Impact of a guideline-based disease management team on outcomes of hospitalized patients with congestive heart failure.
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.
Costantini
O
O
Department of Medicine, University Hospitals of Cleveland and Case Western Reserve university School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106, USA.
Huck
K
K
Carlson
M D
MD
Boyd
K
K
Buchter
C M
CM
Raiz
P
P
Cooper
G S
GS
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D010346:Patient Care Management; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D014463:Ultrasonography; D016277:Ventricular Function, Left
D000806:Angiotensin-Converting Enzyme Inhibitors