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Evaluation of AHRQ's Partnerships for Quality Program

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Appendix B: Summaries of PFQ Grantee Activities (continued)

PFQ Grant Summary: CalNOC Partners for Quality TRIP to Reduce Patient Falls Project

Lead Organization: Association of California Nurse Leaders and California Nursing Outcomes Coalition (CalNOC)
Partner Team: UCSF, Cedars-Sinai Research Institute, American Nurses Association\California, California State University at Fullerton
Title: CalNOC Partners for Quality TRIP to Reduce Patient Falls Project
Topic Area: Reduction of patient falls in hospitals
Principal Investigators: Nancy E. Donaldson, DNSc
AHRQ Project Officer: Denise Burgess (formerly Marge Keyes)
Total Cumulative Award: $1,160,856
Funding Period: 9/2002-9/2006
Project Status: Completed 9/29/2006

1. Project Description

Goals. The aim of the four-year project was to use evidence on effective practices and data from the California Nursing Outcomes Coalition (CalNOC) statewide data repository to support interventions to reduce the incidence of patient falls and the severity of fall-related injuries in California hospitals.  The project builds on CalNOC's efforts to engage acute care hospitals in voluntarily reporting standardized data for nurse staffing, patient falls, and fall-related injuries based on American Nursing Association (ANA) quality indicators. This project was designed to advance CalNOC's efforts to use its quality benchmarking infrastructure to expedite the transfer of evidence-based knowledge into practice and so improve patient care quality and safety.  

The project planned to recruit hospitals from CalNOC's membership network and help them set an agenda for reducing patient falls.  Rather than select a standard intervention for all participating hospitals, the project helped each facility choose an intervention for decreasing patient falls that fit with its organizational strategic priorities. To support these interventions, the project would pair a "Coach" from the Project Team with a "Linker" in each hospital. The project also assisted hospital nursing staff in accessing research-based evidence to support their strategic falls reduction efforts.

Activities and Progress  

Year 1. The project held a strategic planning retreat with the Project Team—a core research group of individuals/organizations—and 20 statewide stakeholders to discuss strategic planning and designate subgroups to implement its plan. The project staff aggregated falls-related data from CalNOC's data repository and synthesized information to identify opportunities for improvement in falls risk assessment, prevention, and injury reduction. The Project Team issued a call to CalNOC's member hospitals to participate, received interest from 32 of them, and began collecting baseline data from these hospitals, which they planned to use to compare indicators from participating and non-participating units. The Project Team developed role descriptions for Coaches and Linkers, with key competencies and expectations, project orientation content and strategies, and coaching documentation tools. Project staff provided coaching for the hospital Linkers by six Coaches from the Project Team of investigators, and a staff coaching coordinator for the state's southern region.   

Year 2.  The project recruited 92 medical/surgical patient care units in 32 CalNOC hospitals to participate in the three-year demonstration (the total was 91 after one unit dropped out later). The medical/surgical units conducted self-assessments on patient falls, and the Project Team engaged sites in a comprehensive review of the CalNOC falls data.  The project initiated its telephone-based educational and supportive coaching intervention by identifying Linkers in each hospital and pairing them with one of the project's Coaches.  The Coaches scheduled telephone meetings with their Linkers about once a month to discuss each hospital's strategic plans, follow their progress, and discuss Linkers' needs. The roles of the Linkers and the hospitals' strategic plans varied to match individual organizational needs, since some hospitals already had strategic initiatives for patient falls in place and others did not. Telephone contacts were complemented by site visits when requested, and evolved to included multi-site conference calls for regional networking. 

The project funds also partially supported the creation of the CalNOC Web site, which went live in August 2003. It provides general information about CalNOC member hospitals and representatives and contact information for CalNOC's committee members. It also has tools specifically designed for members involved in the falls reduction project, such as a bulletin board for posting questions and responses, and an eReserve library that posts curriculum materials.  

Year 3.  The project Coaches continued to support Linkers' efforts to implement evidence-based interventions for reducing the incidence and injury associated with patient falls in medical-surgical units. Hospitals set their own agendas and areas of focus; some hospitals developed general strategies, while others focused on one or two focal areas for improvement. The project provided hospitals with self-assessment tools in Years 1 and 4 to document their progress. 

The six project Coaches and the coaching consultant, Dr. Kristin Geiser, held monthly conference calls to learn from each other and optimize the effectiveness of individual and collective efforts.  The Falls Medication Assessment Fact Sheet emerged from one of these conference calls, and was distributed to Linkers to help them integrate emerging concepts related to medication assessment into their fall risk assessment activities. Dr. Patricia Quigley RN, PhD, an expert in falls based at the VA Tampa, joined the team as a consultant and participated in calls with the coaches to discuss the impact of medication assessment on falls risk assessment/prevention. Coaches documented the monthly contacts with Linkers using a coaching documentation worksheet, which will inform the descriptive analysis of the Coaching intervention.  

Year 4. The last year of the PFQ grant focused on completing a formative evaluation of the project, with pre- and post-analyses comparing data from participating and non-participating units in participating hospitals. The project also sought evaluation feedback from Chief Nursing Officers at these hospitals. The project uses the CalNOC Web site to provide ongoing updated "drill down" reports to assist sites in using their own performance as the basis for guiding ongoing efforts.  The project began exploring ways to disseminate its work through a web-based version of the intervention via ANA's NDNQI Web site.  

2. Partnership Structure/Function

The PFQ project was spearheaded by CalNOC, a coalition of nursing organizations in California, founded in 1995 by the Association of California Nurse Leaders (ACNL)—which serves as the PFQ grantee—and the American Nurses Association of California (ANA\C). CalNOC was formed to develop clinical outcome quality indicators for hospital-based nursing processes and conduct research on efforts to improve them. The PFQ project structure was built around the existing CalNOC governance and committee structure and had three levels of partnerships. The first level of partnership is between the core Project Team, comprised of the individuals in CalNOC's Operations and Research teams3 and outside consultants brought in for their expertise. The second partnership occurs between the project and the 32 participating hospitals. A third level of partnership exists between the Project Team and the national experts and stakeholders that make up the Advisory Council, which helps to shape the project's methods, measures, and strategies.

For the core Project Team, frequent meetings were held between Principal Investigator Dr. Donaldson with UCSF and the grant recipient ACNL's Executive Director, Patricia McFarland, to discuss grants administration, since this was ACNL's first federal grant. The core Project Team, led by the PI and her two co-investigators at Cedars Sinai Research Institute and California State University at Fullerton, had weekly phone calls and met in person about five times a year.  Strategy meetings with other project collaborators—including the investigative and coaching teams—occurred every four to six weeks via conference calls during the implementation of the Coaching/Linker intervention.  These meetings continued after the intervention was underway, although less frequently. 

At the hospital-project team partnership level, the Linkers at hospitals spoke with their Coaches about once a month to discuss strategic plans, update Coaches on hospital activities, and seek guidance. The larger group of Coaches and Linkers convened meetings every four to six months to promote cross-facility learning.

The core Project Team and the project Advisory Council attended a Strategic Planning Retreat in January 2003 to plan and launch the project's partnership activities. The retreat led to the development of working groups that continue to operationalize the strategic plan. The PI, Dr. Donaldson, maintains ongoing collaborative contact with co-investigators and working groups.  

Table 1. Major Partner Organizations and Roles in the Project

 

Organization

Role in Project

Lead Organization (grant recipient)

Association of California Nurse Leaders (ACNL)

Refine processes and procedure to assure compliance and efficient administration of the business aspects of the project; manage sub-contracts

Recruit and retain hospitals for the project

Key Collaborators

Project Team in addition to ACNL:

University of California, San Francisco (UCSF)

Cedars-Sinai Research Institute

California State University Fullerton (CSUF)

CalNOC Advisory Council—All organizations above (except CSUF) and:

ANA National Database for Nursing Quality Indicators (NDNQI), VA NOD, MilNOD, Gorden and Betty Moore Foundation

AHRQ

The PI, Nancy Donaldson from UCSF, and two coinvestigators lead project activities

The core Project Team works on strategic planning and evaluation for the project and are Coaches to Linkers in hospital sites to facilitate implementation

Cedars-Sinai oversees data management for the data received from participating hospitals

The consultant from CSUF, Dana Rutledge, is the only member of the Project Team who also is not part of the CalNOC's Operations and Research teams; Dr. Rutledge developed the role of the Linker and has worked to keep Linkers engaged

Provide advice on methods, measures, and strategies

ANA's NDNQI may help to implement the Coach-Linker intervention nationwide

Target Organizations

91 medical-surgical patient care units in 32 participating CalNOC hospitals statewide

Implement falls risk assessment on admission; patients atrisk receive prevention interventions; provide feedback on effective improvement strategies and barriers faced

3. Project Evaluation and Outcomes/Results

The evaluation of the project consisted of tracking and analyzing the project's effect on falls-related outcomes indicators, e.g., falls per 1000 patient days and injury falls per 1000 patient day. It compared falls-related outcomes in the 91 participating units (called TRIP or Translating Research into Practice units) in the 32 hospitals before and after the intervention, and with non-participating units  (non-TRIP units) in the same hospitals.  The project collected monthly data on these indicators for each participating medical-surgical unit. Pre-intervention data came from the period 2001 to the first quarter of 2003, and post-intervention data was from 2005.  The analysis examined data from all the units with pre- and post-data available—89 TRIP and 260 non-TRIP units.  

The analysis found that the mean changes in falls and falls with injury were not significantly different between the pre- and post-data period for TRIP/participating units. In addition, the mean changes in falls and falls with injury were not significantly different for TRIP versus non-TRIP units. Despite the lack of statistically significant change, the project did find that falls per 1000 patient days for TRIP units were trending in the right direction—decreasing slightly between pre and post periods. The lack of a statistically significant drop in falls in the TRIP hospitals was attributed to convergent impact of JCAHO's 2004 focus on falls rates and the resulting range of organizational and clinical activities to reduce falls implemented in participating hospitals.  In addition, the fact that the outcome variable (falls) is relatively rare and annual rates are highly variable may have affected the power of the interventions to achieve results. The statistically significant increase in injury falls in the TRIP units from the pre to post time period may be due to improved reporting.  The coaching team was exploring further the reasons for these findings at the time this summary was prepared. 

Other outcomes include informal learning about the process of implementing evidence-based interventions in hospitals. For example, the three-year time horizon for this project may be too long in view of hospitals' single-year budgeting cycles, suggesting that the improvement process may need to adopt the rapid cycle model. In addition, the sustainability of the interventions can be compromised by the turnover of Linkers—nurse champions in each hospital—and Chief Nursing Officers, who are the principal administrative sponsors of the programs.   

4. Major Products

  • Presentations at 2002, 2004, and 2006 CalNOC conferences; 2003 National Association of Healthcare Quality Meeting; 2004, 2005, and 2006 ANCL conferences; 2004 ANA Convention; VA Tampa 2004; and 2005 Patient Safety Conferences.  
  • Donaldson, Rutledge, and Ashley "Outcomes of Adoption: Measuring Evidence Uptake by Individuals and Organizations." Worldviews on Evidence-Based Practice Journal (Suppl; Sept. 2004).
  • Expanded CalNOC Web site to include information for sites with bulletin board, library, and project-specific drill-down reports available to participating hospitals on an ongoing basis.  
  • Self-Assessment Tools (Organizational and Unit Level); Fact Sheet; Miles Stone is Falls Improvement; Falls Rater-to-Standard Training Tutorial. 

5. Potential for Sustainability/Expansion after PFQ Grant Ends

The Project Team has executed an agreement with the American Nurses Association to use the ANA NDNQI Web site for transforming "live" coaching at sites into a self-directed online process; this could help to sustain this activity. CalNOC received a follow-up grant from the Gordon and Betty Moore Foundation, which supported CalNOC in continuing some of this work as part of the foundation's efforts to evaluate the impact of its multifaceted $110 million nursing initiative in the San Francisco Bay Area, designed to improve nursing-related quality and safety in acute care hospitals. This partnership with the Gordon and Betty Moore Foundation also has supported increased collaboration between CalNOC, ANA, and NDNQI.


3. The CalNOC Operations Team consists of staff from the UCSF Center for Research and Innovation in Patient Care, the Association of California Nurse Leaders (ACNL), the Cedars-Sinai Research Institute, and representatives of the CalNOC User Members.  Key CalNOC personnel (Dr. Donaldson at UCSF, Dr. Aydin at Cedars-Sinai Research Institute, and Ms. McFarland with ACNL) coordinate and manage the work of CalNOC with the policy direction and advice of the Governance and Advisory Council.  The CalNOC Research Team, under the leadership of Co-Principal Investigators Drs. Donaldson and Brown, is accountable for the integrity of CalNOC methods, studies, and reports.  The CalNOC Governance and Advisory Council engages CalNOC stakeholders as strategic partners in shaping CalNOC methods, measures, and strategies.


Return to Appendix B Contents

PFQ Grant Summary: CHP Heart Failure GAP (Guidelines Applied in Practice)

Lead Organization: Catholic Healthcare Partners (CHP)
Partner Team: CHP HF GAP Partnership, Ohio State University, Case Western University, National Heart Failure Training Program, American Heart Association, and others
Title: CHP's Closing the "GAP" for Heart Failure (GAP=Guidelines Applied in Practice)
Topic Area: Quality improvement for patients with chronic congestive heart failure
Principal Investigators: Donald Casey, Jr., MD (was Chief Medical Officer at CHP but remained PI after his move to Atlantic Health System, NJ in 2005)
AHRQ Project Officer: Margaret Coopey
Total Cumulative Award: $1,278,719
Funding Period: 9/2002-9/2006
Project Status: Request for no-cost extension through September 29, 2007, under review

1. Project Description

Goals. The purpose of this project was to improve health outcomes for patients with heart failure (HF) by promoting the consistent use of evidence-based guidelines in the treatment of such patients, i.e., narrowing the gap between clinical evidence and clinical practice. It sought to motivate quality improvements for such patients throughout Catholic Healthcare Partners (CHP), a large health system comprised of 31 hospitals and other health care facilities located in 9 regional health systems in 5 states. The project tried to develop and demonstrate CHP's ability to improve chronic illness care for patients with HF through the effective use of standardized quality measurement systems for the treatment of HF patients. These improvements were designed so that all hospitals in the CHP system could sustain effective, broad-based national and local partnerships to support and sustain this work on an ongoing basis after the end of the grant period.  

Activities and Progress.  The project initially planned to adapt evidence-based heart failure interventions and develop standardized HF "tools" for all 31 CHP hospitals. However, after an initial planning period, project leadership decided instead to encourage CHP hospitals to adopt nationally endorsed quality interventions through explicit alignment with the health care system organizational structure, culture, and capacity.  The project selected six community hospitals in six of the nine regional CHP systems to participate in the project and convinced hospital CEOs to support or adopt existing HF quality improvement interventions and tools that were evidence-based and met their system's needs.  

In 2003, 21CHP hospitals chose to report nationally developed quality measurement for HF to CMS and JCAHO as a part of the Hospital Quality Alliance (HQA): (1) ACE inhibitor prescribed at discharge, (2) left ventricular function (LVEF) assessment, (3) smoking cessation counseling, and (4) appropriate discharge instructions.  The CHP hospitals regularly collected data for these measures through the MIDAS system, a national proprietary data warehouse with patient outcomes and treatment information that permits comparisons among hospitals using benchmarks set by top performing hospitals. CHP initially set a goal of achieving a minimum score for each measure at or above 75 percent of all HF patients, or in the top 25th percentile in the MIDAS system, whichever was greater.  During this time, CHP also developed an organizational goal of reducing the system's 30-day all-cause readmission rates for patients with an index admission for HF. To create strong incentives for CHP regional health systems to improve HF care quality, CHP evaluated performance for all CHP home office staff, regional CEOs, and other senior management, contingent on successful achievement of these performance targets for chronic HF.  Moreover, CHP added an HF readmission metric to the evaluation of regional health systems by the CHP national and regional boards.  

The project encouraged all CHP regional systems to select evidence-based HF quality improvement tools and plans that best fit their needs.  The project team also decided to develop one common intervention for six specially selected hospitals.  They created a staff position called the "Heart Failure Advocate" (HFA) to facilitate the implementation of quality improvement tools and plans.  The project recruited and trained HFAs, all of whom were nurses, from each of these six hospitals in the second project year.  The HFA job was designed to manage and coordinate care more effectively for HF patients at high risk for readmission or death, and also to implement broader quality improvement initiatives for HF within each of the six hospitals. The HFAs also conducted intensive followup for the high-risk patients after discharge.  The HFAs generally spent 50 percent of their time managing individual HF patients and 50 percent improving the system of HF care.  The project funded the HFA position salaries in the first year with the understanding that the hospitals would transition to providing 50 percent salary support and eventually would fully cover the cost of the staff positions.  At the end of the project, one of the participating hospitals decided not to continue to fund its HFA position, but additional HFA positions were created for implementation in four other CHP hospitals.

The HFAs participated in several types of training to cover a variety of critical skills identified for the project, such as communication, management, and technical and clinical expertise.  They also attended a two-day training session provided by the National Heart Failure Training Program (N-HeFT) to further develop and refine their skills. They were encouraged to attend individual sessions throughout the project period to refine improvement strategies for achieving highest performance on the HF quality measures, as well as to enhance their abilities to better provide care coordination, medication management, and patient/provider education. To build organizational support for quality improvement, the HFAs also recruited physician champions to support the project. These physicians accompanied the HFAs to a special training session provided by N-HeFT and The Ohio State University that focused on disease management strategies, effective communication between nurses and physicians, developing strategies for setting up an effective HF program, and managing change.  

To diffuse the adoption of evidence-based guidelines for the treatment of patients with HF in the community, the project provided HF education to physicians, nurses, and other clinicians in the CHP system, as well as other personnel from organizations external to CHP.  To accomplish this, the project created CME-accredited HF education programs for community physicians and hospital staff.  These were presented through several teleconferences at participating hospitals to explain the project and its progress to the larger HF community and other large "observer" health systems. 

2. Partnership Structure/Function

The CHP project was run by a core project team led by Dr. Donald Casey and other CHP staff, as well as some members of non-CHP partner organizations (see table below).  The core project team included seven co-investigators and their respective teams. National HF experts Dr. Abraham (Ohio State University) and Dr. Piña (Case Western University and N-HeFT) were involved directly in the project, providing training to HFAs and developing and personally presenting education sessions for community physicians at several HFA hospitals. Other co-investigators provided strategic advice and promoted physician participation in project activities. Although the project included monthly conference calls between co-investigators, HFAs, and supervisors, some co-investigators communicated more frequently.   

The project established four sets of partnerships: (1) between CHP and the individuals or organizations that comprised the core project/research team; (2) between the project team and the CHP HF GAP Partnership, comprised of local and national expert cardiologists, advanced practice cardiac care nurses, regional CEOs, and advisors from outside of CHP, who provided multidisciplinary expertise, helped convene/recruit local participants, disseminated the model, and provided feedback on project results; (3) among the project team, HFAs, and the hospitals/regional health systems they represented; (4) between the project team and the "observer" organizations that the project hoped would adopt or endorse the model, (e.g., other large Catholic health systems such as Catholic Health Initiatives, Catholic Healthcare East, or Trinity Health), and the Greater Cincinnati Health Council. 

Table 1. Major Partner Organizations and Roles in the Project

 

Organization

Role in Project

Lead Organization (grant recipient)

Catholic Healthcare Partners

Provided the quality improvement leadership and oversaw the project's activities

Key Collaborators

Core Project/Research Team:

Ohio State University
Case Western Reserve University
N-HeFT
Xavier University
North Ohio Heart Center
Applied Health Services

William Abraham MD, from Ohio State University (co-PI), one of the HF GAP major clinical expert leaders, provided advice for program design/execution and design of program assessment

Ileana Piña MD, from Case Western and N-HeFT (co-PI), another major clinical expert leader, provided training and technical support to Advocates and advice for program design and assessment

John Schaeffer MD, from North Ohio Heart Center, a clinical expert, provided advice for program design/execution and program assessment

Liu Guo, PhD, from Xavier University conducted the program's evaluation

Rick Snow, DO from Applied Health Services

CHP HP GAP Partnership:

Cardiologists from CHP regions, CHP Regional HF Experts, American Heart Association

HF GAP Observers: Catholic Healthcare East, St Joseph Health System, Catholic Health Initiatives, Greater Cincinnati Health Council

Provided multidisciplinary expertise

Helped convene/recruit local participants

Evaluated and provided feedback on project results

Participated in communication/dissemination (particularly AHA) by including the Advocates in its new 'Get With The Guidelines' program

Target Organizations

Six CHP regional health systems, with one hospital from each system hosting an advocate

Heart Failure Advocates managed high-risk patients and implemented quality improvement interventions; hospital executives monitored and managed QI improvements

3. Project Evaluation and Outcomes/Results

Project Evaluation. The evaluation of the project will assess (1) the CHP HF GAP Partnership, based on eight dimensions, such as partnership synergy, partnership involvement, and others; (2) the degree of implementation of HF care interventions; (3) improvement in the process of care delivery; and (4) the impact of improved practices on clinical and cost outcomes. The performance measures include: 

  1. Four national HF inpatient performance measures collected for JCAHO and CMS (ACE inhibitor prescribed at discharge, LVEF assessment, smoking cessation counseling, and appropriate discharge instructions).
  2. 30-day all-cause (not just for HF) readmission rates for patients with an index admission for DRG 127.
  3. Appropriate identification and referral of chronic HF patients to palliative or hospice care at or near the end of life.
  4. Effectiveness of CHP HF Advocates in influencing the above measures.
  5. Effectiveness of the CHP HF GAP Partnerships (system-wide and regional).
  6. Financial impacts of the initiative, with special attention to the effects of pay-for­performance and other monetary and non-monetary incentives on all of the above.

Data for these measures will be derived primarily from existing data already collected by regional CHP organizations, e.g., through the MIDAS system. The methodology uses a quasi-experimental study, comparing patients with versus without interventions, and comparing the same cohort of patients between the pre- and post-intervention periods. 

To determine the effect of interventions, such as training, on HFAs, a survey or focus group will be conducted to determine if the partnership met their needs, how it could better address their needs, and which non-partnership interventions were implemented that affected HFA performance. The project intends to use the tool created by the Partnership Subcommittee in AHRQCoPs to measure the success of its Partnership.  

Outcomes/Results.  Although final data analysis was not complete at the time this summary was written in October 2006, initial analysis of the evaluation data showed that patients under the care of the HFAs have experienced fewer readmissions and a longer time between readmissions than those patients not enrolled in the program (i.e., those with "usual care"). Further analysis indicates that patients experienced a 66 percent reduction of hospitalizations after they were enrolled in the HFA program. Their 30-day readmissions were reduced by 41 percent in the post-enrollment period. Their days elapsing without readmissions were doubled in the post-enrollment period (469 days), compared to the pre-enrollment period (211 days).  Early results also show that 30-day all-cause readmission rate for HF patients cared for by the HFAs consistently ranged from 1 percent to 10 percent on a quarterly basis, compared to the CHP hospitals' average readmission rates.  HF readmission rates for the 21 CHP hospitals decreased to 18.3 percent in the third quarter of 2005 from 22.0 percent in the same quarter of 2003. The CHP system as a whole also has been highly successful in improving its performance on the four national HF quality measures, all of which have improved since 2002. For example, the LVEF assessment measure rose from 77 percent in the third quarter of 2002 to 95 percent in the second quarter of 2006. The most recently available composite score of 95 percent for the four HF quality measures put CHP as a single entity in the top decile of performance within the CMS-Premier Hospital Quality Incentive Demonstration Program.

One lesson learned from the project is that organizational goals and incentives based on standardized quality measures (e.g., the HF measures developed by the American College of Cardiology and the American Heart Association) are more important motivators of quality improvement than standardized tools.  The project's experience also highlights the difficulty of motivating hospitals to adopt a program that is not profitable, since reducing hospital readmissions may lower total revenue.  We were told by some interviewees that while the individual HFAs have been effective change agents, a larger number of HFAs would make a bigger difference in reducing global hospital readmission rates for patients with HF.  

4. Major Products

  • HFA training program developed by N-HeFT.
  • Special video-DVD recording from April, 2005 highlighting the key elements of the CHP HF GAP initiative, presented to CHP Governance Academy, Tucson, AZ.  
  • Publications.
  • Presentations at meetings of the Heart Failure Society of America, American Heart Association, and American College of Cardiology.

5. Potential for Sustainability/Expansion after PFQ Grant Ends

Five of the six participating CHP hospitals have made a commitment to continue funding the Advocate positions on their own. One of the hospitals found the HF Advocate position so useful that they are interested in creating an Advocate position for diabetes as well. Moreover, two new HF Advocates began in May 2006 in Cincinnati, Ohio as part of a pilot to see if the Advocates role can be adopted in other CHP hospitals. A hospital in New Jersey and one in Pennsylvania have also expressed interest in setting up an HF advocate position.  

In 2005-06, the CHP HF GAP Partnership began efforts to create a broad coalition of stakeholders committed to improving HF care in Ohio. The Ohio Heart Failure Coalition (OHFC) was formed in September 2005, made up of organizations such as the national and regional offices of the American Heart Association, the Ohio Department of Health, the Ohio Hospital Association, several large health systems (CHP, University Hospitals of Cleveland, Ohio State, and Christ Hospital in Cincinnati), Ohio KePRO (the QIO in the region), and third party payers, notably Anthem Blue Cross of Ohio. The OHFC will attempt to gain the support and participation of more organizations for HF quality improvement activities based on the CHP HF GAP initiative.  The mission of the OHFC is "to achieve transformational change across the continuum of heart failure care through an innovative collaborative dedicated to sharing best practices and resources."

The CHP HF GAP also is trying to disseminate its approach by collaborating with the American Heart Association's "Get With the Guidelines" project for HF, a quality improvement program available for purchase by hospitals that supplies a data collection tool and materials, including a full patient education program, methods for communicating with physicians, and patient education materials. CHP's HFAs are presenting at regional and national AHA workshops. It was during one such workshop that one of the organizations now involved with the OHFC heard about the HF GAP program, prompting its participation in the OHFC. One grant partner indicated that some people who attended the AHA workshop were impressed by the HFA's message and have taken their "lessons learned" back to their own hospitals.

6. Publication References

Guo L, Chung ES, Casey DE, Snow R. Redefining Hospital Readmissions to Better Reflect Clinical Course of Care for Heart Failure Patients. American Journal of Medical Quality. Accepted for publication in an upcoming issue in 2006. 

Snow R, Guo L, Barrow L, Grossbart S, Miller K, Chung E, Casey D.  The Effect of Heart Failure Trained Advocates on 30 and 60 Day Readmissions. To be presented at the American Heart Association Scientific Sessions 2006, Chicago, Illinois, November 12-15, 2006 and subsequently referenced in Circulation.

Guo L, Chung ES, Snow R, Miller KL, Grossbart S, Casey D.  Redefining Readmissions to Better Reflect the Clinical Course of Heart Failure Patients.  To be presented at the American Heart Association Scientific Sessions 2006, Chicago, Illinois, November 12-15, 2006 and subsequently referenced in Circulation.

Markward BA, Glesser RR, Kaiser D, Baird T, Reinhardt S, Zite G, Piña II, Casey DE, Hitch JA, Blum K.  Development and Evaluation of the Heart Failure Advocate Role in the Care of Patients with Chronic Heart Failure. Journal of Cardiac Failure, August 2006 (Vol. 12, Issue 6 (Supplement), page S123).

Guo L, Chung ES, Snow R, Miller KL, Grossbart S, Casey D. Redefining Readmissions to Better Reflect the Clinical Course of Heart Failure Patients. Journal of Cardiac Failure, August 2006 (Vol. 12, Issue 6 (Supplement), page S110).  

Snow R, Guo L, Barrow L, Grossbart S, Miller K, Chung E, Casey D.  The Effect of Heart Failure Trained Advocates on 30 and 60 Day Readmissions.  Journal of Cardiac Failure, August 2006 (Vol. 12, Issue 6 (Supplement), page S98).  

Casey DE, Abraham W, Barrow L, Namie M, Piña I, Schaeffer J, Snow R.  Catholic Healthcare Partners' Closing the GAP for heart failure initiative: A large multi-state system takes on the challenge to improve care. JACC 47 (4-Supplement A): 267A; 2006.  

Casey DE, Namie MW, Barrow L, Mostajabi R.  Catholic Healthcare Partners' "Closing the Gap for Heart Failure" Initiative: A Large Multi-state Health System Takes on the Challenge to Improve Quality of Care.  Circulation 2005; 111 (20): page 126.

Casey DE, Namie M, Creason H, Barrow L, Abraham WT.  Closing the GAP for heart failure quality of care. Journal of Cardiac Failure, October 2003 (Vol. 9, Issue 5 (Supplement 1), page S87).

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