Abstract 269: A Successful Blended Facilitation Approach with Internal and External Facilitators to Implement the VA Hospital-To-Home (H2H) Initiative: CHF QUERI

Abstract

A Successful Blended Facilitation Approach with Internal and External Facilitators to Implement the VA Hospital-To-Home (H2H) Initiative: CHF QUERI Objectives: Reducing readmission rates for heart failure (HF) patients is the primary goal of the VA and the CHF QUERI. It is also the goal of Hospital to Home (H2H) national quality improvement (QI) initiative cosponsored by the American College of Cardiology and the Institute for Healthcare Improvement. According to Rogers’ Diffusion of Innovation Theory (2003) social networks significantly affect performance and innovation. Additionally, the Promoting Action on Research Implementation in Health Services (PARIHS, 2008) framework emphasizes the function of dynamic relationships among evidence, context and facilitation. In January 2010 the CHF QUERI through its HF Network launched the “VA H2H” QI initiative to implement the national H2H initiative at the VA facilities. Blended facilitation approach was used with the HF Network's leadership being the “external” facilitators and the opinion leaders (OLs) at each facility being the “internal” facilitators. Methods: A total of 122 VA facilities were identified with >100 discharges during 2007-2008. Using the sociometric method OLs were identified to be “internal” facilitators. Members were to nominate up to 2 providers at own facility (physician/nurse/other/self) as the OL. Then OL teams were asked to participate in the VA H2H. As “external” facilitators the HF Network's leadership conducted web-based meetings and provided tool-kit and consultation to members at all 122 facilities. Periodic surveys were used to track projects (or interventions) recently initiated based on VA H2H, planned based on VA H2H, or ongoing to reduce HF readmissions not based on VA H2H initiative. Results: Members from 66% facilities (n=81) responded with 1-2 nominations for OLs. Members from the remaining 34% facilities (n=41) either responded with no nominations (n=3) or were non-responders (n=38). Overall, 47 facilities (39%) reported a total of 243 projects. Among them, 44 facilities had OLs (94%) with 234 projects (96%). In sharp contrast, the remaining 3 facilities (6%) with no OL had only 9 projects (4%). The 44 facilities with OLs reported 37 recently initiated VA H2H projects (versus 3 VA H2H projects at facilities without OL); 40 VA H2H projects being planned (versus 0 project at facilities without OL); and 149 projects ongoing not in response to VA H2H (versus 6 projects at facilities without OL). Conclusions: Facilities with OLs were very successful in implementing the VA H2H initiative. Impact: Use of OLs may be effective in implementing non-mandated QI initiatives to improve care for all VA HF patients.