Overview
The Congestive Heart Failure (CHF) Program is the third state-wide disease management program developed by the Community Care networks.
The program provides resources for clinicians as they follow evidence based clinical practice guidelines in the diagnosis and treatment of patients with CHF. The American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult are used as the basis of the program.
In addition, case managers can work intensively with high risk heart failure patients to promote self management and focus on the importance of dietary changes, exercise, daily weights, adherence to prescribed medications, and recognition of warning signs of worsening symptoms. Incentives are provided to patients to encourage participation in case management and decrease barriers to self-care.
Tools
CCNC CHF Guidelines
CHF Management Plan
Measures
As part of the Continuous Quality Improvement activities, process and outcome measures are tracked to guide network and practice level priorities and resources. These include:
Process Measures
- Percent Heart Failure Patients with Echocardiogram in past 3 years
- Percent with Ejection Fraction < 40%, prescribed ACE Inhibitor or ARB after identification with heart failure
- Percent with Ejection Fraction < 40%, prescribed Beta Blocker after identification with heart failure
- Percent of those prescribed ACEI or ARB, filling prescription at least 80% of months in claims database
Outcome Measures
- Heart Failure Emergency Department Utilization Rate
- Heart Failure Hospitalization Rate
- Heart Failure Re-admission Rate
