Abstract 14295: Exploratory Findings Of A Quality Improvement Collaborative To Optimize Care Provided To Heart Failure Patient In A Network Of Heart Failure Clinics In Argentina

Abstract

Introduction: The in-patient management of heart failure (HF) in Argentina has shown profound gaps in performance. Measurement and feedback as well benchmark comparisons showed increase in the use of evidence-based therapies, adherence to performance measures, and shortened lengths of stay in patients hospitalized with HF. Quality improvement collaboratives (QICs) have been used to improve health care for several decades. Our aim was to adopt a HF discharge bundle of care in 50% of enrolled subjects on discharge will reduce readmission by 10%. Methods: we are conducting a learning QIC, evaluated through a before-after design, from august 2020 to may 2021 (interim analysis), in 8 HF clinics of Argentina, where patients with newly diagnosed or known HF (LVEF <40%) were enrolled when their discharge process was started after an hospital admission. We implemented a HF bundle of care based on four categories that comprised 12 specific interventions: medication, continuum of care, lifestyle habits, pre-discharge exams. Local hospital teams were trained in improvement and change facilitation. The implementation of the bundle was laid out along 8 learning sessions and periods of action using Plan-Do-Check-Act-cycles and an online platform to register interventions and performance.This an ongoing collaborative to be ended in July 2021. IRB approval was granted in all sites. Results: we enrolled 84 patients during baseline (BP) and 96 patients so far after the start of the intervention (IP). No differences were observed related to age, sex, morbidities and left ventricular ejection fraction (LVEF) between periods. Few more patients had history of stroke in the IP period (BP 3.6% vs IP 9.3%, p<0.001). There wasn’t a statistical difference in the accomplishment of all the items of the intervention -all or nothing approach- (BP 10.7% vs IP 17.7%, p=0.183). However, there was a difference in the continuum of care category (BP 27.4% vs IP 53.6%, p<0.001). No differences were observed in the rate of readmissions (BP 8.3% vs IP 3.8%, p=0.231). Conclusions: Initial results of a QIC to improve care before discharge of in-patients with HF NYHA class II-III showed an increase in the adoption of an evidence based practices bundle and no changes were observed in the rate of readmissions.