Expecting Success: Excellence in Cardiac Care Results From Robert Wood Johnson Foundation Quality Improvement Collaborative

Outlines results and lessons learned from a pilot program to track and analyze racial/ethnic disparities in cardiac care quality and to develop and share tools to close the gap. Lists examples of interventions and provides data on improvements

Engaging Patients to Improve Documentation of Oral Intake on a Cardiac Telemetry Unit: A Quality Improvement Initiative

Background InformationIt is important for patients with heart failure to have awareness of their intake & output to effectively manage their disease. There is evidence that tracking intake & output is a component of missed nursing care resulting in discrepancies between the actual patient intake and what is documented in the patient’s electronic health record (EHR). Aim The aim of this quality improvement project was to engage patients in monitoring their intake by using teach-back and patient engagement techniques to track their own oral fluid intake throughout the day. MethodsThe Plan-Do-Study-Act (PDSA) model was used as the framework for this initiative. Patients meeting inclusion criteria were given a teach-back quiz to evaluate baseline knowledge. If patients were able to pass the teach-back quiz, they were given a tracking sheet with instructions on how to use it. After a period of eight hours, the sheet was collected and fluid intake volumes were compared with those documented in the EHR. ResultsUsing the Wilcox on non-parametric test, the mean difference between volume tracked by patient and volume documented by clinician was significant at pConclusion & Implications for CNL PracticeVariation between oral fluid intake volume documented in the EHR and patient stated volumes indicates that EHR documentation is less reliable than records kept by adequately educated and engaged patients. Implications for CNL practice include identification of opportunities to increase patient engagement and to utilize evidence-based techniques for this purpose. The CNL should explore barriers that contribute to inaccuracy of documentation. The CNL may explore more reliable methods for determining accurate patient fluid balance for at-risk populations

Achieving Efficiency: Lessons From Four Top-Performing Hospitals

Synthesizes lessons from case studies of how four hospitals achieved greater efficiency, including pursuing quality and access, customizing technology, emphasizing communications, standardizing processes, and integrating care, systems, and providers

Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review

Background Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. Methods Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. Results Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). Conclusion This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied

Western Diet-Fed, Aortic-Banded Ossabaw Swine: A Preclinical Model of Cardio-Metabolic Heart Failure.

The development of new treatments for heart failure lack animal models that encompass the increasingly heterogeneous disease profile of this patient population. This report provides evidence supporting the hypothesis that Western Diet-fed, aortic-banded Ossabaw swine display an integrated physiological, morphological, and genetic phenotype evocative of cardio-metabolic heart failure. This new preclinical animal model displays a distinctive constellation of findings that are conceivably useful to extending the understanding of how pre-existing cardio-metabolic syndrome can contribute to developing HF

The Medicare Physician Group Practice Demonstration: Lessons Learned on Improving Quality and Efficiency in Health Care

Discusses the experiences of ten large practices earning performance payments for improving the quality and cost-efficiency of health care delivered to Medicare fee-for-service beneficiaries

Design and Rationale of the Cognitive Intervention to Improve Memory in Heart Failure Patients Study

BACKGROUND: Memory loss is an independent predictor of mortality among heart failure patients. Twenty-three percent to 50% of heart failure patients have comorbid memory loss, but few interventions are available to treat the memory loss. The aims of this 3-arm randomized controlled trial were to (1) evaluate efficacy of computerized cognitive training intervention using BrainHQ to improve primary outcomes of memory and serum brain-derived neurotrophic factor levels and secondary outcomes of working memory, instrumental activities of daily living, and health-related quality of life among heart failure patients; (2) evaluate incremental cost-effectiveness of BrainHQ; and (3) examine depressive symptoms and genomic moderators of BrainHQ effect. METHODS: A sample of 264 heart failure patients within 4 equal-sized blocks (normal/low baseline cognitive function and gender) will be randomly assigned to (1) BrainHQ, (2) active control computer-based crossword puzzles, and (3) usual care control groups. BrainHQ is an 8-week, 40-hour program individualized to each patient's performance. Data collection will be completed at baseline and at 10 weeks and 4 and 8 months. Descriptive statistics, mixed model analyses, and cost-utility analysis using intent-to-treat approach will be computed. CONCLUSIONS: This research will provide new knowledge about the efficacy of BrainHQ to improve memory and increase serum brain-derived neurotrophic factor levels in heart failure. If efficacious, the intervention will provide a new therapeutic approach that is easy to disseminate to treat a serious comorbid condition of heart failure

Gaston Memorial Hospital: Driving Quality Improvement With Data, Guidelines, and Real-Time Feedback

Describes efforts to reduce variance in provider practice patterns through data analysis and benchmarking of process-of-care measures. Discusses strategies such as sharing data, feedback, and best practices in ways physicians can utilize them immediately

The Value of Information Technology-Enabled Diabetes Management

Reviews different technologies used in diabetes disease management, as well as the costs, benefits, and quality implications of technology-enabled diabetes management programs in the United States

Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access