Heart Failure Management
Heart failure (HF) is a syndrome characterized by high mortality, frequent hospitalization, reduced quality of life, and a complex therapeutic regimen. Knowledge about HF is accumulating so rapidly that individual clinicians may be unable to readily and adequately synthesize new information into effective strategies of care for patients with this syndrome. Practice guidelines are available from a number of sources, incliding the 2006 HFSA Comprehensive Heart Failure Practice Guidelines Web Site.
Alerts
Conditions:
In VersaForm, the Heart Failure alert would be triggered when at least one of the ICD-9 codes in the following list is present:
The conditions and actions that follow are taken from the criteria for the PQRI Quality Measures for 2009 as issued by CMS. VersaForm does not recommend medical treatment or provide medical information.
402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9
These ICD-9 codes are collected together in a Problem Class named "Heart Failure". Having them collected in this way makes it unnecessary to have to key in the individual codes, perhaps repeatedly.
In addition, if it is desired to exclude pediatric patients (as in some clinical quality measures), the condition “Patient aged >= 18 years” could be added.
Actions:
If the conditions are satisfied, the system could provide a reminder of the standard measures for heart failure:
- Left Ventricular Function Assessment
- Left Ventricular Ejection Fraction Testing
- Weight Measurement
- Blood Pressure Screening
- Patient Education
- Beta-Blocker Therapy
- Ace Inhibitor Therapy
- Warfarin Therapy for Patients HF
- Influenza Vaccination
- Pneumonia Vaccination
Visit Plan
The visit plan for each heart failure patient will automatically include the reminders listed above, in addition to information about the patient.
Health Management Reports
The Health Management Report for HF patients would show:
- Left Ventricular Function Assessment
- Left Ventricular Ejection Fraction Testing
- Weight
- Blood Pressure
- Influenza Vaccination
- Pneumonia Vaccination
The ability to provide these reports is conditioned, of course, on the data having been entered in the Labs and Data section of the VersaForm patient chart. Data can be entered automatically if your lab can download it to you (most can).
Reviewing this report will give the practice an accurate indication of the management of its heart failure patients.
Patient Outreach
Reminder letters may be automatically generated for each heart failure patient whose last office visit was at least (for instance) a specified time in the past. Also, recall letters can be set up for a specific date, or even to be sent if a certain lab value is present.
Reminder letters (indeed all mail merge letters in VersaForm) can be composed by the practice to reflect their own circumstances. VersaForm can print them or email them, and can produce a list of reminders for telephone follow-up if desired.
