Clarificative Evaluation of a Nurse Practitioner-Led Heart Failure Clinic
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Nationally, heart failure (HF) is the leading cause of disability, hospitalizations, and death among veterans. Health care providers continue to struggle to maximize the quality of life and functional status of their patients. A significant amount of research is available on the topic of HF clinics; however, the unique patient population and staffing issues at this facility have made prior attempts to implement national recommendations unsuccessful. A nurse practitioner (NP)-led HF clinic was created in 2009 without any formal planning, treatment criteria, or outcome measures. Intuitively, the clinic seemed to be decreasing hospitalizations and improving symptom management. However, no data existed to prove success or to guide expansion. This clarificative evaluation attempted to step back from the daily operation of the NP HF clinic and verify the value of the current program. A mixed method design, retrospective chart reviews as well as semi-structured interviews with employee and veteran stakeholders, was used to broaden the understanding of clinic performance. Significant findings included: majority male population, lower left ventricular ejection fraction (LVEF), higher rates of systolic HF, higher rate of co-morbidities, and greater distance traveled to clinic visits of veterans enrolled in NP HF clinic as compared to national average. Standards of care were being met in terms of medical management. The NP HF clinic is reducing ED visits without increasing burden on non-acute resources. Qualitative findings revealed a need to improve communication and collaboration as well as suggestions for improving basic mechanics of the clinic.
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