Improving heart failure care and guideline-directed medical therapy through proactive remote patient monitoring-home telehealth and pharmacy integration

BMJ Open Quality

article

Debra Saliba¹  Donald S Chang⁴  Shelly S de Peralta⁵  Kimberly A Lynch¹  David A Ganz² 

[1] VA Greater Los Angeles Healthcare System and UCLA National Clinician Scholars Program;Center for the Study of Healthcare Innovation, Implementation and Policy and Geriatric Research, Education and Clinical Center , VA Greater Los Angeles Healthcare System;Borun Center for Gerontological Research , UCLA;Department of Medicine, David Geffen School of Medicine , UCLA;Division of Cardiology , VA Greater Los Angeles Healthcare System

关键词: quality improvement;    telemedicine;    pharmacists;    chronic disease management;    nurses;   

DOI  :  10.1136/bmjoq-2022-001901

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

To address ambulatory care sensitive hospitalisations in heart failure (HF), we implemented a quality improvement initiative to reduce admissions and improve guideline-directed medical therapy (GDMT) prescription, through proactive integration of remote patient monitoring-home telehealth (RPM-HT) and pharmacist consultations. Each enrolled patient (n=38) was assigned an RPM-HT registered nurse (RN), cardiology licensed independent provider (provider), and, if referred, a clinical pharmacy specialist (pharmacist). The RN called patients weekly and for changes detected by RPM-HT, while the pharmacist worked to optimise GDMT. The RN and pharmacist communicated clinical status changes to the provider for expedited management. Process measures were the percentage of outbound RN weekly calls missed per enrolled patient; the weekly percentage of provider interventions missed; and the number of initiative-driven diuretic changes. Outcome measures included eligible GDMT medications prescribed, optimisation of those medications, and the pre–post difference in emergency department (ED) visits/hospitalisations. After a 4-week run-in period, RN weekly calls missed per enrolled patient decreased from a mean of 21.4% (weeks 5–15) to 10.2% (weeks 16–23). Weekly missed provider interventions decreased from a mean of 15.1% (weeks 1–15) to 3.4% (weeks 16–23), with special cause variation detected. The initiative resulted in 43 diuretic changes in 21 patients. Among 34 active patients, 65 ED visits (0.16 per person-month) occurred in 12 months pre intervention compared with 8 ED visits (0.04 per person-month) for 6 intervention months (p<0.001). Among 16 patients referred to pharmacist, the per cent of eligible GDMT medications prescribed increased by 17.1% (p<0.001); the number of patients receiving all eligible medications increased from 3 to 11 (p=0.008). Similarly, the per cent optimisation of GDMT doses increased by 25.3% (p<0.001), with the number of patients maximally optimised on GDMT increasing from 1 to 6 (p=0.06). We concluded that a cardiology, RPM-HT RN and pharmacist team improved prescription of GDMT and may have reduced HF admissions.quality improvementtelemedicinepharmacistschronic disease managementnursesData availability statementData are available upon reasonable request.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

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