title: Decreased readmissions and improved quality of care with the use of an inexpensive checklist in heart failure.
abstract: Providing effective discharge instructions, appropriate dose uptitration, education regarding heart failure (HF) monitoring, and strict follow-up have all been shown to decrease readmissions for HF but are all underutilized. The authors developed and evaluated the impact of a quality-improvement HF checklist as a tool to remind physicians to improve quality of care in HF patients. The checklist was used in randomly selected patients admitted with a primary diagnosis of acute decompensated HF. It included documentation regarding medications and dose uptitration, relevant counseling, and follow-up instructions at discharge. The checklist was used in 48 patients, and this checklist group was compared with 48 patients as a randomly selected control group. Higher proportions of patients were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in the checklist group compared with the control group (40 of 48 vs 23 of 48, P<.001). Compared with the controls, the rate of dose uptitration for β-blockers and/or ACE inhibitors/ARBs was more common in the checklist group (4 of 48 vs 21 of 48, P<.001). Both 30-day (19% to 6%) and 6-month (42% to 23%) readmissions were lower in the checklist group. The use of an HF checklist was associated with better quality of care and decreased readmission rates for patients admitted with HF.
authors.affiliation: Division of Cardiology, St Joseph Mercy Oakland Hospital, Pontiac, MI 48341, USA. drasbasoor@hotmail.com
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Basoor
authors.forename: Nitin C
authors.initials: NC
authors.lastname: Doshi
authors.forename: John F
authors.initials: JF
authors.lastname: Cotant
authors.forename: Tarek
authors.initials: T
authors.lastname: Saleh
authors.forename: Mina
authors.initials: M
authors.lastname: Todorov
authors.forename: Nishit
authors.initials: N
authors.lastname: Choksi
authors.forename: Kiritkumar C
authors.initials: KC
authors.lastname: Patel
authors.forename: Michele
authors.initials: M
authors.lastname: Degregorio
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Abdul R
authors.initials: AR
authors.lastname: Halabi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D057189:Checklist / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000639:trends*; D010353:Patient Education as Topic; D058996:Quality Improvement / Q000639:trends*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors