Abstract 96: Facilitation of the VA Hospital To Home (H2H) Initiative to Reduce Readmissions for Heart Failure: CHF QUERI

Abstract

Objective: Reducing readmission rates for heart failure (HF) patients is the primary goal of the VA and its' Chronic Heart Failure (CHF) QUERI. It is also the goal of Hospital to Home (H2H) national quality improvement (QI) which has 3 key focus areas: (a) medication management; (b) symptom management; and (c) early follow-up after discharge. 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. The CHF QUERI formed the HF Provider Network consisting of 720+ providers (members) from 150 VA facilities to improve the quality of HF care. In January 2010 through the HF Network the “VA H2H” QI initiative was launched to facilitate the implementation of the national H2H initiative at the VA facilities with focus on H2H's 3 key focus areas. Through e-mails, web-based meetings and conference calls members were encouraged to (1) enroll own facility on national H2H website and (2) initiate and/or plan new projects focusing on the VA H2H initiative. Methods: A total of 122 VA facilities were identified with >100 discharges during 2007-2008. In Spring 2010 and then Spring 2011 members at all facilities were asked to complete surveys to find out (1) enrollment status and (2) number and description of projects initiated and/or planned for the VA H2H initiative, and other ongoing projects focusing on reducing HF readmissions. Results: Altogether 77 (63%) facilities enrolled on the national H2H website. With a survey response rate of 75% (92 facilities) altogether 529 projects were reported focusing on: Medication management=150 (29%); Symptom management=148 (27%); Early follow up=155 (30%); and Other areas=34 (14%). A total of 120 (22%) projects were initiated and another 93 (18%) are being planned based on the VA H2H initiative, and 316 (60%) are ongoing projects to reduce HF readmissions. Conclusions: Supporting the Rogers (2003) and PARIHS (2008) frameworks, these findings demonstrate the successful facilitation of the VA H2H initiative by the CHF QUERI through its HF Provider Network in terms of increased enrollment and significant number of initiated and/or planned VA H2H projects. Impact: Facilitation of non-mandated QI initiatives is crucial to improve the quality of care for HF patients.