Bridging Gap Between Knowledge and Routine Clinical Practice

At the recent eHealth Initiative National Forum on Data & Analytics, I saw a great presentation on how analytics is having a profound impact on one of our most vexing healthcare issues: hospitalizations (and re-hospitalizations) related to heart failure.   

At first glance, the problem itself is daunting from both care and cost perspectives. The total estimated U.S. annual direct and indirect cost of heart failure is $39.2 billion, with more than 50 percent of that spent on hospitalizations. There are more than a million heart failure hospitalizations in the United States each year, and the 30-day re-hospitalization rate is 24.7 percent, with those rates varying widely between hospitals, suggesting that a substantial number of patients are not receiving optimal care. I was surprised to hear that effective strategies to prevent re-hospitalizations are underutilized.

“We do have evidence-based processes that can improve outcomes,” explained Zubin Eapen, M.D., a cardiologist who is an assistant professor of medicine at the Duke University Medical Center. Medication optimization, enhanced patient education and early follow-up and care coordination have been shown to lower readmission rates, he said. “Now we are translating that evidence into practice through analytics,” Eapen said.

Data analytics conducted on the 556,000 patient records contained in the American Heart Association’s Get with the Guidelines Heart Failure quality improvement program revealed that nationwide gaps exist in heart failure care, including the provision of appropriate discharge medications, education and follow-up. For instance, data from January to December 2010 reveal that only 52.9 percent of patients receive an evidence-based beta blocker at discharge, he said. And 53.1 percent are scheduled for a follow-up visit within seven days. Only 4.9 percent receive a referral to a heart failure disease management program, 60 minutes of patient education or a heart failure interactive work book.

To help hospitals improve these results, Target: HF is taking several approaches, including creating treatment guidelines and checklists and providing field staff for consultation. Hospitals are starting to take advantage of a suite of tools made available through Target: Heart Failure that includes checklists regarding medications and follow-up forms to use with patients. AHA’s Get With The Guidelines Heart Failure Clinical Tools Library includes more than 60 heart failure tools, including discharge orders/instructions, order sets, and patient education materials.

 One of the challenges to greater improvement longitudinally, he said, is the data burden hospitals encounter when participating in care registries, but with the focus on patient-level metrics, Target: HF is already seeing improvement in all categories.  “We are improving as a result of these tools,” Eapen said.