QUERI – Quality Enhancement Research Initiative

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VA Hospital To Home (H2H) Initiative

About the National Hospital to Home (H2H) Initiative:
The national H2H initiative is cosponsored by the American College of Cardiology and the Institute for Healthcare Improvement: http://h2hquality.org. It is a national quality improvement initiative to reduce unnecessary readmissions for cardiovascular patients. Goal is to reduce all-cause re-admission rates among patients discharged with heart failure by 20% by Dec 2012.

About the VA Hospital to Home (H2H) Initiative:
To facilitate implementation of the national H2H initiative at the VA facilities in January, 2010 the CHF QUERI through its HF Network launched the VA H2H quality improvement initiative. The Undersecretary for Health has signed a letter offering support as a strategic partner to the national H2H initiative. Dr. Robert Jesse MD, PhD Principal Deputy Under Secretary for Health and John Rumsfeld MD, PhD, Director National Cardiology Program, Office of Patient Care Services strongly recommend the VA H2H initiative.

This initiative to reduce heart failure readmission rates should reduce costs. It is expected that soon all VA facilities will be required to report hospital specific heart failure readmission rates.

Focus areas for VA H2H Initiative (and national H2H Initiative):

  1. Medication management (e.g., help the patient become familiar and competent with their medication)
  2. Early follow up after discharge (specifically, does the patient have a follow-up visit scheduled within a week of discharge and is the patient able to get there?)
  3. Symptom Management (specifically, does the patient fully comprehend signs and symptoms that require medical attention, and know who to contact if they occur?)

Recommended Targets for Facilities:

  • Initiate projects and/or modify ongoing projects based on the VA H2H initiative
  • Enroll your facility on the H2H website: http://www.acc.org/h2h/Enrollment/RequestForInfo.aspx (no data-collection required)
  • Routinely within 1 week of discharge schedule follow up visit
  • Routinely assess quality measures prior to discharge
  • Routinely provide patient education materials to heart failure patients and/or caregivers using the "teach-back" method where the patient/caregiver is asked to repeat the information to insure understanding of instructions. These materials maybe downloaded from CHF QUERI's website: http://www.queri.research.va.gov/chf/products/patient_education.cfm
Live Meetings:
  • Launch of the VA H2H initiative
    January 21, 2010
    Slides
  • Launch of the VA H2H initiative
    September 28, 2010
    Slides
  • Sharing recently initiated projects based on the VA H2H initiative
    May 17, 2010: discussion about projects initiated at the following VA facilities - Charleston, Chicago, Cleveland and Pittsburgh
    Slides:       i. CHF QUERI
          ii. Charleston VA
          iii. Chicago VA
          iv. Cleveland VA
          v. Pittsburgh VA - No slides
    May 25, 2010: discussion about projects initiated at the following VA facilities - Hampton, Miami, Pittsburgh, St. Louis and Washington DC
    Slides:       i. CHF QUERI
          ii. Hampton VA
          iii. Miami VA
          iv. Pittsburgh VA
          v. St. Louis VA

Tools Provided to Facilities by HF Network:
  • Memo to seek support from facility leadership with talking points
  • 30-day readmission rate (HF Principal Dx) for the facility and national VA from January 2007 till December 2008 as estimated by the CHF QUERI
  • 30-day mortality rate for the facility and national VA from January 2007 till December 2008 as estimated by the CHF QUERI
  • Data about HF practices for the facility data and national VA provided by the facility in June 2008
  • Data about discharge policies for hospitalized HF patients for the facility and national VA provided by the facility in June 2008
  • Paul Heidenreich MD, MS, Director, CHF QUERI will be available for consultation

Do contact us if you would like us to resend any of these tools or have questions/clarifications.

Director
Paul Heidenreich, MD MS
CHF QUERI
E-mail: paul.heidenreich@va.gov

Implementation Research Coordinator
Anju Sahay, PhD
CHF QUERI
E-mail: anju.sahay@va.gov