Care process models, decision support tools, care coordination services, and reporting solutions together make up a Health Pathway. Clinicians use these processes and tools when treating patients and managing their health. Intermountain’s Clinical Programs — in which multidisciplinary teams across Intermountain work together to ensure best care — are at the heart of these efforts.
Since 2014, Intermountain’s Cardiovascular Clinical Program team has focused efforts on reducing the rate of heart failures and improving outcomes for high-risk patients, including reducing hospital readmissions and mortality. Here’s how it works:
1. Multidisciplinary teams of doctors, nurses, care managers, dietitians, and pharmacists review a daily report that helps them identify patients who are at high-risk for heart failure, hospital readmission, and mortality. That information helps the teams intervene faster and deliver improved outcomes.
2. The teams then use a set of best-practice processes to treat patients according to their specific needs no matter where they are in the continuum of care.
3. Intermountain’s Cardiovascular Clinical program continually collects data, measures outcomes, and develops tools for the Heart Failure Pathway, then shares those resources with the teams that are actually providing patient care.
4. And because the work is coordinated throughout all of Intermountain, our patients at high risk for heart failure get the same high standard of care, no matter which Intermountain hospital they go to.
Results thus far for the Heart Failure Health Pathway are impressive. When Intermountain’s McKay-Dee Hospital piloted the Heart Failure Clinical Pathway in 2014, mortality rates for patients in the pilot were seven percent, compared to nineteen percent for patients who weren’t participating. Thirty-four percent of the patients in the pilot were able to return to their homes, where they received home health services after they were discharged from the hospital, instead of going to a skilled nursing facility but only nineteen percent of patients who weren’t in the pilot were able to go home after discharge.
The pilot at McKay-Dee Hospital helped prepare the pathway for systemwide implementation. Five Intermountain hospitals began using the pathway in 2015, and the remaining seventeen will adopt it this year.
Heart failure affects six million people in the U.S. Although they represent just over two percent of the total population, heart failure is the number one cause for hospitalization for people over 65 and the prevalence of heart failure is increasing, along with the incidence of hospital readmissions and mortality. If the rates of improvement from our Heart Failure Pathway hold across all heart failure patients, we can expect better outcomes and significant cost savings nationwide.
