"Hub and Satellite" Heart Failure Provider's Network Study
Condition: Heart Failure
MeSH terms: Heart Failure
Study type: Interventional

Summary: 
      The aim of this study is to serve as a pilot showing the feasibility of a "Hub and Satellite"
      Heart Failure (HF) Provider's Network which will aim to provide improved, evidence-based care
      to Veterans with HF. Primary Care Providers in the VA Community Based Outpatient Clinics
      (CBOCs) will undergo a brief period of intensive training in HF management and then practice
      in a network of primary care providers supported by the Regional HF Center.
    

Detailed description: 
      Background:

      Congestive heart failure (HF) is a major public health problem. There is a pressing need to
      improve treatment of HF, but lifesaving therapies remain underused in clinical practice. The
      investigators proposed a novel, potentially cost-effective model of community-based,
      multidisciplinary, collaborative HF care - the "Hub and Satellite" Heart Failure Providers
      Network. Primary care providers trained in HF management would provide improved care to their
      clinic patients with HF in "satellite" clinics, supported by the Regional HF Center "hub".

      Objectives:

        1. To establish and demonstrate the feasibility of the "Hub and Satellite" Heart Failure
           Providers Network

        2. To obtain data examining clinical effectiveness and barriers

      Methods:

      Volunteer community-based primary care providers underwent 3 days of HF management training
      at the regional HF center (Nashville), consisting of 21 hours of lectures, briefings,
      teaching sessions and case presentations. Multiple choice testing and a survey interview were
      completed at the beginning and end of training. Exclusive access was given to the services of
      a clinical pharmacist to titrate HF medications to clinical guideline-recommended doses.

      Providers received updates on advances in HF management. A confidential feedback report on
      their performance was given to HF providers. Formative evaluation was performed through
      pre-educational and 4 subsequent telephone interviews with HF providers.

      Decision Support System (DSS) data was used to identify patients with systolic HF (ejection
      fraction<40%) cared for by the HF providers; systolic HF patients in the same clinics cared
      for by non-HF trained providers were randomly selected as controls. Data on the care received
      over the one year period of follow-up was collected from DSS data and the computerized
      patient record system (CPRS).

      Status:

      One year of study follow-up has been completed. Primary data analysis is continuing. Work
      done to date has successfully demonstrated the feasibility of implementing a "Hub and
      Satellite" HF Providers network, including high provider satisfaction.
    

Intervention name(s): HF training; No HF training
Intervention type(s): Other; Other
Intervention description(s): These are CBOC Providers who received HF Training as the active intervention. HF training includes didactic lectures, case discussions and interactive symposia, course materials including teaching material, textbooks, copies of HF clinical guidelines and patient education material for distribution, participation in HF Clinics and Inpatient Heart Failure Rounds. Providers were given access to clinical pharmacist services Including medication and disease teaching, adjustment and uptitration. There was quarterly analysis of patient compliance including individualized confidential, non-punitive feedback to providers from a set of prespecified core HF performance measures.; These are control providers drawn from the same CBOCs who have not received HF training, access to clinical pharmacist medication titration services or performance feedback
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Heart Failure; Outcome Assessment; Congestive Heart Failure