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Delivering heart failure disease management in 3 tertiary care centers: key clinical components and venues of care.

Publication ,  Journal Article
Shah, MR; Whellan, DJ; Peterson, ED; Nohria, A; Hasselblad, V; Xue, Z; Bowers, MT; O'Connor, CM; Califf, RM; Stevenson, LW
Published in: Am Heart J
April 2008

BACKGROUND: Little data exist to assist to help those organizing and managing heart failure (HF) disease management (DM) programs. We aimed to describe the intensity of outpatient HF care (clinic visits and telephone calls) and medical and nonpharmacological interventions in the outpatient setting. METHODS: This was a prospective substudy of 130 patients enrolled in STARBRITE in HFDM programs at 3 centers. Follow-up occurred 10, 30, 60, 90, and 120 days after discharge. The number of clinic visits and calls made by HF cardiologists, nurse practitioners, and nurses were prospectively tracked. The results were reported as medians and interquartile ranges. RESULTS: There were a total of 581 calls with 4 (2, 6) per patient and 467 clinic visits with 3 (2, 5) per patient. Time spent per patient was 8.9 (6, 10.6) minutes per call and 23.8 (20, 28.3) minutes per clinic visit. Nurses and nurse practitioners spent 113 hours delivering care on the phone, and physicians and nurse practitioners spent 187.6 hours in clinic. Issues addressed during calls included HF education (341 times [52.6%]) and fluid overload (87 times [41.8%]). Medical interventions included adjustments to loop diuretics (calls 101 times, clinic 156 times); beta-blockers (calls 18 times, clinic 126 times); vasodilators (calls 8 times, clinic 55 times). CONCLUSIONS: More than a third of clinician time was spent on calls, during which >50% of patient contacts and HF education and >39% of diuretic adjustments occurred. Administrators and public and private insurers need to recognize the amount of medical care delivered over the telephone and should consider reimbursement for these activities.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2008

Volume

155

Issue

4

Start / End Page

764.e1 / 764.e5

Location

United States

Related Subject Headings

  • Workload
  • Workforce
  • Telephone
  • Prospective Studies
  • Patient Education as Topic
  • Outpatient Clinics, Hospital
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Shah, M. R., Whellan, D. J., Peterson, E. D., Nohria, A., Hasselblad, V., Xue, Z., … Stevenson, L. W. (2008). Delivering heart failure disease management in 3 tertiary care centers: key clinical components and venues of care. Am Heart J, 155(4), 764.e1-764.e5. https://doi.org/10.1016/j.ahj.2007.12.026
Shah, Monica R., David J. Whellan, Eric D. Peterson, Anju Nohria, Vic Hasselblad, Zhenyi Xue, Margaret T. Bowers, Christopher M. O’Connor, Robert M. Califf, and Lynne W. Stevenson. “Delivering heart failure disease management in 3 tertiary care centers: key clinical components and venues of care.Am Heart J 155, no. 4 (April 2008): 764.e1-764.e5. https://doi.org/10.1016/j.ahj.2007.12.026.
Shah MR, Whellan DJ, Peterson ED, Nohria A, Hasselblad V, Xue Z, et al. Delivering heart failure disease management in 3 tertiary care centers: key clinical components and venues of care. Am Heart J. 2008 Apr;155(4):764.e1-764.e5.
Shah, Monica R., et al. “Delivering heart failure disease management in 3 tertiary care centers: key clinical components and venues of care.Am Heart J, vol. 155, no. 4, Apr. 2008, pp. 764.e1-764.e5. Pubmed, doi:10.1016/j.ahj.2007.12.026.
Shah MR, Whellan DJ, Peterson ED, Nohria A, Hasselblad V, Xue Z, Bowers MT, O’Connor CM, Califf RM, Stevenson LW. Delivering heart failure disease management in 3 tertiary care centers: key clinical components and venues of care. Am Heart J. 2008 Apr;155(4):764.e1-764.e5.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2008

Volume

155

Issue

4

Start / End Page

764.e1 / 764.e5

Location

United States

Related Subject Headings

  • Workload
  • Workforce
  • Telephone
  • Prospective Studies
  • Patient Education as Topic
  • Outpatient Clinics, Hospital
  • Middle Aged
  • Male
  • Humans
  • Heart Failure