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- W2018397703 abstract "Background: Heart failure (HF) disease management programs in single institutions have been shown to achieve desirable outcomes in hospitalized patients. It is unclear however, if such intervention targeted efforts are equally effective in academic institutions with HF specialists and community hospitals where HF patients are cared for by general cardiologists and internists. Methods: The University of Pittsburgh Medical Center, representing 12 Western Pennsylvania hospitals (2 academic; 10 community) implemented a standardized HF disease management program across the various facilities. The program was designed by an “expert panel” chaired by a HF specialist and a general cardiologist and implemented across the 12 institutions. A multidisciplinary team was formed in each representative hospital comprising of a cardiologist, internist, clinical nurse specialist, dietitian, cardiac rehabilitation specialist, pharmacist and social worker. Standard orders were developed to provide national guideline based recommendations for quality HF patient care delivery, regardless of the institutional setting. Orders addressed medication prescription, laboratory and cardiac function testing, disease management education, and discharge planning. In addition, standardized patient educational materials, an instructional delivery model, and patient knowledge questionnaire were selected to serve as the foundation of HF patient teaching throughout the system. The “expert panel” provided heart failure seminars, clinical learning opportunities, and mentoring for local multidisciplinary teams prior to program implementation. Outcomes measured at baseline and after 6 months included length of hospital stay (LOS, days); 31 day all cause and HF readmission rates; and all cause mortality rate. Results: Across the entire program (n = 3285), LOS decreased from 5.19 to 4.99 days; all cause 31 day readmission rate decreased from 22.8% to 21.1%; HF 31 day readmission rate declined from 8.8% to 8.2%; and all cause mortality rate decreased from 3.6% to 2.5% at 6 months compared to baseline. Changes in outcomes from baseline in the academic (n = 916) and community hospitals (n = 2369) are tabulated and compared (Table). Conclusions: Our data suggest that though HF disease management programs improve outcomes in patients, this improvement is particularly evident in community hospitals where patients are managed by internists and cardiologists rather than HF specialists. This highlights the need for implementing a HF disease management program to optimize delivery of cost-effective care in the community hospital setting where the majority of HF patients receive care. Tabled 1Improvement in OutcomesDataAcademic HospitalCommunity Hospitaln = 916n = 2369LOS (Days)−0.26−0.15Mortality%−0.4−1.331 Day Readmission%+ 1.7−3.031 Day HF Readmission%+0.2−1.0HF = Heart Failure; LOS = length of hospital stay Open table in a new tab HF = Heart Failure; LOS = length of hospital stay" @default.
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- W2018397703 date "2003-10-01" @default.
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- W2018397703 title "Effectiveness of a standardized heart failure disease management program in an academic versus community hospital setting" @default.
- W2018397703 doi "https://doi.org/10.1016/s1071-9164(03)00196-9" @default.
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