A state-wide approach to multidisciplinary care: Heart failure evaluation and reporting of outcomes (HERO)

Abstract

Background: Collection and reporting of clinical indicators of chronic heart failure (CHF) care in Australia is frequently ad hoc, and difficult to verify or benchmark with other services.[1] Queensland has a CHF steering committee that oversees disease management programs (DMP) supported by a central coordinator. In 2014, the Queensland Cardiac Information Solutions Program agreed to develop systems to support the collection and reporting of clinical indicators. Purpose: To evaluate the feasibility of the Heart Failure Evaluation and Reporting of Outcomes (HERO) clinical indicator reporting tool. Methods: Consensus on the content and methods of collecting data was reached following a Delphi method involving all 24 CHF disease management programs in Queensland. Nine process indicators were agreed upon and included: referral follow-up time and review of left ventricular function for all newly referred patients; and prescribing and titration practices at hospital discharge, first outpatient visit and 6 months after referral. All indicators had detailed inclusion and exclusion criteria. Descriptive data included age, sex, indigenous status, referral source and type of heart failure. Outcomes for mortality, length of stay and readmissions is to be obtained by data linkage. Results: Feasibility was assessed by comparing new referrals numbers with previous manually collected data; reviewing data completion, report quality and frequency. In 2015, the first year of data collection, 4,043 patients newly referred to heart failure DMPs were entered into HERO. This was consistent with manually collected data in the 2013 (n=3951) and 2014 (n=3900). Data was incomplete initially but improved to 90% with the introduction of monthly data quality reports sent to clinicians. Reports benchmark individual services to the state median, and provide details about exclusions and contraindications to inform clinical practice. For example statewide data for 2015 for beta-blocker titration not only shows those who have achieved target doses of beta blockers at 6 months post-hospital discharge (42%), but also includes those who are at maximally tolerated doses (31%) and who are still undergoing up-titration (18%), suggesting that the treatment variance statewide is relatively small (9%). Conclusions: High completion rates suggest that HERO is sustainable and engages clinicians by providing routine reporting that highlights individual site performance benchmarked against state-wide performance with respect to patient follow-up, medication prescription and titration of doses. In the context of a coordinated state-wide approach to CHF-DMPs (which includes data collection and review, education and clinical mentoring) HERO is a powerful tool for achieving best practice.L616173834 <br />