Impact of a guideline-based disease management team on outcomes of hospitalized patients with congestive heart failure

被引:53
作者
Costantini, O
Huck, K
Carlson, MD
Boyd, K
Buchter, CM
Raiz, P
Cooper, GS
机构
[1] Univ Hosp Cleveland, Div Gastroenterol, Dept Med, Cleveland, OH 44106 USA
[2] Case Western Reserve Univ, Sch Med, Cleveland, OH USA
关键词
D O I
10.1001/archinte.161.2.177
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Congestive heart failure is the most common reason for hospitalization in the United States, and guidelines to improve the quality of care for patients with congestive heart failure have been developed. However, adherence is typically low. We hypothesized that a guideline-based care management team would result in greater quality and efficiency of care than guidelines alone. Methods: A faculty cardiologist and nurse care manager at an academic medical center reviewed each patient's data and made guideline-based recommendations. Hospital length of stay, total costs, and use of recommended guidelines were compared between 173 patients before team implementation but with available guidelines, 283 care-managed patients, and 126 concurrent non-care-managed patients. Results: Care-managed patients achieved higher rates of use of angiotensin-converting enzyme inhibitor than baseline or non-care-managed patients (95%, 60%, and 75%, respectively; P<.001), as well as increased adherence to guidelines for daily weight monitoring and assessment of left ventricular function. Hospital length of stay was lower (median, 3, 4, and 5 days, respectively; P<.001) as were costs of hospitalization (median, $2934, $3209, and $4830, respectively; P<.01). These differences persisted after adjustment for severity of illness. Conclusions: When compared with dissemination of guidelines alone, an active care management approach was associated with significant improvements in quality and efficiency of care for hospitalized patients with congestive heart failure.
引用
收藏
页码:177 / 182
页数:6
相关论文
共 24 条
  • [1] β-Blockers -: The new standard of therapy for mild heart failure
    Abraham, WT
    [J]. ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (09) : 1237 - 1247
  • [2] EFFECT OF VASODILATOR THERAPY ON MORTALITY IN CHRONIC CONGESTIVE-HEART-FAILURE - RESULTS OF A VETERANS-ADMINISTRATION COOPERATIVE STUDY
    COHN, JN
    ARCHIBALD, DG
    ZIESCHE, S
    FRANCIOSA, JA
    HARSTON, WE
    TRISTANI, FE
    DUNKMAN, WB
    JACOBS, W
    FRANCIS, GS
    FLOHR, KH
    GOLDMAN, S
    COBB, FR
    SHAH, PM
    SAUNDERS, R
    FLETCHER, RD
    LOEB, HS
    HUGHES, VC
    BAKER, B
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1986, 314 (24) : 1547 - 1552
  • [3] A COMPARISON OF ENALAPRIL WITH HYDRALAZINE ISOSORBIDE DINITRATE IN THE TREATMENT OF CHRONIC CONGESTIVE-HEART-FAILURE
    COHN, JN
    JOHNSON, G
    ZIESCHE, S
    COBB, F
    FRANCIS, G
    TRISTANI, F
    SMITH, R
    DUNKMAN, WB
    LOEB, H
    WONG, ML
    BHAT, G
    GOLDMAN, S
    FLETCHER, RD
    DOHERTY, J
    HUGHES, CV
    CARSON, P
    CINTRON, G
    SHABETAI, R
    HAAKENSON, C
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1991, 325 (05) : 303 - 310
  • [5] EDWARDS N, 1994, HEALTH CARE FINANC R, V16, P45
  • [6] CLINICAL-PRACTICE GUIDELINES
    FLETCHER, RH
    FLETCHER, SW
    [J]. ANNALS OF INTERNAL MEDICINE, 1990, 113 (09) : 645 - 646
  • [7] Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure
    Fonarow, GC
    Stevenson, LW
    Walden, JA
    Livingston, NA
    Steimle, AE
    Hamilton, MA
    Moriguchi, J
    Tillisch, JH
    Woo, MA
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1997, 30 (03) : 725 - 732
  • [8] FONAROW GC, 1995, J AM COLL CARDIOL S, V25, pA264
  • [9] Racial variation in predicted and observed in-hospital death - A regional analysis
    Gordon, HS
    Harper, DL
    Rosenthal, GE
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 276 (20): : 1639 - 1644
  • [10] Patterns of angiotensin-converting enzyme inhibitor prescriptions, educational interventions, and outcomes among hospitalized patients with heart failure
    McDermott, MM
    Lee, P
    Mehta, S
    Gheorghiade, M
    [J]. CLINICAL CARDIOLOGY, 1998, 21 (04) : 261 - 268