American College of Cardiology Launches Patient Navigator Program

The American College of Cardiology (ACC) has a long history of engaging members in quality improvement measures. The latest is an effort to reduce readmissions for patients with heart attacks and heart failure through an innovative Patient Navigator Program. It is an ambitious plan that provides select hospitals with the tools and expertise of the ACC and the support of founding sponsor AstraZeneca, who contributed $10 million to launch the pilot project.

According to the ACC, nearly one in five patients with heart failure returns to the hospital within 30 days of discharge—often for conditions seemingly unrelated to the original diagnosis. Readmissions can be associated with stresses within the hospital, fragility on discharge, lack of understanding of discharge instructions and inability to carry out discharge instructions.

The Patient Navigator Program addresses these issues by using a personalized, patient-centered approach developed by a team of caregivers who follow up with the patient in the weeks post discharge, when he or she is most vulnerable. The ACC will provide a tool kit and funding to test innovative approaches and then provide those strategies for dissemination to the larger healthcare community.

The effort grew out of the ACC’s Hospital to Home (H2H) initiative, says Mary Norine Walsh, MD, FACC. Walsh is the medical director of the Heart Failure and Cardiology Transplant Program at the Saint Vincent Heart Center in Indianapolis, Ind.  It was developed by an ACC learning committee that studied strategies and best practices. “Out of that grew more information about what works and doesn’t in a patient-centered focus,” Walsh says.

What is unique about this program is that the ACC doesn’t dictate to an institution. “There is no stipulation on how to do it,” Walsh says. The pilot program will accept 35 hospital applications. Each hospital may implement the program as they see fit. Assistance is provided by the ACC through a steering committee of experts, including researchers, specialists in transition, acute myocardial infarction and cardiac rehabilitation. The multi-disciplinary team includes nursing experts, cardiologists and staff. Using webinars and on-site visits, at various ‘biopsy’ points, these experts assist in adjusting the program to fit the specific needs of the hospital and its patients. A list serve for the participating hospitals is moderated by experts and intended to generate communal discussion.

In May, the program launched with 15 test-site hospitals. “We decided to roll out with slightly under half the number of hospitals at first,” says Walsh. A second set of hospitals were invited in June.

Hospitals were chosen to represent a variety of sizes and geographic locations. Walsh says that the pilot project also included hospitals that had received a readmission penalty in the past. To ensure infrastructure to support the program, each hospital must have at least one ACC leader, such as a committee chair, governor or trustee, to provide a solid connection with the institution.

All of the participating hospitals had to be participants in the ACC Action Registry and the H2H Initiative. “We wanted to select hospitals with a clear interest in quality improvement,” she says. “The Patient Navigation Program is a fairly high-level initiative. We knew that if they had already participated in these initiatives, they likely already had a quality improvement team in place.”

The ACC starts by working with the hospital to understand its own readiness. It can be difficult to identify a patient with heart failure before they leave the hospital, Walsh notes. One of the basic tenets of the program is to correctly identify these patients. “This is actually both an art and a science,” she says.

She also notes that, as a founding sponsor, AstraZeneca is only providing funding. “They are not in any way involved in the science,” she says.

Although the project is not being conducted as a research trial, the ACC plans to publish the results at a later date. “We are setting up the metrics with the hospitals such that we can approach this with some science,” Walsh says. However, the ACC won’t wait until the conclusion of the project to disseminate important findings. “Some will be anecdotal, but we want to share as we go along,” she says. “The ACC is a knowledge-based organization. We are trying to coalesce around best practices and disseminate what we have learned to other similar institutions.”

For more information. see cvquality.acc.org/patientnavigator.

Teresa McCallion, EMT-B, is the associate editor of Integrated Healthcare Delivery.