Abstract 13165: Work Smarter, Not Harder: Using Technology to Go From Worst to Best

IntroductionAs part of its shift toward value based care, the Centers for Medicare and Medicaid Services (CMS) defined a set of ambulatory care-sensitive conditions. Hospitalizations for these conditions are “felt to be potentially preventable, given appropriate primary and preventative care”, and risk-adjusted rates of hospitalization are reported. The Veterans Health Administration has adopted CMS methodology, but attributes at the level of medical centers allowing reporting of a standardized observed/expected (O/E) admission rate directly comparable across its 170 facilities. Our institution was an outlier in the Veterans Health Administration due to its high rate of heart failure hospitalizations.HypothesisWould the implementation of a High-Risk HF Clinic (HRHFC) improve outcomes?MethodsPatients were designated as high-risk and enrolled in the HRHFC if they had 1) any heart failure admissions in the last 12 months 2) any heart failure emergency department (ED) visit in the last month. An online dashboard populated from the electronic medical record (EMR) was used to identify patients for initial enrollment and track admissions and ED visits in real time for ongoing enrollment. Interventions included intensive management by a multidisciplinary team comprised by a cardiologist, pharmacist and nurse, focus on barriers to care in addition to medical management, initiation of a diuretic infusion protocol in the ED, daily dashboard surveillance for arrangement of early post-hospital, and post-ED follow up.ResultsOver a 27-month period, 140 veterans were enrolled in the HRHFC. The O/E ratio improved from 1.6 to 0.8, which is the largest improvement in the entire VA system. This was accomplished with only 20% cardiologist and 20% pharmacist full-time equivalent.ConclusionsA dashboard driven by the EMR used in conjunction with simple clinical process changes can multiply the effectiveness of providers and produce dramatic improvements in outcomes with minimal investment of clinical full-time equivalent. These results were achieved with off-the-shelf software and are generalizable to any facility with an EMR and a corporate data warehouse.