Paper
Wednesday, 19 July 2006
This presentation is part of : Evidence-Based Practice Outcomes: Measuring and Monitoring Strategies
The Effect of Implementation of Medical Center Guidelines and Focused Education on the JCAHO Quality Measures in Patients Hospitalized for HF
Dee Fontana, RN, MSN, ACNP, Cardiovascular Services, University of Illinois Medical Center at Chicago, Chicago, IL, USA, Karen Vuckovic, RN, MS, CNS, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA, Robert DiDomenico, PharmD, Pharmacy Practice, University of Illinois Medical Center, Chicago, IL, USA, and George T. Kondos, MD, College of Medicine, Department of Cardiology, University of Illinois, Chicago, IL, USA.
Learning Objective #1: Identify the JCAHO quality measures for patients hospitalized with heart failure.
Learning Objective #2: Evaluate the feasibility of implementing medical center guidelines and focused education to improve the quality of care for patients admitted with HF.
Approximately 4.9 million people in the United States are diagnosed with heart failure (HF) each year and acute decompensated heart failure (ADHF) is the primary discharge diagnosis in 1 million hospital admissions.  This diagnosis is associated with staggering readmissions rates, approaching 20% at 30 days and 50% at 6 months.  The 4 year mortality rate in this population following an admission for ADHF is approximately 60%.  The economic burden of HF approximated 24 billion dollars in 2003.  As life expectancy and survival with cardiovascular disease increases, exponential growth of this disease is predicted. 
 
Numerous studies reveal discrepencies in the quality of HF care. This inadequate treatment prompted the the Joint Commission of Accredited Hospital Organizations (JCAHO) to mandate data submission by hospitals which reflects their performance on quality indicators for HF.  The four quality indicators which describe the basic standards for evidenced-based HF care are:

 1.  Documentation of left ventricular function
2.  Prescription at discharge for angiotension converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in patients with documented left ventricular dysfunction
3.  Complete discharge instructions (i.e activity level, daily weight monitoring, low sodium diet, follow up appointments, response to changes in symptoms and a list of discharge medications)
4.  Smoking cessation counseling if appropriate

 The University of Illinois Medical Center at Chicago (UIMCC) created guidelines and computerized order sets consistent with evidenced-based practice to address these disparities in care within the institution.  The purpose of this research project was to compare UIMCC performance regarding these quality indicators prior and subsequent to the intervention.  The results of this project indicate that guidelines and computerized order sets coupled with focused nursing education improve performance compliance with JCAHO quality indicators for heart failure.

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