Open AccessQuality Improvement in Heart Failure: A Randomized Educational Intervention to Change Provider Behavior
Author(s) -
Piña Ileana L.,
Bruckman David,
Lance Craig,
Hitch Jeanne,
Gee Julie,
Schaub Kimberley,
Davidson Michelle,
Ober Scott,
Aron David
Publication year - 2012
Publication title -
congestive heart failure
Language(s) - English
Resource type - Journals
eISSN - 1751-7133
pISSN - 1527-5299
DOI - 10.1111/j.1751-7133.2012.00300.x
Subject(s) - medicine , diuretic , clinical endpoint , primary care , heart failure , randomized controlled trial , intervention (counseling) , physical therapy , family medicine , nursing
©2012 Wiley Periodicals, Inc. Whether provider education changes practice for HF has not been reported. (NHeFT)™ uses didactic and experiential training of primary care providers (PCP) to optimize treatment of HF. We randomized PCP’s in the Cleveland VA clinics to training (T) vs control (C). Endpoints: Primary – the number of patients with EF < 40% treated with ACEI/ARB and Beta Blocker, +/− diuretic post T vs pre T; Secondary – the number of patients with increase in ACEI/ARB or a decrease in diuretic post T vs. pre T. Of 641 patients, 216 (85 C,131 T) had EF < 40%; 188 (85%) did not meet the primary endpoint at baseline. After T, a similar proportion (64.2% C, 74.4%,T) met the endpoint at end of study ( P = 0.14). The odds of a patient meeting the primary endpoint by care of a T provider, was not significantly higher than C (OR 1.496, 95% CI (0.751, 2.982)). Patients seen by T were more likely to have the diuretic dose decreased vs patients under C, without increases in ACEI or ARB ( P < 0.03). Thus, a didactic program of HF plus a preceptorship changed practice modestly. Studies should address provider readiness of change and self efficacy to adhere to evidenced‐based care.