Quality improvement in heart failure: a randomized educational intervention to change provider behavior.
Whether provider education changes practice for HF has not been reported. (NHeFT)™ uses didactic and experiential training of primary care providers (PCP) to optimize treatment of HF. We randomized PCP's in the Cleveland VA clinics to training (T) vs control (C).


METHODS
Primary - the number of patients with EF < 40% treated with ACEI/ARB and Beta Blocker, +/- diuretic post T vs pre T; Secondary - the number of patients with increase in ACEI/ARB or a decrease in diuretic post T vs. pre T. Of 641 patients, 216 (85 C,131 T) had EF < 40%; 188 (85%) did not meet the primary endpoint at baseline. After T, a similar proportion (64.2% C, 74.4%,T) met the endpoint at end of study (P = 0.14). The odds of a patient meeting the primary endpoint by care of a T provider, was not significantly higher than C (OR 1.496, 95% CI (0.751, 2.982)). Patients seen by T were more likely to have the diuretic dose decreased vs patients under C, without increases in ACEI or ARB (P < 0.03). Thus, a didactic program of HF plus a preceptorship changed practice modestly. Studies should address provider readiness of change and self efficacy to adhere to evidenced-based care.
Montefiore-Einstein Medical Center, Bronx, NY 10467, USA. ilppina@aol.com
Ileana L
IL
Piña
David
D
Bruckman
Craig
C
Lance
Jeanne
J
Hitch
Julie
J
Gee
Kimberley
K
Schaub
Michelle
M
Davidson
Scott
S
Ober
David
D
Aron
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002983:Clinical Competence; D016001:Confidence Intervals; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D013223:Statistics as Topic
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents