Heart Failure Clinical Trial
Official title:
Reducing Structural Inequities in Heart Failure Management: An Approach to Improve the Quality of Heart Failure Care on the General Medicine Service: Longitudinal Equity Action Plan (LEAP)
Recent institutional research has demonstrated that black and Latinx patients are significantly less likely to be admitted to cardiology and more likely to be admitted to general medicine for their inpatient heart failure (HF) care. Subsequent HF care on general medicine has been demonstrated to have worse outcomes including lower rates of follow-up with cardiology and higher readmission rates. Given this, this project is a institutional quality improvement initiative, with a stepped wedge design, with the aim to improve the quality of care for heart failure patients admitted to general medicine for their care, and improve discharge planning. General medicine services by hospital pods will be enrolled in a stepped wedge fashion to a Longitudinal Equity Action Plan (LEAP) which includes a standardized clinical management plan to ensure patients are on guideline-appropriate therapy, receive cardiology consultation if appropriate, are discharged when clinically appropriate, discharge planning and systematic follow up with cardiology, transportation support as needed for follow-up visits, post-discharge follow up to identify any post-discharge issues.
Status | Not yet recruiting |
Enrollment | 100 |
Est. completion date | August 31, 2020 |
Est. primary completion date | May 31, 2020 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - All patients admitted to the general medicine service at our hospital with a principal diagnosis of heart failure Exclusion Criteria: - Patients less than 18 years of age |
Country | Name | City | State |
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n/a |
Lead Sponsor | Collaborator |
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Brigham and Women's Hospital |
Caitlin S. Drescher, Kathryn A. Britton, Lynne W. Stevenson, Akshay S. Desai. Clinical Outcomes during Generalist Vs. Subspecialty Care of Inpatients with Heart Failure and Preserved Ejection Fraction. Journal of Cardiac Failure. 2017; 23(8):S23.
Cook NL, Ayanian JZ, Orav EJ, Hicks LS. Differences in specialist consultations for cardiovascular disease by race, ethnicity, gender, insurance status, and site of primary care. Circulation. 2009 May 12;119(18):2463-70. doi: 10.1161/CIRCULATIONAHA.108.825133. Epub 2009 Apr 27. — View Citation
Farias M, Jenkins K, Lock J, Rathod R, Newburger J, Bates DW, Safran DG, Friedman K, Greenberg J. Standardized Clinical Assessment And Management Plans (SCAMPs) provide a better alternative to clinical practice guidelines. Health Aff (Millwood). 2013 May;32(5):911-20. doi: 10.1377/hlthaff.2012.0667. — View Citation
Foody JM, Rathore SS, Wang Y, Herrin J, Masoudi FA, Havranek EP, Krumholz HM. Physician specialty and mortality among elderly patients hospitalized with heart failure. Am J Med. 2005 Oct;118(10):1120-5. — View Citation
Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials. 2007 Feb;28(2):182-91. Epub 2006 Jul 7. Review. — View Citation
Jong P, Gong Y, Liu PP, Austin PC, Lee DS, Tu JV. Care and outcomes of patients newly hospitalized for heart failure in the community treated by cardiologists compared with other specialists. Circulation. 2003 Jul 15;108(2):184-91. Epub 2003 Jun 23. — View Citation
Masters J, Morton G, Anton I, Szymanski J, Greenwood E, Grogono J, Flett AS, Cleland JG, Cowburn PJ. Specialist intervention is associated with improved patient outcomes in patients with decompensated heart failure: evaluation of the impact of a multidisciplinary inpatient heart failure team. Open Heart. 2017 Mar 8;4(1):e000547. doi: 10.1136/openhrt-2016-000547. eCollection 2017. — View Citation
Salata BM, Sterling MR, Beecy AN, Ullal AV, Jones EC, Horn EM, Goyal P. Discharge Processes and 30-Day Readmission Rates of Patients Hospitalized for Heart Failure on General Medicine and Cardiology Services. Am J Cardiol. 2018 May 1;121(9):1076-1080. doi: 10.1016/j.amjcard.2018.01.027. Epub 2018 Feb 7. — View Citation
Selim AM, Mazurek JA, Iqbal M, Wang D, Negassa A, Zolty R. Mortality and readmission rates in patients hospitalized for acute decompensated heart failure: a comparison between cardiology and general-medicine service outcomes in an underserved population. Clin Cardiol. 2015 Mar;38(3):131-8. doi: 10.1002/clc.22372. Epub 2015 Feb 18. — View Citation
Uthamalingam S, Kandala J, Selvaraj V, Martin W, Daley M, Patvardhan E, Capodilupo R, Moore S, Januzzi JL Jr. Outcomes of patients with acute decompensated heart failure managed by cardiologists versus noncardiologists. Am J Cardiol. 2015 Feb 15;115(4):466-71. doi: 10.1016/j.amjcard.2014.11.034. Epub 2014 Dec 2. — View Citation
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013 Oct 15;128(16):1810-52. doi: 10.1161/CIR.0b013e31829e8807. Epub 2013 Jun 5. — View Citation
* Note: There are 11 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Cardiology Consultation | Rates of cardiology consultation | Within admission | |
Other | Transportation Support | Rates of post-discharge follow up visit Transportation Support | Within 14 days of discharge | |
Primary | Cardiology post-discharge follow-up within 14 days | Rates of patients that complete post-discharge follow up appropriate with a cardiologist within 14 days of discharge | 14 days | |
Secondary | Seven-day Heart Failure Readmission | Rate of 7-day HF readmissions | 7 days | |
Secondary | 30-day Heart Failure Readmission | Rate of 30-day HF Readmissions | 30 days | |
Secondary | Cardiology post-discharge follow-up within 30 days | Rates of patients that complete post-discharge follow up appropriate with a cardiologist | 30 days |
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