Study says discharge instructions are poor
Study finds gaps in diagnosis, treatment as well
Less than half of all congestive heart failure (CHF) patients receive adequate education on diet, weight, and even medication prior to discharge, according to a recently completed study by the Missouri Patient Care Review Foundation (MPCRF) in Jefferson City.
Specifically, the study found that 46% of patients received instructions on medication, 27% received instructions on diet, and only 10% were instructed on weight monitoring. "We looked at what was written in the chart, and for our purposes, if it wasn’t written in the chart, it didn’t happen," says Carl Bynum, DO, MPH, principal clinical coordinator for MPCRF, which contracts with the Health Care Financing Administration (HCFA) in Baltimore to monitor quality of care for Medicare beneficiaries.
Post-discharge monitoring is crucial to prevent CHF complications, Bynum points out. He says it’s crucial "for patients to recognize that they might be retaining fluid, that they might need to call the physician or make some changes."
Hospitals that fall short in this area should develop a preprinted form or take some other action to alert nurses and physicians to the importance of discharge planning, he suggests.
Disturbingly, the study also found that clinicians don’t always provide the best diagnoses and don’t always adequately treat the disease.
The foundation’s Regional CHF Cooperative Project looked at whether patients were receiving left ventricular function assessments and whether they were put on ACE inhibitors to improve left ventricular diastolic dysfunction, according to Bynum. The study revealed that the assessment is "not routinely done," Bynum says. "Lots of times, physicians are evaluating and making a diagnosis based on symptoms. To accurately diagnose [left ventricular diastolic dysfunction], you have to evaluate the function of the heart. It’s important because it determines what medication the patient should be placed on."
The assessment of cardiac function was performed in 72% of the patients studied, Bynum says, and most of the patients deemed ideal to be put on ACE inhibitors were given that treatment. That means the study did not consider patients who were allergic to ACE inhibitors or had some other reason for not taking the medication, he adds.
"Of ideal patients, 80% were put on ACE inhibi tors," Bynum notes. "That’s not too bad, but there are still another 20% that had the potential of being on the medication."
The foundation is working with the hospitals involved in the study to implement plans to educate their clinicians and to change their processes, he says. "This is an important aspect of the overall treatment of these patients, and we need to make sure there are processes in place to evaluate that."
MPCRF continues to analyze data from the study, which was initiated by the Kansas City regional office of HCFA, with final outcomes due within the next few months. The study involved eight states, but the percentages cited apply only to the Missouri patients.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content