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Heart Failure Program and Barriers for Improving Quality of Care
Sahay A, Massie B, Heidenreich PA. Heart Failure Program and Barriers for Improving Quality of Care. [Abstract]. Journal of cardiac failure. 2007 Aug 1; 13(6):S163-S163.
Objectives: Heart failure (HF) affects a large number of Veterans and is the most common diagnosis at discharge from the Veterans' Administration (VA) Medical Service. Given the high prevalence, mortality and poor quality of life, improved heart failure care is a priority for the VA. The Chronic Heart Failure Quality Enhancement Research Initiative (CHF QUERI) of the VA is focusing on assessing the status of HF programs and identifying barriers to improve the quality of care for such patients. Methods: A joint cross-sectional survey was conducted by the Ischemic Heart Disease (IHD) QUERI and the CHF QUERI to assess the current practices in HF at all the VA facilities. With a response rate of 80% Chiefs of Cardiology (tertiary centers) and the Chiefs of Medicine (non-tertiary centers) responded to questions about their facility's HF program and barriers for improving care for HF patients. Results: Results were obtained from providers at 112 facilities. Half the facilities reported having HF clinics. Of them, 68% facilities have a cardiologist with focus on HF, in 52% facilities inpatients are routinely seen by a practitioner affiliated with the HF program, and in 45% facilities more than 100 outpatients are enrolled in their HF Disease Management (HFDM) Program. Among the remaining half facilities without HF clinics, only 11% facilities have a cardiologist and 70% facilities have no patients enrolled in HFDM Program. Interestingly, both sets of facilities with and without HF clinics provided similar rankings to the list of barriers for HF care. Overall, biggest barrier was not having enough physicians (54%), with next barrier being difficult to refer HF patients for needed procedures like ICDs/pacemakers (45%), and then not enough nurses or midlevel providers (42%). Other barriers included were lack of administrative support, growing number of patients, lack of space and resources, and poor compliance with guidelines. Conclusions: Only half of VA facilities have a heart failure clinic and one third have a cardiologist with a practice that specializes in heart failure. Inadequate staffing is seen to be most important barrier among facilities with and without HF clinics.