Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic

Autores
Jorro Baron, Facundo Ariel; Suárez Anzorena, Inés; Roberti, Javier Eugenio; Mazzoni, Agustina; Vita, Tomás; Alonso, Juan Pedro; Villarejo, Agustina; De La Vega, Bibiana; Ditata, Fernanda; Facta, Álvaro; Flores, David; Mastantuono, Cristian Exequiel; Saa, Raquel; San Dámaso, Esteban; Vega, Gustavo; Renedo, Florencia; Fernández, Alberto; Fernández Nievas, Simón; Garcia Elorrio, Ezequiel
Año de publicación
2023
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P =. 002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P =. 410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract.
Fil: Jorro Baron, Facundo Ariel. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Suárez Anzorena, Inés. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Vita, Tomás. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Alonso, Juan Pedro. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Villarejo, Agustina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: De La Vega, Bibiana. Provincia de Tucumán. Ministerio de Salud. Sistema Provincial de Salud. Hosp. Centro de Salud "Zenon Santillan"; Argentina
Fil: Ditata, Fernanda. Novartis S.A; Argentina
Fil: Facta, Álvaro. Hospital Privado de Comunidad; Argentina
Fil: Flores, David. Hospital Nacional de Clínicas; Argentina
Fil: Mastantuono, Cristian Exequiel. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Carlos Durand; Argentina
Fil: Saa, Raquel. Gobierno de la Provincia de Mendoza. Hospital Central de Mendoza.; Argentina
Fil: San Dámaso, Esteban. Hospital Italiano; Argentina
Fil: Vega, Gustavo. Gobierno de la Provincia de Mendoza. Hospital El Carmen;
Fil: Renedo, Florencia. Fundación Favaloro; Argentina
Fil: Fernández, Alberto. Sanatorio Modelo Quilmes; Argentina
Fil: Fernández Nievas, Simón. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Garcia Elorrio, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Materia
COLLABORATIVE
HEART FAILURE
INTERVENTION BUNDLE
QUALITY IMPROVEMENT
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/229065
Acceder
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oai_identifier_str oai:ri.conicet.gov.ar:11336/229065
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemicJorro Baron, Facundo ArielSuárez Anzorena, InésRoberti, Javier EugenioMazzoni, AgustinaVita, TomásAlonso, Juan PedroVillarejo, AgustinaDe La Vega, BibianaDitata, FernandaFacta, ÁlvaroFlores, DavidMastantuono, Cristian ExequielSaa, RaquelSan Dámaso, EstebanVega, GustavoRenedo, FlorenciaFernández, AlbertoFernández Nievas, SimónGarcia Elorrio, EzequielCOLLABORATIVEHEART FAILUREINTERVENTION BUNDLEQUALITY IMPROVEMENThttps://purl.org/becyt/ford/3.2https://purl.org/becyt/ford/3Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P =. 002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P =. 410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract.Fil: Jorro Baron, Facundo Ariel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Suárez Anzorena, Inés. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Vita, Tomás. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Alonso, Juan Pedro. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Villarejo, Agustina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: De La Vega, Bibiana. Provincia de Tucumán. Ministerio de Salud. Sistema Provincial de Salud. Hosp. Centro de Salud "Zenon Santillan"; ArgentinaFil: Ditata, Fernanda. Novartis S.A; ArgentinaFil: Facta, Álvaro. Hospital Privado de Comunidad; ArgentinaFil: Flores, David. Hospital Nacional de Clínicas; ArgentinaFil: Mastantuono, Cristian Exequiel. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Carlos Durand; ArgentinaFil: Saa, Raquel. Gobierno de la Provincia de Mendoza. Hospital Central de Mendoza.; ArgentinaFil: San Dámaso, Esteban. Hospital Italiano; ArgentinaFil: Vega, Gustavo. Gobierno de la Provincia de Mendoza. Hospital El Carmen;Fil: Renedo, Florencia. Fundación Favaloro; ArgentinaFil: Fernández, Alberto. Sanatorio Modelo Quilmes; ArgentinaFil: Fernández Nievas, Simón. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Garcia Elorrio, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaOxford University Press2023-09info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/229065Jorro Baron, Facundo Ariel; Suárez Anzorena, Inés; Roberti, Javier Eugenio; Mazzoni, Agustina; Vita, Tomás; et al.; Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic; Oxford University Press; International Journal For Quality In Health Care; 35; 3; 9-2023; 1-201353-4505CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://academic.oup.com/intqhc/advance-article/doi/10.1093/intqhc/mzad060/7241655info:eu-repo/semantics/altIdentifier/doi/10.1093/intqhc/mzad060info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-29T09:55:58Zoai:ri.conicet.gov.ar:11336/229065instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-29 09:55:59.217CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic
title Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic
spellingShingle Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic
Jorro Baron, Facundo Ariel
COLLABORATIVE
HEART FAILURE
INTERVENTION BUNDLE
QUALITY IMPROVEMENT
title_short Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic
title_full Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic
title_fullStr Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic
title_full_unstemmed Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic
title_sort Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic
dc.creator.none.fl_str_mv Jorro Baron, Facundo Ariel
Suárez Anzorena, Inés
Roberti, Javier Eugenio
Mazzoni, Agustina
Vita, Tomás
Alonso, Juan Pedro
Villarejo, Agustina
De La Vega, Bibiana
Ditata, Fernanda
Facta, Álvaro
Flores, David
Mastantuono, Cristian Exequiel
Saa, Raquel
San Dámaso, Esteban
Vega, Gustavo
Renedo, Florencia
Fernández, Alberto
Fernández Nievas, Simón
Garcia Elorrio, Ezequiel
author Jorro Baron, Facundo Ariel
author_facet Jorro Baron, Facundo Ariel
Suárez Anzorena, Inés
Roberti, Javier Eugenio
Mazzoni, Agustina
Vita, Tomás
Alonso, Juan Pedro
Villarejo, Agustina
De La Vega, Bibiana
Ditata, Fernanda
Facta, Álvaro
Flores, David
Mastantuono, Cristian Exequiel
Saa, Raquel
San Dámaso, Esteban
Vega, Gustavo
Renedo, Florencia
Fernández, Alberto
Fernández Nievas, Simón
Garcia Elorrio, Ezequiel
author_role author
author2 Suárez Anzorena, Inés
Roberti, Javier Eugenio
Mazzoni, Agustina
Vita, Tomás
Alonso, Juan Pedro
Villarejo, Agustina
De La Vega, Bibiana
Ditata, Fernanda
Facta, Álvaro
Flores, David
Mastantuono, Cristian Exequiel
Saa, Raquel
San Dámaso, Esteban
Vega, Gustavo
Renedo, Florencia
Fernández, Alberto
Fernández Nievas, Simón
Garcia Elorrio, Ezequiel
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv COLLABORATIVE
HEART FAILURE
INTERVENTION BUNDLE
QUALITY IMPROVEMENT
topic COLLABORATIVE
HEART FAILURE
INTERVENTION BUNDLE
QUALITY IMPROVEMENT
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P =. 002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P =. 410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract.
Fil: Jorro Baron, Facundo Ariel. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Suárez Anzorena, Inés. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Vita, Tomás. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Alonso, Juan Pedro. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Villarejo, Agustina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: De La Vega, Bibiana. Provincia de Tucumán. Ministerio de Salud. Sistema Provincial de Salud. Hosp. Centro de Salud "Zenon Santillan"; Argentina
Fil: Ditata, Fernanda. Novartis S.A; Argentina
Fil: Facta, Álvaro. Hospital Privado de Comunidad; Argentina
Fil: Flores, David. Hospital Nacional de Clínicas; Argentina
Fil: Mastantuono, Cristian Exequiel. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Carlos Durand; Argentina
Fil: Saa, Raquel. Gobierno de la Provincia de Mendoza. Hospital Central de Mendoza.; Argentina
Fil: San Dámaso, Esteban. Hospital Italiano; Argentina
Fil: Vega, Gustavo. Gobierno de la Provincia de Mendoza. Hospital El Carmen;
Fil: Renedo, Florencia. Fundación Favaloro; Argentina
Fil: Fernández, Alberto. Sanatorio Modelo Quilmes; Argentina
Fil: Fernández Nievas, Simón. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Garcia Elorrio, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
description Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P =. 002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P =. 410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract.
publishDate 2023
dc.date.none.fl_str_mv 2023-09
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/229065
Jorro Baron, Facundo Ariel; Suárez Anzorena, Inés; Roberti, Javier Eugenio; Mazzoni, Agustina; Vita, Tomás; et al.; Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic; Oxford University Press; International Journal For Quality In Health Care; 35; 3; 9-2023; 1-20
1353-4505
CONICET Digital
CONICET
url http://hdl.handle.net/11336/229065
identifier_str_mv Jorro Baron, Facundo Ariel; Suárez Anzorena, Inés; Roberti, Javier Eugenio; Mazzoni, Agustina; Vita, Tomás; et al.; Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic; Oxford University Press; International Journal For Quality In Health Care; 35; 3; 9-2023; 1-20
1353-4505
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
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info:eu-repo/semantics/altIdentifier/doi/10.1093/intqhc/mzad060
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
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eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
application/pdf
dc.publisher.none.fl_str_mv Oxford University Press
publisher.none.fl_str_mv Oxford University Press
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
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reponame_str CONICET Digital (CONICET)
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instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 13.070432

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