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Impact of a Guideline-Based Disease Management Team on Outcomes of Hospitalized Patients With Congestive Heart Failure
Ottorino Costantini, MD;
Kimberly Huck, ND, RN, CCRN;
Mark D. Carlson, MD;
Karen Boyd, RN;
Carol M. Buchter, MD;
Pauline Raiz, MS;
Gregory S. Cooper, MD
Arch Intern Med. 2001;161:177-182.
Background Congestive heart failure is the most common reason for hospitalization
in the United States, and guidelines to improve the quality of care for patients
with congestive heart failure have been developed. However, adherence is typically
low. We hypothesized that a guideline-based care management team would result
in greater quality and efficiency of care than guidelines alone.
Methods A faculty cardiologist and nurse care manager at an academic medical
center reviewed each patient's data and made guideline-based recommendations.
Hospital length of stay, total costs, and use of recommended guidelines were
compared between 173 patients before team implementation but with available
guidelines, 283 care-managed patients, and 126 concurrent non–care-managed
patients.
Results Care-managed patients achieved higher rates of use of angiotensin-converting
enzyme inhibitor than baseline or non–care-managed patients (95%, 60%,
and 75%, respectively; P<.001), as well as increased adherence
to guidelines for daily weight monitoring and assessment of left ventricular
function. Hospital length of stay was lower (median, 3, 4, and 5 days, respectively; P<.001) as were costs of hospitalization (median, $2934, $3209,
and $4830, respectively; P<.01). These differences persisted
after adjustment for severity of illness.
Conclusions When compared with dissemination of guidelines alone, an active care
management approach was associated with significant improvements in quality
and efficiency of care for hospitalized patients with congestive heart failure.
From the Department of Medicine, University Hospitals of Cleveland
and Case Western Reserve University School of Medicine, Cleveland, Ohio.
Corresponding author: Gregory S. Cooper, MD, Division of Gastroenterology,
University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106 (e-mail: gxcl2{at}po.cwru.edu).
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