Heart Failure Collaborative Initiative Aims to Decrease Hospital Admissions and Improve Quality of Life for Heart Failure Patients

Nearly six million Americans suffer from congestive heart failure (CHF), according to the American Heart Association. Because CHF is actually an ambulatory sensitive condition, with early intervention and timely outpatient care, patients can avoid complications or a more severe disease. However, nearly one in four CHF patients who are discharged from the hospital are readmitted within 30 days of diagnosis*.

To help, OneCity Health and NYC Health + Hospitals recently launched the Heart Failure Collaborative Initiative, designed to help acute care sites provide the highest quality of care to patients with heart failure by implementing a standard clinical management model that will reduce the risk of readmission. The Collaborative Initiative complements OneCity Health’s ongoing work to support our Performing Provider System (PPS) partners to implement strategies that promote cardiovascular health excellence in the primary care setting.

Yolanda G. Smith, RN, MSN, Assistant Vice President, Chronic Diseases Initiatives, OneCity Health, provides an update on implementation of the Congestive Heart Failure Clinical Pathway at NYC Health + Hospitals/Bellevue, the pilot site. Over 80 participants attended the recent symposium on the Heart Failure Collaborative Initiative.

OneCity Health is providing onsite technical assistance in implementing the Congestive Heart Failure Pathway – Inpatient Admission program, which brings together the patient, self-management support, and hospital and community resources to develop new, standard support services for CHF patients. For example, a Heart Failure Coordinator and PharmD on the Telemetry Unit at NYC Health + Hospitals/Bellevue are assessing CHF patients, discussing their medication regimen, providing disease and lifestyle education, providing follow-up discharge phone calls and referring them to needed services. The Heart Failure Coordinator works closely with the clinical team to manage these patients.

Ensuring patients have access to both an expert at the point of care and information – including the symptoms that they should immediately report to their provider – as well as recommendations to manage their disease can help improve patients’ quality of life, reduce readmissions and decrease their length of time in the hospital.

For more information on OneCity Health’s CHF program, please contact our support desk.

* Desai, A.S., & Stevenson, L.W. (2012). Rehospitalization for heart failure. Circulation. 126, 501-506. Retrieved from http://circ.ahajournals.org/content/126/4/501.full.