North Country Hospital  Quality Improvement Initiative 2005 - 2006

Project 1          Clinical improvement

Project Name: Congestive Heart Failure (CHF) Patients Readmitted Rate

Time Frame:    Baseline gathered prior to July 1st 2005         
                        Interventions implemented July 1st 2005
                        Post intervention performance gathered through end of 2005

Goal:               Fully implement the Centers for Medicare and Medicaid (CMS) evidence based therapy for CHF
                        Implement consistent and comprehensive patient education to manage disease
                        Reduce re-admission rate for CHF patients

Interventions:  Implement physician reminders to address and document adherence to evidence based                         therapies
                        Ongoing audit of care given to CHF patients
                        Educational sessions were conducted to healthcare providers
                        Patient education material was refined and updated and discharge brochure was created
                        Patients review video outlining management of CHF
                        Implemented accountability to ensure education was offered to patients
                        Collaborated for fully with the Vermont Nursing Association to continue home education post                         hospital discharge

Pre and post Data:

Compliance with CMS evidence based therapy:

Base-line
July 1 2005 through September 30 2005 results

• Completed discharge instruction from M.D.  44%
• Evaluated for left ventricular function before or after admission  94%
• Administration of Angiotension-Converting Enzyme (ACE) or Angiotensin II Receptor Blockers (ARB) for patients with left ventricular dysfunction 50%
• Smoking cessation counseling for patients who have smoked within one year 100%

Post Intervention
1st calendar quarter 2006 results

• Completed discharge instruction from M.D.  100%
• Evaluated for left ventricular function before or after admission  100%
• Administration of Angiotension-Converting Enzyme (ACE) or Angiotensin II Receptor Blockers (ARB) for patients with left ventricular dysfunction 100%
• Smoking cessation counseling for patients who have smoked within one year 100%

Percent of CHF patients receiving CHF education pre intervention - not tracked
Percent of CHF patients receiving CHF education post intervention - 100%

CHF patient re-admission rate pre-intervention 50.0% within 6 months (n=90)
CHF patient re-admission rate pre-intervention 11.36% within 6 months (n=44)

Supplemental documentation
Process Flowchart
CHF Patient Education Training Record