CHF

1
CHF
Rooted in Gods love, we treat illness and
promote wellness for all people. With adherence
of its values, Compassion, Courtesy, Quality and
Accountability
2
Objectives

• Increased knowledge on the effectiveness of
  disease management for improving chronic
  conditions
• Improve understanding of effective methods to
  coordinate care between hospitals and HHA
•  Increased knowledge of how to effectively
  telemanage patients with chronic conditions 

3
Why CMS Is Focusing on CHF

• The economic impact of CHF is truly staggering.
• The cost to treat CHF annually in the US is 56
  billion
• CHF account for 43 and of total Medicare
  outlays.1
• It is the single most common reason for
  hospitalization of patients 65 years and older
• The CHF problem is growing worse.
• By 2010 the number of patients suffering from CHF
  will have grown to nearly 7 million , a more than
  40 increase

(1)US Department of Health and Human Services,
Instiutute of health, National Heart, Lung, and
Blood institute, Heart Failure, website
http//www.nhlbi.nih.gov/health/dci/Diseases/Hf/HF
_WhatIs.html, (2) Home Health Line Online, hhl
2/13/04
4
Baby BoomersCHF growth is driven by the aging of
our society.
5
Economic Impact of CHF for Hospitals and Home
Healthcare

• Hospitals incur substantial losses in treating
  CHF.
• One recent study concluded that the average
  hospital loses 2,650 each time it admits a CHF
  patient (J. B. O'Connell, ibid Cardiology
  Roundtable Survey of Hospitals, 1994).
• CHF patients are the least profitable for HHAs
• average net margin of just 104.68 after
  subtracting the costs of 18 average visits per
  episode. (Home Health Line Online, hhl 2/13/04)

6
Why CHF Disease Management?

• Goals
• Patient Self-Management
• Reduce expenditures while maintaining or
  improving care for CHF patients
• Decrease ER visits and re-hospitalizations
• Improve quality of life for CHF patients
• Evidence is growing that indicates as much as 90
  of the care needed to manage a chronic disease
  such as CHF must come directly from the patient.
• Patient learned self-management interventions,
  such as self-monitoring and healthy lifestyle
  changes, lead not only to improved health, but
  also to increased patient satisfaction and
  reductions in hospital and emergency room costs.

Research to Prevention, http//www.researchtopreve
ntion.org/html/aboutus.html, http//www.researchto
prevention.org/html/aboutus.html
7
Why CHF Patients Need Home Health

• Theyre 85, they have heart failure. They go
  into the hospital the hospital fixes them. And
  then, they go back to their old lifestyle
• Home Health Line Issue date August 22, 2003
  Volume XXVIII No. 32

• Studies show that patients who received
  additional care at home had a 33 better chance
  of survival and a 40 lower risk of unplanned
  readmission to the hospital.
• Home Health Line, Issue Date December 31, 2004
  Chronic care improvement A new market for home
  health agencies

8
Collaboration With SJCHS

• Home health in collaboration with SJCHS CRD
  (Continuous Research and Development) team
  developed standardized patient care
  interventions.
• Group representatives
• Cardiologists
• Nurse Directors
• Home Health
• Care call center
• Qualified patients are referred to home health to
  reinforce CHF disease management.

Heart Failure Quality MeasuresRequirement of
Center for Medicare and Medicaid Services
(CMS)(addressograph) If your patient is being
given a diagnosis of congestive heart failure
(CHF) the following criteria need to be met and
documented for the CMS Quality Initiative
Project. ?Yes ?No 1. Did patient have
assessment of LVSF (Left Ventricular Systolic
function)? (Assessed prior to arrival, during
hospital stay or planned after discharge) If
Yes Echocardiogram Date ___________________ Eje
ction Fraction ________________ Documentation
of moderate or severe systolic dysfunction Other
narrative qualitative description of
LVSF________________ (must be documented in
progress note) If No Patient transferred out,
died, left AMA, hospice Other reason
____________________________________ (must be
documented in progress note) ?Yes ?No
2. If Ejection Fraction prescribed ACEI or ARB at Discharge? If No
(check all that apply) ACEI allergy AND ARB
allergy Moderate or Severe Aortic Stenosis
(Contraindication to both ACEI and ARBs) Other
potential contraindication/reasons for not
prescribing both an ACEI AND ARB Low blood
pressure Renal failure Other Reason_______________
____________________ (must be documented in
progress note) Patient transferred, died, left
AMA, hospice ?Yes 3. If
discharging patient to home, was a CHF packet
given to patient and/or family? The CHF packet
includes written discharge instructions
for Activity Level Diet/Fluid Intake Follow up
with a providerMedications What to do if symptoms
worsen Weight Monitoring instructions ?Yes ?No 4.
Patient did smoke within previous 12
months? If Yes (check all that apply) Smoking
cessation advice/counseling/handouts
given Patient refused Patient transferred out,
died, left AMA, or was discharged with
hospice. Provider signature Date/time (par
t of medical record chart)
9
Patient Education Booklet

• Table of Contents
• Congestive Heart Failure
• Patient Education

A patients guide to managing Congestive
Heart Failure A book to help you live
with congestive heart failure.
10

• Daily Tips to Control
• Congestive Heart Failure

EVERYDAY
b
Weigh yourself every day.
Take your medication as directed every day
Eat Salt-free or Low-salt food every day
Keep Active
WHEN TO CALL
THE NURSE
Dry, nagging cough Or coughing at night
Your shortness of breath is getting worse
especially when you lie flat
Increased fatigue or weakness
You have gained More than 5 pounds in 1 week
or have more swelling than usual in your feet,
ankles or belly.
Irregular or rapid heartbeat
Dizziness/light headedness when you rise
Nausea or lack of appetite
WHEN TO CALL YOUR DOCTOR
Sudden or severe chest pain or pressure
Frothy sputum with cough
Severe Shortness of Breath
11
St. Joseph's/Candler Home Healthcare Self-Manageme
nt Checklist (Take this with you when you go to
your doctor's appointment)

12

• Home Exercise Program
• _________________________, here are some
  exercises for you to perform at home. You may do
  these once a day at your convenience. Remember
  to rest in between each exercise, as you need to.
  
• exercising if the following symptoms
  occur
• Moderate pain. Increased swelling, redness or
  numbness.
• Moderate shortness of breath.
• Dizziness or light-headedness.
• Chest pain and/or chest pain radiating down one
  arm.
• Nausea
• Moderate to severe fatigue.
• Make sure someone is nearby with you while you
  are performing your exercises in case you need
  help.
• GOOD LUCK!

13

CHF
Heart Healthy Recipes
14
Disease Management Congestive Heart
Failure Telehealth Standard Orders Disciplines/Fre
quency Skilled Nurse 3 wk 2 2 wk 1 1 wk
1 Home Health Aide 2 wk 2 Therapy 2 wk
2
15
Disease Management Congestive Heart
Failure Telehealth Standard Orders
Staff Signatures __________________________
_________________________ ______________________
_____ _______________________________
_______________________________________
_________________________ _______________________
_____ _______________________________ Teach
? Assess/F-U Follow up recall
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)