Abstract 95: Formative Evaluation of the New Standardized Disease Management Protocol for Heart Failure: CHF QUERI

Abstract

Formative Evaluation of the New Standardized Disease Management Protocol for Heart Failure: CHF QUERI Objectives: The U.S. Department of Veterans Affairs (VA) has been a leader in the use of telemedicine to monitor patients’ health status and self-care using Disease Management Protocols (DMPs) with 35,406 veterans enrolled in home-telehealth in fiscal year 2008. Such protocols have the potential to improve detection of disease exacerbation and to reduce duplication in healthcare resource use. Current technologies include in-home devices from four vendors at all VA facilities that ask the patient several daily questions regarding symptoms and vital signs. Based on the VA Office of Care Coordination’s strong desire for standardizing the type and number of questions asked of the heart failure patients, the VA Chronic Heart Failure (CHF) QUERI developed a standardized DMP for heart failure. After beta-testing it is being implemented by all 4 vendors at all VA facilities. We conducted a formative evaluation of this newly implemented DMP focusing on the frequency and type of patient and provider complaints regarding the new DMP. Method: A structured qualitative process was used to gather the data at 2 VA facilities. Using interview guides in-person semi-structured interviews were conducted with heart failure patients (n=41) currently enrolled in home-monitoring using the new DMP for heart failure. Simultaneously, data were also gathered from providers (telehealth coordinators, n=8) using the new DMP. All data were transcribed. A reflective exploration method was adopted to analyze the qualitative data. Quantitative data analyses relied on descriptive statistics. Results: Patients using the new DMP provided very positive feedback. Half of the patients reported being satisfied with the DMP. On most days 46% (n=19) patients spent 4-5 minutes responding to all questions and 85% responded at least 5 times a week to the questions asked by the device. Almost 100% of them found the questions and answer choices asked by the device easy to understand. These patients also found the questions helpful and relevant for their health condition and based on device 90% knew who to contact if their health condition worsened. Among the providers majority (75%) said the questions were good for screening and based on the questions patients knew who to contact if their health condition were to worsen. Most of them (84%) said their patients didn’t report having problems understanding the questions and choosing appropriate answers. They also said at least 75% of the patients responded to questions at least 5 times a week. Conclusions: These positive results from the formative evaluation of the new DMP for heart failure demonstrate that is a good standardized DMP which will yield good results to track the health of the heart failure patients. Implications: Formative evaluation is an essential component in the implementation of new protocols to relevance, feasibility and sustainability of program use.