Implementing Evidenced Based Palliative Focused CHF Protocol for Advance Practice Clinicians in Long-Term Care
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Part 1 |
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| Project Charter Information | |||||||||||||||
| Project Name | Implementing Evidenced Based Palliative Focused CHF Protocol for Advance
Practice Clinicians in Long-Term Care |
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| Project Site | Optum-United Health Group | ||||||||||||||
| Contact at site | Name with credentials: Adrienne Peart APRN, NPC, Clinical Service Manager.
Organizational Email: Phone Number: |
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| Preceptor | Name with credentials: Lora Crowe, Ph.D., Senior Clinical Service Manager.
Email: Phone Number: |
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| Executive Sponsor | The executive sponsor is Adrienne Peart APRN, NPC, a Clinical Service Manager at Optum. The reason for selecting the sponsor is the extensive experience in handling patients with complex health needs. The manager also coordinates efforts by advanced practice clinicians and monitors outcomes to ensure that the services provided match patients’ needs and expectations. | ||||||||||||||
| Gap Analysis | Optum Health is a subsidiary of the United Healthcare Group responsible for providing healthcare services to those who are insured by United healthcare insurance products. Therefore, the strategic priorities of Optum health reflect the corporate mission and core values that align with the broader United Health Group (UHG) vision of improving customer experience by making healthcare work better for everyone by helping people live healthy lives. The strategic priorities of UGH-Optum health for 2021 include expanding access to preventative care services to 85% of its customers by the year 2030, shifting 55% of outpatient surgeries to a high-quality, cost-effective setting by the year 2030, and closing 600 million gaps in care for customers by 2025 (UHG, 2020). Undoubtedly providing affordable, quality, safe, and effective patient care set precedence and is the number one priority of UHG. Achieving high-quality outcomes, lower costs, and improved consumer and physician satisfaction, driven by our high-performing local care practices. UHG focus on the efficiency and profitability of the services provided by the organization.
Ten patients with heart failure with reduced ejection fraction diagnoses were selected, reviewed, and compared with AHA guidelines. None of the charts audited had ARNI (angiotensin receptor-neprilysin inhibitor) known as Entresto is part of the AHA recommendation for management of heart failure with reduced ejection fraction. Four patients with African American (AA) heritage are not on Hydralazine and only one patient was one SGLT2i as indicated by the guideline (Heidenreich et al., 2022). All ten charts reviewed had full code status indicating a lack of understanding of disease trajectory and recommendations. |
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| Evidence to Support the Need | The lack of use of an evidenced-based protocol for Advanced Practice Clinicians (APCs) limits them from proactively managing patients with CHF at risk of reduced ejection fraction in long-term care (Mechler & Liantonio, 2019). Even though some patients are managed by a cardiologist and have echocardiograms, evidenced based palliative focused CHF protocol may not be readily available to the APC at skilled nursing facilities. The gaps undermine the workforce’s abilty to deliver patient-centered and holistic care to patients with complex health care needs (Ryan et al., 2021). Therefore, managing the polypharmacy and CHF regimen calls for adequate knowledge and expeirncing in using the American Heart Association (AHA) guidelines on managing cardiovascular conditions. | ||||||||||||||
| PICOT | In advanced practice clinicians in complex care management at Optum (P) implementation of CHF palliative care protocol (I) compared to No heart failure protocol (c) to measure APC compliance with CHF protocol for patients in long-term care (O) within 10 weeks(T) | ||||||||||||||
| Project Aim | The aim is to streamline Advanced Practice Clinicians’ use of palliative care protocols for CHF patients at Optum. The project seeks to enhance the implementation of AHA guidelines for Advanced Practice Clinicians (APC) handling members with NYHA class IV heart failure in long-term care. The guidelines will strengthen adherence to evidence-based CHF protocols adopted to protect patients from severe complications and premature deaths. The intervention will addres
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