The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Tag: heart failure (page 1 of 6)

MVC Heart Failure Workgroup Updates and 2018 Opportunities

Deby Evans

Deb Evans is the MVC Site Engagement Manager

The Michigan Value Collaborative (MVC) Congestive Heart Failure (CHF) workgroup has had a productive year of virtual meetings and many useful discussions about a variety of topics that can influence reducing readmissions. Every other month, in collaboration with I-MPACT, another Blue Cross Blue Shield of Michigan quality improvement collaborative focusing on transitions of care, the group has held discussions on a variety of topics pertaining to CHF. The MVC Coordinating Center will be opening up the workgroup for other hospitals to join in 2018 and additional information can be found below. A synopsis of the findings of each 2017 workgroup discussion is detailed below, although more details can be found on the MVC registry under the resource tab or by contacting the Coordinating Center.

Using Skilled Nursing Facilities: This discussion encouraged working closely with skilled nursing facilities to help provide education to staff, patients, family members and care givers in respect to fluid intake and nutrition.  Additionally, the discussion included how to allow staff to facilitate medication administration and finding alternative ways of medication delivery such as giving Lasix via intramuscular injection rather than intravenously.

CHF Referrals to Palliative Care: The discussion centered around getting this patient population referred to palliative care as soon as possible in the course of their disease process. The conversation included triggers for referral along with some benefits of being in a palliative care program and initiatives that Michigan hospitals had implemented or were working on implementing in relation to palliative care programs in their facilities.

Use of Outpatient Heart Failure (HF) Clinics: The group discussed the effectiveness of having a HF clinic to refer their CHF patients too and how attendance at these clinics had helped reduce CHF readmission rates. Some hospitals discussed the collaborative work they had done to implement a HF clinic in their facility. Templates of business plans were provided and members provided information on how they had presented and made the case to open a HF clinic at their facility. An interview with a Michigan hospital ranked number 3 in the country was utilized for a blog post.

Diet and Nutrition Education: Some dieticians from member hospitals joined us to discuss the tools and information they share with HF patients at their facilities. Information sheets containing information on alternative spices to use instead of salt were shared and also initiatives and education on how to provide heart healthy meals to patients either by the facility or via a vendor such as Meals on Wheels.

Medication Reconciliation: Pharmacists joined the discussion about their role or potential role in medication reconciliation and also provided some recommendations for the use of different stakeholders in the medication reconciliation process, not only for CHF patients but for other patient populations too. Some facilities discussed how they have also integrated parts of the reconciliation process into their electronic health record systems.

The CHF longitudinal workgroup will be continuing into 2018 with more discussion topics pertaining to CHF and opportunities for collaboration. If you are interested in joining the workgroup, please sign up here.  Further details will be provided in 2018.

If you have any questions about the workgroup or 2018 workgroup registration  please contact Abeer Yassine (abeery@med.umich.edu) or Deb Evans (debevans@med.umich.edu)

 

Patient Support and Heart Failure (HF) Diets: Meal-Delivery Success for Reduced Readmissions

Abeer Yassine

Abeer is the MVC Engagement Associate

During a recent MVC HF Workgroup, hospitals shared patient education practices regarding HF diets with one another. The feasibility of implementing different programs, barriers in communication, and patient engagement along with potential solutions were discussed. The hospital representatives also shared different programs that their facilities engage in to work with patients on maintaining a healthy HF diet. While hospitals incorporate nutritionists or dieticians and educational materials in diet planning, some take unique approaches to helping patients adhere to their diets. For example, one hospital in the workgroup offers HF patients prepared, in-house meals at a subsidized cost. This helps address barriers such as accessibility to healthy food and any inability to prepare and cook meals due to disability. Addressing these barriers allows for enhanced chronic disease management.

Taking it one step further: What would happen if healthy, HF friendly meals were delivered right to patient homes?

In a recent study, Michigan Medicine observed the impact of nutrition support services, specifically home meal delivery post-discharge, on outcomes such as hospital readmissions and quality of life. In this small pilot trial, 66 HF patients were selected at random to either receive usual care consisting of a pamphlet on low-sodium diets or a meal delivery post discharge.1 The food was delivered to patients through PurFoods/ Mom’s Meals, a service that was also mentioned during the HF Workgroup discussion.1 The results of the pilot were promising: there was a total of 11 HF-related 30-day readmissions among the control group, versus only 3 HF-related readmissions in the experimental group receiving the delivered meals. 2 Although the pilot group was small, it is evident that providing post-discharge support to patients can prove to be significant to patient outcomes and avoidable readmission costs.

Furthermore, providing hospital-to-hospital support has also proven to be helpful through the workgroup discussions as well. During our dialogue, which included representatives from respective nutrition teams, a few hospitals were willing and open to sharing some of their patient education materials, including HF diet tip sheets. This allowed participants to share experiences, and best practices while learning about different initiatives that could have a positive impact on patient outcomes. A synopsis of the HF workgroup discussion on patient education and diet, including resources and a literature review, can be found in the MVC Registry under Resources.

If you are interested in learning more about this initiative, or HF workgroup, please do not hesitate to reach out to Abeer (abeery@med.umich.edu) or Deby (debevans@med.umich.edu).

 

Sources:

1 Geriatric Out of Hospital Randomized Meal Trial in Heart Failure (GOURMET-HF)

2 Does DASH Diet Meal Delivery Help Heart Failure Outcomes?

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