Congestive Heart Failure Diagnosis- Free Essay Sample

Congestive heart failure (CHF) is a diagnosis that has frequently caused readmission for most healthcare systems and institutions. The rehospitalization rates for CHF patients exceed those reported from many other types of patients. Over one million patients are hospitalized for heart failure annually, with over half of these readmitted in the first six months after discharge (Desai & Stevenson, 2016). This poses an overwhelming physical and financial burden on both the patient and the economy. The goal of any healthcare institution today is to reduce the number of readmissions in CHF patients. Most of these health providers have resulted in tackling the common causes of readmissions, including lack of service coordination, incomplete treatment, inadequate follow-up care, lack of proper communication among care management teams. Telehealth and telemedicine have been rolled out in many healthcare systems to solve most of these problems. Reduction in the number of readmissions both improves patient outcomes and saves on the cost of treatment. One of the most effective measures in achieving this goal is the treatment of risks and monitoring cardiac indices. Monitoring of these indices is best achieved by remote monitoring of patients using modern Telehealth tools such as implantable or wearable devices.

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Desai and Stevenson (2016) agree that the prevention of readmissions for CHF can be achieved to a certain extent. However, they highlight the difficulty in structuring a risk model that accurately predicts readmission risks. Physiological indices and markers such as high circulating catecholamines and cardiac biomarkers are features of the disease progression and hence readmission risk. This article proposes a three-phase strategy to prevent these readmissions: a transition phase, a plateau phase, and a phase of palliation and priorities. The transition phase is engineered on time between discharge from hospital and home-based care. This period is assumed to be a reflection of hospital heart failure management. Readmissions during this phase can be prevented by proper hospital management, including measures such as decongestion and fluid balance through oral diuretics, and treatment of exacerbating factors. An appropriate formulation of discharge, especially patient education is critical to the achievement of this goal. During this phase, prevention strategies are projected to reduce early readmission rates by up to 25 percent (Desai & Stevenson, 2016). The plateau phase occurs after the resolution of acute decompensation. The interventions during this time primarily involve disease modification using drugs such as ACE inhibitors and aldosterone antagonists. The final phase consists of the end stage of CHF, where care includes palliative management. Other factors playing a role in readmission rates include psychosocial and socioeconomic factors that directly impact patient adherence to medication and follow up. However, it is difficult to quantify these factors, hence making it hard to predict their effect on disease progression.

While these phases may be recognizable in most CHF patients, the proposed measures may not be as effective in monitoring the patient once they are discharged from the hospital. Telehealth and remote monitoring come in handy in monitoring the patient's cardiac and other physiological parameters. These indices are better predictors of cardiac events and disease progression than just the manifestation of symptoms. Park et al. (2019) published a study on the role played by digital remote monitoring on the readmission rates of CHF patients. They installed software, RXUniverse, to patients' mobile phones. The software was used to relay data, including blood pressure and weight. Abnormal changes in these parameters would alert caregivers through a Web-based dashboard. These teams would then take immediate action. This study showed a significant decline in readmission rates than national and hospital averages (Park et al., 2019). Compliance to the use of the monitors was however a concern.

Similarly, Kakria, Tripathi, & Kitipawang (2015) conducted a study using real-time monitoring tapped into wearable biosensors to record data such as BP, temperature, and heart rate. The system consisted of two interfaces, one for the patient and one for the doctor. The information that was relayed across this system prevented hospitalizations by predicting cardiac events such as arrhythmias and myocardial infarction. A comparative study by (Conn, Schwarz, & Borkholder, 2019) further contributed to the realization of remote patient monitoring. Their toilet seat based monitoring system compared favourably to a clinical gold standard. The patient results obtained from such a system are as reliable as those obtained from standard tools in a hospital setting. A review by Cherofsky et al. (2015) provides further insight into the impact of telehealth and telephone monitoring on cardiac patients. This review concluded that CHF patients on telehealth and telephone remote monitoring have better outcomes than those under the usual hospital care with no remote follow up. Recent studies show increased numbers of cardiac patients opting for cardiac implantable electronic devices (CIEDs) (Martirosyan, Caliskan, Theuns, & Szili-Torok, 2017). These devices are fitted with a wide range of functions, including data relay and storage. They can also predict a broader range of parameters than the wearable biosensors. These additional capabilities include sensors for hemodynamic deterioration and even sleep disorders. Despite the many advantages associated with these CIEDs, some significant downsides have also been documented. Many patients with these devices experience lead disruptions either due to conduction or insulation defects.

Additionally, there are challenges in data comparison due to device differences from different manufacturers. A universal problem faced by device users is the cost/risk/benefit ratio, which has not been accurately defined. Finally, Rogers, 2015 pinpoints the importance of a caring relationship between the healthcare provider and the patient. Using nursing theories such as Jean Watsons' theory of human caring, she highlights the role of an excellent nurse-patient relationship in the recovery, wellbeing, and satisfaction of that patient.

Quality Change Plan

To improve CHF patients' outcomes, healthcare institutions need to shift their focus to the prevention of disease progression via remote patient monitoring through telehealth. Before enacting any quality improvement plan, an institution must undertake several evidence-based studies to establish the existing problem and the most suitable solution.

Feasible Plan for Implementation

Enacting changes to improve CHF patients' outcomes can be carried out using the plan/do/study/act model. Planning would involve identifying people or staff that would help in the execution of the said goal. An aim statement would then be formulated. In this case, an aim statement would be to improve the health outcomes of CHF patients. The team would then identify the current milestones along with their outcomes. At this stage, it would be crucial to dictate the change execution process. The team would later describe the problem as well as the desired outcomes. They would also outline how the outcomes would be assessed, such as the analysis of mortality rates or readmission rates. The final step in planning would be to identify the causes and alternatives to the single best solution that had been identified earlier.

In the second step of the plan/do/study/act model, the team would go ahead and execute the plan. In this case, this would entail the actual enrolment of consenting CHF patients in remote monitoring programs. These include using wearable biosensors, or even implantable monitoring devices, all relaying data to the institution. Data should be collected all through this stage. The third step is to study the data collected in the previous step. Did the remote monitoring reduce readmissions? Did it reduce mortality? The final step would be to act. Depending on the conclusions drawn from the previous step, a favourable outcome would mean that the plan can be rolled out and made a standard protocol in CHF patients.

Key Stakeholders

Hospitals are now required to report their causes for hospital readmissions. These rates have sometimes been used as defining points for performance incentives by both the public and private sectors (Desai & Stevenson, 2016). Following the passing of the Patient Protection and Affordability Care Act in 2010, many institutions made it a priority to reduce readmissions for fear of revenue losses (Desai & Stevenson, 2016). Other than the external forces, this problem directly impacts on health professionals. These individuals are in the frontline of patient treatment and improvement of their outcome. Device manufacturers are also key stakeholders in this issue. This includes all those manufacturing CIEDs, biosensors, and software designers, among others.

Interdisciplinary Team Members

The first professionals required in the implementation of this quality improvement plan are health workers. These include cardiologists, nursing professionals and other caregivers. These would be in direct contact with the patient, implanting devices and even receiving all the relayed data. Software specialists would come in handy in dealing with all the technical issues arising from the monitoring devices and maintain and upgrade the software. Hospital administrators and legal teams would be crucial in the formulation of legal and ethical guidelines for implementing these plans. Health insurance providers must also provide support in covering the costs of treatment of these patients.

Plan for Outcome Analysis

Patient data would be securely recorded and stored. The number of hospital readmissions would be noted, each with the reason for admission as well as the time-lapse between the current and previous events. Adherence must be recorded for patients using non-implantable monitoring devices such as wearable biosensors (Kakria, Tripathi, & Kitipawang, 2015). Dependent variables in this data would be the disease progress itself including readmissions (Park, et al., 2019). The independent variables would range from adherence, types of medications or even the provider setting. The outcomes would be measured in terms of readmissions, mortality rates and worsening of the disease.

Ethical Considerations

Autonomy must be upheld at all times during the implementation of this quality improvement plan. The patient has to be well informed on the risks, procedures, collection of data and all other details affecting them. Their decisions must be respected at all times. Remote patient monitoring continues to raise ethical issues regarding privacy and confidentiality. Many patients also raise concerns regarding the obtrusiveness of the monitoring technology in their private lives. All these issues must be addressed before putting each patient on any kind of remote monitoring programme.

References

Cherofsky, N., Onua, E., Sawo, D., Slavin, E., & Levin, R. (2017). Telehealth in adult patients with congestive heart failure in long term home health care: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 9(30), 1271-1296. Retrieved from: https://journals.lww.com/jbisrir/fulltext/2010/08161/telehealth_in_adult_patients_with_congestive_heart.19.aspx

Conn, N. J., Schwarz, K. Q., & Borkholder, D. A. (2019). In-home cardiovascular monitoring system for heart failure: Comparative study. JMIR mHealth and uHealth, 7(1), e12419.