Implementation Evaluation of PACT Pharmacy Management of Heart Failure in VISN 21

VISN 21 心力衰竭 PACT 药房管理实施评价

基本信息

批准号：
10753388
负责人：
Paul Heidenreich
金额：
--
依托单位：
VETERANS ADMIN PALO ALTO HEALTH CARE SYS
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10753388
关键词：
Address Adherence Adoption Adrenergic beta-Antagonists African American population Appointment Cardiology Caring Clinical Cluster randomized trial Complex Dangerousness Data Dose EFRAC Emergency department visit Evaluation Evidence based practice Feedback Glucose Transporter Goals Guidelines Health Services Accessibility Healthcare Systems Heart failure Hospitalization Hospitals Impact evaluation Improve Access Intervention Knowledge Leadership Learning Life Measures Medical Medical center Medication Management Methods Mineralocorticoid Receptor Monitor Morbidity - disease rate Outcome Patient-Focused Outcomes Patients Pharmaceutical Preparations Pharmacists Pharmacy facility Primary Care Process Protocols documentation Provider Quality of Care Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reporting Resources Safety Site Sodium Specialist Standardization Testing Time Titrations Veterans Wait Time Work adverse drug reaction antagonist cost dashboard data warehouse hospital readmission implementation cost implementation evaluation improved improved outcome inhibitor innovation interest member mortality patient population primary care practice primary care provider primary outcome randomized trial response satisfaction secondary outcome side effect tool

项目摘要

Justification: Heart failure (HF) is a common condition in the VA, with high morbidity and mortality. Accordingly, heart failure hospitalization and mortality are a focus of VA Safety Analytics for Improvement and Learning (SAIL). Furthermore, heart failure medical treatment is complex as there are now four classes of medications known to independently prolong survival and are recommended to be used together. Several medications require titration to recommended doses while monitoring for uncommon but dangerous side effects. A national HF dashboard is available to track guideline recommended therapy and shows many patients are not receiving optimal care. Pharmacist initiation and titration of medications through a protocol overseen by a specialist, has been found to improve recommended care in multiple randomized trials. However, few VA sites have fully implemented this practice for patients with heart failure. Accordingly, VISN 21 leadership has made increased quality of heart failure care through pharmacist management a priority. Several management tools have already been created and made available to pharmacists. The VISN’s goal is to test an audit and feedback intervention to expand pharmacy management. Hypothesis: Audit and feedback will increase PACT Pharmacy medication management for heart failure within VISN 21. Gaps Addressed (Knowledge and Practices). A National HF Dashboard shows many patients are not receiving optimal HF care within VISN21. Innovation. The use of PACT pharmacists to provide protocolized care for HF may increase quality of care, improve outcomes and free up primary care providers allowing them to focus on other patient issues. Given that patients are often referred to VA Cardiology for this medication initiation, pharmacist HF management can also improve access to VA Cardiology. Evaluation Specific Aims: AIM 1) Using a cluster randomized trial, determine the impact of audit and feedback as an intervention to increase implementation of PACT pharmacist management of HF. Hypothesis 1: VISN 21 sites randomized to audit and feedback will have greater use of PACT pharmacist HF management. AIM 2) Determine facilitators, barriers, fidelity, and cost of implementation AIM 3) At the VISN21 and national level, determine if increased use of pharmacist HF management is associated with increased use of guideline recommended therapies, improved adherence to therapy, improved access, and improved patient outcome. Hypothesis: Hospitalizations for HF will be reduced at sites with greater use of pharmacist medication management of HF. Hypothesis: Appropriate use of recommended doses for HF medication, as determined by the VA National HF Dashboard will be improved at sites with greater use of PACT pharmacist medication management. Project Methods AIM 1: VISN 21 sites (CBOCs and medical centers) will be randomized to audit and feedback (yes or no for 12 months of audit and feedback). If found to be successful at 12 months, audit and feedback will be provided to all sites. The primary outcome will be the number of HF patients managed by pharmacists per month per PACT team. Secondary outcomes will include the number of HF medication changes made by pharmacists per month per PACT team, and resource use (pharmacist and other staff time) . AIM 2: We will examine implementation of PACT pharmacy HF management using the RE-AIM framework including reach and adoption, analysis of barriers, facilitators, and provider satisfaction. AIM 3: We will compare facilities with high rates of PACT pharmacy HF management and compare these to similar sites with low rates of PACT pharmacy HF management in their use of guideline recommended life-prolonging medications, mortality, hospitalization, access to care and adherence to therapy. Use of recommended medications will be determined from a national medication dashboard for Veterans with HF. We will determine hospitalization, mortality, adherence to medications, and access to cardiology care using data from the Corporate Data Warehouse.

理由：心力衰竭 (HF) 是退伍军人管理局的常见病症，发病率和死亡率很高。因此，心力衰竭住院率和死亡率是 VA 安全分析改进和改进的重点学习（SAIL）此外，心力衰竭的治疗很复杂，因为现在有四类。已知可独立延长生存期的药物，建议联合使用。药物需要滴定至推荐剂量，同时监测不常见但危险的副作用国家高频仪表板可用于跟踪指南推荐的治疗并显示许多效果。患者没有接受药剂师通过方案启动和滴定药物的最佳护理。在多项随机试验中发现，在专家的监督下可以改善推荐的护理。然而，很少有 VA 机构针对心力衰竭患者完全实施这种做法，VISN 21。领导层已将通过药剂师管理提高心力衰竭护理质量作为优先事项。 VISN 的目标是已经创建了多种管理工具并可供药剂师使用。测试审计和反馈干预措施以扩大药房管理。假设：审核和反馈将增加 PACT 药房对心力衰竭的药物管理 VISN 21. 解决的差距（知识和实践）国家心力衰竭仪表板显示许多患者未在 VISN21 内接受最佳的心力衰竭护理使用 PACT 药剂师提供服务。心力衰竭的规范化护理可以提高护理质量、改善结果并解放初级护理人员鉴于患者经常因此被转诊至 VA 心脏病科，让他们能够专注于其他患者问题。药物治疗开始后，药剂师 HF 管理还可以改善 VA 心脏病学评估的机会。具体目标：AIM 1) 使用整群随机试验，确定审计和反馈的影响干预实施增加 PACT 药剂师对 HF 的管理假设 1：VISN 21。随机接受审核和反馈的场所将更多地使用 PACT 药剂师 HF 管理 2)。确定促进因素、障碍、忠诚度和实施 AIM 的成本 3) 在 VISN21 和国家层面，确定药剂师心衰管理的增加使用是否与指南的使用增加相关推荐治疗方法、提高治疗依从性、改善可及性并改善患者预后。假设：在更多地使用药剂师药物的地方，因心力衰竭住院的人数将会减少假设：根据确定的情况，适当使用心力衰竭药物的推荐剂量。 VA 国家 HF 仪表板将在更多使用 PACT 药剂师药物的场所得到改进项目方法目标 1：VISN 21 个地点（CBOC 和医疗中心）将被随机分配到审核和反馈（12 个月的审核和反馈是或否）如果在 12 个月时发现成功，将向所有地点提供审核和反馈，主要结果将是心力衰竭患者的数量。每个 PACT 团队每月由药剂师管理的次要结果将包括 HF 数量。每个 PACT 团队每月药剂师进行的药物变更，以及资源使用（药剂师和其他人员）目标 2：我们将使用 RE-AIM 检查 PACT 药房 HF 管理的实施情况框架，包括覆盖范围和采用、障碍分析、促进因素和提供商满意度。将比较 PACT 药房 HF 管理率较高的设施，并将其与类似场所进行比较在使用指南推荐的延长寿命时进行 PACT 药房心力衰竭管理的比率较低药物治疗、死亡率、住院治疗、获得护理和坚持使用推荐的治疗。我们将根据国家心力衰竭退伍军人用药仪表板确定药物治疗。住院率、死亡率、服药依从性以及获得心脏病护理的机会（使用来自以下机构的数据）企业数据仓库。