Online Guidance for Better Heart Care

By Jackie Powder

Heart failure currently affects nearly 5 million Americans, and is the number one Medicare diagnosis in terms of cost and number of hospital admissions. Although the disease can be managed with proven, effective therapies—including appropriate medications and lifestyle changes—it’s estimated that less than 68 percent of patients receive the recommended treatment.

Backed by a $400,000 grant, assistant professor Cheryl Dennison, CRNP, PhD, hopes to bridge the gap between scientific research and clinical practice by developing an interactive online system to help nurses and physicians adhere more closely to national guidelines for treating patients with heart failure. The three-year project is funded by the NIH National Institute of Nursing Research.

“While these guidelines exist, it doesn’t mean that all providers are knowledgeable of and confident in applying the guidelines,” says Dennison, whose prior research has focused on treating hypertension in a community setting and understanding barriers to guideline implementation in a hospital setting. And sometimes part of the problem is a lack of communication among nurses, physicians, and other health care team members. “One goal of the system is to get everyone on the same page, and it may help in clarifying some roles,” she says.

While Dennison is just beginning to develop the online system, she envisions that it will be linked to patient data (such as lab values and medications). Based on this clinical information, the system will issue “alerts” to nurses and physicians with recommended treatment options.

If a patient has a four-pound weight gain in 24 hours, for example, the system may prompt the provider to consider adjusting the diuretic dose.

Another possible system feature: a disease-specific “checklist” of diagnostic tests and interventions, based on the guidelines for heart failure care. “The goal of the system is to provide the relevant information at the point of care, at their fingertips,” Dennison explains, “so the nurses and physicians are thinking about the appropriate therapy.”

The system may also help ensure that patients receive the appropriate discharge instructions (including sodium restrictions and weight monitoring). “Often, nurses are caring for a large number of very complex patients, so it can be difficult to find the time to identify and provide the appropriate education,” Dennison says.

She stresses that the system is not a substitute for the informed judgment of a nurse or physician. “Providers [may] choose to accept or not accept the guidance, depending on the individual patient’s needs,” she says.

Dennison also hopes that the system can help identify heart failure patients earlier in the hospital admission process. Sometimes there are delays in recognizing the underlying condition if a patient is admitted for another reason, or with a non-specific diagnosis.

Dennison’s research project calls for the development and testing of the online system over the next two and a half years. She expects that it will be part of a pilot study on two adult inpatient units at Johns Hopkins Hospital. Following testing, she will compare provider adherence to treatment guidelines on the units with the system to provider performance on units without it.

The research study comes at a time when Medicare, insurance companies, and patients are exerting increasing pressure on hospitals to document performance and quality of care. “That’s why this kind of solution has great potential,” Dennison says. “If this system is demonstrated to be effective, it can also be applied to other chronic disease conditions.”