PMID- 37572096 OWN - NLM STAT- MEDLINE DCOM- 20230911 LR - 20230911 IS - 1464-3677 (Electronic) IS - 1353-4505 (Linking) VI - 35 IP - 3 DP - 2023 Sep 8 TI - Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic. LID - mzad060 [pii] LID - 10.1093/intqhc/mzad060 [doi] AB - Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P = .002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P = .410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract. CI - (c) The Author(s) 2023. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. FAU - Jorro-Baron, Facundo AU - Jorro-Baron F AD - Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina. FAU - Suarez-Anzorena, Ines AU - Suarez-Anzorena I AD - Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina. FAU - Roberti, Javier AU - Roberti J AD - Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina. FAU - Mazzoni, Agustina AU - Mazzoni A AD - Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina. FAU - Vita, Tomas AU - Vita T AD - Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina. FAU - Alonso, Juan Pedro AU - Alonso JP AD - Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina. FAU - Villarejo, Agustina AU - Villarejo A AD - Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina. FAU - de la Vega, Bibiana AU - de la Vega B AD - Cardiology, Hospital Centro de Salud "Zenon Santillan", Tucuman T4000, Argentina. FAU - Ditata, Fernanda AU - Ditata F AD - Novartis SA, C1429, Argentina. FAU - Facta, Alvaro AU - Facta A AD - Cardiology, Hospital Privado de Comunidad, Mar del Plata B7602, Argentina. FAU - Flores, David AU - Flores D AD - Cardiology, Hospital Nacional de Clinicas, Cordoba X5000, Argentina. FAU - Mastantuono, Cristian AU - Mastantuono C AD - Cardiology, Hospital General de Agudos Dr Ignacio Pirovano, Buenos Aires C1430, Argentina. FAU - Saa, Raquel AU - Saa R AD - Cardiology, Hospital Central, Mendoza M5589, Argentina. FAU - San-Damaso, Esteban AU - San-Damaso E AD - Cardiology, Hospital Italiano Garibaldi, Rosario, Santa Fe S2200, Argentina. FAU - Vega, Gustavo AU - Vega G AD - Cardiology, Hospital el Carmen, Mendoza M5589, Argentina. FAU - Renedo, Florencia AU - Renedo F AD - Fundacion Favaloro Hospital Universitario, Buenos Aires C1093, Argentina. FAU - Fernandez, Alberto AU - Fernandez A AD - Cardiology, Sanatorio Modelo Quilmes, Buenos Aires B1878, Argentina. FAU - Fernandez-Nievas, Simon AU - Fernandez-Nievas S AD - Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina. FAU - Garcia-Elorrio, Ezequiel AU - Garcia-Elorrio E AD - Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina. LA - eng GR - Novartis/ PT - Journal Article PL - England TA - Int J Qual Health Care JT - International journal for quality in health care : journal of the International Society for Quality in Health Care JID - 9434628 SB - IM MH - Humans MH - Pandemics MH - Quality Improvement MH - Argentina/epidemiology MH - *COVID-19/epidemiology/therapy MH - *Heart Failure/therapy MH - Patient Readmission OTO - NOTNLM OT - collaborative OT - heart failure OT - intervention bundle OT - quality improvement EDAT- 2023/08/13 00:42 MHDA- 2023/09/11 06:42 CRDT- 2023/08/12 10:12 PHST- 2022/09/27 00:00 [received] PHST- 2023/02/22 00:00 [revised] PHST- 2023/08/07 00:00 [accepted] PHST- 2023/09/11 06:42 [medline] PHST- 2023/08/13 00:42 [pubmed] PHST- 2023/08/12 10:12 [entrez] AID - 7241655 [pii] AID - 10.1093/intqhc/mzad060 [doi] PST - ppublish SO - Int J Qual Health Care. 2023 Sep 8;35(3):mzad060. doi: 10.1093/intqhc/mzad060.