Lois Freeman DNP CRNP-BC CCRN

Transcription

1 Lois Freeman DNP CRNP-BC CCRN

2 Conflicts of Interest I have no conflicts of interest to disclose

3 The Problem Heart Failure is the most common and most costly Medicare discharge diagnosis in excess of $35-56 billion annually 6,500,000 hospital days/year and 300,000 deaths/year

4 Heart Failure-The problem Heart Failure currently affects nearly 5.8 million Americans, predominately the elderly. The life expectancy for untreated CHF is five years. Re-hospitalization rates during the 6 months following CHF discharges are as high as 50%. Heart Failure hospitalizations have tripled over the last 25 years. The VAMHCS currently has almost 13K patients with Heart Failure or related diagnoses. Under educated-patients and caregivers

5 Heart Failure- The problem There is a shortage of dedicated Cardiologists and cardiology services in the VA system. Medical management of chronic illness during a 15-minute visit is impractical. Primary care providers are routinely treating sicker patients. HF patients are experiencing increased inpatient admissions, increased emergency room or clinic visits, and increasing disability. Evidence has shown that frequent monitoring and patient education can interrupt this cycle, and that there is a possible cost benefit related to reduction of inpatient bed days of care and emergency visits.

6 Present treatment The present interventions all occur after the development of Heart Failure Medical management- CONTROL HTN****** Cardiac Rehabilitation Few Heart Failure education classes Few NP managed Heart Failure Clinics Hometelehealth assistance-reluctance to refer Diagnosis & discharge without informing patientfrequently

7 What is needed? 2 pronged approach needed, preventive and post diagnosis Better treatment of HTN-Public Heart Initiative Standardized HF Patient Education classes, PT. & staff More NP managed HF Clinics Increased referrals to supportive clinics Shared clinic appointments Teaching patients & staff correct procedure for taking BP & weights

8 What is needed? Adherence with guideline-recommended care: has been shown to have major impact on inpatient and long-term care outcomes in heart failure patients, including survival, quality of life and readmissions. 100 % compliance with performance measures Consider increased utilization of CVT to the home and hometelehealth Post discharge visit 7-10 days after discharge with NP 2 day Post discharge f/u call with NP

9 Elements of needed Heart Failure Care Adequate discharge planning Documentation of ejection fraction(ef) Use of Angiotensin-converting enzyme receptor inhibitors/angiotensin receptor blockers, B-blockers Smoking cessation Counseling/medication Medication reconciliation Treatment of Depression EDUCATION, EDUCATION, EDUCATION

10 APN Role Research in best practices APN managed Heart Failure clinic APN run HF patient education classes Improved management of pre-hf blood pressures Education of patients before development of: HTN, Obesity, CAD- sodium, exercise, low cholesterol, smoking cessation, medication adherence

11 APN Role Development of patient education handouts Build collaborations for referrals a. dietary heart healthy cooking demonstrations & education b. Pharmacy med management c. Kinesiology, PT, walking programs ERI, MOVE, Telemove, Gero-fit

12 Take a look where we are

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15 Prevalence of students in grades 9 to 12 reporting current cigarette use by sex and race/ethnicity (YRBSS, 2009) Percent of the Population NH White NH Black Hispanic Males Females Source: MMWR Surveill Summ. 2010;59:1 142.NH indicates non-hispanic American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2011

16 Trends in the prevalence of obesity among US children and adolescents by age and survey year (National Health and Nutrition Examination Survey: , , , and ) Percent of Population Age (Years) Data derived from Health, United States, 2010: With Special Feature on Death and Dying. NCHS, American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2011

17 Age-adjusted prevalence of obesity in adults years of age, by sex and survey year (NHES: ; NHANES: , , , and ) Percent of Population Men Women Data derived from Health, United States, 2010: With Special Feature on Death and Dying. NCHS, American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2011

18 Prevalence of regular leisure-time physical activity among adults > 18 years of age by race/ethnicity and sex (NHIS: 2009) Percent of Population Men Women NH White NH Black Hispanic Source: Pleis et al, NH indicates non-hispanic. Percents are age-adjusted. Regular leisure-time physical activity is defined as 3 or more sessions per week of vigorous activity lasting at least 20 minutes or five or more sessions per week of light/moderate activity lasting at least 30 minutes American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010

19 Where do we go from here?

20 Population and Community-Wide CVD Risk Reduction Approaches Populations with high rates of CVD are those with Western lifestyles of high-fat diets, physical inactivity, and tobacco use. Targets of a population-wide approach must be these behaviors causative of the physiologic risk factors or directly causative of CVD. Requires public health services such as surveillance, education (AHA, NCEP), organizational partnerships and legislation/policy (Anti-Tobacco policies) Activities in a variety of community settings: schools, barbershops, worksites, churches, healthcare facilities, entire communities

21 Research & Innovate APNs are the patients preferred provider to educate them Research & analyze patient and system problems Develop proposals to solve issues INNOVATE!!!!!!!

22 Innovation

23 $1 MILLION DOLLARS AWARDED FOR DEVELOPMENT & PILOTING 2016 VHA Employee Innovation Competition Heart Failure Mobile (CHF)Application (ID) Facility: VA Maryland Healthcare System Station 512, and VISN 5 Initial Idea Submitted by: Lois A. Freeman DNP, CRNP-BC

24 Description of idea Utilizing electronics and clinical informatics, the CHF patient will be an active participant in their routine care. By developing an application (app) that educates CHF patients on their disease process& the essential components of care, we can reduce the severity of exacerbations and cost related to that care. Providing patients with the ability to recognize early signs & symptoms of worsening heart failure; answering questions with reference materials; tracking blood pressure, weight & medications; monitoring I & Os and daily activity; providing information on nutrition for heart failure/dietary sodium reference; encouraging smoking cessation;, Reminders to take medications and providing access to key stakeholders can assist the patient with contacting their provider when needed, and having their medications managed before an exacerbation leads to readmission. In the future this app would be linked to MyhealtheVet & secure messaging, broadening the utilization of those technologies and thereby increasing patients access to their providers, improving communication of patient data, allowing early intervention and reduction in admissions, and reducing emergency room and clinic visits.

25 Supporting Diagrams Patient tracking & entering data into application Data sent or called to primary care provider, PACT team or Cardiology Trackers: Weight BP I &O Daily steps Reduced cost & re-admission Education Sodium Medications What is heart failure, etc. Heart Smart App Hospital contacts: Pharmacy, PACT team, Primary care provider, cardiology Future Link to MyhealtheVet Potentially eliminating need for hospitalization or clinic visit Medication adjustment and/or instructions called back to patient on home or cell phone By PCP or PACT team member 25

26 How we do Preventing Heart Disease: Healthy Living Habits Living a healthy lifestyle can help keep blood pressure, cholesterol, and sugar normal and lower the risk for heart disease and heart attack. A healthy lifestyle includes the following: Eating a healthy diet. Maintaining a healthy weight. Getting enough physical activity. Not smoking or using other forms of tobacco. Limiting alcohol use. Refer to support services Start with the kids

27 Just a quiz Part of my Heart failure education class

28 High or Low Sodium? Hot Dog one link: 570 milligrams with bun: 990 milligrams

29 High or Low Sodium? 1 oz. Dry Roasted Peanuts With salt: 230mg Unsalted: 2 Milligrams Sodium

30 High or Low Sodium? ½ cup Tomato Sauce 720 Milligrams Sodium

31 High or Low Sodium? Canned Tuna Fish 648 milligrams

32 High or Low Sodium? Tuna Fish - Low Sodium 140 milligrams

33 High or Low Sodium? Burger King Whopper Meal 1741 Milligrams Sodium

34 High or Low Sodium? Outback Bloomin Onion 4,100 Milligrams Sodium

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36 When it come to prevention of Heart Failure, it is a paradigm shift! We need all hands on deck!

37 THANK YOU QUESTIONS?