title: Home diuretic protocol for heart failure: partnering with home health to improve outcomes and reduce readmissions.
abstract: BACKGROUND
  The management of heart failure (HF) is challenging, with high rates of readmission and no single solution. MaineHealth, a health care system serving southern Maine, has shown initial success with home health nurses partnering with physicians in the management of complex patients with HF using the MaineHealth Home Diuretic Protocol (HDP).
  
  
  OBJECTIVE
  To demonstrate that augmented diuretic therapy, both oral and intravenous, an evidence-based treatment for care of patients with HF experiencing fluid retention, can be delivered safely in the home setting using the HDP and can improve outcomes for recently hospitalized patients with HF.
  
  
  METHODS
  In late 2011, the MaineHealth HDP was implemented in two hospitals and in the home health agency serving those hospitals. The patient population included recently hospitalized patients with a diagnosis of advanced HF, eligible for home health services and telemonitoring.
  
  
  METHODS
  Home health nurses reported data on the patients managed using the protocol, including interventions made, physical findings, lab values, and patient disposition after each episode of care. Questionnaires were used to determine patient and clinician satisfaction.
  
  
  RESULTS
  Sixty patients meeting the criteria above were enrolled between November 2011 and January 2014. The protocol was initiated 84 times for 30 of these patients. Sixteen patients had multiple activations. The readmission rate was 10% and no adverse outcomes were observed. Clinician and patient satisfaction was 97% or greater.
  
  
  CONCLUSIONS
  The MaineHealth HDP can be delivered effectively and safely to improve outcomes, reducing readmissions and allowing patients to remain at home.
authors.affiliation: Program Manager for Clinical Integration at MaineHealth in Portland, ME. veillr@mainehealth.org.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Veilleux
authors.affiliation: Former Chair of the MaineHealth Heart Failure Workgroup and the former Director of Heart Failure for the Maine Medical Center in Portland, ME. joseph.wight@mhcardio.com.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Wight
authors.affiliation: Cardiac Rehabilitation Nurse at Turning Point Cardiac Rehabilitation in Scarborough, ME, and the Clinical Specialist for the MaineHealth Heart Failure Program in Portland, ME. cannoa@mmc.org.
authors.forename: Ann
authors.initials: A
authors.lastname: Cannon
authors.affiliation: Telehealth Coordinator and a Home Care Nurse for Home Health Visiting Nurses in Saco, ME. mwhalen@homehealth.org.
authors.forename: Moira
authors.initials: M
authors.lastname: Whalen
authors.affiliation: Senior Medical Director for Transitions of Care at MaineHealth and the Chief Medical Officer for Medical Affairs at Penobscot Bay Health Care in Rockport, ME. bachmd@mainehealth.org.
authors.forename: David
authors.initials: D
authors.lastname: Bachman
mesh_terms: D001291:Attitude of Health Personnel; D019468:Disease Management; D004232:Diuretics / Q000627:therapeutic use*; D006333:Heart Failure / Q000628:therapy*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires
chemical_list: D004232:Diuretics
references.citation: Circulation. 2012 Feb 14;125(6):828-36
references.pmid: 22331920
references.citation: Natl Health Stat Report. 2010 Oct 26;(29):1-20, 24
references.pmid: 21086860
references.citation: N Engl J Med. 2010 Dec 9;363(24):2301-9
references.pmid: 21080835
references.citation: J Am Coll Cardiol. 2008 Aug 5;52(6):435-7
references.pmid: 18672163
references.citation: Eur J Heart Fail. 2008 Mar;10(3):267-72
references.pmid: 18308632
references.citation: Circulation. 2012 Feb 14;125(6):820-7
references.pmid: 22331919
references.citation: N Engl J Med. 2009 Apr 2;360(14):1418-28
references.pmid: 19339721
references.citation: Cochrane Database Syst Rev. 2010 Aug 04;(8):CD007228
references.pmid: 20687083
references.citation: Circ Heart Fail. 2010 Jan;3(1):97-103
references.pmid: 19903931
references.citation: Heart Lung. 2002 Sep-Oct;31(5):340-7
references.pmid: 12487012