America’s Essential Hospitals, a leading association and champion for hospitals and health systems, has recognized Erie County Medical Center (ECMC) Corporation for its Population Health-based Quality Improvement Initiative. This award recognizes activities to improve the quality of care delivered or that work to eliminate events that harm individual patients or groups of patients.
America’s Essential Hospitals, which represents 300 hospitals across the country committed to caring for the vulnerable and keeping communities healthy, awarded ECMC a 2019 Gage Award for Quality Honorable Mention for “Optimizing Guideline-Directed Medical Therapy for Heart Failure.” The association presented the award to Smita Bakhai, MD, MPH, FACP, June 20th at its annual VITAL2019 conference in Miami. Dr. Bakhai led a team of clinicians from ECMC’s Internal Medicine Clinic in the quality improvement initiative.
America’s Essential Hospitals President and CEO Bruce Siegel, MD, MPH, said, “When faced with some of the nation’s most pressing health care challenges, essential hospitals step up. Their innovative programs to improve quality of care and support their communities lead the way for systemic change.”
ECMC Corporation President & Chief Executive Officer Thomas J. Quatroche Jr., PhD, said, “On behalf of ECMC’s dedicated caregivers, we are honored by this recognition from America’s Essential Hospitals. ECMC is our region’s community hospital and we are committed to developing and implementing population health-based initiatives that will improve the quality of life for some of the most vulnerable in our community. Like our fellow AEH member hospitals, ECMC continues to find innovative, cutting-edge healthcare methods to further improve access to quality services for the thousands of individuals that depend on us.”
The Gage Awards, named after association founder Larry Gage, honor and share successful and creative member hospital programs that improve patient care and meet community needs. The Gage Award recognizes activities that improve the quality of care delivered, or reduce or eliminate harmful events to individual patients or groups of patients. The Gage Award for population health recognizes activities that improve delivery, access, or value for specific populations in the recipient’s community and, as a result, have improved health outcomes.
Heart failure is a leading cause of emergency department visits and hospital re-admissions. About 15 percent of patients at ECMC’s Internal Medicine Center (IMC) have a heart failure (HF) diagnosis. The Center launched a quality improvement (QI) initiative to: improve accurate classification of HF from a baseline rate of less than 10 percent to 30 percent; and increase guideline-directed medical therapy (GDMT) use within 12 months in patients aged 40 to 75 with a diagnosis of systolic HF. Echocardiograms are the primary method for classifying systolic HF and excluding other diagnoses.
Barriers to patient follow-through for care include: lack of interest due to knowledge gaps; lack of transportation to appointments; and cost. The ECMC IMC QI team, led by Smita Bakhai, MD, MPH, FACP, launched five Plan-Do-Study-Act cycles to: leverage health information technology; optimize team work; and educate patients, physicians, and IMC staff. The QI team created educational posters and brochures for examination rooms. A social worker helped patients overcome cost and transportation barriers. Physicians worked closely with patients to make decisions to optimize GDMT. Medical staff educated patients about HF complications, medication adherence, weight monitoring, and provided weighing scales and booklets. A case manager was hired to facilitate care transitions from the hospital to the primary care clinic. The case manager worked with social workers to follow-up with patients after Emergency Department visits and schedule follow-up appointments in the clinic. The ambulatory director created a tracking system for hospital discharges and Emergency Department visits to schedule timely clinic appointments. The QI team trained the nursing staff on fluid management and the significance of checking daily weights.
ECMC’s QI team succeeded in “Optimizing Guideline-Directed Medical Therapy for Heart Failure,” having observed a reduction in the total number of ED visits (160 vs. 108), hospital admissions (117 vs. 114), and observation visits (22 vs. 16) comparing one-year before and one-year after the project period in the study population.
