What's Working

The Healthy Heart Team: Managing Heart Failure Patients in Detroit
How Sinai-Grace Hospital is going into the community to reduce readmission rates for cardiac patients

It is common knowledge that heart failure patients who closely manage their disease either avoid hospitalization altogether or greatly reduce their likelihood of being admitted to the emergency department. So when Detroit's Sinai-Grace Hospital realized that less than two percent of its heart failure patients were following up with their in-hospital heart failure clinic each year, they took action. If the patients wouldn't come to them, they would go to the patients.

Since much of Sinai-Grace's patient population is older, and a significant percentage is uninsured, helping avoid costly hospitalizations is important for both the patients and the hospital.

The Healthy Heart Team

"We realized that there was a significant difference between the heart failure patients seen in our multidisciplinary clinic, and those who were being treated in physician offices," says Paru Patel, Pharm.D., administrative director for quality and clinical resources and director of pharmacy services at Sinai-Grace Hospital. "Our clinic patients had fewer emergency department visits and fewer hospitalizations. We decided to reach out directly into the community to provide the care they needed, in their neighborhood."

The result is a multidisciplinary, community-based Healthy Heart Team (HHT) consisting of a nurse, pharmacist and social worker. The full-time, salaried staff from Sinai-Grace rotates among four locations in the community, including a church, community center and two senior living facilities, providing heart failure patients with:

• Disease education
• Medication education
• Medication formulary review
• Diet/nutrition review
• Weight management techniques
• Smoking cessation assistance
• Appointment transportation assistance
• Guidance on local resources and programs
• Enrollment assistance in local social services programs
• Assistance with social problems or concerns

Using wireless laptops to register patients and access medical records, the team closely tracks patients over time. Patients and staff record blood pressure, cholesterol, weight, lipid profile and more in a Healthy Heart Passport so that patients are aware of changes that could affect their condition and result in a hospitalization.

Signs of Success from Doctors and Patients

In order to complement, rather than compete with, care directed by the patient's primary or cardiac care physician, Sinai-Grace developed the HHT Collaborative Practice Agreement–whereby physicians authorize the HHT to join them in managing the care of their heart failure patients.

"The key word is 'collaborative,' which underscores that we're in this together," says Dr. Patel. "We wanted to be sure that the document reflected an equal partnership between physicians and the Healthy Heart Team."

Just a few months into the program, more than 45 physicians have signed the agreement. The team is now seeing nearly a full roster of patients, so the hospital hopes to put additional teams into the community soon. The program should reduce the number of heart failure patients who visit the emergency department or are readmitted to the hospital within 30 days.

"Ultimately, we have to tie success to fewer emergency department visits and fewer hospitalizations," says Dr. Patel. 

To help measure success, the HHT will track hospitalization rates and analyze changes in quarterly quality-of-life surveys with patients.

Improving Care, Reducing Disparities

With an estimated 90 percent of its heart failure patients being African American, Sinai-Grace Hospital is committed to ensuring that all patients receive top-notch care, regardless of race or ethnicity. The hospital is getting help improving processes and reducing disparities through the Expecting Success project.

Although analysis of possible gaps in care is ongoing, Dr. Patel thinks the greatest disparity they may find will relate to prescriptions. She says physicians may assume that their African-American patients are uninsured and cannot pay for the latest, most expensive therapies, and thus do not mention or prescribe them—something she says they can correct with education.  

"Our ultimate goal is to improve care for all of our heart failure patients. We need to get their disease stabilized and get them actively involved in managing it," says Dr. Patel. "The end goal is for the patients to become stronger, to get in control of the disease and finally, to get back in control of their own health."

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Spotlight On...

The 1999 merger of two community hospitals, Sinai Hospital and Grace Hospital, created Detroit's Sinai-Grace Hospital. Located in the city's northwest section, it is the area's leading community academic hospital with nearly 215,000 patients each year. Sinai-Grace's Comprehensive Heart Center provides patients with surgery, cardiac rehabilitation, help in managing heart disease and more.

• Staffed beds: 375
• Hospital type: Community academic hospital
• Community location: Urban
• Annual myocardial infarction and heart failure patients: 1,726
• Annual cardiac catheterizations: 1,350

 

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