Medicolegal Issues

SHM Heart Failure Research Program Awardees


 

Heart failure (HF) afflicts almost 5 million individuals in the United States and ranks among the most costly inpatient conditions, with hospital costs for 2004 estimated between $14 and $20 billion. Approximately 25% of heart failure patients are readmitted within 30 days of hospital discharge, and more than 50% of elderly patients with HF are readmitted to the hospital within six months. SHM believes that hospitalists are well positioned to improve adherence to published guidelines for the care of congestive HF and are ideal candidates for developing and studying strategies for providing safer, more effective care for patients hospitalized with HF.

2005-2006 Survey Factoid

Profile of a Hospital Medicine Group Leader

  • Gender: 80% male, 20% female
  • Age: 41 years*
  • Experience as a hospitalist: 5.8 years*
  • Specialty: Internal Medicine 75%, General Pediatrics 13%, Internal Medicine Sub-specialty 4%, Pediatrics 4%, Family Practice 3%, Pediatric Sub-specialty 2%
  • Full-time Equivalency (can add to more than 1.00): Clinical .90, Administrative .15
  • Compensation: $180,000*
  • Benefits: $30,000*

* Median

Source: SHM’s 2005-2006 “Biannual State of the Hospital Medicine Movement” survey

In May 2005, SHM disseminated a request for applications for the Heart Failure Research Program. The program, which was made possible by an unrestricted educational grant from Scios, Inc. (a biopharmaceutical company), offered two-year grants to support prospective evaluations of hospitalist-led initiatives designed to improve quality of care for patients hospitalized with HF. A 15-member scientific review group, chaired by Andrew Auerbach, MD, and convened in conjunction with the SHM Research Committee and the SHM Executive Board, reviewed the 18 submitted applications and selected two excellent studies for funding.

The Cardiology Quality of Care Study is a collaborative effort between the sections of General Internal Medicine and Cardiology and the University of Chicago Hospitals. Under the direction of principal investigator Chad Whelan, MD, the study team will evaluate a cost-effective system of improving compliance with the well-validated Centers for Medicare and Medicaid Services (CMS) quality indicators for HF. Trained research assistants will perform chart reviews on all hospitalized patients with HF. If a chart review reveals that certain CMS measures have not been met, the research assistant will send a notification e-mail to the clinical team to alert them that a potentially indicated therapy has not been implemented. Follow-up telephone interviews with patients and post-discharge hospital chart abstractions will be used to evaluate the effectiveness of the intervention. The process may be an effective and inexpensive method for hospitals across the country to use to improve compliance with evidence-based, guideline-supported quality of care measures.

The second study, Improving Quality and Efficiency of Heart Failure Care at Hospital Discharge, is being conducted at the Cleveland Clinic Foundation under the direction of Dr. Christopher Phillips. This single-center, randomized, controlled trial will study changes in 30-day readmission rates resulting from an educational intervention designed to enhance self-care behavior in patients discharged with a primary diagnosis of HF. An RN cardiovascular specialist will contact patients weekly by phone for four weeks after hospital discharge. The calls will focus on identifying and correcting deficits in knowledge, motivation, and behavior with respect to HF self-care. Study findings may improve our understanding of patients’ ability to translate HF education and counseling into motivation to adhere to recommended HF self-care behaviors during the post-discharge period. Improved insight into these processes will inform efforts aimed at optimizing the transition from acute hospital care to home, a process that is a major determinant of early readmission.

Both studies are evaluating novel, practical, reproducible means of improving HF care. We look forward to seeing the results. TH

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