Insights into a regional collaboration for improving heart care across the complete care chain

Abstract

Abstract Background The Netherlands Heart Network is a joint-effort of all relevant healthcare providers in primary, secondary, and tertiary care across the complete care chain in a region with an adherence of approximately 1,000,000 inhabitants. This regional collaboration features four non-academic hospitals, over 450 general practitioners and various other healthcare professionals who cooperate for the continuous improvement of cardiac patient care using Value Based Healthcare principles. Purpose Due to predicted demographic changes and the expected rise of cardiovascular diseases, novel initiatives are needed to optimize present-day healthcare systems. Therefore, the NHN has focused on the implementation of transmural integrated care delivery systems and impactful innovations for four major cardiovascular diseases: atrial fibrillation (AF), heart failure (HF), coronary artery disease and valvular diseases. Methods Various new health care initiatives and innovations have been implemented and evaluated in the region. For example, dedicated outpatient clinics and transmural care standards have been implemented for AF and HF across the full care cycle. The effect of the implementation of these care standards on patient-relevant outcomes and healthcare costs has been evaluated using large scale prospective and retrospective quality registries. Furthermore, new health care innovations include, among others, the opportunistic screening for AF within general practices and an optimized pre-hospital triage protocol for NSTEMI patients. Results Patient-relevant outcomes in 446 AF patients who visited dedicated outpatient clinics improved within 6 months of follow-up (EHRA score (1.93 to 1.36; p<0.01), hypertension (55.4% to 52.7%; p<0.01) and persistent AF (30.1% to 12.5%; p<0.01)). The introduction of transmural care standards for HF led to significant improvements in patient-relevant outcomes when comparing data before and after implementation (NYHA class (X2=9.1; p=0,03) and LVEF (41.7% vs. 38.4%; p<0.01)) and a reduction of mean healthcare costs by 25%. Moreover, the results of various innovations, including the AF screening protocol and potential benefits of pre-hospital triage of NSTEMI patients, are currently being evaluated. Conclusion(s) This regional collaboration by health professionals is unique in its approach and highlights that healthcare improvements are not exclusively reserved to large academic centers or referral hospitals. The present approach may serve as a blueprint for the organization of healthcare in other regions. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMWHealth insurance CZ/VGZ