Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina.
Cardiology, Hospital Centro de Salud "Zenón Santillán", Tucuman T4000, Argentina.
Int J Qual Health Care. 2023 Sep 8;35(3). doi: 10.1093/intqhc/mzad060.
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.
心力衰竭（HF）是与高死亡率、高发病率和高医疗保健成本相关的主要临床和公共卫生问题。尽管存在针对 HF 最佳治疗的循证指南，但护理质量仍不理想。我们的目标是在住院和出院期间使 50%的纳入患者使用护理包，并将 HF 病因的再入院率降低 10%。我们在阿根廷的 8 家医院进行了一项无对照前后研究，以评估质量改进干预对 HF 护理包在纽约心脏协会（NYHA）II-III 级 HF 患者中的使用的影响。HF 护理包包括药物、连续护理、生活方式习惯和出院前检查。通过学习会议和计划-执行-研究-行动改进周期对每个中心的多学科团队进行培训和随访。数据收集员在患者出院后审查了纳入患者健康记录中的护理包依从性，并通过在出院后 30-40 天内给患者打电话来验证再入院情况。我们招募了 200 名患者（干预前 83 名，干预后 127 名），护理包依从性从 9.6%增加到 28.3%[优势比 3.71，95%置信区间（8.46；1.63）；P=.002]。尽管在最初的几个月里改善缓慢，但干预接近尾声时，护理包的依从性逐渐加快，超过了 80%。我们观察到干预后时期出院后 30 天内因 HF 导致的再入院率无显著降低[8.4%比 5.5%，优势比 0.63，95%置信区间（1.88；0.21）；P=.410]。定性分析表明，干预团队成员承认工作组织的改善和护理的标准化、团队合作、共同的心理模型以及健康记录的完整性以及培训研究员的效用。尽管与大流行相关的挑战，通过简单的干预和协作工作，可以为 NYHA II-III 级 HF 患者提供更好的护理。
