Reducing Structural Inequities in Heart Failure Management: An Approach to Improve the Quality of Heart Failure Care on the General Medicine Service: Longitudinal Equity Action Plan (LEAP)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 79
- 试验地点
- 2
- 主要终点
- Cardiology post-discharge follow-up within 14 days
研究概览
简要总结
Recent institutional research has demonstrated that black and Latinx patients are significantly less likely to be admitted to cardiology and more likely to be admitted to general medicine for their inpatient heart failure (HF) care. Subsequent HF care on general medicine has been demonstrated to have worse outcomes including lower rates of follow-up with cardiology and higher readmission rates. Given this, this project is a institutional quality improvement initiative, with a stepped wedge design, with the aim to improve the quality of care for heart failure patients admitted to general medicine for their care, and improve discharge planning. General medicine services by hospital pods will be enrolled in a stepped wedge fashion to a Longitudinal Equity Action Plan (LEAP) which includes a standardized clinical management plan to ensure patients are on guideline-appropriate therapy, receive cardiology consultation if appropriate, are discharged when clinically appropriate, discharge planning and systematic follow up with cardiology, transportation support as needed for follow-up visits, post-discharge follow up to identify any post-discharge issues.
详细描述
I. Aims with respect to Health Equity in the Department of Medicine
AIM 1: To improve the quality of care for heart failure patients admitted to the General Medicine Service (GMS) Aim 1a. To increase adherence and uptake of guideline-directed medical therapy and appropriate post-discharge follow-up for patients with heart failure admitted to GMS Aim 1b. To decrease 7-day heart failure readmission rates for patients with heart failure admitted to GMS with a principal diagnosis of heart failure Aim 1c. To decrease 30-day heart failure readmission rates for patients with heart failure admitted to GMS with a principal diagnosis of heart failure
AIM 2: To improve post-discharge outpatient cardiology utilization for heart failure patients admitted to GMS Aim 2a. To increase rates of cardiology clinic follow-up within 14 days of discharge for patients admitted to GMS with a principal diagnosis of heart failure.
II. Significance & Innovation A recent retrospective analysis performed by the Brigham and Women's Hospital (BWH) Cardiovascular Inequities Subcommittee of the Department of Medicine Health Equity Committee of patients self-referred to the Emergency Department with a principal diagnosis of heart failure found that black and Latinx patients were significantly less likely to be admitted to the cardiology service despite adjustment for multiple medical and socioeconomic factors (adjusted odds ratio [AOR] 0.68, 95% CI 0.53-0.87, for black patients; AOR 0.52, 95% CI 0.34-0.82 for Latinx patients). Female gender (AOR 0.75, 95% CI 0.62-0.91) and age>75 (AOR 0.58, 95% CI 0.40-0.86) were also independently associated with lower rates of admission to the cardiology service.
Similar to large observation studies from both community and academic settings, further analysis by the committee revealed differential outcomes for patients receiving specialty cardiology care during admissions for heart failure with lower cardiology clinic follow-up (25% vs. 51%), and higher 7-day (15% vs 5%) and 30-day (24 vs 17%) readmission rates for heart failure patients admitted to GMS as compared to those admitted to the cardiology service.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Sequential
- 主要目的
- Supportive Care
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All patients admitted to the general medicine service at our hospital with a principal diagnosis of heart failure
排除标准
- •Patients less than 18 years of age
结局指标
主要结局
Cardiology post-discharge follow-up within 14 days
时间窗: 14 days
Rates of patients that complete post-discharge follow up appropriate with a cardiologist within 14 days of discharge
次要结局
- Seven-day Heart Failure Readmission(7 days)
- 30-day Heart Failure Readmission(30 days)
- Cardiology post-discharge follow-up within 30 days(30 days)
研究者
Robert Boxer, MD
Principal Investigator
Brigham and Women's Hospital