Saturday, December 15, 2012

Caring for Veterans with CHF

The Veterans Administration’s Quality Enhancement Research Initiative (QUERI) released their Strategic Plan in November describing how the VA is improving care for veterans with Chronic Heart Failure (CHF). Heart Failure (HF) currently affects nearly five million Americans with hospital admissions for this condition increasing six-fold in the U.S. since 1970, due in part to an aging population. Also heart failure is the number one reason why veterans are discharged from the VA healthcare system.

The VA realizes several factors in delivering care to HF patients. For example, a significant portion of outpatient care for heart failure for veterans is delivered by Patient Aligned Care Teams (PACT). It has also been found that at least a third of patients with HF going to primary care providers do not see a cardiologist either at a VA facility or at a non-VA facility. It is also a fact that another third of patients receive dual care with VA primary care and non-VA cardiology care. The VA is now examining the impact of dual care provided by VA primary care and by non-VA specialty care.

According to the recent published QUERI “Strategic Plan for CHF”, the VA is planning to expand their focus on PACTs by evaluating several interventions that will have local pharmacists providing lists of patients to PACT teams for care changes.

In partnership with VA’s Office of Care Coordination, CHF-QUERI completed a standardized Disease Management Protocol (DMP) for HF. This protocol has been beta-tested and all four vendors are installing it into their systems. All veterans at all of the VA facilities enrolled in the Coordination Home Telehealth (CCHT) program will use this standardized DMP for HF.

CHF QUERI has initiated the “Heart Failure Provider Network” a network of over 900 VA providers and staff interested in improving heart failure care throughout the VA’s healthcare system. The goals are to share evidence-based HF program data, understand and help resolve barriers to care, establish collaborations and networking opportunities, and implement quality improvement projects. The HF Network also solicits QUERI funded proposals to establish new affiliations and collaborations with network members.

CHF-QUERI has developed a comprehensive web-based HF Provider Toolkit by collaborating with the members of the HF Provider Network as well as other non-VA organizations. Providers are encouraged to review the toolkit to determine where the tools will be helpful in their practice.

In addition, VA’s CHF-QUERI is implementing the “Hospital-to-Home” (H2H) initiative. As part of the initiative, all facilities have been provided toolkits, along with active support such as web-based meetings, consultations, and emails.

In the future, the VA will examine the HF specific impact of SCAN-ECHO and e-consults each in terms of survival, rehospitalizations, and quality measures. The VA plans to continue to examine disparities in care based on race, gender, age, rural location, and mental health diagnosis.

For more information on CHF-QUERI, email Theresa Marsh-Daniels at Go to to review the Strategic Plan for CHF.