title: Improving heart failure disease management in skilled nursing facilities: lessons learned.
abstract: The purpose of the study was to design and evaluate an improvement project that implemented HF management in four skilled nursing facilities (SNFs). Kotter's Change Management principles were used to guide the implementation. In addition, half of the facilities had an implementation coach who met with facility staff weekly for 4 months and monthly for 5 months. Weekly and monthly audits were performed that documented compliance with eight key aspects of the protocol. Contextual factors were captured using field notes. Adherence to the HF management protocols was variable ranging from 17% to 82%. Facilitators of implementation included staff who championed the project, an implementation coach, and physician involvement. Barriers were high staff turnover and a hierarchal culture. Opportunities exist to integrate HF management protocols to improve SNF care.
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Dolansky
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Hitch
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Boxer
mesh_terms: D019468:Disease Management; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D058996:Quality Improvement; D012866:Skilled Nursing Facilities / Q000458:organization & administration / Q000592:standards*
keywords: clinical research areas; congestive heart failure; diseases; geriatrics; health care settings; post acute care setting