OR4. Emphasis on Post-Acute Care Shows Improved Guideline Adherence in Three Metro Markets

Abstract

<h3>Background</h3> Nearly 6.5 million Americans are living with heart failure. Heart failure remains a leading cause of hospital admission and contribution to healthcare expenditure. It is projected that by the year 2030, the total cost of heart failure will increase by 127%. Participation in a quality improvement initiative aimed at improving adherence to evidenced based guidelines can assist in reducing cost and improving patient outcomes. While hospital participation in an in-hospital quality improvement initiative, such as Get With the Guidelines® Heart Failure (GWTG-HF), has been well-studied, few studies evaluate post-hospital discharge adherence to guideline directed medical therapy. <h3>Objective/Purpose</h3> The objective of this initiative was to create a streamlined easy-to- use post hospital discharge data collection tool, provide quality consultation to utilize data, and form learning collaboratives to share best practice for improving quality of care. <h3>Methods</h3> A multidisciplinary learning collaborative consisting of 40+ hospitals and post-acute care organizations (home health, community paramedicine, skilled nursing facilities, assisted living) was established in three metro markets: St. Louis, Milwaukee, and Chicago. Utilizing feedback from these collaborative groups, a post-acute care data collection form aimed in tracking adherence to guideline- based care was created in GWTG-HF. Hospitals abstracted data into this form beginning with Quarter 3 2019. Data collected was used to guide collaborative group discussion and individual hospital quality consultation aimed at improving patient outcomes across the care continuum. Additional educational guideline-based resources were provided including webinars, conferences, pocket cards, podcasts, order set examples and follow-up phone call templates. <h3>Results</h3> Hospitals entered baseline data from Quarter 3 2019. Data was reviewed from Quarter 3, 2020 for follow-up comparison. Compliance with post-acute measures improved from baseline Q3, 2019 to Q3, 2020 as follows: ACEI/ARB/ARNI 76.9% to 82.4% (+5.5%), Aldosterone Antagonist 58.2% to 64.9% (+6.7%), and Participation in either Cardiac Rehab or Disease Management 58.7% to 66.1% (+7.4%). <h3>Conclusions</h3> Before this initiative, few of the hospitals in the learning collaborative were focusing on post-acute follow up care or collecting data to review. Once a streamlined, easy-to-use post-acute care data collection form was created, all the hospitals in the collaborative were required to use it. Reviewing data, providing education, establishing collaborative teams across the care continuum, and sharing best practices moderately improved post-acute care. Future studies should consider including post-acute care organizations performing data collection to improve data accuracy and provide a comprehensive portrayal of patient follow-up care. Future studies should also consider evaluating post-acute care beyond 30 days of hospital discharge.