ppt课件-aproposalforacomprehensiveheartfailuremanagement.pptVIP

A Comprehensive Heart Failure Management Program for the Portland VA Medical CenterA Collaboration of Primary Care, Specialty Care, Nursing and Pharmacy This Presentation Adapted and shortened from a more detailed “sales” presentation made to Portland VA leadership at an ACA retreat in August, 2005. I am happy to send the full slide set if it will be of use to you Email me: greg.larsen@va.gov What is Wrong With the Status Quo at PVAMC, 2005? For CHF in-patients: 29% readmission rate within 30 days For CHF out-patients: Inadequate dosing of life saving drugs ACE Inhibitors Beta Blockers State of CHF Drug Titration Chart review of 179 CHF patients by Bing Bing Liang, Pharm. D., 2004 Drug % Receiving % at Target Dose ACE 77% 49% Beta Blocker 77% 6% Both 39% 4% Structural Barriers: Primary Care Structural Primary Care Capacity (panel size): 1.7 visits per patient per year Many competing priorities in any visit Alerts, mandates, screening, patient concerns, etc Clinic not designed for frequent drug titration Thus, Limited Capacity for “Short Cycle” Returns Post-Discharge: “See PCP in 1 week” Ongoing medical monitoring: “titrate medications every 1-2 weeks” Structural Barriers in Cardiology: Current CHF Clinic Activity Projected Yearly Cards Clinic: CHF new patient visits: 160 CHF return visits: 565 CHF post-hospital f/u visits: 264 Total 989 visits Primary Care CHF Visits: 2,548 visits (Portland only) Visit “Gap”: 2,548 – 989 = 1559 visits The Case for A Comprehensive CHF Management Program Why do CHF Programs work? They rescue the most vulnerable recently hospitalized patients Chronic NYHA Class 4 patients They titrate life saving drugs to full doses Some CHF patients are not on life prolonging drugs at all Of those who are, most are not on doses shown to provide the life saving benefit The Proposal CHF Clinic Structure Most activities already ongoing, most FTE already in place, but scattered and under-supported. Thus, we propose: A we