Upload
simon23
View
382
Download
1
Tags:
Embed Size (px)
Citation preview
copyright CWRU-CME 2004
National Heart National Heart Failure Training Failure Training for for Improved Patient CareImproved Patient Care
N-HeFTN-HeFT
The Cardiovascular The Cardiovascular Continuum:Continuum:
Targeting Mechanisms and Targeting Mechanisms and MediatorsMediators
Risk Factors:Diabetes
Hypertension
Vascular Dysfunction
Vascular Disease
Tissue Injury(MI, Stroke) Pathological
Remodeling
Target OrganDysfunction (CHF, Renal)
End-stageOrgan Failure
Death
Oxidative Stress/Inflammation
Target Organ Damage
Adapted from Dzau V, Braunwald E. Am Heart J. 1991.
Heart FailureHeart Failure 5 million Americans with heart failure5 million Americans with heart failure 550,000 new cases each year and growing550,000 new cases each year and growing Number one Medicare diagnosis Number one Medicare diagnosis Costs are spiraling Costs are spiraling Responsible for more hospitalizations than any Responsible for more hospitalizations than any
other single diagnosis for the elderlyother single diagnosis for the elderly Newer therapies known to improve patient Newer therapies known to improve patient
outcomes widely underutilizedoutcomes widely underutilized Substantial and preventable morbidity and Substantial and preventable morbidity and
mortalitymortality. .
N-HeFT Bridges the GAPN-HeFT Bridges the GAP
The treatment gap continues to widen between The treatment gap continues to widen between evidence-based approaches to quality care evidence-based approaches to quality care and the reality of practice across the continuum of care, and the reality of practice across the continuum of care, contributing to the increasing economic and social burden contributing to the increasing economic and social burden of this chronic illness.of this chronic illness.
N-HeFT OverviewN-HeFT Overview
Began in 1994 at Temple UniversityBegan in 1994 at Temple University Sponsored and administered by Case Sponsored and administered by Case
Western Reserve University since 1999Western Reserve University since 1999 Customized accredited trainingCustomized accredited training 32 host sites: leading heart failure centers32 host sites: leading heart failure centers Application to practiceApplication to practice Outcomes-driven mentoringOutcomes-driven mentoring
AccreditationAccreditation
AMA CME AMA CME Nursing CENursing CEPharmacy CEUPharmacy CEUAmerican Academy of American Academy of
Family Physicians CMEFamily Physicians CME
32 Centers of Excellence32 Centers of Excellence
PURPOSE OF THE NETWORKPURPOSE OF THE NETWORK
Disseminate best practices to Disseminate best practices to interdisciplinary medical teams who are interdisciplinary medical teams who are eager to learn and enhance their care for eager to learn and enhance their care for HF patientsHF patients
Continuously improve the quality of the Continuously improve the quality of the program as an educational delivery program as an educational delivery systemsystem
DESIRED OUTCOMESDESIRED OUTCOMES Medical teams identify up to 3 Medical teams identify up to 3
changes they will make to improve changes they will make to improve patient care.patient care.
They rank their level of commitment They rank their level of commitment to implementing identified changes. to implementing identified changes.
Teams sign a “Commitment to Teams sign a “Commitment to Change Contract” and submit to N-Change Contract” and submit to N-HeFT for follow up.HeFT for follow up.
Outcomes Follow upOutcomes Follow up
3 mentoring opportunities for medical 3 mentoring opportunities for medical teams up to 6 monthsteams up to 6 months Review “Commitment to Change Contract”Review “Commitment to Change Contract” Discuss approaches to improve quality of Discuss approaches to improve quality of
carecare
Make changes
Assess team needs
Plan training
Assess learning
Plan changes
Review outcome
Revise plan
Training
N-HeFTLive
Organizational StructureOrganizational Structure
Directors Clinical Coordinators
Participating Team
Clinical TeamPatients and Families
Supporters
Executive Committee
Best Practice at All Points of Best Practice at All Points of CareCare
Residents
Skilled Nursing Facility
Nursing Home
Hospice
Industry
Home Care
Outpatient
Hospital
N-HeFT
N-HeFT N-HeFT OnlineOnline
Web site Web site www.nheft.orgwww.nheft.org Online Curriculum Online Curriculum
Cardiology CoreCardiology Core Primary Care CorePrimary Care Core Allied Health CoreAllied Health Core ElectivesElectives
FacultyFaculty Standard curriculum Standard curriculum Resources Resources Tools Tools
Standardization of TrainingStandardization of Training
Curriculum Curriculum Developed and updated by network expert authors Developed and updated by network expert authors Password-protected and posted on web for facultyPassword-protected and posted on web for faculty Accredited for physicians, nurses, pharmacists Accredited for physicians, nurses, pharmacists
Training ProcessesTraining Processes Thorough application processThorough application process Coordinated through Case Western Reserve UniversityCoordinated through Case Western Reserve University Standardized formsStandardized forms Follow up mentoringFollow up mentoring
Louis B. Stokes VA Medical Louis B. Stokes VA Medical Center Center
On site at the Lorain C-BOC On site at the Lorain C-BOC Staff: MD’s, Pharm D, RN, PA, MBAStaff: MD’s, Pharm D, RN, PA, MBA Feb 6, 7Feb 6, 7 Morning Didactic Primary Care CoreMorning Didactic Primary Care Core Afternoon clinic with Dr. Ileana Pina and Afternoon clinic with Dr. Ileana Pina and
participants” patients-Faculty-guided visitparticipants” patients-Faculty-guided visit
Visit Snapshot 07/05-present Visit Snapshot 07/05-present
95 trainings completed 95 trainings completed 11 applications pending 11 applications pending 600+ participants completed training600+ participants completed training 64 Primary Care 64 Primary Care 31 Cardiology31 Cardiology
CollaborationsCollaborations
Think Tank for Cardiovascular Think Tank for Cardiovascular Research in Women Research in Women
CHP: HF AdvocateCHP: HF Advocate Visiting Nurse AssociationVisiting Nurse Association Ohio Coalition of HFOhio Coalition of HF Hospice of the Western ReserveHospice of the Western Reserve
Think TankThink Tank
NeedNeed Public health concerns resulting from Public health concerns resulting from
disparities in management of disparities in management of cardiovascular diseases and related cardiovascular diseases and related outcomes in womenoutcomes in women
GoalGoal To create multi-center prospective studies To create multi-center prospective studies
for women with cardiovascular diseasesfor women with cardiovascular diseases
Think Tank PurposeThink Tank Purpose
Provide an interdisciplinary forum Provide an interdisciplinary forum to discuss promising and novel to discuss promising and novel approaches to management of approaches to management of cardiac disease and its risk factorscardiac disease and its risk factors
Identify promising new directions Identify promising new directions in related researchin related research
Think TankThink Tank
Participation:Participation: National Heart Lung Blood Institute (NHLBI), Food and National Heart Lung Blood Institute (NHLBI), Food and
Drug Administration (FDA, ODE), Department of Health and Drug Administration (FDA, ODE), Department of Health and Human Services (DHHS).Human Services (DHHS).
MeetingsMeetings:: 2/16/06: Bethesda Maryland;2/16/06: Bethesda Maryland; 7/13/06:7/13/06: Rockville, MD; Rockville, MD;
11/11/06 Chicago, 3/24/07: New Orleans, 9/07: 11/11/06 Chicago, 3/24/07: New Orleans, 9/07: WashingtonWashington
Supporters:Supporters: Office of Women’s Health (US Public Health Service), N-Office of Women’s Health (US Public Health Service), N-
HeFTHeFT
VNAVNA N-HeFTN-HeFT 7 home care agencies in Ohio7 home care agencies in Ohio Telemonitor and outcomes researchTelemonitor and outcomes research Standard education for all team members Standard education for all team members
CollaborationCollaboration
Chronic Care ModelChronic Care Model
Health SystemHealth Care Organization
Self- Delivery Decision Clinical Management System Support InformationSupport Design Systems
CommunityResources and Policies
Productive Interactions
Improved Outcomes
Informed Activated patient
Prepared Practice Team
Ohio Heart Failure CoalitionOhio Heart Failure Coalition
Emerged from the “Partnership for Quality” Emerged from the “Partnership for Quality” initiated within the Guidelines Assisting initiated within the Guidelines Assisting Practice Agency for Health Quality Practice Agency for Health Quality Research Grant started in 2004.Research Grant started in 2004.
Started in 2005Started in 2005 Special projectsSpecial projects
MissionMission To achieve transformational change across the To achieve transformational change across the
continuum of heart failure care through innovative continuum of heart failure care through innovative collaboration, dedicated to sharing best practices and collaboration, dedicated to sharing best practices and resourcesresources
GoalsGoals Increase awareness and knowledge of heart failure in Increase awareness and knowledge of heart failure in
Ohioans Ohioans Improve health-related quality of life for people living with Improve health-related quality of life for people living with
heart failure heart failure Improve timeliness, efficiency, and effectiveness of heart Improve timeliness, efficiency, and effectiveness of heart
failure care failure care
N-HeFT Future DirectionsN-HeFT Future Directions
Expand bridge between research and Expand bridge between research and practice through educationpractice through education
Outcomes researchOutcomes research Develop new programs based on identified Develop new programs based on identified
needs: ie-Nursing home, skilled nursing needs: ie-Nursing home, skilled nursing facility, hospice, emergency dept.facility, hospice, emergency dept.
Develop new modules: diabetes, anemia Develop new modules: diabetes, anemia Develop CME for onlineDevelop CME for online Expand collaborative networkExpand collaborative network