Abstract 1253: Nurse-led Heart Failure Quality Collaborative for Rural Hospitals Improves Core Measure Performance
Rural hospital nursing often lacks experts to lead the translation of research into practice. Heart failure (HF) affects over 5 million Americans at a cost of over $33.2 billion annually, with 22% of all patients being discharged from rural hospitals. This high cost is in large part due to underuse of effective therapies despite well-publicized management guidelines. The purpose of this study was to evaluate the impact of a rural hospital collaborative (RHC) model developed to facilitate nurse-led improvements in HF care. Rural hospitals (n=21) in the Mid-Atlantic area participated in the RHC which included a 2-day on-site training session for nurse site coordinators and ongoing facilitation through monthly conference calls and completion of a team check up tool. Key components of the HF toolkit implemented at each hospital were:
HF fact sheet and scientific articles,
nurse education modules,
standardized patient education booklet,
patient education video, and
smoking cessation counseling based on Health and Human Services guidelines.
HF core measures data was collected using standard procedures at baseline and six months. Rates of adherence with HF core measures improved over six months of RHC participation as follows: Comprehensive discharge instructions, 79% to 89% (p<0.01); smoking cessation counseling, 89% to 96% (p<0.05); documentation of left ventricular function, 92% to 94% (p<0.69); and ACE-I or ARB prescribed at discharge, 87% to 92% (p<0.19). Process evaluation identified the following:
over 90% of participating hospitals were successful at implementing a multidisciplinary team to guide HF improvement and 45% implemented HF specific nurse education;
major organizational (18%) and staffing (46%) changes impacted improvement efforts; and
36% encountered physician barriers to implementing improvements.
Rural hospitals embraced and utilized collaborative resources to implement HF improvements. Improvements were seen in all HF core measures, though only changes in discharge instructions and smoking cessation were statistically significant. This nurse-led collaborative approach including a HF toolkit has significant potential to improve HF care and outcomes.