstract

Introduction: Readmission after Congestive heart failure (CHF) exacerbation may be reduced by early follow-up with primary care physicians (PCP). We present a resident-driven quality improvement (QI) initiative to increase early follow-up for Veterans after CHF exacerbation. Primary outcomes were percentage of PCP follow-up within 7-days and median time to follow-up. Secondary outcomes were percentage of patients attending a PCP visit within 7-days, 30-day readmission, and mortality. Methods: This pre-post quasi-experimental study evaluated concurrent QI interventions including a standardized discharge scheduling order, monthly education, and aggregated performance feedback for medical residents with an award to the team with the highest rate of PCP appointments scheduled within 7-days (Fig 1). Patient characteristics and outcomes for a 6-month historic period and 6-month intervention period were compared using test of proportions and Wilcoxon Rank-Sum test. Results: A total of 294 patients were discharged due to CHF exacerbation (161 in historic group and 133 in intervention group). Appointments scheduled within 7-days increased from 43% to 79% (p<0.001). Median time to follow-up decreased from 8 to 6 days (p<0.001). A control chart is shown in figure 2. Patients who completed a PCP appointment within 7-days increased from 16% to 41% (p<0.001). 30-day readmission and mortality were unchanged. Conclusion: A standardized discharge scheduling order, robust resident education, and a monthly patient safety and quality award resulted in a significant increase in the rate of primary care follow-up within 7-days of CHF exacerbation.