Abstract P129: Building Capacity with Opinion Leaders to Implement the VA Hospital-to-Home Initiative: CHF QUERI

Abstract

Objectives: Reducing readmission rates for heart failure (HF) patients is the primary goal of the Department of Veteran Affairs and its' Chronic Heart Failure (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. In January 2010 the CHF QUERI through its HF Provider Network launched the “VA H2H” QI initiative to implement the national H2H initiative at the VA facilities. Based on the PARIHS framework and Rogers Diffusion of Innovation Theory the specific aim was to identify local opinion leaders (OLs) at each facility to help facilitate the implementation of the VA H2H initiative at own facility. Methods: Prior to launching the VA H2H we used the sociometric method to identify OLs. HF Network members from 61 facilities were asked to nominate up to 2 providers at own facility (physician / nurse / other) including self as the local OL. Based on their nominations OLs were identified preferably with a physician and nurse team and they were asked to participate in the VA H2H. In Month 4 and Month 6 all members were asked to complete a survey providing information about the projects (or interventions) recently initiated based on the VA H2H, planned based on the VA H2H, or ongoing not based on VA H2H initiative. Results: 70% of the facilities (n=43) responded with 1-2 nominations for OLs (n=82) and the remaining 30% facilities had no identified OLs. Survey results show that among the facilities with OLs, 79% initiated/planned projects based on the VA H2H initiative; 9% did not initiate/plan project based on the VA H2H initiative; and 12% were non-responders. These facilities with OLs reported a total of 161 projects: 27 initiated planned based on the VA H2H, 52 planned based on the VA H2H, and 82 ongoing projects not related to VA H2H. Facilities without identified OLs reported having only a total of 6 projects. Conclusions: Most VA facilities were able to identify OLs and then successfully implement 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.