title: Delivering heart failure disease management in 3 tertiary care centers: key clinical components and venues of care.
abstract: BACKGROUND
  Little data exist to assist to help those organizing and managing heart failure (HF) disease management (DM) programs. We aimed to describe the intensity of outpatient HF care (clinic visits and telephone calls) and medical and nonpharmacological interventions in the outpatient setting.
  
  
  METHODS
  This was a prospective substudy of 130 patients enrolled in STARBRITE in HFDM programs at 3 centers. Follow-up occurred 10, 30, 60, 90, and 120 days after discharge. The number of clinic visits and calls made by HF cardiologists, nurse practitioners, and nurses were prospectively tracked. The results were reported as medians and interquartile ranges.
  
  
  RESULTS
  There were a total of 581 calls with 4 (2, 6) per patient and 467 clinic visits with 3 (2, 5) per patient. Time spent per patient was 8.9 (6, 10.6) minutes per call and 23.8 (20, 28.3) minutes per clinic visit. Nurses and nurse practitioners spent 113 hours delivering care on the phone, and physicians and nurse practitioners spent 187.6 hours in clinic. Issues addressed during calls included HF education (341 times [52.6%]) and fluid overload (87 times [41.8%]). Medical interventions included adjustments to loop diuretics (calls 101 times, clinic 156 times); beta-blockers (calls 18 times, clinic 126 times); vasodilators (calls 8 times, clinic 55 times).
  
  
  CONCLUSIONS
  More than a third of clinician time was spent on calls, during which >50% of patient contacts and HF education and >39% of diuretic adjustments occurred. Administrators and public and private insurers need to recognize the amount of medical care delivered over the telephone and should consider reimbursement for these activities.
authors: Washington Hospital Center, Washington, DC 20010, USA. monica.r.shah@medstar.net
authors: Monica R
authors: MR
authors: Shah
authors: David J
authors: DJ
authors: Whellan
authors: Eric D
authors: ED
authors: Peterson
authors: Anju
authors: A
authors: Nohria
authors: Vic
authors: V
authors: Hasselblad
authors: Zhenyi
authors: Z
authors: Xue
authors: Margaret T
authors: MT
authors: Bowers
authors: Christopher M
authors: CM
authors: O'Connor
authors: Robert M
authors: RM
authors: Califf
authors: Lynne W
authors: LW
authors: Stevenson
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D019468:Disease Management; D005260:Female; D006302:Health Services Research; D006333:Heart Failure / Q000451:nursing / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011446:Prospective Studies; D013689:Telephone; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data