Evaluation of collaborative therapy review to improve care of heart failure patients

OBJECTIVES: As more demands are placed on primary care providers, new innovative models are required to optimize heart failure (HF) care. The purpose of this study was to evaluate a collaborative therapy review (CTR) program that was implemented to improve guideline-based therapy among HF outpatients.

STUDY DESIGN AND METHODS: We screened patient lists of 18 PCPs at the Portland Veterans Affairs Medical Center to identify patients with an ICD-9 code for HF. The charts of patients with ejection fractions (EFs) < 40% were then abstracted in more detail. The CTR team reviewed each patient and provided specific guideline-based recommendations. The team then gave specific recommendations to providers through the electronic medical record system. We categorized recommendations relating to drug or device therapies, or need for laboratory testing, and calculated provider acceptance rates by recommendation type.

RESULTS: Of the 641 patients reviewed, 156 patients had detailed chart reviews. We found opportunities for improvement in care in 70 (45%) patients who received 100 recommendations. Among the 100 recommendations, 62 (55%) were for guideline-based drugs, 12 (17%) were for consideration of device therapy, and 26 (24%) were to update lab tests or echocardiograms. Eighty percent of the recommendations were acted on within 90 days.

CONCLUSIONS: The CTR program was able to facilitate guideline-based management for HF patients by identifying treatment gaps and making specific guideline-based recommendations to PCPs. While further evaluations are needed, this approach may serve as an efficient method of leveraging the expertise of specialty-trained clinicians to optimize patient care.