Effect of a Quality Improvement Intervention for Acute Heart Failure in South India: An Interrupted Time Series Study
| Autor: | Anubha Agarwal, Syam Natesan, Abigail S. Baldridge, Dimple Kondal, Stigi Joseph, Mark D. Huffman, Johny Joseph, Divin Davies, Jabir Abdullakutty, Dorairaj Prabhakaran, Govindan Unni, Raji Devarajan, P.P. Mohanan, P.B. Jayagopal, Rajesh Gopinath |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Quality management Psychological intervention India 030204 cardiovascular system & hematology Logistic regression Article Ventricular Function Left 03 medical and health sciences 0302 clinical medicine Medicine Outpatient clinic Humans 030212 general & internal medicine Aged Heart Failure Ejection fraction business.industry Interrupted Time Series Analysis Stroke Volume medicine.disease Quality Improvement Heart failure Concomitant Emergency medicine Female Cardiology and Cardiovascular Medicine business Patient education |
| Zdroj: | Int J Cardiol |
| Popis: | BACKGROUND: Although quality improvement interventions for acute heart failure have been studied in high-income countries, none have been studied in low- or middle-income country settings where quality of care can be lower. We evaluated the effect of a quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized for acute heart failure in 8 hospitals in Kerala, India utilizing an interrupted time series design from February 2018 to August 2018. METHODS: The quality improvement toolkit included checklists, audit-and-feedback reports, and patient education materials. The primary outcome was rate of discharge guideline-directed medical therapy for patients with heart failure with reduced ejection fraction. We used mixed effect logistic regression and interrupted time series models for analysis. RESULTS: Among 1400 participants, mean (SD) age was 66.6 (12.2) years, and 38% were female. Mean (SD) left ventricular ejection fraction was 35.2% (9.7%). The primary outcome was observed in 41.3% of participants in the intervention period and 28.1% of participants in the control period (difference 13.2%; 95% CI 6.8, 19.0; adjusted OR = 1.70; 95% CI 1.17, 2.48). Interrupted time series model demonstrated highest rate of guideline-directed medical therapy at discharge in the initial weeks following intervention delivery with a concomitant decline over time. Improvements were observed in discharge process of care measures, including diet counseling, weight monitoring instructions, and scheduling of outpatient clinic follow-up but not hospital length of stay nor inpatient mortality. CONCLUSIONS: Higher rates of guideline-directed medical therapy at discharge were observed in Kerala. Broader implementation of this quality improvement intervention may improve heart failure care in low- and middle-income countries. SUMMARY TWEET: QI toolkit in Kerala, India shows improvements in GDMT at discharge for patients with HFrEF. Centre for Chronic Disease Control, Cardiological Society of India, @DukeGHI, @Fogarty_NIH, @NMCardioVasc, @FSMGlobalHealth |
| Databáze: | OpenAIRE |
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