# Presentation: 899786

## CHF QUERIVA Heart Failure Network

- 9/22/20078

## Agenda

- Introductions
- Survey Results
- Heart Failure Network
- Screening Survey
- Pilot project at Palo Alto
- Facility Survey
- Discussion
- Potential Performance Measures

## HF Network Survey

## HF Network Membership

- 360+ providers
- 167 facilities
- 1-8 members at each facility

## Table: Provider Categories

| PROVIDERS | PERCENT  |
| --- | --- |
| Physician (Staff) | 50 |
| Nurse / Nurse Practitioner | 26 |
| Chief of Cardiology  | 7 |
| Chief of Medicine  | 2 |
| Researcher | 2 |
| Chief of Staff | 1 |
| Pharmacist | 1 |
| Physician Assistant | 1 |
| Psychologist | 1 |
| Others (cardiology tech, supervisor, case manager, clinical care coordinator, tele-care health coordinator, etc.) | 9 |

## Initial Results: Influence of Participation

| Overall, did participation in the sessions influence YOU in terms of the following- | NO | YES |
| --- | --- | --- |
| Help understand facilitators and barriers in setting up or running HF clinic/program | 8% | 92% |
| Help solve implementation-related problem at your facility | 34% | 66% |
| Validated your current practice in  taking care of HF patients | 9% | 91% |
| Provide names of contacts from HF Network for networking and potential problem solving | 9% | 91% |

**Initial Results: Influence of Participation**

## Initial Results: Benefit of Participation                for Influential Members

## Patient Screening Survey

## Screening Survey

- One page
- Sent to all patients at Palo Alto VA with one icd9 diagnosis of heart failure in the last 12 months  (N=2503)
- Asks general questions
- Heart Disease
- Symptoms
- Interest in services

## Response

- 2503 mailed
-    190 found to died
- 1799 surveys received (78% response)

## Have You Been Told You Have  Heart Failure?

**% of  Respondents**

**Have You Been Told You Have  Heart Failure?**

## Outside MD Managing Heart Failure?

**% of  Respondents**

**Outside MD Managing Heart Failure?**

## Outside MD Managing Heart Failure?

**% of  Respondents**

**Outside MD Managing Heart Failure?**

## Patient Interest in Services

**% of  Respondents**

**Patient Interest in Services**

## Facility 

**% of  Respondents**

**Facility **

## Outcome

**% of  Respondents**

**Outcome**

**1 YEAR OUTCOME**

## MD Location and Outcome

**% of  Respondents**

**MD Location and Outcome**

**1 YEAR OUTCOME**

## High Risk for VA Hospitalization

- VA Provider
- Moderate or greater edema
- Moderate or greater dyspnea on walking
- 16% had all of these

## Use of the Survey

- Identification of patients for services
- Note to provider let to care coordination referral in 15-20%.
- Identification of patients at risk for hospitalization
- Candidates for local HF programs
- More powerful if it can be combined with existing VA datasets (medication, lab)

## Patient Survey Offer

- CHF QUERI will identify and survey heart failure patients at other facilities
- Customized lists will be returned based on local need
- Contact _[Paul.Heidenreich@va.gov](mailto:Paul.Heidenreich@va.gov)__ or __[Anju.Sahay@va.gov](mailto:Anju.Sahay@va.gov)__ if interested_

## Facility Survey

## Facility Survey

- 144
- 88% cardiologist
- 93 reported data on fulltime cardiologists (mean 3.3)

## Facility Survey

**% of VAs**

## Home Monitoring

**% of VAs**

## Standardized Orders

**% of VAs**

## Clinical Reminders

**% of VAs**

## Home Monitoring Enrollment

**Number of VAs**

## Follow Up

**% of  Facilities**

## Follow-up Time for Clinic Visit

**% of  Facilities**

**Follow-up Time for Clinic Visit**

**1 YEAR OUTCOME**

## Follow-up Time for Telephone Call

**% of  Facilities**

**Follow-up Time for Telephone Call**

**1 YEAR OUTCOME**

## Future Directions for VA Heart Failure Care

- Office of Quality and Performance
- Potential New Performance Measures
- 30-Day Readmission Rates
- Incident admission rates
- 30-Day Mortality

## Discussion