ACAC Symposium April 14th, 2008: Chinook Health 11 Improving Access to Heart Failure Services in Chinook Health Building the Heart Failure Network ACAC Symposium April 14th, 2008: Chinook Health
1 ACAC Symposium April 14th, 2008: Chinook Health 2 Today…. The issue Where we are Where we want to go How ACAC is helping us get there
1 ACAC Symposium April 14th, 2008: Chinook Health 3 The Issue
1 ACAC Symposium April 14th, 2008: Chinook Health 4 Chinook Heart Function Clinic Physician directed, nurse-managed clinic established in 2001, offering: Expert assessment and follow up A customized, evidence-based treatment plan Education and self-management strategies and support Support and connections to community resources
1 ACAC Symposium April 14th, 2008: Chinook Health 5 Good News…and Bad News We are providing quality care and achieving good outcomes in the HFC but…. Seen in Heart Function Specialty Clinic Heart Failure Population in Chinook
1 ACAC Symposium April 14th, 2008: Chinook Health 6 We know that many patients struggle with HF management… Many patients visit the ER, are treated for HF and discharged Many patients are admitted to acute care facilities for exacerbations of heart failure Many patients struggle in the community with frequent episodes of instability
1 ACAC Symposium April 14th, 2008: Chinook Health 7 Increasing our Reach We seek to create a network of health care providers across the continuum of care who are informed and committed to providing comprehensive, evidence-based heart failure care. The Heart Failure Network
1 ACAC Symposium April 14th, 2008: Chinook Health 8 HFN: Two Phases Phase 1: Urban Lethbridge and immediate area There are a number of gaps Centralizes our initial efforts in one venue Phase 2: Rural Interdisciplinary primary care teams generally more established Communication strengths between health care providers/agencies in smaller locales
1 ACAC Symposium April 14th, 2008: Chinook Health 9 The Heart Failure Network (HFN)… offers navigational support and centralized access to information and resources for patients, families and health care providers living with and caring for chronic heart failure. focuses on improving the lifestyle of heart failure patients creates connections between clients and available community resources. builds on existing strengths to improve heart failure care in Chinook.
1 ACAC Symposium April 14th, 2008: Chinook Health 10 The Patient Journey: HFN 3 Visits: Initial Within 7-14 days of discharge (or referral from community) Visit # 2 Within 30 days of discharge/referral Heart Failure Education Class Visit # 3 Within days of discharge/referral
1 ACAC Symposium April 14th, 2008: Chinook Health 11 Currently… Comprehensive Communication Plan Internal/external audiences Identifying and addressing policy gaps Referral processes Physician orders/evidence-informed care
1 ACAC Symposium April 14th, 2008: Chinook Health 12 Currently… First patients seen April 1!