American College of Cardiology

Heart Failure GAP Project in Oregon

Guideline ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult Principal Investigators Mark M. Huth, MD, PhD, FACC Ruth Medak, MD Project Coordinator Jenny Masengil, RN, BS, CCRN

Partners

Oregon
Acumentra Health, Quality Improvement Organization
CV Outcomes

Project Setting

Physician practices

Project Summary

The Heart Failure GAP Project in Oregon was an 18-month quality improvement initiative introduced in six geographically diverse outpatient cardiology practices in Oregon. The program aimed to improve heart failure treatment by increasing adherence to the ACC/American Heart Association (AHA) heart failure guidelines through the use of patient and clinician tools. A core objective was to increase use of chronic care management methods and evidence-based therapies.

Methods

The study group consisted of heart failure patients with systolic dysfunction (ef<40%). The teams identified seven core measures designed to assess not only drug use but also the use of data and building a role for patients in their own care. The measurement set was tested among the participating teams at outset and again at a re-measurement after tools development. The figure below depicts the results of these measurements:

An important success of the project was the development of a practical “toolkit,” which was developed with input from clinicians and patients.

Tools for Patients

• How to Care for Your Heart
• Heart Care Instructions
• Heart Care Medication Information
• Heart Care Medication List

Tools for Clinicians

• Clinician's Guide to Heart Failure Care
• Increase your Patients' Success
• Sample Heart Failure Visit Template

Tools for Patient & Clinician Collaboration

• My Heart Failure Goals
• HF-GAP Discharge Instructions

Tools for Data Management

• The HF-GAP Patient Registry - E-mail Dr. Medak at rmedak@ompro.org for a sample or full copy of the registry

Results and Lessons Learned

Despite overall acceptance of ACC/AHA guidelines, cardiologists:

• Often do not achieve 100 percent guideline adherence
• Tend to select the guidelines with which they agree
• Are slow to change systems of care
• Are often ahead of the guideline information base in implementing new therapies
• Have a difficult time accepting the concept of the patient being central to the process
  

In the arena of quality improvement, the practicing cardiologist faces challenges:

• Looking beyond a strict “research” format for a project
• “Trying out” a change –- a method integral to quality improvement
• Using a team-style approach to patient care
• Embracing “tools” for both clinicians and patients

Next Steps

The Heart Failure GAP Project in Oregon officially concluded within the outpatient practices in January 2004. Much is left to be done, including:

• Developing a heart failure project for primary care and hospital-based providers that uses the GAP tools and chronic care management principles
• Integrating GAP tools into heart failure care in all Oregon practice settings
• Increasing understanding and use of the chronic care model and its role in cardiac disease
• Disseminating the heart failure toolkit and the chronic care management approach to providers at a regional and national level
  

The College gratefully acknowledges the generous support of an unrestricted educational grant from GlaxoSmithKline for the Heart Failure GAP Project in Oregon.

Click on any of the links below to go to a GAP Program: